Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 22-year-old woman diagnosed with bipolar disorder missed her last two appointments with the PMHNP after she was started on lithium (Eskalith). Her mother brought her to a third appointment. The patient was excited to see the PMHNP, as evidenced by her rapid rate of speech and discussion about the book she was writing. The patient went on to say that God had spoken directly to her and given her a message that only she could give to the world. She said she hadn’t been able to sleep for at least 1 week because she had been so busy working on this book, but she felt “absolutely incredible” despite her lack of sleep. Both the patient and the mother insist she has not stopped taking her medication. The PMHNP orders laboratory studies, including a lithium level. Which level of lithium will be subtherapeutic and indicate a need for an increased dose?
A. 5 mEq/L
A lithium level of 5 mEq/L is critically high and would indicate severe toxicity, not subtherapeutic dosing.
B. 0.5 mEq/L
A lithium level of 0.5 mEq/L is at the low end or below the therapeutic range for acute mania (0.8–1.2 mEq/L), suggesting subtherapeutic dosing and a need for an increased dose.
C. 1.2 mEq/L
A lithium level of 1.2 mEq/L is within the therapeutic range for acute mania and would not indicate underdosing.
D. 15 mEq/L
A lithium level of 15 mEq/L is lethally toxic and requires immediate medical intervention, not dose escalation.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: A lithium level of 5 mEq/L is critically high and would indicate severe toxicity, not subtherapeutic dosing.
Choice B reason: A lithium level of 0.5 mEq/L is at the low end or below the therapeutic range for acute mania (0.8–1.2 mEq/L), suggesting subtherapeutic dosing and a need for an increased dose.
Choice C reason: A lithium level of 1.2 mEq/L is within the therapeutic range for acute mania and would not indicate underdosing.
Choice D reason: A lithium level of 15 mEq/L is lethally toxic and requires immediate medical intervention, not dose escalation.
Similar Questions
The nurse practitioner provides education about treatments to a 45-year-old woman with a diagnosis of chronic low back pain. Which of the following is NOT considered a first-line treatment for chronic low back pain?
A. Exercise therapy
Exercise therapy is a cornerstone of first-line treatment, improving strength, flexibility, and pain outcomes.
B. Cognitive behavioral therapy
Cognitive behavioral therapy addresses the psychosocial aspects of chronic pain and is recommended as first-line management.
C. Spinal manipulation
Spinal manipulation is not universally considered first-line treatment; it is adjunctive and varies in effectiveness depending on provider and patient.
D. Advice to remain active
Encouraging patients to remain active is first-line advice, as immobility can worsen pain and disability.
Full Explanation
Choice A reason: Exercise therapy is a cornerstone of first-line treatment, improving strength, flexibility, and pain outcomes.
Choice B reason: Cognitive behavioral therapy addresses the psychosocial aspects of chronic pain and is recommended as first-line management.
Choice C reason: Spinal manipulation is not universally considered first-line treatment; it is adjunctive and varies in effectiveness depending on provider and patient.
Choice D reason: Encouraging patients to remain active is first-line advice, as immobility can worsen pain and disability.
The PMHNP is treating an 81-year-old man believed to have dementia. She asks him questions about memories that his family has described as prominent aspects of his life. The patient is unable to recall any of these memories. Which area of the brain is affected?
A. Hippocampus
The hippocampus is central to the formation and retrieval of long-term memories. Impairment in this region leads to significant anterograde and retrograde memory deficits seen in dementia.
B. Hypothalamus
The hypothalamus regulates homeostasis and autonomic functions but does not play a primary role in memory recall.
C. Thalamus
The thalamus acts as a relay station for sensory and motor signals and contributes to attention and consciousness but is not the main center for episodic memory retrieval.
D. Amygdala
The amygdala is involved in emotion, fear responses, and emotional memory processing, not the recall of specific episodic memories.
Full Explanation
Choice A reason: The hippocampus is central to the formation and retrieval of long-term memories. Impairment in this region leads to significant anterograde and retrograde memory deficits seen in dementia.
Choice B reason: The hypothalamus regulates homeostasis and autonomic functions but does not play a primary role in memory recall.
Choice C reason: The thalamus acts as a relay station for sensory and motor signals and contributes to attention and consciousness but is not the main center for episodic memory retrieval.
Choice D reason: The amygdala is involved in emotion, fear responses, and emotional memory processing, not the recall of specific episodic memories.
A 30-year-old woman who has tried for a year to become pregnant presents to the nurse practitioner, who diagnoses cervical stenosis as the probable cause of her infertility. Which is the most appropriate treatment?
A. IUD insertion
IUD insertion is a contraceptive method and would not address cervical stenosis or aid fertility.
B. Cervical dilation
Cervical dilation is the standard treatment for cervical stenosis to mechanically open the cervical canal and restore patency for conception.
C. Colposcopy
Colposcopy is a diagnostic procedure for abnormal cervical findings, not a therapeutic intervention for stenosis.
D. LEEP procedure
LEEP (Loop Electrosurgical Excision Procedure) removes abnormal cervical tissue, not indicated for mechanical stenosis without dysplasia.
Full Explanation
Choice A reason: IUD insertion is a contraceptive method and would not address cervical stenosis or aid fertility.
Choice B reason: Cervical dilation is the standard treatment for cervical stenosis to mechanically open the cervical canal and restore patency for conception.
Choice C reason: Colposcopy is a diagnostic procedure for abnormal cervical findings, not a therapeutic intervention for stenosis.
Choice D reason: LEEP (Loop Electrosurgical Excision Procedure) removes abnormal cervical tissue, not indicated for mechanical stenosis without dysplasia.