BEHAVIORAL HEALTH EXAM 2

Bipolar I vs Bipolar II

*I*: higher highs *II*: lower lows, and more low than high II has a greater suicide risk Antidepressants can precipitate mania

MAOIs

- isocarboxazid (Marplan), - phenelzine (Nardil), - tranylcypromine (Parnate) MAOI Hypertensive Crisis - Tyramine-containing foods (fermented foods, wine and cheese) Warning signs: increased blood pressure, palpitations, headache Symptoms of hypertensive crisis develop, progressing to palpitations, chest pain, sweating, fever, nausea, vomiting, dilated pupils, photophobia Treatment Hold MAOI doses Do not lie down (elevates blood pressure) Chlorpromazine IM to block norepinephrine Phentolamine IV to bind with norepinephrine receptor sites, blocking norepinephrine Manage fever by external cooling techniques Evaluate diet, adherence, teaching

Lithium toxicity

2 or greater, tremors, metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too

who is most at risk for substance abuse

35 yo recently divorced mother of two who has a full time job and a mother with a history of alcohol abuse

It will be most helpful for a nurse to describe a relapse to a recovering substance abuser as a(n): a. error from which to learn. b. indicator of treatment failure. c. event with a physiological cause. d. need for additional environmental support.

ANS: A Abstinence and relapse should be viewed as a process rather than distinct events. Recovery is not an all-or-nothing proposition. Success can be measured by improvements, whereas relapse can be viewed as an error from which to learn—a temporary setback on the road to recovery.

A nurse reviews the laboratory data of a 29-year-old client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+ ) level of 4.2 mEq/L C. Sodium (Na+ ) level of 140 mEq/L D. Calcium (Ca 2+ ) level of 9.5 mg/dL

ANS: A According to the DSM-5, symptoms of major depressive disorder cannot be due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). The diagnosis of major depressive disorder may be ruled out if the clients laboratory results indicate a high TSH level (normal range for this age group is 0.4 to 4.2 U/mL), which results from a low thyroid function, or hypothyroidism. In hypothyroidism metabolic processes are slowed, leading to depressive symptoms.

A short-term goal for a patient in the early stage of therapy for addiction to sedatives and stimulants is, "The patient will: a. verbalize dependence on drugs." b. discuss his or her addictive behavior with others." c. recognize the situations in which drugs are abused." d. understand the reasons the dependency on drugs developed."

ANS: A Acknowledging the problem is an appropriate short-term goal. Discussing the addictive behavior with others may or may not be of initial value, while recognizing triggering situations and understanding the reasons that facilitated the addiction are intermediate to long-term goals.

Which statement represents the most appropriate instructions for a patient with a past suicide attempt who is prescribed amitriptyline (Elavil), 150 mg PO at bedtime? a. "You will need to pick up your 7-day supply of medication at the pharmacy each week." b. "Your prescription will provide you with a 6-month supply to save you money and time." c. "I'm going to strongly suggest that your spouse dispense this medication to you each evening." d. "Stop by the clinic each evening for your medication so your emotional state of mind can be assessed."

ANS: A Amitriptyline (Elavil) is a tricyclic antidepressant (TCA) medication (tertiary amine). The TCAs are very toxic when ingested at levels of 1000 to 3000 mg, and overdosage and suicide attempts with this medication are extremely dangerous and often require emergency medical attention. Because an overdose often requires only a 1-week supply of medication, it is the nurse's responsibility to suggest that the prescription be dispensed in weekly doses.

A nurse using cognitive behavioral therapy to treat a patient with substance abuse problems will: a. help the patient to develop self-control and social skills. b. support the use of emotion-focused coping mechanisms. c. focus on addiction as a disease requiring confrontational tactics. d. help the patient see that society shares responsibility for the problem.

ANS: A Cognitive behavioral approaches are aimed at improving self-control and social skills to reduce substance use. Self-control strategies include goal setting, self-monitoring, analysis of drinking antecedents, and learning of alternative coping skills. Social-skills training focuses on learning skills for forming and maintaining interpersonal relationships, assertiveness, and drink refusal.

A nurse is working with a patient with depression whose identical twin committed suicide. In assessing this patient for suicidal risk, the nurse should consider that this patient: a. is at increased risk for suicide. b. has the same risk as the general population. c. cannot be assigned a level of risk based on such limited data. d. is at low risk because the patient has experienced the trauma of suicide.

ANS: A Family history of suicide is a significant risk factor for self-destructive behavior. In addition, monozygotic twins have a high concordance rate for suicide.

Based on current sociocultural risk factors for mental illness, a nurse assesses that which patient is at highest risk for depression? a. A 26-year-old female b. A 33-year-old male c. A 57-year-old male d. A 72-year-old female

ANS: A Females are at greater risk for being diagnosed and treated for depression than males. The rate of depression among aging adults is lower than the rate in younger age groups.

When a patient begins fluoxetine (Prozac), what information should be included in the plan for patient education? a. The onset of action is 2 to 6 weeks. b. Foods containing tyramine should be restricted. c. Intake of salt and salty foods should be restricted. d. The patient should be alert for symptoms of hypomania.

ANS: A Patients should be made aware that antidepressant medications work slowly, requiring 2 to 6 weeks for symptoms to be reduced. Patients without this knowledge may discontinue taking the medication, thinking it is not working. The remaining options are not relevant to administration of fluoxetine (Prozac).

A patient displays positive symptoms of schizophrenia as evidenced by psychotic disorders of thinking. The nurse can expect the patient to evidence: a. delusions and hallucinations. b. grimacing and mannerisms. c. echopraxia and echolalia. d. avolition and anhedonia.

ANS: A Positive symptoms of schizophrenia represent an excess or distortion of normal function. Delusions and hallucinations are considered psychotic disorders of thinking. The other symptoms listed are noted in schizophrenia, but they are not considered thought disorders.

A nurse should specifically assess a patient opiate withdrawal for: a. lacrimation, rhinorrhea, dilated pupils, and muscle pain. b. somnolence, constipation, normal pupils, and hypothermia. c. tremors, hypertension, constricted pupils, and deep sleep. d. visual and tactile hallucinations, agitation, and generalized seizures.

ANS: A The classic signs of opiate withdrawal are flulike symptoms and dilated pupils.

A nurse is assessing a patient who was recently prescribed an antipsychotic medication. Which side effects could the nurse expect to observe? a. Constipation, decreased sweating, and increased sensitivity to heat b. Increased moisture around the eyes, vomiting, and frontal headache c. Slurred speech, hand tremors, and severe occipital headache d. Sleeplessness, irritability, and muscle weakness

ANS: A The most common side effects of antipsychotic medications include the following: dry mouth, blurred vision, nasal stuffiness, weight gain, difficulty urinating, infection, decreased sweating, increased sensitivity to sunlight, yellowing of the eyes (especially the whites of the eyes), breast enlargement/lactation, skin rash, anhedonia, itchy skin, and constipation.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the childs face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

ANS: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family, who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.

ANS: A The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. Theres an alien growing in my liver. B. I see my dead husband everywhere I go. C. The IRS may audit my taxes. D. Im not going to eat my food. It smells like brimstone.

ANS: A The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the persons intelligence or cultural background.

A patient being treated for depression reports experiencing nausea, palpitations, and "a terrible headache." When the physical examination determines the patient is diaphoresic and hypertensive, the nurse should ask: a. "When did you last take your phenelzine (Nardil)?" b. "Did you take your amitriptyline (Elavil) on schedule?" c. "What natural foods have you had in the last 24 hours?" d. "Have you had any alcohol to drink within the last 24 hours?"

ANS: A The patient is experiencing the clinical manifestation of hypertensive crisis resulting from taking an MAOI (Nardil). The classic symptoms of this condition are severe occipital headache, dilated pupils, hypertension, and palpitations or arrhythmias

A client who has been diagnosed with bipolar I disorder states, God has taught me how to decode the Bible. A nurse should anticipate that which combination of medications would be ordered to address this clients symptoms? A. Lithium carbonate (Lithobid) and risperidone (Risperdal) B. Lithium carbonate (Lithobid) and carbamazepine (Tegretol) C. Valproic acid (Depakote) and sertraline (Zoloft) D. Valproic acid (Depakote) and lamotrigine (Lamictal)

ANS: A The patient who is experiencing psychosis (in this case, delusions of grandeur) may be benefited by the addition of an antipsychotic medication (risperidone) to the mood stabilizer (lithium). In addition, since lithium does not immediately reach therapeutic levels, the sedative properties of an antipsychotic may be useful in reducing agitation, hyperactivity, and/or insomnia.

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

ANS: A The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia

4. An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. Well go to the day room when you are ready for group. B. Ill walk with you to the day room. Group is about to start. C. It must be difficult for you to attend group when you feel so bad. D. Let me tell you about the benefits of attending this group.

ANS: B A client diagnosed with major depressive disorder exhibits little to no motivation and must be actively directed by staff to participate in therapy. It is difficult for a severely depressed client to make decisions, and this function must be temporarily assumed by the staff.

Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment? A. I will limit my intake of fluids daily. B. I will maintain normal salt intake. C. I will take Lithobid on an empty stomach. D. I will increase my caloric intake to prevent weight loss

ANS: B A client taking Lithobid should be taught not to skimp on dietary sodium intake. He or she should take Lithobid on a full stomach to avoid gastrointestinal upset and choose lower-calorie foods to prevent weight gain.

A patient asks a nurse, "What is the primary aim of self-help groups for alcohol abusers?" The nurse should reply, "The goal is first to: a. always be available to help others with an addiction." b. commit to always strive for total abstinence." c. find and rely on the help of the member's sponsor." d. admit powerlessness over the addiction."

ANS: B Although all the options are expectations in the program, admitting to having alcoholism and staying alcohol-free are the aims of the Alcoholics Anonymous (AA) program.

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders? A. Sertraline (Zoloft) B. Valproic acid (Depakote) C. Trazodone (Desyrel) D. Paroxetine (Paxil)

ANS: B Although lithium is a prototype drug in the treatment of bipolar disorders, anticonvulsants such as valproic acid also have demonstrated efficacy for mood stabilization.

Which teaching point will have the most positive effect on patients diagnosed with schizophrenia and their families concerning the risk of relapses? a. Patients who take their medications will not relapse. b. Caffeine and nicotine can reduce the effectiveness of antipsychotic drugs. c. With support, education, and adherence to treatment, patients will not relapse. d. Schizophrenia is a chronic disorder that is characterized by repeated relapses.

ANS: B Caffeine intake greater than 250 mg daily or smoking 10 to 20 cigarettes daily dramatically reduces the effectiveness of antipsychotic and antianxiety drugs and lithium. The need to limit the use of these substances is an important teaching point.

A clients spouse asks, What evidence supports the possibility of genetic transmission of bipolar disorder? Which is the best nursing reply? A. Clients diagnosed with bipolar disorders have alterations in neurochemicals that affect behaviors. B. Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder. C. Higher rates of relatives of clients diagnosed with bipolar disorder respond in an exaggerated way to daily stress. D. More individuals diagnosed with bipolar disorder come from higher socioeconomic and educational backgrounds.

ANS: B Family studies have shown that if one parent is diagnosed with bipolar disorder, the risk that a child will have the disorder is around 28%. If both parents are diagnosed with the disorder, the risk is two to three times as great.

A nurse caring for a hospitalized suicidal patient on one-to-one supervision should initially focus on: a. mobilizing social support for the patient and family. b. facilitating awareness, expression, and labeling of feelings. c. helping the patient test new mechanisms for coping with stress. d. talking to the patient about the effect suicide would have on family members.

ANS: B Nursing care of suicidal patients should initially be directed toward protection, increasing patient self-esteem, and helping patients to become aware of their feelings, to label them, and to express them appropriately.

A patient hospitalized 3 weeks ago with major depressive disorder presented with suicidal ideations but no suicide plan. Sertraline (Zoloft) was prescribed, and the patient now reports that the feelings of depression have somewhat lessened. The guiding factor the nurse considers when planning care is that there is: a. little risk for injury if the patient has no plan. b. an increased risk for suicide as the depression lifts. c. little suicide risk after 3 weeks on an antidepressant. d. an increase in patient compliance with sertraline (Zoloft).

ANS: B Patients with severe depression may have suicidal ideation but lack the cognitive ability to plan an attempt and the energy to implement a plan. As depression lifts, the patient may be better able to plan a suicide attempt and may have sufficient energy to carry out a plan. Self-report of feeling less depressed does not mean the risk for self-injury is diminished. Vigilance continues to be necessary.

A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred? A. Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives. B. Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. C. Reminiscence therapy is a social group where members chat about past events and future plans. D. Reminiscence therapy encourages members to share positive memories of significant life transitions.

ANS: B Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. Stimulation of life memories serves to help older clients work through their losses and maintain self-esteem. Reminiscence therapy can take place in one-on-one or group settings.

After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of which client statement? A. I should expect to feel better in a couple of days. B. Ill call my doctor immediately if I experience any diarrhea or ringing in my ears. C. If I forget a dose, I can double the dose the next time I take this drug. D. I need to restrict my intake of any food containing salt.

ANS: B The initial signs of lithium toxicity include ataxia, blurred vision, severe diarrhea, persistent nausea and vomiting, and tinnitus.

10. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, I heard about something called a monoamine oxidase inhibitor (MAOI). Cant my doctor add that to my medications? Which is an appropriate nursing reply? A. This combination of drugs can lead to delirium tremens. B. A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis. C. Thats a good idea. There have been good results with the combination of these two drugs. D. The only disadvantage would be the exorbitant cost of the MAOI.

ANS: B The nurse should explain to the client that combining an MAOI and Luvox can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread

Which symptom should a nurse identify that would differentiate clients diagnosed with neurocognitive disorders from clients with pseudodementia (depression)? A. Altered sleep B. Impaired attention and concentration C. Altered task performance D. Impaired psychomotor activity

ANS: B The nurse should identify that attention and concentration are impaired in neurocognitive disorder and not in pseudodementia (depression).

8. A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred? A. This disorder is more prevalent in the lower socioeconomic groups. B. This disorder is more prevalent in the higher socioeconomic groups. C. This disorder is equally prevalent in all socioeconomic groups. D. This disorders prevalence cannot be evaluated on the basis of socioeconomic groups.

ANS: B The nursing student is accurate when stating that bipolar disorder is more prevalent in higher socioeconomic groups. Theories consider both hereditary and environmental factors in the etiology of bipolar disorder

. A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level? A. 1.3 mEq/L B. 1.7 mEq/L C. 2.3 mEq/L D. 3.7 mEq/L

ANS: B The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy. There is a narrow margin between the therapeutic and toxic levels. The symptoms presented in the question can be correlated with a lithium level of 1.7 mEq/L. Levels of 2.3 mEq/L and 3.7 mEq/L would produce more extreme symptoms of intensified toxicity, eventually leading to death.

. A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include? A. Elderly people use less lethal means to commit suicide. B. Although the elderly make up less than 13% of the population, they account for 16% of all suicides. C. Suicide is the second leading cause of death among the elderly. D. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

ANS: B This factual information should be included in the nursing instructors teaching plan. An expressed desire to die is not normal in any age group.

Which remark by a nurse best represents an attempt to assess the patient's current ability to organize and enact a suicide wish? a. "What is your educational background?" b. "What plan do you have for committing suicide?" c. "Have you ever thought about or tried to hurt yourself?" d. "Are your self-destructive thoughts constant or intermittent?"

ANS: B This question will give the nurse information as to whether a plan exists, the lethality of the method chosen, and the accessibility of the method.

The nurse is caring for a patient experiencing auditory hallucinations who says, "When I first heard the voices they said nice things about me but now they say bad things." Which question will have an impact on the care this patient is initially provided? (Select all that apply.) a. "Do you trust me to help you with the voices?" b. "Are the voices commanding you to hurt yourself?" c. "How often during 24 hours do you hear the voices?" d. "Do you hear the voices if you're busy in a noisy environment?" e. "When did you first start hearing voices that were saying bad things?"

ANS: B, C, D The correct options are patient-focused and will help assure patient safety and appropriate nursing interventions. The other options do not constructively address client needs.

A priority for nurses working with psychiatric patients would be the assessment of suicide risk for individuals who have the tendency to be: (Select all that apply.) a. blaming. b. hostile. c. hopeless. d. impulsive. e. controlling.

ANS: B, C, D The three aspects of personality most closely associated with increased risk for suicide are hostility, impulsivity, and hopelessness. These traits cross diagnostic groups.

A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option? A. Because the client is extremely suicidal, ECT is an appropriate option. B. Because antidepressant medications have been ineffective, ECT is a good alternative. C. Because informed consent is required for ECT, cognitive deficits could preclude this option. D. Because of the clients cognitive deficits, a signed consent is waived

ANS: C A client who is experiencing cognitive deficits cannot give informed consent, which is required prior to ECT. A court proceeding could determine the clients level of competency and, if necessary, the judge would appoint a guardian.

. Which client data indicate that a suicidal client is participating in a plan for safety? A. Compliance with antidepressant therapy B. A mood rating of 9/10 C. Disclosing a plan for suicide to staff D. Expressing feelings of hopelessness to nurse

ANS: C A degree of the responsibility for the suicidal clients safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide.

A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide? A. Family history of depression B. The clients orientation to reality C. The clients history of suicide attempts D. Family support systems

ANS: C A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the clients risk.

8. A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out neurocognitive disorder D. To rule out a personality disorder

ANS: C A mini-mental status exam should be performed to rule out neurocognitive disorder. The elderly are often misdiagnosed with neurocognitive disorder such as Alzheimers disease, when depression is their actual diagnosis. Memory loss, confused thinking, and apathy are common symptoms of depression in the elderly

A patient reports, "The government has implanted a device in my head." What outcome would the nurse identify as being appropriate for the patient to achieve within 1 week of admission? a. Taking antipsychotic medication as prescribed without objection b. Giving coherent data to support beliefs that a device has been implanted c. Interpreting reality correctly by stating that no implantation has occurred d. Reporting feeling less anxious about having the government listening to interior thoughts

ANS: C An appropriate outcome for a delusional patient is that the patient will interpret reality correctly.

A patient tells the nurse, "I can't go to any unit meetings because everyone can hear my thoughts." The nurse can correctly assess this symptom as: a. concrete thinking. b. loose associations. c. thought broadcasting. d. auditory hallucinations.

ANS: C Believing that others can hear one's unexpressed thoughts is called thought broadcasting.

A patient hospitalized for depression demonstrates dysfunctional thinking as evidenced by persistent pessimism and predictions of disastrous outcomes. A nurse using cognitive therapy will focus on: a. uncovering unconscious conflicts that affect the "here and now" behavior. b. finding an area of mutual understanding to serve as a basis for therapy. c. patient recognition and replacement of automatic negative evaluations. d. analyzing and enhancing relationships with significant others.

ANS: C Cognitive therapy focuses on changing distortions and negative thinking patterns that affect the patient's feelings and behaviors.

A client on an inpatient unit is diagnosed with bipolar disorder: manic episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. What should be the nurses initial intervention? A. Ask the group to take a vote on alternative weekend events. B. Remind the client to quiet down or leave the dayroom. C. Assist the client to move to a calmer location. D. Discuss with the client impulse control problems.

ANS: C During a manic episode, the client experiences increased agitation and extreme hyperactivity that can lead to a risk for injury. Overstimulation can exacerbate these symptoms. Therefore, the nurses initial action should focus on removing the client from the stimulating environment to a calmer location.

The spouse of a patient with alcoholism asks, "How do I respond in a helpful way even though this abuse is so harmful to my family?" The nurse's best response would be: a. "Search the house regularly for hidden alcohol." b. "Include your spouse in family activities whether or not drinking has occurred." c. "Make your spouse responsible for the consequences of the disruptive behavior." d. "Refuse to be supportive when your spouse is under the influence of alcohol."

ANS: C Dysfunctional families often try to protect the patient, avoid confrontation, and blame themselves. These are called enabling behaviors. Making the patient responsible for the consequences of drinking is difficult and usually requires professional support and/or involvement in Alcoholics Anonymous (AA).

A patient with severe depression and suicidal ideation has not improved after trials with selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. Which treatment option can a nurse expect the health care provider will now consider? a. Light therapy b. Benzodiazepines c. Electroconvulsive therapy d. Antipsychotic medication

ANS: C Electroconvulsive therapy remains a viable treatment for patients with depression who do not respond to antidepressants. Light therapy is more useful for seasonal affective disorder than for severe depression. Antipsychotics and benzodiazepines are not therapies of choice for depression.

The nurse can expect to find which assessment findings in a patient who is hypomanic? a. Psychomotor symptoms more severe than mania b. Some motor hyperactivity but depressive affect c. Clinical symptoms less severe than those of a manic state d. Grandiosity, distractibility, flight of ideas, and excessive psychomotor activity

ANS: C Hypomania is a state just below mania at which psychomotor activity and other symptoms are less pronounced than those observed when a patient is in the manic state.

A nursing instructor is teaching about the medications given prior to and during electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred? A. Atropine (Atro-Pen) is administered to paralyze skeletal muscles during ECT. B. Succinylcholine chloride (Anectine) decreases secretions to prevent aspiration. C. Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious. D. Glycopyrrolate (Robinul) is given to prevent severe muscle contractions during seizure

ANS: C In order to render a client unconscious during the ECT procedure, an anesthesiologist administers intravenously a short-acting anesthetic such as thiopental sodium (Pentothal).

A patient reports, "My brain is controlled by government agents who can trace my whereabouts and listen to my thoughts." An appropriate nursing response to this information would be: a. "Your story is very strange and too bizarre for me to believe." b. "Tell me why you think your brain is being controlled by the government." c. "Were you experiencing any stress just before you began to think your brain was being controlled?" d. "Are you feeling frightened or angry about the government violating your body and controlling your brain?"

ANS: C It is appropriate for the nurse to help the patient place the delusion in a time frame and to identify triggers that may be related to stress or anxiety.

A patient is delusional and has auditory hallucinations. The best statement to make when approaching the patient with an oral electronic thermometer would be: a. "I need your vital signs. Put this in your mouth. This will not hurt. " b. "I hope I can count on you to hold still while I take your temperature." c. "Please sit here while I put the thermometer under your tongue for a little while." d. "This probe is only a thermometer that will tell us whether you have a fever. It will be all over in just a few seconds."

ANS: C Psychotic patients often are preoccupied with internal stimuli and find it difficult to comprehend the words and actions of others. They may misinterpret both words and actions. To gain cooperation, use simple, explicit, concrete explanations and directions.

A patient experiencing delirium secondary to drug toxicity is manifesting paranoid thinking and noisy, assaultive behavior and is currently pacing the room. The nurse's initial intervention is to: a. prepare to apply supervised restraints. b. request an intravenous sedative. c. calmly attempt to quiet the patient. d. attempt to divert the patient's attention.

ANS: C Restraints may be ordered to protect the delirious patient from self-injury or from injuring others. Initially an attempt should be made to calm the patient by addressing him in a quiet, controlled manner.

The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client, using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation

ANS: C The CAGE questionnaire is a screening tool used to determine whether the individual has a problem with alcohol. This questionnaire is composed of four simple questions. Scoring two or three yes answers strongly suggests a problem with alcohol.

Select the most appropriate goal for a patient with depression. The patient will be: a. experiencing less severe signs of being depressed. b. physically recovered and able to take on new responsibilities. c. emotionally responsive and functioning at the pre-illness level. d. able to tolerate high levels of stress and exceeding pre-illness hardiness.

ANS: C The expected outcome for a patient with depression is that he or she will be emotionally responsive and return to a pre-illness level of functioning.

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply? A. Thats strange. Weight loss is the typical pattern. B. What have you been eating? Weight gain is not usually associated with lithium. C. Weight gain is a common but troubling side effect. D. Weight gain occurs only during the first month of treatment with this drug.

ANS: C The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication compliance and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication.

After 1 week of continuous mental confusion, an elderly African American client is admitted with a preliminary diagnosis of major neurocognitive disorder due to Alzheimers disease. What should cause the nurse to question this diagnosis? A. Neurocognitive disorder does not typically occur in African American clients. B. The symptoms presented are more indicative of Parkinsonism. C. Neurocognitive disorder does not develop suddenly. D. There has been no T3 or T4 level evaluation ordered.

ANS: C The nurse should know that neurocognitive disorder (NCD) does not develop suddenly and should question this diagnosis. The onset of NCD symptoms is slow and insidious and is unrelated to race, culture, or creed. The disease is generally progressive and debilitating.

On the first day of a clients alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

ANS: C The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol), 50 mg bid; benztropine (Cogentin), 1 mg prn; and zolpidem (Ambien), 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity

16. What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The clients understanding of the need for regular bloodwork B. The clients mood and affect score, according to the facilitys mood scale C. The clients cognitive ability to understand information about the medication D. The clients access to a support network willing to participate in treatment

ANS: C There are many dietary and medication restrictions when taking Nardil. A client must have the cognitive ability to understand information about the medication and which foods, beverages, and medications to eliminate when taking Nardil.

A nurse caring for a patient with Alzheimer disease can anticipate that the family will most likely need information about: a. antimetabolites. b. benzodiazepines. c. immunosuppressants. d. acetylcholinesterase inhibitors.

ANS: D Acetylcholinesterase inhibitors are often prescribed to treat Alzheimer disease. These drugs allow greater concentration of acetylcholine in the brain, thereby improving cognitive function.

A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a clients Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 156 electroconvulsive therapy (ECT) procedure. What is the rationale for administering this medication? A. Robinul decreases anxiety during the ECT procedure. B. Robinul induces an unconscious state to prevent pain during the ECT procedure. C. Robinul prevents severe muscle contractions during the ECT procedure. D. Robinul decreases secretions to prevent aspiration during the ECT procedure

ANS: D Glycopyrrolate (Robinul) is the standard preoperative medication given prior to ECT procedures to decrease secretions and prevent aspiration.

A nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 204 receiving which medication? A. Tofranil B. Senequan C. Geodon D. Parnate

ANS: D Hypertensive crisis occurs in clients receiving a monoamine oxidase inhibitor (MAOI) who consume foods or drugs with a high tyramine content.

A nurse has concerns about erratic behavior and slurred speech of another member of the nursing staff. The most appropriate action for the concerned nurse to take is to: a. immediately confront the impaired nurse with the observation. b. ask other nurses if they have observed anything unusual regarding the nurse in question. c. personally supervise the team member whenever the care involves the preparation of pain medication. d. notify the nursing supervisor to assess the team member's condition and performance.

ANS: D Impairment should be documented by more than one person. The impaired nurse then must be relieved of duty. Further intervention can be planned and implemented at a later time.

An appropriate short-term goal for a withdrawn, isolated patient diagnosed with schizophrenia is, "The patient will: a. participate in all therapeutic activities." b. define major barriers to communication." c. talk about feelings of withdrawal in group." d. consistently interact with an assigned nurse."

ANS: D Interacting with at least one person is desirable to reduce complete withdrawal and isolation. Such interaction provides the basis for formation of trust and the development of a nurse-patient relationship.

A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? A. Suicidal threats and gestures should be considered manipulative and/or attention-seeking. B. Suicide is the act of a psychotic person. C. All suicidal individuals are mentally ill. D. Fifty to eighty percent of all people who kill themselves have a history of a previous attempt

ANS: D It is a fact that between 50% and 80% of all people who kill themselves have a history of a previous attempt. All other answer choices are myths about suicide.

The nursing intervention of highest priority relative to alcohol withdrawal delirium is: a. application of restraints. b. reorientation of the patient to reality. c. identification of existing social supports. d. maintenance of fluid and electrolyte balance.

ANS: D Maintaining physiological stability is of highest priority. Withdrawal delirium is often accompanied by loss of fluid and electrolytes through vomiting, diarrhea, and diaphoresis.

An appropriate short-term goal related to abstinence for a drug abuser would be "The patient will: a. verbalize details of the addiction to significant others." b. declaratively state an intention to abstain from drug use of any sort." c. be able to identify the underlying causes that resulted in an addiction to drugs." d. contact a supportive person if experiencing an urge to use an addictive substance."

ANS: D Patients often become anxious at the thought of never again using the substance to which they are addicted. Therefore it may be helpful to focus on short-term goals, such as using a supportive sponsor when the urge to use occurs. The remaining options reflect long-term goals.

During discharge planning, a patient whose manic symptoms are remitting asks, "Do I have to take lithium even though I'm not high any longer?" The most appropriate response is: a. "You can stop the medication 1 week after discharge." b. "You will need to take medication for about 12 weeks." c. "Usually patients take medication for 6 months after discharge." d. "Taking the medication daily will help you avoid relapses and recurrences."

ANS: D Patients with bipolar disorder are maintained on medication indefinitely to prevent recurrences. The earlier and the more thoroughly the patient understands this need, the more likely it is that he or she will comply with the long-term treatment plan.

The medical record of a patient diagnosed with schizophrenia states that the patient has cognitive dysfunction. From this statement, the nurse can expect to see evidence of: a. anxiety, fear, and agitation. b. aggression, anger, hostility, or violence. c. blunted or flat affect or inappropriate affective responses. d. impaired memory and attention as well as formal thought disorder.

ANS: D Problems in cognitive functioning include impaired short-term and long-term memory, distractibility and poor concentration, loose associations, tangentiality, incoherence, illogical speech, concrete thinking, indecisiveness, impaired judgment, and delusions.

Patients of which demographic group have the highest suicide rate in the United States? a. Female between the ages of 13 and 19 years b. Male between the ages of 19 and 27 years c. Female age 65 years or older d. Male age 50 years or older

ANS: D The highest suicide rate for any group in the United States is among people over the age of 65 years, especially white men over the age of 85 years. Although this group constitutes 12.6% of the total U.S. population, it accounts for about 18.1% of suicide deaths. White males over the age of 50 years represent the greatest number of these deaths.

The critical element a nurse must consider when completing a behavioral assessment of a patient with a mood disturbance is: a. the level of anxiety present. b. the degree of agitation noted. c. the depth of depression reported. d. a change in usual patterns and responses.

ANS: D The key element is change. In depression, patients and family see the depression as a change from their usual selves. In mania, others note major changes in usual patterns and responses while patients may indicate they are more creative or active. Present anxiety again must be compared to a baseline level of anxiety.

A nurse is assessing a client diagnosed with schizophrenia. The nurse asks the client, Do you receive special messages from certain sources, such as the television or radio? Which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoia C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.

ANS: D The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior would be exhibiting manic symptoms. According to the DSM-5, these symptoms would rule out the diagnosis of major depressive disorder.

A client diagnosed with schizophrenia, who has been taking antipsychotic medication for the last 5 months, presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome, treated by discontinuing antipsychotic medications B. Agranulocytosis, treated by administration of clozapine (Clozaril) C. Extrapyramidal symptoms, treated by administration of benztropine (Cogentin) D. Tardive dyskinesia, treated by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? A. Symptoms indicate consumption of foods high in tyramine. B. Symptoms indicate lithium carbonate discontinuation syndrome. C. Symptoms indicate the development of lithium carbonate tolerance. Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 210 D. Symptoms indicate lithium carbonate toxicity.

ANS: D The nurse should interpret that the clients symptoms indicate lithium carbonate toxicity (levels over 1.5). The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly during maintenance therapy to ensure proper dosage.

A confused client has recently been prescribed sertraline (Zoloft). The clients spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect, and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIs

ANS: D The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor

Which data gathered from the assessment of a family with a member diagnosed with schizophrenia would be of greatest importance in discharge planning for the patient? a. The patient is the middle sibling. b. The patient's mother is a talented artist. c. The patient's paternal grandfather was eccentric. d. The patient becomes anxious when family members are critical of one another.

ANS: D The patient and family should be made aware of symptom triggers to which the patient is particularly reactive. Triggers may precipitate relapse. Teaching the family to modify this behavior is ideal, but if it is impossible, the patient can be taught to contact a mental health provider.

An individual who is admitted to an alcohol detoxification unit has had no alcohol intake for 3 days. On admission the patient is noted to have tremors, anxiety, insomnia, and disorientation accompanied by tachycardia and diaphoresis. These signs and symptoms are characteristic of the syndrome known as: a. alcoholic hallucinosis. b. alcohol-induced psychosis. c. alcoholic seizure disorder. d. alcohol withdrawal delirium.

ANS: D The signs and symptoms listed are consistent with alcohol withdrawal delirium. It usually has its onset 3 to 5 days after the last drink and lasts 2 to 3 days. It is considered a medical emergency.

A nurse performing an admission interview identifies a need for one-to-one supervision when the patient admits to having suicidal ideations with a plan. The best way to inform the patient of the planned intervention is to say: a. "We cannot trust you to remain safe, so someone will always be with you." b. "It is our policy to have a staff member stay with all new admissions to the unit." c. "The hospital can't let you hurt yourself. Someone will stay with you at all times to protect you from self-harm." d. "I understand your impulse to harm yourself. A staff member will stay with you to help you control that impulse."

ANS: D This explanation is honest and suggests caring as well as collaboration between the nurse and patient. The other choices are impersonal and do little to convey caring.

TCAs (tricyclic antidepressants)

Amitriptyline (Elavil) (Tofranil) Anticholinergic effects and orthostatic hypotension may occur. Side effects toxicity- palpitations, tachycardia, dizziness => excessive CNS stimulation => NE in Heart. - ¼ COMPLIANCE dry mouth, excessive perspiration, constipation, blurred vision, mydriasis, metallic taste, urine retention => muscarinic blockade. Orthostatic hypotension => a1-AR and possibly a2-AR blockade. Drowsiness, sedation and weight gain => Histamine-receptor blockade

18. A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, Im feeling a lot better, so you can stop watching me. I have taken up too much of your time already. Which is the best nursing reply? A. I really appreciate your concern but I have been ordered to continue to watch you. B. Because we are concerned about your safety, we will continue to observe you. C. I am glad you are feeling better. The treatment team will consider your request. D. I will forward you request to your psychiatrist because it is his decision.

B

Care planning for a patient undergoing detoxification for both alcohol and sedative-hypnotics is based on the treatment principle that states that: a. medications are used to treat symptoms as they appear. b. a cross-tolerant drug is used to gradually wean the patient. c. liver function is preserved best by avoiding detoxification drugs. d. forcing fluids is therapeutic since detoxification mainly occurs in the kidneys.

B

A patient is admitted with a tentative diagnosis of delirium. The patient repeatedly mistakes one of the nursing staff for a family member. The nurse documents that this patient is experiencing a disturbance in which area of functioning? a. Consciousness b. Attention c. Perception d. Cognition

C

During group therapy, a client diagnosed with alcohol use disorder states, I would not have boozed it up if my wife hadnt been nagging me all the time to get a job. She never did think that I was good enough for her. How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

C

The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

C

A client diagnosed with alcohol use disorder joins a community 12-step program and states, My life is unmanageable. How should the nurse interpret this clients statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor

C The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.

The most positive initial action for a health care agency to take for an impaired nurse would be: a. job dismissal. b. eliciting a promise to abstain. c. counseling by the nurse manager. d. referral to the employee assistance program.

D

A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)

D.

ECT medications

Medications Used ROBINOL - used to dry secretions, like atropine, 0.2 MG IV, if given IM, must be given 20 minutes prior to procedure. PROPOFOL - Anesthetic, PT feels a burning sensation when administered works immediately 1MG/KG, common side effect: HICCUPS ANECTINE- Muscle relaxer, lasts 2-3 minutes, diaphragm is last muscle to relax; 1MG/KG *TO INCREASE SEIZURES FLUID HYDRATION CAFFEINE 500-1000MG IV THEOPHYLLINE HYPERVENTILATION WITH 100% O2

atypical antipsychotics

Olanzapine (obesity) Clozapine (agranulocytosis) Respiradone (increase prolactin)

. A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess? A. The client expresses feeling blue most of the time. B. The client has endured periods of elation and dysphoria lasting for more than 2 years. C. The client fixates on hopelessness and thoughts of suicide continually. D. The client has labile moods with periods of acute mania.

The essential feature of cyclothymic disorder is a chronic mood disturbance of at least 2 years duration, involving numerous episodes of hypomania and depressed mood of insufficient severity or duration to meet the criteria for bipolar I or II disorder.

A patient admitted in a semistuporous catatonic state has neither left the apartment nor attended to personal hygiene for several weeks. The patient's last 48 hours have been spent lying in bed, mute and motionless. The priority nursing diagnosis is: a. self-care deficit. b. situational low self-esteem. c. disturbed thought processes. d. impaired verbal communication.

a

In assessing risks and planning interventions, a nurse should recognize that the longer the half-life of a drug of abuse, the: a. shorter the withdrawal. b. less intense the withdrawal symptoms. c. sooner the patient will begin to crave the drug. d. shorter the withdrawal and the more intense the symptoms.

b

diagnosis of substance dependence

disruptions in family, social, professional lives changes in eating habits

SSRIs

increase 5-HT by inhibiting reuptake. Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) Vilazodone (Viibryd) Drug-drug interactions: MAOIs in particular. Adverse effects include: nausea, decreased libido, decrease sexual function. Low threat for overdose. Suicide may be considered in severe depression. "Serotonin Syndrome" - Hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status and vital signs. Treatment - wait up to 6 weeks after medication is stopped, before starting with another drug.

45 yo presents to er with tremors, delirium, diaphoresis, and agitation. what is the nursing priority

safety

54 yo male comes into the hospital with hx of alcohol abuse. initial nursing intervention

withdrawal safely and with minimal discomfort