Mental Health Exam 1

What medication class is amitriptyline?

a. TCA

b. SSRI

c. MAOi

d. SNRI

What medication class is amitriptyline?

a. TCA

b. SSRI

c. MAOi

d. SNRI

a. TCA

What statement made by the patient would indicate further teaching by the nurse?

a. “Sexual dysfunction is a possible side effect of SSRIs”

b. “My buspirone may also be able to help manage my ADHD, off label”

c. “I will be given a 2 months dose of TCAs at a time”

d. “I should monitor for discontinuation syndrome in SNRIs”

c. “I will be given a 2 months dose of TCAs at a time”

Flumazenil is an antidote for which medication?

a. Lorazepam

b. Pentobarbital

c. Duloxetine

d. Phenelzine

a. Lorazepam

Which order would a nurse question?

a. A patient is being administered phenelzine and is also given an anti-hypertensive medication

b. A patient taking pentobarbital is ordered to have CPR equipment at bedside.

c. A patient was discontinued off of phenelzine two days ago and it now being started on fluoxetine today.

d. A patient on bupropion is being told to take the medication in the morning.

a. A patient is being administered phenelzine and is also given an anti-hypertensive medication. → i would say this is normal, bc MAOis can cause HTN

b. A patient taking pentobarbital is ordered to have CPR equipment at bedside. → normal - resp. depp. is huge s/e

c. A patient was discontinued off of phenelzine two days ago and it now being started on fluoxetine today. → you should wait 14 days before giving a patient SSRIs after taking MAOis!

d. A patient on bupropion is being told to take the medication in the morning. → Bupropion is an excitatory drug - this is normal!

Which meal would be appropriate for a patient taking MAOis?

a. An Italian deli meat sandwich with a glass of water and a piece of watermelon for desert.

b. A bowl of white rice topped with soy sauce and kimchi.

c. A slice of salmon covered in rosemary and olive oil with a glass of orange juice.

d. A salad covered with olive oil, topped with chicken, and covered with apple slices.

a. An Italian deli meat sandwich with a glass of water and a piece of watermelon for desert. → no salami no bad no

b. A bowl of white rice topped with soy sauce and kimchi. → soy sauce and fermented foods are no

c. A slice of salmon covered in rosemary and olive oil with a glass of orange juice. → citrus fruits not allowed

d. A salad covered with olive oil, topped with chicken, and covered with apple slices.

Which medication is a first line defense for depression?

a. Disulfiram

b. Fluoxetine

c. Trazodone

d. Nortriptyline

a. Disulfiram → alcohol withdrawal

b. Fluoxetine → SSRI

c. Trazodone → sleep agent

d. Nortriptyline → SNRI

Which statement made by the patient would require immediate intervention by the nurse?

a. “Ever since I started taking my bupropion, my smoking urges have decreased.”

b. “Anytime I spray even a drop of perfume on myself, I feel really nauseas with my disulfiram.”

c. “I stopped taking my lorazepam a yesterday because I didn’t like how fatigued I was feeling.”

d. “I accidentally had a small, tiny bite of pepperoni yesterday.”

a. “Ever since I started taking my bupropion, my smoking urges have decreased.” → yeah das normal homie

b. “Anytime I spray even a drop of perfume on myself, I feel really nauseas with my disulfiram.” → mmmmmm, close but meh

c. “I stopped taking my lorazepam a yesterday because I didn’t like how fatigued I was feeling.” → DO NOT STOP TAKING ABRUPTLY

d. “I accidentally had a small, tiny bite of pepperoni yesterday even though I’m taking phenelzine.” → meh, they’re okay

What class of medication does phenelzine belong to?

a. SNRIs

b. SSRIs

c. MAOis

d. Barbital

c. MAOis

What class of medication does venlafaxine belong to?

a. SSRI’s

b. SNRI’s

c. MAOis

d. TCAs

b. SNRI’s

What medications class does fluoxetine belong to?

a. SSRIs

b. SNRIs

c. TCAs

d. MAOis

a. SSRIs

What medication class does citalopram belong to?

a. TCAs'

b. SNRIs

c. SSRIs

d. Benodiazepams

c. SSRIs

Which medication is an anticholinergic drug?

a. Nortriptyline

b. Sertraline

c. Midazolam

d. Pentobarbital

a. Nortriptyline → TCAs are also anticholinergic

A patient has abruptly stopped taking their duloxetine, an SNRI. What are some expected signs and symptoms of discontinuation syndrome?

a. A BP of 180/120.

b. Shivering, increased heart rate, increased blood pressure and increased respirations.

c. Tremors, tactile hallucinations and intense sweating.

d. Achiness, fatigue, insomnia and nausea

a. A BP of 180/120. → MAOis

b. Shivering, increased heart rate, increased blood pressure and increased respirations. → SNRIs and SSRIs (Serotonin Syndrome)

c. Tremors, tactile hallucinations and intense sweating. → Delirium Tremens

d. Achiness, fatigue, insomnia and nausea → flu like s/s

A nurse is arriving on the psych unit during shift change. Which of the following patients would the nurse see first?
a. A patient with BPD and a sitter who is screaming, “Someone come help me, I’m going to kill myself!”

b. A patient with OCD who is constantly washing their hands in order to satisfy their compulsions.

c. A patient going through severe alcohol withdrawal who is experience intense tremors and bugs on their skin.

d. A patient with Panic Disorder who is experiencing intense chest pain and who is clawing at their throat and gasping for air.

d. A patient with Panic Disorder who is experiencing intense chest pain and who is clawing at their throat and gasping for air.

An alcoholic patient is 6 days post-withdrawal. They are alerted and orient to person and situation, but not place and time. The nurse does an eye assessment and finds that the patient’s eyes are quivering quickly back and forth. His blood lab comes back and his Vit B1 levels are very low. The patient remarks, “Why are there 2 nurses above me?” - there were not two nurses above him. He has an unsteady gait, so the nurse puts him on fall precautions. The patient is not experiencing hallucinations or tactile disturbances. What do you think is going on?

a. Delirium Tremens

b. Wernicke’s Encephalopathy.

c. Korsakoff’s Syndrome.

d. Wernicke’s-Korsakoff’s syndrome.

a. Delirium Tremens

b. Wernicke’s Encephalopathy. → confusion, nystagmus, diplopia, low thiamine and ataxia are all signs of Wernicke’s. An MRI can also confirm degradation of the brainstem.

c. Korsakoff’s Syndrome. → difficulty remembering and making new memories,

d. Wernicke’s-Korsakoff’s syndrome.

A patient comes in with alcohol withdrawal. He is having difficulty remembering anything. He cannot even remember anything that happened five minutes ago. When trying how he got to the hospital he starts telling wild tales about how he hit his head riding a horse in the middle of highway 66. A liver lab comes back with low thiamine levels and his MRI shows he has degradation of his Mammillary Bodies. What do you think is going on with him?

a. Wernicke’s syndrome

b. Delirium Tremens

c. Korsakoff’s Syndrome

d. None of the above

c. Korsakoff’s Syndrome

A patient has been withdrawing in the hospital for 12 hours. The patient was hooked up to Thiamine Drip when they were first admitted, and now their thiamine levels are starting to rise. Suddenly, the patient begins to sweat profusely, and his blood pressure and heart rate begin to rise rapidly. He starts screaming “Bugs! Bugs!” The nurse does a quick neuro assessment and is only a/o x 1 (he is only oriented to person). His EKG starts beeping because his heart rate is increased rapidly and is very irregular. Suddenly, his eyes roll backwards, he collapses and then starts shaking violently. What do you think is going on?

a. Wernicke’s Encephalopathy

b. Delirium Tremens

c. Korsakoff’s Syndrome

d. The patient is in hypertensive crisis

a. Wernicke’s Encephalopathy → erm no

b. Delirium Tremens → yeah boiii

c. Korsakoff’s Syndrome → he isn’t having confabulations and he’s having more somatic manifestations (BP, HR and seizures).

d. The patient is in hypertensive crisis → i never gave you a BP so no

A patient is currently having severe chest pain and is bleeding profusely from a gunshot wound after being attacked by a mugger while on a walk with his friend of 30 years, Jeff. Jeff died in the hospital 5 minutes ago due to exacerbations of his injuries from the mugging. The patient keeps asking where Jeff is and is screaming from his wounds. The nurse decides she won’t tell the patient about his friend until they’ve taken care of his pain and bleeding. What Ethical Principal is the nurse following?

a. Beneficence

b. Paternalism

c. Justice

d. Veracity

a. Beneficence - to help and do no harm - it would harm the patient more to tell him his best friend died

b. Paternalism - no because she’s not drawnig a boundary with the patient

c. Justice - she is not focusing on being fair and equitable

d. Veracity - she is not telling the truth right now

At what age is personality set in stone?

a. 5 years old

b. 10 years old

c. 15 years old

d. 20 years old

a. 5 years old

What are some statements that are common with people with Borderline Personality Disorder? SATA

a. “I don’t care if I’m NPO. If I don’t get a burger now, I’m going to get my daughter to bring one anyways.”

b. “I think it’s really annoying that my friend is constantly talking about her mom who died one week ago.”

c. “I think I’m going to break up with my boyfriend because he forgot to take the trash out yesterday, so it means he doesn’t love me anymore.”

d. “Thank the Lord you’re here! All the nurses last night were absolutely the worst! Please don’t leave me!”

a. “I don’t care if I’m NPO. If I don’t get a burger now, I’m going to get my daughter to bring one anyways.” → inflexibility

b. “I think it’s really annoying that my friend is constantly talking about her mom who died one week ago.” → inability to emotionally connect and provoking interpersonal drama

c. “I think I’m going to break up with my boyfriend because he forgot to take the trash out yesterday, so it means he doesn’t love me anymore.” → viewing people as black or white

d. “Thank the Lord you’re here! All the nurses last night were absolutely the worst! Please don’t leave me!” → splitting

A patient is coming into the clinic complaining of an increase in respiratory rate and heart rate. The patient claims that they’ve been studying intensely for the NCLEX for the past two weeks and it’s practically taken over her life. She has noticed she has fast breathing and heart rate only when she thinks about the exam, which is now almost all the time. She says she hasn’t felt this way for long, just for the past two weeks. What does the nurse suspect is going on?

a. Acute Stress

b. Chronic Stress

c. Generalized Anxiety Disorder

d. OCD

a. Acute Stress

A woman comes into the clinic because she has been under a lot of stress lately. 8 months ago, she found out that she had colon cancer and had to get an emergency ostomy. She has been struggling coping with the new surgery and bag. She says she’s been feeling really down lately and has been getting sick about every 2 weeks. She’s also had increased difficulty concentration. She’s constantly plagues by the worry that she’s going to get a new form of cancer, and that next time they won’t be able to catch it. What do you think is going on with the patient?

a. Chronic Stress

b. Acute Stress

c. Suicidal Ideation

d. OCD

a. Chronic Stress

What is the definition of addiction?

a. Metabolic and biological tolerance of a chemical substance.

b. Physical and Psychological dependence on a substance with a tolerance being developed.

c. Constantly needing to be high or drunk in order to go to work.

d. Having a drink or two after work once a month in order to relax.

b. Physical and Psychological dependence on a substance with a tolerance being developed.

c. Constantly needing to be high or drunk in order to go to work. → you can have an addiction without constantly being drunk or high

Which medication is used to help people withdraw from alcohol in an outpatient setting?

a. Naltrexone

b. Lorazepam

c. Librium

d. Disulfram

c. Librium

What actions are considered restraints? SATA

a. PRN Haldol

b. 5 point tie down

c. Putting all the bed rails up

d. Placing a sitter with the patient

e. Placing posey mitts on a patient (pictured)

b. 5 point tie down

c. Putting all the bed rails up

e. Placing posey mitts on a patient (pictured)

What are some instances where we must make a patient’s medical or personal history known? SATA

a. Duty to Warn

b. HIV Status

c. COVID Vaccination Status

d. Child/Vulnerable Adult Abuse

a. Duty to Warn

b. HIV Status

d. Child/Vulnerable Adult Abuse

What must you do if you place emergency restraints on a patient?

a. You must make sure that everyone on the staff is notified.

b. You must do rounding on the patient every 45 minutes

c. Get the order from the doctor within 15 minutes of placing the restraints.

d. Contact the chaplain in order to come and do a spiritual assessment on the patient.

c. Get the order from the doctor within 15 minutes of placing the restraints.

When does a patient NOT have a right to refuse?

a. When they are confused and not able to make a coherent decision.

b. When the patient does not speak English.

c. If they are a danger to themselves or others.

d. If they are on hospice or palliative care.

c. If they are a danger to themselves or others.

What is mood?

a. What a patient is feeling.

b. How a patient is showing their feeling.

c. A patient’s baseline emotion over the past 6 months

d. Any emotion that deflects from normal societal standards.

a. What a patient is feeling.

b. How a patient is showing their feeling. → Affect!

c. A patient’s baseline emotion over the past 6 months → erm no

d. Any emotion that deflects from normal societal standards. → Disorder

A patient comes into the clinic experiencing confusion and feelings that “something bad is going to happen to them.” They are pacing and constantly getting up from the bed to walk around the room. They claim that the nurses are constantly laughing at them behind their back. Every time the nurses try to document on the MAR, the patient breaks down and cries, “What bad things are you writing about me?” The patient does not respond well to complex direction and the nurse has to constantly remind them that they’re safe. What stage of anxiety are they experiencing?

a. Mild

b. Moderate

c. Severe

d. Panic

c. Severe

A 22-year-old patient comes in complaining of chest pain and shortness of breath. She is experiencing severe tremors and keeps saying “I’m going to die - please help me!” Apart from that, she’s mumbling and saying unintelligible things. She suddenly starts vomiting and is sweating profusely, even though she claims she’s also cold. What stage of anxiety do you think she’s in?

a. Mild

b. Moderate

c. Severe

d. Panic

d. Panic

A patient comes into their PCP clinic complaining of insomnia, stomach pain and back pain. They have recently started a new job at the local ICU. They say their friends are distancing themselves from him because “He’s grumpy all the time.” He is rocking back and forth in his chair. He also rates his headache a 6/10. What level of anxiety is he experiencing?

a. Mild

b. Moderate

c. Severe

d. Panic

b. Moderate

What are the three PRIORITY questions that you must ask a person experiencing SI? SATA

a. “When are you planning on killing yourself?”

b. “Have you thought about suicide?”

c. “What are you feeling right now?”

d. “Have you given away any belongings?”

e. “Do you have a plan?”

f. “Do you have a means?”

b. “Have you thought about suicide?”

e. “Do you have a plan?”

f. “Do you have a means?”

make sure you phrase this in a “yes or no” question

Which client is unstable?

a. A client who is actively compulsing and closing their door 15 times before leaving the room.

b. Someone who is in art therapy and actively drawing how their feeling.

c. A patient who is not alert and oriented and is aimlessly wandering the halls of the unit.

d. A patient with severe anxiety who is sobbing heavily and has an RR of 36.

d. A patient with severe anxiety who is sobbing heavily and has an RR of 36.

What medication is an antihistamine that can be used to treat insomnia and anxiety?

a. Hydroxyzine

b. Gabapentin

c. Propranolol

d. Lorazepam

a. Hydroxyzine