Psych Review Questions & Answers
Question Answer/Rationale
Depression
1. The nurse is planning care with a Mexican-American client who 1. 4. RATIONALE: Including the root healer gives credibility and respect to
is diagnosed with depression. The client believes in “mal ojo” the client’s cultural beliefs. Avoiding talking about the healer demonstrates
(the evil eye), and uses treatment by a root healer. The nurse either ignorance or disregard for the client’s cultural values. Negative
should do which of the following? comparison of root healing with Western medicine not only denigrate the
1. Avoid talking to the client about the root healer. client’s beliefs, but are likely to alienate him or her and cause them to end
2. Explain to the client that Western medicine has a scientific, treatment.
not mystical, basis. TEST-TAKING STRATEGY: #4 is more “collaborative”, involves more
3. Explain that such beliefs are superstitious and should be teamwork….it’s something that would happen in a perfect NCLEX world!
forgotten.
4. Involve the root healer in a consultation with the client,
physician and nurse.
2. After a period of unsuccessful treatment with Elavil 2. 3. RATIONALE: Cheese and yeast products contain tyramine which the
(amitriptyline), a woman diagnosed with depression is client should avoid to prevent a negative interaction with Parnate, a
switched to Parnate (tranylcypromine). Which statement by monoamine oxidase (MAO) inhibitor. Sodium will not interact with Parnate
the client indicates the client understands the side effects of and neither exercise nor sugar needs to be limited.
Parnate?
1. “I need to increase my intake of sodium.”
2. “I must refrain from strenuous exercise.”
3. “I must refrain from eating aged cheese or yeast products.”
4. “I should decrease my intake of foods containing sugar.”
, Question Answer/Rationale
3. A client is scheduled for the first electroconvulsive therapy
(ECT) treatment in the morning. The client has been unable to
sleep, but at 10 p.m. refused to take Restoril as the nurse
suggested. The client is still unable to sleep at 11:15 p.m. In
what order should the nurse do the following?
1. Sit quietly with the client
2. Encourage the use of Restoril.
3. Offer use of MP3 player with relaxing music.
4. Discuss specific concerns. RATIONALE: The client is likely anxious about the procedure. The nurse
should first spend time with the client and then discuss the client’s concerns
about the procedure. Next, the nurse could suggest the client listen to
relaxing music. The use of the sleeping medication would only be considered
as a last resort since it might interfere with the effectiveness of the seizure
required for the treatment.
TEST-TAKING STRATEGY: The most therapeutic thing to do would be just to
sit with him….and get him to reveal his specific concerns. Giving him meds
would be last – you would try non-medication efforts first.
4. The client is receiving 6 mg of selegiline transdermal system 4. 1. RATIONALE: Selegiline transdermal system is the first transdermal
(Emsam) every 24 hours for major depression. The nurse monoamine oxidase inhibitor. The client on Emsam needs to avoid exposing
should judge teaching about Emsam to be effective when the the application site to external sources of direct heat, such as saunas,
client makes which statement? heating lamps, electric blankets, heating pads, heated water beds, and
1. “I need to avoid using the sauna at the gym.” prolonged direct sunlight because heat increases the amount of selegiline
2. “I can cut the patch and use a smaller piece.” that is absorbed, resulting in elevated serum levels of selegiline. Cutting the
3. “I need to wait until the next day to put on a new patch if it patch and using a smaller piece will result in a decreased amount of
falls off.” medication absorption, most likely leading to a worsening of the symptoms
4. “I might gain at least 10 lb from Emsam.” of depression. The client should apply a new patch as soon as possible if one
falls off to ensure an adequate amount of medication absorption. Emsam is
not associated with significant weight gain, although a weight gain of 1 to 2
lb (2.2 to 4.4 kg) is possible.
5. A client has been taking 30 mg of duloxetine hydrochloride 5. 3. RATIONALE: The nurse should report the client’s beer consumption to
(Cymbalta) twice daily for 2 months because of depression and the physician. Duloxetine should not be administered to a client with renal
, Question Answer/Rationale
vague aches and pains. While interacting with the nurse, the or hepatic insufficiency because the medication can elevate liver enzymes
client discloses a pattern of drinking a 6-pack of beer daily for and, together with substantial alcohol use, can cause liver injury. Referring
the past 10 years to help with sleep. What should the nurse do the client to the dual diagnosis program, sharing information at the next
first? interdisciplinary treatment conference, and teaching the client relaxation
1. Refer the client to the dual diagnosis program at the clinic. exercises are helpful interventions for the nurse to implement. However,
2. Share the information at the next interdisciplinary reporting the findings to the physician is most important.
treatment conference.
3. Report the client’s beer consumption to the physician.
4. Teach the client relaxation exercises to perform before
bedtime.
6. A client was admitted to the inpatient unit 3 days ago with a 6. 2. RATIONALE: The client’s sudden improvement and decrease in anxiety
flat affect, psychomotor retardation, anorexia, hopelessness, most likely indicates that the client is relieved because he has made the
and suicidal ideation. The physician prescribed 75 mg of decision to kill himself and may now have the energy to complete the
venlafaxine extended release (Effexor XR) to be given every suicide. Symptoms of severe depression do not suddenly abate because
morning. The client interacted minimally with the staff and most antidepressants work slowly and take 2 to 4 weeks to provide a
spent most of the day in his room. As the nurse enters the unit maximum benefit. The client will improve slowly due to the medication. The
at the beginning of the evening shift, the client is smiling and sudden improvement in symptoms does not mean the client is nearing
cheerfully greets the nurse. He appears to be relaxed and joins discharge and decreasing observation of the client compromises the client’s
the group for community meeting before supper. What should safety.
the nurse interpret as the most likely cause of the client’s
behavior?
1. The Effexor is helping the client’s symptoms of depression
significantly.
2. The client’s sudden improvement calls for close observation
by the staff.
3. The staff can decrease their observation of the client.
4. The client is nearing discharge due to the improvement of
his symptoms.
7. The nurse is conducting an intake interview with an Asian 7. 1, 2, 5. RATIONALE: It is important for the nurse to obtain information
American female who reports sadness, physical and mental about the client’s use of tea, herbal medicine, and a folk healer because the
fatigue, anxiety, and sleep disturbance. Prior to the client’s information is critical to the safe prescription of psychotropic medication.
, Question Answer/Rationale
time with the physician, it is important for the nurse to obtain Breathing exercises, massage, and acupuncture are also traditional therapies
information about the client’s use of which of the following? used by the Asian American population, but do not interfere with the use of
Select all that apply. medications.
1. Tea.
2. Herbal medicine.
3. Breathing exercise.
4. Massage.
5. Folk healer.
8. The client is taking 50 mg of lamotrigine (Lamictal) daily for 8. 1. RATIONALE: The nurse should immediately report the rash to the
bipolar depression. The client shows the nurse a rash on his physician because lamotrigine can cause Stevens-Johnson syndrome, a toxic
arm. What should the nurse do? epidermal necrolysis. The rash is not a temporary adverse effect. Giving the
1. Report the rash to the physician. client an ice pack and questioning the client about recent sun exposure are
2. Explain that the rash is a temporary adverse effect. irresponsible nursing actions because of the possible seriousness of the rash.
3. Give the client an ice pack for his arm. TEST-TAKING STRATEGY: Calling the MD is almost NEVER the right answer –
4. Question the client about recent sun exposure. but in this case, the rash could be a very serious adverse effect. KNOW
WHICH MEDS CAN RESULT IN STEVENS-JOHNSON SYNDROME!
9. The nurse is reviewing the laboratory report with the client’s 9. 2. RATIONALE: The nurse should hold the 5 p.m. dose of lithium because
lithium level taken that morning prior to administering the 5 a level of 1.8 mEq/ L can cause adverse reactions, including diarrhea,
p.m. dose of lithium. The lithium level is 1.8 mEq/ L. The nurse vomiting, drowsiness, muscle weakness, and lack of coordination, which are
should: early signs of lithium toxicity. The nurse should report the lithium level to
1. Administer the 5 p.m. dose of lithium. the physician, including any symptoms of toxicity. Administering the 5 p.m.
2. Hold the 5 p.m. dose of lithium. dose of lithium, giving the client the lithium with 8 oz (236 mL) of water, or
3. Give the client 8 oz (236 mL) of water with the lithium. giving it after supper would result in an increase of the lithium level, thus
4. Give the lithium after the client’s supper. increasing the risk of lithium toxicity.
TEST-TAKING STRATEGY: KNOW YOUR LITHIUM LEVELS!
10. A nurse is conducting a psychoeducational group for family 10. 3. RATIONALE: Additional teaching is needed for the family member
members of clients hospitalized with depression. Which family who states her son will only need to attend outpatient appointments when
member’s statement indicates a need for additional teaching? he starts to feel depressed again. Compliance with medication and
1. “My husband will slowly feel better as his medicine takes outpatient follow-up are key in preventing relapse and rehospitalization. The
effect over the next 2 to 4 weeks.” statements expressing expectations of feeling better as medication takes
2. “My wife will need to take her antidepressant medicine and effect, needing medicine and group therapy to stay well, and needing help
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