1.2 Psychosis/Mood & Affect #1 EAQ
A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When unable to do this, the client becomes upset. What should the nurse do? Distract the client, which will help the client forget about touching the chairs Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed
Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed Rationale It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because the client uses the ritual as a defense against anxiety.
A nurse is monitoring a client with the diagnosis of schizophrenia who is experiencing opposing emotions simultaneously. When providing a change-of-shift report, how should the nurse refer to this emotional experience of the client? Double bind Ambivalence Loose association Inappropriate affect
Ambivalence Rationale Ambivalence is the existence of two conflicting emotions, impulses, or desires. Double bind is two conflicting messages, not emotions, in a single communication. Loose associations are not two conflicting emotions but instead the loosening of connections between thoughts. Inappropriate affect is the inappropriate expression of emotions.
A client remains depressed even after an 8-week trial on several antidepressant medications. A decision to initiate electroconvulsive therapy (ECT) is being considered by the treatment team. Which condition is a contraindication to ECT? Brain tumor Type 1 diabetes Hypothyroid disorder Urinary tract infection
Brain tumor Rationale ECT is contraindicated in the presence of a brain tumor, because the treatment causes an increase in intracranial pressure. ECT is not contraindicated in the presence of diabetes, hypothyroid, or urinary tract infection.
A nurse is caring for several clients with major thought disorders such as schizophrenia. They are all being treated with neuroleptic drugs. How do these drugs act in the body to promote mental health? By inhibiting enzymes at the postsynaptic receptor site By decreasing serotonin at the postsynaptic receptor site By increasing dopamine uptake at the postsynaptic receptor site By blocking access to dopamine receptors at the postsynaptic receptor site
By blocking access to dopamine receptors at the postsynaptic receptor site Rationale Neuroleptics block access to dopamine receptors, rather than inhibiting enzymes, at postsynaptic sites. They increase, not decrease, serotonin at postsynaptic sites.
The nurse is assigned to work with a 20-year-old client on an inpatient unit. In assessing the woman, the nurse notes that she is mute, does not show any type of movement, is unresponsive, and appears unaware of her surroundings. What is the best term for the nurse to use to describe these symptoms? Alogia Catatonia Echopraxia Affective flattening
Catatonia Rationale Catatonia is the term to describe stupor, rigidity, or extreme flexibility of the limbs; excitability; confusion; and lack of verbal expression. Alogia is a term used to describe an inability to speak or near-absence of speech. Echopraxia is the term for the mimicking or repetition of the actions of another person. Affective flattening is the term for blunted or constricted facial expression.
Which toxic effect would the nurse find in a client who has overdosed on isocarboxazid? Mydriasis Bradycardia Hypothermia Circulatory collapse
Circulatory collapse Rationale The clinical symptoms of monoamine oxidase inhibitors (MAOIs) generally appears after 12 hours of ingestion. Circulatory collapse is associated with MAOI toxicity. Mydriasis, bradycardia, and hyperthermia are not associated with an isocarboxazid overdose.
Which is a second-generation antidepressant drug? Doxepin Citalopram Protriptyline Trimipramine
Citalopram Rationale Citalopram is an example of a second-generation antidepressant drug. Doxepin, protriptyline, and trimipramine are examples of first-generation antidepressant drugs.
What is the best drug of choice for treating obsessive-compulsive disorder? Imipramine Lithium salts Amitriptyline Clomipramine
Clomipramine Rationale Clomipramine is a tricyclic antidepressant drug prescribed for treating of obsessive-compulsive disorder. Childhood enuresis necessitates the administration of imipramine. Lithium salt is prescribed to treat bipolar disorders. Dysthymias can be treated by the administration of antidepressant drugs such as amitriptyline.
Which statement is true regarding antipsychotic drugs? All first- and second-generation antipsychotics are equally effective. Second-generation antipsychotics pose a risk of extrapyramidal symptoms. First-generation antipsychotics pose a significant risk of metabolic side effects. Clozapine is more effective than other second-generation antipsychotics.
Clozapine is more effective than other second-generation antipsychotics. Rationale Clozapine is a second-generation antipsychotic drug that is more effective than other second-generation antipsychotics. Most (but not all) first- and second-generation antipsychotics are equally effective. Second-generation antipsychotics may cause metabolic side effects such as diabetes and dyslipidemia. First-generation antipsychotics may cause extrapyramidal side effects.
A client with a history of schizophrenia who responds poorly to medication is now being treated for acute depression. In light of the information elicited from the medication list and laboratory results, what does the nurse advise? Come in for weekly blood tests to monitor for drug-induced agranulocytosis. Report incidents of unusual bleeding or easy bruising while taking fluoxetine. Expect to be prescribed only 1 week's supply of fluoxetine at a time. Consume a high-protein diet to offset the risk of anemia while taking clozapine.
Come in for weekly blood tests to monitor for drug-induced agranulocytosis. Rationale The antipsychotic medication clozapine poses a risk for the development of agranulocytosis, especially when combined with a selective serotonin reuptake inhibitor such as fluoxetine. The client's neutrophil and white blood cell (WBC) counts are borderline and therefore suggestive of the disorder. Weekly blood testing to monitor these blood values in required. The client's platelet count is in the low-normal range, but fluoxetine is not generally considered a factor in bleeding disorders. Clozapine, not fluoxetine, would likely be prescribed on a week-by-week basis to both help manage side effects and encourage weekly visits for lab work. Clozapine is not generally considered a factor in the development of anemia.
A nurse is assisting with the administration of electroconvulsive therapy (ECT) to a severely depressed client. What side effect of the therapy should the nurse anticipate? Loss of appetite Postural hypotension Total memory loss Confusion immediately after the treatment
Confusion immediately after the treatment Rationale The electrical energy passing through the cerebral cortex during ECT results in a temporary state of confusion after treatment. Loss of appetite, postural hypotension, and total memory loss are not usual or expected side effects. Memory loss is usually restored after a few months of treatment.
During a one-on-one interaction with a client with paranoid-type schizophrenia, the client says to the nurse, "I've figured out how foreign agents have infiltrated the news media. They want to shut me up before I spill the beans." How should the nurse describe this statement when documenting this client's response? Nihilistic delusion Delusions of persecution Delusions of control Delusions of grandeur
Delusions of persecution Rationale Thoughts of being pursued by powerful agents because of one's special attributes or powers are fixed false beliefs and are referred to as delusions of persecution. There is no evidence to indicate that there are nihilistic delusions of total or partial nonexistence. There is also no evidence to support that external forces are controlling the client (delusions of control) or that the client has false beliefs of being a famous figure (delusions of grandeur).
Which condition is contraindicated for St. John's wort herbal therapy? Anxiety Seizures Dementia Cardiac disease
Dementia Rationale Dementia is contraindicated for St. John's wort herbal therapy; this herbal therapy is used to treat anxiety. Seizures are contraindicated for bupropion therapy. Cardiac disease is contraindicated for valerian (Valeriana Officinalis).
Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? Trazodone Bupropion Duloxetine Mirtazapine
Duloxetine Rationale Duloxetine can worsen uncontrolled angle-closure glaucoma. Trazodone is contraindicated in clients with a known drug allergy. Bupropion is contraindicated for clients with seizures. Mirtazapine is contraindicated in cases of known drug allergy and concurrent use of monoamine oxidase inhibitors.
The nursing staff is discussing the best way to develop a relationship with a new client who has antisocial personality disorder. What characteristic of clients with antisocial personality should the nurses consider when planning care? Engages in many rituals Independence of others Exhibits lack of empathy for others Possesses limited communication skills
Exhibits lack of empathy for others Rationale Self-motivation and self-satisfaction are of paramount concern to people with antisocial personality disorder, and they have little or no concern for others. Clients with obsessive-compulsive disorder, not antisocial personality disorder, engage in rituals. Individuals with antisocial personality disorder are extremely dependent on others; they count on others to extricate them from their problems. They are usually charming on the surface and can easily con people into doing what they want.
During an interview of a client with a diagnosis of bipolar I disorder, manic episode, what does the nurse expect the client to demonstrate? Flight of ideas Ritualistic behaviors Associative looseness Auditory hallucinations
Flight of ideas Rationale Flight of ideas is a fragmented, pressured, nonsequential pattern of speech typically used during a manic episode. Ritualistic behaviors are repetitive, purposeful, and intentional behaviors that are carried out in a stereotyped fashion; they are found in clients with obsessive-compulsive disorders. Associative looseness is the pattern of speech found in clients with schizophrenia; usual connections between words and phrases are lost to the listener and meaningful only to the speaker. Hallucinations are false perceptions generated by internal stimuli; they are found in clients with the diagnosis of schizophrenia.
Which drug most commonly causes extrapyramidal side effects (EPS)? Clozapine Haloperidol Risperidone Aripiprazole
Haloperidol Rationale Haloperidol is a typical antipsychotic that commonly causes extrapyramidal side effects. Clozapine is an atypical antipsychotic that has a low risk of causing extrapyramidal side effects. Risperidone and aripiprazole have a low risk of causing extrapyramidal side effects.
What characteristics are commonly associated with adolescent depression? Select all that apply. Exercising daily Having suicidal ideation Exhibiting tearfulness Having poor muscle tone Avoiding previously enjoyed activities and relationships
Having suicidal ideation, Exhibiting tearfulness, Avoiding previously enjoyed activities and relationships Rationale Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.
Which clinical manifestation is found in a client with a deficiency of adrenocorticotropic hormone? Anovulation Dehydration Malaise and lethargy Menstrual abnormalities
Malaise and lethargy Rationale Malaise is a general feeling of discomfort or illness and lethargy is a lack of energy. A client with deficiency of adrenocorticotropic hormone may experience malaise and lethargy. Adrenocorticotropic hormone deficiency is not associated with anovulation, dehydration, and menstrual abnormalities. Anovulation (ovaries do not release an oocyte during the menstrual cycle) occurs due to deficiency of gonadotropins. Dehydration is a result of deficiency of antidiuretic hormone. The deficiency of thyroid-stimulating hormone may result in menstrual abnormalities.
Which medication is the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD)? Clonidine Guanfacine Atomoxetine Methylphenidate
Methylphenidate Rationale Methylphenidate is the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD). Clonidine, guanfacine, and atomoxetine are nonstimulants used to treat ADHD; these medications are less effective than methylphenidate.
After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client? Caffeine Modafinil Atomoxetine Methylphenidate
Modafinil Rationale Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).
A male client with a history of schizophrenia comes to the emergency department, accompanied by his wife. What is the emergency department nurse's priority intervention? Observing and evaluating his behavior Writing a plan of care for the mental health team Obtaining a copy of the client's past medical records Meeting separately with his wife and exploring why he came to the hospital
Observing and evaluating his behavior Rationale The client and his needs are the priority, and assessment is the first step of the nursing process. Writing a plan of care for the mental health team is done after a thorough assessment is completed. The nurse must deal with the present, not the past. Although meeting separately with the wife should be done, it is not the priority.
Which condition contraindicates the use of ginseng herbal therapy? Pregnancy Schizophrenia Bipolar depression Alzheimer disease
Pregnancy Rationale Pregnancy is contraindicated for ginseng herbal therapy. Schizophrenia, bipolar depression, and Alzheimer disease are contraindicated for St. John's Wort herbal therapy.
In addition to hallucinating, a client yells and curses throughout the day. What should the nurse do? Ignore the client's behavior. Isolate the client until the behavior stops. Explain the meaning of the behavior to the client. Seek to understand what the behavior means to the client.
Rationale Seek to understand what the behavior means to the client. All behavior has meaning; before planning intervention, the nurse must try to understand what the behavior means to the client. Ignoring behavior does little to alter it and may even cause further acting out. Isolation may increase anxiety and precipitate more acting-out behavior. The nurse cannot explain the meaning of the client's behavior; only the client can.
Which antidepressant drug is a selective monoamine oxidase-B inhibitor? Selegiline Phenelzine Isocarboxazid Tranylcypromine
Rationale Selegiline Selegiline is a selective monoamine oxidase-B inhibitor. Phenelzine, isocarboxazid, and tranylcypromine are nonselective monoamine oxidase-A and monoamine oxidase-B inhibitors.
A nurse is working in the orientation phase of a therapeutic relationship with a client who has borderline personality disorder. What will be most difficult for the client at this stage of the relationship? Controlling anxiety Terminating the session on time Accepting the psychiatric diagnosis Setting mutual goals for the relationship
Setting mutual goals for the relationship Rationale Clients with borderline personality disorder frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals. Although the client with a borderline personality disorder may have difficulty in the areas of controlling anxiety, ending sessions on time, and accepting the diagnosis, none is the most significant issue.
A client with depression is to be given fluoxetine. What precaution will the nurse consider when initiating treatment with this drug? It must be given with milk and crackers to prevent hyperacidity and discomfort. Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. The blood level should be checked weekly for 3 months to monitor for an appropriate level.
The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. Rationale Fluoxetine does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Consuming milk and crackers to help prevent hyperacidity and discomfort is not necessary. Avoiding cheese, pickled herring, and wine is a precaution taken with the monoamine oxidase inhibitors. Weekly blood level checks are not necessary with fluoxetine.
A client with paralysis of the legs is found to have somatoform disorder, conversion type. What must the nurse consider when formulating a plan of care for this client? The illness is very real to the client and requires appropriate nursing care. Although the client believes that there is an illness, there is no cause for concern. There is no physiological basis for the illness; therefore only emotional care is needed. Nursing intervention is needed even though the nurse understands that the client is not ill.
The illness is very real to the client and requires appropriate nursing care. Rationale Individuals who have somatoform disorders are really ill; they need care in a nonthreatening environment. The client requires physiological and emotional care for treatment of motor or sensory functional deficits.
A nurse is caring for a hyperactive, manic client who exhibits flight of ideas and is not eating. What may be the reason why the client is not eating? Feeling undeserving of the food Too busy to take the time to eat Wishes to avoid others in the dining room Believes that there is no need for food at this time
Too busy to take the time to eat Rationale Hyperactive clients frequently will not take the time to eat because they are overinvolved with everything in their environment. Feeling undeserving of the food is characteristic of a depressive episode. The client is unable to sit long enough with the other clients to eat a meal; this is not conscious avoidance. The client probably gives no thought to food because of overinvolvement with the activities in the environment.
While watching television in the dayroom, a client who has demonstrated withdrawn, regressed behavior suddenly screams, bursts into tears, and runs from the room to the far end of the hallway. What is the most therapeutic intervention by the nurse? Walking to the end of the hallway where the client is standing Accepting the action as the impulsive behavior of a sick person Asking another client in the dayroom why the client acted in this way Documenting the incident in the client's record while the memory is fresh
Walking to the end of the hallway where the client is standing Rationale Walking to the end of the hallway where the client is standing lets the client know that the nurse is available. It also demonstrates an acceptance of the client. Accepting the action as the impulsive behavior of a sick person is an avoidance technique; it shows a lack of acceptance of the client as a person. Another client's perception of the incident may or may not be valid. Although it is important to document the incident in the client's record, this does not take precedence over letting the client know the nurse is available if needed.