Psych Exam 1

How long after administering a medication should blood levels be monitored?

12 hours

When haloperidol is given as a depot injection, it has an effectiveness of which duration?

4 weeks

A client with an anxiety disorder is exhibiting agitation after missing some doses of diazepam. The nurse interprets the aggression as relating to which cause?

A rebound phenomenon, referred to as paradoxical excitation, may occur after the abrupt discontinuation of benzodiazepines. The client may become more anxious, exhibit aggressive or antisocial behavior, or experience withdrawal symptoms of confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens.

A nurse is developing a plan of care for a client diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved?

Abnormally high activity of dopamine has been associated with schizophrenia.

A nurse is caring for a client with a chronic illness. Which behaviors by the client indicate the identification phase, according to the Peplau's model of nurse-client relationship? Select all that apply.

According to the Peplau's model of nurse client relationship, recognizing the nurse as an individual and understanding the continuity of the healthcare related session are activities in the identification phase.

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?

According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end.

When describing the various neurotransmitters, which chemical would a nurse identify as the primary cholinergic neurotransmitter?

Acetylcholine is the primary cholinergic neurotransmitter.

he nurse is treating the client with positive regard to help build a trusting nurse-client relationship. Which nursing action(s) may convey positive regard? Select all that apply.

Addressing the client by name Actively listening to the client. Responding openly to the client.

What is a red flag for benzodiazepine interactions?

Alcohol and benzodiazepines can be lethal.

Abnormalities in which lobe is believed to be associated with schizophrenia?

An abnormality in the frontal lobe has been associated with schizophrenia.

During an early meeting in the orientation phase, a client arrives late and then accuses the nurse of sharing confidential information. In which way would the nurse interpret the client's behavior?

At the beginning of the orientation phase, the exchanges are pleasant and are considered the "honeymoon phase." However, after a while, rough times occur and the client begins to demonstrate behaviors such as arriving late to sessions and making false accusations. This is called "testing the relationship." This is a normal way to develop trust and the nurse should not become angry or accept the behavior.

What is the difference between traditional and atypical antipsychotics?

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

During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of:

Being empathetic is an active process requiring careful listening and attending to the client. Direct eye contact, a concerned expression, occasional head nods, and a lean forward while listening are nonverbal communication skills that convey empathy. Empathetic responses, such as "You're going through a difficult time," can provide clients with an opportunity to listen to themselves and gain self-awareness.

Benzodiazepines and buspirone are included in which therapeutic category?

Benzodiazepines have the pharmacologic effects of anxiolysis, sedation, centrally mediated muscle relaxation, and elevation of the seizure threshold.

Antianxiety Agents

Benzodiazepines: Alprazolam Diazepam Oxazepam Lorazepam

The use of psychopharmacologic agents in the treatment of mental illness comes from which domain of the biopsychosocial model?

Biologic

Caution with Alprazolam

Clients who are taking alprazolam need to be taught that this medication must not be stopped abruptly. Frequently, abrupt cessation will cause severe rebound insomnia as well as nightmares.

Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit?

Countertransference occurs when a mental health care professional redirects his or her feelings toward a client or becomes emotionally entangled with a client, as is occurring with the nurse's "granny."

What does damage to the thalamus cause?

Damage to the thalamus results in obsessive-compulsive behavior or decreased ability to experience pleasure.

A decrease in which neurotransmitter has been implicated in seizure disorders?

Decreased GABA activity is involved in the development of seizure disorders.

An older adult reporting concerns of anxiety is prescribed diazepam (Valium) by a health care provider. The provider asks the office nurse to explain the problematic side effects of this medication to the client. Which instruction is most important for the nurse to emphasize about this drug?

Diazepam (Valium) is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client.

Benzodiazepines increase which neurotransmitter function?

Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep.

GABA

Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep.

A client is in the acute phase of mania and is receiving lithium. Which blood concentration of lithium is within the therapeutic range for acute mania?

During the acute phase of mania, lithium blood concentrations of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control.

During which phase of the nurse-client relationship does the client identify and explore specific problems?

During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them.

Lobes of the Brain

Each hemisphere of the brain is divided by four lobes including the frontal, parietal, occipital, and temporal. The lobes work in coordinated ways, but each lobe is responsible for specific functions. The frontal lobes are responsible for working memory, insight, judgment, reasoning, self-evaluation, problem-solving, concept formation, and mood and personality. The parietal lobes are responsible for sensory function and spatial relationships. The temporal lobes are responsible for auditory and olfactory areas. The occipital lobes are responsible for vision. The client experiencing labile mood and personality changes likely has had damage to their frontal lobe(s).

What occurs during the working phase of the nurse-client relationship?

Evaluation of mutually identified goals occurs in the working phase of the nurse-client relationship. The nurse discusses expectations during the orientation phase. During the working phase, the nurse assesses client needs. Discussion regarding the termination of the relationship occurs during the orientation phase.

Neuroleptic Malignant Syndrome

Fever, hypertension, and diaphoresis are cardinal symptoms of NMS and should be immediately addressed.

Red flag symptoms of NMS?

Fever, hypertension, and diaphoresis are cardinal symptoms of NMS and should be immediately addressed.

When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible?

Frontal lobe damage shows symptoms that include loss of emotional control, rage, violent behavior as well as changes in mood and personality and uncharacteristic behavior. Thus, when a client who is generally pleasant and cooperative begins to show aggressive behavior toward most members of the milieu, the nurse suspects the client has experienced cerebral trauma to the frontal lobe.

Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?

Hypertensive crisis

A nurse is caring for a client who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the client is most likely to have difficulty with what activity?

Identifying a shape by touch. The parietal lobes interpret sensations of taste and touch and assist in spatial orientation, and they contribute to the ability to recognize objects by touch, calculate, write, draw, and organize spatial stimuli.

How are antipsychotics administered if patient is non-adherent?

If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly.

Enuresis Medication

Imipramine

What is the first line treatment for bipolar disorder?

Lithium

Mood Stabilizer

Lithium Carbonate

A 46-year-old client sustained a closed-head injury 4 hours ago. The client now presents to the emergency department because the client is having difficulty breathing. This is a result of swelling surrounding which brain structure?

Medulla oblongata; The hindbrain, which runs from the top of the spinal cord into the midbrain, is the most primitive area of the brain and contains the brain stem, where the pons and medulla oblongata are located. These areas of the brain control basic, vital functions, such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; the swallowing center, which coordinates the complex swallowing reflex; and the reticular activating system (RAS), which controls arousal and awareness of stimuli and contains the sleep center.

Lithium was one of the first psychotropic drugs developed. Lithium is in which medication classification?

Mood stabilizer

A nurse is teaching a patient about how impulses are transmitted and describes the factors that can impact this transmission. Which factor would the nurse most likely identify as increasing synaptic transmission?

Neurotransmitter

Though the client does not exhibit any signs or symptoms of depression, a client's physician has prescribed a low dose of the antidepressant mirtazapine. What is the most likely rationale for the physician's action?

Off-label prescribing is providing a drug for a different diagnosis, at an unapproved dose, outside the approved age group, for longer than the approved interval, or at a different dose schedule. An example is prescribing mirtazapine to induce sleep.

Antidepressant Agents

Paroxetine Fluoxetine Bupropion Citalopram Sertraline

ADHD Medication

Pemoline and methylphenidate are used to treat attention deficit hyperactivity disorder.

The nurse is preparing to interview a newly admitted client. Which action will the nurse make a priority during the first interaction with this client?

Rapport is the development of interpersonal harmony characterized by understanding and respect. Rapport is important in developing a trusting, therapeutic relationship and should be established as soon and quickly as possible with a new client.

During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply.

Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems.

A nurse is teaching a client about the underlying research-supported causes of mental illnesses. Which aspect would the client identify as the likely underlying cause of most psychiatric disorders?

Recent research indicates that a dysfunctional neurocircuitry underlies most psychiatric disorders.

2nd Generation Antipsychotics

Risperidone Olanzapine Typical antipsychotics do have side effects, often lead to weight gain, and, in rare cases, cause dysrhythmias and kidney failure. Thus, atypical antipsychotics block both serotonin and dopaminergic receptors.

SSRIs (selective serotonin reuptake inhibitors)

SSRIs block the neuronal transport of serotonin, which stimulates many postsynaptic receptor sites and probably contributes to associated side effects. These include nausea, vomiting, weight changes, agitation or restlessness, and delayed or impaired orgasm.

A 36-year-old client has been receiving a selective serotonin reuptake inhibitor for treatment of depression. The client is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which symptom of this syndrome?

Symptoms of serotonin syndrome include hyperreflexia, tachycardia, hyperthermia, and diarrhea. Serotonin syndrome can be life threatening. The treatment for serotonin syndrome is discontinuation of the medication and symptom management.

Antipsychotics and Type 2 DM

The FDA has determined that all atypical antipsychotics increase the risk for type 2 DM. Nurses should routinely assess for emerging symptoms of diabetes and alert the prescriber of these symptoms. A BMI that indicates overweight or obesity is a finding that requires health care practitioner notification because it is indicative of type 2 DM.

The brain stem consists of which structure?

The brain stem consists of the midbrain, pons, and medulla.

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?

The client is able to independently express feelings and emotions with the client's friends.

Akathisia

The client's inability to "sit still" and/or frequent pacing is termed "akathisia," an extrapyramidal effect of the antipsychotic medication.

A client is brought to the emergency department by a 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 condition should the nurse most likely suspect?

The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI]) suggest serotonin syndrome.

The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase?

The conversation indicates that the client is trying to understand the problems and trying to solve them by asking for suggestions from the nurse. This behavior is seen in the working phase of the nurse-client relationship.

The nurse prepares educational material for a client who is newly diagnosed with Alzheimer disease. Which structure of the limbic system should the nurse focus the teaching materials?

The hippocampus is involved in storing information, especially the emotions attached to memory. Deterioration of the nerves of the hippocampus and other related temporal lobe structures found in Alzheimer disease produces the disorder's hallmark symptoms of memory dysfunction.

The client cannot remember anything before an accident yesterday. Which brain structure might be injured?

The hippocampus, part of the limbic system, controls emotions, memory, and learning. It is also thought to mediate feelings of aggression, sexual impulses, and submissive behavior.

What is the hippocampus responsible for?

The hippocampus, part of the limbic system, controls emotions, memory, and learning. It is also thought to mediate feelings of aggression, sexual impulses, and submissive behavior.

A client is returning from military service and has been diagnosed with post-traumatic stress disorder (PTSD). Dysfunction in which brain structure contributes to the rage and fear experienced in PTSD?

The hypothalamus is a part of the limbic system, which is sometimes called the emotional brain. The hypothalamus is involved in impulsive behavior associated with feelings of anger, rage, or excitement.

A client with depression is prescribed a monoamine oxidase inhibitor (MAOI). Which client statement indicates to the nurse that dietary teaching about the medication was effective?

The major problem with the MAOIs is their interaction with tyramine-rich foods and certain medications that can result in a hypertensive crisis. If the individual ingests food that contains high levels of tyramine while taking MAOIs, severe headaches, palpitation, neck stiffness and soreness, nausea, vomiting, sweating, hypertension, stroke, and, in rare instances, death may result. The client should be instructed to eat fresh cheeses such as ricotta. Red wine, pepperoni, and sauerkraut all contain tyramine and should be avoided when taking an MAOI.

What is the midbrain responsible for?

The midbrain is vital to life. It is the only brain area maintaining heart and lung function in an otherwise comatose person with no higher-level capacities.

Side effects of Antipsychotics

The most serious and potentially fatal side effect of the typical antipsychotics is neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered consciousness, disorientation, dysphagia, elevated creatinine phosphokinase, stupor, catatonia, hyperpyrexia, labile pulse and blood pressure. This life-threatening condition can occur after a single dose of a neuroleptic; however, it is more common in the first 2 weeks of administration or with an increase in dose. It can continue for up to 2 weeks after discontinuation of the medication.

Frontal Lobe vs Temporal Lobe

The nurse can anticipate that the client will have difficulty with concept formation, insight, judgment, and reasoning. The temporal lobes contain the primary auditory and olfactory areas. Wernicke's area, located at the posterior aspect of the superior temporal gyrus, is primarily responsible for receptive speech.

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase.

A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what?

The positron emission tomography (PET) scan is used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity. Magnetic resonance imaging (MRI) can detect demyelination. The electroencephalogram (EEG) is used to assess brain activity. Ultrasonography is used to examine vasculature.

A client has begun taking 1 mg of eszopiclone at bedtime, a dose which is considered to be equivalent to a 3.75-mg dose of her previous hypnotic, zopiclone. This comparison of the relative dosages of these two drugs is referred to as what?

The potency of a drug refers to the relative dosage of a drug that is required to achieve a desired effect.

Occipital Lobe

The primary visual area is in the most posterior aspect of the occipital lobes. Damage to this area results in a condition called cortical blindness. In other words, the retina and optic nerve remain intact, but the individual cannot see.

A resident at a long-term care facility has been ordered an antipsychotic for dementia-related aggressive behavior. What element(s) should the nurse consider in administering this medication related to effects and use? Select all that apply.

The resident must be monitored by the nurse for antipsychotic toxic effects. Due to lower body fat ratios in older adults, the resident may become toxic. A lower dose may be needed to obtain the desired effect to decrease aggression. The aggression may stem from interactions with other medications ordered.

A client has developed deficits involving the senses of smell and hearing. The nurse would correlate this sensory dysfunction with which cerebral lobe?

The temporal lobes contain the primary auditory and olfactory areas.

The function of the thalamus and the hypothalamus is to coordinate:

The thalamus and hypothalamus coordinate internal and external responses and direct information into the cerebral cortex.

A client is receiving amitriptyline as part of the treatment plan for depression. The health care provider orders a drug plasma level. Which result would the nurse identify as being therapeutic?

Therapeutic blood levels for amitriptyline range from 110 to 250 ng/mL.

Typical antipsychotics work by blocking which receptor?

Typical or traditional antipsychotic agents (neuroleptics) block dopamine receptors in the brain, thus altering the release and turnover of dopamine.

The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?

Use of clozapine requires weekly monitoring of white blood cell (WBC) counts to assess for agranulocytosis. Clozapine suppresses the development of WBCs in 1 to 2% of all clients who take it. If WBC levels decrease significantly from baseline, immediate discontinuation of clozapine is recommended. Clients should never use clozapine with other agents that suppress WBC production, such as carbamazepine.

The nurse and client have been meeting weekly. Which action indicates to the nurse that the relationship has moved into the working phase?

When the client begins identifying problems to work on, the relationship has moved into the working phase.

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase?

When the client can begin to recognize feelings and talk about them, the relationship has moved into a working phase.

The nurse is caring for a client diagnosed with chronic alcohol use disorder. The client tells the nurse that their drinking does not impact their children. The nurse notices feeling unexpectedly angry and recognizes that what may be occurring?

When the nurse responds to the client based on personal unconscious needs and conflicts; this is called countertransference. When the client responds to the nurse based on personal unconscious needs and conflicts, it is called transference.

A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what?

While all the above principles are followed, the nurse's questioning best reflects the principle that all behavior has meaning and can be understood from the person's perspective.

What does myasthenia gravis lack in?

a neuromuscular disorder, has a decreased amount of acetylcholine.

Primary Cholinergic Neurotransmitter

acetylcholine

What does damage to the medulla cause?

affects circulation and respiration.

What are antipsychotics used for?

also known as neuroleptics, are used to treat severe psychiatric disorders such as schizophrenia. They also are used for acute and chronic thought disorders and confusion that commonly accompany psychotic disorders, extremely aggressive behaviors, and dementia.

What would you see used to treat is used to treat specific symptoms such as temper tantrums and stereotypic behavior (repeatedly bangs head on the wall or door).?

antipsychotic medication such as haloperidol.

What is the basal ganglia responsible for?

assume motor skills that have become automatic and also initiate and control activities and muscle tone.

What does the cerebellum control?

controls fine movement, balance, position sense, and integration of sensory input.

What is the reticular formation responsible for?

controls sleep and wakefulness and directs visual and auditory reflexes.

How are neurotransmitters deactivated?

deactivated in one of two ways. They are either broken down by enzymes, primarily the enzyme MAO, or they are returned back into the neuron--a process known as reuptake.

he nurse provides care to a client who is diagnosed with a traumatic brain injury (TBI) because of a motor vehicle accident. The client is noted to have mood and affect changes, specifically impulsive behavior. Which lobe of the brain is likely affected based on the client's symptoms?

frontal

Serotonin Syndrome

has some overlapping signs and symptoms, but it is characterized by hyperreflexia rather than rigidity and is usually the result of taking an MAOI and an SSRI.

What are some symptoms of serotonin syndrome?

include hyperreflexia, tachycardia, hyperthermia, and diarrhea. Serotonin syndrome can be life-threatening. The treatment for serotonin syndrome is discontinuation of the medication and symptom management.

Pseudoparkinsonism

includes rigidity, slowed movements, and tremor.

Dystonia

involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles.

Caution with Phenelzine

is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine, such as tap beers, matured and aged cheeses, dried aged and fermented meats, broad bean pods, concentrated yeast extract, sauerkraut, and soy sauce.

What can lack of norepinephrine cause?

may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension.

What can lack of dopamine lead to?

may lead to imbalance difficulties, speech problems, and postural changes.

What can lack of histamine cause?

means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations.

What do you need to watch for with antidepressants?

patients with seizure or cardiac disorders. Can cause cardiac dysrhythmias.

What does lack of serotonin cause?

produces symptoms such as aggression, hostility, and compulsiveness.

What is emotional lability?

refers to rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing or crying, or heightened irritability or temper) occur.

What can damage to the hippocampus cause?

short-term memory loss and lack of motivation

What does frontal damage show?

shows symptoms that include loss of emotional control, rage, violent behavior as well as changes in mood and personality, and uncharacteristic behavior. Thus, when a client who is generally pleasant and cooperative begins to show aggressive behavior toward most members of the milieu, the nurse suspects the client has experienced cerebral trauma to the frontal lobe.

Akinesia

slowed movement