Chapter 2: PrepU
A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The nurse is teaching about effective administration of methylphenidate to the parents. What education given by the nurse is appropriate? "Administer the drug before breakfast and lunch." "Monitor the presence of dizziness in your child." "Administer the drug early in the morning." "Monitor your child for nausea and vomiting."
"Administer the drug early in the morning." Explanation: Insomnia is a common side effect associated with methylphenidate. The drug should be administered early in the morning to combat insomnia. Unlike with atomoxetine, nausea and vomiting are not the side effects of methylphenidate. Unlike with clonidine, dizziness is not known to be a side effect associated with methylphenidate. Appetite suppression is another side effect associated with this drug. If the drug is administered before breakfast or lunch, it would limit dietary intake. Therefore the drug should be administered along with breakfast to maintain good dietary intake.
A Cuban American client has been prescribed an antipsychotic medication. Which response is most important for the nurse to make to this client? "Will your mother be available to help administer this medication for you?" "Remember to take this medication at the times we've discussed." "Do you have any questions about why you are taking this medication?" "Call the doctor immediately if you experience any of the side effects we talked about."
"Call the doctor immediately if you experience any of the side effects we talked about." Explanation: In general, non-Whites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. While the other options are not inappropriate, they do not address the issue of the client's increased risk for the development of side-effects.
A client is brought to the emergency department with reports of slurred speech, spasms, and jerky movements. The significant other shows the nurse a pill bottle and states that the client has been taking antipsychotic medications for "awhile". The nurse notices that an "improper dose" is ordered on the prescription bottle. How would the nurse explain what system is causing the movements? A: "Dysfunction of the pyramidal motor track can manifest plantar extension and hyperreflexia" B: " Dysfunction of the extrapyramidal motor track can manifest serious neurologic symptoms including dystonia, pseudoparkinsonism, and akathisia" C: "Dysfunction of the corticospinal motor track may include masses such as strokes, subdural hemorrhage, abscesses and tumors" D: " Dysfunction of the primary motor cortex can manifest in paralysis on the opposite side of the body"
"Dysfunction of the extrapyramidal motor track can manifest serious neurologic symptoms including dystonia, pseudoparkinsonism, and akathisia" The extrapyramidal system is a bundle of nerve fibers connecting the thalamus to the basal ganglia and cerebral cortex. Muscle tone, common reflexes, and automatic voluntary motor functioning are controlled by this nerve track. Dysfunction of this motor track can manifest serious neurologic symptoms including dystonia, pseudoparkinsonism, and akathisia. The term pyramidal tracts refers to upper motor neurons that originate in the cerebral cortex and terminate in the spinal cord (corticospinal) or brainstem (corticobulbar). Pyramidal signs basically mean plantar extension and hyperreflexia. The role of the primary motor cortex is to generate neural impulses that control the execution of movement. You can end up paralyzed on the opposite side of the lesion (so damage the left side means paralysis on the right side), fully paralyzed, or difficulty to learn and select the right movement for the action you want. The corticospinal tract is a descending tract of the spinal cord which contains bundles of axons which originate in the cerebral cortex and descend to synapse within the brainstem or spinal cord. If fibers of the corticospinal tracts are damaged anywhere along their course from the cerebral cortex to the lower end of the spinal cord, this will give rise to an upper motor neuron syndrome. A few days after the injury to the upper motor neurons, a pattern of motor signs and symptoms appears, including spasticity, hyperactive reflexes, a loss of the ability to perform fine movements, and an extensor plantar response known as the Babinski sign. Symptoms generally occur alongside other sensory problems. Causes of damage may include masses such as strokes, subdural hemorrhage, abscesses and tumors, inflammation such as meningitis and multiple sclerosis, and trauma to the spinal cord, including from slipped discs.
After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states: "I don't have to worry about getting dizzy when I get up from lying down." "I need to avoid foods with fiber because diarrhea can occur." "I need to be careful because the drug can make me sleepy." "I might notice some excess saliva in my mouth at different times."
"I need to be careful because the drug can make me sleepy." Imipramine is a tricyclic antidepressant and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high fiber intake would be appropriate to decrease possible constipation.
A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating? "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." "Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks."
"Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite. Serotonin also controls food intake, irritability, sleep and wakefulness, compulsiveness, temperature regulation, pain control, sexual behaviors, and regulation of emotions. Norepinephrine, histamine, and dopamine are not correct. Lack of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Lack of histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Lack of dopamine may lead to imbalance difficulties, speech problems, and postural changes.
A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating? "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks." "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." "Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness."
"Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." Explanation: -Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite. Serotonin also controls food intake, irritability, sleep and wakefulness, compulsiveness, temperature regulation, pain control, sexual behaviors, and regulation of emotions. -Lack of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. -Lack of histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. -Lack of dopamine may lead to imbalance difficulties, speech problems, and postural changes.
The client presents to the mental health clinic with reports of fibromyalgia, migranes, and GI distress. The nurse talks about the different neurotransmitters and what each neurotransmitter does. How would you elaborate on the type of symptoms this client is demonstrating? "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks." "Lack of serotonin in the body produces symptoms such as irritability, sleep disturbances, and compulsiveness."
"Lack of serotonin in the body produces symptoms such as irritability, sleep disturbances, and compulsiveness." Serotonin is a neurotransmitter found only in the brain, primarily an excitatory neurotransmitter that is diffusely distributed within the cerebral cortex, limbic system, and basal ganglia. Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions, such as sleep and appetite. As a neurotransmitter in the central nervous system, norepinephrine increases alertness and arousal, and speeds reaction time. Low levels of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Histamines boost blood flow in the area of your body allergens affect. This causes inflammation, which lets other chemicals from your immune system step in to do repair work. Too little histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Dopamine is an excitatory neurotransmitter found in distinct regions of the CNS and is involved in cognition, complex movements, motivation, and regulation of emotional responses. Dopamine is the neurotransmitter that stimulates the body's natural "feel good" reward pathways, producing pleasant euphoric sensation under certain conditions.
A client receiving an antipsychotic agent develops acute extrapyramidal symptoms. Which response by the nurse would be most appropriate? -"These symptoms are not real; the medication makes your brain think they are real." -"You have developed an allergy to the medication, so we need to change it." -"These are the results of the drug and can be treated; your illness is not getting worse." -"The sunlight together with the medication has caused these symptoms; just stay indoors."
"These are the results of the drug and can be treated; your illness is not getting worse." Individuals with acute extrapyramidal symptoms need frequent reassurance that these are not a worsening of their psychiatric condition but instead are treatable side effects of the medication. They also need validation that what they are experiencing is real and that the nurse is concerned and will be responsive to changes in these symptoms. From Google: The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome. Extrapyramidal symptoms are not indicative of an allergy. Photosensitivity occurs with antipsychotic agents and sunlight.
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." Weight gain is a common side effect of the atypical antipsychotics, particularly clozapine and olanzapine, which can cause a weight gain of up to 20 pounds within 1 year. -Orthostatic hypotension may occur with this drug. ---Breast engorgement would be more likely with typical antipsychotics. -Photosensitivity, not dermatitis, is associated with antipsychotic use.
A client is prescribed medication for a psychiatric disorder. After 3 days, the client reports being constipated. Which instruction would the nurse give the client? "Ask your psychiatrist to prescribe a stool softener for you." "You need to eat more high-protein foods such as meat and peanut butter." "This side effect should disappear within a week or so." "You need to eat more fruits and vegetables and drink more water."
"You need to eat more fruits and vegetables and drink more water." The nurse should instruct the client to increase fiber and fluid intake. A mild laxative, exercise, and fiber supplement also may help the client's constipation. High-protein foods would have no effect on constipation. Stool softeners may be appropriate if an increase in fiber and fluids is ineffective. The side effect will not necessarily disappear.
The psychiatric-mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply. Contraindications Adverse reactions Indications for use Food and drug interactions Cost of the medication
(the branch of pharmacology concerned with the movement of drugs within the body)_Contraindications Adverse reactions Indications for use Food and drug interactions When responsible for the administration of medications, the psychiatric-mental health nurse needs to have a basic understanding of factors affecting pharmacodynamics (the effects of drugs and the mechanism of their action) and pharmacokinetics (the movement of drugs within the body) that include individual drugs' contraindications, adverse reactions, indications for use, and food and drug interactions. Cost of medication is useful knowledge for cost containment; however, it does not impact client safety. Therefore, it is not considered a priority with regard to medication knowledge.
An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply. -The client exhibits delusional thinking that is uncharacteristic -The client makes repetitive movements with the fingers -The client reports nightmares and frequent awakenings at night -The client recently fainted after getting up quickly from a chair -The client often smacks lips when at rest
-The client often smacks lips when at rest -The client makes repetitive movements with the fingers Tardive dyskinesia is usually characterized by repetitive involuntary movements. Syncope, sleep disturbances, and symptom exacerbation are not suggestive of tardive dyskinesia. TARDIVE DYSKINESIA: Definition: A condition affecting the nervous system, often caused by long-term use of some psychiatric/antipsychotic (which used to be known as neuroleptics) drugs. Tardive dyskinesia causes repetitive, involuntary movements, such as grimacing and eye blinking. Stopping or tapering drugs that may be contributing to involuntary repetitive movements can help. In rare cases, botulinum toxin, deep brain stimulation, or medications can help.
A nurse administers a prescribed dose of lithium at 8 p.m. The nurse would schedule a specimen to be obtained for a blood concentration at which time? 10 p.m. 12 p.m. 4 p.m. 8 a.m.
8 a.m. Blood concentrations should be monitored 12 hours after the last dose of medication.
During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate? Discussing the timing of tapering the medication Instructing the client about relapse prevention Determining if the medication is losing its effect Assessing the client for target symptoms and side effects
Assessing the client for target symptoms and side effects During stabilization, the medication dosage is adjusted or titrated to achieve the maximum amount of improvement with a minimum of side effects. Psychiatric-mental health nurses assess target symptoms, looking for changes or improvements and side effects. Education about relapse prevention and target symptoms and assessing if the medication is losing its effect occur during the maintenance phase. Tapering occurs during the discontinuation phase.
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. 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 is the correct answer.
What is the difference between traditional and atypical antipsychotics? A-Traditional antipsychotics work mostly as dopamine agonists, but antipsychotics work through antagonizing the dopamine receptor. B-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. C-Traditional antipsychotics have a more powerful effect on the negative symptoms of schizophrenia, whereas atypical antipsychotics exert stronger effects on the positive symptoms. D-Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade.
Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade. Atypical antipsychotics work on dopamine receptors and serotonin receptors, thus affecting both positive and negative symptoms of schizophrenia. -Positive symptoms are additional behaviors/signs of the disease. A "presence of symptoms" -Negative symptoms refer to an absence or lack of normal mental function involving thinking, behavior, and perception
The use of psychopharmacologic agents in the treatment of mental illness comes from which domain of the biopsychosocial model? Psychological Social Biologic Environmental
Biologic Neurobiologic theories serve as a basis for understanding and administering pharmacologic agents.
A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse? Call the client's psychiatrist because her symptoms are indicative of moderate toxicity Say that you and the client will monitor these side effects to be sure they do not increase in severity Explain to the client that these are common side effects and that they will subside soon Ask the client to return 3 days later to see the psychiatrist, who will be in the clinic on that day
Call the client's psychiatrist because her symptoms are indicative of moderate toxicity The client's complaints indicate lithium toxicity and should be reported to the client's physician for possible adjustment of the medication. From the book: Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination. Untreated, these symptoms worsen and can lead to renal failure, coma, and death.
The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain? Cerebellum Medulla oblongata Cerebrum Hippocampus
Cerebellum The cerebellum controls and guides movements, as well as maintains muscle tone. -The cerebrum is composed of the frontal, parietal, occipital, and temporal regions and contributes to intellectual function, including learning, judgment, reasoning, and memory. -The medulla oblongata controls respiration, gastrointestinal motility, and circulation. -The hippocampus is part of the limbic system. Me: remember: cerebellum --> Belle from B&TB; think of her dancing, v graceful/elegant
What part of the brain would be responsible for activities such as walking and dancing? Brain stem Cerebrum Midbrain Cerebellum
Cerebellum The cerebellum, which is located behind and below the cerebrum, controls and coordinates muscle movement integral to physical activities such as walking and dancing. Me: remember, Belle from B&TB, dancing, coordinated
A client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence? Changing the client's medication route to intramuscular depot Establishing a system of rewards and consequences for adherence and nonadherence Transitioning from oral to intravenous antipsychotics Administering a benzodiazepine 30 minutes prior to the antipsychotic
Changing the client's medication route to intramuscular depot Depot medications can effectively compensate for a client's lack of adherence and are likely to be more effective in the long term than a system of rewards and consequences. Antipsychotics are not administered intravenously. The use of benzodiazepines will have no effect on adherence.
Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells? Selectively Chemically Excitably Accessibly
Chemically The transmission of information between two nerves or between a nerve and a gland or muscle is chemical.
A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter? Noradrenergic GABA-ergic Cholinergic Dopaminergic
Cholinergic The cholinergic system uses acetylcholine as a neurotransmitter. The dopaminergic system uses dopamine as its neurotransmitter. The GABA-ergic system uses GABA as its neurotransmitter. The noradrenergic system uses norepinephrine as its neurotransmitter.
Which is the primary role of neurotransmitters? Communicate information from one cell or cell group to another Excite the receptor cell located inside the synaptic cleft Inhibit the receptor cell found inside of glial cells Communicate information within the receptor cell
Communicate information from one cell or cell group to another Neurotransmitters are referred to as first messengers, which means molecules that communicate information or change from one cell or cell group to another, cause an immediate effect, and are typically found in circuitry that produces behavior.
A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms? Damage to the medulla Damage to the thalamus Damage to the nucleus accumbeus Damage to the hippocampus
Damage to the hippocampus Damage to the hippocampus causes short-term memory loss and lack of motivation. Damage of the nucleus accumbeus does not cause memory loss. Damage to the thalamus results in obsessive-compulsive behavior or decreased ability to experience pleasure. Damage to the medulla affects circulation and respiration.
A nurse observes an older adult client who has been taking antipsychotic medications for 8 months. The nurse sees the client's lips smacking and eyes blinking rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate? Instruct the client to begin tapering the medication. Document the client's symptoms of tardive dyskinesia. Contact the client's physician for a different medication order. Ask whether the client has been experiencing side effects.
Document the client's symptoms of tardive dyskinesia. The nurse should document the symptoms of tardive dyskinesia, a chronic syndrome caused by long-term use. Asking whether the client has been experiencing side effects would be inappropriate because the client is already exhibiting signs. Contacting the physician for a different medication implies that these effects can be reversed. Tardive dyskinesia is typically irreversible. It is not within the nurse's scope of practice to instruct the client to begin to taper the drug.
A client has been diagnosed with Parkinson's disease. His symptoms of spasticity are related to a decrease in which neurotransmitter? Acetylcholine Serotonin Dopamine Adrenocorticotropic hormone
Dopamine A client with Parkinson's disease develops symptoms of spasticity related to a decrease in dopamine. A client with Parkinson's disease will have an increase in acetylcholine. Adrenocorticotropic hormone and serotonin will not be influenced in relation to the disease process. Me: Remember: people w/ Parkinson's movement is affected; think of Dopey from snow white Ppl w/ parkinson's=Dopey=Dopamine
A client with Parkinson's disease is hospitalized on a medical unit. The nurse would be correct in identifying which neurotransmitter decreased in this disease? Acetylcholine Dopamine Neurontin Serotonin
Dopamine Parkinson's disease develops from decreased availability of dopamine, while acetylcholine binding to muscle cells is impaired in myasthenia gravis. Therefore acetylcholine, neurontin, and serotonin are incorrect. Me: Remember: people w/ Parkinson's movement is affected; think of Dopey from snow white Ppl w/ parkinson's=Dopey=Dopamine
Typical antipsychotics work by blocking which receptor? Serotonin Norepinephrine Dopamine and serotonin Dopamine
Dopamine Typical or traditional antipsychotic agents (neuroleptics) block dopamine receptors in the brain, thus altering the release and turnover of dopamine. Typical psychotropic agents do not play a role in the blockade of serotonin or norepinephrine.
All but which are currently used neuroimaging techniques? Positron-emission tomography (PET) scan Computed tomography (CT) scan Electrocardiogram (ECG) Single-photon emission tomography (SPECT) scan
Electrocardiogram (ECG) Current neuroimaging techniques include computed axial tomography (CAT) scan, positron-emission tomography (PET) scan, single-photon emission tomography (SPECT) scan, magnetic resonance imaging (MRI), electroencephalogram (EEG), angiography, ultrasonography, and polysomnography.
A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment? Ascertaining that the client is taking a full dose daily Educating the client about the side effects of lithium Ensuring the client's blood levels reach a therapeutic and safe dose Monitoring the client's cardiac status
Ensuring the client's blood levels reach a therapeutic and safe dose Lithium has few side effects if maintained within a therapeutic range. Adverse reactions begin to occur with toxic levels.
Which is the most commonly seen adverse side effect of typical antipsychotics? Serotonin syndrome Auditory and visual hallucinations Accidental overdosage as a result of the narrow therapeutic range Extrapyramidal symptoms and tardive dyskinesia
Extrapyramidal symptoms and tardive dyskinesia The greatest hazard of typical antipsychotics involves adverse effects, such as extrapyramidal symptoms (EPSs) and tardive dyskinesia. Risk of EPSs and other movement disorders is highest for clients who use older, high-potency neuroleptics, such as haloperidol or perphenazine, for long periods.
Abnormalities in which lobe is believed to be associated with schizophrenia? Temporal Occipital Parietal Frontal
Frontal An abnormality in the frontal lobe has been associated with schizophrenia.
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? Temporal lobes Limbic lobes Frontal lobes Occipital lobes
Frontal lobes 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. Temporal, occipital, and limbic lobe damage do not exhibit aggressive behavior or personality changes.
Benzodiazepines increase which neurotransmitter function? GABA Serotonin Norepinephrine Acetylcholine
GABA Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep. Benzodiazepines do not increase the function of serotonin, norepinephrine, or acetylcholine.
While discussing the CNS, the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what? Acetylcholine Dopamine GABA Serotonin
GABA Gamma-aminobutyric acid (GABA), which is found in the brain, inhibits nerve activity and is important in preventing over excitability or stimulation such as seizure activity. Acetylcholine, dopamine, and serotonin are not the major inhibitory neurotransmitter in the CNS.
A nurse is assessing a child with a diagnosis of autism spectrum disorder. The child has severe uncontrollable temper outbursts and repeatedly bangs the head on the wall or door. When considering medication for treatment, the nurse knows which will be the most effective? Imipramine Pemoline Methylphenidate Haloperidol
Haloperidol Antipsychotic medication like haloperidol is used to treat specific symptoms such as temper tantrums and stereotypic behavior (repeatedly bangs head on the wall or door). -Pemoline and methylphenidate are used to treat attention deficit hyperactivity disorder. -Imipramine is used to treat enuresis.
The client cannot remember anything before an accident yesterday. Which brain structure might be injured? Basal ganglia Midbrain Hippocampus Reticular formation
Hippocampus Explanation: 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. -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. -The reticular formation controls sleep and wakefulness and directs visual and auditory reflexes. -The basal ganglia assume motor skills that have become automatic and also initiate and control activities and muscle tone. Me: remember: Just like 'an elephant never forgets', a hippo remembers everything! Imagine a hippo who is very wise and put together; he wears a top hat and a monocle, and is calm. He controls his emotions, sexual impulses, and is submissive. He has a vast memory, and is always learning. He is rarely aggressive, bc he controls his impulses very well.
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 Fever, hypertension, and diaphoresis are cardinal symptoms of NMS and should be immediately addressed.
Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what? Serotonin syndrome Agitation Hypertensive crisis Tardive dyskinesia
Hypertensive crisis Normally, MAO breaks down tyramine; however, because MAOIs inhibit MAO, tyramine can accumulate in the bodies of clients taking these drugs and eating tyramine-rich foods. Tyramine also releases norepinephrine from nerve endings. These metabolic actions can precipitate a hypertensive crisis.
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? Corpus callosum Pons Basal ganglia Hypothalamus
Hypothalamus 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. The pons connects the cerebellum and the brainstem. The basal ganglia initiates motor function. The corpus callosum is the pathway that connects the two hemispheres of the brain.
A client in the operating room goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is what? Midbrain Cerebellum Hypothalamus Thalamus
Hypothalamus The hypothalamus plays an important role in the endocrine system because it regulates the pituitary secretion of hormones that influence metabolism, reproduction, stress response, and urine production. It works with the pituitary to maintain fluid balance through hormonal release and maintains temperature regulation by promoting vasoconstriction or vasodilatation. In addition, the hypothalamus is the site of the hunger center and is involved in appetite control.
Which reason do clients cite most frequently as the cause for self-discontinuation of medication? Fear of becoming addicted Social stigma associated with taking psychotropic medications Desire to control their own lives Intolerable side effects
Intolerable side effects Clients may have many reasons for failing to adhere to medication regimens. The most frequent reason is adverse effects, many of which are debilitating and difficult to manage.
A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition? Intramuscularly Intravenously Orally Subcutaneously
Intramuscularly If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly. Antipsychotic medications are not normally administered by the intravenous or subcutaneous routes, and oral administration is more challenging when a client is noncompliant with treatment.
A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition? Orally Intramuscularly Intravenously Subcutaneously SUBMIT ANSWER
Intramuscularly If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly. Antipsychotic medications are not normally administered by the intravenous or subcutaneous routes, and oral administration is more challenging when a client is noncompliant with treatment.
Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug? Its ability to block the reuptake of serotonin The management of the symptomology related to depression The inhibition of the hormonal cascade that affects the release of serotonin The increase in the number of serotonin receptor sites in the central nervous system
Its ability to block the reuptake of serotonin An SSRI antidepressant drug's primary effect typically involves its ability to block the reuptake of serotonin.
The structure of the brain associated with emotional control, memory, and learning is what? Basal ganglia Brainstem Limbic system Cerebellum
Limbic system The limbic system controls emotions, memory, and learning. The basal ganglia initiate and control voluntary motor activities and muscle tone. The brainstem controls respiration, gastrointestinal motility, circulation, and sleep and wakefulness, and directs visual and auditory reflexes. The cerebellum controls and guides movements and maintains muscle tone.
A group of nursing students are reviewing information related to drug therapy for mood disorders. The students demonstrate understanding of the information when they identify which agent as the gold standard for treating bipolar disorder? Lithium Valproate Lamotrigine Carbamazepine
Lithium Although carbamazepine, valproate, and lamotrigine are anticonvulsants used to treat patients with mood disorders, lithium is considered the gold standard. *me: remember GOLD BATTERY*
A group of nurses is reviewing the various drug classes used to treat psychiatric disorders. The nurses demonstrate understanding when they identify which as examples of antianxiety medications? Select all that apply. Selegiline Lorazepam Buspirone Zolpidem Methylphenidate
Lorazepam Buspirone Examples of antianxiety agents include lorazepam and buspirone. -Selegiline is a monoamine oxidase inhibitor (MAOI/antidepressant) -zolpidem is a hypnotic -methylphenidate is a stimulant.
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? Thalamus Cerebrum Pituitary Medulla oblongata
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.
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? Cerebrum Pituitary Medulla oblongata Thalamus
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. Me: remember: Medulla Oblongata is the most PRIMITIVE part of the brain; imagine a caveman (who is v primitive) named Medulla Oblongata
A client with a history of schizophrenia is being treated with olanzapine. Which assessment should the nurse prioritize when planning care for this client? Seizures Metabolic syndrome Systemic infections Depression
Metabolic syndrome The use of olanzapine is associated with the development of metabolic syndrome (hyperglycemia, dyslipidemia, and abdominal obesity). Metabolic screening is critical to preventing long term co-morbidities such as type II diabetes mellitus and cardiac disease. With the use of olanzapine, seizures and depression are not common side effects of the drug. Systemic infections are more likely with medications such as clozapine, which have a higher incidence of causing agranulocytosis.
The brain stem consists of which structure? Cerebellum Thalamus Hypothalamus Midbrain
Midbrain The brain stem consists of: -midbrain -pons -medulla oblongata
Dietary modifications are most likely necessary when a client is being treated with which antidepressant? Atypical antidepressants Selective serotonin reuptake inhibitors(SSRIs) Tricyclic antidepressants Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) MAOIs are antidepressants that are well known for their multiple drug and food interactions (tyramines). As such, dietary modifications are necessary. Such modifications are not normally necessary when a client is receiving SSRIs, tricyclic antidepressants, or atypical antidepressants.
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 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, and 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.
A nurse is teaching a patient about how impulses are transmitted and describes the factors that can impact this transmission. Which factor would the nure most likely identify as increasing synaptic transmission? Reduction of chemicals Electrical impulse Calcium reaction Neurotransmitter
Neurotransmitter As the electrical action potential reaches the ends of the axons, called terminals, calcium ion channels are opened, allowing an influx of Ca++ ions into the neuron. This increase in calcium stimulates the release of neurotransmitters into the synapse. Rapid signaling among neurons requires a ready supply of neurotransmitter. These neurotransmitters are stored in small vesicles grouped near the cell membrane at the end of the axon. When stimulated, the vesicles containing the neurotransmitter fuse with the cell membrane, and the neurotransmitter is released into the synapse. The neurotransmitter then crosses the synaptic cleft to a receptor site on the postsynaptic neuron and stimulates adjacent neurons.
A client presents to the mental health clinic with reports including lack of focus, lethargy, and inattention. The nurse talks about the different neurotransmitters and what each neurotransmitter does. How would you elaborate on the type of symptoms this client is demonstrating? "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." "Lack of serotonin in the body produces symptoms such as irritability, sleep disturbances, and compulsiveness." "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks."
Norepinephrine is the most prevalent neurotransmitter in the nervous system, it's located primarily in the brainstem and plays a role in generating and maintaining mood states such as attention, learning, memory, sleep, and mood states. Serotonin is believed to help regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function. Low serotonin levels have been linked to depression. Dopamine is an excitatory neurotransmitter found in distinct regions of the CNS and is involved in cognition, complex movements, motivation, and regulation of emotional responses. Dopamine is the neurotransmitter that stimulates the body's natural "feel good" reward pathways, producing pleasant euphoric sensation under certain conditions. Histamines boost blood flow in the area of your body allergens affect. This causes inflammation, which lets other chemicals from your immune system step in to do repair work. Too little histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations.
Which is considered an atypical antipsychotic? Thiothixene Olanzapine Haloperidol Thioridazine
Olanzapine Olanzapine is considered an atypical antipsychotic. Haloperidol, thioridazine, and thiothixene are considered conventional antipsychotics.
A drug that is an antagonist functions to do what? Reduce synapses Prevent natural or other substances from activating cell function Accelerate reuptake of neurotransmitters Stabilize a receptor in an inactive state
Prevent natural or other substances from activating cell function Drug antagonists block the actions of everything in the agonist spectrum. These chemicals bind to and block a receptor, producing no response and preventing agonists from binding or attaching to the receptor.
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? Dystonia Pseudoparkinsonism Akathisia Neuroleptic malignant syndrome (NMS)
Pseudoparkinsonism Symptoms of pseudoparkinsonism include the classic triad of Parkinson's disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms. -Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. -Dystonia is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating use of an antipsychotic. -NMS is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever.
A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter? Serotonin Calcitonin Parathyroid Melatonin
Serotonin Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone, not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone.
Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)? Myopathy Exophthalmia Liver failure Sexual dysfunction
Sexual dysfunction SSRIs block 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 client has been recently diagnosed with schizophrenia and is just beginning treatment with olanzapine. What anticipatory guidance should the nurse provide to the client? Strategies for preventing and managing weight gain The importance of blood level monitoring for the first several weeks The importance of regular eye examinations Signs and symptoms of tardive dyskinesia
Strategies for preventing and managing weight gain Weight gain is a common side effect of olanzapine. Tardive dyskinesia is associated with long-term use of typical antipsychotics. Atypical antipsychotics are not associated with eye damage and they do not require blood level monitoring.
In the discharge instructions for a client who is taking alprazolam, the nurse should include what? Sedative hypnotics are effective analgesics. The potential for addiction and abuse of anxiolytics is low. Sudden cessation of alprazolam can cause rebound insomnia and nightmares. Caffeine beverages can increase the effect of sedative hypnotics.
Sudden cessation of alprazolam can cause rebound insomnia and nightmares. 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.
A college student wakes up and notices a racing heart and dilated pupils. The student is scheduled to write an exam later that morning. Which system is responsible for this physiological response? Sympathetic nervous system Autonomic nervous system The release of dopamine Cardiovascular irregularity
Sympathetic nervous system The sympathetic nervous system is stimulated by physical or emotional stress, such as strenuous exercise or work, pain hemorrhage, intense emotions, and temperature extremes. The specific body responses include: increased arterial blood pressure and cardiac output and pupil dilation to aid vision. The autonomic nervous system affects the cardiovascular function to decrease heart rate responses. The patient does not suffer from a cardiac irregularity. The release of dopamine will not affect pupillary response.
An older adult client has been taking diazepam on a daily basis for several years. On the advice of the client's daughter, the client now wants to stop taking it. Due to the possible effects of discontinuation, the nurse should perform what intervention? Educate the client about the risks of respiratory depression Educate the client about the need to report any symptoms of depression to her primary care provider Encourage the client to have follow-up blood levels taken in 8 to 10 days Teach the client nonpharmacologic strategies for promoting sleep
Teach the client nonpharmacologic strategies for promoting sleep Discontinuation of benzodiazepines can result in rebound insomnia. Blood levels are not necessary and there is no associated risk for depression or respiratory depression.
The nurse is administering a sedative drug to a client before the magnetic resonance imaging (MRI) procedure. What are the possible reasons for which the nurse had to sedate the client? Select all that apply. The client may have severe anxiety. The client has a pacemaker. The client may have claustrophobia. The client has not given consent for having the MRI. The client may have high blood pressure.
The client may have claustrophobia. The client may have severe anxiety. The MRI procedure requires the client to lie down in a small closed chamber and be motionless for approximately 45 minutes. A client who has claustrophobia or severe anxiety may not be able to cooperate during the procedure. Thus, such clients require sedation. Clients with high blood pressure can undergo this procedure safely. High blood pressure is not an indication for the client to be sedated before procedure. Pacemakers are contraindicated for MRI. If the client has not given consent for MRI, the procedure should not be performed.
Benzodiazepines work by the following mechanism of action: -They act indirectly through a second messenger to affect levels of circulating GABA. -They act directly on GABA receptors and are thought to increase the amount of GABA available. -They act directly on dopaminergic neurons in the medulla. -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. Explanation: Benzodiazepines act directly on GABA receptors and are thought to increase GABA available to dampen neural overstimulation.
Which antipsychotic drug can cause a lengthening of the QT interval? Olanzapine Clozapine Thioridazine Haloperidol
Thioridazine Certain antipsychotic drugs, such as thioridazine, can cause a lengthening of the QT interval.
A nurse is reviewing the process of neuronal transmission. The nurse demonstrates understanding of this concept by identifying which part of the neuron as carring information into the neuron from other neurons? axon dendrite nucleus soma
dendrite Dendrites route information to the nerve and axons carry information from a nerve to be transmitted to effector cells, which are found in muscles, glands, or another nerve. Soma refers to the cell body, and the nucleus is the central part of a cell, which is responsible for the cell's growth, reproduction, and metabolism.
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? acetylcholine dopamine norepinephrine serotonin
dopamine Abnormally high activity of dopamine has been associated with schizophrenia. Loss of cholinergic neurons is associated with Alzheimer's disease. Decreased norepinephrine is associated with depression; excessive norepinephrine is associated with manic symptoms. Increased serotonin is associated with mania; decreased serotonin is associated with depression and insomnia.
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. As the major organ of the nervous system, the brain governs all behavior of the body, including respiration, locomotion, and sensory activity, as well as cognition, thought, and the actions that constitute our conduct and performance as humans. Nurses need a basic working knowledge of the major neurotransmitters because many psychiatric medications work to increase or decrease neurotransmitter levels in the brain.
The nurse is working with a client that has not been diagnosed yet. The client is aggressive, unable to control anger, and violent at times. The client was brought to the emergency deparment by local police. The nurse selects what system as the etiology for the clients' behavior? Classify the symptoms according to origin in the body. circulatory system peripheral nervous system limbic system endocrine system
limbic system The limbic system that includes the thalamus, hypothalamus, hippocampus, and amygdala. The thalamus regulates activity, sensation, and emotion. The hypothalamus is involved in temperature regulation, appetite control, endocrine function, sexual drive, and impulsive behavior associated with feelings of anger, rage, or excitement. Not only does the limbic system function as the seat of emotions, but the limbic system also is involved with aspects of memory. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The endocrine system influences how the heart beats, how bones and tissues grow, even the ability to make a baby. It plays a vital role in the development of diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders. The human circulatory system functions to transport blood and oxygen from the lungs to the various tissues of the body. The heart pumps the blood throughout the body. The lymphatic system is an extension of the human circulatory system that includes cell-mediated and antibody-mediated immune systems. Common diseases of the cardiovascular system include: coronary artery disease, stroke, hypertension, and heart failure. The peripheral nervous system includes all of the nerves that branch out from the brain and spinal cord and extend to other parts of the body including muscles and organs. The three major forms of nerve damage are: peripheral neuropathy, autonomic neuropathy, and mono-neuropathy. The most common form is peripheral neuropathy, which mainly affects the feet and legs. Sciatica is pain, tingling, or numbness produced by an irritation of the sciatic nerve
The nurse is working with a client that has not been diagnosed yet. The client is aggressive, unable to control anger, and violent at times. The client was brought to the emergency deparment by local police. The nurse selects what system as the etiology for the clients' behavior? Classify the symptoms according to origin in the body. circulatory system peripheral nervous system limbic system endocrine system
limbic system The limbic system that includes the thalamus, hypothalamus, hippocampus, and amygdala. The thalamus regulates activity, sensation, and emotion. The hypothalamus is involved in temperature regulation, appetite control, endocrine function, sexual drive, and impulsive behavior associated with feelings of anger, rage, or excitement. Not only does the limbic system function as the seat of emotions, but the limbic system also is involved with aspects of memory. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The endocrine system influences how the heart beats, how bones and tissues grow, even the ability to make a baby. It plays a vital role in the development of diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders. The human circulatory system functions to transport blood and oxygen from the lungs to the various tissues of the body. The heart pumps the blood throughout the body. The lymphatic system is an extension of the human circulatory system that includes cell-mediated and antibody-mediated immune systems. Common diseases of the cardiovascular system include: coronary artery disease, stroke, hypertension, and heart failure. The peripheral nervous system includes all of the nerves that branch out from the brain and spinal cord and extend to other parts of the body including muscles and organs. The three major forms of nerve damage are: peripheral neuropathy, autonomic neuropathy, and mono-neuropathy. The most common form is peripheral neuropathy, which mainly affects the feet and legs. Sciatica is pain, tingling, or numbness produced by an irritation of the sciatic nerve.
After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid: fresh cottage cheese. cooked sliced ham. tap beers. soy milk.
tap beers. 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.
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? hyperreflexia bradycardia hypothermia constipation
hyperreflexia 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.
An older adult reports anxiety and is prescribed diazepam by a family physician. The physician asks the office nurse to explain to the client the problematic side effects of this medication. Which instruction about this drug would be most important for the nurse to emphasize? "You may find that you have temporary memory disturbances." "You need to use this medication cautiously because it can cause dependence." "You may feel dizzy and be prone to falls after taking this medication." "You may experience minor urine incontinence from time to time."
"You may feel dizzy and be prone to falls after taking this medication." Diazepam 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. Me: dependence is a concern, but since the Q specifically mentions an older adult, falls risk is the best answer.
The therapeutic level of lithium range includes what? 2 to 2.5 mEq/L 2.5 to 3 mEq/L 1 to 1.5 mEq/L 1.5 to 2 mEq/L
1 to 1.5 mEq/L Therapeutic levels in acute mania range from 0.8 to 1.4 mEq/L. Therapeutic maintenance doses range from 0.4 to 1 mEq/L.
When haloperidol is given as a depot injection, it has an effectiveness of which duration? 1 week 4 weeks 2 weeks 3 weeks
4 weeks Haloperidol has a duration of 4 weeks.
The prescription of clozapine requires weekly blood samples for which time frame? 4 months 6 months 2 months 8 months
6 months Although agranulocytosis can occur with any antipsychotic, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment and then every 2 weeks after that for as long as the drug is taken.
Which client is most likely to benefit from treatment with an antiparkinsonism agent? A client who has a medication-induced movement disorder A client who is being treated with an atypical antidepressant A client who has been admitted to the hospital with a diagnosis of lithium toxicity A client who is scheduled to begin electroconvulsive therapy (ECT) for the treatment of major depression
A client who has a medication-induced movement disorder Antiparkinsonism agents have been used to treat medication-induced movement disorders, such as neuroleptic-induced parkinsonism. The presence of lithium toxicity or the use of antidepressants or ECT is not likely to necessitate the use of antiparkinsonism agents.
Which client is most likely to benefit from treatment with an antiparkinsonism agent? A client who is being treated with an atypical antidepressant A client who has a medication-induced movement disorder A client who has been admitted to the hospital with a diagnosis of lithium toxicity A client who is scheduled to begin electroconvulsive therapy (ECT) for the treatment of major depression
A client who has a medication-induced movement disorder Antiparkinsonism agents have been used to treat medication-induced movement disorders, such as neuroleptic-induced parkinsonism. The presence of lithium toxicity or the use of antidepressants or ECT is not likely to necessitate the use of antiparkinsonism agents.
Which client would not be able to undergo a magnetic resonance imaging scan (MRI)? A client with a pacemaker A client who is obese A client with a longstanding history of claustrophobia A client with a diagnosed anxiety disorder
A client with a pacemaker Clients with pacemakers or metal implants, such as heart valves or orthopedic devices, cannot undergo an MRI. There are not contraindications for obese clients can to undergo an MRI. Clients who are claustrophobic or those with anxiety can have an MRI but may need special intervention such as sedation.
A client is having difficulty standing without assistance and is exhibiting swaying. The client has a history of falls. Which area of the brain is most likely affected? Cerebellum Hypothalamus Thalamus Hippocampus
Cerebellum ***cereBELLum = BALance*** The cerebellum regulates postural balance and positioning. -The hypothalamus regulates temperature. -The thalamus functions as a regulatory structure to relay all sensory information, except smell, sent to the central nervous system from the peripheral nervous system. -The hippocampus is involved in storing information, especially the emotions attached to memories.
The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test? Blood urea nitrogen and creatinine White blood cell count Cardiac enzymes Liver function tests
White blood cell count 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.
When describing the various neurotransmitters, which would a nurse identify as the primary cholinergic neurotransmitter? dopamine serotonin norepinephrine acetylcholine
acetylcholine Acetylcholine is the primary cholinergic neurotransmitter. Biogenic amines include dopamine, norepinephrine, and serotonin.
Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure? intellect engorgement behavior suppression
behavior This part of the brain seems to be largely responsible for the human aspect of brain function. Drug therapy aimed at alleviating emotional disorders, such as depression and anxiety, often involves attempting to alter the levels of epinephrine, norepinephrine, and serotonin. Limbic system = human (i.e., behavior, soul, etc) Me: People who do the LIMBO are full of life
Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of: smoking cardiac or seizure disorders. liver disease. asthma and respiratory diseases.
cardiac or seizure disorders. Antidepressants, especially tricyclic antidepressants, can cause cardiac dysrhythmias.
A nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the client will have difficulty in what area? smell concept formation receptive speech hearing
concept formation Working memory is an important aspect of frontal lobe function. The nurse can anticipate that the client will have difficulty with concept formation, insight, judgment, and reasoning. The temporal lobes contain the primary auditory (hearing) and olfactory (smell) areas. Wernicke's area, located at the posterior aspect of the superior temporal gyrus, is primarily responsible for receptive speech.
Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply. diarrhea tunny nose constipation dry mouth urinary retention
dry mouth constipation urinary retention Anticholinergic side effects resulting from blockade of acetylcholine are commonly associated with antipsychotic drugs. Others include dry mouth, slowed gastric motility, constipation, urinary hesitancy or retention, and nasal congestion. Diarrhea and a runny nose are not anticholinergic side effects. Can't see, Can't pee, Can't spit, Can't shit
One of the most common ways in which neurotransmitters are deactivated within the nervous system at the neuronal level is: -the blood-brain barrier ensures that they are deactivated. -enzymatic degradation, primarily by monoamine oxidase (MAO). -killer cells scavenge the remains of the neurotransmitters. -RNA transferase breaks them down.
enzymatic degradation, primarily by monoamine oxidase (MAO). Neurotransmitters are 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.
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? acute dystonic reaction serotonin syndrome neuroleptic malignant syndrome hypothyroidism
serotonin syndrome The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI] ) suggest serotonin syndrome. -Neuroleptic malignant syndrome and acute dystonic reaction would occur with antipsychotic uses. -Hypothyroidism may result from lithium use.
A client has developed deficits involving the senses of smell and hearing. The nurse would correlate this sensory dysfunction with which cerebral lobe? occipital frontal temporal parietal
temporal The temporal lobes contain the primary auditory and olfactory areas. The parietal lobes contribute to the ability to recognize objects by touch, calculate, write, recognize fingers of the opposite hands, draw, and organize spatial directions, such as how to travel to familiar places. The frontal lobes are thought to contain the highest or most complex aspects of cortical functioning, which collectively make up a large part of personality. The occipital lobes are involved in many aspects of visual integration of information, including color vision, object and facial recognition, and the ability to perceive objects in motion.
Which medication classification blocks serotonin reuptake? Antidepressant Antianxiety Antimanic Antibiotic
Antidepressant The medication classification, selective serotonin reuptake inhibitors (SSRIs) blocks the reuptake of serotonin. Antianxiety, antibiotic, and antimanic medications do not block the reuptake of serotonin.
A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client? "Make sure that you don't drink any alcohol when you're taking this medication." "Ask your pharmacist for a list of the foods you should avoid while you're taking this medication." "You might find that you have trouble falling asleep if you take this medication too late in the day." "If you notice that you have tremors in your arms or hands, stop taking the medication and tell your doctor."
"Make sure that you don't drink any alcohol when you're taking this medication." Interactions between benzodiazepines and alcohol can be lethal. Drowsiness, not insomnia, is likely. There are not dietary restrictions normally associated with benzodiazepine use, and these drugs are not a common cause of neuromuscular effects.
Benzodiazepines and buspirone are included in which therapeutic category? Antidepressants Antipsychotics Anxiolytics Mood stabilizers
Anxiolytics Benzodiazepines have the pharmacologic effects of anxiolysis, sedation, centrally mediated muscle relaxation, and elevation of the seizure threshold.
Clients diagnosed with myasthenia gravis have a decrease in which receptor? Norepinephrine Acetylcholine Dopamine Serotonin
Acetylcholine Clients diagnosed with myasthenia gravis, a neuromuscular disorder, have a decreased amount of acetylcholine. Acetylacholine is a neurotransmitter found in the brain, spinal cord, and peripheral nervous system, particularly at the neuromuscular junction of the skeletal muscle. -Dysfunction of dopamine is associated with with schizophrenia and other psychoses as well as Parkinson's disease. -Serotonin plays an important role in anxiety, mood disorders, and schizophrenia. -Norepinephrine dysfunction is implicated in several anxiety disorders, deficits may contribute to memory loss, social withdrawal, and depression.
The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain? Cerebrum Medulla oblongata Hippocampus Cerebellum
Cerebellum ***cereBELLum = BALance*** The cerebellum controls and guides movements, as well as maintains muscle tone. -The cerebrum is composed of the frontal, parietal, occipital, and temporal regions and contributes to intellectual function, including learning, judgment, reasoning, and memory. -The medulla oblongata controls respiration, gastrointestinal motility, and circulation. -The hippocampus is part of the limbic system.
A client with Parkinson's disease is hospitalized on a medical unit. The nurse would be correct in identifying which neurotransmitter decreased in this disease? Acetylcholine Dopamine Neurontin Serotonin
Dopamine Parkinson's disease develops from decreased availability of dopamine, while acetylcholine binding to muscle cells is impaired in myasthenia gravis.
Extrapyramidal side effects are characterized by a triad of symptoms, including what? Dystonia, akathisia, and pseudoparkinsonism Dystonia, flat affect, and cogwheeling Sadness, flattened affect, and anxious behavior Shuffling gait, cogwheeling, and drooling
Dystonia, akathisia, and pseudoparkinsonis
Which is considered the first-line treatment for bipolar disorder? Olanzapine Thioridazine Lithium Haloperidol
Lithium Lithium is considered the first-line treatment for bipolar disorder. Lithium is the most established mood stabilizer.
A nurse is aware that the likelihood a client will be in adherence with psychotropic medications is affected by what? The number of other medications the client is taking. The support the client has at home for taking medications. Receiving education and information about the medication. A history of taking these types of medications.
Receiving education and information about the medication. Understanding the rationale and anticipated results of medications prescribed increases the patient's insight into the importance of treatment. Client history of medication compliance, number of medications prescribed, and support at home influence compliance but are not the most important factors.
A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client? hypertension agranulocytosis diabetes hypotension
agranulocytosis Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a reduction in neutrophils in the blood, to develop. While the remaining options are potential side effects of antipsychotics, agranulocytosis is both life threatening and specific to clozapine.
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: encephalitis. severe anemia. neuroleptic malignant syndrome. agranulocytosis.
agranulocytosis. definition: an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, and thus causing a neutropenia in the circulating blood High fever, sore throat, and mouth sores are indicative of infection secondary to agranulocytosis, which has been associated with clozapine. The medication can suppress the bone marrow and cause a significant decrease in white blood cells. The client's signs and symptoms do not suggest anemia, neuroleptic malignant syndrome, or encephalitis.
A hospitalized male client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he "cannot sit still." The nurse documents this finding as: akinesia. pseudoparkinsonism. akathisia. dystonia.
akathisia The client's inability to "sit still"; and the client's frequent pacing are termed akathisia, an extrapyramidal effect of the antipsychotic medication. -Akinesia is slowed movements. -Dystonia involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles. -Pseudoparkinsonism includes rigidity, slowed movements, and tremor. Me: remember, Kathy, bouncing off the walls, she cannot sit still!
The function of the thalamus and the hypothalamus is to coordinate: speech and communication. sensation. movement. internal and external responses.
internal and external responses. The thalamus and hypothalamus coordinate internal and external responses and direct information into the cerebral cortex Me: remember: thalamus and hypothalamus, internal and external response
Clients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in: tyramine sodium fat sugar
tyramine Tyramine has a vasopressor effect that induces hypertension. If an individual ingests food that contains high concentrations of tyramine while taking MAOIs, severe headaches, palpitations, neck stiffness and soreness, nausea, vomiting, sweating, hypertension, stroke, and (in rare instances) death may result. Patients who are taking MAOIs are placed on a low-tyramine diet. Sodium, fat, and sugar are generally not restricted in patients receiving MAOIs.
When caring for an older adult taking a psychotropic medication, the psychiatric nurse must be aware that older adults: usually require a lower dose of these medications than do younger counterparts. are often refractory to psychotropic medications. are always reluctant to take these medications because of stigma and stereotyping. are not as sensitive to the effects of the psychotropics, and so are usually given slightly higher doses than in younger people.
usually require a lower dose of these medications than do younger counterparts. The pharmacologic actions of psychotropic medications change dramatically for older persons as a result from differences in drug absorption secondary to diminished gastrointestinal motility, decreased plasma proteins, decreased kidney function, congestive heart failure, or normal age-related changes in body composition, lean body mass, and muscle mass or increased fatty tissue.
