Mental Health Nursing NCLEX Study
Exam | Psychiatric Nursing Questions
and Rationales
1. 1. Question
Which nursing intervention would be most appropriate if a male client develops
orthostatic hypotension while taking amitriptyline (Elavil)?
A. Consulting with the physician about substituting a different type of
antidepressant.
B. Advising the client to sit up for 1 minute before getting out of bed.
C. Instructing the client to double the dosage until the problem resolves.
D. Informing the client that this adverse reaction should disappear within 1
week.
Correct Answer: B. Advising the client to sit up for 1 minute before getting
out of bed.
To minimize the effects of amitriptyline-induced orthostatic hypotension, the
nurse should advise the client to sit up for 1 minute before getting out of bed.
Amitriptyline is FDA approved medication to treat depression in adults.
Secondary to its alpha-adrenergic receptor blockade, it can cause orthostatic
hypotension, dizziness, and sedation. It can also cause heart rate variability, slow
intracardiac conduction, induce various arrhythmias, and cause QTc (corrected
QT) prolongation.
2. 2. Question
Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of
hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor
concentration, and difficulty making decisions. The client states that these
symptoms began at least 2 years ago. Based on this report, the nurse Tiffany
suspects:
A. Cyclothymic disorder.
, B. Atypical affective disorder.
C. Major depression.
D. Dysthymic disorder.
Correct Answer: D. Dysthymic disorder.
Dysthymic disorder is marked by feelings of depression lasting at least 2 years,
accompanied by at least two of the following symptoms: sleep disturbance,
appetite disturbance, low energy or fatigue, low self-esteem, poor concentration,
difficulty making decisions, and hopelessness. These symptoms may be relatively
continuous or separated by intervening periods of normal mood that last a few
days to a few weeks.
After taking an overdose of phenobarbital (Barbita), Mario is admitted to the
emergency department. Dr. Trinidad prescribes activated charcoal (Charcocaps)
to be administered by mouth immediately. Before administering the dose, the
nurse verifies the dosage ordered. What is the usual minimum dose of activated
charcoal?
A. 5 g mixed in 250 ml of water
B. 15 g mixed in 500 ml of water
C. 30 g mixed in 250 ml of water
D. 60 g mixed in 500 ml of water
Correct Answer: C. 30 g mixed in 250 ml of water
The usual adult dosage of activated charcoal is 5 to 10 times the estimated
weight of the drug or chemical ingested, or a minimum dose of 30 g, mixed in
250 ml of water. Doses less than this will be ineffective; doses greater than this
can increase the risk of adverse reactions, although toxicity doesn’t occur with
activated charcoal, even at the maximum dose. Activated charcoal is widely used
in Emergency Departments to treat many types of toxic ingestions. Its use
significantly prevents the absorption of many toxic drugs and other poisons if
given early post-ingestion.
.
3. 4. Question
What herbal medication for depression, widely used in Europe, is now being
prescribed in the United States?
, A. Ginkgo biloba
B. Echinacea
C. St. John's wort
Correct answer
D. Ephedra
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to
prescription antidepressants. St. John’s Wort (Hypericum perforatum) is
commonly used to treat mild-to-moderate depression. Several bioactive
compounds have been identified in St. John’s Wort that work synergistically to
provide its antidepressant and anti-inflammatory attributes. St. John’s Wort was
more efficacious than standard antidepressant therapy in patients with mild-to-
moderate depression.
.
4. 5. Question
Cely with manic episodes is taking lithium. Which electrolyte level should the
nurse check before administering this medication?
A. Calcium
B. Sodium
Correct answer
C. Chloride
D. Potassium
Correct Answer: B. Sodium
Lithium is chemically similar to sodium. If sodium levels are reduced, such as from
sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk
of toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and
should drink adequate amounts of fluid each day. It is also important to monitor
patients for dehydration and lower the dose when there are signs of infection,
excessive sweating, or diarrhea. Toxic levels are when the drug level is more than
2 mEq/L.
5. 6. Question
, Nurse Josefina is caring for a client who has been diagnosed with delirium. Which
statement about delirium is true?
A. It's characterized by an acute onset and lasts about 1 month.
B. It's characterized by a slowly evolving onset and lasts about 1 week.
C. It's characterized by a slowly evolving onset and lasts about 1 month.
D. It's characterized by an acute onset and lasts hours to a number of days.
Correct Answer: D. It’s characterized by an acute onset and lasts hours to a
number of days
Delirium has an acute onset and typically can last from several hours to several
days. Delirium, also known as the acute confusional state, is a clinical syndrome
that usually develops in the elderly. It is characterized by an alteration of
consciousness and cognition with reduced ability to focus, sustain, or shift
attention.
6. 7. Question
Edward, a 66-year-old client with slight memory impairment and poor
concentration, is diagnosed with primary degenerative dementia of the
Alzheimer’s type. Early signs of this dementia include subtle personality changes
and withdrawal from social interactions. To assess for progression to the middle
stage of Alzheimer’s disease, the nurse should observe the client for:
A. Occasional irritable outbursts.
B. Impaired communication.
Correct answer
C. Lack of spontaneity.
D. Inability to perform self-care activities.
Correct Answer: B. Impaired communication.
Signs of advancement to the middle stage of Alzheimer’s disease include
exacerbated cognitive impairment with obvious personality changes and
impaired communication, such as inappropriate conversation, actions, and
responses. Symptoms of Alzheimer’s disease depend on the stage of the disease.
Alzheimer’s disease is classified into preclinical or presymptomatic, mild, and
Exam | Psychiatric Nursing Questions
and Rationales
1. 1. Question
Which nursing intervention would be most appropriate if a male client develops
orthostatic hypotension while taking amitriptyline (Elavil)?
A. Consulting with the physician about substituting a different type of
antidepressant.
B. Advising the client to sit up for 1 minute before getting out of bed.
C. Instructing the client to double the dosage until the problem resolves.
D. Informing the client that this adverse reaction should disappear within 1
week.
Correct Answer: B. Advising the client to sit up for 1 minute before getting
out of bed.
To minimize the effects of amitriptyline-induced orthostatic hypotension, the
nurse should advise the client to sit up for 1 minute before getting out of bed.
Amitriptyline is FDA approved medication to treat depression in adults.
Secondary to its alpha-adrenergic receptor blockade, it can cause orthostatic
hypotension, dizziness, and sedation. It can also cause heart rate variability, slow
intracardiac conduction, induce various arrhythmias, and cause QTc (corrected
QT) prolongation.
2. 2. Question
Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of
hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor
concentration, and difficulty making decisions. The client states that these
symptoms began at least 2 years ago. Based on this report, the nurse Tiffany
suspects:
A. Cyclothymic disorder.
, B. Atypical affective disorder.
C. Major depression.
D. Dysthymic disorder.
Correct Answer: D. Dysthymic disorder.
Dysthymic disorder is marked by feelings of depression lasting at least 2 years,
accompanied by at least two of the following symptoms: sleep disturbance,
appetite disturbance, low energy or fatigue, low self-esteem, poor concentration,
difficulty making decisions, and hopelessness. These symptoms may be relatively
continuous or separated by intervening periods of normal mood that last a few
days to a few weeks.
After taking an overdose of phenobarbital (Barbita), Mario is admitted to the
emergency department. Dr. Trinidad prescribes activated charcoal (Charcocaps)
to be administered by mouth immediately. Before administering the dose, the
nurse verifies the dosage ordered. What is the usual minimum dose of activated
charcoal?
A. 5 g mixed in 250 ml of water
B. 15 g mixed in 500 ml of water
C. 30 g mixed in 250 ml of water
D. 60 g mixed in 500 ml of water
Correct Answer: C. 30 g mixed in 250 ml of water
The usual adult dosage of activated charcoal is 5 to 10 times the estimated
weight of the drug or chemical ingested, or a minimum dose of 30 g, mixed in
250 ml of water. Doses less than this will be ineffective; doses greater than this
can increase the risk of adverse reactions, although toxicity doesn’t occur with
activated charcoal, even at the maximum dose. Activated charcoal is widely used
in Emergency Departments to treat many types of toxic ingestions. Its use
significantly prevents the absorption of many toxic drugs and other poisons if
given early post-ingestion.
.
3. 4. Question
What herbal medication for depression, widely used in Europe, is now being
prescribed in the United States?
, A. Ginkgo biloba
B. Echinacea
C. St. John's wort
Correct answer
D. Ephedra
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to
prescription antidepressants. St. John’s Wort (Hypericum perforatum) is
commonly used to treat mild-to-moderate depression. Several bioactive
compounds have been identified in St. John’s Wort that work synergistically to
provide its antidepressant and anti-inflammatory attributes. St. John’s Wort was
more efficacious than standard antidepressant therapy in patients with mild-to-
moderate depression.
.
4. 5. Question
Cely with manic episodes is taking lithium. Which electrolyte level should the
nurse check before administering this medication?
A. Calcium
B. Sodium
Correct answer
C. Chloride
D. Potassium
Correct Answer: B. Sodium
Lithium is chemically similar to sodium. If sodium levels are reduced, such as from
sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk
of toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and
should drink adequate amounts of fluid each day. It is also important to monitor
patients for dehydration and lower the dose when there are signs of infection,
excessive sweating, or diarrhea. Toxic levels are when the drug level is more than
2 mEq/L.
5. 6. Question
, Nurse Josefina is caring for a client who has been diagnosed with delirium. Which
statement about delirium is true?
A. It's characterized by an acute onset and lasts about 1 month.
B. It's characterized by a slowly evolving onset and lasts about 1 week.
C. It's characterized by a slowly evolving onset and lasts about 1 month.
D. It's characterized by an acute onset and lasts hours to a number of days.
Correct Answer: D. It’s characterized by an acute onset and lasts hours to a
number of days
Delirium has an acute onset and typically can last from several hours to several
days. Delirium, also known as the acute confusional state, is a clinical syndrome
that usually develops in the elderly. It is characterized by an alteration of
consciousness and cognition with reduced ability to focus, sustain, or shift
attention.
6. 7. Question
Edward, a 66-year-old client with slight memory impairment and poor
concentration, is diagnosed with primary degenerative dementia of the
Alzheimer’s type. Early signs of this dementia include subtle personality changes
and withdrawal from social interactions. To assess for progression to the middle
stage of Alzheimer’s disease, the nurse should observe the client for:
A. Occasional irritable outbursts.
B. Impaired communication.
Correct answer
C. Lack of spontaneity.
D. Inability to perform self-care activities.
Correct Answer: B. Impaired communication.
Signs of advancement to the middle stage of Alzheimer’s disease include
exacerbated cognitive impairment with obvious personality changes and
impaired communication, such as inappropriate conversation, actions, and
responses. Symptoms of Alzheimer’s disease depend on the stage of the disease.
Alzheimer’s disease is classified into preclinical or presymptomatic, mild, and
