NR-326 Mental Health Nursing - Set 3 - Part 2

Correct Answer: Hold the drug and notify the provider

Cholinesterase inhibitors raise acetylcholine everywhere, and bradycardia with syncope is the dangerous consequence. The nurse checks the pulse personally, holds the dose and tells the provider before the client falls. Option a is incorrect because fluids will not lift a pulse slowed by cholinergic stimulation. Continuing the dose keeps the drug that caused the bradycardia in play while the client remains at risk of collapse. Option b is incorrect because charting alone treats a drug reaction as a routine observation. A pulse this slow with dizziness is exactly what the label tells the nurse to report. Option d is incorrect because slower position changes address orthostatic symptoms without touching the cause. Postural advice is worth giving later, yet it leaves an unsafe heart rate uninvestigated and the next dose due.

Correct Answer: Blockade of muscarinic receptors

Muscarinic blockade dries secretions, relaxes the ciliary muscle and weakens bladder emptying, which produces exactly this cluster. Teaching covers sugar free candy, fluids, fibre and a check for urinary retention. Option a is incorrect because histamine blockade brings sedation, increased appetite and weight gain. Nothing in that pattern explains a dry mouth or a bladder that will not empty on demand. Option b is incorrect because alpha one blockade shows itself in dizziness on standing, a falling blood pressure and nasal stuffiness. The client here describes secretions and bladder function instead. Option c is incorrect because serotonin receptor blockade eases movement side effects and contributes to sedation and weight gain. Its consequences are metabolic and motor, never the drying pattern this client describes.

Correct Answer: Drink two to three litres of fluid daily

Lithium is a salt cleared by the kidney, so fluid loss from sweating concentrates it quickly. Two to three litres daily plus steady dietary salt keeps the level inside its narrow window. Option a is incorrect because reducing sodium makes the tubule hold on to lithium instead. A client sweating all day needs a consistent, normal salt intake, which is the opposite of this instruction. Option c is incorrect because clients never adjust their own dose. Adding a tablet on a hot day stacks more drug on top of a concentration that heat has already pushed upward. Option d is incorrect because missing doses destabilises mood without solving the fluid problem. Sweating calls for extra water and a call to the clinic if illness follows, not silent gaps in the schedule.

Correct Answer: Assess the airway and summon help immediately

A strained voice and trouble swallowing suggest the spasm has reached the larynx, which can close the airway within minutes. Airway assessment and immediate help come before any other step. Option b is incorrect because charting alone leaves a client whose throat muscles are locking without treatment. Dystonia responds to intramuscular benztropine or diphenhydramine within minutes, so the delay to handover is indefensible. Option c is incorrect because breathing exercises do nothing to release a sustained muscle contraction driven by dopamine blockade. Treating this as anxiety wastes the narrow window before the throat obstructs. Option d is incorrect because a structured movement scale screens for the late involuntary movements of tardive dyskinesia. It measures nothing useful during an acute spasm and postpones care the client needs now.

Correct Answer: Assess directly for suicidal thoughts and increase observation

Psychomotor activity recovers before hopelessness does, and that gap is the highest risk period in treatment. Asking directly about suicidal thoughts and raising the level of observation protects the client now. Option a is incorrect because routine observation matches a client whose mood has actually lifted. Here the hopelessness is unchanged while the capacity to act has grown, so surveillance must rise rather than stay level. Option b is incorrect because group attendance is a reasonable milieu goal but it delays the safety question. Sending the client to an activity leaves the stated hopelessness unassessed and the client less closely watched. Option c is incorrect because praise reinforces behaviour without gathering data. Complimenting movement around the unit tells the nurse nothing about intent, and it can read as dismissal to someone who still feels worthless.

Correct Answer: Complete a movement scale and notify the provider

Early involuntary oral movements are the only warning the nurse gets, and reversal depends on catching them now. A structured rating with prompt provider notification drives the decision to change or stop the drug. Option a is incorrect because calling these movements harmless buries the earliest sign of a syndrome that can become permanent. False comfort costs the client the window in which the damage can still reverse. Option b is incorrect because a nurse does not unilaterally suspend a prescribed antipsychotic, and abrupt cessation risks relapse. The decision to stop, lower or switch belongs to the provider after assessment. Option d is incorrect because waiting a full year lets involuntary movements settle in while the drug continues. Any new abnormal movement earns attention at the visit where it is first observed.

Correct Answer: The client's upper denture plate remains in place

Dentures must come out before anesthesia because they can dislodge, obstruct the airway or break during the jaw contraction. Jewelry, hairpins and lenses are removed for the same protective reason. Option a is incorrect because voiding immediately beforehand is exactly what the protocol wants. An empty bladder prevents incontinence during the seizure and spares the client embarrassment in the recovery area. Option b is incorrect because removing rings and earrings is a completed safety step, not a problem. Metal near the stimulus site and loose items that could be lost belong off the client. Option c is incorrect because baseline readings give the team a comparison point for post treatment monitoring. Charting them before transport satisfies the workup rather than signaling anything the nurse must correct.

Correct Answer: Twelve hours after the last dose

Lithium levels are drawn as a trough, eight to twelve hours after the last dose, which in practice means the morning sample taken before that day's first tablet. Peak samples read falsely high. Option b is incorrect because a sample taken an hour after swallowing the tablet catches absorption at its height. The number would look alarming and could prompt a dose cut the client does not need. Option c is incorrect because drawing right after an evening dose measures peak concentration, not the steady state the provider titrates against. Results collected that way cannot be compared with earlier values. Option d is incorrect because counting backward from the next dose ignores when the previous one was swallowed. The trough is defined by the interval since the last dose, so this schedule drifts.

Correct Answer: Offer sealed items he can open himself

Sealed or packaged food the client opens himself removes the chance to tamper without arguing about the belief. Letting him choose his own tray works the same way and protects intake. Option a is incorrect because reassurance about testing is an attempt to disprove a fixed belief. The client will simply fold the nurse into the plot, and the tray still goes back untouched. Option b is incorrect because pressure at mealtimes turns eating into a struggle and raises the anxiety that intensifies delusional thinking. Force feeding is never the answer, and intake falls further. Option d is incorrect because a relative handing over food changes nothing about the suspicion attached to the kitchen. Control over the container is what reassures this client, not the identity of the server.

Correct Answer: The client began a cough syrup with dextromethorphan

Dextromethorphan is serotonergic, and adding it to an existing reuptake inhibitor tips the client into serotonin syndrome within hours. Clonus, dilated pupils and hyperactive bowel sounds are the neuromuscular and autonomic signature. Option a is incorrect because missed doses produce the opposite syndrome. Withdrawal from a serotonergic drug brings flu like aches, dizziness, vivid dreams and sensory shocks, not clonus and hyperactive gut sounds. Option c is incorrect because calcium supplements carry no serotonergic activity. They may bind other medications in the gut and cause constipation, which is the reverse of the hyperactive bowel picture described here. Option d is incorrect because moving the dose to the evening changes only the timing of peak levels. Total daily exposure stays the same, and a schedule shift alone does not generate hyperreflexia or clonus.

Correct Answer: Tremor with rising blood pressure and confusion

Withdrawal from a long standing benzodiazepine mirrors alcohol withdrawal and can end in seizures and death. Tremor with rising pressure and confusion marks the escalation point, so the team must restart cover and taper. Option a is incorrect because nausea appears early in withdrawal and on its own it carries no threat to life. Treating it while ignoring the missing prescription would still leave the client heading toward crisis. Option b is incorrect because disturbed dreaming reflects rebound of suppressed sleep architecture. Unpleasant as it is, vivid dreaming does not carry the autonomic instability that precedes a withdrawal seizure. Option d is incorrect because irritability is a common early feature that responds to a calm environment and a restored dose. Ranking it above vital sign change and altered thinking misreads the severity ladder.

Correct Answer: Abdominal pain with vomiting and yellow sclerae

Abdominal pain, persistent vomiting and jaundice point to hepatotoxicity or pancreatitis, both boxed warnings for valproate. Liver studies and pancreatic enzymes are needed now, and the drug is usually held while results return. Option a is incorrect because thinning hair is a cosmetic effect that threatens adherence rather than safety. It deserves discussion at the routine visit, and it usually improves once the drug is stopped. Option c is incorrect because modest weight gain accompanies this drug in many clients and is addressed with diet and activity counselling. Four pounds over six weeks signals no organ injury at all. Option d is incorrect because a light tremor is among the ordinary effects of valproate and often eases with a dose adjustment. Nothing about it suggests bleeding, liver failure or pancreatic inflammation.

Correct Answer: Withhold the dose and obtain a serum level

Fluid loss concentrates lithium, and a coarse tremor with slurred speech marks early toxicity. Holding the drug stops further accumulation while a stat level and provider notification determine what comes next. Option a is incorrect because cutting salt drives the level higher still. Kidneys reabsorb lithium alongside sodium, so a client who is already dry and toxic would deteriorate on that advice. Option b is incorrect because food softens stomach upset without touching the underlying problem. Another dose adds to a serum concentration that is already climbing, and the tremor would coarsen further. Option c is incorrect because waiting until morning wastes the window when intervention is simple. Neurologic signs can progress to ataxia, confusion and seizures within hours once the level keeps rising.

Correct Answer: "I will have a turkey sandwich on fresh bread with cottage cheese."

Fresh poultry, fresh bread and cottage cheese are all low in tyramine, which forms as protein ages or ferments. The rule the client carries away is fresh, refrigerated and not fermented. Option b is incorrect because salami is a cured fermented meat and Swiss is a matured cheese. Pairing two high tyramine foods in one meal is exactly the combination that drives blood pressure upward. Option c is incorrect because fermented cabbage and smoked meat both carry heavy tyramine loads. Tap and draft beer sit on the restricted list as well, making this plate the riskiest of the four. Option d is incorrect because cheddar heads the list of aged cheeses to avoid entirely. Red wine belongs among the limited choices as well, so this selection shows the client still misunderstands the diet.

Correct Answer: Use sunscreen, a hat and sunglasses

Chlorpromazine makes skin burn far faster than usual, so covered skin, a broad brimmed hat, sunglasses and sunscreen let the client stay outdoors without risking a severe burn. Option a is incorrect because timing the dose around swimming changes nothing about how the skin reacts to ultraviolet light. Sensitivity persists throughout the day while drug remains in the body. Option b is incorrect because extra fluid guards against heat illness rather than against a chemical burn of the skin. Hydration is sensible in the sun yet leaves the photosensitivity entirely unaddressed. Option d is incorrect because stopping an antipsychotic invites the return of symptoms the drug is holding in check. Sun protection solves the problem without surrendering months of hard won stability.

Correct Answer: It dries secretions and blocks vagal slowing of the heart

An anticholinergic such as glycopyrrolate or atropine dries oral and respiratory secretions and blunts the parasympathetic surge that can drop the heart rate sharply or cause brief asystole after the stimulus. Option a is incorrect because study guides that describe this drug as an antidote to sedation state it wrongly. Nothing in the regimen is meant to keep the client awake during the procedure. Option c is incorrect because paralysis of skeletal muscle comes from succinylcholine, the depolarizing agent given after induction. Glycopyrrolate has no effect on the neuromuscular junction and will not soften convulsive movement. Option d is incorrect because seizure length is governed by the electrical dose and by drugs that alter the threshold, such as benzodiazepines. Drying agents neither lengthen nor shorten the therapeutic convulsion.

Correct Answer: Hold the drug and notify the provider immediately

The picture is serotonin syndrome, and stopping the serotonergic drug is what reverses it. Withholding the next dose and telling the provider at once allows treatment before hyperthermia and rigidity escalate. Option b is incorrect because external cooling belongs in the supportive package once the drug is stopped. Cooling alone leaves the offending agent circulating, so clonus and temperature keep climbing. Option c is incorrect because giving another dose adds serotonin to a system already overloaded. Food changes absorption slightly and changes nothing about the neuromuscular hyperactivity that makes this an emergency. Option d is incorrect because antipyretics do not work here. The heat comes from sustained muscle activity rather than a raised hypothalamic set point, so the fever falls only when the agent is withdrawn.

Correct Answer: Monotone voice with an immobile face

Blunted affect strips away the ordinary expression of emotion, so the face stays still and the voice stays level. That subtraction from normal function defines a negative symptom rather than an added one. Option a is incorrect because clang association picks words for their rhyme, adding a distorted speech pattern to the client's output. Anything added to normal function sits on the positive side of the ledger. Option b is incorrect because an idea of reference gives ordinary broadcasts a private personal meaning, which is a delusion. Delusions are extra beliefs layered onto reality, placing this client in the positive column. Option c is incorrect because echolalia repeats another person's words back, a disorganized behavior that appears alongside catatonic features. Repetition is a behavior the client produces, not a capacity the illness has taken away.

Correct Answer: Give the dose after breakfast and avoid late doses

Taking the stimulant with or after breakfast protects appetite, and keeping the last dose before mid afternoon protects sleep. Height and weight are checked at every visit because growth can slow. Option b is incorrect because a bedtime stimulant guarantees a sleepless night, and an empty stomach worsens the nausea and appetite loss already reported. Both halves of that instruction work against the child. Option c is incorrect because waiting for hunger cues fails when the drug suppresses them. Scheduled meals, calorie dense foods and an evening snack are what keep weight on a treated child. Option d is incorrect because an evening dose extends the drug into the hours meant for sleep. The family already reports difficulty settling, so more medication late in the day compounds the problem.

Correct Answer: Sudden pounding headache at the back of the head

A sudden severe occipital headache is the classic first sign of hypertensive crisis from a tyramine interaction. Blood pressure can climb high enough to cause intracranial bleeding, so emergency evaluation cannot wait. Option a is incorrect because dry mouth reflects ordinary anticholinergic activity and troubles comfort rather than survival. Sugar free sweets, sips of water and good oral hygiene handle it at the next routine visit. Option b is incorrect because postural dizziness is an expected effect of these agents on vascular tone. Teaching the client to rise slowly and dangle before standing manages the fall risk safely at home. Option d is incorrect because insomnia appears often in the first weeks and responds to a morning dosing change or sleep hygiene. Two restless nights carry no signal of a vascular emergency.