ATI BOOK: Mental Health Unit 4: Ch 21-26
A nurse is assisting with the admission of a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? A. "Current medical conditions include diabetes that is controlled by diet." B. "Recent medications include a course of prednisone for acute bronchitis." C. "Current vaccinations include a flu vaccine last month." D. "Current medications include furosemide for congestive heart failure."
"Current medications include furosemide for congestive heart failure." *Diuretics (furosemide) are contraindicated for use with lithium due to the risk of toxicity. This is the greatest risk for the client and is therefore the highest priority to report to the provider
A nurse is determining a client's understanding of a new prescription of a new prescription for clonidine for the treatment of opioid use disorder. Which of the following statements by the client indicates an understanding of the instruction? A. "Taking this medication will reduce my craving for heroin." B. "While taking this medication, I should keep a pack of sugarless gum." C. "I can expect some diarrhea from taking this medication." D. "Each dose of this medication should be placed under my tongue to dissolve."
"I can expect some diarrhea from taking this medication." *Clonidine commonly causes clients to experience dry mouth, Chewing sugarless gum is an effective method to address this adverse effect *Clonidine is useful during opioid withdrawal. However, it does not reduce cravings *Clonidine reduces, rather than causes, diarrhea and other withdrawal manifestations related to autonomic hyperactivity *Buprenorphine, rather than clonidine, is administered sublingually
A nurse is reinforcing teaching to a client who has a new prescription of amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? A. "I can expect to experience diarrhea while taking this medication. B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni while taking this medication." D. "This medication will help me lose the weight that I have gained over the last year."
"I may feel drowsy for a few weeks after starting this medication." *Sedation is an adverse effect of amitriptyline during the first few weeks of therapy *Constipation rather than diarrhea can occur with TCAs, due to anticholinergic effects *Foods (pepperoni) should be avoided if the client is prescribed an MAOI rather than a TCA like amitriptyline *Observe for manifestations of hypomania or mania caused by CNS stimulation with phenelzine
A nurse is reinforcing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the instructions? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." D. "This medication is highly addictive and must be withdrawn slowly."
"I will be careful not to gain too much weight while taking this medication." *Antipsychotic medications (iloperidone) have a high risk of for significant weight gain. *Antipsychotic medications are considered a long-term treatment for schizophrenia. Discontinuing the medication can result in an exacerbation of manifestations *Drowsiness is a common adverse effect of antipsychotic medications. However, it is not appropriate to discontinue the medication *Antipyschotic medications are not considered addictive, and it is not necessary to titrate iloperidone when discontinuing treatment
A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication? A. "I will take the medication at bedtime." B. "I will follow a low-sodium diet whike taking this medication." C. "I will need to discontinue this medication slowly." D. "I will be at risk for weight loss with long-term use of this medication."
"I will need to discontinue this medication slowly." *When discontinuing fluoxetine, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal symptoms *The client should take fluoxetine in the morning to minimize sleep disturbances *The client is at risk for hyponatremia while taking fluoxetine *The client is at risk for weight gain, rather than loss, with long-term use of fluoxetine
A nurse is caring for a client who is prescribed lithium therapy. The client tells the nurse of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium fall too low."
"Regular aspirin would be a better choice than ibuprofen." *Aspirin is recommended as a mild analgesic rather than ibuprofen due to the risk of lithium toxicity. *Ibuprofen is not recommended for clients taking lithium. It does not decrease the effectiveness of ibuprofen but concurrent use is not recommended due to the risk of toxicity. It increases the risk for a toxic, rather than low, lithium level
A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine." B. "I should tell the client about the likelihood of insomnia while taking this medication." C. "This medication is contraindicated for clients who have an eating disorder." D. "Sexual dysfunction is a common adverse effect of this medication."
"This medication increases the release of serotonin and norepinephrine." *Mirtazapine provides relief from depression by increasing the release of serotonin and norepinephrine *Tell the client about the likelihood of drowsiness rather than insomnia when taking this medication *Buproprion, rather than mirtazapine, is contraindicated in clients who have an eating disorder *Sexual dysfunction is an adverse effect of SSRIs rather than mirtazapine
A nurse is reinforcing teaching with a cliet who has alcohol use disorder and a new presciption for carbamezepine. Which of the following information should the nurse include? A. "This medication will help prevent seizures during alcohol withdrawal." B. "Taking this medication will decrease your cravings for alcohol." C. "This medication maintains your blood pressure at a normal level during alcohol withdrawal." D. "Taking this medication will improve your ability to maintain abstinence from alcohol."
"This medication will help prevent seizures during alcohol withdrawal." *Carbamazepine is used during withdrawal to decrease the risk for seizures *Carbamazepine is used to promote safe withdrawal rather than to decrease cravings for alcohol *Clonidine or propranolol is used during withdrawal to depress the autonomic response and its effect on blood pressure *Carbamazepine is used to promote safe withdrawal rather than abstinence
A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following laboratory tests? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Blood sodium and potassium
AST/ALT and LDH *Routine monitoring of liver function tests is necessary due to the risk for hepatotoxicity *Baseline levels can be drawn. However, routine monitoring of creatinine and BUN, WBC and granulocyte counts, blood sodium and potassium is not necessary
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A. Administrer the next dose of lithium carbonate as scheduled B. Prepare for administration of aminophylline C. Notify the provider for a possible increase in the dosage of lithium carbonate D. Request a stat repeat of the client's lithium blood level
Administrer the next dose of lithium carbonate as scheduled *During a manic episode, the lithium blood level should be 0.8 to 1.4 mEq/L. It is appropriate to administer the next dose as scheduled *Aminophylline can be prescribed for treatment of severe toxicity for levels greater than 1.5 mEq/L *A dosage increase would place the client at risk for toxicity and is therefore not and appropriate action *A lithium level of 1.2 mEq/L is an expected finding for a client who is experiencing a manic episode. It is not necessary to request a stat repeat of the lab test
A nurse is reinforcing teaching to a client who has tobacco use disorder about the use of nicotine gum. Which of the following information should the nurse reinforce? A. Chew the gum for no more than 10 min B. Rinse out the mouth immediately before chewing the gum C. Avoid eating 15 min prior to chewing the gum D. Use of the gum is limited to 90 days
Avoid eating 15 min prior to chewing the gum *The client should avoid eating or drinking 15 min prior to and while chewing the gum *The client should chew the gum slowly and intermittently over 30 min *The client should avoid drinking 15 min prior to chewing gum *Use of nicotine gum is not recommended for longer than 6 months
A nurse is reinforcing teaching with an adolescent clietn who has a new prescription for clomipramine for OCD. Which of the following information should the nurse provide? A. Eat a diet high in fiber B. Check temperature daily C. Take medication first think in the morning before eating D. Add extra calories to the diet as between-meal snacks
Eat a diet high in fiber *Eating a diet high in fiber will decrease constipation, an anticholinergic effect associated with TCA use *Checking the client's temperature daily is not necessary while taking a TCA *Taking the medication at bedtime rather than in the morning will prevent daytime sleepiness *Following a well-balanced diet rather than adding extra calories as snacks will help prevent weight gain, a common adverse effect of TCAs
A nurse is assisting with providing care for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? A. Administer flumazenil B. Idenitify the client's level of orientation C. Ensure the administration of IV fluids D. Prepare the client for gastric lavage
Idenitify the client's level of orientation *When taking the nursing process approach to client care, the intial step is data collection. Identifying the client's level of orientation is the priority action *Administer flumazenil will reverse the effects of benzodiaxepine, ensure the administration of IV fluids to maintain blood pressure, and gastric lavage will remove excessive medication from the client's GI system; however, another action is the priority
A nurse is reinforcing teaching with a school-age child who has conduct disorder and a new prescription for methylphenidate transdermal patches. Which of the following information should the nurse provide about the medication? A. Apply the patch once daily at bedtime B. Place the patch carefully in a trash can after removal C. Apply the transdermal patch to the anterior waist area D. Remove the patch each day after 9 hr
Remove the patch each day after 9 hr *The transdermal patch is applied once daily in the morning to a clean, dry area on the hip and is removed after 9 hr. For safety when discarding the transdermal preparation, the client should fold the patch and flush it down the toilet to prevent others from using it. The waist area should be avoided
A nurse is reinforcing teaching with a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse reinforce? A. Three to six weeks of treatment is required to achieve therapeutic benefit B. Combining alcohol with alprazolam will produce a paradoxical reponse C. Alprazolam has a lower risk for dependence than other antianxiety medications D. Report confusion as a potential indication of toxicity
Report confusion as a potential indication of toxicity *Confusion is a potential indication of alprazolam toxicity that the client should report to the provider *Buspirone, rather than alprazalom, requires 3-6 weeeks to achieve therapeutic benefit *Combining alcohol with alprazalam can produce CNS and respiratory depression rather than a paradoxical response *Alprazolam is preferably used for short-term treatment because of the increased risk of dependence
A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat effect. The nurse should expect a prescription from the provider for which of the following medications? A. Chlorpromazine B. Thithixene C. Risperidone D. Haloperidol
Risperidone *Second-generation antipsychotics (risperidone) are effective in treating negative symptoms of schizophrenia (lack of grooming and flat effect) *First-generation antipsychotics (Chlorpromazine, Thithixene, and Haloperidol) are used mainly to control positive, rather than negative, symptoms of schizophrenia
A nurse is reviewing the medical record of a client who has a new prescription for buproprion for depression. Which of the following findings is the priority for the nurse to report to the provider? A. The client has a family history of seasonal pattern depression B. The client currently smokes 1.5 packs of cigarettes per day C. The client had a motor vehicle crash last year and sustatined a head injury D. The client has a BMI of 25 and has gained 10 lb over the last year
The client had a motor vehicle crash last year and sustatined a head injury *The greatest risk to the client is development of seizures. Buproprion can lower the seizure threshold and should be avoided by clients who have a history of a head injury. This information is the highest priority to report to the provider
A nurse is discussin the use of methadone with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the instruction (select all that apply) A. "Methadone is a replacement for physical dependence to opioids." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C. "Methadone can be used during opioid withdrawal and to maintain abstinence." D. "Methadone increases the risk for acetaldehyde syndrome." E. "Methadone must be prescribed and dispensed by an approved treatment center."
1. "Methadone is a replacement for physical dependence to opioids." 2. "Methadone reduces the unpleasant effects associated with abstinence syndrome." 3. "Methadone can be used during opioid withdrawal and to maintain abstinence." 4. "Methadone must be prescribed and dispensed by an approved treatment center." *Disulfiram, rather than methadone, places the client at risk for acetaldehyde syndrome if the client consumes alcohol while taking the medication
A nurse is reinforcing teaching with a client who has intermittent explosive disorder about a new prescription for fluoxetine. Which of the following information should the nurse provide? (select all that apply) A. An adverse effect of this medication is CNS depression B. Administer the medication in the morning C. Monitor for weight loss while taking this medication D. Therapeutic effects of this medication while taking this medication E. This medication blocks the synaptic reuptake of serotonin in the brain
1. Administer the medication in the morning 2. Monitor for weight loss while taking this medication 3. This medication blocks the synaptic reuptake of serotonin in the brain *Fluoxetine should be administered in the morning due to the potential for insomnia. It can result in weight loss. And it works by blocking the synaptic reuptake of serotonin, allowing more serotonin to stay at the junction of the neurons *An adverse effect of fluoxetine is CNS stimulation rather than CNS depression *Initial therapeutic effects of fluoxetine occur in 1 to 2 weeks, with full effectiveness occurring by 12 weeks.
A nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the nurse identify as being effectively treated by first-generation antipsychotics? (select all that apply) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeuer D. Severe agitation E. Anhedonia
1. Auditory hallucinations 2. Delusions of grandeuer 3. Severe agitation *First-generation antipsychotics have minimal effectiveness with negative symptoms of schizophrenia (social withdrawal and anhedonia)
A nurse is caring for a client who takes paroxetine to treat post traumatic stress disorder. The client states, "I grind my teeth during the night, which causes pain in my mouth." The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply) A. Concurrent administration of buspirone B. Administration of a different SSRI C. Use of a mouth guard D. Changing to a different class of antianxiety medication E. Increasing the dose of paroxetine
1. Concurrent administration of buspirone 2. Use of a mouth guard 3. Changing to a different class of antianxiety medication *Other SSRIs will also have bruxism as an adverse effect and increasing the dose of paroxetine can cause the adverse effect to worsen; therefore these are not effective measures
A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should expect prescriptions to promote long-term abstinence from alcohol? (select all that apply) A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. Acamprosate
1. Disulfiram 2. Naltrexone 3. Acamprosate *Disulfiram promotes abstinence through aversion therapy *Naltrexone promotes abstinene by suppressing the cravig and pleasurable effects of alcohol *Acamprosate decreases the unpleasant effects resulting from abstinence *Lorazepam is prescribed for short-term use during withdrawal *Diazepam is prescribed for short-term use during withdrawal
A nurse is caring for a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing
1. Drooling 2. Involuntary arm movements 3. Continual pacing *Decreased LOC is an indication of neuroleptic malignant syndrome rather than an EPS *Urinary retention is an antocholinergic effect rather than an EPS
A nurse is collecting data on a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the RN and provider as indications of serotonin syndrome? (Select all that apply) A. Hypothermia B. Hallucinations C. Muscular flaccidity D. Diaphoresis E. Agitation
1. Hallucinations 2. Diaphoresis 3. Agitation *Fever, rather than hypothermia and muscle tremors, rather than flaccidity, are indications of serotonin syndrome
A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to request a change to which of the following medications? (select all that apply) A. Olanzapine B. Quetiapine C. Aripriprazole D. Clozapine E. Asenapine
1. Olanzapine 2. Aripriprazole 3. Clozapine 4. Asenapine *Quetiapine is available only in tablets or extended-release tablets and will therefore not address the current concerns with medication administration. The other medications areavailable in an orally disintegrating appropriate for clients who have difficulty swallowing tablets. This route also decreases the risk for agitation associated with an injection.
A nurse is caring for a client who is taking phenelzine. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (Select all that apply) A. Elevated blood glucose level B. Orthostatic hypotension C. Priapism D. Hypomania E. Bruxism
1. Orthostatic hypotension 2. Hypomania *An elevated blood glucose is anot an adverse effect of phenelzine *Priapism is an adverse effect of trazodone, rather than phenelzine *Bruxism is an adverse effect of SSRIs, rahter than phenelzine
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the discussion? (Select all that apply) A. Constipation B. Polyruria C. Rash D. Muscle weakness E. Tinnitus
1. Polyruria 2. Muscle weakness *Diarrhea, rather than constipation, is an early indication of lithium toxicity *A rash is not indicated of lithium toxicity *Tinnitus is an indication of severe, rather than early, toxicity
A nurse is reinforcing teaching with the parents of a child who has autism spectrum disorder and a new prescription for imipramine about indications of toxicity. Which of the the following should the nurse include? (select all that apply) A. Seizures B. Agitations C. Photophobia D. Dry mouth E. Irregular pulse
1. Seizures 2. Agitations 3. Irregular pulse *Photophobia and dry mouth are an anticholinergic effect rather than an indication of TCA toxicity
A nurse is reinforcing teaching to a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (select all that apply) A. Void just before taking the medication B. Increase the dietary intake of potassium C. Wear sunglasses when outside D. Change positions slowly when getting up E. Chew sugarless gum
1. Void just before taking the medication 2. Wear sunglasses when outside 3. Chew sugarless gum *Voiding minimizies urinary hesitancy or retention, sunglasses minimizes the effect of photophobia, and chewing sugarless gum minimizes the effect of dry mouth. orthostatic hypotension is not an anticholinergic effect and the client's potassium level is not effected with imipramine
A nurse is reinforcing teaching with an adolescent client who is to begin taking atomoxetine for ADHD. The nurse should instruct the client to monitor for which of the following adverse effects? A. Somnolence B. Yellowing skin C. Increased appetite D. Fever E. Malaise
1. Yellowing skin 2. Fever 3. Malaise *Yellowing skin, fever, and malaise is a potential indication of hepatotoxicity that the client should report to the provider *Insomnia, rather than somnolence, is an adverse effect that the client should report to the provider *Decreased appetite with resulting weight loss, rather than an increased appetite is a potential adverse effect that the client should report to the provider