Mental Health Exam 2
Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system, as well as regulation of appetite and temperature? Temporal Lobe Parietal Lobe Cerebellum Hypothalamus
Hypothalamus
Patients with depression may have low self-esteem and may present with self-care deficits. In addition, they may feel powerlessness. As an intervention, it is important to encourage the client to take responsibility (as much as possible) for his/her own self-care practices. However, with severe depression, clients have difficulty making decisions. When this happens, it is helpful to use active communication to help patients accomplish even basic Activities of Daily Living (ADLs). Based on this, which is the better statement to say to a severely depressed patient: It is time to eat lunch. Would you like to eat lunch now? What would you like to eat for lunch? Would you like a turkey sandwich or a ham sandwich for lunch?
It is time to eat lunch.
Which of the following are used in the treatment of bipolar disorder? (select all) Olanzapine (Zyprexa) Oxycodone (oxycontin) Carbamazepine (Tegretol) Gabapentin (Neurontin) Tranylcypromine (Parnate)
Olanzapine (Zyprexa) Oxycodone (oxycontin) Gabapentin (Neurontin)
Margaret, a 68 year old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been on medication for many years. The sister-in-law reports Margaret quit her medication a few months ago, thinking she no longer needed it. Margaret is agitated, pacing, demanding, and speaking very loudly. She has lost weight, eats little, and gets very little sleep, her sister says. "I'm afraid she's going to collapse!" Margaret is admitted to the psychiatric unit. What is the priority nursing diagnosis? Imbalanced nutrition :less than body requirement rt not eating. Risk for injury due to hyperactivity Distrubed sleep pattern rt agitation. Ineffective coping rt denial of depression.
Risk for injury due to hyperactivity
Margaret, age 68, is a widow of six months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband is buried. She told her sister today that she "doesn't have anything more to live for". She has been hospitalized with major depressive disorder. The priority nursing diagnosis for Margaret would be: Imbalanced nutrition: less than body requirements. Complicated grieving Risk for suicide Social isolation
Risk for suicide
Signs and Symptoms with: •Serotonin Syndrome: •Neuroleptic Malignant Syndrome: •Extrapyramidal Symptoms:
SS: Tachycardia, hyperthermia, nausea, vomiting, diarrhea, confusion, agitation, anxiety, tremor, hyper deep tendon reflexes, muscle rigidity, diaphoresis, seizure hyperreflexia, clonus, dilated pupils, hyperactive bowel sounds; onset variable but less than 12 hours NMS: hyperthermia (up to 107F), severe muscle rigidity, autonomic instability, tachycardia, diaphoresis, altered consciousness hyporeflexia, normal pulpils, normal bowel sounds, severe onset variable, 1-3 days EPS: Acute dystonia Akathisia Pseudoparkinsonism; stooped posture, shuffling gate, cogwheeling drooling; tremor; bradykinesia; and coarse pill rolling movements of the thumb and fingers while at rest; Tardive dyskinesia (TD)Neuroleptic malignant syndrome (NMS)
Using table 4.2, match the medication with the action on neurotransmitter and/or receptor: A. strong dopamine receptor blockades B. bind to site on the GABA2 C. inhibit the reuptake of serotonin SSRIs, Antianxiety/benzodiazepines, Antipsychotics
SSRI: C Antipsychotics: A Antianxiety/benzodiazepines: B
Doses of bupropion should be administered at least 4-6 hours apart and bevr doubled when a dose is missed in order to prevent: Orthostatic hypotension Seizures Hypertensive Crisis Extrapyramidal symptoms
Seizures
what drug interaction can happen when tricyclic antidepressants are taken with St. John's wort (an herbal supplement): Paralytic ileus Hypertensive crisis Increased risk of bleeding Serotonin syndrome
Serotonin syndrome note that when tricyclics are taken with St. John's wort that seizures and serotonin syndrome can occur.
The primary goal in working with an actively psychotic, suspicious client would be to: Promote interaction with others Decrease his anxiety and increase trust. Improve his relationship with his parents Encourage participation in therapy activities.
Decrease his anxiety and increase trust.
Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Brandon's belief is an example of: Delusion of persecution Delusion of reference Delusion of control or influence Delusion of grandeur.
Delusion of persecution
An acutely depressed client isolates herself in her room and just sits in her room, staring into space. What is the best example of active communication with this client? "Do you like to exercise?" "Come with me. I will go to group therapy with you" "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" "Why do you stay in your room all the time?
"Come with me. I will go to group therapy with you"
Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: "That's ridiculous, Brandon. No one is going to hurt you" "The CIA isn't interested in people like you, Brandon" "Why do you think the CIA wants to kill you?" "I know you believe that Brandon, but it's very hard for me to believe."
"I know you believe that Brandon, but it's very hard for me to believe."
The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with major depressive disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response of the nurse? "Cheer up, you have so much to be happy about" "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms" "I'll report that to the physician. Maybe he will order something different." "Try not to dwell on your symptoms. Why don't you join the others in the dayroom?"
"Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms"
A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse "I started feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for thinking that." What is the appropriate response of the nurse? "Yes, he should have stopped smoking and probably wouldn't have gotten cancer" "I can understand how you must feel" "Those feelings are a normal part of the grief response" "Just think about the good times you had when he was alive"
"Those feelings are a normal part of the grief response"
The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with bipolar 1 disorder. There is a narrow therapeutic range, the range for acute mania is: 1.0 to 1.6 mEq/L 10 to 15 mEq/L 0.5 to 1.0 mEq/L 5 to 10 mEq/L
1.0 to 1.6 mEq/L
There is a very narrow margin between therapeutic and toxic levels of lithium carbonate. Symptoms of toxicity are most likely to appear if the serum levels exceed: 0.15 mEq/L 1.5 mEq/L 15.0 mEq/L 150 mEq/L
1.5 mEq/L
A client, who is prescribed lithium carbonate, is being discharged from inpatient care. Which medication information should the nurse teach this client? A. Do not skimp on dietary sodium intake. B. Have serum lithium levels checked every six months. C. Limit fluid intake to 1000 ml of fluid per day. D. Adjust the dose if you feel out of control.
A
In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis? A.Risk for injury related to excessive hyperactivity B.Disturbed sleep pattern related to manic hyperactivity C.Imbalanced nutrition, less than body requirements, related to inadequate intake D.Situational low self-esteem related to embarrassment secondary to high-risk behaviors
A
2.In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis? A. Risk for injury related to excessive hyperactivity B. Disturbed sleep pattern related to manic hyperactivity C. Imbalanced nutrition, less than body requirements related to inadequate intake D. Situational low self-esteem related to embarrassment secondary to high-risk behaviors
A (always safety)
Margaret, a 68 year old widow is experiencing a manic episode and yells "My sister in law is jealous of me and is trying to make me look insane!!" This is an example of: A delusion of grandeur A delusion of persecution A delusion of reference A delusion of control or influence
A delusion of persecution
Which of the following describe the symptoms of the manic phase of bipolar disorder? (select all that apply): a) Excessive energy b) Fatigue and increased sleep c) Low self-esteem d) Pressured speech e) Purposeless movement f) Racing thoughts g)Withdrawal from environment h) Distractibility
A, D, E, F, H Correct
A concern with children on long-term therapy with CNS stimulants for ADHD is: Addiction Weight Gain Substance Abuse Growth Suppression
Addiction
If the foregoing extrapyramidal symptoms should occur, which of the following is a priority nursing intervention? Notify physician Administer prn trihexyphenidyl (Artane) Withhold the next dose of antipsychotic medication Explain to the client that these symptoms are temporary and will disappear soon.
Administer prn trihexyphenidyl (Artane)
Terms: Akathisia •Dystonia •EPS •Pseudoparkinsonism •Tardive Dyskinesia Definitions: I.Restlessness II.Repetitive facial and tongue movements III.Movement symptoms associated with antipsychotic use IV.Tremor, shuffling gait, drooling, rigidity V.Involuntary muscle spasms
Akathisia i Dystonia v EPS iii Pseudoparkinsonism iv Tardive Dyskinesia ii
A client with depression asks the nurse "Why would they be checking my thyroid function when I clearly have depression and I'm not overweight?" Which is the accurate response? An underactive thyroid can manifest as depression. Depression has been proven to be a hormonal illness Thyroid hormone replacement is the first line of treatment for most clients All of the above.
An underactive thyroid can manifest as depression.
A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them" this is an example of which type of schizophrenia? Delusions of reference Loose association Anosognosia Auditory Hallucinations
Anosognosia
The nurse is interviewing a client in the psychiatric unit. The client tilts his head to the side, stops talking in mid sentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptoms is: Ask the client to describe his physical symptoms Ask the client to describe what he is hearing Administer a dose of benztropine Call the physician for additional orders.
Ask the client to describe what he is hearing
What is the most common comorbid condition in children with bipolar disorder? Schizophrenia Substance disorders Oppositional defiant disorder Attention-deficit/hyperactivity disorder
Attention-deficit/hyperactivity disorder
The nurse is interviewing a client in the psychiatric unit. The client tilts his head to the side, stops talking in mid sentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing: Somatic delusions Catatonic stupor Auditory hallucinations Pseudoparkinsonism
Auditory hallucinations
1.A suicidal client, with a history of manic behavior, is admitted to the ED. The client's diagnosis is documented as bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder? A. The physician does not believe the client is suffering from major depression. B. The client has experienced a manic episode in the past. C. The client does not exhibit psychotic symptoms. D. There is no history of major depression in the client's family.
B
A patient with bipolar disorder takes lithium. After playing soccer on a hot summer day, the patient complains of nausea, vomiting, diarrhea, and thirst. The patient's hands begin to tremble and the gait becomes unsteady. Select the priority nursing intervention(s). You may select more than one answer. a) Complete an AIMS evaluation on this patient immediately. b) Instruct the patient not to take any more lithium until directed the physician. c) Collaborate with the physician about drawing a serum lithium level immediately. d) Administer an antiemetic medication to the patient. e) Collaborate with the physician regarding increasing the daily lithium dose.
B, C CORECT: The patient likely became dehydrated by the high activity in the summer heat. Lithium toxicity has probably developed. The lithium must be held, and a serum lithium level needs to be drawn. It is the nurse's responsibility to discuss possible toxicity with the physician.
A client has been prescribed an antipsychotic medication for the management of symptoms associated with schizophrenia. Which behaviors will show improvement as a result of adhering to the medication therapy? (Select all that apply.) a) Fears being abducted by alien creatures b) Acknowledges regularly hearing voices c) Regularly discusses his or her alter identity as a spy for Hitler d) Consistently avoids the dayroom when other clients are there e) Stays in his or her room most of the day staring out the window
B, C, CORRECT: The negative symptoms (poor social adjustment, lack of motivation, withdrawal) are more debilitating and do not respond as well to antipsychotic drug therapy. The remaining symptoms are positive symptoms and are more florid (hallucinations, delusions, looseness of associations) and respond to antipsychotic drug therapy.
Antipsychotic medications are thought to decrease psychotic symptoms by: Blocking reuptake of norepinephrine and serotonin Blocking the action of dopamine in the brain Inhibition production of the enzyme MAO Depressing the CNS
Blocking the action of dopamine in the brain
Prototype: •Buproprion (Wellburtin) •Fluoxetine (Prozac) •Venlafaxine (Effexor) •Mirtazapine (Remeron) •Amitriptyline (Elavil) •Imipramine (Tofranil) •Trazodone (Desyrel) •Phenelzine (Nardil) Antidepressant: •Buproprion (Wellburtin) •Fluoxetine (Prozac) •Venlafaxine (Effexor) •Mirtazapine (Remeron) •Amitriptyline (Elavil) •Imipramine (Tofranil) •Trazodone (Desyrel) •Phenelzine (Nardil)
Buproprion (Wellburtin) E Fluoxetine (Prozac) C Venlafaxine (Effexor) D Mirtazapine (Remeron) F Amitriptyline (Elavil) A Imipramine (Tofranil) A Trazodone (Desyrel) G Phenelzine (Nardil) B
1.A client has been diagnosed with major depression. The psychiatrist prescribes paroxetine (paxil). Which of the following medication information should the nurse include in discharge teaching? A. Do not eat chocolate while taking this medication. B. The medication may cause priapism. C. The medication should not be discontinued abruptly. D. The medication may cause photosensitivity.
C. The medication should not be discontinued abruptly.
When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use FIRST? Provide large motor activities to relieve the client's pent-up tension. Administer a dose of prn chlorpromazine to keep the client calm Call for sufficient help to control the situation safely. Convey to the client that his behavior is unacceptable and will not be permitted.
Call for sufficient help to control the situation safely.
One of your goals for a client with depression may be that the client will not harm him/herself . Select the interventions noted in your book in chapter 25 regarding interventions when someone is at risk of suicide. (select all that apply) Create a safe environment Assess for the presence and lethality risk of suicidal ideation Convey an attitude of unconditional acceptance Encourage active participation in establishing a safety plan Maintain close observation of the client Maintain special care in the administration of medications Round at frequent, irregular intervals Spend time with the client Do not directly and matter-of-factly ask about suicide
Create a safe environment Assess for the presence and lethality risk of suicidal ideation Convey an attitude of unconditional acceptance Encourage active participation in establishing a safety plan Maintain close observation of the client Maintain special care in the administration of medications Round at frequent, irregular intervals Spend time with the client
Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (select all) Early intervention at the first episode of psychosis Support for employment and or educational pursuits Rapid high-dose loading with antipsychotic medication Court-ordered sanctions for treatment Recovery-focused psychotherapy
Early intervention at the first episode of psychosis Support for employment and or educational pursuits Recovery-focused psychotherapy
Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the ED. The INITIAL nursing intervention is: Give him an injection of Thorazine Ensure a safe environment for him and others Place him in restraints Order him a nutritious diet.
Ensure a safe environment for him and others
True/False: Tangentiality is the delay in reaching the point of a communication because of unnecessary and tedious details
False : Tangentiality: inability to get to the point of communication due to introduction of many new topics Word salad: group of words put together in a random fashion, . "What would you like?" "The thing that goes, the nails who made me barf.") Circumstantiality: delay in reaching the point of a communication because of unnecessary and tedious details Mutism: inability or refusal to speak Perseveration: Persistent repetition of the same word or idea in response to different ques
Negative symptoms of psychotic disorders are manifestation of things not normally present.
False: Negative symptoms (absence of things that are normally present) Characteristic dimensions of psychotic disorders: Positive symptoms (manifestation of things not normally present) Negative symptoms (absence of things that are normally present) Cognitive symptoms (thinking) Affective symptoms (emotion)
Which of the following parts of the brain is associated with voluntary body movements, thinking and judgement, and expression of feelings? Frontal Lobe Parietal Lobe Temporal Lobe Occipital Lobe
Frontal Lobe
The goal of cognitive therapy with depressed clients is to: Identity and change dysfunctional patterns of thinking. Resolve the symptoms and initiate or restore adaptive family functioning. Alter the neurotransmitters that are creating the depressed mood. Provide feedback from peers who are having similar experiences.
Identity and change dysfunctional patterns of thinking.
Which of the following hormones has been implicated in the etiology of mood disorder with seasonal pattern? Increased levels of melatonin Decreased levels of oxytocin Decreased levels of prolactin Increased levels of thyrotropin
Increased levels of melatonin
Your book identifies different treatment modalities for depression. Select the modalities mentioned in your book: (select all that apply) Individual psychotherapy Group therapy Family therapy Cognitive therapy Electroconvulsive therapy Transcranial magnetic stimulation Vagal nerve stimulation and deep brain stimulation Light therapy Psychopharmacology
Individual psychotherapy Group therapy Family therapy Cognitive therapy Electroconvulsive therapy Transcranial magnetic stimulation Vagal nerve stimulation and deep brain stimulation Light therapy Psychopharmacology
Psychotropic medications may act at the neural synapse to accomplish which of the following? (select all) Inhibit the reuptake of certain neurotransmitters, creating more availability Inhibit catabolic enzymes, promoting more availability of a neurotransmitter Block receptors, resulting in less neurotransmitter activity Add synthetic neurotransmitters found in the drug
Inhibit the reuptake of certain neurotransmitters, creating more availability Inhibit catabolic enzymes, promoting more availability of a neurotransmitter Block receptors, resulting in less neurotransmitter activity
Please review table 4.8 for the safety issues and nursing interventions for patients taking antidepressants. Using the table, what nursing intervention would be indicated when a patient has the safety issue of blurred vision (with Tricylic antidepressants and atypicals). Select all that apply. Instruct client to avoid driving Reassure the pt that this side effect usually resolves within 3 weeks This side effect is permanent; make an appointment with an eye doctor monitor blood pressure to rule out symptoms of hypertension
Instruct client to avoid driving Reassure the pt that this side effect usually resolves within 3 weeks monitor blood pressure to rule out symptoms of hypertension
. A client expresses interest in alternative treatments for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the client? (select all) Light therapy has demonstrated effectiveness that is comparable to antidepressants. Light therapy should be used regularly until the season changes. Light therapy should be used only when ECT has proven to be ineffective. Side effects such as headache, nausea, or agitation, when they occur, are usually mild and transient. Light therapy causes sedation, so the best time to use it before bed.
Light therapy has demonstrated effectiveness that is comparable to antidepressants. Light therapy should be used regularly until the season changes. Side effects such as headache, nausea, or agitation, when they occur, are usually mild and transient.
What structure is sometimes called the emotional brain. Hypothalamus Thalamus Limbic system Cerebrellum
Limbic system
Part of the nurse's continual assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Which of the following are examples of extrapyramidal symptoms? Muscular weakness, rigidity, tremors, facial spasms Dry mouth, blurred vision, urinary retention, orthostatic hypotension Amenorrhea, gynecomastia, retrograde ejaculation Elevated blood pressure, severe occipital headache, stiff neck
Muscular weakness, rigidity, tremors, facial spasms
At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? Potassium Ions Interneurons Neurotransmitters The Myelin Sheath
Neurotransmitters
A decrease in which of the following neurotransmitters has been implicated in depression? Gamma-aminobutyric acid, acetylcholine, and aspartate Norepinephrine, serotonin, and dopamine Somatostatin, substance P, and glycine Glutamate, histamine, and opioid peptides
Norepinephrine, serotonin, and dopamine
Which of the following parts of the brain is concerned with visual reception and interpretation? Frontal Lobe Parietal Lobe Temporal Lobe Occipital Lobe
Occipital Lobe
Some of the common but manageable side effect of antidepressant medications include anticholinergic effects such as dry mouth, blurred vision as well as sedation, nausea, and sexual dysfunction. Select the nursing interventions that were suggested by Townsend and Morgan (2018) to address these concerns (select all that apply): Offer hard candy, ice and frequent sips of water to alleviate dry mouth Take medication at bedtime to lessen sedating effects Take with food to minimize nausea Discontinue medication abruptly if sexual side effects occur
Offer hard candy, ice and frequent sips of water to alleviate dry mouth Take medication at bedtime to lessen sedating effects Take with food to minimize nausea Stopping the medication abruptly may put the patient at risk for discontinuation syndrome and worsen the symptoms of depression
Which of the following parts of the brain deals with sensory perception and interpretation? Hypothalamus Cerebellum Parietal Lobe Hippocampus
Parietal Lobe
Margaret, a 68 year-old is diagnosed with bipolar I disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake is: Sit with her during meals to make sure she eats everything Have her sister-in-law bring food from home bc she knows her likes/dislikes Provide high-caloric, nutritious, finger foods and snacks so she can eat "on the run" Tell her she will be on room restriction until she gets her weight up.
Provide high-caloric, nutritious, finger foods and snacks so she can eat "on the run"
A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. What is the appropriate nurse intervention? Tell her she cannot wear outfit in hospital Do nothing and allow her to learn from responses of peers Quietly walk with her back to her room, help her change. Explain to her if she wears this, she will have to stay in her room.
Quietly walk with her back to her room, help her change.
A client has been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (select all that apply) Slumped posture Delusional thinking Feelings of despair Feels best early in the morning and worse as the day progresses Anorexia
Slumped posture Delusional thinking Feelings of despair Anorexia
Please carefully review table 4.12 which highlights the "safety issues and nursing interventions for clients taking antipsychotic medications. " Also review the "additional issues for client education" on page 73. Select all the health risks of taking antipsychotics that are noted in the text. Select all that apply. Smoking increasing the metabolism of antipsychotics Body temperature is harder to maintain with antipsychotics—dress warm in cold weather Alcohol and antipsychotic drugs potentiate each other's effects so avoid alcohol while on antipsychotic therapy Excessive salivation can occur when clients take clozapine. Sugar free gum and medications may help alleviate symptoms
Smoking increasing the metabolism of antipsychotics Body temperature is harder to maintain with antipsychotics—dress warm in cold weather Alcohol and antipsychotic drugs potentiate each other's effects so avoid alcohol while on antipsychotic therapy Excessive salivation can occur when clients take clozapine. Sugar free gum and medications may help alleviate symptoms
Sally is admitted to the hospital with major depression disorder and repeatedly makes negative statements about herself. Which intervention will promote positive self-esteem? (select all) Teach assertive communication techniques Make observations to Sally when she completes a goal or task. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. Offer to spend time with Sally using a non judgemental, accepting approach.
Teach assertive communication techniques Make observations to Sally when she completes a goal or task. Offer to spend time with Sally using a non judgemental, accepting approach.
Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? Temporal Lobe Thalamus Limbic System Hypothalamus
Thalamus
A child with bipolar disorder also has ADHD. How would these comorbid conditions be treated? No medication for either Medication given for both simultaneously The bipolar condition would be stabilized before ADHD medication would be given The ADHD would be treated before consideration of the bipolar disorder.
The bipolar condition would be stabilized before ADHD medication would be given
The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bim prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? The client's level of agitation increases. The client complains of a sore throat The client's skin has a yellowish cast The client develops muscle spasms
The client develops muscle spasms
Psychoneuroimmunology is a branch of science that involves which of the following? (select all) The impact of psychoactive medications at the neural synapse The relationships between the immune system, the nervous system, and psychological processes including mental illness. The correlation between psychosocial stress and the onset of illness The potential role of virus in the onset of schizophrenia The genetic factors that influence prevention of mental illness.
The relationships between the immune system, the nervous system, and psychological processes including mental illness. The correlation between psychosocial stress and the onset of illness The potential role of virus in the onset of schizophrenia
A nurse is educating a client about his lithium therapy and explaining signs and symptoms of lithium toxicity. What would she tell the client to be alert for? Fever, sore throat, malaise Tinnitus. Severe diarrhea, ataxia Occipital headache, palpitations, chest pain Skin rash, marked rise in blood pressure, bradycardia.
Tinnitus. Severe diarrhea, ataxia
The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bim prn. Why is chlorpromazine ordered? To reduce extrapyramidal symptoms To prevent neuroleptic malignant syndrome To decrease psychotic symptoms To induce sleep
To decrease psychotic symptoms
The primary focus of family therapy for clients with schizophrenia and their families is: To discuss concrete problem-solving and adaptive behaviors for coping with stress. To introduce the family to others with the same problem To keep the client and family in touch with the health-care system To promote family interaction and increase understanding of the illness
To promote family interaction and increase understanding of the illness
Hallucinations are false sensory perceptions not associated with real external stimuli.
True Hallucinations: false sensory perceptions not associated with real external stimuli.
Education for the client who is taking MAOIs should include which of the following? Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2-4 weeks Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at the end of treatment. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.
Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.
Education for the client who is taking MAOIs should include which of the following? Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2-4 weeks. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.
Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.
Initial symptoms of lithium toxicity include: Constipation, dry mouth Dizziness, thirst Vomiting, diarrhea Anuria, arrhythmias
Vomiting, diarrhea
Which statement made by the client demonstrates an understanding of the benefit of clozapine? a) "I'm less likely to develop a stooped, shuffling walk." b) "It will help keep me from developing type 2 diabetes." c) "It will provide me with some protection against a heart attack." d) "This medication cost less than the first-generation antipsychotic types."
a) "I'm less likely to develop a stooped, shuffling walk." Correct Clozapine is an example of a second-generation antipsychotic (SGA) atypical medication. The atypical SGAs have fewer disturbing extrapyramidal side effects (EPS). However, the SGAs in general have a higher risk for metabolic syndrome (weight gain, diabetes, and dyslipidemia) than the first-generation antipsychotics. As well, the SGAs lead to more cardiovascular events and premature deaths than the first-generation antipsychotics. The SGAs are also considerably more expensive than the more traditional FGAs.
Which of the following parts of the brain is concerned with hearing, short-term memory, and sense of smell? Temporal Lobe Parietal Lobe Cerebellum Hypothalamus
temporal lobe
Which statement by a client scheduled for a series of electroconvulsive therapy (ECT) treatments indicates to the nurse that the client has an understanding of the goals of this treatment? a) "It is expected that my chance for remission is very good." b) If this works, I will likely be able to stop taking lithium." c) "I'm prepared to deal with the certain loss of my short-term memory." d) "My prognosis is so much better since I didn't have any delusional symptoms."
a) "It is expected that my chance for remission is very good." Correct ECT is safe and effective, and can achieve a 70% to 90% remission rate in depressed patients within 1 to 2 weeks. ECT is useful in treating patients with major depressive disorder especially when psychotic symptoms are present (e.g., delusions of guilt, somatic delusions, or delusions of infidelity). On awakening from ECT, the patient may be confused and disoriented. Many patients state that they have memory deficits for the first few weeks after treatment. Memory usually, although not always, recovers. ECT is not a permanent cure for depression, and maintenance treatment with TCAs or lithium decreases the relapse rate.
A patient has been taking citalopram (Celexa) for 2 years for depression. The patient's outcomes have been achieved and the patient wants to discontinue the medication. Which information should the nurse provide? a) "It's important for you to gradually stop taking this drug over 2 to 4 weeks." b) "Citalopram is an antidepressant medication that is usually taken for life." c) "Because your depression is alleviated, you may discontinue the medication." d) "Stopping this medication all of a sudden can cause serotonin syndrome."
a) "It's important for you to gradually stop taking this drug over 2 to 4 weeks." Correct SSRIs should be gradually tapered off over a period of 2 to 4 weeks to avoid a withdrawal syndrome. Symptoms of the withdrawal syndrome include headache, GI upset, dizziness, insomnia, anxiety, and flu-like symptoms. Serotonin syndrome is a potentially life-threatening consequence of drug interactions with SSRIs.
Which of the following would be assessed as a negative symptom of schizophrenia? a) Anhedonia b) Hostility c) Agitation d) Hallucinations
a) Anhedonia Correct Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition(lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.
A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: a) Bradykinesia, akathisia, and agitation b) Excessive weight gain c) Hypertension d) Potentially fatal agranulocytosis
a) Bradykinesia, akathisia, and agitation
Which intervention associated with bipolar disorder best minimizes the risk for the development of suicidal ideations? a) Early diagnosis b) Family counseling c) Medication therapy d) Stress identification
a) Early diagnosis Correct Bipolar disorder often remains unrecognized, and early detection can help diminish co-occurring substance use disorders, suicide, and declines in social and personal relationships and may help promote more positive outcomes. While the remaining options are appropriate interventions they are not best for minimizing risk for suicide.
Which behavior would be most characteristic of a client during a manic episode? a) Going rapidly from one activity to another b) Taking frequent rest periods and naps during the day c) Being unwilling to leave home to see other people d)Watching others intently and talking little •
a) Going rapidly from one activity to another Correct Hyperactivity and distractibility are basic to manic episodes
Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? a) Onset of action is from 2 to 4 weeks. b) They tend to be more effective for men. c) They may cause recent memory impairment. d) They often cause the client to have diurnal variation.
a) Onset of action is from 2 to 4 weeks. Correct People are accustomed to fast results from medication. Thirty minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance.
Which nursing intervention has priority during the acute phase of a client's manic episode? a)Providing fluids frequently to promote hydration b) Monitoring the amount of sleep the client achieves c) Identifying triggers for exacerbation of manic behavior d) Including family in regular counseling and therapy sessions
a) Providing fluids frequently to promote hydration Correct During the acute phase of mania, physical needs often take priority and demand nursing interventions. Therefore deficient fluid volume is the priority. While the remaining options are appropriate they lack the potential effect on physical health that fluid deficiency has.
What intervention can the nurse suggest when a client reports that lithium gives him an upset stomach? a) Take it with meals b) Take it with an antacid c) Take it 30 minutes before meals d) Take it 2 hours after meals
a) Take it with meals Correct Many clients find that taking lithium with or shortly after meals minimizes gastric distress
What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a) Withhold medication and notify the physician b) Continue to administer medication as ordered c) Advise the client to limit fluids for 12 hours d) Advise the client to curtail salt intake for 24 hours
a) Withhold medication and notify the physician Correct The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified.
A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmersare coming to execute me." The term "volmers" can be assessed as a)a neologism. b)clang association. c) blocking. d) a delusion.
a) a neologism. Correct A neologism is a newly coined word that has meaning only for the client.
A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will a) ask for validation of reality. b) describe content of hallucinations. c) demonstrate a cool, aloof demeanor. d) identify prodromal symptoms of disorder.
a) ask for validation of reality. Correct Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.
When a client diagnosed with schizophrenia hears voices saying that he is a horrible human being, the nurse can correctly assume that the hallucination a)is a projection of the client's own feelings. b)derives from neuronal impulse misfiring. c) is a retained memory fragment. d) may signal seizure onset.
a) is a projection of the client's own feelings. Correct One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about himself or herself. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period
The first-line drug used to treat mania is a)lithium. b)carbamazepine. c) lamotrigine d) clonazepam.
a) lithium. Correct Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder.
A depressed client tells the nurse "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by a) suggesting "Let's look at what you just said, that you can 'never do anything right.'" b) querying "Tell me what things you think you are not able to do correctly." c) asking "Is this part of the reason you think no one likes you?" d) saying "That is the most unrealistic thing I have ever heard."
a) suggesting "Let's look at what you just said, that you can 'never do anything right.'" Correct Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate.
To plan care for a manic client the nurse must consider that lithium cannot be started until a) the physical examination and laboratory tests are analyzed. b) the initial doses of antipsychotic medication have brought behavior under control. c) seclusion has proven ineffective as a means of controlling assaultive behavior. d) electroconvulsive therapy can be scheduled to coincide with lithium administration.
a) the physical examination and laboratory tests are analyzed. Correct Lithium should not be given to clients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally.
Patients who are on MAOI therapy will have dietary restrictions. They will have to avoid foods that have tyramine. Using Table 4.7 select the foods that the clients should avoid while on MAOIs. aged cheese Baked potato Red wine Corn Smoked/processed meats Pasta Avocados Fresh fish Chocolate Rice
aged cheese Red wine Smoked/processed meats Avocados Chocolate
A patient with schizophrenia was changed to a new antipsychotic medication 3 weeks ago. The patient calls the clinic nurse complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in determining the cause of these findings? a) Serum lithium level b) Absolute neutrophil count c) Liver panel d) Urinalysis
b) Absolute Neutrophil Count (ANC) Correct clozapine is associated with severe neutropenia which can lead to life threatening infections (sore throat, fever, and malaise would raise the concern of a serious infection). Chief complaints are flulike symptoms.
Lithium is prescribed for a client admitted with a diagnosis of bipolar disorder. Which other therapy is also initially prescribed to temporarily help manage the client's symptoms? a) Antimanic medication b) Antipsychotic medication c) Electroconvulsive therapy (ECT) d) Cognitive behavioral therapy (CBT)
b) Antipsychotic medication Correct Antipsychotic agents may be needed because of their sedating and mood-stabilizing properties, especially during initial treatment until antimanic medications, such as lithium, take effect. While the remaining options are appropriate, they do not support the antimanic medication therapy initially
Which nursing intervention is generally included in the plan of care for any hospitalized client experiencing a psychotic episode associated with schizophrenia? a) Identifying theme of hallucinations b) Suicide precautions per institution policies c) Boundary setting to manage aggressiveness d) Assessing for the presence of feelings of guilt
b) Suicide precautions per institution policies Correct When the nurse works with patients with schizophrenia, four specific groups of symptoms may be evident. No one symptom is found in all cases but depression is almost always present. Suicide precautions are necessary to keep the client safe.
A client demonstrating delusional behavior is escalating as a result of increasing anxiety regarding his or her safety. Which action demonstrates that the client has an understanding of actions to de-escalate his or her anxiety? a) The client retreats to his or her room accompanied by staff b) The client asks that he or she be allowed to seclude him- or herself d) The client engages in a group therapy session led by nursing staff d) The client expresses the understanding that his or her safety is the primary nursing goal
b) The client asks that he or she be allowed to seclude him- or herself Correct If anxiety escalates and the patient is losing control, least restrictive interventions (e.g., one-to-one therapy, last resort seclusion) are most appropriate. Self-seclusion is an example that the client understands how to manage his or her anxiety effectively. None of the other options demonstrate the necessary principles associated with anxiety de-escalation.
A desired outcome for the maintenance phase of treatment for a manic client would be that the client will a) exhibit optimistic, energetic, playful behavior. b) adhere to follow-up medical appointments. c) take medication more than 50% of the time. d) use alcohol to moderate occasional mood "highs."
b) adhere to follow-up medical appointments. Correct The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable.
An outcome for a manic client during the acute phase that would indicate that his treatment plan was successful would be that the client a) reports racing thoughts. b) is free of injury. c) is highly distractible. d) ignores food and fluid.
b) is free of injury. Correct Risk for injury is a diagnosis of high priority for manic clients because of their hyperactivity. Lack of injury is a highly desirable outcome.
The major reason for hospitalization for depressed patients is: a) inability to go to work. b) suicidal ideation. c) loss of appetite. d) psychomotor agitation.
b) suicidal ideation. Correct Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.
A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? a) The side-effects are unpleasant b)The voices tell the client to stop taking it c) The client prefers to feel "high" and energetic d) The client feels well and denies the possibility of recurrence
b)The voices tell the client to stop taking it Correct Manic clients may hallucinate during the delirious state but generally do not hear voices. Psychoeducation would not be going on during the time the client is delirious.
The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client with severe depression. The most reliable evaluation of outcomes will be based on a) energy level. b)weekly weights. c) observed eating patterns. d) client statement of appetite.
b)weekly weights. Correct Client body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis
A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be a) "You are safe here in the hospital; nothing bad will happen to you." b) "The voices are wrong about the hospital food. It is not contaminated." c) "I understand that the voices are very real to you, but I do not hear them." d) "Other people are eating the food, and nothing is happening to them."
c) "I understand that the voices are very real to you, but I do not hear them." Correct This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing.
Sasha is started on fluoxetine. Which statement by Sasha indicates that she understands the medication teaching you have provided? a) "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." b) "I will not take any over-the-counter medication while on the fluoxetine." c) "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." d) "I will report increased thirst and urination to my provider."
c) "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." Correct This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.
Which room placement would be best for a client experiencing a manic episode? a) A shared room with a client with dementia b) A single room near the unit activities area c) A single room near the nurse's station d) A shared room away from the unit entrance
c) A single room near the nurse's station Correct The room placement that provides anonstimulatingenvironment is best. Being near the nurse's station means close supervision can occur.
Which symptom would NOT be assessed as a positive symptom of schizophrenia? a) Delusion of persecution b) Auditory hallucinations c) Affective flattening d) Idea of reference
c) Affective flattening Correct Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.
One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: a) Orthostatic hypotension b) Agitation and irritability c) Drowsiness and nausea d) Painful urination and abdominal pain
c) Drowsiness and nausea
Declan is being discharged from the psychiatric unit on risperidone (Risperdal). You are providing medication teaching to Declan and his mother, who is his primary caregiver. Which of the following statements is the appropriate response to Declan's mother's question regarding the risk for extrapyramidal side effects (EPSs) while taking risperidone? a) All antipsychotic medications have an equal chance of producing EPSs. b) Newer antipsychotic medications have a higher risk for EPSs. c) Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. d) Advise Declan's mother to ask the provider to change the medication to clozapine instead of risperidone.
c) Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Correct Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.
When the clinician mentions that a client has anhedonia, the nurse can expect that the client a) has poor retention of recent events. b) has weight loss of 10 lb or more from anorexia. c) obtains no pleasure from previously enjoyed activities. d) has difficulty with tasks requiring fine motor skills.
c) obtains no pleasure from previously enjoyed activities. Correct Anhedonia is the term for the lack of ability to experience pleasure.
A patient hospitalized for major depression has been taking sertraline (Zoloft) for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask? a) "Have you experienced any side effects from this drug?" b) "How has your appetite changed since starting this drug?" c) "Do you think your depression is less severe?" d) "Are you having any thoughts of harming yourself?"
d) "Are you having any thoughts of harming yourself?" Correct The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, but suicide is the highest priority.
When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be a) "You are safe here. This is a locked unit, and no one can get in." b) "I do not believe I understand the word volmers. Tell me more about them." c) "Why do you think someone or something is going to harm you?" d) "It must be frightening to think something is going to harm you."
d) "It must be frightening to think something is going to harm you." Correct This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the client will likely be unable to answer
Tyler is being discharged home to his family. Which of the following is important teaching to include for the patient and the family to recognize possible signs of impending mania? a) Increased appetite b) Decreased social interaction c) Increased attention to bodily functions d) Decreased sleep
d) Decreased sleep Correct Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.
Quetiapine (Seroquel) is prescribed for a patient who smokes two packs of cigarettes per day. Which effect would be expected? a) Quetiapine will have a longer half-life for the patient, so fewer doses per day are needed. b) The doses of quetiapine will be lower than usual because of slowed metabolism. c) This patient has a higher risk of developing tardive dyskinesia. d) Higher doses of quetiapine will likely be needed to achieve therapeutic effects.
d) Higher doses of quetiapine will likely be needed to achieve therapeutic effects. Correct Cigarette smoking activates hepatic enzymes, which causes antipsychotic medications to be metabolized more quickly. The patient will either need higher doses or more frequent dosing. Smoking will shorten the drug's half-life.
client diagnosed with depression has been prescribed various first-line antidepressant agents but has demonstrated only minimal improvement. In preparation for the prescription of a second-line agent, the nurse will educate the client on which classification of antidepressant? a) Atypical b) Tricyclic c) Dual action d) Monoamine oxidase inhibitors
d) Monoamine oxidase inhibitors Correct First-line agents include cyclic antidepressants (e.g., TCAs), dual action antidepressants (SSRIs, SNRIs, and NDRIs), and atypical antidepressants while monoamine oxidase inhibitors (MAOIs) are considered second-line agents.
Which side effect of antipsychotic medication is generally nonreversible? a) Anticholinergic effects b) Pseudoparkinsonism c) Dystonic reaction d) Tardive dyskinesia
d) Tardive dyskinesia Correct Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects in A, B, and C often appear early in therapy and can be minimized with treatment
Sasha's roommate Kate was admitted with major depression and suicidal ideation with a plan to overdose. Kate is preparing for discharge and asks you, "Why did Dr. Travis give me a prescription for only 7 days of amitriptyline?" Your response is based on the knowledge that: a) amitriptyline (Elavil) is very expensive, so the patient may have to buy fewer at a time. b) Dr. Travis is going to see how Kate responds to the first week of medication to evaluate its effectiveness. c) Dr. Travis wants to see whether any minor side effects occur within the first week of administration. d) amitriptyline (Elavil) is lethal in overdose.
d) amitriptyline (Elavil) is lethal in overdose. Correct Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only one week. Side effects are always a consideration but not the most important consideration with TCAs.
The type of altered perception most commonly experienced by clients with schizophrenia is a) delusions. d) illusions. c) tactile hallucinations. d) auditory hallucinations.
d) auditory hallucinations. Correct Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.
When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that a) no research exists to suggest genetic transmission. b) much depends on the socioeconomic class of the individuals. c) highly creative people tend toward development of the disorder. d) the rate of bipolar disorder is higher in relatives of people with bipolar disorder.
d) the rate of bipolar disorder is higher in relatives of people with bipolar disorder. Correct This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.
