NR-326 Mental Health Nursing - Set 3 - Part 1

Correct Answer: Move the discussion out of the client's sight

Whispering within view of a paranoid client confirms the plot he already suspects. Staff conversations belong somewhere he cannot see them, and anything about his care should be said to him directly. Option a is incorrect because ignoring the watching leaves the client to fill the silence with his own explanation. What looks harmless to staff reads as evidence of a conspiracy to him. Option b is incorrect because sending him away punishes the client for a staff habit and restricts him without cause. He loses access to the dayroom while the suspicion stays exactly where it was. Option d is incorrect because pulling a suspicious client into a staff discussion he was not part of increases his distress. Group closeness and unexpected inclusion feel intrusive rather than reassuring.

Correct Answer: Ventilating with oxygen by bag and mask

Succinylcholine paralyzes respiratory muscles along with everything else, so the client cannot breathe until it wears off. The anesthesia provider ventilates with oxygen by bag and mask throughout the treatment. Option b is incorrect because a chest tube drains air or fluid from the pleural space after trauma or a pneumothorax. Nothing about a brief drug induced paralysis calls for an invasive thoracic procedure. Option c is incorrect because atropine and glycopyrrolate dry secretions and protect heart rate rather than reversing blockade. Succinylcholine is short acting and simply wears off within minutes without any reversal agent. Option d is incorrect because withholding oxygen from a paralyzed client invites hypoxia within seconds. Oxygenation is maintained continuously, and the seizure itself raises cerebral demand, making adequate delivery more important rather than less.

Correct Answer: Depression resisting medication often improves quickly with this treatment

Treatment resistant depression, psychotic depression, catatonia and food refusal are core indications because the seizure therapy works faster than medication. A rapid response matters when the client is medically deteriorating or at high risk. Option a is incorrect because electroconvulsive therapy is not reserved for clients who have exhausted everything else. Speed, safety and a prior good response can make it a reasonable early choice rather than a final gamble. Option b is incorrect because anesthesia only renders the client unconscious for a few minutes. The antidepressant benefit comes from the induced seizure itself, and medications are usually continued alongside the treatment series. Option d is incorrect because the electrical stimulus simply triggers a generalized seizure and repairs no tissue. Structural brain damage has never been demonstrated, and the therapeutic effect is attributed to the seizure activity.

Correct Answer: Visual and tactile hallucinations suggest a medical cause

Seeing and feeling things point first to delirium, substance withdrawal or another medical problem, especially with acute confusion and no psychiatric history. Hearing voices is the modality that leans toward schizophrenia. Option b is incorrect because no voices are described, and schizophrenia would not begin abruptly overnight in an older adult during an infection. The modality reported here points away from that diagnosis. Option c is incorrect because an illusion requires a real object to misread, and crawling sensations under the skin have no external source. Dim lighting cannot account for a felt perception. Option d is incorrect because treating new psychosis in an older adult as ordinary delays the workup that finds the cause. Infection, dehydration and metabolic derangement all produce this picture and are treatable.

Correct Answer: Constant thirst, frequent urination and blurred vision

Thirst, urinary frequency and blurred vision together announce new hyperglycemia, and diabetic ketoacidosis can follow within days on a second generation antipsychotic. A glucose check and provider contact belong today. Option a is incorrect because histamine blockade makes daytime sleepiness expected, and moving the dose to bedtime usually settles it. Drowsiness alone signals no metabolic emergency and can wait for the scheduled visit. Option b is incorrect because a dry mouth answered by candy shows the client already managing a muscarinic effect well. Successful self care is a reason for praise rather than an urgent appointment. Option d is incorrect because slow weight gain deserves counselling, diet review and a possible change of agent at the next visit. It moves over weeks, unlike the sudden glucose rise threatening this client.

Correct Answer: Older drugs cause more movement disorders

First generation agents bind dopamine receptors tightly and push the risk into the motor system, so dystonia, akathisia, parkinsonism and tardive dyskinesia appear far more often than with newer drugs. Option b is incorrect because the weight problem belongs to the newer agents, especially clozapine and olanzapine. Metabolic harm is the trade the second generation makes for its gentler effect on movement. Option c is incorrect because serotonin blockade added to the newer drugs loosens the motor grip, lowering stiffness and spasm. Risk is reduced rather than eliminated, and high dose risperidone still behaves like an older agent. Option d is incorrect because prolactin elevation runs highest with haloperidol, fluphenazine and similar older drugs. Among the newer agents only risperidone and paliperidone rival them, while aripiprazole actually lowers the hormone.

Correct Answer: "I saw you lead the walk and help a peer."

Restructuring answers a distorted automatic thought with specific evidence the client can weigh. Naming two things she actually did today lets her test the belief instead of accepting it. Option a is incorrect because advising her to ease up offers no evidence against the thought. Well meant advice leaves the belief untouched and shifts the work back onto the client alone. Option b is incorrect because promising a good outcome is false reassurance, a recognized communication block. Reframing supplies verifiable facts, whereas a blanket guarantee closes the topic and cannot be tested. Option c is incorrect because a why question demands that she defend herself and adds an accusation about always. Defensiveness follows, and the exchange moves away from examining the thought together.

Correct Answer: Scheduled absolute neutrophil count testing

Clozapine can destroy neutrophils, leaving a client defenceless against infection, so counts are drawn weekly at first and then less often as safety is established. Fever or sore throat must be reported at once. Option b is incorrect because clozapine is not guided by a routine therapeutic blood level. Dosing rises slowly against the client's response, blood pressure and tolerance, so no target concentration is chased. Option c is incorrect because thyroid surveillance follows a different psychotropic entirely and has no place in a clozapine protocol. The gland is untouched by dopamine and serotonin receptor blockade at these doses. Option d is incorrect because ammonia is checked when confusion develops on an anticonvulsant, a situation unrelated to this prescription. Nothing in clozapine therapy raises that value or calls for the test.

Correct Answer: Short term memory loss around the treatment period

Memory for events close to each treatment is patchy during the course and typically improves over the following weeks to months. The nurse frames it as expected, temporary for most clients, and worth reporting if it worsens. Option a is incorrect because skills, vocabulary and long established knowledge survive the treatment course intact. Some scattered memories from the surrounding weeks may not return, but wholesale erasure of learning does not occur. Option b is incorrect because a downhill dementia course is not a described outcome of this therapy. Imaging and follow up studies have found no evidence of structural brain damage from the treatments. Option d is incorrect because failing to recognize relatives points toward delirium or advanced neurocognitive disease. Confusion after a treatment clears within roughly an hour, and clients still know the people around them.

Correct Answer: Nausea, loose stools and mild headache

Gastrointestinal upset, loose stools and headache appear in the first one to two weeks with a serotonin reuptake inhibitor and usually settle. Taking the dose with food eases the nausea while the body adjusts. Option a is incorrect because a coarse tremor with an unsteady walk points to lithium accumulation rather than a new antidepressant. That combination calls for a serum level, not reassurance about early side effects. Option b is incorrect because that headache pattern signals hypertensive crisis in someone taking a monoamine oxidase inhibitor after eating aged or fermented food. It is an emergency, never an expected early complaint. Option c is incorrect because a prolonged painful erection is priapism, a urologic emergency linked to trazodone. The client needs the emergency department at once, and the finding has no place on a routine list.

Correct Answer: Make brief, frequent contacts and keep every promise

Short, predictable contacts are tolerable for a suspicious client and, repeated reliably, they build trust faster than any single long conversation. Doing exactly what was promised is the other half. Option b is incorrect because a long interview overwhelms a client who already feels watched and cornered. Endurance is not the goal early on; tolerable repetition is what earns the client's confidence. Option c is incorrect because jokes and idioms are read literally by concrete thinkers and effusive warmth reads as manipulation to a suspicious client. A matter of fact manner works far better. Option d is incorrect because waiting passively leaves a withdrawn client alone with his fear and offers nothing to trust. The nurse initiates the contact, then keeps it short and consistent.

Correct Answer: Prolactin elevation from dopamine blockade

Dopamine normally holds prolactin down, so blocking it in the pituitary pathway lets the hormone climb. Risperidone raises prolactin more than most agents, producing absent periods, breast discharge and sexual difficulty. Option a is incorrect because metabolic harm from these drugs shows as weight gain, high glucose and abnormal lipids. Menstrual loss and breast discharge come from a hormone pathway, not from insulin resistance. Option b is incorrect because tardive dyskinesia is a movement disorder of the face, tongue and limbs. It never affects menstruation, and nothing about involuntary movement produces secretion from the breast. Option d is incorrect because muscarinic blockade dries the mouth, blurs vision and holds urine in the bladder. Its reach stops at glands and smooth muscle, well short of the reproductive hormone axis.

Correct Answer: Schizoaffective disorder, depressive type

Psychosis persisting at least two weeks while mood is normal is the criterion that names schizoaffective disorder. Without that gap the picture would be a mood disorder carrying psychotic features. Option a is incorrect because psychotic features in major depression appear only during the depressive episode and disappear when mood recovers. The documented stretch of hallucinations without depression breaks that pattern. Option b is incorrect because schizophrenia allows only brief mood symptoms relative to the total illness. Here the depressive episodes run through most of the two years, which pushes the diagnosis toward the schizoaffective category. Option c is incorrect because nothing in the history describes mania or hypomania, and the mood episodes recorded are depressive. A bipolar label needs an elevated or irritable episode that never appears here.

Correct Answer: The client hearing personal orders in newscasts

Ideas of reference give ordinary public events a private message aimed at the client, which is exactly what a newscast delivering personal orders describes. The belief is about meaning, not persecution or identity. Option a is incorrect because a poisoning belief is persecutory, the most common delusional theme, in which the client feels conspired against or deliberately harmed. Persecution encodes fear rather than personal significance in public events. Option c is incorrect because rotting organs describe a somatic delusion centered on the body being diseased or altered. Its content stays inside the client's own physiology and never touches outside broadcasts. Option d is incorrect because a prophet claim mixes grandiose and religious themes, inflating identity and special mission. Grandiosity elevates the self, whereas reference reads hidden messages into events anyone can watch.

Correct Answer: The identified client carrying the family's problem

Systems thinking treats the family as the unit of care, so the member labeled as the problem is the identified client carrying strain that belongs to the whole system. Treating him alone misses it. Option a is incorrect because a double bind delivers clashing messages at two levels, so the receiver cannot win or comment on the trap. The parents here are stating one blunt position. Option b is incorrect because differentiation describes holding onto your own identity while staying emotionally connected to relatives. Low differentiation produces fusion and reactivity, which is not what this label from the parents shows. Option c is incorrect because homeostasis names the pull toward keeping things exactly as they are, which explains resistance when a member improves. Naming a scapegoat is a separate mechanism inside that pull.

Correct Answer: Ask the provider to plan a gradual taper

Paroxetine has a short half life and produces the most abrupt discontinuation syndrome, so the dose comes down slowly over weeks under provider direction. Abrupt cessation brings flu like aches, dizziness and sensory shocks. Option a is incorrect because stopping outright is what triggers the withdrawal picture within one to three days. Restarting later also blurs the line between rebound symptoms and a genuine return of depression. Option b is incorrect because a single week is far too fast for an agent taken this long. Tapers for serotonergic drugs run over several weeks, slowing further as the final doses come down. Option d is incorrect because alternate day dosing creates swings in serum concentration that provoke the very symptoms a taper avoids. Half life, not dosing gaps, determines how smoothly a client comes off.

Correct Answer: Accepting the client while building skills for change

The dialectic holds two truths at once, radical acceptance of the client as she is alongside the necessity of change. Mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness supply the skills. Option a is incorrect because retrieving buried material is the aim of analytic therapy. Skills training keeps attention on what the client can do differently in the next distressing hour. Option c is incorrect because withdrawing privileges as leverage is punishment, which has no place in this model or on a therapeutic unit. Nurses validate the emotion while still holding the agreed limit. Option d is incorrect because reading meaning into artwork belongs to expressive therapies, where the client rather than the nurse describes the piece. Structured skill modules and coaching calls define this treatment instead.

Correct Answer: "I do not hear the voices, but I understand that you do."

The nurse states her own reality plainly while accepting that the experience is real to the client. That combination presents reality without arguing, which protects trust and keeps the conversation open. Option b is incorrect because pretending to share the perception validates the psychosis and hands the client false confirmation. Once the deception is discovered, the nurse loses the credibility the relationship depends on. Option c is incorrect because demanding proof turns the exchange into an argument the client cannot win. Being told to look around reads as an accusation of lying and pushes a frightened client further away. Option d is incorrect because advice to ignore the voices skips assessment altogether. The nurse still does not know whether the voices are issuing commands, which is the one question safety turns on.

Correct Answer: Stay beside him and reorient him calmly

Waking confused and disoriented is expected after the induced seizure, and repeated calm reorientation by the nurse who stays present is both the treatment and the safety measure during postictal confusion. Option a is incorrect because postictal disorientation lasting under an hour is anticipated, not a change worth paging anyone about. Leaving the bedside to make a call abandons a client who is climbing out. Option c is incorrect because delegating presence hands off the very assessment the nurse must perform herself. Cognitive status, orientation and recovery from anesthesia are nursing judgments that assistive personnel cannot make. Option d is incorrect because sedation on top of recent anesthesia deepens confusion and blunts the airway reflexes still recovering. Chemical restraint answers a normal recovery phenomenon with an unnecessary and risky drug.

Correct Answer: He states that life still feels not worth living

Energy and psychomotor activity often improve before hopelessness lifts, which opens a window of raised suicide risk. Continued statements that life is not worth living need immediate reporting, direct questioning and close observation. Option b is incorrect because headache follows most treatments and is handled with a routine analgesic order. Relief from acetaminophen confirms the expected pattern rather than flagging anything the provider must hear about urgently. Option c is incorrect because sore muscles come from the fasciculations succinylcholine produces before paralysis sets in. Aching shoulders and jaw soreness are anticipated, self limited complaints managed with comfort measures on the unit. Option d is incorrect because trouble forming new memories during a treatment series is the anterograde effect described in teaching. Losing a staff name fits that picture and usually clears once the course finishes.