Nokea
A client with major depressive disorder is prescribed lithium carbonate. Which finding should the RN report to the healthcare provider?
- A. Serum lithium level of 0.8 mEq/L
- B. Blood urea nitrogen (BUN) level of 16 mg/dL
- C. Serum sodium level of 138 mEq/L
- D. Urine output of 800 mL in 24 hours
Correct Answer: B
Rationale: The correct answer is B: Blood urea nitrogen (BUN) level of 16 mg/dL. This finding should be reported as it may indicate potential renal impairment, a common side effect of lithium carbonate. Elevated BUN levels can suggest decreased kidney function, which can lead to lithium toxicity.
A: A serum lithium level of 0.8 mEq/L is within the therapeutic range for lithium carbonate.
C: A serum sodium level of 138 mEq/L is within the normal range and not a concerning finding.
D: Urine output of 800 mL in 24 hours is a normal amount and not indicative of any immediate concerns related to lithium therapy.
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Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:
- A. Limited executive function
- B. Cerebellum maturation
- C. Cerebral stasis and hormonal changes
- D. A slight reduction in brain volume
Correct Answer: B
Rationale: The correct answer is B: Cerebellum maturation. During adolescence, the cerebellum undergoes significant development, leading to improved emotional and behavioral control. The cerebellum plays a crucial role in coordinating movement and regulating emotions. As it matures, adolescents become better at processing and responding to emotions, leading to increased emotional regulation and tolerance for frustration. Limited executive function (choice A) would actually hinder emotional control. Cerebral stasis and hormonal changes (choice C) do not directly contribute to improved emotional regulation. A slight reduction in brain volume (choice D) is not associated with increased emotional control.
The RN is leading a group on the inpatient psychiatric unit. Which approach should the RN use during the working phase of group development?
- A. Establishing a rapport with group members.
- B. Clarifying the nurse’s role and clients’ responsibilities.
- C. Discussing ways to use new coping skills learned.
- D. Helping clients identify areas of problem in their lives.
Correct Answer: C
Rationale: The correct answer is C: Discussing ways to use new coping skills learned. During the working phase of group development, the focus is on implementing and practicing new skills and strategies. This helps group members apply what they have learned to their real-life situations. By discussing ways to use new coping skills, the RN is facilitating the group's progress towards achieving their therapeutic goals.
A: Establishing a rapport with group members is important in the initial phase of group development, not during the working phase.
B: Clarifying the nurse’s role and clients’ responsibilities is more relevant to the orientation phase, not the working phase.
D: Helping clients identify areas of problem in their lives is typically done in the initial assessment phase, not during the working phase.
The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.
- A. Is the patient expressing suicidal thoughts?
- B. Does the patient have intact judgment and insight into his situation?
- C. Does the patient have experiences with either community or inpatient mental healthcare facilities?
- D. Does the patient require a therapeutic environment to support the management of psychotic symptoms?
Correct Answer: C
Rationale: The correct answer is C: Does the patient have experiences with either community or inpatient mental healthcare facilities? This question is crucial in determining the most appropriate setting for the patient's treatment. If the patient has prior experience with either setting, it can help the mental health team understand which environment may be more beneficial for the patient's current needs. If the patient has had positive experiences in a community outpatient setting, they may be more likely to benefit from that environment. On the other hand, if the patient has had previous success in an inpatient setting, that may be a more appropriate option. This question helps the team tailor the treatment plan to the patient's individual needs based on their past experiences.
Choices A, B, and D are incorrect as they do not directly address the patient's past experiences with different treatment settings, which is the most relevant factor in determining the appropriate treatment setting for the patient.
Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:
- A. I was so mad I wanted to hit my mother.
- B. I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.
- C. I forgot that you told me to breathe when I become angry.
- D. I scream as loud as I can when the train goes by the house.
Correct Answer: B
Rationale: The correct answer is B because it demonstrates cognitive restructuring in cognitive-behavioral therapy. The patient challenges their negative thought ("everyone hates me") with evidence to the contrary ("most people like me and I have a friend named Todd"). This shows progress in changing maladaptive thought patterns.
Choice A indicates potential aggression, choice C suggests poor retention of coping strategies, and choice D implies a maladaptive coping mechanism. Overall, B is the correct choice as it aligns with the goals of cognitive-behavioral therapy to challenge and reframe negative thoughts.
A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone (Risperdal). When the client walks to the nurse’s station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?
- A. Medicate the client with the prescribed antipsychotic thioridazine (Mellaril)
- B. Offer the client a prescribed physical therapy hot pack for muscle spasms.
- C. Administer the prescribed anticholinergic benztropine (Cogentin) for dystonia.
- D. Direct client to occupational therapy to distract him from somatic complaints.
Correct Answer: C
Rationale: The correct action is to administer the prescribed anticholinergic benztropine (Cogentin) for dystonia. Dystonia is a side effect of antipsychotic medications like risperidone and can present as abnormal muscle contractions or postures. Benztropine is commonly used to manage dystonia by blocking excess acetylcholine in the brain. This helps to alleviate the muscle spasms and contractions that the client is experiencing. Mediating with thioridazine may not be appropriate as it is not the prescribed medication and may not effectively address the dystonia. Offering a hot pack for muscle spasms might provide temporary relief but does not address the underlying cause of dystonia. Directing the client to occupational therapy or distracting him may not effectively manage the dystonia symptoms. Administering benztropine is the most appropriate action to address the client's physical symptoms and improve his comfort and well-being.