A nurse is caring for a client on a mental health unit.

The nurse needs assistance to perform multiple tasks at this time. For each task, click to specify if the task is best delegated to a licensed practical nurse (LPN) or an assistive personnel (AP).

Administer prescribed medication stat

Monitor the client's status and obtain VS

Apply restraints

Stay with the client

Offer a high-calorie snack to the client

Evaluate for therapeutic effects of meds

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"B"},"F":{"answers":"A"}}

Choice A reason:

Administering IM olanzapine requires knowledge of pharmacology and monitoring for adverse effects. LPNs are licensed to give injections and assess immediate safety, while APs cannot perform invasive medication administration. This addresses urgent safety needs in bipolar mania.

Choice B reason:

Vital signs after antipsychotic use must be interpreted for hypotension or sedation. LPNs can measure and interpret, while APs only record. Monitoring ensures safe response to medication and meets provider’s request for re-evaluation.

Choice C reason:

Restraints involve legal and safety standards. LPNs are trained to apply and monitor circulation and skin integrity. APs may assist but cannot initiate. This protects the client and others during acute agitation.

Choice D reason:

Staying with the client provides observation and reassurance. APs can perform this supportive task without clinical judgment. Continuous presence reduces risk of harm and supports emotional safety.

Choice E reason:

Offering snacks addresses poor nutrition, a common issue in mania. APs can encourage intake and provide food, meeting basic physiological needs. No advanced judgment is required.

Choice F reason:

Evaluating therapeutic effects of olanzapine requires clinical judgment. LPNs assess changes in agitation, aggression, and cooperation. APs cannot interpret medication response. This ensures accurate reporting to the provider.

Task	LPN	AP
Administer prescribed medication stat	✔
Monitor the client's status and obtain VS	✔
Apply restraints	✔
Stay with the client		✔
Offer a high-calorie snack to the client		✔
Evaluate for therapeutic effects of meds	✔

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Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is commonly associated with sexual dysfunction, including decreased libido, delayed orgasm, or erectile difficulties. This is an important teaching point because it can affect adherence to therapy if the client is not prepared for this side effect.

Choice B reason: Drooling is not a typical side effect of fluoxetine. Excessive salivation is more commonly seen with antipsychotics such as clozapine, not SSRIs.

Choice C reason: Improvement in depressive symptoms with fluoxetine usually takes 2 to 4 weeks, not 2 to 3 days. Clients should be counseled to continue taking the medication consistently and not expect immediate relief.

Choice D reason: Appetite changes can occur with SSRIs, but decreased appetite is not a primary or consistent side effect of fluoxetine. Some clients may experience weight changes, but sexual dysfunction is more characteristic.

A. Emotional numbing B. Elevated mood C. Impulsivity D. Anxiety

Correct Answer is C

Explanation

Choice A reason: Emotional numbing is more commonly associated with post-traumatic stress disorder (PTSD) or depressive disorders rather than ADHD. ADHD is characterized by hyperactivity, inattention, and impulsivity, not emotional blunting.

Choice B reason: Elevated mood is typically seen in bipolar disorder during manic episodes. ADHD does not present with sustained elevated mood; instead, it involves distractibility, restlessness, and impulsive behavior.

Choice C reason: Impulsivity is a hallmark symptom of ADHD. Adolescents with ADHD often act without considering consequences, interrupt conversations, and struggle with self-control. This symptom directly aligns with the diagnostic criteria for ADHD.

Choice D reason: Anxiety can co-occur with ADHD but is not a defining feature. While some adolescents with ADHD may experience anxiety due to difficulties in school or social situations, it is not a primary symptom of the disorder.

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A nurse is caring for a client on a mental health unit. The nurse needs assistance to perform multiple tasks at this time. For each task, click to specify if the task is best delegated to a licensed practical nurse (LPN) or an assistive personnel (AP).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has a depressive disorder about fluoxetine (Prozac). Which of the following information should the nurse include in the teaching?

Correct Answer is A

Explanation

A nurse is assessing an adolescent client who has attention deficit hyperactivity disorder (ADHD). Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse in a mental health clinic is caring for a client who reports an increase in headaches and confusion over the past month.

A nurse is preparing a client who has chronic anxiety for discharge from the psychiatric unit. Which of the following instructions should the nurse include in the client's discharge plan?

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A nurse in a mental health facility is assessing a client. For each client assessment finding, specify if the finding is a potential risk for suicide or a protective factor against suicide.

A nurse in an emergency department is assessing a client who has been taking haloperidol for 3 months. The client has a temperature of 39.7° C (103.4° F), blood pressure of 150/110 mm Hg, and muscle rigidity. Which of the following complications should the nurse suspect?

A nurse is caring for a newly admitted client who has obsessive-compulsive disorder (OCD). Which of the following actions should the nurse take first?

A nurse is caring for a client who has schizophrenia and generalized anxiety disorder. The client has a prescription for 0.25 mg PO every 8 hr PRN anxiety. For which of the following client statements should the nurse consider administering alprazolam?

A nurse is discussing comorbidities associated with eating disorders with a newly admitted client. Which of the following conditions should the nurse include in the discussion? (Select all that apply.)

A nurse is caring for a client on a mental health unit.

The nurse needs assistance to perform multiple tasks at this time. For each task, click to specify if the task is best delegated to a licensed practical nurse (LPN) or an assistive personnel (AP).