RPN Mental Health and Psychiatric Nursing 2 — Questions and Answers
Question 1: A client is newly prescribed phenelzine (Nardil), an MAOI. Which dietary teaching is most important?
- Avoid grapefruit juice due to cytochrome P450 interactions
- Limit fluid intake to prevent lithium toxicity
- Avoid tyramine-rich foods such as aged cheese and cured meats (Correct answer)
- Increase calcium intake to prevent bone density loss
Correct answer: Avoid tyramine-rich foods such as aged cheese and cured meats
MAOIs inhibit the breakdown of tyramine; consuming tyramine-rich foods can cause a hypertensive crisis, which is potentially life-threatening.
Question 2: Which of the following is the therapeutic serum level for lithium carbonate in maintenance therapy?
- 0.1–0.3 mEq/L
- 0.6–1.2 mEq/L (Correct answer)
- 1.5–2.0 mEq/L
- 2.5–3.5 mEq/L
Correct answer: 0.6–1.2 mEq/L
The therapeutic range for lithium maintenance is 0.6–1.2 mEq/L; levels above 1.5 mEq/L are associated with toxicity.
Question 3: A client with borderline personality disorder becomes verbally aggressive when the nurse mentions a limit on phone calls. Which nursing response is most appropriate?
- Remove the client's phone privileges immediately to enforce the limit
- 'I understand you're upset. The limit remains in place, and I'm here to support you.' (Correct answer)
- Negotiate a compromise to avoid escalating the client's distress
- Avoid enforcing the limit today because the client is emotionally dysregulated
Correct answer: 'I understand you're upset. The limit remains in place, and I'm here to support you.'
Consistent, calm limit-setting while acknowledging the client's emotions is therapeutic for borderline personality disorder and prevents reinforcing splitting or manipulation.
Question 4: A client taking haloperidol (Haldol) develops muscle rigidity, hyperthermia, and altered consciousness. The nurse suspects:
- Tardive dyskinesia
- Akathisia
- Neuroleptic malignant syndrome (NMS) (Correct answer)
- Extrapyramidal side effect (EPS)
Correct answer: Neuroleptic malignant syndrome (NMS)
Neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotics, characterized by the classic tetrad of hyperthermia, muscle rigidity, altered consciousness, and autonomic instability.
Question 5: A client with dementia becomes increasingly confused and agitated after sundown each evening. The nurse documents this as:
- Sundowner's syndrome (sundowning) (Correct answer)
- Confusional psychosis
- Nocturnal delirium episode
- Circadian rhythm disorder
Correct answer: Sundowner's syndrome (sundowning)
Sundowning is a well-recognized pattern in dementia where confusion, agitation, and behavioral changes worsen in the late afternoon and evening.
Question 6: Which symptom is classified as a POSITIVE symptom of schizophrenia?
- Flat affect
- Alogia (poverty of speech)
- Avolition
- Delusions (Correct answer)
Correct answer: Delusions
Positive symptoms represent an excess or distortion of normal function and include hallucinations, delusions, and disorganized speech; negative symptoms represent a loss of normal function.
Question 7: A client with obsessive-compulsive disorder (OCD) spends 3 hours each morning performing handwashing rituals. Which therapeutic approach is evidence-based first-line treatment?
- Systematic desensitization
- Exposure and Response Prevention (ERP) (Correct answer)
- Psychodynamic therapy to explore childhood origins
- Relaxation training and mindfulness meditation
Correct answer: Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) is the gold-standard cognitive-behavioral therapy for OCD, involving gradual exposure to feared stimuli while preventing the compulsive ritual.
RPN Mental Health and Psychiatric Nursing 2
A client is newly prescribed phenelzine (Nardil), an MAOI.
Which dietary teaching is most important?