Psych Review Questions & Answers
Question Answer/Rationale
Depression
1. The nurse is planning care with a Mexican- 1. 4. RATIONALE: Including the root healer gives credibility and respect to
American client who is diagnosed with depression. The the client’s cultural beliefs. Avoiding talking about the healer demonstrates
client believes in “mal ojo” (the evil eye), and uses either ignorance or disregard for the client’s cultural values. Negative
treatment by a root healer. The nurse should do which of comparison of root healing with Western medicine not only denigrate the
the following? client’s beliefs, but are likely to alienate him or her and cause them to end
1. Avoid talking to the client about the root healer. treatment.
2. Explain to the client that Western medicine has a scientific, TEST-TAKING STRATEGY: #4 is more “collaborative”, involves more
not mystical, basis. teamwork….it’s something that would happen in a perfect NCLEX world!
3. Explain that such beliefs are superstitious and should be
forgotten.
4. Involve the root healer in a consultation with the client,
physician and nurse.
2. After a period of unsuccessful treatment 2. 3. RATIONALE: Cheese and yeast products contain tyramine which the
with Elavil (amitriptyline), a woman diagnosed with client should avoid to prevent a negative interaction with Parnate, a
depression is switched to Parnate (tranylcypromine). monoamine oxidase (MAO) inhibitor. Sodium will not interact with Parnate
Which statement by the client indicates the client and neither exercise nor sugar needs to be limited.
understands the side effects of 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. RATIONALE: The client is likely anxious about the procedure. The nurse
4. Discuss specific concerns. 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 4. 1. RATIONALE: Selegiline transdermal system is the first transdermal
transdermal system (Emsam) every 24 hours for major monoamine oxidase inhibitor. The client on Emsam needs to avoid exposing
depression. The nurse should judge teaching about Emsam the application site to external sources of direct heat, such as saunas,
to be effective when the 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 5. 3. RATIONALE: The nurse should report the client’s beer consumption to
duloxetine hydrochloride (Cymbalta) twice daily for 2 the physician. Duloxetine should not be administered to a client with renal
, Question Answer/Rationale
months because of depression and vague aches and pains. or hepatic insufficiency because the medication can elevate liver enzymes
While interacting with the nurse, the client discloses a and, together with substantial alcohol use, can cause liver injury. Referring
pattern of drinking a 6-pack of beer daily for the past 10 the client to the dual diagnosis program, sharing information at the next
years to help with sleep. What should the nurse do 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 6. 2. RATIONALE: The client’s sudden improvement and decrease in anxiety
3 days ago with a flat affect, psychomotor retardation, most likely indicates that the client is relieved because he has made the
anorexia, hopelessness, and suicidal ideation. The decision to kill himself and may now have the energy to complete the
physician prescribed 75 mg of venlafaxine extended suicide. Symptoms of severe depression do not suddenly abate because
release (Effexor XR) to be given every morning. The client most antidepressants work slowly and take 2 to 4 weeks to provide a
interacted minimally with the staff and spent most of the maximum benefit. The client will improve slowly due to the medication. The
day in his room. As the nurse enters the unit at the sudden improvement in symptoms does not mean the client is nearing
beginning of the evening shift, the client is smiling and discharge and decreasing observation of the client compromises the client’s
cheerfully greets the nurse. He appears to be relaxed and safety.
joins the group for community meeting before supper.
What should 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 7. 1, 2, 5. RATIONALE: It is important for the nurse to obtain information
interview with an Asian American female who reports about the client’s use of tea, herbal medicine, and a folk healer because the
, Question Answer/Rationale
sadness, physical and mental fatigue, anxiety, and sleep information is critical to the safe prescription of psychotropic medication.
disturbance. Prior to the client’s time with the physician, it Breathing exercises, massage, and acupuncture are also traditional therapies
is important for the nurse to obtain information about the used by the Asian American population, but do not interfere with the use of
client’s use of which of the following? 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 8. 1. RATIONALE: The nurse should immediately report the rash to the
(Lamictal) daily for bipolar depression. The client shows physician because lamotrigine can cause Stevens-Johnson syndrome, a toxic
the nurse a rash on his 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 9. 2. RATIONALE: The nurse should hold the 5 p.m. dose of lithium because
report with the client’s lithium level taken that morning a level of 1.8 mEq/ L can cause adverse reactions, including diarrhea,
prior to administering the 5 p.m. dose of lithium. The vomiting, drowsiness, muscle weakness, and lack of coordination, which are
lithium level is 1.8 mEq/ L. The nurse 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 10. 3. RATIONALE: Additional teaching is needed for the family member
group for family members of clients hospitalized with who states her son will only need to attend outpatient appointments when
depression. Which family member’s statement indicates a he starts to feel depressed again. Compliance with medication and
need for additional teaching? outpatient follow-up are key in preventing relapse and rehospitalization. The
1. “My husband will slowly feel better as his medicine takes statements expressing expectations of feeling better as medication takes
Question Answer/Rationale
Depression
1. The nurse is planning care with a Mexican- 1. 4. RATIONALE: Including the root healer gives credibility and respect to
American client who is diagnosed with depression. The the client’s cultural beliefs. Avoiding talking about the healer demonstrates
client believes in “mal ojo” (the evil eye), and uses either ignorance or disregard for the client’s cultural values. Negative
treatment by a root healer. The nurse should do which of comparison of root healing with Western medicine not only denigrate the
the following? client’s beliefs, but are likely to alienate him or her and cause them to end
1. Avoid talking to the client about the root healer. treatment.
2. Explain to the client that Western medicine has a scientific, TEST-TAKING STRATEGY: #4 is more “collaborative”, involves more
not mystical, basis. teamwork….it’s something that would happen in a perfect NCLEX world!
3. Explain that such beliefs are superstitious and should be
forgotten.
4. Involve the root healer in a consultation with the client,
physician and nurse.
2. After a period of unsuccessful treatment 2. 3. RATIONALE: Cheese and yeast products contain tyramine which the
with Elavil (amitriptyline), a woman diagnosed with client should avoid to prevent a negative interaction with Parnate, a
depression is switched to Parnate (tranylcypromine). monoamine oxidase (MAO) inhibitor. Sodium will not interact with Parnate
Which statement by the client indicates the client and neither exercise nor sugar needs to be limited.
understands the side effects of 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. RATIONALE: The client is likely anxious about the procedure. The nurse
4. Discuss specific concerns. 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 4. 1. RATIONALE: Selegiline transdermal system is the first transdermal
transdermal system (Emsam) every 24 hours for major monoamine oxidase inhibitor. The client on Emsam needs to avoid exposing
depression. The nurse should judge teaching about Emsam the application site to external sources of direct heat, such as saunas,
to be effective when the 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 5. 3. RATIONALE: The nurse should report the client’s beer consumption to
duloxetine hydrochloride (Cymbalta) twice daily for 2 the physician. Duloxetine should not be administered to a client with renal
, Question Answer/Rationale
months because of depression and vague aches and pains. or hepatic insufficiency because the medication can elevate liver enzymes
While interacting with the nurse, the client discloses a and, together with substantial alcohol use, can cause liver injury. Referring
pattern of drinking a 6-pack of beer daily for the past 10 the client to the dual diagnosis program, sharing information at the next
years to help with sleep. What should the nurse do 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 6. 2. RATIONALE: The client’s sudden improvement and decrease in anxiety
3 days ago with a flat affect, psychomotor retardation, most likely indicates that the client is relieved because he has made the
anorexia, hopelessness, and suicidal ideation. The decision to kill himself and may now have the energy to complete the
physician prescribed 75 mg of venlafaxine extended suicide. Symptoms of severe depression do not suddenly abate because
release (Effexor XR) to be given every morning. The client most antidepressants work slowly and take 2 to 4 weeks to provide a
interacted minimally with the staff and spent most of the maximum benefit. The client will improve slowly due to the medication. The
day in his room. As the nurse enters the unit at the sudden improvement in symptoms does not mean the client is nearing
beginning of the evening shift, the client is smiling and discharge and decreasing observation of the client compromises the client’s
cheerfully greets the nurse. He appears to be relaxed and safety.
joins the group for community meeting before supper.
What should 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 7. 1, 2, 5. RATIONALE: It is important for the nurse to obtain information
interview with an Asian American female who reports about the client’s use of tea, herbal medicine, and a folk healer because the
, Question Answer/Rationale
sadness, physical and mental fatigue, anxiety, and sleep information is critical to the safe prescription of psychotropic medication.
disturbance. Prior to the client’s time with the physician, it Breathing exercises, massage, and acupuncture are also traditional therapies
is important for the nurse to obtain information about the used by the Asian American population, but do not interfere with the use of
client’s use of which of the following? 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 8. 1. RATIONALE: The nurse should immediately report the rash to the
(Lamictal) daily for bipolar depression. The client shows physician because lamotrigine can cause Stevens-Johnson syndrome, a toxic
the nurse a rash on his 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 9. 2. RATIONALE: The nurse should hold the 5 p.m. dose of lithium because
report with the client’s lithium level taken that morning a level of 1.8 mEq/ L can cause adverse reactions, including diarrhea,
prior to administering the 5 p.m. dose of lithium. The vomiting, drowsiness, muscle weakness, and lack of coordination, which are
lithium level is 1.8 mEq/ L. The nurse 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 10. 3. RATIONALE: Additional teaching is needed for the family member
group for family members of clients hospitalized with who states her son will only need to attend outpatient appointments when
depression. Which family member’s statement indicates a he starts to feel depressed again. Compliance with medication and
need for additional teaching? outpatient follow-up are key in preventing relapse and rehospitalization. The
1. “My husband will slowly feel better as his medicine takes statements expressing expectations of feeling better as medication takes
