Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 155

1. A 35-year-old client is receiving psychopharmacological treatment of his major depression with tranylcypromine sulfate (Parnate), a monoamine oxidase (MAO) inhibitor. The nurse teaches the client that while he is taking this type of antidepressant, he needs to restrict his dietary intake of:

A) Potassium-rich foods
B) Tryptophan
C) Tyramine
D) Saturated fats

2. The nurse will be alert to the most potentially lifethreatening side effect associated with the administration of monoamine oxidase (MAO) inhibitor. This is:

A) Oculogyric crisis
B) Hypertensive crisis
C) Orthostatic hypotension
D) Tardive dyskinesia

3. A 38-year-old female client with a history of chronic schizophrenia, paranoid type, is currently an outpatient at the local mental health and mental retardation clinic.The client comes in once a week for medication evaluation and/or refills. She self-administers haloperidol 5 mg twice a day and benztropine 1 mg once a day.During a recent clinic visit, she says to the nurse, 'I can - t stay still at night. I toss and turn and can - t fall asleep.' The nurse suspects that she may be experiencing:

A) Akathisia
B) Akinesia
C) Dystonia
D) Opisthotonos

4. On assessment, the nurse learns that a chronic paranoid schizophrenic has been taking 'the blue pill' (haloperidol) in the morning and evening, and 'the white pill'(benztropine) right before bedtime. The nurse might suggest to the client that she try:

A) Doubling the daily dose of benztropine
B) Decreasing the haloperidol dosage for a few days
C) Taking the benztropine in the morning
D) Taking her medication with food or milk

5. A 27-year-old male client is admitted to the acute care mental health unit for observation. He has recently lost his job, and his wife told him yesterday that she wants a divorce. The client is placed on suicide precautions. In assessing suicide potential, the nurse should pay close attention to the clients:

A) Level of insight
B) Thought processes
C) Mood and affect
D) Abstracting abilities

1. Right Answer: C
Explanation: (A) The client may need to avoid some potassium-rich foods (such as bananas, raisins, etc.). However, this is not because of the potassium content of these foods. (B) Tryptophan is an essential amino acid that is present in high concentrations in animal and fish protein. (C) The client will need to watch his dietary intake of tyramine. Tyramine is a by-product of the conversion of tyrosine to epinephrine. Tyramine is found in a variety of foods and beverages, ranging from aged cheese to caffeine drinks. Ingestion of tyramine-rich foods while taking a MAO inhibitor may lead to an increase in blood pressure and/or a life-threatening hypertensive crisis. (D) To maintain a healthy lifestyle, restriction of dietary saturated fats is advisable.

2. Right Answer: B
Explanation: (A) Oculogyric crisis, involuntary upward deviation and fixation of the eyeballs, is usually associated with either postencephalitic parkinsonian or drug-induced extrapyramidal symptoms (EPS). (B) Hypertensive crisis is a potentially life-threatening side effect. This may occur if the client ingests foods, beverages, or medications containing tyramine. (C) Orthostatic hypotension, a drop in blood pressure resulting from a rapid change of body position, can occur with the administration of antidepressants. (D) Tardive dyskinesia, characterized by slow, rhythmical, automatic or stereotyped muscular movements, usually is associated with the administration of certain antipsychotic medications.

3. Right Answer: A
Explanation: (A) Akathisia, or motor restlessness, is a reversible EPS frequently associated with the administration of antipsychotic drugs such as haloperidol. (B) Akinesia, or muscular or motor retardation, is an example of reversible EPS frequently associated with the administration of major tranquilizers such as haloperidol. (C) Acute dystonic reactions, bizarre and severe muscle contractions usually of the tongue, face, neck or extraocular muscles, are examples of EPS. (D) Opisthotonos, a severe type of whole-body dystonic reaction in which the head and heels are bent backward while the body is bowed forward, is an example of EPS.

4. Right Answer: C
Explanation: (A) Suggesting that a client increase a medication dosage is an inappropriate (and illegal) nursing action. This action requires a physicians order. (B) To suggest that a client decrease a medication dosage is an inappropriate (and illegal) nursing action. This action requires a physicians order. (C) This response is an appropriate independent nursing action. Because motorrestlessness can also be a side effect of cogentin, the nurse may suggest that the client try taking the drug early in the day rather than at bedtime. (D) Certain medications can cause gastric irritation and may be taken with food or milk to prevent this side effect.

5. Right Answer: C
Explanation: (A) Assessing the clients level of insight is an important part of the mental status exam (MSE), but it does not reflect suicide potential. (B) Assessing the clients thought processes is an important part of the MSE, but it does not reflect suicide potential. (C) Assessing the clients mood and affect is an important part of theMSE, and it can be a very valuable indicator of suicide potential. Frequently a client who has decided to proceed with suicide plans will exhibit a suddenly improved mood and affect. (D) Assessing a clients abstracting abilities is an important part of the MSE, but it does not reflect suicide potential.

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