Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice Quiz #1: 75 Questions

1. Question Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, nurse Gina should be prepared for which common adverse effect? o A. Seizures o B. Shivering o C. Anxiety o D. Chest pain Incorrect Correct Answer: A. Seizures Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Benzodiazepine reversal has correlations with seizures. Seizures may happen more frequently in patients who have been on benzodiazepines for long-term sedation or in patients who are showing signs of severe tricyclic antidepressant overdose. The required dosage of Flumazenil should be measured and prepared by the practitioners to manage seizures. Flumazenil use requires caution in patients relying on a benzodiazepine for seizure control. o Option B: Shivering is not an adverse effect of flumazenil. Monitor the patient for the possible return of sedation, mostly in those who are tolerant of benzodiazepines. Patients should have monitoring for respiratory depression, benzodiazepine withdrawal, and other residual effects of benzodiazepines for at least 2 hours. o Option C: Anxiety is a rare adverse effect for people using flumazenil. Flumazenil has some associations with precipitation of seizures in patients with benzodiazepine dependence with a history of seizures. Flumazenil overdose is extremely rare. There is no precise antidote for flumazenil toxicity. In mild to severe toxicity, symptomatic and supportive treatment should be a consideration. o Option D: An overdose of flumazenil in a patient who is not a chronic benzodiazepine user would not be expected. Chronic benzodiazepines users may experience withdrawal with abrupt discontinuation of the drug. Administration of benzodiazepines or barbiturates may be necessary for seizure control.  2. Question Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: o A. Avoid shopping for large amounts of food. o B. Control eating impulses. o C. Identify anxiety-causing situations. o D. Eat only three meals per day. Incorrect Correct Answer: C. Identify anxiety-causing situations Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Bulimia nervosa is a condition that occurs most commonly in adolescent females, characterized by indulgence in binge-eating, and inappropriate compensatory behaviors to prevent weight gain. o Option A: Controlling shopping for large amounts of food isn’t a goal early in treatment. It is important to educate patients who abuse laxatives that these medications work in the gastrointestinal tract after the areas where caloric absorption has occurred primarily. It is crucial to inform patients that a period of edema and weight gain may follow up to several weeks after discontinuation of purging behavior. o Option B: Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues. The primary objective of treatment is a cessation of the binging and purging behavior. Selective serotonin reuptake inhibitors such as fluoxetine, citalopram, and sertraline have shown to reduce symptoms of bulimia nervosa. Fluoxetine is the only FDA approved medication for bulimia nervosa. It appears that a higher dose (60 mg) is significantly better than a placebo in decreasing the frequency of binge and vomiting episodes. o Option D: Eating three meals per day isn’t a realistic goal early in treatment. Patients with bulimia nervosa who purge by vomiting often brush their teeth immediately after purging, which can accelerate dental erosion. The clinician should instruct the patients who persist in vomiting to rinse their mouths with water or fluoride rather than brushing their teeth within 30 minutes of each episode. Consider consulting a dentist to address dental issues associated with vomiting.  3. Question A female client who’s at high risk for suicide needs close supervision. To best ensure the client’s safety, Nurse Mary should: o A. Check the client frequently at irregular intervals throughout the night. o B. Assure the client that the nurse will hold in confidence anything the client says. o C. Repeatedly discuss previous suicide attempts with the client. o D. Disregard decreased communication by the client because this is common with suicidal clients. Incorrect Correct Answer: A. Check the client frequently at irregular intervals throughout the night Checking the client frequently but at irregular intervals prevents the client from predicting when observation will take place and altering behavior in a misleading way at these times. Once the patient is deemed to be at risk for suicide, then intervention steps must be initiated right away. The individual must not be left alone. Enlist the help of a support person while at home. The suicidal individual must be treated in a safe and secure place. In addition, the place has to be monitored. o Option B: This may encourage the client to try to manipulate the nurse or seek attention for having a secret suicide plan. Assessing the individual’s judgment is critical. One should try and determine how the individual can handle stress. Does he or she have an impairment in decision making? Does the individual know that jumping in front of a train is dangerous? Reflect empathy and concern. Offer a hand to help. Provide the patient with confidence that he or she can overcome the issues. o Option C: This may reinforce suicidal ideas. Help develop internal coping strategies (e.g., exercise, journaling, reading, developing a hobby). Utilize the help of healthcare professionals to follow up on therapy. Once the individual is safe as an inpatient or outpatient, a formal treatment plan should be established. The next step is to refer all patients deemed to be at higher risk for suicide to a mental health counselor as soon as possible. Every state has laws and procedures regarding this process which must be incorporated into the clinical practice when addressing individuals at high suicide risk. o Option D: Decreased communication is a sign of withdrawal that may indicate the client has decided to commit suicide; the nurse shouldn’t disregard it. In some cases, assessment of the mental status may provide a clue to the individual’s potential for self-harm. Depressed patients will often tend to appear unclean and unkempt. The clothing may not be ironed or dirty. The risk of suicide is often high in people who appear very anxious or depressed. The patient may exhibit a flat affect or no emotions at all. Some depressed patients may develop hallucinations that may be telling him or her to kill themselves. The majority of these hallucinations are auditory.  4. Question Which of the following drugs should Nurse Mary prepare to administer to a client with a toxic acetaminophen (Tylenol) level? o A. Deferoxamine mesylate (Desferal) o B. Succimer (Chemet) o C. Flumazenil (Romazicon) o D. Acetylcysteine (Mucomyst) Incorrect Correct Answer: D. Acetylcysteine (Mucomyst) The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites. Acetaminophen (N-acetyl-para-aminophenol, paracetamol, APAP) toxicity is common primarily because the medication is so readily available, and there is a perception that it is very safe. More than 60 million Americans consume acetaminophen on a weekly basis. All patients with high levels of acetaminophen need admission and treatment with N-acetyl-cysteine (NAC). This agent is fully protective against liver toxicity if given within 8 hours after ingestion. o Option A: Deferoxamine mesylate is the antidote for iron intoxication. Desferal is indicated for the treatment of acute iron intoxication and chronic iron overload due to transfusiondependent anemias. Desferal is an adjunct to, and not a substitute for, standard measures used in treating acute iron intoxication, which may include the following: induction of emesis with syrup of ipecac; gastric lavage; suction and maintenance of a clear airway; control of shock with intravenous fluids, blood, oxygen, and vasopressors; and correction of acidosis. o Option B: Succimer is an antidote for lead poisoning. Succimer is an oral heavy metal chelating agent used to treat lead and heavy metal poisoning. Succimer has been linked to a low rate of transient serum aminotransferase elevations during therapy, but its use has not been linked to cases of clinically apparent liver injury with jaundice. Succimer does not significantly chelate essential metals such as zinc, copper, or iron, and its specificity, safety and oral availability make it preferable to other chelating agents for treating lead poisoning such as Ca-EDTA which must be given intravenously and dimercaprol (British anti-Lewisite [BAL) which requires intramuscular administration. o Option C: Flumazenil reverses the sedative effects of benzodiazepines. Flumazenil is a benzodiazepine antagonist. Flumazenil is also indicated for the management and treatment of benzodiazepine overdose in adults. It is useful in reversing coma due to benzodiazepine overdose. Flumazenil is more effective in reversing sedation or coma in patients with benzodiazepine intoxication rather than in patients with multiple drug overdoses.  5. Question A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is Nurse Alice most likely to administer to reduce the symptoms of alcohol withdrawal? o A. Naloxone (Narcan) o B. Haloperidol (Haldol) o C. Magnesium sulfate o D. Chlordiazepoxide (Librium) Incorrect Correct Answer: D. Chlordiazepoxide (Librium) Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Chlordiazepoxide is a long-acting benzodiazepine and is an FDA approved medication for adults with mild-moderate to severe anxiety disorder, preoperative apprehension and anxiety, and withdrawal symptoms of acute alcohol use disorder. Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and weak analgesic actions. It binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex and enhances GABA’s inhibitory effects. o Option A: Naloxone (Narcan) is administered for narcotic overdose. Naloxone is indicated for the treatment of opioid toxicity, specifically to reverse respiratory depression from opioid use. It is useful in accidental or intentional overdose and acute or chronic toxicity. Naloxone is a pure, competitive opioid antagonist with a high affinity for the mu-opioid receptor, allowing for reversal of the effects of opioids. The onset of action varies depending on the route of administration but can be as fast as one minute when delivered intravenously (IV) or intraosseous (IO). o Option B: Haloperidol (Haldol) may be given to treat clients with psychosis, severe agitation, or delirium. Haloperidol is a firstgeneration (typical antipsychotic) which exerts its antipsychotic action by blocking dopamine D2 receptors in the brain. When 72% of dopamine receptors are blocked, this drug achieves its maximal effect. Haloperidol is not selective for the D2 receptor. It also has noradrenergic, cholinergic, and histaminergic blocking action. The blocking of these receptors is associated with various side effects. o Option C: Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal. Magnesium sulfate administration can be oral (PO), intramuscular (IM), intraosseous (IO), or intravenous (IV). For every 1 gram of magnesium sulfate, it contains 98.6 mg or 8.12Eq of elemental magnesium. Magnesium sulfate can be combined with dextrose 5% or water to make intravenous solutions.  6. Question During postprandial monitoring, a female client with bulimia nervosa tells the nurse, “You can sit with me, but you’re just wasting your time. After you had sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.” What is the nurse’s best response? o A. “I trust you not to purge.” o B. “How are you purging and when do you do it?” o C. “Don’t worry. I won’t allow you to purge today.” o D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.” Incorrect Correct Answer: D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.” This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Since recovery involves patients having to face their deepest, most painful, and traumatic thoughts and emotions, supporting them as they go through treatment can be emotionally challenging for nurses. This emotional challenge can be exacerbated when the patient has also been diagnosed with Obsessive-Compulsive Disorder (OCD), depression, or substance abuse, as these may require more intensive one-to-one support. o Option A: Because their therapeutic relationships with caregivers are less important than their need to purge, they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it. As this might take nurses out of their comfort zone or clinical remit, worksheets are available for nurses to use in efforts to help patients challenge and overcome their obsessive and ritualistic behaviors and to adopt a more flexible perspective in day-to-day life.6 These can be supplemented by nurses familiarising themselves with the detailed guidelines and resources offered by NICE. o Option B: Learning motivational interviewing techniques can help facilitate communication with those who might be resistant to discussing topics related to food, weight, and recovery. Such techniques can help develop the skills of empathic understanding, rolling with resistance, and gently assisting patients to make their own, autonomous decision to work towards recovery. Often, the aim is to help patients learn new and healthier ways of coping, and nurses can achieve this through a mix of emotional support, education, and signposting. o Option C: An authoritarian or challenging response may trigger a power struggle between the nurse and client. Assisting patients to remain strong and adhere to treatment requires nurses to develop a relationship that is caring, empathetic and trusting, and in line with the person-centered approach to care. Patients affected by eating disorders require individualized support to better understand their condition, rediscover their identity, learn to accept themselves, enhance a positive body image and sense of self-worth, and achieve a balance in their lives so that they can move towards better health and wellbeing.  7. Question A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, “It felt so wonderful to get high.” Which of the following is the most appropriate response? o A. “If you continue to talk like that, I’m going to stop speaking to you.” o B. “You told me you got fired from your last job for missing too many days after taking drugs all night.” o C. “Tell me more about how it felt to get high.” o D. “Don’t you know it’s illegal to use drugs?” Incorrect Correct Answer: B. “You told me you got fired from your last job for missing too many days after taking drugs all night.” Confronting the client with the consequences of substance abuse helps to break through denial. Present reality by spending time with the client to facilitate reality orientation because your physical presence is the reality. Be simple, direct, and concise when speaking to the client. Talk with the client about concrete or familiar things; avoid ideological or theoretical discussions. The client’’s ability to process abstractions or complexities is impaired. o Option A: Making threats isn’t an effective way to promote self-disclosure or establish a rapport with the client. Motivational counseling works according to the idea that motivation for change is dynamic rather than static. Professional uses may influence change by developing a therapeutic relationship to increase therapeutic alliance, developing insight, and coping skills to resolve ambivalence, and change health-related behavior. o Option C: Although the nurse should encourage the client to discuss feelings, the discussion should focus on how the client felt before, not during, an episode of substance abuse. Encouraging elaboration about his experience while getting high may reinforce the abusive behavior. Persons may withdraw from their environment with regressive behavior, fail to engage with others, or even notice physical illness and pain. Social exclusion and homelessness may ensue. In the longer term, psychosis and its potential disruption of the capacity to fulfill social roles can result in further burdens. o Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this effect is unlikely to alter behavior. Drug addiction exacerbates social alienation and increases potential for violent lashing out and low self-esteem, along with poor coping skills. Under these circumstances, emotional, social, or symptom-related cues can provoke recourse to available substances and suicidal ideation. They may also contribute to psychosocial instability, self-image issues, and achievement motivation. In some cases, social hostility and rejection may result.  8. Question For a female client with anorexia nervosa, Nurse Jimmy is aware that which goal takes the highest priority? o A. The client will establish adequate daily nutritional intake. o B. The client will make a contract with the nurse that sets a target weight. o C. The client will identify self-perceptions about body size as unrealistic. o D. The client will verbalize the possible physiological consequences of self-starvation. Incorrect Correct Answer: A. The client will establish adequate daily nutritional intake. According to Maslow’s hierarchy of needs, all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need. Treatment for anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Refeeding syndrome can occur following prolonged starvation. As the body utilizes glucose to produce molecules of adenosine triphosphate (ATP), it depletes the remaining stores of phosphorus. Also, glucose entry into cells is mediated by insulin and occurs rapidly following long periods without food. Both cause electrolyte abnormalities such as hypophosphatemia and hypokalemia, triggering cardiac and respiratory compromise. Patients should be followed carefully for signs of refeeding syndrome and electrolytes closely monitored. o Option B: Recovery from an eating disorder can be a long process that requires not only a qualified team of professionals but also the love and support of family and friends. It is not uncommon for someone who suffers from an eating disorder to feel uncertain about their progress or for their loved ones to feel disengaged from the treatment process. These potential roadblocks may lead to feelings of ambivalence, limited progress, and treatment dropout. o Option C: Anorexia nervosa is a psychiatric disease in which patients restrict their food intake relative to their energy requirements through eating less, exercising more, and/or purging food through laxatives and vomiting. Despite being severely underweight, they do not recognize it and have distorted body images. They can develop complications from being underweight and purging food. Diagnose by history, physical, and lab work that rules out other conditions that can make people lose weight. Treatment includes gaining weight (sometimes in a hospital if severe), therapy to address body image, and management of complications from malnourishment. o Option D: The nurse may give lesser priority to goals that address long-term plans, self-perception, and potential complications. Eating disorders can affect every organ system in the body, and people struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery.  9. Question When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem? o A. The injury isn’t consistent with the history or the child’s age. o B. The mother and father tell different stories regarding what happened. o C. The family is poor. o D. The parents are argumentative and demanding with emergency department personnel. Incorrect Correct Answer: A. The injury isn’t consistent with the history or the child’s age. When the child’s injuries are inconsistent with the history given or impossible because of the child’s age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. Physical indicators may include injuries to a child that are severe, occur in a pattern or occur frequently. These injuries range from bruises to broken bones to burns or unusual lacerations. The child may present for care unrelated to the abuse, and the abuse may be found incidentally. o Option B: The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question, this is a clue that child abuse may be a problem. Physical abuse should be considered in the evaluation of all injuries of children. A thorough history of present illness is important to make a correct diagnosis. Important aspects of the history-taking involve gathering information about the child’s behavior before, during, and after the injury occurred. Historytaking should include the interview of each caretaker separately and the verbal child, as well. The parent or caretaker should be able to provide their history without interruptions in order not to be influenced by the physician’s questions or interpretations. o Option C: Child abuse occurs in all socioeconomic groups. All races, ethnicities, and socioeconomic groups are affected by child abuse with boys and adolescents more commonly affected. Infants tend to have increased morbidity and mortality with physical abuse. Multiple factors increase a child’s risk of abuse. These include risks at an individual level (child’s disability, unmarried mother, maternal smoking or parent’s depression); risks at a familial level (domestic violence at home, more than two siblings at home); risks at a community level (lack of recreational facilities); and societal factors (poverty). o Option D: Parents may argue and be demanding because of the stress of having an injured child. To diagnose a patient with child maltreatment is difficult since the victim may be nonverbal or too frightened or severely injured to talk. Also, the perpetrator will rarely admit to the injury, and witnesses are uncommon. Physicians will see children of maltreatment in a range of ways that include the perpetrators may be concerned that the abuse is severe and bring in the patient for medical care.  10. Question For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? o A. They tend to overprotect their children. o B. They usually have a history of substance abuse. o C. They maintain emotional distance from their children. o D. They alternate between loving and rejecting their children. Incorrect Correct Answer: A. They tend to overprotect their children. Clients with anorexia nervosa typically come from a family with parents who are controlling and overprotective. These clients use eating to gain control of an aspect of their lives. Similarly, issues like anxiety, depression, and addiction can also run in families, and have also been found to increase the chances that a person will develop an eating disorder. Many people with anorexia report that, as children, they always followed the rules and felt there was one “right way” to do things. o Option B: Substance abuse and eating disorders frequently co-occur, with up to 50% of individuals with eating disorders who abuse alcohol or illicit drugs, a rate five times higher than the general population. Substance abuse problems may begin before or during an eating disorder, or even after recovery. Those struggling with co-occurring substance use and disordered eating should speak with a trained professional who can understand, diagnose, and treat both substance use disorders and eating disorders. o Option C: Loneliness and isolation are some of the hallmarks of anorexia; many with the disorder report having fewer friends and social activities, and less social support. Whether this is an independent risk factor or linked to other potential causes (such as social anxiety) isn’t clear. o Option D: Eating disorders are complex and affect all kinds of people. Risk factors for all eating disorders involve a range of biological, psychological, and sociocultural issues. These factors may interact differently in different people, so two people with the same eating disorder can have very diverse perspectives, experiences, and symptoms. Still, researchers have found broad similarities in understanding some of the major risks for developing eating disorders.