Menyal exam (Samuel merit university)
Total Questions : 26
Showing 25 questions, Sign in for moreTiffany is a 16-year-old teenager who has obsessive-compulsive disorder and continually washes her hands until they are cracked and bleeding. She was placed on the inpatient unit on a 5150 after a recent suicide attempt in which she overdosed on her mother’s sleeping pills in the medicine cabinet. She is medically stable. You are her assigned nurse, and when you approach her room, you hear her in the bathroom washing her hands.Tiffany describes the ending of her relationship with her boyfriend as “ghosting.” He just “stopped calling me after a year of going out.” Important cognitive behavioral approaches for her lack of self-esteem and anxiety may be (select all that apply):
Explanation
Choice A reason:
Reframing “all or nothing” thinking and that it is all “her fault” is an important cognitive behavioral approach. This technique helps Tiffany recognize and challenge irrational thoughts that contribute to her low self-esteem and anxiety. By learning to see situations in a more balanced way, she can reduce feelings of guilt and self-blame.
Choice B reason:
Having Tiffany identify self-soothing activities for decreasing anxiety is another effective cognitive behavioral approach. Self-soothing activities, such as deep breathing, listening to music, or engaging in hobbies, can help her manage anxiety and reduce the urge to engage in compulsive behaviors like handwashing.
Choice C reason:
Reframing self-criticism and giving positive feedback for insightful comments during group therapy can help Tiffany build self-esteem and develop a more positive self-image. Positive reinforcement encourages her to recognize her strengths and achievements, which can counteract negative self-perceptions.
Choice D reason:
Telling Tiffany she “has her entire life ahead of her and shouldn’t be worried about her former boyfriend” is not a cognitive behavioral approach. While it may be intended to provide reassurance, it does not address the underlying cognitive distortions or provide strategies for managing anxiety and low self-esteem.
Mr. Jones is a 55-year-old divorced white male who was recently fired from his job. He lives alone in an apartment, and his sister, who lives nearby, called the police when she found no food in his refrigerator, his house was in shambles, and he threatened “to shoot himself.” When the police arrived, they placed him on an involuntary hold 5150 for danger to self (DTS). In the ambulance, his blood pressure is 180/96, his pulse is 96, respirations are 20 with pulse ox at 99%, and his temperature is 98.6. He looks down and is moving around a lot in his chair.When conducting an admission assessment for Mr. Jones on the psychiatric unit, your first nursing priority is (select the best answer):
Explanation
Choice A reason:
Asking Mr. Jones if he is taking any illegal drugs or has been drinking is important for a comprehensive assessment, but it is not the first priority. The immediate concern is to assess his current risk of self-harm and ensure his safety.
Choice B reason:
Asking Mr. Jones why he wants to kill himself is a direct approach, but it may not be the most effective way to establish rapport and assess his immediate risk. It is important to first build trust and ensure he feels safe and understood.
Choice C reason:
Avoiding direct questioning and putting Mr. Jones in a private room away from the nurses’ station is not appropriate. It is important to assess his risk of self-harm directly and ensure he is in a safe environment where he can be closely monitored.
Choice D reason:
Introducing yourself, explaining procedures clearly, and asking Mr. Jones directly if he feels like harming himself is the best approach. This establishes rapport, provides clarity, and allows for an immediate assessment of his risk of self-harm. It ensures that he understands the process and feels supported.
Mr. Jones is a 55-year-old divorced white male who was recently fired from his job. He lives alone in an apartment, and his sister, who lives nearby, called the police when she found no food in his refrigerator, his house was in shambles, and he threatened “to shoot himself.” When the police arrived, they placed him on an involuntary hold 5150 for danger to self (DTS). You are his admitting nurse in Psychiatric Emergency. In the ambulance, his blood pressure is 180/96, his pulse is 96, respirations are 20 with pulse ox at 99%, and his temperature is 98.6. He looks down and is moving around a lot in his chair.Mr. Jones endorses these common symptoms of major depression (select all that apply):
Explanation
Choice A reason:
Hopelessness with poor concentration is a common symptom of major depression. Individuals with depression often feel a pervasive sense of hopelessness and find it difficult to concentrate on tasks or make decisions.
Choice B reason:
Increased energy is not a typical symptom of major depression. In fact, individuals with depression often experience fatigue and a lack of energy. Increased energy may be more indicative of a manic episode in bipolar disorder.
Choice C reason:
Difficulty falling asleep and early morning awakening are common symptoms of major depression. Sleep disturbances, including insomnia and early morning awakening, are frequently reported by individuals with depression.
Choice D reason:
Anhedonia, or the loss of interest or pleasure in previously enjoyed activities, is a hallmark symptom of major depression. Individuals with depression often find it difficult to experience joy or satisfaction in activities they once found pleasurable.
Tiffany is a 16-year-old teenager who has obsessive-compulsive disorder and continually washes her hands until they are cracked and bleeding. She was placed on the inpatient unit on a 5150 after a recent suicide attempt in which she overdosed on her mother’s sleeping pills in the medicine cabinet. She is medically stable and receiving treatment for Major Depression and OCD. You are her assigned nurse, and when you approach her room, you hear her in the bathroom washing her hands.The nurse investigates triggers to Tiffany’s anxiety and rituals by asking (choose the best answer):
Explanation
Choice A reason:
Saying “If you don’t stop this, you are going to get an infection and I will have to call the doctor” is not an effective way to address Tiffany’s behavior. This statement is likely to increase her anxiety and does not help her understand or manage her triggers.
Choice B reason:
Asking “Can you tell me about what increases your anxiety?” is the best approach. This question is open-ended and non-judgmental, encouraging Tiffany to share her thoughts and feelings. Understanding her triggers is essential for developing effective coping strategies and interventions.
Choice C reason:
Ignoring the behavior and asking other questions is not appropriate. It is important to address Tiffany’s anxiety and compulsive behaviors directly to provide appropriate support and interventions.
Choice D reason:
Asking “Why do you keep washing your hands? They are starting to bleed!” is likely to be perceived as critical and may increase Tiffany’s anxiety. It is important to approach the topic with empathy and understanding, focusing on identifying triggers and developing coping strategies.
Edward is a 20-year-old college student. The student’s roommates tell the school nurse that their friend has seemed more moody than usual since a grandparent died of a COVID-19 infection last month. They also report that the patient sleeps all day and sometimes doesn’t wake up until noon or later. They tell the nurse that they invite the patient to go with them to the dining hall most meals, but he declines most of the time and, when he does go, he will only eat a few bites. Edward admits to feeling “empty most days” and “doesn’t do much most days” and that “nothing is really fun anymore.”Edward states he “abandoned his grandfather who died alone in the ICU.” The nurse determines his depressive symptoms may be complicated due to “survivor’s guilt” and identifies his grief as (choose the best answer):
Explanation
Choice A reason:
Anger is a common stage of grief where individuals may feel frustration and helplessness. While Edward may experience anger, his primary issue appears to be more complex, involving feelings of guilt and abandonment, which are indicative of a more complicated form of grief.
Choice B reason:
Bargaining is another stage of grief where individuals may try to make deals or promises in an attempt to reverse or lessen the loss. Edward’s feelings of guilt and abandonment do not align with the bargaining stage but rather suggest a deeper, more complicated grief process.
Choice C reason:
Denial is the initial stage of grief where individuals may refuse to accept the reality of the loss. Edward’s acknowledgment of his feelings and his depressive symptoms indicate that he is not in denial but rather struggling with more complex emotions related to his loss.
Choice D reason:
Complex or disenfranchised grief refers to a prolonged and intense form of grief that can occur when the loss is not openly acknowledged or socially supported. Edward’s feelings of guilt and abandonment, along with his depressive symptoms, suggest that he is experiencing a more complicated form of grief that requires specialized support and intervention.
Edward is a 20-year-old college student. The student’s roommates tell the school nurse that their friend has seemed more moody than usual since a grandparent died of a COVID-19 infection last month. They also report that the patient sleeps all day and sometimes doesn’t wake up until noon or later. They tell the nurse that they invite the patient to go with them to the dining hall most meals, but he declines most of the time and, when he does go, he will only eat a few bites. Edward admits to feeling “empty most days” in the last month and has skipped many of his classes due to feeling “too tired to attend.” Edward reports that he “doesn’t do much most days” and that “nothing is really fun anymore.”The nonverbal cues that therapy and medication are working for Edward include (select all that apply):
Explanation
Choice A reason:
Improvement in activities of daily living (ADLs) and displaying hopefulness in interactions with others are positive nonverbal cues indicating that therapy and medication are effective. These improvements suggest that Edward is regaining interest in daily activities and looking forward to the future.
Choice B reason:
Being less tearful and able to discuss openly the loss of his grandfather with friends and in group settings are signs that Edward is processing his grief and benefiting from therapy. Open communication about his loss indicates emotional progress and acceptance.
Choice C reason:
Continuing to isolate is not a positive nonverbal cue. Isolation suggests that Edward is still struggling with his depressive symptoms and not fully engaging with his support system. This behavior indicates that further intervention may be needed.
Choice D reason:
Smiling appropriately and interacting with peers are positive nonverbal cues that therapy and medication are working. These behaviors show that Edward is beginning to re-engage socially and experience moments of joy and connection.
Edward is a 20-year-old college student. The student’s roommates tell the school nurse that their friend has seemed more moody than usual since a grandparent died of a COVID-19 infection last month. They also report that the patient sleeps all day and sometimes doesn’t wake up until noon or later. They tell the nurse that they invite the patient to go with them to the dining hall most meals, but he declines most of the time and, when he does go, he will only eat a few bites. Edward admits to feeling “empty most days in the last month” and has skipped many of his classes due to feeling “too tired to attend.” Edward reports that he “doesn’t do much most days” and that “nothing is really fun anymore.”In California, Edward meets the criteria for a 5150 involuntary hold for “Danger to Self” when: (choose the best answer)
Explanation
Choice A reason:
Expressing an active suicide ideation by stating, “I will take an overdose if I return to the dorm room,” meets the criteria for a 5150 involuntary hold for “Danger to Self.” This statement indicates a clear and immediate risk of self-harm, which warrants immediate intervention to ensure Edward’s safety.
Choice B reason:
Starting to cry when discussing his grandfather’s death is a normal emotional response to grief and does not meet the criteria for a 5150 involuntary hold. While it indicates emotional distress, it does not suggest an immediate risk of self-harm.
Choice C reason:
Refusing to take antidepressant medication is concerning and may indicate non-compliance with treatment, but it does not meet the criteria for a 5150 involuntary hold unless it is accompanied by behaviors that indicate an immediate risk of self-harm.
Choice D reason:
Admitting to feeling hopeless but agreeing to return to the clinic in the morning escorted by his classmate who will stay with him does not meet the criteria for a 5150 involuntary hold. While feelings of hopelessness are serious, the plan to return to the clinic with support indicates that Edward is not an immediate danger to himself.
Mr. Jones is a 35-year-old male with severe depression and has had failed treatment with SSRIs such as Citalopram (Celexa) and Fluoxetine (Prozac). He has a passive concentration and anhedonia. He has also lost 20 lbs in the last 3 months and has a poor appetite. He is scheduled for ECT tomorrow, and you are his nurse.Some important considerations prior to ECT may be on a Pre-Op checklist that the nurse completes and some interventions include (select all that apply):
Explanation
Choice A reason:
Advising the patient he will have permanent memory loss is incorrect. While temporary memory loss can occur with ECT, it is not typically permanent. It is important to provide accurate information about potential side effects without causing unnecessary fear.
Choice B reason:
Authorizing MD signs off medical clearance that may require pre-op checklist to include EKG or lab work is an important consideration. Medical clearance ensures that the patient is physically fit for the procedure and helps identify any potential risks.
Choice C reason:
Signed informed consent by MD and patient and nurse follows up using “Teach Back Method” answering any further post-op or pre-op questions is essential. Informed consent ensures that the patient understands the procedure, risks, and benefits. The “Teach Back Method” confirms that the patient comprehends the information provided.
Choice D reason:
NPO after midnight and hold all meds unless specified such as a sip of water and blood pressure pill ordered by MD is a standard pre-op instruction. Fasting reduces the risk of aspiration during anesthesia, and holding medications ensures that the patient does not take anything that could interfere with the procedure.
Edward is a 20-year-old college student. The student’s roommates tell the school nurse that their friend has seemed more moody than usual since a grandparent died of a COVID-19 infection last month. They also report that the patient sleeps all day and sometimes doesn’t wake up until noon or later. They tell the nurse that they invite the patient to go with them to the dining hall most meals, but he declines most of the time and, when he does go, he will only eat a few bites. Edward admits to feeling “empty most days” in the last month and has skipped many of his classes due to feeling “too tired to attend.” Edward reports that he “doesn’t do much most days” and that “nothing is really fun anymore.”When Edward enters the “Grief Support Group,” he discusses how frustrating it is and says, “I would like to punch my aunt for not calling me first and letting me know what was happening.” This statement can reflect what stage of grief according to Kubler-Ross (select the best answer):
Explanation
Choice A reason:
Anger is one of the stages of grief according to Kubler-Ross. Edward’s statement about wanting to punch his aunt reflects feelings of frustration and anger, which are common during this stage. Anger can be directed at various targets, including loved ones, healthcare providers, or even the deceased.
Choice B reason:
Denial is the initial stage of grief where individuals may refuse to accept the reality of the loss. Edward’s statement does not indicate denial but rather an active expression of anger and frustration.
Choice C reason:
Acceptance is the final stage of grief where individuals come to terms with the loss. Edward’s statement indicates unresolved anger, suggesting that he has not yet reached the stage of acceptance.
Choice D reason:
Bargaining involves making deals or promises in an attempt to reverse or lessen the loss. Edward’s statement does not reflect bargaining but rather anger towards his aunt for not informing him sooner.
Mr. Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.Some yes or no questions on the geriatric depression scale may include (select all that apply):
Explanation
Choice A reason:
“Do you feel your life is empty?” is a relevant question on the geriatric depression scale. Feelings of emptiness can indicate depression, especially in older adults who may experience significant life changes and losses.
Choice B reason:
“Are you on a low cholesterol diet?” is not a relevant question for assessing depression. This question pertains to dietary habits and cardiovascular health rather than mental health.
Choice C reason:
“Have you dropped your activities or interests?” is a pertinent question on the geriatric depression scale. A loss of interest in activities that were once enjoyable is a common symptom of depression.
Choice D reason:
“Do you feel happy most of the time?” is a relevant question on the geriatric depression scale. Assessing overall happiness helps identify depressive symptoms, as individuals with depression often report feeling unhappy or sad most of the time.
Mr. Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.You are assessing Mr. Greene’s ability to self-administer insulin. What actions observed and documented by the nursing staff make him a candidate for self-administration of insulin safely? (select all that apply)
Explanation
Choice A reason:
If Mr. Greene has memory retention and a neurological evaluation that has demonstrated understanding of how to follow the sliding scale and recognize proper dosage, use, and potential side effects of insulin, he is a candidate for self-administration. This ensures he can manage his insulin therapy safely and effectively.
Choice B reason:
If Mr. Greene states “I can do it” but has severe hand tremors, he is not a candidate for self-administration of insulin. Severe hand tremors can impair his ability to accurately draw up and administer the correct dose of insulin, increasing the risk of errors.
Choice C reason:
If Mr. Greene demonstrates the ability to self-administer insulin over a period of time successfully using the “Teach Back” method by a number of staff or visiting nurse, he is a candidate for self-administration. The “Teach Back” method confirms that he understands and can perform the procedure correctly.
Choice D reason:
If Mr. Greene no longer is actively suicidal and has hand-eye coordination that is accurate, he is a candidate for self-administration of insulin. Accurate hand-eye coordination is essential for safely drawing up and administering insulin.
Mr. Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.This SNRI antidepressant is commonly used for chronic pain and depression (choose the correct answer):
Explanation
Choice A reason:
Duloxetine (Cymbalta) is an SNRI antidepressant commonly used for both chronic pain and depression. It works by increasing the levels of serotonin and norepinephrine in the brain, which helps improve mood and alleviate pain. Duloxetine is often prescribed for conditions such as fibromyalgia, diabetic neuropathy, and chronic musculoskeletal pain, in addition to its use in treating major depressive disorder.
Choice B reason:
Sertraline (Zoloft) is an SSRI antidepressant used primarily to treat depression, anxiety disorders, and other mood disorders. While it is effective for these conditions, it is not specifically indicated for chronic pain management.
Choice C reason:
Fluoxetine (Prozac) is another SSRI antidepressant used to treat depression, anxiety disorders, and certain eating disorders. Like sertraline, it is not typically used for chronic pain management.
Choice D reason:
Citalopram (Celexa) is also an SSRI antidepressant used to treat depression. It is not indicated for chronic pain management and is primarily used to improve mood and alleviate symptoms of depression.
The risk of experiencing serotonin syndrome is increased when SSRIs are given with monoamine oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in which of the following?
Explanation
Choice A reason:
Tea-colored urine and constipation are not characteristic symptoms of serotonin syndrome. These symptoms may indicate other medical conditions but are not related to the excessive accumulation of serotonin in the body.
Choice B reason:
A productive cough and vomiting are not typical symptoms of serotonin syndrome. While vomiting can occur in severe cases, a productive cough is unrelated to serotonin syndrome and more indicative of respiratory conditions.
Choice C reason:
Muscle rigidity and high fever are hallmark symptoms of serotonin syndrome. This condition results from an excess of serotonin in the central nervous system and can lead to severe autonomic instability, hyperthermia, and neuromuscular abnormalities. Immediate medical intervention is required to manage these symptoms and prevent complications.
Choice D reason:
Hypotension and urinary retention are not primary symptoms of serotonin syndrome. While autonomic dysfunction can occur, the key features of serotonin syndrome include neuromuscular hyperactivity, autonomic instability, and altered mental status.
What statement is true regarding the “Diathesis-Stress Model of Depression”? (select the correct answer)
Explanation
Choice A reason:
The statement “The stress of nursing school will cause depression” is not accurate according to the Diathesis-Stress Model. While stress can contribute to the development of depression, the model emphasizes the interaction between genetic vulnerabilities and environmental stressors, not a direct cause-and-effect relationship.
Choice B reason:
“Depression is a result of cultural and religious perspectives” is not a statement supported by the Diathesis-Stress Model. This model focuses on the interplay between genetic predispositions and environmental stressors, rather than cultural or religious factors alone.
Choice C reason:
“The stress of parenting often causes depression” is an oversimplification. While parenting can be stressful and may contribute to depression in some individuals, the Diathesis-Stress Model highlights the importance of genetic vulnerabilities interacting with life stressors to trigger depression.
Choice D reason:
“People with genetic vulnerabilities can develop depression with added stress of life events” accurately reflects the Diathesis-Stress Model. This model posits that individuals with a genetic predisposition to depression are more likely to develop the condition when exposed to significant stressors, such as life events or environmental challenges.
Mr. Jones is a 35-year-old male with severe depression and has had failed treatment with SSRIs such as Citalopram (Celexa) and Fluoxetine (Prozac). He has a passive suicide ideation and has recently been unemployed after his anergia, poor concentration, and anhedonia. He has also lost 20 lbs in the last 3 months and has a poor appetite. He is scheduled for ECT tomorrow, and you are his nurse.If ECT is contraindicated for Mr. Jones because of his history of intracranial pressure and cardiac arrest, Repetitive Transcranial Magnetic Stimulation (rTMS) may be an alternative if (choose the best answer):
Explanation
Choice A reason:
Being afraid of medical providers is not a determining factor for the suitability of rTMS. While patient comfort and willingness to undergo treatment are important, the primary considerations for rTMS eligibility are medical and safety-related.
Choice B reason:
His family’s agreement to take him to the hospital each week is supportive but not a primary criterion for rTMS eligibility. The focus should be on the patient’s medical suitability and safety for the procedure.
Choice C reason:
Signing an informed consent and having no presence of metal in the area of the magnetic stimulation, such as cochlear implants or medication pumps, are critical factors for rTMS eligibility. Metal implants in the head or neck can interfere with the magnetic fields used in rTMS, posing safety risks. Informed consent ensures that the patient understands the procedure, risks, and benefits.
Choice D reason:
Being angry about the death of his father is an emotional response and does not impact the medical suitability for rTMS. The decision to use rTMS should be based on medical criteria and safety considerations.
Mr. Jones is a 35-year-old male with severe depression and has had failed treatment with SSRIs such as Citalopram (Celexa) and Fluoxetine (Prozac). He has a passive suicide ideation and has recently been unemployed after his anergia, poor concentration, and anhedonia. He has also lost 20 lbs in the last 3 months and has a poor appetite. He is scheduled for ECT tomorrow, and you are his nurse.Some important considerations prior to ECT may be on a Pre-Op checklist that the nurse completes and some interventions include (select all that apply):
Explanation
Choice A reason:
Advising the patient he will have permanent memory loss is incorrect. While temporary memory loss can occur with ECT, it is not typically permanent. It is important to provide accurate information about potential side effects without causing unnecessary fear.
Choice B reason:
Authorizing MD signs off medical clearance that may require pre-op checklist to include EKG or lab work is an important consideration. Medical clearance ensures that the patient is physically fit for the procedure and helps identify any potential risks.
Choice C reason:
Signed informed consent by MD and patient and nurse follows up using “Teach Back Method” answering any further post-op or pre-op questions is essential. Informed consent ensures that the patient understands the procedure, risks, and benefits. The “Teach Back Method” confirms that the patient comprehends the information provided.
Choice D reason:
NPO after midnight and hold all meds unless specified such as a sip of water and blood pressure pill ordered by MD is a standard pre-op instruction. Fasting reduces the risk of aspiration during anesthesia, and holding medications ensures that the patient does not take anything that could interfere with the procedure.
Mr. Jones is a 35-year-old male with severe depression and has had failed treatment with SSRIs such as Citalopram (Celexa) and Fluoxetine (Prozac). He has passive suicide ideation and has recently been unemployed after his anergia, poor concentration, and anhedonia. He has also lost 20 lbs in the last 3 months and has a poor appetite. He is scheduled for ECT tomorrow, and you are his nurse.These non-medication modalities may also be effective for Mr. Jones’ depression, and they include (select all that apply):
Explanation
Choice A reason:
Supportive friends and family members play a crucial role in the recovery process for individuals with depression. Social support can provide emotional comfort, reduce feelings of isolation, and encourage adherence to treatment plans. Having a strong support network can significantly improve mental health outcomes.
Choice B reason:
Attending outpatient therapy or a partial hospital program offers structured support and treatment for individuals with depression. These programs provide access to mental health professionals, group therapy, and other therapeutic activities that can help manage symptoms and promote recovery. They offer a higher level of care than standard outpatient visits but do not require full hospitalization.
Choice C reason:
Consistent daily structure and exercise that is not overwhelming can help manage depression by providing routine and physical activity. Regular exercise has been shown to improve mood, reduce anxiety, and increase overall well-being. Establishing a daily routine can also help individuals with depression feel more in control and reduce feelings of chaos or unpredictability.
Choice D reason:
A well-balanced diet and restful sleep are essential components of mental health. Proper nutrition supports brain function and overall health, while adequate sleep is crucial for emotional regulation and cognitive function. Addressing these basic needs can help improve mood and energy levels, making it easier to cope with depression.
A client is taking an MAOI inhibitor such as Nardil, an old class of antidepressant rarely used because of food interactions with items such as (choose the correct answer):
Explanation
Choice A reason:
Yogurt is one of the foods that can interact with MAOI inhibitors like Nardil. MAOIs can cause dangerous increases in blood pressure when taken with foods containing high levels of tyramine, such as aged cheeses, yogurt, fermented foods, and certain meats. Patients on MAOIs must follow strict dietary restrictions to avoid these interactions.
Choice B reason:
Vegetable salad is generally safe for individuals taking MAOI inhibitors. Fresh vegetables do not contain high levels of tyramine and do not pose a risk of interaction with MAOIs.
Choice C reason:
Oatmeal is also safe for individuals taking MAOI inhibitors. It does not contain high levels of tyramine and is not associated with adverse interactions with these medications.
Choice D reason:
Crackers are typically safe for individuals taking MAOI inhibitors, provided they do not contain aged cheeses or other high-tyramine ingredients. Plain crackers do not pose a risk of interaction with MAOIs.
The risk of experiencing serotonin syndrome is increased when SSRIs are given with monoamine oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in which of the following?
Explanation
Choice A reason:
Tea-colored urine and constipation are not characteristic symptoms of serotonin syndrome. These symptoms may indicate other medical conditions but are not related to the excessive accumulation of serotonin in the body.
Choice B reason:
A productive cough and vomiting are not typical symptoms of serotonin syndrome. While vomiting can occur in severe cases, a productive cough is unrelated to serotonin syndrome and more indicative of respiratory conditions.
Choice C reason:
Muscle rigidity and high fever are hallmark symptoms of serotonin syndrome. This condition results from an excess of serotonin in the central nervous system and can lead to severe autonomic instability, hyperthermia, and neuromuscular abnormalities. Immediate medical intervention is required to manage these symptoms and prevent complications.
Choice D reason:
Hypotension and urinary retention are not primary symptoms of serotonin syndrome. While autonomic dysfunction can occur, the key features of serotonin syndrome include neuromuscular hyperactivity, autonomic instability, and altered mental status.
What statement is true regarding the “Diathesis-Stress Model of Depression”? (select the correct answer)
Explanation
Choice A reason:
The statement “The stress of nursing school will cause depression” is not accurate according to the Diathesis-Stress Model. While stress can contribute to the development of depression, the model emphasizes the interaction between genetic vulnerabilities and environmental stressors, not a direct cause-and-effect relationship.
Choice B reason:
“Depression is a result of cultural and religious perspectives” is not a statement supported by the Diathesis-Stress Model. This model focuses on the interplay between genetic predispositions and environmental stressors, rather than cultural or religious factors alone.
Choice C reason:
“The stress of parenting often causes depression” is an oversimplification. While parenting can be stressful and may contribute to depression in some individuals, the Diathesis-Stress Model highlights the importance of genetic vulnerabilities interacting with life stressors to trigger depression.
Choice D reason:
“People with genetic vulnerabilities can develop depression with added stress of life events” accurately reflects the Diathesis-Stress Model. This model posits that individuals with a genetic predisposition to depression are more likely to develop the condition when exposed to significant stressors, such as life events or environmental challenges.
The nurse is evaluating if a patient who made a suicide attempt several days ago is recovering. Which observation suggests the patient’s mood is improving? (Choose the correct answer)
Explanation
Choice A reason:
Sleeping 4 hours each night is not an indication that the patient’s mood is improving. In fact, inadequate sleep can be a sign of ongoing depression or anxiety. Recovery from a suicide attempt typically involves improvements in sleep patterns, energy levels, and engagement in daily activities.
Choice B reason:
Showing a lack of energy with activities suggests that the patient is still experiencing depressive symptoms. Recovery from depression and suicidal ideation generally includes an increase in energy and participation in activities.
Choice C reason:
Discussing ways to find an outpatient therapist with a social worker indicates that the patient is taking proactive steps towards recovery. This behavior shows that the patient is engaging in their treatment plan, seeking support, and planning for ongoing care, all of which are positive signs of mood improvement.
Choice D reason:
Refusing to talk to staff or family is a sign that the patient may still be struggling with depressive symptoms and social withdrawal. Effective recovery involves open communication and support from healthcare providers and loved ones.
The nurse assesses the speech pattern of the patient’s:
Explanation
Choice A reason:
Thought content refers to the actual ideas and themes that a person expresses. It includes what the person is thinking about, such as delusions, obsessions, or preoccupations. Assessing thought content involves understanding the specific topics and beliefs the patient discusses.
Choice B reason:
Thought process refers to the way in which thoughts are organized and connected. Describing a patient’s speech as hesitant, slow, and with thought blocking indicates issues with the thought process. Thought blocking, where a person’s speech is interrupted by sudden silences, suggests difficulty in maintaining a coherent flow of ideas.
Choice C reason:
Affect refers to the observable expression of emotion. It includes the patient’s facial expressions, tone of voice, and body language. While affect can provide clues about a person’s emotional state, it does not directly relate to the organization of their thoughts.
Choice D reason:
Mood refers to the patient’s sustained emotional state, such as feeling depressed, anxious, or euphoric. While mood can influence speech patterns, the description of hesitant, slow speech with thought blocking specifically pertains to thought process rather than mood.
Which age group is most likely to be at risk for social isolation and have chronic health problems that lead to suicidal risk? (choose the correct answer)
Explanation
Choice A reason:
Adolescents can experience social isolation and mental health challenges, but they are not the age group most likely to face chronic health problems that lead to suicidal risk. While adolescent suicide is a serious concern, older adults are more prone to chronic health issues and social isolation.
Choice B reason:
Young adults may also face social isolation and mental health issues, but they generally have fewer chronic health problems compared to older adults. The combination of social isolation and chronic health conditions is more prevalent in the geriatric population.
Choice C reason:
Middle-aged adults can experience significant stressors, such as career pressures and family responsibilities, which may contribute to mental health issues. However, they are not the age group most at risk for social isolation and chronic health problems leading to suicidal risk.
Choice D reason:
Geriatric or older adults are the age group most likely to be at risk for social isolation and have chronic health problems that lead to suicidal risk. Older adults often face multiple chronic health conditions, loss of loved ones, and reduced social networks, all of which can contribute to feelings of isolation and increased suicidal risk. Addressing these issues through social support and healthcare interventions is crucial for this population.
Mr. Jones is a 55-year-old divorced white male who was recently fired from his job. He lives alone in an apartment, and his sister, who lives nearby, called the police when she found no food in his refrigerator, his house was in shambles, and he threatened to shoot himself. When the police arrived, they placed him on an involuntary hold 5150 for danger to self (DTS). In the ambulance, his blood pressure is 180/96, his pulse is 96, respirations are 20 with pulse ox at 99%, and his temperature is 98.6. He looks down and is moving around a lot in his chair.Priority discharge planning for Mr. Jones should include: (select all that apply)
Explanation
Choice A reason:
Canceling Netflix by Internet service is not relevant to Mr. Jones’ discharge planning. While managing finances and subscriptions may be part of overall life management, it does not address the immediate safety and mental health needs of Mr. Jones.
Choice B reason:
Releasing information signed for family to secure Mr. Jones’ loaded gun or having the police secure the gun if needed prior to discharge is crucial for ensuring his safety. Removing access to firearms reduces the risk of self-harm and is an important step in discharge planning for someone with suicidal ideation.
Choice C reason:
Obtaining a psychiatric provider follow-up appointment as soon as possible and evaluating for PHP (Partial Hospitalization Program) or residential treatment with the treatment team is essential. Continuity of care and appropriate follow-up are critical for managing Mr. Jones’ depression and preventing relapse.
Choice D reason:
Assisting in developing a safety plan prior to discharge that is written with phone numbers and interventions is vital. A safety plan provides Mr. Jones with clear steps to take if he feels at risk of harming himself, including contact information for crisis services and supportive individuals.
Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.Nortriptyline and some tricyclic antidepressants may be helpful with neuropathic pain but are often contraindicated in elderly clients such as Mr. Greene because (select the best answer)
Explanation
Choice A reason:
While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain. The primary concern with their use in elderly clients is not their age but their side effect profile.
Choice B reason:
Tricyclic antidepressants, including nortriptyline, can increase cardiac side effects and urinary retention, which are significant concerns in elderly clients. These medications can cause orthostatic hypotension, arrhythmias, and exacerbate urinary retention, making them less suitable for older adults with pre-existing health conditions.
Choice C reason:
The timing of medication administration (e.g., only taken at night) is not the primary issue with tricyclic antidepressants. The concern lies in their side effects, which can be particularly problematic for elderly clients.
Choice D reason:
While the cost of medication can be a factor in treatment decisions, it is not the primary reason tricyclic antidepressants are contraindicated in elderly clients. The main concern is their potential to cause serious side effects.
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