HESI LPN
HESI Mental Health
1. A client with bipolar disorder is prescribed lithium. What is the most important instruction the nurse should provide?
- A. Avoid foods high in potassium while taking this medication.
- B. Take your medication with food to prevent nausea.
- C. Be sure to maintain a consistent sodium intake.
- D. You can stop taking the medication once your symptoms improve.
Correct answer: C
Rationale: Maintaining a consistent sodium intake is crucial for clients taking lithium because changes in sodium levels can impact lithium concentrations, potentially leading to toxicity. It is essential to avoid excessive sodium intake, as both low and high levels can affect lithium levels. Choices A, B, and D are incorrect. A high potassium diet is not a concern with lithium therapy. While taking lithium with food can help reduce gastrointestinal side effects, it is not the most important instruction. Finally, abruptly stopping lithium can lead to a recurrence of symptoms or a worsening of the condition, so it is vital to follow the prescribed regimen.
2. A client with depression reports difficulty sleeping. What is the most appropriate nursing intervention?
- A. Encourage the client to take short naps during the day.
- B. Suggest the client drink a warm beverage before bedtime.
- C. Recommend the client exercise immediately before bedtime.
- D. Advise the client to take a sleep aid nightly.
Correct answer: B
Rationale: The most appropriate nursing intervention for a client with depression reporting difficulty sleeping is to suggest the client drink a warm beverage before bedtime. A warm beverage can promote relaxation and help establish a bedtime routine, which may aid in improving sleep quality. Encouraging short naps during the day (Choice A) may disrupt the client's nighttime sleep pattern. Recommending exercise immediately before bedtime (Choice C) can have a stimulating effect, making it harder for the client to fall asleep. Advising the client to take a sleep aid nightly (Choice D) should only be considered after other non-pharmacological interventions have been attempted and in consultation with a healthcare provider due to potential side effects and risks associated with sleep aids.
3. A child with diabetes insipidus is being treated with vasopressin. The nurse would assess the child closely for signs and symptoms of which condition?
- A. Syndrome of inappropriate antidiuretic hormone (SIADH)
- B. Thyroid storm
- C. Cushing syndrome
- D. Vitamin D toxicity
Correct answer: A
Rationale: The correct answer is A: Syndrome of inappropriate antidiuretic hormone (SIADH). Vasopressin is a medication used to treat diabetes insipidus by increasing water reabsorption in the kidneys. However, an excessive dose of vasopressin can lead to water retention, causing SIADH, which is characterized by dilutional hyponatremia. Choices B, C, and D are incorrect. Thyroid storm is a severe form of hyperthyroidism characterized by increased metabolism and can lead to life-threatening complications. Cushing syndrome results from excess cortisol production and is characterized by weight gain, hypertension, and other features. Vitamin D toxicity occurs due to an overdose of vitamin D, leading to hypercalcemia and symptoms such as nausea, vomiting, and weakness.
4. A healthcare provider is reviewing a client's medication list during a routine visit. Which action is most important to ensure medication safety?
- A. Ask the client about any allergies to medications
- B. Review the purposes of each medication
- C. Check for potential drug interactions
- D. All of the above
Correct answer: D
Rationale: A comprehensive review of allergies, medication purposes, and potential interactions is crucial for ensuring medication safety. Asking about allergies helps prevent adverse reactions, reviewing medication purposes ensures the correct use of each drug, and checking for potential drug interactions reduces the risk of harmful effects when medications interact. Choosing 'All of the above' is the correct answer because all three actions are essential steps to enhance medication safety. Options A, B, and C individually play vital roles in promoting medication safety, making option D the most appropriate choice.
5. A nurse is providing discharge teaching to a client with schizophrenia who is prescribed clozapine (Clozaril). Which information should the nurse include?
- A. You need to come in for regular blood tests.
- B. This medication can cause weight loss.
- C. You can stop taking this medication once you feel better.
- D. Avoid foods high in tyramine while on this medication.
Correct answer: A
Rationale: The correct answer is A: 'You need to come in for regular blood tests.' Clozapine can cause agranulocytosis, a potentially life-threatening condition, so regular blood tests are required to monitor the client's white blood cell count. Choice B is incorrect because clozapine is associated with weight gain, not weight loss. Choice C is incorrect because the client should never stop taking clozapine abruptly due to the risk of withdrawal symptoms and symptom relapse. Choice D is incorrect because avoiding foods high in tyramine is typically associated with MAOIs, not clozapine.