ATI RN
Psychobiological Disorders Questions
Question 1 of 5
A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, This medicine isnt working. The nurses best intervention would be to:
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 2 of 5
A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, I took a few extra tablets earlier today and now I feel bad. Which assessments are most critical? Select all that apply.
Correct Answer: C
Rationale: The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. The patient may have urinary retention, but frequency would not be expected.
Question 3 of 5
A patient fearfully runs from chair to chair crying, Theyre coming! Theyre coming! The patient does not follow the staffs directions or respond to verbal interventions. The initial nursing intervention of highest priority is to:
Correct Answer: A
Rationale: Safety is of highest priority because the patient experiencing panic is at high risk for self-injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Offering an outlet for the patients energy can occur when the current panic level subsides. Respecting the patients personal space is a lower priority than safety. Clarification of feelings cannot take place until the level of anxiety is lowered.
Question 4 of 5
A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurses comments and asks, What do you mean? What are they going to do? Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patients level of anxiety?
Correct Answer: B
Rationale: Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a lessthan-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.
Question 5 of 5
A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient?
Correct Answer: A
Rationale: Individuals experiencing severe to panic-level anxiety require a safe environment that is quiet, non-stimulating structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the patient could cause self-harm, and a small floor space in which the patient can move about. A small, empty storage room without windows or furniture would feel like a jail cell. The nurses office or a room with an examining table and instrument cabinets may be over-stimulating and unsafe.