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Psychiatric-Mental Health Nursing Final Exam
Download now
Johns Hopkins University
HIGH YIELDS QUESTIONS
NEWEST MODEL 2026 EXAM LATEST
VERSION SOLVED QUESTIONS &
ANSWERS VERIFIED 100 %
Exam
, Page 2 of 222
Final Exam
The physician prescribes lithium carbonate (Eskalith) for a client who has just
been diagnosed with bipolar disorder. Now the nurse is teaching the client
about signs and symptoms of lithium toxicity, which include:
1. skeletal muscle contractions, cogwheel rigidity, and a thick tongue.
2. dry mouth, blurred vision, and urine retention.
3. edema, orthostatic hypotension, and rash.
4. lethargy, vomiting, and diarrhea.
4. lethargy, vomiting, and diarrhea.
Lethargy is an early sign of lithium toxicity; if it goes undetected, vomiting and
diarrhea soon develop. Lithium doesn't cause extrapyramidal effects, such as
skeletal muscle contractions, cogwheel rigidity, and a thick tongue, or cholinergic
effects, such as dry mouth, blurred vision, and urine retention. The drug also doesn't
cause edema, orthostatic hypotension, or rash.
A depressed client in the psychiatric unit hasn't been getting adequate rest
and sleep. To encourage restful sleep at night, the nurse should:
1. talk with the client for a long time at night to reduce anxiety.
2. encourage environmental stimulation during the evening.
3. gently but firmly set limits on time spent in bed during the day.
4. encourage the client to take an antianxiety agent as needed at bedtime.
3. gently but firmly set limits on time spent in bed during the day.
Setting limits on how much time the client may spend in bed and what time the client
must get up in the morning lets the client know what is expected while conveying
genuine concern. Talking with the client for a long time at night would interfere with
sleep and give the client attention for not sleeping. Encouraging environmental
stimulation in the evening would discourage rest and sleep at night. While most
antianxiety agents have sedative adverse effects, they aren't intended for use as
sleep-inducing agents.
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A client is admitted to the local psychiatric facility with bipolar disorder in the
manic phase. The physician decides to start the client on lithium carbonate
(Lithonate) therapy. One week after this therapy starts, the nurse notes that the
client's serum lithium level is 1 mEq/L. What should the nurse do?
1. Call the physician immediately to report the laboratory result.
2. Observe the client closely for signs and symptoms of lithium toxicity.
3. Withhold the next dose and repeat the laboratory test.
4. Continue to administer the medication as ordered.
4. Continue to administer the medication as ordered.
The serum lithium level should be maintained between 1 and 1.4 mEq/L during the
acute manic phase; therefore, the nurse should continue to administer the
medication as ordered. Unless the client has signs or symptoms of lithium toxicity,
the nurse has no need to call the physician, withhold the medication, or repeat the
laboratory test. Nonetheless, the nurse should continue to monitor the client's serum
lithium level and watch for indications of toxicity if the level begins to rise.
A client with a diagnosis of depression is started on imipramine (Tofranil), 75
mg by mouth at bedtime. The nurse should tell the client that:
1. this medication may be habit forming and will be discontinued as soon as
the client feels better.
2. this medication has no serious adverse effects.
3. the client should avoid eating such foods as aged cheeses, yogurt, and
chicken livers while taking the medication.
4. this medication may initially cause tiredness, which should become less
bothersome over time.
4. this medication may initially cause tiredness, which should become less
bothersome over time.
Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant,
and usually decreases as tolerance develops. Antidepressants aren't habit forming
and don't cause physical or psychological dependence. However, after a long course
of high-dose therapy, the dosage should be decreased gradually to avoid mild
withdrawal symptoms. Serious adverse effects, although rare, include myocardial
infarction, heart failure, and tachycardia. Dietary restrictions, such as avoiding aged
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cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine
oxidase inhibitor, not a tricyclic antidepressant.
A client has been taking imipramine (Tofranil), 125 mg by mouth daily, for 1
week. Now the client reports wanting to stop taking the medication because he
still feels depressed. At this time, what is the nurse's best response?
1. "Imipramine may not be the most effective medication for you. You should
call your physician for further evaluation."
2. "Because imipramine must build to a therapeutic level, it may take 2 to 3
weeks to reduce depression."
3. "The physician may need to increase the dosage for you to get the
medication's maximum benefit."
4. "Don't stop taking the medication abruptly because you may develop
serious adverse effects."
2. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to
reduce depression."
Antidepressant agents such as imipramine don't produce antidepressant effects until
they reach a therapeutic level in the blood, usually about 2 to 3 weeks after the initial
dose. Therefore, the nurse should encourage the client to continue therapy at least
until the drug reaches that level. After this time, if the client's depression doesn't
abate, the nurse may use the other responses.
A client, age 87, with major depression undergoes a sixth electroconvulsive
therapy (ECT) treatment. When assessing the client immediately after ECT, the
nurse expects to find:
1. transitory short-term memory loss and permanent long-term memory loss.
2. transitory short- and long-term memory loss and confusion.
3. permanent short-term memory loss and hypertension.
4. permanent long-term memory loss and hypomania.
2. transitory short- and long-term memory loss and confusion.
ECT commonly causes transitory short- and long-term memory loss and confusion,
especially in geriatric clients. It rarely results in permanent short- and long-term
memory loss. ECT is more likely to lead to hypotension than hypertension and rarely
causes hypomania.
Psychiatric-Mental Health Nursing Final Exam
Download now
Johns Hopkins University
HIGH YIELDS QUESTIONS
NEWEST MODEL 2026 EXAM LATEST
VERSION SOLVED QUESTIONS &
ANSWERS VERIFIED 100 %
Exam
, Page 2 of 222
Final Exam
The physician prescribes lithium carbonate (Eskalith) for a client who has just
been diagnosed with bipolar disorder. Now the nurse is teaching the client
about signs and symptoms of lithium toxicity, which include:
1. skeletal muscle contractions, cogwheel rigidity, and a thick tongue.
2. dry mouth, blurred vision, and urine retention.
3. edema, orthostatic hypotension, and rash.
4. lethargy, vomiting, and diarrhea.
4. lethargy, vomiting, and diarrhea.
Lethargy is an early sign of lithium toxicity; if it goes undetected, vomiting and
diarrhea soon develop. Lithium doesn't cause extrapyramidal effects, such as
skeletal muscle contractions, cogwheel rigidity, and a thick tongue, or cholinergic
effects, such as dry mouth, blurred vision, and urine retention. The drug also doesn't
cause edema, orthostatic hypotension, or rash.
A depressed client in the psychiatric unit hasn't been getting adequate rest
and sleep. To encourage restful sleep at night, the nurse should:
1. talk with the client for a long time at night to reduce anxiety.
2. encourage environmental stimulation during the evening.
3. gently but firmly set limits on time spent in bed during the day.
4. encourage the client to take an antianxiety agent as needed at bedtime.
3. gently but firmly set limits on time spent in bed during the day.
Setting limits on how much time the client may spend in bed and what time the client
must get up in the morning lets the client know what is expected while conveying
genuine concern. Talking with the client for a long time at night would interfere with
sleep and give the client attention for not sleeping. Encouraging environmental
stimulation in the evening would discourage rest and sleep at night. While most
antianxiety agents have sedative adverse effects, they aren't intended for use as
sleep-inducing agents.
, Page 3 of 222
A client is admitted to the local psychiatric facility with bipolar disorder in the
manic phase. The physician decides to start the client on lithium carbonate
(Lithonate) therapy. One week after this therapy starts, the nurse notes that the
client's serum lithium level is 1 mEq/L. What should the nurse do?
1. Call the physician immediately to report the laboratory result.
2. Observe the client closely for signs and symptoms of lithium toxicity.
3. Withhold the next dose and repeat the laboratory test.
4. Continue to administer the medication as ordered.
4. Continue to administer the medication as ordered.
The serum lithium level should be maintained between 1 and 1.4 mEq/L during the
acute manic phase; therefore, the nurse should continue to administer the
medication as ordered. Unless the client has signs or symptoms of lithium toxicity,
the nurse has no need to call the physician, withhold the medication, or repeat the
laboratory test. Nonetheless, the nurse should continue to monitor the client's serum
lithium level and watch for indications of toxicity if the level begins to rise.
A client with a diagnosis of depression is started on imipramine (Tofranil), 75
mg by mouth at bedtime. The nurse should tell the client that:
1. this medication may be habit forming and will be discontinued as soon as
the client feels better.
2. this medication has no serious adverse effects.
3. the client should avoid eating such foods as aged cheeses, yogurt, and
chicken livers while taking the medication.
4. this medication may initially cause tiredness, which should become less
bothersome over time.
4. this medication may initially cause tiredness, which should become less
bothersome over time.
Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant,
and usually decreases as tolerance develops. Antidepressants aren't habit forming
and don't cause physical or psychological dependence. However, after a long course
of high-dose therapy, the dosage should be decreased gradually to avoid mild
withdrawal symptoms. Serious adverse effects, although rare, include myocardial
infarction, heart failure, and tachycardia. Dietary restrictions, such as avoiding aged
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cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine
oxidase inhibitor, not a tricyclic antidepressant.
A client has been taking imipramine (Tofranil), 125 mg by mouth daily, for 1
week. Now the client reports wanting to stop taking the medication because he
still feels depressed. At this time, what is the nurse's best response?
1. "Imipramine may not be the most effective medication for you. You should
call your physician for further evaluation."
2. "Because imipramine must build to a therapeutic level, it may take 2 to 3
weeks to reduce depression."
3. "The physician may need to increase the dosage for you to get the
medication's maximum benefit."
4. "Don't stop taking the medication abruptly because you may develop
serious adverse effects."
2. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to
reduce depression."
Antidepressant agents such as imipramine don't produce antidepressant effects until
they reach a therapeutic level in the blood, usually about 2 to 3 weeks after the initial
dose. Therefore, the nurse should encourage the client to continue therapy at least
until the drug reaches that level. After this time, if the client's depression doesn't
abate, the nurse may use the other responses.
A client, age 87, with major depression undergoes a sixth electroconvulsive
therapy (ECT) treatment. When assessing the client immediately after ECT, the
nurse expects to find:
1. transitory short-term memory loss and permanent long-term memory loss.
2. transitory short- and long-term memory loss and confusion.
3. permanent short-term memory loss and hypertension.
4. permanent long-term memory loss and hypomania.
2. transitory short- and long-term memory loss and confusion.
ECT commonly causes transitory short- and long-term memory loss and confusion,
especially in geriatric clients. It rarely results in permanent short- and long-term
memory loss. ECT is more likely to lead to hypotension than hypertension and rarely
causes hypomania.
