Mental Health (PSYCH) HESI - PRACTICE 2021 Study Guide
A 60 year old client diagnosed with chronic schizophrenia presents in an emergency department with
uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment
should a nurse anticipate when planning care for this client?
A. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications.
B. Agranulocytosis treated by administration of clozapine (Clozaril).
C. Extrapyramidal symptoms treated by administration of benztropine (Cogentin).
D. Tardive dyskinesia treated by discontinuing antipsychotic medications. - ansAnswer:
D. Tardive dyskinesia treated by discontinuing antipsychotic medications.
(happens after pt has chronically taken antipsychotic medications. When prescribing antipsychotics, you want
to start low and gradually increase dose because of this. Question clues: "Chronic schizophrenia",
"uncontrollable tongue movements, stiff neck, difficulty swallowing")
A client began taking lithium for the treatment of BP disorder approximately 1 month ago. The client asks if it is
normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response?
A. "Thats strange. Weight loss is the typical pattern."
B. "What have you been eating? Weight gain is not usually associate with lithium."
C. "Weight gain is a common but troubling side effect."
D. "Weight gain only occurs during the first month of treatment with this drug." - ansAnswer:
C. "Weight gain is a common but troubling side effect."
A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically
cleared. The client states, "My parents watch me like a hawk and never let me out of their sight. " Which
nursing diagnosis would take priority at this time?
A. Altered nutrition less than body requirements
B. Altered social interaction
C. Impaired verbal communication
D. Altered family processes - ansAnswer:
D. Altered family processes
,A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m. requesting to
phone a lawyer to discuss filing for divorce. The unit rules state that no phone calls are permitted after 10:00
p.m. Which nursing response is most appropriate?
A. "Go ahead and use the phone. I know this pending divorce is stressful."
B. "You know better than break the rules. Im surprised at you. "
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
D. "The decision to divorce should not be considered until you have had a good nights sleep." - ansAnswer:
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a
12- pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis?
A. Knowledge deficit R/T bipolar disorder AEB concern about symptoms.
B. Altered nutrition: Less than body requirements r/t hyperactivity AEB weight loss.
C. Risk for suicide r/t powerlessness AEB insomnia and anorexia.
D. Altered sleep patterns r/t mania AEB insomnia for the past 3 nights. - ansAnswer:
B. Altered nutrition: Less than body requirements r/t hyperactivity AEB weight loss. (physical needs/health
always priority.)
A client diagnosed with bipolar disorder: depressive phase intentionally overdoses on sertraline (Zoloft). Family
members report that the client has experience anorexia, insomnia, and recent job loss. What should be the
priority nursing diagnosis for this client?
A. Risk for suicide r/t hopelessness.
B. Anxiety: severe r/t hyperactivity
C. Imbalanced nutrition: less than body requirements r/t refusal to eat
D. Dysfunctional grieving r/t loss of employment. - ansAnswer:
A. Risk for suicide r/t hopelessness.
A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community
, meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the
nursing staff best handle this situation?
A. Allow the clients to apply the democratic process when developing unit rules.
B. Maintain consistency of care by open communication to avoid staff manipulation.
C. Allow the client spokesman to verbalize concerns during a unit staff meeting.
D. Maintain unit order by the application of autocratic leadership. - ansAnswer:
B. Maintain consistency of care by open communication to avoid staff manipulation.
(borderline personality disorder is very manipulative. They want to cause splitting which looks like pitting the
nurses against each other, or one day you are the best nurse ever and then the next day you are the worst
nurse in the world.)
A client diagnosed with BP disorder has been taking lithium carbonate (Lithaine) for 1 year. The client presents
in an emergency department with a temp of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How
should the nurse interpret these symptoms?
A. Symptoms indicate consumption of foods high in tyramine.
B. Symptoms indicate lithium carbonate discontinuation syndrome.
C. Symptoms indicate the development of lithium carbonate tolerance.
D. Symptoms indicate lithium carbonate toxicity. - ansAnswer:
D. Symptoms indicate lithium carbonate toxicity. (0.6-1.2 normal range. blurred vision and tinnitus is most
obvious clue)
A client diagnosed with BP disorder is exhibiting severe manic behaviors. A physician prescribes lithium
carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the
appropriate nursing response?
A. "Zyprexa in combination with Eskalith cures manic symptoms."
B. "Zyprexa prevents extrapyramidal side effects."
C. "Zyprexa ensures a good night's sleep."
D. "Zyprexa calms hyperactivity until the Eskalith takes effect." - ansAnswer:
D. "Zyprexa calms hyperactivity until the Eskalith takes effect."
(when it comes to psych meds, it takes 4-6 wks to see effect. Give Zyprexa as a bridge until Lithium takes in
A 60 year old client diagnosed with chronic schizophrenia presents in an emergency department with
uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment
should a nurse anticipate when planning care for this client?
A. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications.
B. Agranulocytosis treated by administration of clozapine (Clozaril).
C. Extrapyramidal symptoms treated by administration of benztropine (Cogentin).
D. Tardive dyskinesia treated by discontinuing antipsychotic medications. - ansAnswer:
D. Tardive dyskinesia treated by discontinuing antipsychotic medications.
(happens after pt has chronically taken antipsychotic medications. When prescribing antipsychotics, you want
to start low and gradually increase dose because of this. Question clues: "Chronic schizophrenia",
"uncontrollable tongue movements, stiff neck, difficulty swallowing")
A client began taking lithium for the treatment of BP disorder approximately 1 month ago. The client asks if it is
normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response?
A. "Thats strange. Weight loss is the typical pattern."
B. "What have you been eating? Weight gain is not usually associate with lithium."
C. "Weight gain is a common but troubling side effect."
D. "Weight gain only occurs during the first month of treatment with this drug." - ansAnswer:
C. "Weight gain is a common but troubling side effect."
A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically
cleared. The client states, "My parents watch me like a hawk and never let me out of their sight. " Which
nursing diagnosis would take priority at this time?
A. Altered nutrition less than body requirements
B. Altered social interaction
C. Impaired verbal communication
D. Altered family processes - ansAnswer:
D. Altered family processes
,A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m. requesting to
phone a lawyer to discuss filing for divorce. The unit rules state that no phone calls are permitted after 10:00
p.m. Which nursing response is most appropriate?
A. "Go ahead and use the phone. I know this pending divorce is stressful."
B. "You know better than break the rules. Im surprised at you. "
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
D. "The decision to divorce should not be considered until you have had a good nights sleep." - ansAnswer:
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a
12- pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis?
A. Knowledge deficit R/T bipolar disorder AEB concern about symptoms.
B. Altered nutrition: Less than body requirements r/t hyperactivity AEB weight loss.
C. Risk for suicide r/t powerlessness AEB insomnia and anorexia.
D. Altered sleep patterns r/t mania AEB insomnia for the past 3 nights. - ansAnswer:
B. Altered nutrition: Less than body requirements r/t hyperactivity AEB weight loss. (physical needs/health
always priority.)
A client diagnosed with bipolar disorder: depressive phase intentionally overdoses on sertraline (Zoloft). Family
members report that the client has experience anorexia, insomnia, and recent job loss. What should be the
priority nursing diagnosis for this client?
A. Risk for suicide r/t hopelessness.
B. Anxiety: severe r/t hyperactivity
C. Imbalanced nutrition: less than body requirements r/t refusal to eat
D. Dysfunctional grieving r/t loss of employment. - ansAnswer:
A. Risk for suicide r/t hopelessness.
A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community
, meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the
nursing staff best handle this situation?
A. Allow the clients to apply the democratic process when developing unit rules.
B. Maintain consistency of care by open communication to avoid staff manipulation.
C. Allow the client spokesman to verbalize concerns during a unit staff meeting.
D. Maintain unit order by the application of autocratic leadership. - ansAnswer:
B. Maintain consistency of care by open communication to avoid staff manipulation.
(borderline personality disorder is very manipulative. They want to cause splitting which looks like pitting the
nurses against each other, or one day you are the best nurse ever and then the next day you are the worst
nurse in the world.)
A client diagnosed with BP disorder has been taking lithium carbonate (Lithaine) for 1 year. The client presents
in an emergency department with a temp of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How
should the nurse interpret these symptoms?
A. Symptoms indicate consumption of foods high in tyramine.
B. Symptoms indicate lithium carbonate discontinuation syndrome.
C. Symptoms indicate the development of lithium carbonate tolerance.
D. Symptoms indicate lithium carbonate toxicity. - ansAnswer:
D. Symptoms indicate lithium carbonate toxicity. (0.6-1.2 normal range. blurred vision and tinnitus is most
obvious clue)
A client diagnosed with BP disorder is exhibiting severe manic behaviors. A physician prescribes lithium
carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the
appropriate nursing response?
A. "Zyprexa in combination with Eskalith cures manic symptoms."
B. "Zyprexa prevents extrapyramidal side effects."
C. "Zyprexa ensures a good night's sleep."
D. "Zyprexa calms hyperactivity until the Eskalith takes effect." - ansAnswer:
D. "Zyprexa calms hyperactivity until the Eskalith takes effect."
(when it comes to psych meds, it takes 4-6 wks to see effect. Give Zyprexa as a bridge until Lithium takes in
