Saudi Prometric Nursing Psychiatric and Mental Health Nursing 1 — Questions and Answers
Question 1: A patient with major depressive disorder is started on fluoxetine. What must the nurse monitor for in the first 2 weeks?
- Increased risk of suicidal ideation, especially in patients under 25 (Correct answer)
- Serotonin syndrome from the first dose
- Agranulocytosis and bone marrow suppression
- Severe hypertension and tachycardia
Correct answer: Increased risk of suicidal ideation, especially in patients under 25
SSRIs, including fluoxetine, carry a black-box warning for increased suicidal thoughts particularly in children, adolescents, and young adults (under 25) during the first few weeks of treatment. Close monitoring for mood changes and emergent suicidality is essential.
Question 2: A patient with schizophrenia on haloperidol develops sudden severe muscle rigidity, hyperthermia, and altered consciousness. The nurse should suspect:
- Neuroleptic malignant syndrome (NMS) (Correct answer)
- Acute dystonia
- Tardive dyskinesia
- Extrapyramidal syndrome
Correct answer: Neuroleptic malignant syndrome (NMS)
Neuroleptic malignant syndrome (NMS) is a rare but life-threatening reaction to antipsychotics, presenting with hyperthermia, severe muscle rigidity, altered consciousness, and autonomic instability. It requires immediate discontinuation of the antipsychotic and supportive care.
Question 3: The nurse is using therapeutic communication with a patient who says, 'I feel like no one cares about me.' Which response is most therapeutic?
- 'It sounds like you're feeling very alone right now. Tell me more about that.' (Correct answer)
- 'I'm sure people care about you — you have family!'
- 'Why would you feel that way?'
- 'You shouldn't think like that. Focus on positive things.'
Correct answer: 'It sounds like you're feeling very alone right now. Tell me more about that.'
Reflective listening and open-ended exploration validate the patient's feelings and encourage further communication. Reassuring, minimizing, or asking 'why' questions can make patients feel dismissed or put on the defensive.
Question 4: A patient with alcohol use disorder is admitted. Which withdrawal symptom requires the most urgent intervention?
- Delirium tremens (DTs) with seizures and autonomic instability (Correct answer)
- Mild anxiety and diaphoresis
- Nausea and vomiting
- Tremors and insomnia
Correct answer: Delirium tremens (DTs) with seizures and autonomic instability
Delirium tremens (DTs) typically occur 48–72 hours after last drink and represent the most severe form of alcohol withdrawal with a mortality rate of up to 15% if untreated. Features include severe agitation, confusion, seizures, tachycardia, hypertension, and hyperthermia.
Question 5: The nurse is caring for a patient with anorexia nervosa. Which physical complication is most life-threatening?
- Cardiac arrhythmias from electrolyte imbalances (Correct answer)
- Amenorrhea
- Lanugo hair growth
- Parotid gland enlargement
Correct answer: Cardiac arrhythmias from electrolyte imbalances
Hypokalemia and other electrolyte imbalances from starvation and purging can cause fatal cardiac arrhythmias in anorexia nervosa. Malnutrition also causes cardiomyopathy. Cardiac complications are the leading cause of death in anorexia nervosa.
Question 6: The nurse is assessing a patient for lithium toxicity. Which early sign should be monitored?
- Coarse tremor, nausea, diarrhea, and confusion at levels >1.5 mEq/L (Correct answer)
- Fine tremor at therapeutic levels (0.6–1.2 mEq/L)
- Hyperreflexia only at levels >3.0 mEq/L
- Polyuria and polydipsia as signs of toxicity
Correct answer: Coarse tremor, nausea, diarrhea, and confusion at levels >1.5 mEq/L
Lithium toxicity occurs when levels exceed 1.5 mEq/L. Early signs include coarse tremors (vs. fine tremors at therapeutic levels), GI upset, drowsiness, and confusion. Levels >2.5 mEq/L cause seizures, cardiac arrhythmias, and coma. Therapeutic range is 0.6–1.2 mEq/L.
Saudi Prometric Nursing Psychiatric and Mental Health Nursing 1
A patient with major depressive disorder is started on fluoxetine.
What must the nurse monitor for in the first 2 weeks?