EXAM 3 Quizlet
Which antiepileptic drug is used as the first-line treatment for absence seizures? Phenytoin Diazepam Valproic acid Acetazolamide
Valproic acid
While assessing an elderly client, a nurse infers cognitive impairment. Which statements made by the client confirm the nurse's conclusion? Select all that apply. "I have difficulty judging things." "I forget to take medicines." "I am unable to do financial calculations." "I get confused about the proper date and time." "I am unable to recall words during conversations with my family."
"I have difficulty judging things." "I am unable to do financial calculations." "I am unable to recall words during conversations with my family." Poor judgment, loss of the ability to calculate, and loss of language skills are related to cognitive impairment. These changes may develop due to an imbalance of neurotransmitters in brain. Forgetfulness and getting confused are symptoms that may be associated with normal aging changes.
What is the priority nursing objective of the therapeutic psychiatric environment for a confused client? Helping the client relate to others Making the hospital atmosphere more homelike Helping the client become accepted in a controlled setting Maintaining the highest level of safe, independent function
Maintaining the highest level of safe, independent function The therapeutic milieu is directed toward helping the client develop effective ways of functioning safely and independently. Helping the client relate to others is one small part of the overall objectives. The therapeutic milieu allows some items from home to make the client less anxious; however, the objective is not to duplicate a home situation. Helping the client become accepted in a controlled setting is a worthwhile objective but not as important as working toward the maximal degree of safe, independent function.
While assessing a client with schizophrenia who is receiving chlorpromazine, the nurse finds lead pipe rigidity, sudden high fever, and sweating. Which drugs would be prescribed by the healthcare provider? Select all that apply. Loxapine Dantrolene Thiothixene Haloperidol Bromocriptine
Dantrolene Bromocriptine Lead pipe rigidity, sudden high fevers, and sweating are symptoms of neuroleptic malignant syndrome; this condition is an adverse effect of chlorpromazine. Drugs used to treat this syndrome are dantrolene and bromocriptine. Loxapine, thiothixene, and haloperidol are the first-generation antipsychotics that should not be prescribed because these may lead to severe complications.
A pregnant woman who reports confusion and jerky arm movements is diagnosed with epilepsy and treated with antiepileptic drugs. Which physiologic change in the drug metabolism would the nurse expect in this client? The elimination of the drug will increase to 100%. There will be a decreased clearance of the drug. There will be an increased hepatic metabolism. The drug's reabsorption will be decreased.
There will be an increased hepatic metabolism
Which medication is the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD)? Clonidine Guanfacine Atomoxetine Methylphenidate
Methylphenidate 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.
During a seizure, a client had sudden loss of muscle tone that lasted for a few seconds followed by confusion. Which statement about this type of seizures is true? Select all that apply. These seizures are associated with amnesia. These seizures increase the risk of injuries due to fall. These seizures are most resistant to drug therapy. These seizures are preceded by perception of an offensive smell. These seizures cause one sided movement of extremities in the client.
These seizures increase the risk of injuries due to fall. These seizures are most resistant to drug therapy.
What is the priority nursing action for a client with delirium? Maintaining skin integrity Planning for behavioral interventions Creating a calm and safe environment Maintaining personal contact through touch
Creating a calm and safe environment The nurse caring for a client with delirium should ensure client safety and ensure a calm and safe environment. The nurse should encourage family members to stay at the bedside along with the client or move the client to the nurses' station to guarantee safety. The client is at a risk for skin breakdown, which is of medium priority. The nurse should ensure the safe environment first, then when it is possible, plan for client-specific behavioral interventions. Reorientation is then followed by contacting the client personally through touching and verbal communication.
A nurse notes that a client with dementia tries to cope with anxiety by using confabulation. What does the nurse plan to teach the family about confabulating? The client may fantasize about past experiences. The client has poor control of disorganized thoughts. The client will make up what cannot be remembered. The client experiences opposing feelings simultaneously
The client will make up what cannot be remembered. Confabulation is a deliberate face-saving defense wherein stories are made up to fill in gaps and disguise memory loss. A client does not fantasize when confabulating. Having poor control of disorganized thoughts reflects loose associations, not confabulation. Experiencing opposing feelings simultaneously is ambivalence, not confabulation.
A nurse is assessing aclient who is suspected of having memory loss. Which question asked by the nurse will be appropriate to test recent recall memory of the client? "What is your date of birth?" "How did you reach the clinic?" "How many schools have you attended?" "Can you count backwards from 100 to 1?"
"How did you reach the clinic?" To test the recent recall memory of a client, questions regarding the mode of transportation to the clinic can be asked. Questions regarding date of birth can be asked to test the remote memory of a client. Questions about number of schools attended can be asked to test the remote memory of a client. Backward counting of numbers can be asked to assess the attention of a client.
The nurse is assessing a client for recall memory. Which statements made by the client indicate that the client's recall memory is intact? Select all that apply. "I was born in New York city." "I came to the hospital in a car." "You asked me to repeat the words apple, street, and chair." "I was admitted on the 24th of September at 5 in the evening." "I had an appointment with a neurophysician last month."
"I came to the hospital in a car." "You asked me to repeat the words apple, street, and chair." "I was admitted on the 24th of September at 5 in the evening." "I had an appointment with a neurophysician last month." Recall memory can be tested by asking questions related to the recent past, such as mode of transportation to the hospital, time and date of admission, and history of appointments with healthcare providers. Asking the client to repeat words tests recall memory. Remote memory is tested by asking the client about the city of birth or birth date.
A confused, hallucinating client says, "My arms are turning to stone." What is the most therapeutic response by the nurse? "May I examine your arms?" "When did this feeling first start?" "That's a rather unusual sensation." "It can be frightening to feel that way."
"It can be frightening to feel that way." Depersonalization communication is the result of a high anxiety level; projecting empathy to the client will facilitate exploration of concerns. The response "May I examine your arms?" does not acknowledge the frightening experience for the client and supports the client's hallucination. When the feeling started is irrelevant; the nurse must address what the client is experiencing now. The response "That's a rather unusual sensation" belittles the client's feelings and may make establishment of a therapeutic relationship difficult.
A client with dementia who feels highly anxious and confused believes that the current day is actually different than what it is. Which statement made by the nurse is an example of validation therapy? "No, try to be in your sense of reality." "Yes, today is the day that you just mentioned." "You should try improving your awareness level." "Try to recall your past memories associated with the day."
"Yes, today is the day that you just mentioned." Validation therapy an approach to communication with a confused client with dementia. In this approach, the nurse accepts the description of the time and place as stated by the client. Therefore, the statement "Yes, today is the day that you just mentioned" represents the use of validation therapy. Asking the client to reorient himself or herself to reality and asking him or her to improve his or her awareness level are examples of the reality orientation approach. Reminiscence is an approach that asks the client to recall his or her past experience
The nurse finds that a child has inattention, hyperactivity, and impulsivity upon assessment. Which medication would be beneficial for the child? Modafinil Doxapram Armodafinil Atomoxetine
Atomoxetine Inattention, hyperactivity, and impulsivity in a child may indicate that the child has attention deficit hyperactivity disorder. Atomoxetine is a nonstimulant second-line drug used to treat attention deficit hyperactivity disorder (ADHD). Modafinil is a nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). Doxapram and armodafinil are nonamphetamine stimulants used to treat shift-work sleep disorder (SWSD).
A client tells the nurse, "That man on the television is talking only to me." What should the nurse document that the client is exhibiting? Illusion Hallucination Idea of reference Autistic thinking
Idea of reference An idea of reference, also called a delusion of reference, is a fixed, false personal belief that public events and people are connected directly to the client. An illusion is a misinterpretation of a sensory stimulus. A hallucination is a perceived experience that occurs in the absence of an actual sensory stimulus. Autistic thinking is a distortion in the thought process that is associated with schizophrenic disorders.
The nurse is caring for a community-dwelling older adult who is suffering from confusion. Which are the best nursing interventions in this situation? Select all that apply. The nurse should provide a protective environment. The nurse should assist with personal hygiene. The nurse should educate the client about correct body mechanics. The nurse should promote activities that reinforce reality. The nurse should teach the client's caregiver proper feeding techniques.
The nurse should provide a protective environment. The nurse should assist with personal hygiene. The nurse should promote activities that reinforce reality. When caring for an older adult who is in a confused state, the nurse should provide a protective environment, assist with personal hygiene, and promote activities that reinforce reality. If a client is suffering from arthritis, the nurse should educate him or her about correct body mechanics. If the nurse is caring for a dementia client, then he or she should teach the family caregiver proper feeding techniques.
Which color of cerebrospinal fluid (CSF) may indicate subarachnoid hemorrhage in the client? Hazy Yellow Brown Colorless
Yellow
A young client with schizophrenia says, "I'm starting to hear voices." What is the nurse's most therapeutic response? "How do you feel about the voices, and what do they mean to you?" "You're the only one hearing the voices. Are you sure you hear them?" "The health team members will observe your behavior. We won't leave you alone." "I understand that you're hearing voices talking to you and that the voices are very real to you. What are the voices saying to you?"
"I understand that you're hearing voices talking to you and that the voices are very real to you. What are the voices saying to you?" Acknowledging that client is hearing voices and that the voices are very real to the client validates the presence of the client's hallucinations without agreeing with them, which communicates acceptance and can form a foundation for trust; it may help the client return to reality. The nurse also needs to assess the content of the voices to determine the risk of self-injury or violence against others. The client's contact with reality is too tenuous to explore what the voices mean. Saying that the client is the only one hearing the voices and asking whether the client is sure the voices are being heard demeans the client, which blocks the development of a trusting relationship and future communication. Telling the client that the health team members will observe the behavior and that the client won't be left alone is condescending and may impair future communication.
A client with a disturbed state of mind is under observation. Which statement made by the nurse indicates that the client is suffering from dementia? Select all that apply "The client is very depressed." "The client is not able to make decisions." "The client always tells about his/her failures." "The client is not able to perform purposeful work." "The client has a completely disturbed sleep/wake cycle."
"The client is not able to make decisions." "The client is not able to perform purposeful work." A client with dementia may not able to make decisions because it affects thinking ability. The client with dementia may suffer from apraxia in which the client is not able to perform purposeful work. In depression, the client will remain depressed but in dementia, the mood is affected superficially. A client with depression may tell about his/her failures, but in dementia, the client may or may not be able to recollect details of life. In dementia, the sleep/wake cycle of the client is a bit fragmented but in depression, it is completely disturbed.
A client who is taking haloperidol has developed tardive dyskinesia. Which therapy is beneficial for the client? Administering benzodiazepines Providing anticholinergics therapy Administering nonsteroidal antiinflammatory drugs Switching to other first-generation antipsychotic drugs
Administering benzodiazepines The long-term usage of first-generation antipsychotics such as haloperidol increases the risk of tardive dyskinesia. The client should be treated with benzodiazepines. Any anticholinergics drugs should be discontinued in the client. Nonsteroidal antiinflammatory drugs may not be beneficial for the client. The client should not switch to another first-generation antipsychotic because the risk of tardive dyskinesia still remains.
A client on antipsychotic drug therapy develops parkinsonism. Which drugs would be beneficial for the client? Select all that apply. Levodopa Benztropine Amantadine Bromocriptine Diphenhydramine
Benztropine Amantadine Diphenhydramine Benztropine is a centrally-acting anticholinergic drug that can be used to treat symptoms of parkinsonism associated with antipsychotic drugs. Amantadine is also used to treat antipsychotic-induced parkinsonism. Diphenhydramine is another centrally-acting anticholinergic drug that can be used to treat symptoms of antipsychotic-induced parkinsonism. Levodopa and direct dopamine agonists such as bromocriptine should be avoided in antipsychotic-induced Parkinsonism because these drugs activate dopamine receptors, which might counteract the beneficial effects of antipsychotic treatment.
A healthcare provider prescribes clozapine to a client with schizophrenia. Which parameters should be assessed before initiating the drug? Select all that apply. Prolactin levels Body mass index White blood cell count Serum potassium levels Absolute neutrophil count
Body mass index White blood cell count Absolute neutrophil count Clozapine is a second-generation antipsychotic drug that may lead to agranulocytosis. Therefore, the white blood cell count and the absolute neutrophil count should be tested for normal levels before administering the drug. Because this drug may lead to weight gain, a baseline body mass index should be calculated before initiating the therapy and at every visit for six months. The drug risperidone may increase the prolactin levels and lead to gynecomastia and galactorrhea. The serum potassium levels should be assessed before administering first-generation antipsychotics.
A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin. What instructions will the nurse give to the client? Take the medication on an empty stomach. Brush the teeth and gums three times daily. Stop taking the drug if abdominal pain occurs. Note any change in pulse and respiratory rates.
Brush the teeth and gums three times daily.
Which antiseizure drugs are used to stabilize a client's mood by suppressing mania associated with bipolar disorder (BPD)? Select all that apply. Lithium Quetiapine Ziprasidone Carbamazepine Divalproex sodium
Carbamazepine Divalproex sodium
Which clients with schizophrenia should not be prescribed chlorpromazine? Select all that apply. Clients with glaucoma Clients with dynamic ileus Clients with Parkinson disease Clients with severe hypertension Clients w/ prostatic hypertrophy
Clients with Parkinson disease Clients with severe hypertension Chlorpromazine is a first-generation antipsychotic drug that should be avoided in clients with a history of Parkinson disease or severe hypertension. Clients with a history of glaucoma, dynamic ileus, or prostatic hypertrophy should be prescribed chlorpromazine with caution.
A nurse is caring for an older adult with a history of recent memory loss. Which action should the nurse take? Instruct the client to move slowly when changing positions Remind the client to look where places feet while walking Adjust the daily schedule to accommodate sleep pattern Employ electronic devices that provide alerts
Employ electronic devices that provide alerts Providing electronic devices that give alerts can help an older adult who has developed recent memory loss. Adjusting the daily schedule can aid older adults who have changes in their sleep pattern. Instructing the client to move slowly when changing positions can prevent dizziness and falls caused by orthostatic blood pressure changes or altered balance/coordination. Reminding the client to check where feet are placed can help older adults with a decreased sensory perception of touch
Which drug most commonly causes extrapyramidal side effects (EPS)? Clozapine Haloperidol Risperidone Aripiprazole
Haloperidol 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.
Which drugs may lead to a prolongation of the QT interval in a client who is on drug therapy for schizophrenia? Select all that apply. Loxapine Haloperidol Thiothixene Thioridazine Chlorpromazine
Haloperidol Thioridazine Chlorpromazine Prolongation of the QT interval indicates severe dysrhythmias. This is due to the use of haloperidol, thioridazine, and chlorpromazine, which are first generation antipsychotics. Loxapine and thiothixene do not cause prolongation of the QT interval.
A client with dementia and chronic confusion is suspected to have Alzheimer disease. Which imaging technique is specific for Alzheimer disease? Diffusion imaging (DI) Magnetic resonance imaging (MRI) Magnetic resonance angiography (MRA) Magnetic resonance spectroscopy (MRS)
Magnetic resonance spectroscopy (MRS) In diseases such as Alzheimer disease, stroke, and epilepsy, the biochemical process in the brain is altered. Abnormalities in biochemical processes of the brain are diagnosed with magnetic resonance spectroscopy (MRS). Diffusion imaging (DI) is used to evaluate ischemia in the brain to determine the location and severity of a stroke. Magnetic resonance imaging (MRI) involves taking multiple sets of images to determine normal and abnormal anatomy. Magnetic resonance angiography (MRA) is used to evaluate blood flow and blood vessel abnormalities, such as arterial blockage, intracranial aneurysms, and arteriovenous malformations in the brain.
Nursing management of a client with dementia, who is disoriented, forgetful and with inappropriate behaviors, should be directed toward what? Restricting gross motor activity to prevent injury Preventing further deterioration in the client's condition Maintaining scheduled activities through behavior modification Rechanneling the client's energies into more appropriate behaviors
Rechanneling the client's energies into more appropriate behaviors Disoriented clients need assistance in how they direct their energy to limit inappropriate behaviors. The staff cannot prevent all gross motor activity; the client needs to use the muscles, but their use must be controlled. Further deterioration usually cannot be prevented in this disorder. Behavior modification methods do not work well with disoriented, forgetful clients.
Which nursing intervention is most helpful in meeting the needs of an older adult with the diagnosis of dementia of the Alzheimer type? Providing nutritious foods that are high in carbohydrates and protein Offering opportunities for choices in the daily schedule to stimulate interest Developing a consistent plan with a fixed time schedule to fulfill emotional needs Simplifying the environment as much as possible and eliminating the need for decisions and choice
Simplifying the environment as much as possible and eliminating the need for decisions and choice Clients with this disorder need a simple environment. Because of brain cell destruction, they are unable to make choices. A well-balanced diet is important throughout life, not just during senescence; a diet high in carbohydrates and protein may be lacking in other nutrients such as fat. The client may be incapable of making choices; providing alternative choices will increase anxiety. Emotional needs must be met on a continuous basis, not just at fixed times.
