Exam 4: NURS660 / NURS 660 (2026–2027 Edition) Psychopharmacology and Advanced Mental Health | Comprehensive Q&A | Verified, Accurate Solutions | Grade A – Maryville

Exam 4: NURS660 / NURS 660 (2026–2027 Edition) Psychopharmacology and Advanced Mental Health | Comprehensive Q&A | Verified, Accurate Solutions | Grade A – Maryville Q. 1. How do anti anxiety medications, such as benzodiazepines, produce a calming effect? ANSWER a. Depressing the CNS Q. 2. There is a narrow margin between the therapeutic and toxic levels of lithium carbonate. Symptoms of toxicity are most likely to appear when the serum levels exceed: ANSWER b. 1.5 mEq/L Q. 3. Initial symptoms of lithium toxicity include: ANSWER c. Vomiting, diarrhea Q. 4. Antipsychotic medications are thought to decrease psychotic symptoms by: ANSWER b. Blocking the action of dopamine in the brain Q. 5. Part of the nurse's ongoing assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Which of the following are examples of extrapyramidal symptoms? ANSWER a. Muscular weakness, rigidity, tremors, facial spasms Q. 6. A client who is prescribed haloperidol is observed to be staring at the ceiling and says they cannot move their eyes. The nurse notices that the client also appears to have muscle spasms in their legs and hands. What is the most appropriate action for the nurse to take at this point? ANSWER b. Administer prn benztropine (Cogentin). Q. 7. A client reports to the nurse that, after having been on their antidepressant medication (fluoxetine) for almost 2 weeks, they don't feel much better. Which of these actions by the nurse demonstrates the best clinical judgment? ANSWER a. Educate the client that this medication may not be fully effective for up to 4 weeks. Q. 8. A client who was recently prescribed an MAOI tells the nurse that they drink 3 to 4 cups of coffee with each meal. Which of these actions by the nurse demonstrates the best clinical judgment? ANSWER b.. Inform the client that foods or beverages with high caffeine content increase the risk for serious hypertension and arrhythmias. Q. 9. A young adult client has been prescribed an SSRI antidepressant, which they have been taking for 1 week. The client reports that they feel that they are getting worse and that nothing is going to help. Which of these actions by the nurse is a priority? ANSWER d. Conduct a suicide risk assessment. Q. 10. A licensed practical nurse who is administering medications reports to the RN in charge that he forgot to give the last scheduled dose of bupropion to a client. He asks the RN if he should give the client two doses at the next scheduled time. Which of these responses by the nurse demonstrates the best clinical judgment? ANSWER b. "No. Doses of this medication should not be doubled since that poses an increased risk for seizures." Q. 1. An example of a treatable (reversible) form of NCD is one that is caused by which of the following? (Select all that apply.) ANSWER c. Electrolyte imbalances e. Folate deficiency Q. 2. NCD due to Alzheimer's disease is associated with the presence of which anomaly? ANSWER d. Amyloid beta plaques and neurofibrillary tangles Q. 3. Which medications have been indicated for improvement in cognitive functioning in mild to moderate Alzheimer's disease? (Select all that apply.) ANSWER a. Donepezil (Aricept) b. Rivastigmine (Exelon) e. Galantamine (Razadyne) Q. 4. Which factor is not associated with an increased incidence of neurocognitive disorder due to Alzheimer's disease? ANSWER a. Multiple small strokes Q. 5. In addition to disturbances in cognition and orientation, individuals with Alzheimer's disease may also show changes in which of the following? (Select all that apply.) ANSWER a. Personality c. Speech e. Mobility Q. 6. A client, who has NCD due to Alzheimer's disease, says to the nurse, "I have a date tonight. I always have a date on Christmas." Which of the following is the most appropriate response? ANSWER b. "Today is Tuesday, October 21st. We will have supper soon, and then your daughter will come to visit." Q. 7. A client, who has NCD due to Alzheimer's disease, has trouble sleeping and wanders around at night. Which of the following nursing actions would be best to promote sleep in this client? ANSWER d. Ensure that the client gets regular physical exercise during the day. Q. 8. The night nurse finds a client with Alzheimer's disease wandering the hallway at 4 a.m. and trying to open the door to the side yard. Which statement is the best initial response by the nurse? ANSWER c. "This is the patio door. Are you looking for the bathroom?" Q. 9. A client with neurocognitive disease due to Alzheimer's disease is admitted to the hospital. Which action by the nurse is a priority? ANSWER b. Ensuring that the environment is safe to prevent injury Q. 10. Which intervention is most appropriate for helping a client with Alzheimer's disease with ADLs? ANSWER c. Provide step-by-step instructions and plenty of time to perform independently as many ADLs as possible. Q. 1. A client has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? ANSWER D. The client stays at home for fear of being in a place from which they cannot escape. Q. 2. Which of the following is the most appropriate therapy for a client with agoraphobia? ANSWER c. Facing fears in gradual step progression Q. 3. With implosion therapy, a client with phobic anxiety would be: ANSWER d. Presented with intense exposure to a variety of stimuli associated with the phobic object or situation Q. 4. A client with OCD spends many hours each day washing their hands. Which is the most likely reason for washing hands so much? ANSWER a. Relieve anxiety Q. 5. A client is receiving habit-reversal therapy. Which element would be included in this therapy? (Select all that apply.) ANSWER a. Awareness training b. Competing response training c. Social support Q. 6. The initial care plan for a client with OCD who washes their hands obsessively would include which nursing intervention? ANSWER b. Structure the client's schedule so that they have plenty of time for washing their hands. Q. 7. A client with OCD says to the nurse, "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill at ease with the staff or other clients anymore." In light of this change, which nursing intervention is most appropriate? ANSWER c. Set limits on the amount of time the client may engage in the ritualistic behavior. Q. 8. A new client at the mental health clinic has been diagnosed with body dysmorphic disorder. Which nursing intervention is the priority? ANSWER c. Encourage the client to describe reasons for seeking treatment. Q. 9. A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client? ANSWER a. Stay with the client and reassure them of their safety. Q. 10. A client diagnosed with generalized anxiety disorder has been prescribed buspirone 15 mg daily. The client says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which response by the nurse would be appropriate? ANSWER b. "Buspirone must be taken daily in order to be effective." Q. 1. Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which is an adverse effect associated with use of amphetamines that makes this practice undesirable? ANSWER c. Tolerance Q. 2. The Maudsley approach to treatment of adolescents with anorexia nervosa advances which fundamental concept? ANSWER a. Family should be actively involved in each phase of treatment. Q. 3. A client has sought help for their concern that they are binge eating, and the client believes it has "gotten out of control." The client asks the nurse what can be done to help them. Which is the most accurate response? ANSWER b. "Some medications and psychological treatments that have demonstrated effectiveness in reducing binge eating behaviors." Q. 4. Which physical manifestations would you expect to assess in a client with anorexia nervosa? ANSWER c. Bradycardia, hypotension, hypothermia Q. 5. Which medication has been used with some success in clients with bulimia nervosa? ANSWER c. Fluoxetine (Prozac) 6. A client is hospitalized on the psychiatric unit with a history and current diagnosis of bulimia nervosa. Which symptoms would be congruent with this client's diagnosis? b. Binging, purging, normal weight, hypokalemia Q. 7. A 14-year-old client has just been admitted to the psychiatric unit for anorexia nervosa. They are emaciated and refuses to eat. What is the primary nursing diagnosis for this client? b. Imbalanced nutrition: Less than body requirements Q. 8. The nurse is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." 9. A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse they are afraid they're going to gain weight. Which is the most appropriate response by the nurse? c. . "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition; but for now, I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." 10. A client presents in the emergency department with complaints of suicidal ideation. The following data is collected by the nurse. Which assessment findings suggest that bulimia nervosa might be a health problem? (Select all that apply.) a. Parotid glands appear enlarged. b. Teeth have a "moth eaten" pattern of tooth decay. c. Client reports taking laxatives daily. d. Client's weight is within the expected range. all of them 1. Trauma-informed care is foundational to all interventions with a victim of violence for which of the following reasons? c. Victims of violence are at high risk for retraumatization. 2. A SANE nurse's primary role when intervening with a victim of violence is to: a. Conduct a sexual assault examination and preserve evidence 3. A female child, age 5, is sent to the school nurse's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that the child has numerous bruises on her arms and torso in various stages of healing. She also notices some small scars, and her abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse should screen further for: b. Physical abuse and neglect 4. A school nurse notices bruises and scars on a 5-year-old child's body, but the child refuses to say how they received them. Which of the following is an evidence-based approach for further assessment by the nurse? d. Use a "family" of dolls to role-play the child's family with them. 5. The nurse is providing education to a support group for survivors of rape. Which of the following items is evidence-based information to include in this teaching? d. Rape is an expression of power and dominance by means of sexual aggression and violence. 6. A female client arrives at the emergency department and tells the nurse her husband inflicted the cuts to her face that required sutures. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is: b. "It is not your fault. You did the right thing by coming here." 7. A woman who has a long history of being battered by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is: d. "I hope you have made the right decision. Call this number if you need help." 8. A school nurse notices suspicious bruises and scars on a child's body. The nurse suspects that the child is being physically abused. Which action by the nurse is a priority at this point? a. As a health-care worker, report the suspicion to child protective services. 9. A college-age female client is brought to the emergency department by their roommate after she confided that she was raped by her date who invited her to a frat party. The client says to the nurse, "It's all my fault. I shouldn't have gone to a party where I knew there was going to be alcohol." Which of these is the best response by the nurse? b. "You are not to blame for his behavior. You obviously made some right decisions, because you survived the attack." 10. A young man who has just undergone a sexual assault is brought into the emergency department by a friend. What is the priority nursing intervention? b. Provide physical and emotional support during evidence collection. 1. Which of the following is most likely to initiate a grief response in an individual? (Select all that apply.) a. Death of a pet dog b. Onset of menopause c. Failing an examination d. Divorce all of them 2. A client, who is dying of cancer, says to the nurse, "I just want to see my new grandbaby. If only God will let me live until she is born. Then I'll be ready to go." This is an example of which of Kübler-Ross's stages of grief? c. Bargaining 3. A recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did that. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? c. Task III. Adjusting to a world without the lost entity 4. Engel identifies which of the following as successful resolution of the grief process? d. When the bereaved person can discuss both positive and negative aspects about the lost entity 5. Which of the following is thought to facilitate the grief process? a. The ability to grieve in anticipation of the loss 6. A client who lost his wife after 35 years of marriage presents at his primary care physician's office 10 months later. He has lost 20 pounds and tells the nurse, "I just don't want to eat or do anything else for that matter." Which action by the nurse is a priority? a. Assess the client for depression and suicide risk. 7. An 80-year-old client arrives at the emergency department accompanied by her daughter. The daughter tells the nurse that her mom lost her husband 2 months ago and since then her mom has complained of feeling depressed and anxious. Earlier today, she began complaining of chest pain. Which action by the nurse is a priority? b. Assess vital signs and obtain an ECG. 8. A 10-year-old child returns to school after the death of his mother. The school nurse becomes aware that this child is frequently talking in the classroom about fears that he will die, too. The classroom teacher is asking for recommendations about how to handle this situation. Which action by the nurse is most appropriate? c. Educate the teacher that this a common reaction in children of this age and it is best for the teacher to offer reassurance that he is safe. 9. A client whose husband died from cancer 1 month ago attends a grief support group being conducted by the hospice nurse. During the group this client states, "Sometimes I wish I could go be with my husband. I just want to die." Which action by the nurse is a priority? a. Ask the client if she is having thoughts of harming or killing herself. 10. An adolescent who recently lost his brother in a fatal accident is referred to the school nurse following a physical fight with a peer. After attending to the client's bleeding lip, the parents ask the nurse for recommendations because their son has had several physical confrontations after the death of his brother. Which action by the nurse is most beneficial? c. Provide information about available support groups for adolescents who have also experienced the loss of a loved one. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD), spends 1 hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior? A. It relieves anxiety For the last year, a college student continually and unrealistically worries about academic performance and love life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which diagnosis? B. Generalized anxiety disorder (GAD) When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? D. communicate with simple words and brief messages. What should the nurse plan to teach a client who is taking alprazolam (xanax) three times a day? A. that there is a potential for dependence and tolerance From a biological theory perspective, which of the following predisposes individuals to be abusive? C. Various levels of serotonin and testosterone. A 12 year old girl suddenly refuses to change for gym, participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. what should the school nurse consider when assessing this childs symptoms? A. sexual abuse A young mother in a severely abusive relationship is admitted to the psychiatric unit after an attempted suicide. the client tells the nurse "im sure things will be better between us once i go home". which is the most appropriate nursing response? D. lets develop a safety plan in case he becomes violent in the future. After an examination and treatment for rape, the nurse prepares to discharge a client from the emergency department (ED). Which discharge teaching should the nurse provide? A. Information on available community resources A patients husband died 1 year ago, she has recently started dating a gentleman from her grief support group. this behavior is indicative of which of the grief tasks described by Worden? D. Task 4: finding an enduring connection with the lost entity in the midst of embarking on a new life. Which statement would indicate to the nurse that a widow is nearing the end of the grief process? B. "My husband was often grumpy, but I know he loved me unconditionally" Which would the nurse identify as a maladaptive grieving response? B. A patient is experiencing marked feelings of worthlessness and low-self esteem. Elderly individuals often experience a convergence of losses. the timing of which makes it impossible for the aging individual to complete the grief process in response to one loss before another occurs, what term is used to describe this situation? C. Bereavement Overload Which is characteristic of the diagnosis of anorexia nervosa? B. Body Image disturbance Which assessment finding would the nurse expect in clients diagnosed with bulimia? D. They are within their normal wight range. A client is 5 feet 8 inches tall and weighs 105 pounds. The client has been taking laxatives daily, and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? D. Imbalanced nutrition, less than body requirements Hospitalized and diagnosed in the fourth stage of neurocognitive disorder due to Alzheimers disease, a patient, when asked about the previous evening, describes a wonderful evening spent on a cruise, which symptom is the patient exhibiting? B. Confabulation A patient is newly diagnosed with second-stage neurocognitive disorder due to Alzheimers disease. which cognitive change would a nurse observe? A. Memory Disturbance Which statement is true about vascular dementia? D. Vascular dementia involves a variable pattern of cognitive functioning. A patient has recently been diagnosed with mild-moderate neurocognitive disorder due to Alzheimers disease. Which medication would the nurse expect the physician to order for this patients cognitive impairment? C. Donzepil (Aricept) A nurse is teaching a group of newly licensed nurses about the progressive nature of Alzheimer's disease. Which of the following should the nurse include in the teaching as manifestations seen in the moderate stage of Alzheimer's disease? Difficulty with talking or reading A nurse in the emergency department is caring for a client who reports chest pain, headache, and shortness of breath. He continues to state, "I don't know why my wife left me." The client receives a diagnosis of anxiety. The nurse realizes the client's findings support which level of anxiety? Severe A nurse is caring for a client who requires a crisis intervention for acute anxiety. Which of the following actions is the highest priority? Protecting the client from injury A nurse in the emergency department is implementing a plan of care for an older adult client who is experiencing delirium tremens. Which of the following actions should the nurse take first? Raise the side rails of the bed. A nurse is caring for a group of older adult clients. Which of the following manifestations indicates one of the clients is experiencing delirium? A client attempts to climb out of bed and repeatedly states she must get home. A nurse is counseling a client for the management of anxiety. The client is consistently late for appointments and ignores household chores. The client states, "I'm just too stressed. I need someone to take care of me." The nurse identifies this behavior as an example of which of the following defense mechanisms? Regression A nurse working in a long-term care facility is admitting a client who has dementia. Medical History: For last 3 months, the client reports forgetfulness, episodes of agitation, and difficulty balancing their checkbook. The client reports becoming more confused at night and having an inability to sleep. Client reports having a lack of appetite and states that they were unable to remember their home address 2 days ago. Which of the following interventions should the nurse include in the plan of care? Select all that apply. Give one task at a time to the client. Encourage the client to take deep breaths when feeling agitated. Offer the client finger foods for meals. Obtain client's weight weekly. A nurse is planning care for a client who has generalized anxiety disorder. Which of the following interventions should the nurse implement to promote relaxation? Assist the client in practicing meditation. A nurse is caring for a young adult client who says he is experiencing increased anxiety and an inability to concentrate. Which of the following responses should the nurse make? "It sounds like you're having a difficult time." Alzehimers memory deficit, aphasia, apraxia, agnosia Dementia w/ Lewy bodies Memory deficit, fluctuating attention, EPS, psychosis Frontotemporal dementia memory deficit, speech/language disorders, disinhibition, hyperorality Huntington's disease Memory deficit, executive dysfunction, chorea Creutzfeldt-Jakob disease memory deficit, ataxia, myoclonus, language alzehimers dx amyloid/tau pathology Alzheimers disease course insidious onset and gradual progression VaD course presentation based on extent and location of CV event, step wise decline DLB and PaD (parkinsons), FTD(frontotemporal) course insidious onset and gradual progression, like AD vascular dementia disease cause cardiovascular or CV event what sx for Lewy body dementia visual hallucinations early on, cognitive sx with motor sx. Rapid eye movements, sleep disturbances. 50% sensitive to antipsychotics. Frontotemporal dementia sx executive dysfunction, impaired social cognition/ lack of empathy, loss of words, speech finding, compulsive behavior, visual hallucinations, EPS Fronto temporal dementia ages 55-65 yo most common 3/4, Pseudo dementia depression can look like dementia Signs/sx of depression compared to alzheimers no sun downing vs sundowning For alcohol detox use these meds Ativan, valium, lithium Alcohol has what transmitter GABA Why do you give thiamine before glucose for Wernicke's Korsakoff? Thiamine is metabolized by glucose, so if glucose used first will use more thiamine. When does CDT lab get back to normal after drinking 2-4 wks of abstinence When does GGT lab get back to normal after drinking 2-6 weeks after abstinence When does AST and ALT get back to normal after drinking 12-24 hours and 37-54 hours When does MCV get back to normal after drinking? 3 months What causes EtOH cravings? Resensitization of the GABA receptor What causes cannabis cravings? Re sensitization of CB1 or CB2 What causes nicotine cravings? Resensitization of nicotinic receptors, alpha 4, beta 2 How is cocaine intoxication and opiate withdrawal sx the same High BP/HR, dilation of pupils, diaphoresis How is cocaine intoxication and alcohol withdrawal the same? Risk for seizures. What level of CIWA scale for alcohol detox protocol? Above 10, if less than 10 tx is symptomatic What are complications of alcohol intake? Wernickes encephalopathy Alcohol neuropathy Paronychia inflammation Esophageal varices Gout Aspiration pneumonia If opioids cause constipation what does withdrawal cause? Diarrhea, generalized pain, rhinitis, What drugs are used to treat alcohol use disorder? acamprosate naltrexone topamax gabapentin What is used for heroin avoidance? clonidine first 72 hours (alpha 2 adrenergic agonist Suboxone after 72 hours or patient could die Too much NE DA causes mania psychosis Too little NE DA causes Fatigue/distracted, disorganized DCIV dorsal striatum - compulsivity, Impulsivity - ventral striatum Dorsal anterior cingulate cortex leads to what sx selective attention DLPFC leads to what ADHD sx Sustained attention problem solving, Orbitofrontal cortex leads to what ADHD sx think "squirrel" impulsive sx Cortico-striatal-thalamic-cortical loop leads to what Impulsivity and compulsivity/anxiety