Nokea
A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?
- A. Reinforce that the level is above the therapeutic range.
- B. Instruct the patient to hold the next dose of medication and contact the prescriber.
- C. Advise the patient to go to the hospital emergency room immediately.
- D. Inform the patient about the possibility of seizures and appropriate precautions.
Correct Answer: B
Rationale: A lithium level of 1.7 mEq/L is above the therapeutic range, indicating a potential risk of toxicity. The initial nursing intervention should be to instruct the patient to hold the next dose of medication and promptly contact the prescriber for further guidance and management. This action aims to prevent adverse effects and ensure the patient's safety by addressing the elevated lithium level appropriately.
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In pediatric mental health, there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select one that doesn't apply.
- A. Children of color and poor economic conditions being underserved
- B. Increased stress in the family unit
- C. Markedly increased funding
- D. Premature termination of services
Correct Answer: C
Rationale: The lack of resources in pediatric mental health leads to underserved populations, increased stress in the family unit, and premature termination of services. However, markedly increased funding does not align with the negative consequences of resource shortages; instead, it would be a potential solution to address the lack of resources and providers in pediatric mental health.
Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:
- A. Generally good health despite the mental illness.
- B. An aversion to drinking fluids.
- C. Anxiety and depression.
- D. The ability to express his needs.
Correct Answer: C
Rationale: Individuals with schizophrenia often turn to excessive alcohol consumption as a way to manage symptoms of anxiety and depression. This maladaptive coping mechanism can exacerbate the challenges associated with schizophrenia and may hinder effective treatment outcomes. Recognizing the presence of anxiety and depression alongside alcohol abuse is crucial for providing holistic care and support to individuals with schizophrenia.
Which behavior is consistent with therapeutic communication?
- A. Offering your opinion when asked to convey support.
- B. Summarizing the essence of the patient's comments in your own words.
- C. Interrupting periods of silence before they become awkward for the patient.
- D. Telling the patient they did well when you approve of their statements or actions.
Correct Answer: B
Rationale: Summarizing the essence of the patient's comments in your own words is a key aspect of therapeutic communication as it demonstrates active listening and understanding. It shows the patient that their words have been heard and understood, fostering a sense of validation and empathy. Offering opinions, interrupting silence, or giving approval may not always align with the principles of therapeutic communication, which focus on patient-centered interactions and empathetic responses.
A woman was abducted and raped at gunpoint by an unknown assailant. When found, she was confused and disoriented. The nurse makes the following observations about the client. She is talking rapidly in disjointed phrases, is unable to concentrate, and is indecisive when asked to make simple decisions. The client's level of anxiety can be assessed as
- A. moderate
- B. severe
- C. mild
- D. nonexistent
Correct Answer: B
Rationale: The client's presentation, including rapid and disjointed speech, inability to concentrate, and indecisiveness, are indicative of severe anxiety. These symptoms suggest a high level of distress and impairment in cognitive functioning, which aligns with severe anxiety rather than mild or moderate levels. The traumatic experience of being abducted and raped at gunpoint would likely contribute to such a severe level of anxiety.
A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?
- A. Obsessive-compulsive disorder
- B. Generalized anxiety disorder
- C. Persistent depressive disorder
- D. Substance use disorder
Correct Answer: D
Rationale: The correct answer is D, Substance use disorder. Ramelteon is preferred for patients with substance use disorder because it lacks abuse potential. This makes it a safer choice for individuals with a history of substance misuse. Choosing a medication with a lower risk of abuse in this population is crucial to prevent potential misuse or dependence issues.