Download NCLEX Psychiatric Medications Practice Quiz 75 Questions & Answers 2024/25 Update and more Exams Nursing in PDF only on Docsity!
NCLEX Psychiatric Medications Practice
Quiz: 75 Questions & Answers 2024/
Update
1. 1. Question
Jose is diagnosed with amphetamine psychosis and was admitted to the emergency room. Nurse Ronald would most likely prepare to administer which of the following medication? o A. Librium o B. Valium o C. Ativan o D. Haldol Incorrect Correct Answer: D. Haldol The nurse would prepare to administer an antipsychotic medication such as Haldol to a client experiencing amphetamine psychosis to decrease agitation & psychotic symptoms, including delusions, hallucinations & cognitive impairment. Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world. Food and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe aggressivity, mood instability, and frustration intolerance), severe childhood behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups. It is a typical antipsychotic because it works on positive symptoms of schizophrenia, such as hallucinations and delusions. Option A: 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. It is also FDA approved for pediatric patients greater than six years old for anxiety. Chlordiazepoxide has anti-anxiety, sedative, appetite- stimulating, and weak analgesic actions. Option B: Diazepam is an anxiolytic benzodiazepine, first patented and marketed in the United States in 1963. It is a fast- acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders. In the setting of acute alcohol withdrawal, diazepam is useful for symptomatic relief of agitation, tremor, alcoholic hallucinosis, and acute delirium tremens. Option C: Lorazepam has common use as the sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute) onset of action when administered intravenously. Lorazepam is also one of the few sedative-hypnotics with a relatively clean side effect profile. Lorazepam is FDA approved for short-term (4 months) relief of anxiety symptoms related to anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults to relieve anxiety, or to produce sedation/amnesia, and treatment of status epilepticus.
2. 2. Question
Which of the following liquids would nurse Leng administer to a female client who is intoxicated with phencyclidine (PCP) to hasten excretion of the chemical? A. Shake B. Tea C. Cranberry Juice D. Grape juice Incorrect Correct Answer: C. Cranberry Juice An acid environment aids in the excretion of PCP. The nurse will definitely give the client with PCP intoxication cranberry juice to acidify the urine to a ph of 5.5 & accelerate excretion. PCP begins to cause symptoms at a dose of 0.05mg/kg, and a dose of 20 mg or more can
B. Postponing discussion of the accident until the client brings it up. C. Telling the client to avoid details of the accident. D. Helping the client to evaluate her sister’s behavior. Incorrect Correct Answer: A. Facilitating progressive review of the accident and its consequences The nurse would facilitate progressive review of the accident and its consequence to help the client integrate feelings & memories and to begin the grieving process. Help patients reframe any destructive cognitions (eg, beliefs that they acted terribly and are terrible people or are weak for being so distraught, that life is hopeless or worthless, or that the world is totally unsafe). Option B: Support self-esteem; help patients understand that their reaction to the trauma is a normal reaction to an abnormal situation, not a sign of weakness or psychopathology. Reassure and help survivors concerning immediate needs, such as rest, food, shelter, social support, or a sense of belonging to a community (some feel cut off and detached). Option C: Promote coping mechanisms. Avoid prompting discussion of issues that cannot be resolved; avoid abreaction in groups and the resulting contagion effect; respect defenses, and do not force reality on people who cannot handle it yet; keep in mind that debriefing may be harmful. Discuss the experience with patients who want to talk about it, and avoid pressuring those who do not wish to discuss it. Option D: Check to see if children feel that they somehow caused the death or disaster or if they have other misunderstandings, and take pains to reassure them or correct any misunderstanding; do not assume children are fine just because they are not saying anything. Let them know it is all right to talk about unpleasant feelings (including sadness and anger) and listen to them; sharing personal feelings of sadness with them is all right as well.
4. 4. Question
The nursing assistant tells nurse Ronald that the client is not in the dining room for lunch. Nurse Ronald would direct the nursing assistant to do which of the following?
A. Tell the client he’ll need to wait until supper to eat if he misses lunch. B. Invite the client to lunch and accompany him to the dining room. C. Inform the client that he has 10 minutes to get to the dining room for lunch. D. Take the client a lunch tray and let the client eat in his room. Incorrect Correct Answer: B. Invite the client to lunch and accompany him to the dining room. The nurse instructs the nursing assistant to invite the client to lunch & accompany him to the dining room to decrease manipulation, secondary gain, dependency and reinforcement of negative behavior while maintaining the client’s worth. Staff working with manipulative patients are best prepared when they establish firm rules that are rigidly interpreted and consistently enforced among all members of the health care team. Frequent discussions regarding the patient’s progress can help reduce staff frustration and isolation and minimize the patient’s attempts at staff splitting. Option A: Discussing realistic expectations of time and resources available with the patient is of paramount importance. This establishes boundaries and forms a solid foundation on which to build future rapport. The patient will learn that you can be trusted because you will practice with integrity. By putting forth realistic expectations, you can mitigate many manipulative behaviors exhibited in the healthcare setting. Option C: One of the best ways to become accountable for exemplary care is to advocate for the patient’s autonomy. Giving the patient choices regarding his or her care restores a sense of control that is imperative to feeling secure. Many times the lack of a routine or schedule prompts a patient to allege that the nurse is neglectful. Formulating a schedule and faithfully notifying the manipulative patient of changes will demonstrate that you believe he or she is worthy of your time and efforts. Option D: There are many specific interventions that may be put into place by an interdisciplinary team caring for a patient who exhibits manipulative behavior. For example, designating one caregiver to be the patient’s contact will result in more consistent
of stress can be used as an opportunity for growth and family development.
6. 6. Question
Joy’s stream of consciousness is occupied exclusively with thoughts of her father’s death. Nurse Ronald should plan to help Joy through this stage of grieving, which is known as: A. Shock and disbelief B. Developing awareness C. Resolving the loss D. Restitution Incorrect Correct Answer: C. Resolving the loss Resolving a loss is a slow, painful, continuous process until a mental image of the dead person, almost devoid of negative or undesirable features emerges. The individual is preoccupied with the loss, the lost person or object is idealized, the mourner may even imitate the lost person. Eventually, the preoccupation decreases, usually in a year or perhaps more. Option A: The initial reaction to a loss is a stunned, numb feeling accompanied by a refusal to acknowledge the reality of the loss in an attempt to protect the self against overwhelming stress. Option B: As the individual begins to acknowledge the loss, there may be crying, feelings of helplessness, frustration, despair, and anger that can be directed at self or others, including God or the deceased person. Option D: Participation in the rituals associated with death, such as a funeral, wake, family gathering, or religious ceremonies that help the individual accept the reality of the loss and begin the recovery process.
7. 7. Question
When taking a health history from a female client who has a moderate level of cognitive impairment due to dementia, the nurse would expect to note the presence of:
A. Accentuated premorbid traits B. Enhance intelligence C. Increased inhibitions D. Hypervigilance Incorrect Correct Answer: A. Accentuated premorbid traits A moderate level of cognitive impairment due to dementia is characterized by increasing dependence on environment & social structure and by increasing psychological rigidity with accentuated previous traits & behaviors. There are some cases in which the cause of mild cognitive impairment is due to the effects of a treatable illness or disease. However, researchers have now determined that for most patients with mild cognitive impairment (MCI), the MCI is a point along the pathway to dementia. The MCI is considered the stage between the mental changes that are seen in normal aging and early-stage dementia. Option B: Example of memory and thinking problems that might be seen in someone with mild cognitive impairment including memory loss. Forgets recent events, repeats the same questions and the same stories forgets the names of close friends and family members, forgets appointments or planned events, forgets conversations, misplaces items often. Option C: The patient struggles with planning and problem solving and has a hard time making decisions. May struggle, but can complete complex tasks such as paying bills, taking medications, shopping, cooking, household cleaning, driving. Option D: Some gradual mental (cognitive) decline is seen with normal aging. For example, the ability to learn new information may be reduced, mental processing slows, speed of performance slows, and the ability to become distracted increases. However, these declines due to normal aging do not affect overall functioning or ability to perform activities of daily living. Normal aging does not affect recognition, intelligence, or long-term memory.
8. 8. Question
What is the priority care for a client with dementia resulting from AIDS?
the basis for the evaluation or comparison that will come, and influence the choice of intervention.
9. 9. Question
Jerome who has an eating disorder often exhibits similar symptoms. Nurse Lhey would expect an adolescent client with anorexia to exhibit: A. Affective instability B. Dishered, unkempt physical appearance C. Depersonalization and derealization D. Repetitive motor mechanisms Incorrect Correct Answer: A. Affective instability Individuals with anorexia often display irritability, hospitality, and a depressed mood. Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. Option B: Patients will report symptoms such as amenorrhea, cold intolerance, constipation, extremity edema, fatigue, and irritability. They may describe restrictive behaviors related to food like calorie counting or portion control, and purging methods, for example, self-induced vomiting or use of diuretics or laxatives. Many exercise compulsively for extended periods of time. Patients with anorexia nervosa develop multiple complications related to prolonged starvation and purging behaviors. Option C: Depersonalization/derealization disorder is a type of dissociative disorder that consists of persistent or recurrent feelings of being detached (dissociated) from one’s body or mental processes, usually with a feeling of being an outside observer of one’s life (depersonalization), or of being detached from one’s surroundings (derealization). The disorder is often triggered by severe stress. Diagnosis is based on symptoms after other possible causes are ruled out. Treatment consists of psychotherapy plus drug therapy for any comorbid depression and/or anxiety.
Option D: Stereotyped motor behaviors are defined as repetitive, often rhythmic, movements that are topographically alike and that serve no obvious purpose or function (Lewis & Bodfish, 1998). Repetitive behaviors are diagnostic for autism spectrum disorders and common in related neurodevelopmental disorders such as intellectual disability.
10. 10. Question
The primary nursing diagnosis for a female client with a medical diagnosis of major depression would be: A. Situational low self-esteem related to altered role B. Powerlessness related to the loss of idealized self C. Spiritual distress related to depression D. Impaired verbal communication related to depression Incorrect Correct Answer: D. Impaired verbal communication related to depression Depressed clients demonstrate decreased communication because of a lack of psychic or physical energy. The common features of all depressive disorders are sadness, emptiness, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. Initially, provide activities that require minimal concentration (e.g., drawing, playing simple board games). Depressed people lack concentration and memory. Activities that have no “right or wrong” or “winner or loser” minimizes opportunities for the client to put himself/herself down. Option A: Assess the self-esteem level of the patient. Signs of low self-esteem include withdrawal from social relationships, feeling of inadequacy, neglect of personal hygiene and dress, and rejecting self which all may indicate a negative thought pattern. Allow the patient to engage in simple recreational activities, advancing to more complex activities in a group environment. The patient may feel overwhelmed at the start when participating in a group setting. Option B: The investigation into depressive symptoms begins with inquiries of the neurovegetative symptoms which include changes in sleeping patterns, appetite, and energy levels.
can increase psychomotor activity. When possible, provide an environment with minimum stimuli (e.g., quiet, soft music, dim lighting). Reduction in stimuli lessens distractibility. Option D: Solitary activities requiring short attention spans with mild physical exertion are best initially (e.g., writing, taking photos, painting, or walks with staff). Solitary activities minimize stimuli; mild physical activities release tension constructively.
12. 12. Question
Grace is exhibiting withdrawn patterns of behavior. Nurse Johnny is aware that this type of behavior eventually produces a feeling of: A. Repression B. Loneliness C. Anger D. Paranoia Incorrect Correct Answer: B. Loneliness The withdrawn pattern of behavior presents the individual from reaching out to others for sharing the isolation produces a feeling of loneliness. Prolonged loneliness can affect mental health, too. It can make any symptoms you’re already dealing with worse, for one. But it can also factor into the development of serious mental health conditions, including depression. Loneliness may not feel very comfortable, but it’s a transient emotional state that specifically relates to your needs for connection and belonging. Once you meet those needs, you’ll probably feel less lonely. Option A: Repression is a type of psychological defense mechanism that involves keeping certain thoughts, feelings, or urges out of conscious awareness. The goal of this form of defense is to keep unacceptable desires or thoughts out of the conscious mind in order to prevent or minimize feelings of anxiety. This process involves pushing painful or disturbing thoughts into the unconscious in order to remain unaware of them. The concept was first identified and described by Sigmund Freud, who was most famous for the development of psychoanalysis.
Option C: Anger is an emotion characterized by antagonism toward someone or something you feel has deliberately done you wrong. Anger can be a good thing. It can give you a way to express negative feelings, for example, or motivate you to find solutions to problems. But excessive anger can cause problems. Increased blood pressure and other physical changes associated with anger make it difficult to think straight and harm your physical and mental health. Option D: Paranoia involves intense anxious or fearful feelings and thoughts often related to persecution, threat, or conspiracy. Paranoia occurs in many mental disorders, but is most often present in psychotic disorders. Paranoia can become delusions, when irrational thoughts and beliefs become so fixed that nothing (including contrary evidence) can convince a person that what they think or feel is not true. When a person has paranoia or delusions, but no other symptoms (like hearing or seeing things that aren’t there), they might have what is called a delusional disorder. Because only thoughts are impacted, a person with delusional disorder can usually work and function in everyday life, however, their lives may be limited and isolated.
13. 13. Question
One morning a female client on the inpatient psychiatric service complains to nurse Hazel that she has been waiting for over an hour for someone to accompany her to activities. Nurse Hazel replies to the client “We’re doing the best we can. There are a lot of other people in the unit who need attention too.” This statement shows that the nurse’s use of: A. Defensive behavior B. Reality reinforcement C. Limit-setting behavior D. Impulse control Incorrect Correct Answer: A. Defensive behavior The nurse’s response is not therapeutic because it does not recognize the client’s needs but tries to make the client feel guilty for being demanding. Another non-therapeutic communication technique is
Correct Answer: B. Recognizing each existing personality The client must recognize the existence of the sub-personalities so that interpretation can occur. Review intervention guidelines for each personality disorder in this chapter. All clients are individuals, even within the same diagnostic category. However, guidelines for specific categories are helpful for planning. Identify behavioral limits and behaviors that are expected. Client needs a clear structure. Expect frequent testing of limits initially. Maintaining limits can enhance feelings of safety in the client. Option A: Regardless of the clinical setting, the nurse must provide structure and limit setting in the therapeutic relationship; in a clinic setting, this may mean seeing the client for scheduled appointments of a predetermined length rather than whenever the client appears and demands the nurse’s immediate attention. Option C: Minimizing unstructured time by planning activities can help clients to manage time alone; clients can make a written schedule that includes appointments, shopping, reading the paper, and going for a walk. Option D: Cognitive restructuring is a technique useful in changing patterns of thinking by helping clients to recognize negative thoughts and feelings and to replace them with positive patterns of thinking; thought stopping is a technique to alter the process of negative or self-critical thought patterns.
15. 15. Question
A 25-year-old male is admitted to a mental health facility because of inappropriate behavior. The client has been hearing voices, responding to imaginary companions, and withdrawing to his room for several days at a time. Nurse Monette understands that the withdrawal is a defense against the client’s fear of: A. Phobia B. Powerlessness C. Punishment D. Rejection Incorrect Correct Answer: D. Rejection
An aloof, detached, withdrawn posture is a means of protecting the self by withdrawing and maintaining a safe, emotional distance. When confronted by stressful events, people sometimes abandon coping strategies and revert to patterns of behavior used earlier in development. Anna Freud called this defense mechanism regression, suggesting that people act out behaviors from the stage of psychosexual development in which they are fixated. For example, an individual fixated at an earlier developmental stage might cry or sulk upon hearing unpleasant news. Option A: Patients with a specific phobia experience high levels of anxiety and panic attacks along with excessive and unreasonable fear due to either exposure or anticipation of exposure to a feared stimulus. As a result, these patients will try to avoid the anxiety-provoking stimulus to any extent possible. The fear or anxiety experienced is out of proportion to the actual danger posed by the specific object or situation. The fear or anxiety experienced is out of proportion to the actual danger posed by the specific object or situation. Option B: The opposite of power is powerlessness. Powerlessness refers to the expectancy that people’s behaviors cannot determine the outcomes or reinforcements that they seek. Powerlessness may further be explained as the lack of strength or the absence of power. People experiencing powerlessness may feel out of control and have no solution to regain control. Subsequent to feeling out of control comes the lack of capability to be in command of most aspects of one’s life. Powerlessness also can be considered as the absence of complete authority or status to affect how others will act toward others. It is viewed by some that, when confronting powerlessness, individuals may be able to affect or change the negative behaviors (e.g., compulsions and addictions) of either themselves or others. Option C: Punishment is a term used in operant conditioning to refer to any change that occurs after a behavior that reduces the likelihood that that behavior will occur again in the future. While positive and negative reinforcements are used to increase behaviors, punishment is focused on reducing or eliminating unwanted behaviors.
16. 16. Question
Jose, who has been hospitalized with schizophrenia tells Nurse Ron, “My heart has stopped and my veins have turned to glass!” Nurse Ron is aware that this is an example of: A. Somatic delusions B. Depersonalization C. Hypochondriasis D. Echolalia Incorrect Correct Answer: A. Somatic delusions Somatic delusion is a fixed false belief about one’s body. Of the delusional symptoms, somatic delusions-those that pertain to the body-are rather rare. Somatic delusions are defined as fixed false beliefs that one’s bodily function or appearance is grossly abnormal. They are a poorly understood psychiatric symptom and pose a significant clinical challenge to clinicians. Option B: Depersonalization is described as feeling disconnected or detached from one’s self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Option C: Illness anxiety disorder (IAD) is a recent term for what used to be diagnosed as hypochondriasis, or hypochondria. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms. Yet IAD patients’ concerns are to them very real. Even if they go to doctors and no illnesses are found, they are generally not reassured and their obsessive worry continues. Option D: Echolalia is the unsolicited repetition of vocalizations made by another person (when repeated by the same person, it is called palilalia). In its profound form, it is automatic and effortless.
18. 18. Question
In recognizing common behaviors exhibited by a male client who has a diagnosis of schizophrenia, nurse Josie can anticipate:
A. Slumped posture, pessimistic outlook, and flight of ideas B. Grandiosity, arrogance, and distractibility C. Withdrawal, regressed behavior, and lack of social skills D. Disorientation, forgetfulness, and anxiety Incorrect Correct Answer: C. Withdrawal, regressed behavior, and lack of social skills These are the classic behaviors exhibited by clients with a diagnosis of schizophrenia. Traditionally, symptoms have divided into two main categories: positive symptoms which include hallucinations, delusions, and formal thought disorders, and negative symptoms such as anhedonia, poverty of speech, and lack of motivation. Option A: Negative symptoms refer to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure. Option B: Delusions are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia. Option D: Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.
19. 19. Question
One morning, nurse Diane finds a disturbed client curled up in the fetal position in the corner of the dayroom. The most accurate initial evaluation of the behavior would be that the client is: A. Physically ill and experiencing abdominal discomfort.
