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Questions 227

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Extract:


Question 1 of 5

An adult is admitted to the psychiatric unit with a severe phobia. She develops severe anxiety when she crosses any type of bridge. She can no longer go to work or go shopping at the mall. The day after admission, she develops a panic attack and refuses to go to occupational therapy because she has to cross a bridge-like structure to go from one area of the hospital to another. How should the nurse respond to this situation?

Correct Answer: C

Rationale: Using an alternate route avoids triggering the phobia, allowing participation in therapy while respecting her current anxiety level.

Question 2 of 5

A patient with major depressive disorder is prescribed fluoxetine (Prozac). Which of the following instructions should the nurse include?

Correct Answer: C

Rationale: Fluoxetine’s full effect takes 4–6 weeks, and patients must continue it to maintain benefits. Bedtime dosing is not standard, grapefruit juice is irrelevant, and stopping early risks relapse.

Question 3 of 5

The nurse is caring for a client with a history of bipolar disorder who is prescribed lithium. Which of the following laboratory values should the nurse monitor?

Correct Answer: A

Rationale: Lithium can cause hyponatremia, and monitoring serum sodium ensures safe levels (therapeutic lithium range: 0.6–1.2 mEq/L). Glucose (
B), calcium (
C), and hemoglobin (
D) are not directly affected by lithium therapy.

Extract:

Marie is a 5-year-old girl is admitted with a diagnosis of Acute Lymphoblastic Leukemia.


Question 4 of 5

Which of the following nursing interventions would be contraindicated to the patient with Leukemia?

Correct Answer: A

Rationale: Rectal temperatures risk rectal injury and infection in neutropenic patients.

Extract:


Question 5 of 5

A client is admitted with low T3 and T4 levels and an elevated thyroid stimulating hormone (TSH) level. On initial assessment, the nurse would anticipate which of the following findings?

Correct Answer: A

Rationale: Lethargy. Hypothyroidism slows metabolism, leading to symptoms like lethargy, constipation, and cold intolerance.

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