LVN Mental Health & Psychiatric Nursing 2 — Questions and Answers
Question 1: A patient with schizophrenia is started on haloperidol and develops muscle rigidity, hyperthermia, and autonomic instability. The LVN should recognize this as:
- Tardive dyskinesia
- Neuroleptic malignant syndrome (Correct answer)
- Akathisia
- Acute dystonia
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotics characterized by muscle rigidity, hyperthermia, altered consciousness, and autonomic instability.
Question 2: When using therapeutic communication, which response is most appropriate when a depressed patient says, 'Nobody cares if I live or die'?
- 'Of course people care about you.'
- 'I care about what happens to you. Are you having thoughts of suicide?' (Correct answer)
- 'You shouldn't think that way; things will get better.'
- 'Let me get your family to come talk to you.'
Correct answer: 'I care about what happens to you. Are you having thoughts of suicide?'
The most therapeutic response acknowledges the patient's feelings and directly assesses for suicidal ideation without dismissing or deflecting.
Question 3: A patient with bipolar disorder is in the manic phase. Which nursing intervention takes priority?
- Encourage participation in group therapy sessions
- Provide a calm, low-stimulation environment (Correct answer)
- Offer high-calorie snack foods only at mealtimes
- Arrange a structured schedule of social activities
Correct answer: Provide a calm, low-stimulation environment
Reducing environmental stimulation is the priority during mania to prevent escalation of hyperactivity, agitation, and potential harm.
Question 4: Which statement best describes the concept of 'milieu therapy' in a psychiatric setting?
- One-on-one psychotherapy between patient and psychiatrist
- Use of the total therapeutic environment to promote healing and recovery (Correct answer)
- Administration of medications to stabilize mood
- Group cognitive behavioral therapy sessions
Correct answer: Use of the total therapeutic environment to promote healing and recovery
Milieu therapy uses the entire therapeutic environment—physical space, staff interactions, and peer relationships—as a tool for treatment and recovery.
Question 5: A patient taking lithium reports nausea, vomiting, tremors, and confusion. The LVN should first:
- Administer an antiemetic and reassure the patient
- Hold the next lithium dose and notify the charge nurse immediately (Correct answer)
- Encourage the patient to increase fluid intake
- Document the findings and monitor for further changes
Correct answer: Hold the next lithium dose and notify the charge nurse immediately
These signs indicate lithium toxicity; the LVN should hold the medication and notify the charge nurse immediately so the lithium level can be checked and treatment initiated.
Question 6: The nurse is caring for a patient with anorexia nervosa. Which behavior by the patient warrants the most immediate intervention?
- Refusing to discuss body image
- Exercising vigorously in the room after meals (Correct answer)
- Expressing ambivalence about treatment
- Requesting smaller meal portions
Correct answer: Exercising vigorously in the room after meals
Vigorous exercise after meals in anorexia nervosa indicates a compensatory behavior that directly counteracts nutritional therapy and signals escalating risk.
Question 7: A patient with obsessive-compulsive disorder (OCD) spends 3 hours each morning washing hands until they bleed. The initial nursing approach should be:
- Lock the bathroom to prevent access during restricted hours
- Allow the ritual while gradually working toward setting limits with the treatment team (Correct answer)
- Confront the patient and explain that the behavior is irrational
- Ignore the behavior to avoid reinforcing it with attention
Correct answer: Allow the ritual while gradually working toward setting limits with the treatment team
Abruptly blocking rituals increases anxiety and can be harmful; the therapeutic approach is to allow the behavior initially while collaborating with the team to gradually set limits.
LVN Mental Health & Psychiatric Nursing 2
A patient with schizophrenia is started on haloperidol and develops muscle rigidity, hyperthermia, and autonomic instability.
The LVN should recognize this as: