ATI RN
Mental Health Nursing Practice Questions Questions
Question 1 of 5
When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:
Correct Answer: D
Rationale: Anosognosia is a lack of insight that affects patients with schizophrenia, leading them to deny or lack awareness of their illness. This lack of awareness often results in patients refusing medication because they genuinely believe they are not ill and do not need treatment. It is crucial for healthcare providers to approach such situations with understanding and empathy, recognizing the impact of anosognosia on treatment adherence.
Question 2 of 5
Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:
Correct Answer: C
Rationale: Individuals with schizophrenia often turn to excessive alcohol consumption as a way to manage symptoms of anxiety and depression. This maladaptive coping mechanism can exacerbate the challenges associated with schizophrenia and may hinder effective treatment outcomes. Recognizing the presence of anxiety and depression alongside alcohol abuse is crucial for providing holistic care and support to individuals with schizophrenia.
Question 3 of 5
Which response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar disorder and her support system? Select the incorrect one.
Correct Answer: B
Rationale: In managing bipolar disorder, it is vital to educate the patient and their support system about triggers like alcohol and caffeine, the significance of good sleep, and the need for family involvement. However, the statement in choice B is incorrect. While antidepressants need to be carefully monitored in bipolar disorder, they can be used in conjunction with mood stabilizers to manage depression in some cases.
Question 4 of 5
Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select one that doesn't apply.
Correct Answer: C
Rationale: **Rationale:** **Correct Answer (C) - "Lithium may help me lose the few extra pounds I tend to carry around."** This statement is incorrect and demonstrates a misunderstanding of lithium therapy. Lithium is not associated with weight loss; in fact, it is widely documented to cause **weight gain** as a common side effect. The mechanism involves increased thirst and fluid retention, metabolic changes, and potential hypothyroidism, all of which can contribute to higher body weight. Patients are often counseled about this side effect to manage expectations and adopt strategies like dietary modifications. Thus, the idea that lithium aids weight loss is factually wrong and reflects a lack of proper education about the medication’s effects. **Incorrect Choices:** **A: "I remind myself to consistently drink six 12-ounce glasses of fluid every day."** This statement is accurate and reflects proper understanding. Lithium requires **adequate hydration** to maintain therapeutic serum levels and reduce the risk of toxicity. Dehydration can lead to elevated lithium concentrations, increasing the likelihood of adverse effects like tremors, confusion, or renal damage. Patients are typically advised to consume 2–3 liters of fluids daily and maintain consistent salt intake. The specificity of "six 12-ounce glasses" aligns with general guidelines, showing the patient’s awareness of this critical requirement. **B: "I discussed the diuretic prescribed by my cardiologist with my psychiatric care provider."** This statement is correct and demonstrates **appropriate medication management**. Diuretics (especially thiazides) can significantly increase lithium levels by reducing renal excretion, posing a risk of toxicity. Coordination between healthcare providers is essential to adjust lithium doses or monitor levels closely when diuretics are used. The patient’s proactive communication reflects an understanding of the importance of interdisciplinary care and lithium’s narrow therapeutic index. **D: "I take my lithium on an empty stomach to help with absorption."** While this statement contains a common misconception, it is not entirely incorrect. Lithium is generally **well-absorbed** regardless of food, though taking it with food may reduce gastrointestinal side effects like nausea. However, the belief that empty stomach administration enhances absorption is not clinically significant enough to be harmful, as bioavailability is not drastically affected. Thus, this choice does not reflect a critical misunderstanding like option C does. **Conclusion:** Option C stands out as the only choice that directly contradicts evidence-based knowledge about lithium, while the others reflect either correct practices (A, B) or minor, non-critical inaccuracies (D). The focus on weight loss is particularly misleading, as it could delay interventions for actual side effects like weight gain or electrolyte imbalances.
Question 5 of 5
The healthcare provider is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the healthcare provider stress to the patient? Select one that does not apply.
Correct Answer: C
Rationale: Lithium is a mood stabilizer commonly used for bipolar disorder, but it has a narrow therapeutic index, making early recognition of toxicity crucial. The correct answer is C (Improved vision) because this is never listed as a sign of lithium toxicity in clinical guidelines or pharmacological literature. Vision changes associated with lithium are typically **blurred vision** (a sign of severe toxicity) rather than improved vision, which has no pathophysiological basis in lithium's mechanism of action or side effect profile. **Why the other options are incorrect:** **A: Increased attentiveness** – While this may seem unrelated, it can actually be an early sign of mild lithium toxicity. Lithium affects the central nervous system (CNS), and subtle cognitive changes, including unusual alertness or cognitive hyperactivity, can precede more severe neurological symptoms like tremors or confusion. Early toxicity may manifest as paradoxical effects before progressing to impairment. **B: Getting up at night to urinate** – Polyuria (excessive urination) is a classic **early** side effect of lithium due to its interference with renal concentrating ability, often leading to nephrogenic diabetes insipidus. Patients frequently report nocturia (nighttime urination) before other symptoms arise. This is a well-documented and clinically significant warning sign. **D: An upset stomach for no apparent reason** – Gastrointestinal disturbances (nausea, vomiting, diarrhea) are among the **earliest** and most common signs of lithium toxicity. These symptoms result from lithium's irritation of the gastric mucosa and its impact on the CNS at higher serum levels. Patients are routinely advised to monitor for unexplained GI distress as a potential red flag. **Why C is correct:** Improved vision is not associated with lithium toxicity or its therapeutic effects. While blurred vision or difficulty focusing can occur in severe toxicity, **enhanced** visual acuity has no physiological correlation with lithium’s pharmacological actions (e.g., altered sodium transport in neurons and kidneys). This distractor is included to test the student’s ability to differentiate between plausible side effects and unrelated, implausible symptoms. The question reinforces the importance of recognizing **early** versus **late** and **severe** toxicity signs. Nocturia, GI upset, and subtle CNS changes precede life-threatening symptoms (ataxia, seizures, coma), whereas improved vision is irrelevant to lithium’s adverse effects. Students must prioritize memorizing clinically validated symptoms and disregarding distractors without a pathophysiological basis.