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Home Test Prep NCLEX-RN

Test Prep NCLEX-RN Exam Practice Questions (P. 3)

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Question #21
The therapeutic blood-level range for lithium is:
  1. A
    0.25–1.0 mEq/L
  2. B
    0.5–1.5 mEq/L
  3. C
    1.0–2.0 mEq/L
  4. D
    2.0–2.5 mEq/L

Correct Answer:
B
(A) This range is too low to be therapeutic. (B) This is the therapeutic range for lithium. (C) This range is above the therapeutic level. (D) This range is toxic and may cause severe side effects.

Question #22
A client with bipolar disorder taking lithium tells the nurse that he has ringing in his ears, blurred vision, and diarrhea. The nurse notices a slight tremor in his left hand and a slurring pattern to his speech. Which of the following actions by the nurse is appropriate?
  1. A
    Administer a stat dose of lithium as necessary.
  2. B
    Recognize this as an expected response to lithium.
  3. C
    Request an order for a stat blood lithium level.
  4. D
    Give an oral dose of lithium antidote.

Correct Answer:
C
(A) These symptoms are indicative of lithium toxicity. A stat dose of lithium could be fatal. (B) These are toxic effects of lithium therapy. (C) The client is exhibiting symptoms of lithium toxicity, which may be validated by lab studies. (D) There is no known lithium antidote.

Question #23
Which of the following activities would be most appropriate during occupational therapy for a client with bipolar disorder?
  1. A
    Playing cards with other clients
  2. B
    Working crossword puzzles
  3. C
    Playing tennis with a staff member
  4. D
    Sewing beads on a leather belt

Correct Answer:
C
(A) This activity is too competitive, and the manic client might become abusive toward the other clients. (B) During mania, the clients attention span is too short to accomplish this task. (C) This activity uses gross motor skills, eases tension, and expands excess energy. A staff member is better equipped to interact therapeutically with clients. (D) This activity requires the use of fine motor skills and is very tedious.

Question #24
A client diagnosed with bipolar disorder continues to be hyperactive and to lose weight. Which of the following nutritional interventions would be most therapeutic for him at this time?
  1. A
    Small, frequent feedings of foods that can be carried
  2. B
    Tube feedings with nutritional supplements
  3. C
    Allowing him to eat when and what he wants
  4. D
    Giving him a quiet place where he can sit down to eat meals

Correct Answer:
A
(A) The manic client is unable to sit still long enough to eat an adequate meal. Small, frequent feedings with finger foods allow him to eat during periods of activity.
(B) This type of therapy should be implemented when other methods have been exhausted. (C) The manic client should not be in control of his treatment plan.
This type of client may forget to eat. (D) The manic client is unable to sit down to eat full meals.

Question #25
Three weeks following discharge, a male client is readmitted to the psychiatric unit for depression. His wife stated that he had threatened to kill himself with a handgun. As the nurse admits him to the unit, he says, "I wish I were dead because I am worthless to everyone; I guess I am just no good." Which response by the nurse is most appropriate at this time?
  1. A
    "I don’t think you are worthless. I’m glad to see you, and we will help you."
  2. B
    "Don’t you think this is a sign of your illness?"
  3. C
    "I know with your wife and new baby that you do have a lot to live for."
  4. D
    "You’ve been feeling sad and alone for some time now?"

Correct Answer:
D
(A) This response does not acknowledge the clients feelings.
(B) This is a closed question and does not encourage communication.
(C) This response negates the clients feelings and does not require a response from the client. (D) This acknowledges the clients implied thoughts and feelings and encourages a response.

Question #26
Which of the following statements relevant to a suicidal client is correct?
  1. A
    The more specific a client’s plan, the more likely he or she is to attempt suicide.
  2. B
    A client who is unsuccessful at a first suicide attempt is not likely to make future attempts.
  3. C
    A client who threatens suicide is just seeking attention and is not likely to attempt suicide.
  4. D
    Nurses who care for a client who has attempted suicide should not make any reference to the word "suicide" in order to protect the client’s ego.

Correct Answer:
A
(A) This is a high-risk factor for potential suicide. (B) A previous suicide attempt is a definite risk factor for subsequent attempts. (C) Every threat of suicide should be taken seriously. (D) The client should be asked directly about his or her intent to do bodily harm. The client is never hurt by direct, respectful questions.

Question #27
The physician orders fluoxetine (Prozac) for a depressed client. Which of the following should the nurse remember about fluoxetine?
  1. A
    Because fluoxetine is a tricyclic antidepressant, it may precipitate a hypertensive crisis.
  2. B
    The therapeutic effect of the drug occurs 2–4 weeks after treatment is begun.
  3. C
    Foods such as aged cheese, yogurt, soy sauce, and bananas should not be eaten with this drug.
  4. D
    Fluoxetine may be administered safely in combination with monoamine oxidase (MAO) inhibitors.

Correct Answer:
B
(A) Fluoxetine is not a tricyclic antidepressant. It is an atypical antidepressant. (B) This statement is true. (C) These foods are high in tyramine and should be avoided when the client is taking MAO inhibitors. Fluoxetine is not an MAO inhibitor. (D) Fatal reactions have been reported in clients receiving fluoxetine in combination with MAO inhibitors.

Question #28
The day following his admission, the nurse sits down by a male client on the sofa in the dayroom. He was admitted for depression and thoughts of suicide. He looks at the nurse and says, "My life is so bad no one can do anything to help me." The most helpful initial response by the nurse would be:
  1. A
    "It concerns me that you feel so badly when you have so many positive things in your life."
  2. B
    "It will take a few weeks for you to feel better, so you need to be patient."
  3. C
    "You are telling me that you are feeling hopeless at this point?"
  4. D
    "Let’s play cards with some of the other clients to get your mind off your problems for now."

Correct Answer:
C
(A) This response does not acknowledge the clients feelings and may increase his feelings of guilt. (B) This response denotes false reassurance. (C) This response acknowledges the clients feelings and invites a response. (D) This response changes the subject and does not allow the client to talk about his feelings.

Question #29
A long-term goal for the nurse in planning care for a depressed, suicidal client would be to:
  1. A
    Provide him with a safe and structured environment.
  2. B
    Assist him to develop more effective coping mechanisms.
  3. C
    Have him sign a "no-suicide" contract.
  4. D
    Isolate him from stressful situations that may precipitate a depressive episode.

Correct Answer:
B
(A) This statement represents a short-term goal. (B) Long-term therapy should be directed toward assisting the client to cope effectively with stress. (C) Suicide contracts represent short-term interventions. (D) This statement represents an unrealistic goal. Stressful situations cannot be avoided in reality.

Question #30
After 3 weeks of treatment, a severely depressed client suddenly begins to feel better and starts interacting appropriately with other clients and staff. The nurse knows that this client has an increased risk for:
  1. A
    Suicide
  2. B
    Exacerbation of depressive symptoms
  3. C
    Violence toward others
  4. D
    Psychotic behavior

Correct Answer:
A
(A) When the severely depressed client suddenly begins to feel better, it often indicates that the client has made the decision to kill himself or herself and has developed a plan to do so. (B) Improvement in behavior is not indicative of an exacerbation of depressive symptoms. (C) Thedepressed client has a tendency for self-violence, not violence toward others. (D) Depressive behavior is not always accompanied by psychotic behavior.

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