Test #2

ANS: B Opioid overdose causes respiratory depression, which is the primary cause of death among opioid abusers. The assessment of the other body systems is not the priority.

A nurse caring for a patient who experienced an opioid overdose will give priority to which focused assessment? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

ANS: A Amitriptyline is a tricyclic antidepressants (TCA) that has a high risk of producing orthostatic hypotension. The patient is placed at even greater risk because of older age and diuretic therapy, which reduces fluid volume. The other options are either unassociated or are remote possibilities.

A 75-year-old patient with a long history of depression begins amitriptyline 100 mg/day. The patient also takes a diuretic daily for hypertension. What is the highest priority nursing diagnosis this patient is at risk for? a. Falls related to dizziness and orthostatic hypotension. b. Ineffective thermoregulation related to anhidrosis. c. Infection related to suppressed white blood cell count. d. Constipation related to slowed gastrointestinal peristalsis.

ANS: D Latino patients often do not express depression as being related to their mood; rather, they present vague somatic symptoms. Noting the client's recent immigration to the United States, the nurse should first screen for other signs and symptoms of depression. While the other options are appropriate interventions, the existence of depression needs to be established or rule out before they are added to the client's plan of care.

A clinic nurse assesses a Latino patient who reports having frequent headaches beginning about 6 months ago when immigrating to the United States. When no organic pathology is found, what intervention should the nurse implement first? a. Providing information regarding stress reduction techniques b. Encouraging the patient to maintain good health habits c. Assessing the client for possible sources of stress d. Screening for signs and symptoms of depression

ANS: B Formication is the term used when an individual describes feeling bugs crawling under the skin. It is seen in cocaine use. The other options refer to altered sensory perceptions of sight and sound or to inventing stories to make up for memory deficit.

A cocaine abuser complains, "There are bugs crawling under my skin." Which term should the nurse use to document this finding? a. Confabulation b. Formication c. Synesthesia d. Euphoria

ANS: B To be of maximal benefit to the patient, anger should be accepted and explored. Apologies by the nurse are unnecessary. The other options are defensive and rigid reactions.

A depressed patient has just responded to the nurse in an overtly angry manner. What is the nurse's best response? a. "I seem to have hit a raw nerve. I'm sorry." b. "You are angry. Let's talk about the issue." c. "Please watch your tone of voice when you speak to me." d. "I don't think I deserved to be shouted at. What's really the matter?"

ANS: D Desipramine is an activating antidepressant, and it might provide a patient who has suicidal ideation with the energy to make an attempt. Because the therapeutic dose and lethal dose are not widely separated, tricyclic antidepressants (TCA) overdose is an often-used suicide plan. Because desipramine appears to be the most toxic TCA, prescribing only a 7-day supply limits the possibility of using the drug in a suicide attempt. The other options are either less relevant or incorrect.

A depressed patient preparing for discharge is prescribed desipramine and will have follow-up outpatient visits. The patient reports, "Why did they gave me only a 1-week supply of my medicine?" Select the nurse's best reply. a. "Federal law limits the amount you may be given at any one time." b. "It will save you money if the drug doesn't work well for your symptoms." c. "This is a way of ensuring that you will come in for your follow-up appointment." d. "Prescribing a small amount of drug addresses our concerns for your continuing safety."

ANS: D PTSD follows exposure to a traumatic event. Symptoms include those described in the scenario, as well as persistent symptoms of arousal and avoidance of stimuli associated with the traumatic event. GAD is an anxiety disorder that lacks a focus or trigger. Agoraphobia is characterized by marked fear or anxiety triggered by real or anticipated exposure to certain situations. A panic attack is an abrupt surge of intense fear or discomfort that peaks within 10 minutes.

A driver was trapped in a car for several hours after an earthquake caused a bridge to collapse. A year later this person still has nightmares and re-experiences feelings of fear associated with being trapped in the car. The assessment findings are consistent with symptoms of which mental health diagnosis? a. Agoraphobia b. Panic attacks c. Generalized anxiety disorder (GAD) d. Posttraumatic stress disorder (PTSD)

ANS: B Lorazepam is a benzodiazepine that has a short half-life. It might be administered safely to older adult patients, although the dose should often be modified downward. It is inadvisable to give benzodiazepines with longer half-lives to older adult patients. None of the other options support safe lorazepam therapy for this patient.

A health care provider prescribes lorazepam for an anxious older adult at a longer than usual dose. To assure patient safety, what is the nurse's best action? a. Assess for a history of drug abuse. b. Administer the drug as prescribed. c. Confer with the health care provider. d. Assess the patient's pupillary reaction to light.

ANS: B In moderate anxiety states, the body is preparing for protective action. Cognitive symptoms include difficulty concentrating, distractibility, narrowed perceptions, short attention span, tangentiality or circumstantiality, and decreased problem-solving ability. Alertness is associated with mild anxiety. Distorted perceptions are associated with severe anxiety. Irrational reasoning is associated with panic.

A nurse is assigned to care for a patient diagnosed with moderate (+2) anxiety. Which assessment findings are most likely? a. Distorted perceptions, disorientation, and defensiveness b. Poor concentration, narrow perceptions, and irritability c. Irrational reasoning and loss of contact with reality d. Alertness, attentiveness, and accurate perceptions

ANS: C, D The patient must avoid foods high in tyramine so as to prevent a hypertensive crisis. Sausage, avocados, and chocolate contain significant amounts of tyramine.

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary guidelines. Which nutritional choices by the patient indicate that the teaching was effective? (Select all that apply.) a. Sausage b. Avocados c. Pork chops d. Strawberries e. Chocolate chip cookies

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

A patient asks, "How does Alcoholics Anonymous (AA) work?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be given a sponsor who will plan your treatment program."

ANS: A Wernicke-Korsakoff syndrome is a mental disorder characterized by amnesia, clouding of consciousness, confabulation (falsification of memory) and memory loss, and peripheral neuropathy. Confabulation is a symptom typically displayed by an individual with Wernicke-Korsakoff syndrome. The individual attempts to make up for memory loss by filling in the blanks with false memories. Auditory hallucinations are often described as hearing voices that no one else can hear. Paranoid delusions are characterized by an unrealistic or unsubstantiated belief that one is in danger. None of these options are symptoms of memory impairment associated with Wernicke-Korsakoff syndrome.

A patient diagnosed with Wernicke-Korsakoff syndrome has the nursing diagnosis impaired memory, related to neurotoxicity of alcohol. Which statement made by the patient confirms the presences of a defining characteristic that applies to this diagnosis? a. "I sometimes make up a story to cover up for something I can't remember." b. "I often hear voices that others claim they don't hear." c. "All of a sudden, I'll have a vivid memory of the accident that killed my son." d. "Regardless of what you say, I know that the mob or CIA is out to kill me."

ANS: C The patient's symptoms suggest benzodiazepine withdrawal. The nurse knows that patients often attempt to manage their own care by discontinuing medication when they begin to feel better. Benzodiazepines should be slowly withdrawn if withdrawal symptoms are to be avoided. Drinking alcohol would result in different symptoms. Development of tolerance and panic attack symptoms would be different from those mentioned.

A patient diagnosed with agoraphobia took alprazolam 0.5 mg three times daily for 3 months and then discontinued it. The next day the patient called the nurse reporting insomnia, shakiness, and sweating. What should be the focus of the nurse's assessment questions? a. Whether the patient may have also been drinking alcohol or taking antihistamines. b. The possibility that the patient has built up tolerance to alprazolam and needs an increased dose. c. The likelihood that the patient is having withdrawal symptoms from abrupt discontinuation of the drug. d. Whether the patient has progressed to panic attacks and needs a nonbenzodiazepine medication.

ANS: B SSRIs often produce sexual dysfunction, such as decreased libido. Patients readily tell nurses about anticholinergic, gastrointestinal, and other side effects, but are not as forthcoming in reporting sexual problems. The nurse might need to ask directly to elicit this information. Patients are more willing to discuss the other options.

A patient diagnosed with depression has taken a selective serotonin reuptake inhibitor (SSRI) for 1 month. The nurse should use direct questions to evaluate which potential side effect? a. Aggressive impulses b. Sexual dysfunction c. Paranoid delusions d. Weight gain

ANS: C Bupropion has no lethal-overdose potential, making it well suited for use in outpatient treatment of depression. Bupropion has a narrow therapeutic index but is far less lethal than TCAs or monoamine oxidase inhibitors (MAOIs). However, it might cause agitation, anxiety, seizures, anorexia, and weight loss.

A patient diagnosed with depression is prescribed the tricyclic antidepressant (TCA) bupropion. What is the benefit of this medication for nonhospitalized patients? a. It has antianxiety properties as well as antidepressant effects. b. It lowers the seizure threshold to a lesser extent than TCAs. c. There is reduced potential for lethal overdose. d. It stimulates appetite and weight gain.

ANS: C The psychomotor energy of agitation might be channeled into simple, repetitive activities. Providing an activity that is of value to others can help relieve guilt. As for the other options, the patient will be unable to lie down, global reassurance is ineffective, and an antipsychotic medication is not indicated.

A patient diagnosed with depression paces, pulls at clothing constantly, and cannot sit for longer than 5 minutes. What nursing intervention should the nurse implement to help manage the client's behavior? a. Reassure the patient that depression is treatable. b. Direct the patient to lie down every 2 hours. c. Ask the patient to assist in a simple, repetitive activity. d. Seek a prescription for a PRN antipsychotic medication.

ANS: B Serotonin dysregulation is hypothesized to play a part in OCD. Relief associated with SSRIs supports this hypothesis. The other theories are nonrelated.

A patient diagnosed with obsessive-compulsive disorder (OCD) experiences improvement after beginning treatment with a selective serotonin reuptake inhibitor (SSRI). This phenomenon supports the theory that OCD is associated with what neurotransmitter issue? a. Norepinephrine deficiency b. Serotonin dysregulation c. Dopamine excess d. GABA deficiency

ANS: D Secondary amines increase the availability and enhance the action of norepinephrine. They do have a similar effect on any of the other options.

A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will significantly increase the availability of which neurotransmitter? a. GABA b. Glutamate c. Serotonin d. Norepinephrine

ANS: D The performance of the pacing-counting ritual is decreasing the patient's anxiety. Stopping will increase anxiety. Rituals should be restricted only when they physically endanger the patient. The other options will not promote anxiety reduction for this patient.

A patient diagnosed with obsessive-compulsive disorder (OCD) paces up and down the corridor counting every floor tile. How should the nurse address the patient's behavior? a. Offer to play cards with the patient in the dayroom as a distraction. b. Encourage the patient to focus by asking, "Why are you pacing and counting?" c. Interrupt the behavior by taking the patient's arm and escort the patient to a quiet area. d. Permit the patient to pace and count while monitoring for safety.

ANS: D Hyperventilation should be addressed immediately by having the patient breathe using a paper bag. Bringing breathing under control will help diminish the other symptoms. The calm presence of the nurse is vital to symptom reduction. The other interventions would not be effective in relieving the hyperventilation.

A patient diagnosed with panic attacks frequently awakens from sleep and is diaphoretic and hyperventilating. What instruction should the nurse provide the patient to help manage this situation in the future? a. Immediately use one of the various relaxation techniques they've learned. b. Immediately use the call bell to alert staff of the panic attack. c. Get out of bed immediately and watch television as a distraction. d. Immediately breathe into a paper bag kept in the nightstand.

ANS: A, B, C, E These measures are designed to help reduce PTSD symptoms. Anger should be expressed and accepted. Patients with PTSD should learn that their feelings are commonly experienced by others with the same disorder. Recounting the traumatic event helps patients integrate the feelings of distress, so limiting such behavior is not therapeutic.

A patient diagnosed with posttraumatic stress disorder (PTSD) has frequent flashbacks and persistent hyperarousal symptoms. Which nursing interventions should be planned to effectively need the patient's needs? (Select all that apply.) a. Offer empathy and support. b. Encourage relaxation activities. c. Encourage verbalization of anger. d. Set limits when the patient begins to tell of the story of the traumatic incident. e. Help the patient associate current feelings and behaviors with trauma experience.

ANS: B Seasonal affective disorder is a depression occurring in conjunction with a seasonal change, most often beginning in fall and winter and remitting in spring in the Northern Hemisphere. The correct answer is the only option that reflects the information regarding the seasonal nature of the disorder.

A patient diagnosed with seasonal affective disorder asks, "Will I ever feel better?" Based on an understanding of this psychopathology, what is the nurse's best response? a. "Your depressed mood will probably spontaneously improve in 6 months to a year." b. "People with seasonal affective disorder usually feel better in spring and summer, when there are longer periods of light." c. "It's important to engage in community activities to improve your depressed mood. Activity stimulates important brain chemicals." d. "Most people with seasonal affective disorder feel better during the fall and winter seasons as they experience the pleasure of the holidays."

ANS: A Propranolol is a beta blocker that interrupts the physiologic responses of anxiety associated with social phobias, such as sweaty palms. Bradycardia may be associated with lightheadedness. The other options are not likely.

A patient diagnosed with social phobia begins propranolol. The nurse should teach the patient to expect what reaction to this therapy? a. Sympathetic nervous system symptoms of anxiety will be reduced. b. A sense of euphoria for 30 minutes after taking the drug. c. Experience amnesia for the social situations that are most intimidating. d. Feeling a little drowsy but having no orthostatic hypotension.

ANS: A Selective serotonin reuptake inhibitors (SSRIs) are approved for panic disorder and might be the most effective and safest agents for prophylaxis and long-term treatment. Benzodiazepines are effective during a panic attack but should not be used for long-term treatment because of the abuse and dependence potentials. It's important that the nurse show compassion for the patient's distress. Meditation may help overall, but not during panic attacks.

A patient had five emergency room visits in the past month and reports, "I feel so nervous. I think I'm having heart attacks." The patient is diagnosed with panic attacks. Which comment by the nurse shows understanding of treatment for panic attacks? a. "Selective serotonin reuptake inhibitors (SSRIs) are often helpful for long-term treatment and prevention of panic attacks." b. "Benzodiazepine tranquilizers are therapeutic for long-term treatment and prevention of panic attacks." c. "No medications are particularly helpful for panic attacks. Let's work on some strategies to help you manage your fears." d. "Panic attacks result from an instability of the neurotransmitter acetylcholine. Meditation will be more helpful than drugs."

ANS: C Cross-addiction occurs with CNS depressant drugs. Chlordiazepoxide is a benzodiazepine, so cross-dependence is expected. The other drugs will not produce cross-dependence.

A patient has a history of alcohol abuse. Which prescription drug would cause the nurse to be most concerned about of its risk for cross-dependency? a. Hydrochlorothiazide b. Benztropine c. Chlordiazepoxide d. Olanzapine

ANS: A There is evidence to suggest that abrupt withdrawal of clonazepam might precipitate status epilepticus. With this in mind, withdrawal from long-term use warrants seizure precautions. The patient does not have an overdose, so flumazenil is not indicated. The other options are inappropriate.

A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's priority action? a. Begin seizure precautions. b. Refer the patient for addiction counseling. c. Institute a behavior modification program. d. Prepare to administer flumazenil.

ANS: C Tolerance to most side effects of benzodiazepines, including drowsiness, develops quickly. There is no need to decrease the dos

A patient has taken diazepam for 1 week for back spasms. The patient reports "feeling sleepy all the time." Which response will best address the patient's concern? a. "The dosage probably needs to be decreased." b. "Drowsiness indicates a paradoxical reaction to the drug." c. "Tolerance to the sedative effect of the drug will develop quickly." d. "Sleepiness is an unavoidable side effect of nonbenzodiazepine drugs."

ANS: B Symptoms of hallucinogen use (e.g., LSD) include depersonalization, loss of reality, hallucinations, synesthesia, panic, paranoid thinking, and loss of contact with reality and synesthesia, which is the blending of senses (e.g., smelling a color or tasting a sound). Data given in the scenario do not support a schizophreniform disorder or formication (abnormal crawling sensations under the skin). While an appropriate assessment question, determining if this ever happened before doesn't focus on cause.

A patient in the emergency department says, "I took a drug that makes me feel like I'm outside my body looking at the world while making colors move like music." What question should the nurse ask to assess for the possible cause of the patient's experience? a. "Have you ever been diagnosed with schizophreniform disorder?" b. "Did you knowly ingest a hallucinogenic substance?" c. "Are you currently taking an antidepressant?" d. "Have you ever experienced anything like this before?"

ANS: A Valium is the drug of choice in status epilepticus because of its rapid action. Each of the other benzodiazepines has a slower onset of action. Buspirone is not indicated to treat seizures.

A patient in the emergency room has status epilepticus. The nurse should anticipate administration of what medication? a. Diazepam (Valium) b. Buspirone (BuSpar) c. Clorazepate (Tranxene) d. Chlordiazepoxide (Librium)

ANS: B, D, E Benzodiazepine toxicity may result from an overdose. Assessment findings include hypotension, somnolence, confusion, and diminished reflexes.

A patient in the emergency room is suspected to have an overdose of benzodiazepines. Which assessment findings validate this diagnosis? (Select all that apply.) a. Blood pressure 180/94 mm Hg b. Diminished reflexes c. Hypervigilance d. Somnolence e. Confusion

ANS: B, C, E Opioid withdrawal symptoms include yawning, rhinorrhea (runny nose), sweating, chills, piloerection (goose bumps), tremor, restlessness, irritability, leg spasm, bone pain, diarrhea, and vomiting. Sexually erection is not generally affected.

A patient is about to begin detox for an opioid addiction. Which statements by the patient demonstrate an understanding of the signs/symptoms of the withdrawal process? (Select all that apply.) a. "I've been told to expect to be constipated." b. "My nose is going to run like I have a bad cold." c. "My legs are going to spasm painfully." d. "I'll have erection issues for several weeks." e. I'm going to have goose bumps from the chills."

ANS: D Severe anxiety requires intervention to relieve the heightened tension and discomfort that the patient is experiencing. Perceptions are often distorted, focusing is difficult, and problem-solving is impossible, even with help. Environmental simplification and kind, firm directions are approaches to decreasing stimuli and pressure. The other options will not be as effective.

A patient is demonstrating severe (+3) anxiety. Nursing interventions should center around which patient need? a. Encouraging ventilation and refocusing attention b. Discussing possible sources of anxiety c. Taking control to guide the patient d. Decreasing stimuli and pressure

ANS: A La belle indifference refers to an attitude of unconcern or indifference about a symptom when the symptom is unconsciously used to lower anxiety. Dissociative disorders are characterized by a disruption in consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior. Dissociative fugue involves a lack of memory for a move or change of identify. A trance is a half-conscious state characterized by an absence of response to external stimuli.

A patient is hospitalized with somatic blindness. The patient is unconcerned about the blindness and says, "I'm sure things will turn out all right." Which term best describes this reaction? a. La belle indifference b. Trance c. Dissociation d. Fugue

ANS: D Drugs that have a high probability for serious interactions (e.g., monoamine oxidase inhibitors {MAOIs} like fluoxetine) will need to be withheld for up to 6 weeks or more as fluoxetine is washing out of the system. The remaining options are too short an interval.

A patient prescribed fluoxetine is being changed to tranylcypromine. The nurse provides education on this change that will include a time lapse between the last dose of fluoxetine and the first dose of tranylcypromine of at least how long? a. 7 days. b. 14 days. c. 3 weeks. d. 6 weeks.

ANS: C The patient's symptoms are suggestive of hypertensive crisis. It is vital to know whether or not the blood pressure is elevated, so obtaining the blood pressure is the necessary first action. The most probable reason for the reaction would be drug-food interaction. The nurse may notify the health care provider and withhold the morning dose as subsequent actions. Cogwheel rigidity is associated with antipsychotic medications.

A patient prescribed phenelzine reports a sudden headache and palpitations. What is the nurse's initial intervention when observing the patient demonstrating dilated pupils and diaphoresis? a. Assess for cogwheel rigidity. b. Notify the health care provider. c. Assess the patient's blood pressure. d. Withhold the morning dose of phenelzine.

ANS: A Flumazenil, which is given to patients who have overdosed with benzodiazepines and so the nurse must be vigilant for signs that the patient is reverting to the preflumazenil state. None of the other options are relevant to this medication.

A patient received one dose of flumazenil. What is the nurse's next action? a. Carefully observe for benzodiazepine overdose symptoms. b. Teach the patient about dietary restrictions. c. Prevent injury during seizure activity. d. Force 500 mL oral fluids over 2 hours.

ANS: D The patient's persistent intrusive thoughts are obsessions, and the need to continually clean is a compulsion. Hence, the patient's disorder can be identified as OCD. The symptoms are not consistent with a fear of interacting with others, extreme fear, or physical symptoms that have no physiological basis.

A patient says, "I have the same continuous and intrusive thoughts that my house is contaminated with lethal bacteria. I spend hours cleaning the walls, floors, and furniture." These symptoms are most consistent with which diagnosis? a. Social phobia b. Panic disorder c. Somatoform disorder d. Obsessive compulsive disorder (OCD)

ANS: B Buspirone's action is entirely different from that of the benzodiazepines. It reduces anxiety, with its accompanying concentration and cognitive problems, but without CNS depression. The patient's description of anxiety indicates that it is interfering with daily life, so medication may be helpful. There is no evidence that the patient is trying to manipulate the nurse.

A patient seeking treatment for anxiety says, "I can't think. My job depends on my ability to think. I need medicine, but the drugs I took a few years ago made me too sleepy. I could lose my job." What information is most important for the nurse to consider when formulating a response? a. All antianxiety medication has sedating properties. b. Buspirone alleviates anxiety without sedation or cognitive clouding. c. The patient's description of anxiety does not warrant treatment with medication. d. The patient may be trying to manipulate the nurse to assist with getting the desired prescription.

ANS: B Tolerance is the need for increasing amounts of a substance to achieve the same effects. The other terms, defined in the text, do not account for this phenomenon.

A patient started diazepam 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. What phenomenon is responsible for this situation? a. Addiction b. Tolerance c. Dependence d. Disinhibition

ANS: D Clomipramine is an antidepressant that has proven effective for obsessive-compulsive disorder (OCD). The other drugs have no proven effectiveness in treating OCD.

A patient states, "I have the same thoughts over and over. I feel compelled to count all my footsteps." The nurse can expect the health care provider to prescribe what medication? a. Alprazolam b. Propranolol c. Clonazepam d. Clomipramine

ANS: A, E Cimetidine increases the plasma level of benzodiazepines. The benzodiazepine interferes with phenytoin metabolism, thus increasing serum levels of the anticonvulsants. The distracters do not reflect actual interactions.

A patient takes antacids, cimetidine, and phenytoin. The health care provider prescribes a benzodiazepine for anxiety. Which drug interactions is the patient at risk for experiencing? (Select all that apply.) a. Increased plasma level of benzodiazepine related to cimetidine therapy b. Increased absorption of the benzodiazepine if taken with the antacid c. Euphoria and disinhibition associated with phenytoin therapy d. Serotonin syndrome associated with cimetidine use e. Potential phenytoin toxicity

ANS: C Selective serotonin reuptake inhibitor (SSRI) commonly causes sexual dysfunction. Changing to another type of antidepressant or adding bupropion in small doses can be helpful. The other options are not compassionate or therapeutic.

A patient tells the nurse, "I've stopped taking sertraline because the drug made me impotent. Which statement by the nurse will provide the best patient support? a. "Your doctor still wants you to continue taking your medication." b. "Have you talked with your therapist regarding your feelings about sex?" c. "Let's talk with your doctor. Changing your medication might be a possibility." d. "Our priority is to treat your depression. Impotence can be addressed in a few weeks."

ANS: A Two factors suggest that the patient should take tapering doses of benzodiazepine while beginning buspirone therapy. Benzodiazepines should be tapered gradually for discontinuation to avoid withdrawal. Buspirone takes 7 to 10 days to begin to exert its therapeutic effect. The other statements about buspirone are incorrect.

A patient who has been taking a benzodiazepine for panic attacks is to be started on buspirone. Which instruction should the nurse provide? a. "Take decreasing doses of the benzodiazepine for several days until the buspirone becomes effective." b. "Stop taking the benzodiazepines immediately. Wait 2 days, and then start the buspirone." c. "You should take buspirone only once a day. More frequent dosing can cause dependency." d. "Tolerance to buspirone may develop in about a month, requiring larger doses to be prescribed."

ANS: A Antidepressant medications typically have a lag time of 2 to 4 weeks before being maximally therapeutic. A patient should be made aware of this instead of expecting symptom relief within 24 to 48 hours. Global reassurance is meaningless. Symptom abatement would not have occurred. Exploring the patient's understanding of the disease process does not address the patient's question.

A patient who was prescribed a selective serotonin reuptake inhibitor (SSRI) 3 days ago says, "I'm so disappointed, this medicine isn't working." What intervention best addresses the client's expressed concern? a. Explaining that it's normal for a time lag between starting the antidepressants and symptom relief b. Reassuring the patient that the medication is an excellent therapy and it will be effective soon c. Critically assessing the patient for indications that there is a lessening of symptoms d. Assessing the patient's understanding of depression

ANS: D Specific phobias typically develop after a traumatic event or observing others going through a traumatic event. The extreme physical and emotional reactions are consistent with panic-level anxiety. Rituals are associated with obsessive-compulsive disorder (OCD). GAD lacks a general focus while an acute stress disorder would not be associated with an event so long ago.

A patient's family member died in the 9/11 World Trade Center explosion. The patient says, "I can't go into tall buildings because I get sweaty, my heart races, and I can't breathe. I get terrifying feelings the building will explode." Which response demonstrates the nurse's understanding of this symptoms/signs? a. "What rituals do you preform to control your anxiety?" b. "Have you ever been diagnosed with generalized anxiety disorder (GAD)?" c. "Your symptoms/signs suggest possible acute stress disorder (ASD)." d. "It appears you are experiencing a specific phobia associated with your family's tragedy."

ANS: A Alcohol ingested with another CNS depressant can produce lethal depressant effects. The other options are not relevant based on the information given in the scenario nor the effects of combining the medication and alcohol.

A pregnant patient experiencing insomnia reports taking diazepam and wine in increasing amounts to be able to sleep. The nurse should teach the patient about what risk associated with this habit? a. Central nervous system (CNS) depression b. Acetaldehyde toxicity c. Fetal alcohol syndrome d. Miscarriage

ANS: B The neonate whose mother has received SSRIs might experience respiratory depression, hypoglycemia, tremor, and low birth weight as part of neonatal serotonin syndrome. The disorder normally is resolved within 2 weeks of birth. The other options are not usually seen as a result of in utero exposure to SSRIs.

A pregnant patient took selective serotonin reuptake inhibitors (SSRIs) during the third trimester of pregnancy. The newborn will be carefully assessed for which neonatal complication? a. Temperature dysregulation b. Serotonin syndrome c. Seizure disorder d. Diabetes

ANS: D Antidepressant effects might take several weeks to be noticeable. Avoidance of tyramine (as is present in aged cheeses) is necessary for monoamine oxidase inhibitors (MAOIs) therapy but not for TCAs. It is not necessary to take TCAs on an empty stomach. Sweating, tremors, and urination problems are not commonly experienced with TCA therapy.

A tricyclic antidepressant (TCA) is prescribed for a patient newly diagnosed with depression. What information should be included in patient teaching? a. "Take this medication on an empty stomach." b. "Do not eat aged cheese while using this medication." c. "You might experience sweating, tremors, and excessive urination." d. "It might be 2 weeks or more before you notice the effects of this medicine."

ANS: A Acute stress reactions are marked by dissociative symptoms such as numbing of emotional responsiveness, feelings of detachment, and decreased awareness of surroundings. The other options list behaviors that are atypical of acute stress reactions.

After a mass transit disaster many injured patients are expected at the emergency room. The nurse prepares to plan interventions for which likely mental health assessment findings? a. Dissociative symptoms, numbing, detachment, and derealization b. Auditory hallucinations and other perceptual distortions including paranoia c. Somatic neurologic disorders and amnesia d. Exaggerated mood including both depression and manic-related elation

ANS: A Depressed patients often want to lie down, whether or not they wish to sleep. Solitude permits self-defeating ruminations and should not be encouraged. Kind firmness in helping the patient adhere to the treatment program is necessary. Because the patient has only been up long enough to eat breakfast, rest should not be necessary. Bargaining is not therapeutic. Threatening the team's displeasure is not therapeutic as a motivator.

After breakfast a depressed patient pleads with the nurse, "Please let me go to my room to lie down for a while." What response should the nurse provide to maintain a therapeutic environment? a. "You need to attend scheduled unit activities so you won't isolate yourself." b. "If you agree to attend the next activity, then you can rest." c. "Just this once, I'll rearrange the activity schedule so you can rest." d. "Your health care team will be displeased if you go to sleep."

ANS: C Cognitive symptoms of severe anxiety include distorted perceptions, difficulty focusing, and ineffective reasoning. Other symptom constellations relate to the other levels.

An anxious patient has distorted perceptions and ineffective reasoning. On an anxiety rating scale, the nurse would expect to record the patient's level of anxiety at what level? a. Mild, +1 b. Moderate, +2 c. Severe, +3 d. Panic, +4

ANS: D Benzodiazepines mute incoming stimuli and evoke less reaction. The hyperalertness and environmental scanning that accompany high anxiety are notably decreased when the drug is effective. Impaired problem-solving is a negative outcome. Because of its sedating properties, the individual might not be more alert, talkative, or active.

An emergency room patient was very anxious after a serious car accident. Lorazepam 2 mg intramuscularly was administered. One hour later, which finding indicates to the nurse that the medication was effective? a. Improved problem-solving skills b. Increased alertness c. Increased verbalization d. Reduced environmental scanning

ANS: A Naloxone, a narcotic antagonist, permits the individual to respond and respirations to improve. However, because most opioids have a longer lasting effect than naloxone, the effects of naloxone will wear off before the effects of the opioid. The administration of naloxone might have to be repeated. If it is not, the individual is in danger of death due to respiratory depression. None of the remaining options would support client safety when considering the effects of a heroin overdose.

An individual experiencing a heroin overdose has been given one dose of naloxone intravenously. What the priority nursing intervention is to assure patient safety? a. Close observation to determine the need for an additional dose of naloxone b. Seizure precautions for 2 hours immediately after administration of naloxone c. Acidification of urine by encouraging the patient to drink cranberry juice d. A nonstimulating environment and administration of oral fluids

ANS: D Heroin is a CNS depressant. It causes respiratory depression and lowered BP, with a compensatory rise in the pulse rate. Only the correct option follows this pattern

An unconscious patient is brought to the emergency department with a suspected heroin overdose. Which vital signs support the suspected diagnosis? a. Blood pressure (BP) 200/100 mm Hg; pulse (P) 92 beats/min; respirations (R) 22 b. BP 150/85 mm Hg; P 76 beats/min; R 28 breaths/min c. BP 110/70 mm Hg; P 84 beats/min; R 20 breaths/min d. BP 70/40 mm Hg; P 100 beats/min; R 10 breaths/min

ANS: D Benzodiazepines enhance the effects of the inhibitory neurotransmitter GABA, slowing neuronal firing. They do not affect dopamine, serotonin, or norepinephrine

By what mechanism does lorazepam reduce anxiety? a. Increasing serotonin levels b. Blocking dopamine receptors c. Depressing norepinephrine levels d. Potentiating gamma-aminobutyric acid (GABA)

ANS: A Assessing for altered social interactions will give the nurse information about whether relationships with significant others are intact or disrupted. Often, the depressed person has withdrawn to the extent that formerly supportive relationships have been disrupted, leaving the patient without situational support. Diversional activities are an integral part of management of the therapeutic milieu. The patient's ability to make decisions would be assessed in other ways. A support system is important but it doesn't address social interactions.

During an interview of a depressed client, why is it important for the nurse to assess social interactions? a. To determine any disruptions in relationships with others b. To identify the client's need for diversional activities therapy c. To determine the presence of an available support system d. To assess the patient's ability to make effective decisions

ANS: D Naltrexone is an opioid receptor antagonist. It compromises the pleasurable effects of alcohol and reduces craving. Naltrexone does not affect sleep or anxiety nor is it an anxiolytic drug that makes drinking uncomfortable.

During the rehabilitation phase of alcoholism treatment, naltrexone is prescribed. Which statement by the client demonstrates that the medication is achieving. It's intented goal to reduce the pleasurable effects of drinking alcohol. The nurse can expect to teach the patient about what medication? a. "I sleep much better than I have in years." b. "I get really sick if I drink now." c. "I'm not as nervous as I was." d. "I don't crave alcohol like I did."

ANS: A, B, E Improved appetite is likely due to the antihistaminic effect of the drug. Anxiety reduction is another positive effect of TCAs. Sedation is a therapeutic effect of some of these drugs as well. Neither improvement in mood nor elimination of suicidal ideations are likely to occur for 2 to 4 weeks.

Evaluation of a patient's response after 1 week of tricyclic antidepressant (TCA) therapy would be expected to focus on what assessment question? (Select all that apply.) a. "Have you noticed a change in your sleep patterns?" b. "Has your appetite improved?" c. "Are you still having suicidal ideations?" d. "Are you feeling less depressed?" e. "Would you say you are less anxious now?"

ANS: D Often the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors. Learning to face those consequences is part of the recovery process. The other options are co-dependent behaviors or are of no help.

Family members of an individual undergoing a 30-day alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search-and-destroy tactics to keep the home alcohol free." c. "Prevent embarrassment by covering for your loved one's lapses." d. "Make your loved one responsible for the consequences of his or her behavior."

ANS: D A blackout is defined as a period of time in which a drinker functions socially but for which there is no memory. The distracters omit aspects of a blackout.

How is a blackout is described? a. A comatose period related to alcohol withdrawal. b. A comatose episode associated with alcohol intoxication and poisoning. c. A time period in which a person who has used alcohol is unresponsive to the environment. d. An episode in which a person under the influence of alcohol functions normally but later is unable to remember.

ANS: A, B, C, D Dependence is marked by multiple criteria defined in the DSM-V. A substance-specific syndrome due to recent ingestion of the substance refers to substance intoxication.

How is substance dependence best defined? (Select all that apply.) a. A compulsion to use a substance b. Loss of control over use of a substance c. A physiological need to use a substance d. Continued use of a substance despite adverse consequences e. A substance-specific syndrome due to recent ingestion of a substance

ANS: B Lowering the threshold set point for anxiety will result in the patient becoming anxious more easily. Thus, lesser effect and ease of handling are incorrect options. Marked personality disorganization would not necessarily occur.

If a patient's threshold set point for anxiety is lowered, the nurse can expect subsequent stressors to: a. have a lesser effect. b. easily reactivate the anxiety response. c. produce marked personality disorganization. d. be easily managed using familiar coping strategies.

ANS: C Steps 8 and 9, making amends, could restore relationships and reduce social isolation from family and former friends. The other steps are less clearly related to this goal.

Loneliness, related to unacceptable interpersonal behaviors is the nursing diagnosis for a patient in an alcohol rehabilitation program. Which AA step is most directly related to this problem? a. Admitted powerlessness over alcohol b. Turned our lives over to a higher power c. Made amends to persons we had harmed d. Tried to carry the AA principles to alcoholics

ANS: A, D Naltrexone, like any drug for treatment of chemical dependence, is only part of a total treatment program. It will help decrease the pleasure associated with alcohol, but it will not eliminate the desire. It reduces craving, which in turn will help reduce the likelihood of relapses. The distracters relate to disulfiram and monoamine oxidase inhibitors.

Naltrexone is prescribed for a patient diagnosed with alcohol dependency. What information should the nurse provide to the patient? (Select all that apply.) a. "This medication is part of a total program to help you remain abstinent from alcohol." b. "Do not use alcohol-containing products, such as aftershave lotion and mouthwash." c. "Avoid foods that contain tyramine, such as aged cheeses and meats." d. "This medication will help reduce the likelihood of a relapse." e. "This medication will eliminate your desire for alcohol."

ANS: B Nortriptyline is a secondary amine with a good side effect profile. It is somewhat sedating, which is helpful to patients with insomnia. The other options are not considered outcomes for this medication.

Nortriptyline was prescribed for a 68-year-old patient diagnosed with depression and insomnia. What assessment question should the nurse ask to determine the effectiveness of nortriptyline? a. "Are you having regular bowel movements?" b. "Are you no longer experiencing insomnia?" c. "Have you been successful with weight loss?" d. "Would you say you are concentrating better?"

ANS: B Selye found that the effects of stress can be seen by objective measurement of structural and clinical changes in the body. Roy nursing theory uses this foundation. None of the other options deal with stress.

The effects of stress can be seen by measurement of clinical changes of the body. This statement is a tenet of which theorist? a. Freud b. Selye c. Peplau d. Sullivan

ANS: D Amphetamines enhance dopamine activity. The psychosis that is induced by amphetamines closely mimics the symptoms of paranoid schizophrenia. The other disorders have less to do with dopamine dysregulation.

The nurse assesses a patient who admits to abusing large quantities of amphetamines. Assessment findings are likely to be similar to which psychiatric disorder? a. Wernicke-Korsakoff syndrome b. Bipolar disorder, manic phase c. Generalized anxiety disorder d. Paranoid schizophrenia

ANS: B Using problem-solving is an appropriate goal for a patient experiencing moderate anxiety, because these patients are capable of problem-solving with assistance. Use of time-out, providing firm guidance and control, and giving parenteral medication are interventions more often used for severe and panic-level anxiety.

The nurse is assigned to care for a patient with moderate anxiety (+2). Which intervention will best manage the patient's signs and symptoms? a. Appropriate use of time-out b. Initiating problem-solving techniques c. Planning care to include firm guidance and control d. Assessing the need for a parenteral antianxiety drug

ANS: C A patient with psychomotor retardation might need assistance with hygiene and grooming often a result of apathy or a lack of interest. While all the other options address client needs, apathy is often the root of most of the client's behaviors and deserves priority.

The nurse observes a severely depressed patient leaving the dining room with a shirt that is soiled from spilled food. What intervention should the nurse implement to assist the client deal with the primary issue? a. Fostering independence by suggesting changing shirts b. Ignoring the spill to avoid embarrassing the patient c. Assisting the patient to change shirts to help with motivation d. Asking the client if they have a clean shirt to help with self-esteem

ANS: A, E Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

The nurse should assure that the milieu for a patient admitted for a hallucinogen overdose should have which features? (Select all that apply.) a. Focused attention on safety b. Well lighted c. Social interaction d. Mentally challenging e. Low sensory stimuli

ANS: A Tolerance refers to the need for increasing amounts of a substance to achieve the same effects. The other terms are not related to needing more of a substance to achieve the same effect.

The nurse suspect that a patient has developed a tolerance for alcohol. Which patient statement supports that suspicion? says, The nurse assesses this phenomenon as related to: a. "I felt good from drinking a six-pack a few months ago. Now I need a few extra cans to get the same high." b. withdrawal. c. co-dependency. d. abstinence syndrome.

ANS: C Benzodiazepines are metabolized in the liver. The cirrhotic liver will slow the metabolism rate of the drugs, leading to an exaggerated response. The distracters are not associated with decreased hepatic function.

The nurse would expect a patient with which comorbid diagnosis to have a magnified response to the usual dose of a benzodiazepine drug? a. Rheumatoid arthritis b. Migraine headache c. Hepatic cirrhosis d. Osteoporosis

ANS: B Flumazenil is a benzodiazepine receptor antagonist. Response occurs within 30 to 60 seconds; however, it might not reverse associated respiratory depression. Because it has a short duration of action and does not speed metabolism of benzodiazepines, administration of flumazenil might need to be repeated several times. Flumazenil is not indicated for treatment of any of the other conditions

The nurse would expect to administer flumazenil for a patient with which diagnosis? a. Acute alcohol withdrawal b. Benzodiazepine overdose c. Benzodiazepine-resistant anxiety d. Psychotic disorder

ANS: A In depersonalization, individuals feel detached from parts of their body or their mental processes. The distracters reflect somatization disorder, conversion disorder, and schizophrenia.

The nurse would expect which comment from a patient diagnosed with depersonalization disorder? a. "I feel like I'm outside my body, watching what's happening." b. "I feel as though someone is reading thoughts in my mind." c. "I know I have cancer, but the doctors can't find it." d. "When I woke up, my legs were paralyzed."

ANS: B Depressed patients evaluate situations as being negative. Cognitive therapy aims at symptom removal by identifying and correcting distorted negative thinking. The other options are not directed at correcting negative thinking.

The plan for a depressed patient includes use of cognitive therapy. Which nursing intervention best supports this therapy? a. Uncovering unconscious conflicts by encouraging description of childhood traumas b. Challenging pessimistic beliefs and recognizing the patient's accomplishments c. Determining areas of mutual understanding between the nurse and patient d. Using role-playing to rehearse new behaviors

ANS: C Depressed patients often allow people to violate their rights and then feel resentful or angry. Assertiveness training will help the patient change her interpersonal style from acquiescent to assertive and reduce resentfulness. Cognitive therapy and working on guilt feelings will not address the passive behavior. It would not be appropriate to include the sibling in the patient's group therapy.

The sibling of a depressed patient says, "When we were children my sister always gave up easily. Now as an adult, everyone in the family takes advantage of her." What is the most appropriate nursing intervention to support the client's self-esteem? a. Begin cognitive therapy to reduce negative thinking. b. Plan measures to reduce inappropriate feelings of guilt. c. Discuss the value of assertiveness training with the patient. d. Invite the sibling to join the patient's group therapy sessions.

ANS: C It is believed that buspirone is a serotonin agonist. Because buspirone is not a benzodiazepine, it does not bind to benzodiazepine receptor sites, affect GABA, or affect norepinephrine. This accounts for its different effects and lack of CNS depression as side effects.

The teaching plan for a patient beginning buspirone should include information identifying this drug as having what property? a. Norepinephrine inhibitor b. Serotonergic antagonist c. Serotonin agonist d. GABA inhibitor

ANS: B, E Patients must be informed that abrupt discontinuation of benzodiazepines produces withdrawal symptoms. Use of herbal preparations such as kava-kava and valerian can produce harmful additive effects. The other options contain information that is inappropriate to teach patients.

The teaching plan for a patient beginning oxazepam should include what instructions? (Select all that apply.) a. Take the drug on an empty stomach. b. Avoid discontinuing the drug abruptly. c. Stop taking the drug if side effects occur. d. Drink only moderate amounts of alcohol. e. Avoid herbal preparations.

ANS: A, E Delirium and seizures are considered serious withdrawal symptoms requiring seizure precautions and frequent monitoring of levels of consciousness. Nausea may be experienced but is not considered a serious side effect of withdrawal. Depressed respirations and increased heart rate are signs of barbiturate overdose.

What are the most important interventions for the nurse to implement with caring for a client experiencing barbiturate withdrawal? (Select all that apply.) a. Monitoring level of consciousness b. Supporting effective respirations c. Medicating for nausea d. Monitoring for tachycardia e. Seizure precautions

ANS: D, E Tricyclic antidepressants (TCAs) like amitriptyline produce anticholinergic (blurred vision) and antiadrenergic (orthostatic hypotension leading to falls and arrhythmias) side effects. Gastrointestinal symptoms, sexual dysfunction, and weight variations are related to selective serotonin reuptake inhibitor (SSRI) therapy. Seizures are seen with bupropion therapy. Agranulocytosis is not considered a major problem with any of the groups of antidepressants.

What are the priority history assessments for a patient beginning amitriptyline therapy? (Select all that apply.) a. Agranulocytosis b. Seizures c. Sexual dysfunction d. Orthostatic hypotension e. Blurred vision

ANS: C The major distinguishing factor between major depressive disorder (MDD) and dysthymic disorder is that dysthymic disorder has persisted for 2 years or more, with low mood occurring more than 50% of the time. It is a disease of chronicity, whereas MDD is a disease of severity. Suicidal ideation can be present in any type of depression. Delusions and hallucinations are noted primarily in psychotic depression.

What assessment data would best support a client's diagnosis of dysthymic? a. Changes in appetite and weight b. Presence of suicidal ideation c. How long symptoms have persisted d. Presence of delusions or hallucinations

ANS: A, C, D Psychomotor agitation is marked by increased, purposeless, repetitive motor activity, often performed with a sense of urgency. Behaviors include pacing, handwringing, and the inability to sit still (fidgeting). Neither singing loudly nor refusing to eat are motor activities.

What excessive behaviors support the nurse's suspections that the client is demonstrating psychomotor agitation? (Select all that apply.) a. Pacing b. Singing loudly c. Handwringing d. Fidgeting e. Refusing to eat

ANS: D Because of decreased liver size and function in older adults, the half-life of benzodiazepines is markedly lengthened to 80 hours. Benzodiazepines with long half-lives are unsuitable for older adults.

What is the half-life of diazepam for an older adult likely to be? a. 10 hours b. 30 hours c. 40 hours d. 80 hours

ANS: B The correct response would provide information relevant to dissociative amnesia, dissociative fugue, or dissociative identity disorder, making it a good assessment question. The other questions are of no particular relevance to a dissociative disorder assessment.

What is the most important assessment question to ask a patient suspected of having a dissociative disorder? a. "Do any members of your family have problems with drugs or alcohol?" b. "Do you ever find yourself in places with no idea how you got there?" c. "How would you describe your current level of anxiety?" d. "How do you think we can be of help to you?"

ANS: A It is necessary to assess cardiovascular function, because cardiovascular reactions can occur suddenly, even several days after the TCA overdose, and can result in acute heart failure. The other options are not as closely aligned with cardiovascular problems.

What is the nurse's highest priority when caring for a patient after a tricyclic antidepressant (TCA) overdose? a. Frequently monitor blood pressure and heart rate/rhythm. b. Monitor for skin rashes, particularly on the torso. c. Measure and record intake and output every 12 hours. d. Institute cooling blankets for hyperthermia.

ANS: A Patients with PTSD are often withdrawn and feel suspicious, detached, or estranged from others. Developing a trusting relationship might be difficult for them; however, the development of trust is fundamental to the therapeutic nurse-patient relationship. The other interventions will not be possible until a trusting relationship exists.

What is the nurse's initial action when working with a patient with diagnosed with posttraumatic stress disorder (PTSD)? a. Assure the patient that the nurse can be trusted. b. Work with the patient to find a way to reduce stress. c. Encourage verbalization rather than physical acts to address anger. d. Support the patient's ability to evaluate past behaviors as either effective or noneffective.

ANS: A Antidepressant medication tends to energize depressed patients, possibly giving them the impetus to act on suicidal ideation that has been present related to the depression. This complication is particularly applicable to adolescents. Some suggest that suicidal ideation might be the actual result of antidepressant therapy. In either case the implication for nursing is clear—patients should be carefully assessed for the presence of suicidal ideation, suicidal plans, and means for carrying out the plans. This option is related to patient safety and takes priority over the other options.

What is the nurse's priority assessment for a patient taking an antidepressant medication? a. Presence of suicidal ideations b. Presence of antiadrenergic side effects c. Presence of anticholinergic side effects d. Presence of symptoms of sexual dysfunction

ANS: B Buspirone provides anxiety relief within 7 to 10 days from the time it is begun. For this reason, benzodiazepines are continued for their anxiolytic effect and gradually tapered as the buspirone becomes effective. The other options are incorrect.

What medication information should the nurse provide the patient newly prescribed buspirone? a. Produces profound sedation. b. Will be effective in 7 to 10 days. c. Has a high risk for development of dependence. d. Is often associated with cross-tolerance with other CNS depressants.

ANS: A Patients with DID have a host personality and one or more alternates. It is not unusual for one of the alternate personalities to be depressed and wish to commit suicide or for a personality to wish to harm the others. Safety is the priority concern in care. None of the other options are directly associated with the primary issues of DID

What should the priority focus of milieu management be for a client diagnosed with dissociative identity disorder (DID)? a. Ensuring client safety b. Stimulating memory return c. Attending insight-oriented group therapy d. Gathering data about family relationships

ANS: B Propofol, an anesthetic, would have a predictable additive effect with alprazolam in producing significant sedation and CNS depression. While the patient needs closer medical supervision, one cannot state that the combination of drugs was safe. Tolerance to alprazolam would occur regardless of use of propofol.

When a patient reports using both alprazolam and propofol, which inference applies? a. The combination of these medications will not result in a drug-drug interaction. b. Potentially lethal sedation and CNS depression would be expected with this drug combination. c. Tolerance to propofol probably developed very quickly in the presence of alprazolam. d. This drug combination was safe, but the patient needs close medical supervision.

ANS: B These drugs are highly addictive. Psychological craving during withdrawal is intense. The physical signs/symptoms of withdrawal, however, are relatively mild. The degree of withdrawal signs/symptoms are not necessarily associated with the route of drug administration.

When caring for patients withdrawing from cocaine and amphetamines, the nurse should plan measures recognizing what unique characteristic of this withdrawal process? a. Physical withdrawal is severe and often fatal. b. Psychological withdrawal is more severe than physical. c. Physical and psychological withdrawal are equally severe. d. Physical withdrawal is a problem only if the individual used injection.

ANS: A MAOIs and ingested tyramine interact to produce hypertensive crisis, a life-threatening medical emergency, so it is necessary to teach the patient foods to avoid. The other options are unrelated to tranylcypromine therapy.

When teaching about the monoamine oxidase inhibitor (MAOI) tranylcypromine, the nurse should consider it a priority to provide what information? a. A list of tyramine-rich foods b. A warning to avoid direct sunlight c. Instructions to manage fever with acetaminophen d. Directions to report dry mouth and blurred vision

ANS: C Strengths serve as the foundation for later therapeutic work to promote more adaptive coping, so identifying and supporting strengths is a fundamental initial intervention. The other options are useful but are not achievable until the patient's coping mechanisms (strengths and weaknesses) have been identified.

When working with a patient diagnosed with dissociative amnesia, the nurse should begin the care by implementing which intervention? a. Setting mutual goals for behavioral changes b. Instituting measures to prevent identity diffusion c. Identifying and supporting the patient's strengths d. Helping the patient develop a realistic self-concept

ANS: D Dysthymia is a depressive disorder marked by chronicity. The depression must have been present more than 50% of the time for at least 2 years. The other options describe major depression and psychotic depression.

Which account of history and symptoms is most consistent with the diagnosis of dysthymia? a. Depressed mood for 2 weeks; anhedonia; feelings of worthlessness b. Delusions of guilt and poverty; weight loss; agitation beginning 3 weeks ago c. Depressed mood for 3 months; suicidal ruminations; hypersomnia; sullen affect d. Depressed for 3 years; poor concentration; anhedonia; low self-esteem; indecision

ANS: A The events that predispose children and adolescents to develop depression involve loss such as death or separation from parents, death of a close relative, death of a pet, a move to another neighborhood, academic problems, or illness or injury that requires hospitalization. This is the only answer that reflects the relationship of loss to the disorder.

Which adolescent would the nurse consider to have the highest priority for health promotion interventions aimed at reducing risk for depression, based on the person's history? a. Parents killed in an auto accident b. Lived with adoptive parents since birth c. Allergies to dust, pollen, and mold d. Frequent conflicts with siblings

ANS: D Dissociative fugue involves unplanned travel away from one's usual home and either confusion about identity or assumption of a new identity. The person does not seem to be wandering but behaves purposefully. The other options relate to body dysmorphic disorder, depersonalization disorder, and hypochondriasis.

Which assessment data supports a patient's diagnosis of dissociative fugue? a. Preoccupation about having a serious disease b. Feeling of detachment from one's body c. Believing that part of the body is ugly or disproportionate d. Having no memory of assuming a new identity

ANS: A, C, E The correct response suggests serotonin syndrome, an acute medical problem requiring immediate medical and nursing attention. The distracters are examples of anticholinergic effects and are not considered emergencies.

Which assessment finding warrants the nurse's priority attention when caring for a patient prescribed a selective serotonin reuptake inhibitor (SSRI)? (Select all that apply.) a. Hyperthermia b. Frontal headache c. Confusion d. Photophobia e. Agitation

ANS: D, E Inhalants are usually CNS depressants, giving rise to confusion and ataxia. The other options relate to cocaine snorting and opioid use.

Which assessment findings support a nurse's suspicion that a patient has possibly been abusing inhalants? (Select all that apply.) a. Perforated nasal septum b. Hypertension c. Pinpoint pupils d. Confusion e. Ataxia

ANS: D A disulfiram reaction consists of any combination of the following symptoms: flushing, sweating, rapid pulse, hypotension, throbbing headache, nausea, vomiting, palpitations, dyspnea, tremor, and weakness. The patient is acutely uncomfortable. The other options do not characterize the disulfiram/alcohol reaction.

Which assessment findings would prompt the nurse to suspect a disulfiram reaction? a. Skin rash, itching, and urticaria b. Pallor, hypotension, and muscle cramping c. Dry skin, bradycardia, fatigue, and headache d. Headache, dyspnea, nausea, vomiting, and flushing

ANS: A The correct entry suggests that weight, sleep pattern, and mood are returning to normal. The other entries suggest that symptoms of depression continue to be present.

Which entry in the medical record best indicates that the treatment plan for a depressed patient was successful? a. Gained 2 lb; sleeping 8 hours nightly; states, "I'm feeling better about my life situation" b. Weight stable; sleeping 6 hours nightly; reports of abdominal pain and headache decreasing c. Gained 6 lb; sleeping 10 hours nightly; sensitive to interpersonal conflicts d. Lost 2 lb; sleeping 5 hours nightly; shows moderate interest in activities

ANS: A Paradoxical reactions to benzodiazepines are most likely in children, older adults, and persons with poor impulse control (such as ADHD) or organic brain syndromes.

Which individual would be most likely to experience a paradoxical reaction to a benzodiazepine drug? a. A child with attention-deficit hyperactivity disorder (ADHD) b. An adult with obsessive-compulsive disorder c. A teenager with an eating disorder d. An adult with major depression

ANS: C Individuals with the depressive variant of melancholia often display anhedonia, depression worse in the morning, early-morning awakening, anorexia and/or weight loss, and inappropriate guilt. It is appropriate to monitor sleep patterns to ascertain if sleep disturbance is present. Homeostasis is contingent on adequate sleep. The distracters are seen in depression with catatonic features, atypical depression, and seasonal affective disorder.

Which intervention has the highest priority for inclusion in the care plan of a client diagnosed with anhedonia? a. Assess history of seasonal variations of mood. b. Observe for increased sensitivity to rejection. c. Monitor and document sleep patterns. d. Assess for echolalia and posturing.

ANS: C The overall affective sense of the depressed person is one of low self-esteem. Guilt often accompanies the low self-esteem. Data about depressed individuals do not suggest the applicability of body image disturbance. Denial and risk for violence may or may not be present.

Which nursing diagnosis is almost universally applicable to persons with depression? a. Ineffective denial b. Disturbed body image c. Chronic low self-esteem d. Risk for other-directed violence

ANS: C Benzodiazepines taken with alcohol produce marked central nervous system (CNS) depression, even death. Antacids prevent absorption. Larger doses of benzodiazepines by themselves are rarely lethal. Depression in and of itself is not an indicator of overdose risk. Suicidal ideation might be present, but benzodiazepines by themselves are rarely lethal.

Which patient behavior should the nurse identify as the greatest risk for overdose with a benzodiazepine? a. Taking the drug with antacids b. Taking the drug before meals c. Combining the drug with alcohol d. Experiencing depression as well as anxiety

ANS: C Often, patients with conversion disorder think that their symptom makes them interesting and that they are not interesting as persons. The nurse should matter-of-factly accept the symptom without focusing on it and direct attention to the person as an individual. Two distracters refer to care of a patient with OCD and care of a patient with PTSD.

Which principle best applies to care of a patient diagnosed with conversion disorder? a. Structure care to provide time for rituals. b. Facilitate progressive review of the trauma. c. Give attention to the patient, not the symptom. d. Permit dependence while the symptoms are acute.

ANS: B This statement suggests that the patient's preoccupation with physical symptoms has decreased. The other options suggest ongoing concern with his or her physical state.

Which statement by a patient diagnosed with somatic symptom disorder indicates that goals for treatment are being achieved? a. "I need to be very careful about what I eat." b. "I can focus on things other than my symptoms." c. "I understand that my doctor is not an expert in everything." d. "I try to figure out my diagnosis by reading articles on the Internet."

ANS: B Patients with anxiety disorders experience discomfort from the anxiety. The patient must feel safe, acknowledged, and cared for before problem-solving can begin. The nurse's first priority is to provide support and understanding. Allowing the patient to remain alone fosters social withdrawal and may allow anxiety to increase. Patients with anxiety seldom lose contact with reality.

Which statement demonstrates a nurse's understanding of the first intervention when caring for a patient experiencing severe anxiety over an impending divorce? a. "Let me you solve the biggest problem the divorce will cause you." b. "I want you know I'll be here to keep you safe." c. "Please tell me what today's date is." d. "You can go into your room and close the door when you need privacy."

ANS: B Delusions associated with depression are congruent with the depressed mood. They often relate to somatic function or being a bad person, or they focus on faults. The other delusions are more likely to be present in an individual with schizophrenia.

Which statement made by a newly admitted depressed patient best demonstrates a depression-related delusion? a. "I am a presidential advisor." b. "Cancer is rotting my body." c. "There are aliens chasing me." d. "I discovered a cure for cancer."

ANS: D Treatment has been successful when an individual can use coping mechanisms to move forward and find meaning in the traumatic event. Continued use of drugs and alcohol is maladaptive. Continued sleep disturbances and insomnia as well as dissociation or depersonalization do not indicate that treatment was effective.

Which statement made by an individual diagnosed with PTSD best indicates that treatment was effective? a. "I'm drinking less now that I've faced my problems." b. "I feel like the accident happened to someone else." c. "I sleep for 3 to 4 hours a night without nightmares." d. "My artwork distracts me and eases my anxiety."

ANS: C After the dexamethasone is given, periodic blood and urine samples are collected and sent to the laboratory to determine whether or not cortisol suppression has occurred. None of the other options accurately describe the dexamethasone suppression test.

Which statement should the nurse include when preparing a patient for a scheduled dexamethasone suppression test? a. "This test will determine whether or not you are clinically depressed." b. "This test is like a computed tomography scan. It will take about 20 minutes and will be painless." c. "You will be given an injection; then, blood and urine samples will be collected." d. "You will not be allowed to eat or drink after midnight, and a fasting blood sample will be collected in the morning."

ANS: A, E The alcohol dehydrogenase in the gastrointestinal tissue of men who are not dependent on alcohol oxidizes a significant amount of CH3CH2OH in the gut before it enters the bloodstream. The inability of women's bodies to undergo this first-pass metabolism accounts for their enhanced vulnerability to alcohol. The remaining options do not reflect accurate research findings.

Which statements accurately portray differences in the effects of alcohol between men and women? (Select all that apply.) a. Women's gastrointestinal systems have less alcohol dehydrogenase, so less ethanol is oxidized on first pass before it enters the bloodstream. b. Hot coffee increases the metabolic rate and speeds oxidation of ethanol more in men than in women. c. Women have higher proportions of body fat, which absorbs alcohol and releases it slowly. d. The microsomal ethanol-oxidizing system in women is less efficient than in men. e. Women become intoxicated more easily than men.

ANS: D The individual moves from experiencing the symptoms of anxiety to the use of coping behaviors to alleviate these symptoms. Panic is a level of anxiety. Crisis involves disorganization, which is not always the end product of anxiety. Disorganization is not always experienced as the product of anxiety.

Which term describes the final stage in the normal process of anxiety? a. Panic b. Crisis c. Disorganization d. Coping

ANS: B, D, E Patients with MDD characteristically display weight change; anorexia produces weight loss, and excessive eating produces weight gain. Sleep disturbance is characteristically present in MDD, with many or early awakenings and hypersomnia seen. Changes in activity include psychomotor retardation and excessive motor agitation. Indecision and poor concentration are characteristic cognitive symptoms. Flight of ideas and increased energy, importance, and elated mood are seen in bipolar disorder, manic type.

Which topics should be included by the nurse preparing psychoeducational groups for patients diagnosed with major depressive disorder (MDD) and their families? (Select all that apply.) a. Flight of ideas b. Changes in weight and sleep c. Feelings of importance or elation d. Psychomotor retardation or agitation e. Inability to concentrate or make decisions

ANS: A TCAs inhibit the reuptake of both norepinephrine and serotonin and because of their nonselectivity produce many side effects. The other options are incorrect statements about the action of TCAs.

Why do patients taking tricyclic antidepressants (TCAs) exhibit more side effects than patients taking selective serotonin reuptake inhibitors (SSRIs)? a. TCAs inhibit reuptake of norepinephrine and serotonin. b. TCAs selectively inhibit dopamine reuptake. c. TCAs selectively block serotonin uptake. d. TCAs block enzymatic breakdown.