D449 Psychology and Mental Health - Set 2 - Part 1

Correct Answer: Limit setting

Option c is correct because adolescents with depression frequently present with aggression, anger, outbursts, vandalism, and skipping class rather than the typical sadness and withdrawal commonly seen in depressed adults. Option a is incorrect because typical adult depression symptoms include depressed mood, anhedonia, and psychomotor retardation, which differ significantly from the aggressive and defiant behavioral presentation commonly observed in depressed adolescents. Option b is incorrect because oppositional defiant disorder involves a persistent pattern of hostile and defiant behavior toward authority figures, whereas this student's sudden behavioral shift from social engagement suggests an underlying mood change. Option d is incorrect because conduct disorder involves a long-standing pattern of violating societal rules and the rights of others, whereas this student's abrupt change from previously social behavior points toward a depressive episode instead.

Correct Answer: Suicide risk evaluation

Option a is correct because depressed patients, especially adolescents, carry an increased risk for suicidal thoughts and behaviors, making suicide risk assessment the highest priority before any other care plan interventions. Option b is incorrect because although nutritional status screening addresses the weight loss concern, it does not take priority over assessing for suicide risk, which represents the most immediate and life-threatening complication of adolescent depression. Option c is incorrect because cognitive function testing may help evaluate concentration difficulties, but it is secondary to determining whether the depressed adolescent is experiencing suicidal ideation, which poses an immediate safety threat. Option d is incorrect because family conflict assessment can help identify contributing stressors for the adolescent's depression, but ensuring the patient's safety through suicide risk evaluation must always come before exploring psychosocial factors.

Correct Answer: Effective therapeutic intervention response

Option d is correct because signs that depression interventions are working include increased mood, talking about the future, and making plans, all of which demonstrate renewed engagement with life and improved emotional functioning. Option a is incorrect because treatment resistance involves a lack of response to therapeutic interventions rather than improvement, and this adolescent is demonstrating positive behavioral changes including optimism and future planning consistent with recovery. Option b is incorrect because symptom masking through social desirability would typically involve superficial compliance without genuine behavioral changes, whereas this adolescent is actively initiating future-oriented planning and expressing authentic optimism. Option c is incorrect because a manic episode would present with grandiosity, decreased need for sleep, and pressured speech, whereas this adolescent's optimism and college planning represent realistic and goal-directed thinking consi

Correct Answer: Stressful life events and personal losses

Option b is correct because depression in adolescents can be triggered by many factors including loss of a family member, stressful life events, relationship breakups, and other significant personal losses that overwhelm coping abilities. Option a is incorrect because although hormonal changes during puberty can contribute to mood fluctuations, attributing depression solely to hormones oversimplifies the condition and ignores the significant role of psychosocial stressors and life events. Option c is incorrect because while genetic predisposition may increase vulnerability to depression, identifying it as the sole cause is inaccurate since environmental factors such as loss, stress, and trauma play equally important contributing roles. Option d is incorrect because academic pressure can certainly contribute to adolescent depression, but this response is too narrow and fails to capture the broader range of stressful life events and losses that commonly trigger depressive episodes.

Correct Answer: Cognitive behavioral therapy and exercise

Option c is correct because cognitive behavioral therapy and exercise are both evidence-based treatments for adolescent depression that address negative thought patterns while promoting physical well-being and natural mood improvement through activity. Option a is incorrect because while pharmacotherapy may be appropriate for adolescent depression, physical restraints are not a depression treatment and are reserved for situations involving immediate danger to the patient or to others nearby. Option b is incorrect because electroconvulsive therapy is typically reserved for severe or treatment-resistant depression, and isolation is contraindicated as it can worsen depressive symptoms by increasing feelings of loneliness and worthlessness. Option d is incorrect because vagus nerve stimulation is generally reserved for treatment-resistant cases rather than moderate depression, and sedation is not a therapeutic intervention for depression and may mask important symptom changes.

Correct Answer: Increased capability for self-harm

Option d is correct because SSRIs can increase energy levels before fully resolving depressive thoughts, giving patients who still feel hopeless the renewed physical and mental capacity to carry out a suicidal plan. Option a is incorrect because serotonin syndrome typically presents with agitation, fever, diaphoresis, and tremors occurring as a cluster of symptoms, whereas this patient's increased energy with persistent hopelessness is more concerning for suicide risk. Option b is incorrect because the medication appears to be producing initial effects by increasing the patient's energy and talkativeness, suggesting it is beginning to work rather than being therapeutically ineffective for this patient's condition. Option c is incorrect because a manic episode would include grandiosity, decreased sleep need, and pressured speech as prominent features, whereas this patient's increased energy paired with ongoing hopelessness is more consistent with partial SSRI respons

Correct Answer: First few weeks after starting

Option a is correct because the risk of suicidal thoughts and behaviors is highest in adolescents and young adults during the first few weeks of starting SSRI medications, before the full therapeutic effect stabilizes mood. Option b is incorrect because after six months of treatment, the medication has typically reached full therapeutic effectiveness and the patient's mood has stabilized, making this a lower-risk period compared to the initial weeks of therapy. Option c is incorrect because SSRIs do not produce immediate effects upon the first dose, as these medications require time to build up in the system, so the risk emerges gradually over the first weeks rather than instantly. Option d is incorrect because while medication tapering requires monitoring, the highest risk period for increased suicidal thoughts specifically occurs during the initial weeks of starting SSRI therapy in adolescents and young adults.

Correct Answer: Serotonin syndrome reaction

Option c is correct because agitation, fever, diaphoresis, and tremors are hallmark signs of serotonin syndrome, which can develop when SSRIs like paroxetine are combined with serotonin-enhancing supplements such as St. John's Wort. Option a is incorrect because neuroleptic malignant syndrome is associated with antipsychotic medications rather than SSRIs, and while it shares some features like fever, it typically includes severe muscle rigidity and altered mental status as distinguishing features. Option b is incorrect because extrapyramidal symptoms such as dystonia, akathisia, and tardive dyskinesia result from dopamine-blocking antipsychotic medications, not from SSRI therapy or interactions with herbal serotonin-enhancing supplements. Option d is incorrect because anticholinergic toxicity presents with dry mouth, urinary retention, constipation, and blurred vision, which differs significantly from the agitation, diaphoresis, and tremors this patient is currently experiencing.

Correct Answer: Increased energy precedes improved mood

Option b is correct because antidepressants increase serotonin levels, which can boost energy before fully lifting depressive mood, giving patients the physical and motivational capacity to act on preexisting suicidal thoughts. Option a is incorrect because antidepressants do not worsen depression severity as part of their therapeutic mechanism; rather, the timing gap between restored energy and improved mood creates a dangerous window where patients can act on suicidal ideation. Option c is incorrect because drug side effects like insomnia or appetite changes do not mimic suicidal behavior, and the increased risk stems from the pharmacological timeline where energy returns before hopelessness fully resolves in the depressed patient. Option d is incorrect because medication-induced psychosis is not a typical response to antidepressant therapy, and the paradoxical danger arises from the differential timing of energy restoration versus mood improvement rather than from psychotic symptoms

Correct Answer: Educating that full effects need two-plus weeks

Option d is correct because SSRIs require two or more weeks to reach full therapeutic effectiveness, and educating the patient about this timeline helps manage expectations while the medication continues building to therapeutic levels. Option a is incorrect because recommending immediate discontinuation of an SSRI showing partial improvement through increased energy would be premature and potentially dangerous, as abrupt stopping can cause withdrawal symptoms and worsened depression. Option b is incorrect because suggesting the patient double their dosage without a prescriber's order is outside the nurse's scope of practice and could increase the risk of adverse effects including serotonin syndrome from excessive serotonin activity. Option c is incorrect because continuing periods of sadness during the first weeks of SSRI therapy is expected rather than indicative of treatment failure, since the full antidepressant effects require adequate time to fully develop.

Correct Answer: Tardive dyskinesia from prolonged use

Option a is correct because tardive dyskinesia involves involuntary rhythmic movements of the tongue, lips, and face that develop with prolonged use of first-generation antipsychotics like haloperidol and may become irreversible over time. Option b is incorrect because acute dystonic reactions present with sudden, sustained muscle contractions of the neck, eyes, or tongue occurring shortly after medication initiation, unlike the gradual onset of rhythmic involuntary movements seen here. Option c is incorrect because drug-induced parkinsonism manifests with tremors, rigidity, bradykinesia, and shuffling gait rather than the rhythmic tongue and lip movements characteristic of tardive dyskinesia from long-term antipsychotic use. Option d is incorrect because akathisia presents as an intense inner restlessness and inability to sit still, driving the patient to constant movement, which differs entirely from the involuntary rhythmic facial movements described in this scenario.

Correct Answer: Orthostatic hypotension occurrence

Option c is correct because orthostatic hypotension is a common side effect of first-generation antipsychotics like chlorpromazine, causing dizziness when changing positions due to a sudden drop in blood pressure upon standing. Option a is incorrect because extrapyramidal symptoms manifest as involuntary movements, muscle rigidity, or tremors rather than positional dizziness, and they represent a different category of side effects from typical antipsychotic medications. Option b is incorrect because anticholinergic dry mouth effects involve reduced saliva production causing oral dryness, which is unrelated to the positional dizziness experienced when standing that characterizes orthostatic blood pressure changes. Option d is incorrect because neuroleptic malignant syndrome is a rare, life-threatening reaction presenting with severe muscle rigidity, high fever, and autonomic instability, which is far more serious than the positional dizziness described here.

Correct Answer: Dantrolene for symptom management

Option b is correct because dantrolene is the medication used to treat neuroleptic malignant syndrome, a life-threatening reaction to antipsychotics presenting with high fever, severe muscle rigidity, altered consciousness, and autonomic instability. Option a is incorrect because benztropine is used to treat extrapyramidal symptoms such as dystonia and drug-induced parkinsonism, not neuroleptic malignant syndrome, which requires dantrolene and immediate discontinuation of the offending antipsychotic medication. Option c is incorrect because increasing the antipsychotic dosage would worsen neuroleptic malignant syndrome since the condition is caused by the antipsychotic itself, and the drug must be immediately discontinued to prevent further life-threatening deterioration. Option d is incorrect because while benzodiazepines may have a supportive role, dantrolene is the primary pharmacological intervention for neuroleptic malignant syndrome because it directly addresses the dangerous ske

Correct Answer: EPS and anticholinergic effects

Option d is correct because first-generation antipsychotics carry an increased risk of extrapyramidal symptoms, neuroleptic malignant syndrome, anticholinergic effects, seizures, and sexual dysfunction, remembered through the ENRAGED mnemonic for their profile. Option a is incorrect because weight gain and metabolic syndrome are more strongly associated with second-generation atypical antipsychotics rather than first-generation typical antipsychotics, which primarily carry risks for extrapyramidal symptoms and movement disorders. Option b is incorrect because serotonin syndrome is associated with serotonergic medications such as SSRIs and SNRIs, not with first-generation antipsychotics, which primarily act on dopamine receptors and cause movement-related side effects instead. Option c is incorrect because hyperglycemia and cholesterol elevation are characteristic side effects of second-generation atypical antipsychotics included in the metabolic syndrome profile, rather than the moveme

Correct Answer: Altering dopamine activity in brain

Option a is correct because first-generation antipsychotics work by altering the action of dopamine in the central nervous system, primarily blocking dopamine receptors to reduce the positive symptoms of schizophrenia effectively. Option b is incorrect because enhancing GABA effects in the central nervous system describes the mechanism of action for benzodiazepines used to treat anxiety and seizures, not the dopamine-blocking action of first-generation antipsychotic medications. Option c is incorrect because inhibiting serotonin reuptake is the mechanism of action for SSRI antidepressant medications used to treat depression and anxiety, which is fundamentally different from how typical antipsychotics reduce psychotic symptoms. Option d is incorrect because while first-generation antipsychotics may produce anticholinergic side effects, their primary therapeutic mechanism involves dopamine blockade rather than intentional acetylcholine receptor antagonism for treating psychotic symptoms.

Correct Answer: Blood glucose and weight tracking

Option b is correct because second-generation antipsychotics like olanzapine carry significant risk for metabolic syndrome, including hyperglycemia, weight gain, and cholesterol elevation, requiring regular monitoring of blood glucose and body weight. Option a is incorrect because while liver function may be periodically monitored with various medications, daily liver panel testing is not the primary monitoring concern for second-generation antipsychotics, which are primarily associated with metabolic syndrome. Option c is incorrect because hourly neurological checks are not standard monitoring for second-generation antipsychotics, which have a decreased risk of extrapyramidal symptoms compared to first-generation medications and primarily require metabolic monitoring. Option d is incorrect because weekly thyroid hormone measurements are associated with lithium therapy for bipolar disorder rather than second-generation antipsychotics, which require monitoring focused on metabolic param

Correct Answer: White blood cell count results

Option d is correct because clozapine carries a unique risk of agranulocytosis, a dangerous drop in white blood cells that presents with infection signs like sore throat, fever, and mouth ulcers requiring urgent blood count monitoring. Option a is incorrect because serum lithium levels are monitored for patients taking lithium for bipolar disorder, not for patients on clozapine, where the primary hematological concern is agranulocytosis requiring white blood cell count monitoring. Option b is incorrect because while hepatic enzyme monitoring may be part of general medication management, the presenting symptoms of sore throat, fever, and mouth ulcers with clozapine therapy specifically suggest agranulocytosis rather than liver dysfunction. Option c is incorrect because blood urea nitrogen and creatinine are renal function indicators associated with lithium therapy and nephrotoxicity monitoring, not with the agranulocytosis risk that is uniquely associated with clozapine treatment.

Correct Answer: They treat both positive and negative symptoms

Option a is correct because second-generation atypical antipsychotics control both positive symptoms like hallucinations and delusions and negative symptoms like flat affect and avolition, providing broader therapeutic coverage overall. Option b is incorrect because no antipsychotic medication permanently eliminates all psychotic symptoms, and patients with schizophrenia typically require ongoing medication management to maintain symptom control and prevent relapse to their pre-medication state. Option c is incorrect because second-generation antipsychotics carry significant side effects including metabolic syndrome, weight gain, hyperglycemia, cholesterol increase, sedation, and orthostatic hypotension, making the claim of no side effects quite inaccurate. Option d is incorrect because second-generation antipsychotics do not necessarily work faster than first-generation medications; their advantage lies in broader symptom coverage and decreased risk of extrapyramidal symptoms rather t

Correct Answer: Sedation and orthostatic hypotension

Option c is correct because the SCHIZO mnemonic includes sedation causing daytime drowsiness and orthostatic hypotension explaining near-fainting episodes when rising from bed, both commonly reported with risperidone use. Option a is incorrect because sexual dysfunction and hyperglycemia, while part of the second-generation side effect profile, do not explain daytime drowsiness or positional near-fainting, which are specifically caused by sedation and blood pressure changes. Option b is incorrect because cholesterol increase and weight gain are metabolic side effects that develop gradually over time and would not directly explain the patient's acute complaints of daytime drowsiness and near-fainting upon standing. Option d is incorrect because increased appetite and metabolic changes relate to the weight gain component of the side effect profile and do not account for the sedation-related drowsiness or blood pressure-related near-fainting described by this patient.

Correct Answer: Aripiprazole has lower EPS risk

Option b is correct because second-generation antipsychotics like aripiprazole carry a decreased risk of extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome compared to first-generation medications like haloperidol. Option a is incorrect because medication cost is not the primary clinical rationale for choosing between antipsychotic generations, and second-generation medications are often more expensive than older first-generation antipsychotics like haloperidol. Option c is incorrect because haloperidol has significant therapeutic benefit in treating positive symptoms of schizophrenia and remains an important medication option, particularly when first-line atypical antipsychotics are ineffective or contraindicated. Option d is incorrect because haloperidol effectively treats hallucinations and other positive symptoms of schizophrenia by blocking dopamine receptors, and it was a standard treatment for psychotic symptoms before second-generation medications w