Mental Health Final:

Working Stage of Group Development

begins as members begin to focus their attention on the purpose or task the group is trying to accomplish. This may happen relatively quickly in a work group with a specific assigned project, but may take two or three sessions in a therapy group because members must develop some level of trust before sharing personal feelings or difficult situations. During this phase, several group characteristics may be seen. Group cohesiveness is the degree to which members work together cooperatively to accomplish the purpose. Cohesiveness is a desirable group characteristic and is associated with positive group outcomes. It is evidenced when members value one another's contributions to the group; members think of themselves as "we" and share responsibility for the work of the group. When a group is cohesive, members feel free to express all opinions, positive and negative, with little fear of rejection or retribution. If a group is "overly cohesive," in that uniformity and agreement become the group's implicit goals, there may be a negative effect on the group outcome. In a therapy group, members do not give one another needed feedback if the group is overly cohesive. In a work group, critical thinking and creative problem-solving are unlikely, which may make the work of the group less meaningful. Some groups exhibit competition, or rivalry, among group members. This may positively affect the outcome of the group if the competition leads to compromise, improved group performance, and growth for individual members. Many times, however, competition can be destructive for the group; when conflicts are not resolved, members become hostile, or the group's energy is diverted from accomplishing its purpose to bickering and power struggles.

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... partial hospitalization programs. inpatient psychiatric units. psychosocial rehabilitation programs. collaborative mental health care.

collaborative mental health care.

Halodal

duration of 4 weeks.

Prolixin

duration of 7 to 28 days

Therapeutic Relationship

focuses on the needs, experiences, feelings, and ideas of the client only.

Healthy Intimate Relationship

involves two people who are emotionally committed to each other.

The most important reason that psychiatric nurses need to know about the brain is that ... it is the organ of the mind and governs all forms of human behavior. it is the center of all metabolic processes for drugs that are used for psychiatric disorders. it is responsible for the etiology of many mental disorders. it is the central location for transcription of genes related to behavior.

it is the organ of the mind and governs all forms of human behavior.

Lithium

neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.

Social Relationship

primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task.

Self Awareness

process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how these qualities affect others.

A female client is brought to the emergency department by her sibling, who reports that the client became very agitated and "started hallucinating." Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The sibling states that the client is taking paroxetine for depression. Which would the nurse most likely suspect? neuroleptic malignant syndrome acute dystonic reaction serotonin syndrome hypothyroidism

serotonin syndrome

Partial Hospitalization Program

structured treatment at an agency or a facility for clients living in the community; designed to help clients make a gradual transition from being an inpatient to living independently or to avoid hospital admission

Stimulant Drugs

treat psychiatric disorders in the 1930s for their pronounced effects on CNS stimulation; a selective norepinephrine reuptake inhibitor, was approved for the treatment of ADHD

Serotonin Syndrome

uncommon but potentially life-threatening disorder called serotonin or serotonergic syndrome; characterized by agitation, sweating, fever, tachycardia, hypotension, rigidity, hyperreflexia, confusion, and, in extreme cases, coma and death; most commonly results from a combination of two or more medications with serotonin-enhancing properties, such as taking MAOI and SSRI antidepressants at the same time or too close together

A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family? "You may experience hypertension while taking this medication." "One of the side effects of this medication is breast engorgement." "People taking this medication often experience dermatitis." "You may experience noticeable weight gain while taking this medication."

"You may experience noticeable weight gain while taking this medication."

Basic Level Functions

-Counseling -Milieu Therapy -Self Care Activities -Psychobiologic Interventions -Health Teaching -Case Management -Health Promotion and Maintenance

Counseling:

-Intervention & communication -Problem solving -Crisis Interventions -Stress Management -Behavior Modification

Milieu Therapy:

-Maintain therapeutic environment -Teach skills -Encourage communication between clients and others -Promote growth through role modeling

Primary, Secondary, Tertiary Levels of Prevention

...

Piaget's Cognitive Stages of Development

1. Sensorimotor—birth to 2 years: The child develops a sense of self as separate from the environment and the concept of object permanence; that is, tangible objects do not cease to exist just because they are out of sight. He or she begins to form mental images. 2. Preoperational—2 to 6 years: The child develops the ability to express self with language, understands the meaning of symbolic gestures, and begins to classify objects. 3. Concrete operations—6 to 12 years: The child begins to apply logic to thinking, understands spatiality and reversibility, and is increasingly social and able to apply rules; however, thinking is still concrete. 4. Formal operations—12 to 15 years and beyond: The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.

When haloperidol is given as a depot injection, it has an effectiveness of which duration? 1 week 2 weeks 3 weeks 4 weeks

4 weeks

The prescription of clozapine requires weekly blood samples for which time frame? 6 months 2 months 4 months 8 months

6 months

Which client may be the most appropriate candidate for telepsychiatry? A client with bipolar disorder who has been admitted to the hospital during a manic episode A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health A client who has been brought to the emergency department because of acute psychosis An inpatient who is on visual checks every 15 minutes as a suicide precaution

A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health

A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time? A day-treatment program Admission to a long-term care facility Subacute care Rehabilitative care

A day-treatment program

Which community activity is an example of tertiary prevention in a community that experienced a massive fire? Mental health professionals offered educational programs on effective coping strategies. A master plan was formulated for what to do in case of another fire. City officials installed warning signals in remote areas where no warning signals were heard. Hospital personnel reviewed their emergency response plans and made changes.

A master plan was formulated for what to do in case of another fire.

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Ability to provide services in a variety of locations Improvement in therapeutic relationship Ensured quality of care Ability to provide high-intensive services for many mental illnesses

Ability to provide services in a variety of locations

Which is the most restrictive setting in the continuum? Acute inpatient hospitalization Crisis intervention Residential care Partial hospitalization

Acute Inpatient Hospitalization

In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase After the initiating or orienting phase has been completed During the working phase After the working phase has been completed

After the initiating or orienting phase has been completed

Frequency of blood tests on Clozapine

Agranulocytosis failure of the bone marrow to produce adequate white blood cells Can occur as long as 18 to 24 weeks after the initiation of therapy. The drug must be discontinued immediately. Clients taking this antipsychotic must have Weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter. Clozapine is dispensed every 7 or 14 days only, and evidence of a white blood cell count above 3500 cells/mm3 is required before a refill is furnished.

Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)? Atypical antipsychotics block both serotonin and dopaminergic receptors. There are no side effects with the typical antipsychotics. Typical antipsychotics often lead to weight gain. Atypical antipsychotics can cause arrhythmias and kidney failure in rare cases.

Atypical antipsychotics block both serotonin and dopaminergic receptors.

What is the difference between traditional and atypical antipsychotics? Traditional antipsychotics work mostly as dopamine agonists, but antipsychotics work through antagonizing the dopamine receptor. Traditional antipsychotics have a more powerful effect on the negative symptoms of schizophrenia, whereas atypical antipsychotics exert stronger effects on the positive symptoms. Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade. There are no major differences between these two classes of drugs; their advantages are that there is a wider spectrum of drugs from which to choose.

Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade.

A nurse administers haloperidol to a client to promote deescalation. The nurse finds that after administering the drug, the client has started having jerky and involuntary movements of the head and arms. Which medication would be useful in treating this problem? Clozapine Risperidone Olanzapine Benztropine

Benztropine

Mood-Stabilizing Drugs

Bipolar

Therapeutic Use of Self

By developing self-awareness and beginning to understand his or her attitudes, the nurse can begin to use aspects of his or her personality, experiences, values, feelings, intelligence, needs, coping skills, and perceptions to establish relationships with clients.

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Crisis intervention Partial hospitalization Case management Respite residential care

Case management

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship? Client self-exploration Self-disclosure Empathy Respect

Client Self-Exploration

A nurse has transferred recently to a forensic practice setting from an acute care medical setting. During the orientation period, the nurse's mentor helps the nurse learn the culture of a forensic setting. The nurse learns to be alert to one of the most dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier? Clients commonly struggle with trusting others. Clients are transferred frequently to other forensic institutions. The lifestyle of the incarcerated client is solitary. Nurses often transgress professional boundaries with the clients.

Clients commonly struggle with trusting others.

Postinjection delerium syndrome

Cluster of symptoms, such as slurred speech, confusion, sedation, altered gait, or unconsciousness that result from accidental intravascular injection of a portion of olanzapine (Zyprexa Relprevv)

Beginning Stage of Group Development

Commences as soon as the group begins to meet. Members introduce themselves, a leader can be selected (if not done previously), the group purpose is discussed, and rules and expectations for group participation are reviewed. Group members begin to "check out" one another and the leader as they determine their levels of comfort in the group setting.

A nurse encourages a client to enroll in outpatient services immediately upon discharge from the inpatient setting. The nurse does this to promote which outcome? Relapse prevention . Community reintegration . Empowerment. Stabilization.

Community Reintegration

A forensic nurse working in a prison must view all clients as people who deserve respect and professionalism. What should the nurse do to enforce this viewpoint? Apply the nurse's morals and values to everyone. Conduct ongoing self-reflection and self-awareness. Apply religious beliefs to patient care. Conduct thorough physical assessments of clients.

Conduct ongoing self-reflection and self-awareness

Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply. dry mouth constipation urinary retention diarrhea tunny nose

Dry mouth Constipation Urinary Retention

While interviewing a client, the nurse imagines what it would be like to be in the client's situation and how it would feel. The nurse is demonstrating: rapport. empathy. self-awareness. projection.

Empathy

The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what? Drug abuse prevention Spiritual aspects of care Ensuring a sustainable living situation Nutritional therapies

Ensuring a sustainable living situation

Which is not involved in empathy? Careful listening Being in touch with what clients are saying Feeling the same emotions that the client is feeling at a given time Having insight into the meaning of clients' thoughts, feelings, and behaviors

Feeling the same emotions that the client is feeling at a given time

Which type of residential setting may care for one to three clients in a family-like atmosphere, including meals and social activities with the family? Foster homes Halfway houses Group homes Independent living

Foster homes

Which is a difference between counseling and psychotherapy? Psychotherapy is reserved for clients who have a documented history of failing to respond to counseling. Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. Transference and countertransference are significant obstacles in psychotherapy that can be avoided in a counseling mode. Counseling may be used in the care of acutely psychotic clients, but psychotherapy is contraindicated.

Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role.

A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs? Chest pain, tachycardia, and cardiac dysrhythmias Respiratory distress, cyanosis, and pallor Nausea, vomiting, diarrhea, and gastric pain Hyperpyrexia, severe hypertension, and diaphoresis

Hyperpyrexia, severe hypertension, and diaphoresis

A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus? Cost savings Consistent third-party reimbursement Improved access to less costly services Individualized care for additional inpatient stays

Improved access to less costly services

Which is an inaccurate statement regarding a preconception? It enables the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave. It prevents people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.

It enables the nurse to get an accurate picture of the client's problems.

Residential Treatment Setting

Long-term treatment provided in a living situation; vary according to structure, level of supervision, and services provided

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Inclusion of both art therapy and psychotherapy Maintenance of the therapeutic environment A multidisciplinary approach Therapy that does not include medication

Maintenance of the therapeutic environment

Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function? Milieu therapy Counseling Health teaching Case management

Milieu therapy

A client receives the first dose of fluphenazine. The next day, during the follow-up appointment, the nurse finds the client is confused and the client's temperature is 103°F, pulse rate is 116 beats per minute, respirations are 34 breaths per minute, and blood pressure is 100/50 mmHg. The nurse should investigate further for which condition? Heatstroke Serotonin syndrome Neuroleptic malignant syndrome Parkinsonism

Neuroleptic malignant syndrome

When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Psychiatrist Case manager Nurse Social worker

Nurse

Final Stage of Group Development

Occurs before the group disbands. The work of the group is reviewed, with the focus on group accomplishments or growth of group members or both, depending on the purpose of the group.

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model? Orientation phase Identification phase Exploitation phase Termination phase

Orientation phase

A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding by identifying which type as providing the most intensive outpatient nursing care? Partial hospitalization programs Crisis intervention programs Outpatient detoxification programs Rehabilitation programs

Partial hospitalization programs

Which mental health treatment setting is not a residential treatment setting? Partial hospitalization programs Group homes Adult foster care Respite

Partial hospitalization programs

When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? Hildegard Peplau Florence Nightingale Dorothea Dix Sigmund Freud

Peplau

Neuroleptic Malignant Syndrome

Potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug

Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years? Increased federal and state funding for psychiatric home care Pressures to reduce health care costs associated with inpatient care Improved pharmacological treatments for major depression Research suggesting that inpatient psychiatric treatment is less effective than previously believed

Pressures to reduce health care costs associated with inpatient care

Antidepressant Drugs

Primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression Norepinephrine and serotonin

A case manager is working with a parent whose child has schizophrenia. The parent reports sadness, frequent crying, and fatigue. The case manager works with the parent to establish some scheduled rest, relaxation, and respite from caring for the child. At which level of prevention is the case manager working with the parent? Primary Secondary Tertiary Rehabilitative

Primary

One goal of transitional care in mental health care is what? Provide intensive monitoring of the client at home Provide crisis intervention services when needed Provide an alternative for inpatient admission Encourage the parents to participate in the client's care

Provide an alternative for inpatient admission

A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying? Pseudoparkinsonism Akathisia Dystonia Neuroleptic malignant syndrome (NMS)

Pseudoparkinsonism

Which mental health service is an advanced-level function? Psychotherapy Milieu therapy Counseling Self-care activities

Psychotherapy

What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care? Using the standards to determine if a nurse's action is considered criminally negligent. Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. Using the standards as a guide to identify advanced level nursing functions. Citing the standards as a guide for determining the delegation of care.

Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice.

The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend? Respite residential care Assertive community treatment (ACT) Psychosocial rehabilitation Recovery center

Respite residential care

The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest? Partial hospitalization Acute inpatient care Respite residential care Intensive outpatient program

Respite residential care

What are neuroleptic medications used to treat? Bipolar disorder Attention deficit/hyperactivity disorder Seizure disorders Schizophrenia

Schizophrenia

The case manager makes a home visit to the client's household and finds that the client has become psychotic in the prior 3 days and has bolted himself in the his room. The case manager works to encourage the client to come out and calls the ambulance to take the client to the emergency department. At what level of prevention is the case manager working? Secondary Primary Tertiary Rehabilitative

Secondary

Inpatient Hospitalization Stays

Short and Long

Case management has been proposed as a cost-effective model of psychiatric care for mentally ill clients. Which describes the goal of case management? A return to the practice of institutionalizing chronically ill clients Short-term inpatient, crisis stabilization, and community referral Increased use of psychotropic medication to stabilize psychotic behavior quickly Infrequent use of partial hospitalization and increased use of inpatient treatment

Short-term inpatient, crisis stabilization, and community referral

A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client's family members that the primary focus of the client's hospitalization is what? Provide long-term therapy Provide rehabilitative services Stabilize acute symptoms Provide 24-hour supervision

Stabilize acute symptoms

ANA

Standards of care are authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable.

The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is what? Symptom acuity does not require psychiatric hospitalization Treatment plan can be completed in less than 3 months Family home can be returned to each evening Diagnosis interferes with employability

Symptom acuity does not require psychiatric hospitalization

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what? Symptom stabilization Psychoeducation Discharge planning Recovery

Symtom stabilization

A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what? Tardive dyskinesia Neuroleptic malignant syndrome Dystonia Akathisia

Tardive dyskinesia

A patient scheduled to be released from prison in 1 month has been assigned a case manager and has been meeting with her 3 times a week. This is an example of which level of prevention? Primary Secondary Tertiary Chronic

Tertiary

When engaged in a therapeutic relationship, the nurse's focus is on what? The client The self The environment The family

The Client

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior? The client is nervous and insecure. The client is experiencing symptoms of a disorder. The client is demonstrating a normal reaction. The client is attempting to engage in a social relationship.

The client is nervous and insecure.

Which is a nurse's primary tool for treating clients with mental disorders? Psychotropic medications The therapeutic use of self Self-help groups Family education and therapy

Therapeutic use of self

Benzodiazepines work by the following mechanism of action: They act directly on dopaminergic neurons in the medulla. They act directly on GABA receptors and are thought to increase the amount of GABA available. They act indirectly through a second messenger to affect levels of circulating GABA. The mechanism of action of this category of drugs is unknown at this time.

They act directly on GABA receptors and are thought to increase the amount of GABA available.

Which antipsychotic drug can cause a lengthening of the QT interval? Thioridazine Clozapine Olanzapine Haloperidol

Thioridazine

What was the original purpose for developing the role of the case manager in community-based care? To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions To relieve already-burdened psychiatrists from having to make home visits to critically mentally ill clients To reduce stress on the emergency system (ie, ambulances, 911 services), which were increasingly being taxed by mentally ill individuals and their families To provide more comprehensive mental health psychotherapy to clients who were homebound

To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions

Erikson's Stages of Psychosocial Development

Trust vs. mistrust (infant). Hope. Viewing the world as safe and reliable; relationships as nurturing, stable, and dependable Autonomy vs. shame and doubt (toddler). Will. Achieving a sense of control and free will Initiative vs. guilt (preschool). Purpose. Beginning development of a conscience; learning to manage conflict and anxiety Industry vs. inferiority (schoolage). Competence. Emerging confidence in own abilities; taking pleasure in accomplishments Identity vs. role confusion (adolescence). Fidelity. Formulating a sense of self and belonging Intimacy vs. isolation (youngadult). Love. Forming adult, loving relationships and meaningful attachments to others Generativity vs. stagnation(middle adult). Care. Being creative and productive; establishing the next generation Ego integrity vs. despair (maturity). Wisdom. Accepting responsibility for one's self and life

A client will soon be completing a course of inpatient treatment for the treatment of schizophrenia. At what point should the care team review the client's eligibility for additional services, coverage, and programs in the community? Upon admission to the inpatient setting Once the client experiences an exacerbation of symptoms When requested by the client's health maintenance organization (HMO) When the client and/or client's family advocates for such a review

Upon admission to the inpatient setting

Antianxiety drugs, or anxiolytic drugs

Used to treat anxiety and anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, and alcohol withdrawal Benzodiazepines mediate the actions of the amino acid GABA, the major inhibitory neurotransmitter in the brain

Antipsychotic Drugs

Used to treat the symptoms of psychosis Blocking receptors of the neurotransmitter dopamine

Medication Warning:

When a drug is found to have serious or life-threatening side effects, even if such side effects are rare, the FDA may issue a black box warning.

A psychiatric-mental health nurse is conducting a self-examination of beliefs and values to develop self-awareness. Asking which question would be appropriate for the nurse to determine the fundamental personal attitudes about people of diverse cultures? Did you grow up in a rural or urban community? While a child, what attitudes did your family express about other cultures? What kinds of experiences have you had with people of other cultures? Do you think you hold bias or prejudice attitudes?

While a child, what attitudes did your family express about other cultures?

Empathy

ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client.

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client? agranulocytosis hypotension hypertension diabetes

agranulocytosis

A client who has been taking clozapine for 6 weeks visits the clinic reporting fever, sore throat, and mouth sores. The nurse notifies the client's physician because the nurse suspects: severe anemia . neuroleptic malignant syndrome. encephalitis. agranulocytosis.

agranulocytosis.