NSG322: Exam 1 Topics 1-2

1

The nurse cares for a client admitted with severe postpartum depression. Which cue is most concerning?

1. The client does not want to hold her baby.

2. The client says she's only able to sleep 3-4 hours each night.

3. The client is tearful most of the day

4. The client denies suicidal ideation.

2

A client attends therapy. During the session they focus on a homework assignment in which the client discusses an event which triggered a negative emotion and the automatic thought that goes with it. What type of therapy is this client participating in?

1. Behavioral

2. Cognitive Behavioral

3. Interpersonal

4. Systematic Desensitization

3

Which of the following theorists believed that therapeutic communication between nurse and client was at the center of healing clients and created the Interpersonal Relations Theory?

1. Virginia Henderson

2. Dorothy Orem

3. Hildegard Peplau

4. Mary Seacole

4

Which of the following therapies are used for depressive disorders?

1. Electroconvulsive therapy (ECT)

2. Vagus nerve stimulation

3. Repetitive transcranial magentic stimulation

4. All of the above

1

Norepinephrine stimulates sympathetic branch of autonomic nervous system for fight or flight response to stress

1. True

2. False

3

The nurse prepares to administer a prescribed dose of bupropion to a client with major depressive disorder. What is the nurse's priority assessment before giving the medication?

1. Check pulse and heart rate.

2. Measure oxygen status

3. Review chart for history of seizure disorders

4. Tell the client to report any signs of dizziness or headache.

2

The nurse prepares to administer a prescribed dose of phenelzine to a client with major depressive disorder. Which statement by the client requires further evaluation before delivery of the medication?

1. I took my last dose of fluoxetine three weeks ago.

2. I'm vegetarian and I eat alot of cheese.

3. I'm currently suicidal.

4. "I haven't urinated in a long time."

3

The client is at a therapist's office for their weekly ketamine treatment session. In which situation should the nurse contact the provider immediately?

1. The client has failed to have effectiveness with two prior anti-depressants.

2. The client reports not sleeping well for the past two nights and being fatigued.

3. The client's blood pressure is 170/100

4. The client appears with flat affect and is tearful.

4

The nurse instructs a new graduate nurse how to manage the therapeutic milieu. Which action by the new nurse indicates further clarification of the management of a milieu is needed?

1. The new nurse orders patient snacks from the kitchen.

2. The new nurse rounds regularly to observe patients in their rooms and dayrooms.

3. The new nurse checks with UAPs to be sure all exit doors are locked.

4. The new nurse allows clients to use the unit phone outside of posted use hours.

2

Which of the following ethical principles does the nurse exhibit when they complete annual continuing educational units in their nursing skill?

1. Veracity (telling the truth)

2. Fidelity (faithfulness/loyalty)

3. Beneficence (do good)

4. Justice

5

Which of the following is an example of the concept of least restrictive environment?

1. Referring a non-suicidal depressed client to an inpatient facility

2. Treatment of a bulimic patient who is medically stable in an intensive outpatient program.

3. Weekly outpatient therapy for a client who is threatening to kill someone.

4. A depressed post-partum mother is in the hospital receiving brexanolone treatment.

5. 2 and 4

2

Which of the following are expected side effects of sertraline?

1. Nausea, coarse tremors and hyperreflexia

2. Nausea, insomnia and sexual dysfunction

3. Dry mouth, urinary retention and dizziness

4. Lowered seizure threshold

2

The nurse admits a client who reports blood pressure of 200/120 and takes newly prescribed tranyclcypromine. What assessment data should the nurse obtain first?

1. Ask another nurse to check the blood pressure.

2. Ask them what they had to eat today.

3. Ask them if they have taken any over the counter supplements.

4. Ask them if they are taking an selective serotonin reuptake inhibitor (SSRI)

2

Which of the following elements are not required to prove negligence?

1. Duty of care has been assumed.

2. Invasion of privacy

3. Duty of care has been breached

4. The nurse's actions resulted in patient harm.

3

The nurse admits a client who takes prescribed medication citalopram and reports a fever of 103 F, severe nausea, vomiting and diarrhea, difficulty with coordination. What does the nurse suspect is happening?

1. Seizures

2. Reaction to monoamine oxidase inhibitor drugs due to diet restrictions

3. Serotonin syndrome

4. Side effects of electroconvulsive therapy (ECT)

2

The nurse observes a client with no emotional expression. How does the nurse document this on the mental status exam?

1. Mood: depressed

2. Affect: flat

3. Judgment: poor

4. Level of consciousness: confused

7

Which actions should the nurse take as soon as a severely depressed client arrives on the inpatient unit?

1. Assess for suicidal ideation

2. Ask if they have a plan to harm themselves

3. Evaluate their access to means to harm themselves (ex. gun, pills, etc.)

4. Seclusion and restraint

5. A, B and C

6. Remove all contraband from their room and possession

7. 1, 2, 3 and 6

2

Which is the priority teaching for a client receiving amitriptyline

1. Take in the morning to avoid insomnia

2. Take in the evening and don't drive; very sedating

3. Report any short term memory

4. Report dry mouth

3

The client says they don't believe in taking medications for psychiatric issues. Which of the following is a non-therapeutic response?

1. "Tell me more about your beliefs about psychiatric medications"

2. "You don't believe in taking medicatons for psychiatric issues."

3. "Why don't you want to take psychiatric medications?"

4. The medication is for increasing the availability of neurotransmitters in certain areas of your brain to improve mood."

2

An inpatient client diagnosed with major depressive disorder starts a prescribed dose of fluoxetine. What priority assessment does the nurse conduct after administering the dose?

1. Nausea

2. Suidical ideation

3. Priapism

4. Signs of seizures

1, 2, 3

Which of the following client summaries documents symptoms of depression? SATA

1. No memory issues, reduced sleep, irritability, and sadness

2. Decreased appetite, increased sleep, social isolation, and poor hygiene

3. Suicidal ideation, professional success, healthy weight, and extended family

4. Excessive handwashing, hearing voices, stable relationships, and good support

1

Norepinephrine can increase heart rate and blood pressure

1. True

2. False

4

Priapism is an adverse reaction for which of these medications?

1. Isocarboxazide

2. Mirtazapine

3. Sertraline

4. Trazodone

5. Phenelzine

4

Which disorder includes symptoms of decreased energy, loss of sleep, loss of interest in activities, and suicidal thoughts for at least two weeks?

1. Persistent Depressive Disorder

2. Seasonal Affective Disorder

3. Disruptive Mood Dysregulation Disorder

4. Major Depressive Disorder

3

Which of the following assessment terms means lack of joy/pleasure?

1. Anergia

2. Avolition

3. Anhedonia

4. Euphoria

2

What is one difference between Major Depressive Disorder and Persistent Depressive Disorder?

1. MDD requires medication, and PDD does not

2. MDD has acute symptoms and is diagnosed after two weeks of these.

3. Clients with both have suicidal thoughts

4. PDD is chronic and diagnosed after one month of symptoms

2

Which of the following medications increased seizure risk by 4x?

1. Fluoxetine

2. Bupropion

3. Diazepam

4. Phenelzine

2

Which of the following is most frequently comorbid with depression?

1. Eating disorders

2. Anxiety disorders

3. Obesity

4. Seizures

1, 4, 5

Which of the following neurotransmitters are monoamines?

1. Serotonin

2. GABA

3. Glutamate

4. Dopamine

5. Norepinephrine

6. Orexin

2

The therapist focuses on assisting the client to identify mistaken beliefs and reframe them so they feel differently.

1. Behavioral therapy

2. Cognitive Behavioral therapy

3. Interpersonal therapy

4. Psychoanalytic therapy

4

Hildegard Peplau's Interpersonal Therapy theory states that the key to healing clients with mental health issues is:

1. Systematic desensitization

2. Administering medications without resistance

3. Brain stimulation

4. Nurse/client meetings focused on interpersonal interactions

3

Children tend to manifest their symptoms of depression in Disruptive Mood Dysregulation Disorder in …

1. Overwhelming sadness

2. Lack of attachment

3. Irritability

4. Bedwetting

4

First line treatment for seasonal affective disorder is:

1. Vitamin D

2. Antidepressants

3. Electroconvulsive therapy

4. Light therapy

2

Asking clients if they are thinking of harming or killing themselves increases suicide risk

1. True

2. False

1, 2, 4, 6

A client began taking sertraline a few days ago and is now diagnosed with serotonin syndrome. They have...

1. Hypertension

2. Tachycardia

3. Hypotension

4. GI symptoms

5. Constricted pupils

6. Hyperthermia

1, 2, 3, 4, 5

Which of the following foods are high in tyramine and contraindicated for pts taking MAOIS?

1. Bananas

2. Avocados

3. Wine and aged cheese

4. Dried fruit like raisins

5. Smoked meat like bacon

6. Potatoes

1

A patient has been prescribed phenelzine. Which of the following breakfasts is safe to order for them?

1. Eggs with cereal

2. Avocado toast with bananas

3. Pancakes and bacon

4. Ham and cheese omelet

1

A client stops taking imipramine and begins take fluoxetine. Which symptom is a sign of serotonin syndrome?

1. Fever of 103 F

2. Insomnia

3. Dry mouth

4. Mild nausea

4

Which nursing theorist created the Interpersonal Relations Theory?

1. Freud

2. Watson

3. Beck

4. Peplau

4

What is a common side effect of Electroconvulsive Therapy (ECT)?

1. Incisional pain

2. Nausea

3. Delirium

4. Short-term memory loss

2

Which treatment setting is least restrictive?

1. Partial hospitalization program

2. Outpatient therapy

3. Inpatient psychiatric unit

4. Intensive Outpatient program

3

Which intervention is part of a suicide assessment?

1. Reframing negative thoughts

2. Face-to-face debrief

3. Asking about suicidal ideation

4. Rewarding positive behavior

2

A client says they plan to shoot their landlord when discharged. What is the RN's priority?

1. Place the client in seclusion

2. Inform the provider immediately

3. Contact the landlord

4. Call 911

1, 2, 3, 4

What are the nursing diagnoses for a client with Major Depressive Disorder? SATA

1. Risk for suicide

2. Social isolation

3. Impaired coping

4. Hopelessness

5. Chronic depression

2, 3, 5

Which are therapeutic responses according to the Interpersonal Relations Theory? SATA

1. "It will all work out in the end."

2. "So, you're sad about your pet dying."

3. "Tell me more about that."

4. "Why did you stop taking your medications?"

5. "You appear tense."

3

Which action by the RN generalist needs immediate follow-up by the preceptor?

1. The nurse teaches stress reduction techniques to the client.

2. The nurse is attending an interdisciplinary treatment team meeting.

3. The nurse says she is going to change the client’s DSM5 diagnosis.

4. The nurse is evaluating the milieu.

A client in an inpatient psych hospital with depression refuses prescribed medications. What is the nurse's best action?

1. Notify the provider and document client's refusal in EHR.

2. Tell the client refusal of meds will result in discharge.

3. Administer meds against client's wishes.

4. Place the client in restraints to ensure compliance with meds.

3

Which antidepressant has highest overdose risk?

1. Monoamine oxidase inhibitors

2. Serotonin norepinephrine reup-take inhibitors

3. Tricyclics

4. Selective serotonoin reup-take inhibitors

1

Which action can result in a nurse being charged with battery?

1. Pushing a client against a wall when they yell at you.

2. Abandoning a client by leaving the shift early without a handoff report.

3. Failure to check a psych client in a hospital every 15 minutes.

4. Threatening to give the client an IM injection if they don't calm down.

1, 2, 3, 4

Which interventions are therapeutic and less restrictive than seclusion & restraint? SATA

1. Reducing stimulation

2. Verbal de-escalation

3. Offering a distraction such as music

4. Offering PRN meds

5. Preventing a cleint from leaving their room

1

Which is FALSE regarding the use of seclusion and restraint?

1. Orders can be written "Use restraints PRN."

2. Thorough documentation is required when the client is secluded & restrained.

3. There are time limits on the use of restraints.

4. Frequent assessments must be completed.

3

The client has not been able to enjoy their usual activities for several weeks. How does the nurse document this symptom?

1. Anergia

2. Avolition

3. Anhedonia

4. Euphoria

4

A client lost her husband 1 month ago, lost 20 Ibs., stopped going to work, and stopped bathing. Best interpretation by RN?

1. A common grief reaction

2. Happens as part of old age

3. Normal grief response, not depression

4. Major depression, triggered by grief

2

Which medication is contraindicated for a client with a history of epilepsy?

1. Fluoxetine

2. Bupropion

3. Diazepam

4. Phenelzine