Exam 3 mental health

The spouse of a patient with Alzheimer's disease (AD) asks, "Can you give me a simple explanation of what happened in my partner's brain?" Select the nurse's best response.

"Brain cells and chemical messengers that form memories are dying."

The family of a patient diagnosed with AD asks the nurse, "How can drugs help our parent?" The reply that provides the most realistic expectations would be:

"Drugs can help preserve mental abilities for a time

An adult says, "I take provastatin (Pravachol) for my high cholesterol. It will prevent stroke and heart attack." Select the nurse's most informative response.

"Some research indicates that statin drugs may also interfere with development of AD."

An adult says, "I take vitamins B and E to prevent AD, but these vitamins are so expensive." Select the nurse's most informative response.

"There is conflicting research evidence about effectiveness of these vitamins for prevention of AD.

A patient has taken lithium (Lithane) 600 mg three times daily for 1 week. A laboratory result in which range shows that the desired serum lithium level was achieved?

0.6 to 1.2 mEq/L Therapeutic serum lithium levels are 0.6 to 1.2 mEq/L. The other options are either too low or too high. Serum levels above 1.5 mEq/L can cause symptoms of toxicity.

When comparing major differences between traditional and atypical antipsychotic drugs, which statements are correct? (Select all that apply.) a. Traditional antipsychotic drugs produce more EPSEs. b. Traditional antipsychotic drugs are more likely to produce weight gain. c. Traditional antipsychotic drugs alter dopamine and serotonin transmission. d. Atypical medications have a greater therapeutic effect on both positive and negative symptoms. e. Atypical medications are more likely to cause tardive dyskinesia.

A, D Traditional antipsychotics have a higher incidence of EPSEs and tardive dyskinesia. Atypical antipsychotics are more likely to produce weight gain and alter dopamine and serotonin transmission.

A nurse reviews laboratory reports for a patient who has taken clozapine for 1 year. Which WBC and granulocyte values would prompt the nurse to notify the health care provider of the need to suspend treatment? a. 2900 cells/mm3 and 1450 cells/mm3. b. 3500 cells/mm3 and 1850 cells/mm3. c. 4000 cells/mm3 and 2000 cells/mm3. d. 4500 cells/mm3 and 2500 cells/mm3.

A. 2900 cells/mm3 and 1450 cells/mm3 These values indicate that leukopenia is present. Agranulocytosis is a sometimes fatal side effect of clozapine. The other values are above baseline.

When a patient experiencing a first episode of type I schizophrenia is hospitalized, the nurse can expect to administer: a. a typical antipsychotic drug. b. an atypical antipsychotic drug. c. a mood-stabilizing anticonvulsant. d. a selective serotonin reuptake inhibitor.

A. A typical antipsychotic Delusions, hallucinations, and other symptoms of type I schizophrenia usually respond to the typical antipsychotic medications. Positive symptoms are considered to be the result of a subcortical dopaminergic process. The typical antipsychotics are dopamine blockers.

A patient has taken perphenazine (Prolixin) for a year. The nurse observes lip smacking and grinding teeth. Which tool should the nurse use to complete the assessment? a. AIMS b. EPSE c. SAD PERSONS d. CAGE questionnaire

A. AIMS AIMS is the Abnormal Involuntary Movement Scale. It was developed to screen for tardive dyskinesia. EPSE refers to extrapyramidal side effects. The other tools are for assessing alcohol abuse and suicidality.

Which information should the nurse include in the teaching plan for a patient receiving clozapine? a. "Abstain from using tobacco products." b. "Increase your daily carbohydrate intake." c. "Notify your health care provider if you start drooling." d. "You will need monthly electrocardiographic tracings done."

A. Abstain from using tobacco products Use of tobacco products speeds metabolism of clozapine in the liver, reducing the clozapine level and diminishing its effectiveness in reducing symptoms. Increasing carbohydrate intake is contraindicated because of the possibility of developing metabolic syndrome. Drooling is a common side effect. Monthly electrocardiographic tracings are unnecessary, but annual or semiannual tracings might be suggested, because arrhythmia development is possible.

Which neurotransmitter is most affected by an anticholinergic drug? a. Acetylcholine b. Dopamine c. Serotonin d. GABA

A. Acetylcholine Anticholinergic drugs inhibit acetylcholine, thereby preventing stimulation of the cholinergic excitatory pathways. The other neurotransmitters are associated with the etiology of schizophrenia, anxiety, and depression.

When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for which common extrapyramidal (EPSE) side effect? A. Akathisia B. Mydriasis C. Hypotension D.constipation

A. Akathisia It is estimated that more than 25% of all patients receiving antipsychotic medication experience akathisia, a subjective feeling of restlessness and jitteriness and a desire to stand or walk. Akathisia typically manifests itself early in treatment. The other options are not considered EPSEs.

When developing a teaching plan for a patient receiving benztropine (Cogentin), a priority consideration for the nurse is: a. anticholinergic drugs often cause blurred vision. b. urinary frequency may impair the patient's concentration. c. akathisia produced by the drug will make concentration difficult. d. increased peristalsis might cause gastrointestinal distress and impair concentration.

A. Anticholinergic drugs often cause blurred vision CNS effects include confusion, drowsiness, and decreased memory and learning. This might affect the patient's ability to learn. Anticholinergics do not cause urinary frequency, akathisia, or increased peristalsis.

How long must the symptoms of schizophrenia be present before a diagnosis can be made? a. At least 6 months b. At least 1 month c. More than 1 week d. On at least three occasions in the past year

A. At least 6 month To meet diagnostic criteria, signs of schizophrenia must be continuously present for a minimum of 6 months and not caused by substance abuse or a medical disorder.

Which type of perceptual alteration is most commonly displayed by patients with schizophrenia? a. Auditory hallucinations b. Inappropriate affect c. Loose associations d. Illusions

A. Auditory hallucinations Auditory hallucinations are the most commonly experienced perceptual alteration noted in schizophrenia. Illusions are less common. The other symptoms are not altered perceptions.

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, which aspect of physical assessment is most important?

A. Blood pressure, pulse and respiration A traditional antipsychotic medication administered intramuscularly might produce the marked antiadrenergic side effect of hypotension, thus making blood pressure an important assessment. It may also precipitate cardiac arrhythmias, so monitoring pulse and respirations is important. Decreased urinary output is related to anticholinergic side effects and would not be a priority assessment during the first 2 hours. The AIMS scale assesses for tardive dyskinesia, a late complication of antipsychotic therapy. Temperature assessment is relevant if assessing for neuroleptic malignant syndrome, a complication that develops after several doses of antipsychotic medication.

The nurse should focus assessment for a patient with type I schizophrenia primarily on gathering data about: a. cognition and perception. b. attention and motivation. c. grooming and hygiene. d. abstract thinking skills.

A. Cognition and perception Altered perception includes hallucinations, illusions, and paranoid thinking. These positive symptoms, along with abnormal thoughts, are hallmarks of type I schizophrenia. The other options are more often seen in patients with type II schizophrenia.

A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, "I'm the only one who understands this code." How should the nurse document these findings? a. Grandiose and paranoid delusions b. Affective blunting and anhedonia c. Autism and loose associations d. Delusions of reference

A. Grandiose and paranoid delusions Delusions are fixed false beliefs. Paranoid delusions reflect the idea that the person is being persecuted. Grandiose delusions are characterized by the idea that one is of great importance. The scenario does not describe any of the behaviors that would be consistent with the other options.

When assessing for a positive outcome to drug therapy with fluphenazine, the nurse would look primarily for improvement in which focus area?

A. Hallucinations Fluphenazine, a typical antipsychotic, will produce improvement in the positive symptoms associated with schizophrenia, such as hallucinations. Less improvement is expected in negative symptoms such as affect, activity, and grooming.

A patient diagnosed with Parkinson's disease begins levodopa therapy. The nurse understands that administration of levodopa will: a. improve symptoms of Parkinson's disease by increasing dopamine in the CNS. b. improve symptoms of Parkinson's disease by decreasing levels of GABA. c. cause the patient to develop symptoms of depression and an unsteady gait. d. lead to an increased risk of dysphagia.

A. Improve symptoms of Parkinson's disease by increasing dopamine in the CNS Levodopa is converted to dopamine in the central nervous system (CNS), so its administration will cause a reduction in the symptoms of Parkinson's disease related to dopamine deficiency. The other options are incorrect. Levodopa increases dopamine levels. Levodopa is not associated with changes in -aminobutyric acid (GABA). Levodopa will improve the patient's swallowing ability and gait, and will reduce symptoms of depression.

A patient diagnosed with schizophrenia has experienced good symptom control through medication therapy. Today, the patient is admitted with paranoia and auditory hallucinations. The nurse should initially determine if the patient's symptoms are related to which possible trigger?

A. Not taking the drug as prescribed When a patient does not respond to a drug, or when symptoms reappear after a good response to the drug, the nurse should assess for compliance. Is the patient taking the drug? Is the patient taking less of the drug than ordered? The other options are less relevant or of no value to the development of the stated symptoms.

A patient has taken a traditional antipsychotic medication for several years is now demonstrating involuntary tongue movements and lip smacking. What should be the nurse's initial action? a. Notifying the health care provider b. Administering PRN doses of an anticholinergic drug c. Implementing behavioral modification techniques to help the patient manage these motions. d. Counseling the patient about the social ramifications of these movements by others.

A. Notifying the health care provider These symptoms suggest the presence of tardive dyskinesia and should be reported to the health care provider, who will probably discontinue the drug or change to an atypical drug. The movements are involuntary so behavioral modification would not be effective and counseling would not be directed to this aspect of the problem. Tardive dyskinesia does not respond to anticholinergics.

A 60-year-old female patient who has taken traditional antipsychotic medication for 20 years should be screened for which potential side effect? a. Osteoporosis b. Metabolic syndrome c. Polycystic ovary disease d. Neuroleptic malignant syndrome (NMS)

A. Osteoporosis Traditional antipsychotic medications increase prolactin levels, placing patients at risk for development of osteoporosis. Atypical antipsychotics increase the risk for metabolic syndrome. Screening for NMS and polycystic ovary disease are not indicated.

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The patient says, "I couldn't sleep last night because I needed to pace." The nurse's communication to the health care provider would be to suggest: a. prescribing an anticholinergic drug. b. discontinuing the antipsychotic drug. c. prescribing dopaminergic medication. d. using an antihistamine at bedtime to promote sleep.

A. Prescribing an anticholinergic drug The patient's motor symptoms can be assessed as akathisia. Anticholinergic medication provides relief for some patients. The nurse should report the patient's symptoms to the health care provider and anticipate the order to begin anticholinergic therapy. The other options do not provide acceptable alternatives.

The nurse caring for a patient receiving a dopaminergic drug should assess the individual for early symptoms of: a. psychosis. b. fluid imbalance. c. tardive dyskinesia. d. labile hypertension.

A. Psychosis Dopamine excess is associated with schizophrenia. When dopaminergic drugs are given, symptoms of psychosis might appear or be exacerbated. Tardive dyskinesia is associated with dopamine deficiency. The other options are unrelated.

Which therapeutic activity would be most important in helping a patient diagnosed with schizophrenia remain in the work force? a. Social skills training b. Physical therapy to develop muscle strength c. Occupational therapy to improve coordination d. Group therapy to improve motivation for working

A. Social skills training Patients with schizophrenia often cannot obtain and hold jobs, not from lack of work skills but from inability to cope socially on the job. Social skills training would therefore be of greatest assistance if work skills are present. This premise is especially true for an individual with residual schizophrenia, since active psychosis is no longer present.

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic. What is the nurse's best first action when suspecting that a patient is experiencing neuroleptic malignant syndrome (NMS)? a. Take the patient's vital signs. b. Position the patient in the semi-Fowler position. c. Begin oxygen by nasal cannula at 2 L/min. d. Place the patient on one-to-one supervision.

A. Take the patients vital signs When signs and symptoms suggest that the patient might be experiencing NMS, the first action would be to check vital signs. NMS produces elevated temperature, blood pressure fluctuations, and irregular heart rate in addition to muscle rigidity and altered levels of consciousness. None of the other options address the assessment needs of such a patient

Which patient diagnosed with schizophrenia and receiving antipsychotic medication should receive the nurse's priority attention based on presenting characteristics? a. The one assessed with diaphoresis and a temperature of 104°F b. The one reporting feelings of neck and shoulder stiffness c. The one reporting auditory hallucinations of loudly clanging church bells d. The who chanting, "I am the messiah, delivered to earth from the heavens above"

A. The one assessed with diaphoresis and temp of 104 F Diaporesis and fever are findings indicating neuroleptic malignant syndrome (NMS), a serious adverse reaction to antipsychotic medication. The other findings may be significant but are a lesser priority.

Research on neurostructural theories of schizophrenia indicates that pathoanatomic findings often include: a. ventricular enlargement, brain atrophy, and diminished cerebral blood flow. b. ventricular blocking, brain swelling, and enhanced cerebral blood flow. c. decreased cortical thickness and hippocampal hyperplasia. d. increased cortical thickness and temporal lobe scarring.

A. Ventricular enlargement, brain atrophy, and enhanced cerebral blood flow Theorists have suggested that type II schizophrenia is the result of pathoanatomy, specifically increased ventricular brain ratios, brain atrophy, and decreased cerebral blood flow. The other alterations are not supported by research findings.

A nurse at the mental health clinic plans a series of psychoeducational groups for persons with schizophrenia. Which topics would take priority? a. The importance of taking your medication correctly b. How to complete an application for employment c. How to dress when attending community events d. How to give and receive compliments e. Ways to quit smoking

ANS: A, E Stabilization is maximized by adherence to the antipsychotic medication regime. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiologic well-being. The other topics are also important, but are not priority topics.

Of the patients the nurse will see at the mental health center, which one should be assessed most carefully for EPSEs? a. 59-year-old man with severe mental illness for 20 years; takes olanzapine (Zyprexa) b. 18-year-old woman with a first episode of schizophrenia; takes haloperidol (Haldol) c. 26-year-old man with generalized anxiety disorder; takes lorazepam (Ativan) d. 30-year-old woman with depression; takes amitriptyline (Elavil)

ANS: B Risk factors for EPSEs include female gender, first episode of schizophrenia, and use of a traditional antipsychotic medication. The other patients are at lower or no risk because of taking an atypical antipsychotic, a tricyclic antidepressant, and an antianxiety drug. Men are at lower risk.

A patient's serum lithium level is 1.8 mEq/L. Select the nurse's priority action.

Assess for signs of toxicity. A serum level of 1.8 mEq/L is higher than desirable. It suggests that the patient might be experiencing toxic effects. Clinical assessment should be conducted.

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The nurse should use which term to document these findings? a. Dystonia b. Akathisia c. Dyskinesia d. Bradykinesia

B. Akathisia A patient with akathisia describes feeling restless, jittery, and unable to sit, and has restless legs that feel better only if the patient is moving. Dystonia refers to sustained, twisted muscle contractions. Dyskinesia refers to jerky motions. Bradykinesia refers to slow movement.

An elderly nursing home resident has been diagnosed with type 2 diabetes, hypertension, and dementia. The patient begins taking an antipsychotic drug for agitation. Tremor and bradykinesia develop, so an anticholinergic is added to the drug regimen. Within 3 days the patient displays a marked cognitive deficit. Which medication is the most likely cause of the cognitive change? a. Antihypertensive b. Anticholinergic c. Antipsychotic d. Antidiabetic

B. Anticholinergic Anticholinergic medications often produce cognitive changes in older adults. Although the other medications listed might produce untoward effects, because the symptoms appeared after the introduction of the anticholinergic, one would suspect this drug first.

A patient who takes haloperidol (Haldol) for a diagnosis of schizophrenia has a dystonic reaction. Benztropine (Cogentin) 2 mg is given intramuscularly and then continued orally twice daily. Three days later, the patient has fever, disorientation, and tachycardia. Select the best analysis of this scenario. a. Tardive dyskinesia has emerged. b. Benztropine toxicity has developed. c. Extrapyramidal symptoms have returned. d. Dopaminergic benztropine effects have exacerbated the psychosis.

B. Benztropine toxicity has developed CNS hyperstimulation from anticholinergics causes fever, disorientation, excitement, agitation, delirium, and hallucinations as well as cardiovascular, urinary, and gastrointestinal symptoms. Collectively, these findings indicate anticholinergic toxicity. The symptoms described in the scenario do not accurately reflect any of the other options.

Parents of a 17-year-old patient diagnosed with schizophrenia ask the nurse what the future will be like for their child. The nurse's answer should be based on knowledge that the usual course of illness is: a. a steady lessening of symptoms until stability is achieved. b. characterized by alternating acute and stable phases. c. totally different for each individual patient. d. progressive deterioration.

B. Characterized by alternating acute and stable phases Most patients with schizophrenia experience alternating acute and stable phases throughout life. Complete and permanent remission is rare. The course of the illness might be somewhat different from individual to individual, but the alternating phases are seen more often than any other course.

A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, "I'm the only one who understands this code." What is the priority nursing diagnosis? a. Impaired environmental interpretation syndrome related to inability to reason b. Disturbed thought processes related to thinking not based on reality c. Risk for other-directed violence related to persecutory delusions d. Powerlessness related to feelings of persecution

B. Disturbed thought processes related to thinking not based on reality Disturbed thought processes based on thinking not based on reality is a priority diagnosis for a delusional patient. Impaired environmental interpretation is more useful for an individual who has been disoriented for more than 3 months. Risk for violence might be considered if the patient had given any indication of wishing to attack his persecutors or of willingness to fight back if personally attacked. Further investigation is necessary. No information was presented to suggest that the patient feels powerless. This would require further investigation.

Which statement by the nurse should be included in the teaching plan for patients receiving anticholinergic agents? a. "Avoid eating foods high in tyramine." b. "Do not abruptly stop taking the drug." c. "Take oral medications on an empty stomach." d. "Take a multivitamin and mineral supplement daily."

B. Do not abruptly stop taking the drug Tapering off the drug over a 1-week period is advisable instead of abruptly stopping the drug. This prevents uncomfortable withdrawal symptoms. Avoiding foods high in tyramine is important teaching for patients taking monoamine oxidase inhibitors (MAOIs). The other statements are not applicable.

Considering potency, what should the nurse closely monitor a patient receiving a traditional high-potency antipsychotic medication for:

B. Extrapyramidal side effects High-potency antipsychotics are more likely to cause extrapyramidal side effects (EPSEs) than low-potency antipsychotics. The other effects are not related to potency

A patient began trihexyphenidyl (Artane) for treatment of drug-induced parkinsonism. Which finding demonstrates a positive response to the medication? a. Blood pressure returns to patient's normal range. b. Gait is steady with decreased rigidity. c. Patient reports fewer feelings of depression. d. Patient has tremors with voluntary movement.

B. Gary is steady with decreased rigidity Gait disturbance, tremor, bradykinesia, and rigidity are symptoms of drug-induced parkinsonism. Reduction in these symptoms constitutes a positive outcome. The other options are not expected outcomes.

An antipsychotic medication is prescribed for a 72-year-old patient with a psychiatric disorder. It is most critical for the nurse to obtain information about which preexisting condition by asking what assessment question?

B. Have you ever been diagnosed with heart disease The anticholinergic and antiadrenergic effects of this drug might produce reflex tachycardia and/or arrhythmias. Individuals with known heart disease must be carefully evaluated before and during therapy. The remaining options are not influenced as directly by this medication.

An adult diagnosed with schizophrenia was started on clozapine 4 days ago. At 2100 today, the patient's vital signs are temperature 101°F; pulse 143 beats/min; respirations 20 breaths/min; blood pressure 100/60 mm Hg. What is the nurse's best action regarding the 2100 dose of clozapine? a. Recognize the alterations in vital signs as typical for early therapy, and administer the medication. b. Hold the medication, and notify the health care provider. c. Give the drug and continue to monitor vital signs every 4 hours. d. Postpone the dose until vital signs are normal.

B. Hold the medication, and notify the health care provider Clozapine might cause agranulocytosis, a potentially fatal illness. Any symptoms or signs of infection raise suspicion and call for investigation of white cell differential counts. Clozapine should be withheld until the white blood cell (WBC) count and absolute neutrophil count (ANC) are known. Administering the drug has the potential for further lowering the WBC count and ANC.

A patient is to be discharged on a maintenance dose of a high-potency antipsychotic medication. Which remark indicates that discharge teaching about the medication was effective? a. "I will be able to have a few glasses of wine." b. "I have to use sun block when I go to the beach." c. "It is important for me to dress warmly in all seasons." d. "If I miss a dose, I will take an extra one the next day."

B. I have to use sum block when i go to the beach The patient understands that antipsychotics cause photosensitivity and sunburn with minimal exposure to the sun. The other remarks suggest that the patient does not understand the additive effects of the antipsychotics and other central nervous system depressants, and does not understand what to do in the event of a missed dose.

Patient teaching for a patient beginning an anticholinergic drug should include: a. limiting fluid intake to 1000 ml/day. b. limiting strenuous activity on hot days. c. eating small, frequent meals to decrease nausea. d. wearing adequate clothing to prevent hypothermia.

B. Limiting strenuous activity on hot days An anticholinergic side effect is decreased sweating. Sweating produces body cooling through evaporation. Heat strokes is a greater possibility when the body cannot cool

A patient displays disorganized speech and behavior as well as a flat affect. The patient prefers to sit alone and often appears to be listening and responding to unseen stimuli. To begin a therapeutic relationship, the nurse should: a. take the patient to a medication education class. b. offer a simple activity, and sit with the patient. c. ask the patient what the voices are saying. d. quietly watch television with the patient.

B. Offer a simple activity, and sit with the patient For withdrawn patients, nurses should begin with undemanding one-to-one interactions. Providing a simple activity might help the patient focus on the here and now and provide a basis for reality-oriented communication. Watching television together does nothing to build trust. Medication education might be of little benefit if the patient is hallucinating and unable to pay attention to what is being taught. Asking what the voices are saying time after time is not beneficial to the patient, who needs to be distracted from them and focus on the real world.

A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, "I'm the only one who understands this code." Select a realistic and desirable outcome for this patient. The patient will: a. express a willingness to be supervised by staff by day 2. b. report feeling safe from harm by others by day 3. c. allow the nurse to read coded writings by day 2. d. recognize the need for medication by day 1.

B. Report feeling safe from harm by others by day 3 Reporting that he is no longer afraid of harm emanating from hostile forces would suggest a reduction in delusions. Allowing the nurse to read the coded writings or wishing to have a staff member nearby do not necessarily suggest improvement in reality-based thinking. Stating that he needs medication to clear his thinking by day 1 is not realistic, because delusions are fixed beliefs.

The family of a patient with type I schizophrenia asks, "Did this illness occur because of all the chaos in our family?" Select the nurse's best response. a. "It is likely that the chaos in your family caused the disorder. It is very important for every family member to keep calm." b. "Stress in your family may make the disorder more difficult to manage, but it is not the cause." c. "Too little is known about the cause of this illness for anyone to speculate." d. "That question would be best answered by the psychiatrist."

B. Stress in your family may make the disorder more difficult to manage, but it is not the cause The concept of disordered family interaction as the cause of schizophrenia is largely outdated. There is more reliance on the dopamine hypothesis or the stress-vulnerability model at present. Two options are dismissive, and the other suggests that the nurse is not qualified to give information.

An older adult patient who takes trihexyphenidyl (Artane) for drug-induced parkinsonism begins taking diphenhydramine (Benadryl) for cold symptoms. The nurse should carefully monitor this patient for: a. polyuria. b. tachycardia. c. constipation. d. hypothermia.

B. Tachycardia An anticholinergic effect on the vagus nerve causes tachycardia by removing the braking effect on the sinoatrial node. The additive effects of trihexyphenidyl and diphenhydramine would be likely to produce tachycardia, which could lead to cardiac decompensation in an older adult. In terms of priority of problems, hyperthermia may occur later, after toxic levels of anticholinergics had been ingested; constipation would be less life-threatening than cardiac decompensation. Anticholinergics cause urinary retention, not polyuria.

A patient receiving a traditional low-potency antipsychotic medication should assess closely for what possible peripheral nervous system related side effect?

B. Urinary retention Low-potency antipsychotics tend to cause anticholinergic side effects. Urinary retention and other anticholinergic effects are important findings for which the nurse should be alert. The other effects would not be expected.

Which patient receiving fluphenazine (Prolixin) should be monitored most closely for EPSEs? a. 35-year-old man b. 45-year-old woman c. 74-year-old woman d. Patient with a 5-year history of schizophrenia

C. 74 year old woman Women, older adults, patients with affective symptoms, and patients with first episodes of schizophrenia have a higher risk for EPSEs.

A highly suspicious patient tells the nurse, "When I sit in the dayroom I can see other people whispering about me and laughing. It makes me want to punch them." The direction that the nurse should give staff is: a. "Gently and frequently touch the patient while conversing." b. "Stop laughing immediately when the patient enters the room." c. "Be direct. Do not whisper, laugh, or look sideways at the patient." d. "Engage the patient in conversation by leaning close to speak softly."

C. Be direct. Do not whisper laugh, or loo sideways at the patient. Suspicious patients misinterpret the actions of others as being potentially harmful to self. Be direct and open, and avoid behaviors that can be misinterpreted, such as whispering or laughing. In addition, the suspicious patient needs additional personal space. Leaning close is ill-advised. Touching should be avoided because of the high potential for misinterpretation of staff members' motives by the suspicious patient. To stop laughing abruptly when the patient appears would make the individual even more suspicious.

A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The nurse observes that the patient's eyes are rolled upward in a fixed gaze. The nurse should administer which drug from the patient's PRN list? a. Vitamin E b. Carbidopa (Sinemet) c. Benztropine (Cogentin) d. Amantadine (Symmetrel)

C. Benztropine (Cogentin) Benztropine is an anticholinergic that can be given orally or parenterally in case of an emergency, such as oculogyric crisis or dystonic reaction. The other options would not relieve the dystonia.

An initial short-term outcome for a withdrawn, socially isolated patient diagnosed with schizophrenia is that the patient will: a. participate in scheduled activities. b. identify barriers to social communication. c. consistently interact with an assigned nurse. d. share feelings of isolation with group members.

C. Consistently interact with an assigned nurse Consistently interacting with one person reduces isolation. One-to-one interaction is the basis for developing trust and a therapeutic nurse-patient relationship. Later, the patient's willingness to participate in activities or discuss feelings indicates progress.

A therapist believes that persons diagnosed with schizophrenia have ego disintegration. This concept is based on which model? a. Biologic b. Interpersonal c. Developmental d. Stress-vulnerability

C. Developmental The concept of ego disintegration is distinctly freudian. Freud is considered a developmental theorist. This theory is not considered biologic, interpersonal, or stress-vulnerability based.

Which symptom of Parkinson's disease has the highest priority for nursing intervention? a. Tremor b. Akathisia c. Dysphagia d. Tardive dyskinesia

C. Dysphasia Dysphagia is difficulty swallowing. Because dysphagia can lead to a compromised airway, it is the priority symptom among those listed.

Which medication from the patient's pharmacologic profile would most likely led to the development of neuroleptic malignant syndrome?

C. Haloperidol Neuroleptic malignant syndrome is more likely to occur in patients taking traditional high-potency antipsychotic drugs. The distracters are not antipsychotic drugs.

Which medication from a patient's pharmacologic profile is most likely to precipitate neuroleptic malignant syndrome (NMS)? a. Diphenhydramine (Benadryl) b. Risperidone (Risperdal) c. Haloperidol (Haldol) d. Clozapine (Clozaril)

C. Haloperidol (Haldol) Haloperidol is a first-generation high-potency antipsychotic drug. It has a greater risk for producing NMS than atypical antipsychotic drugs. Diphenhydramine is not an antipsychotic drug.

A patient laughs while saying, "My dog died yesterday." The nurse documents this behavior using what terminology? a. Autistic b. Ambivalence c. Inappropriate affect d. Associative looseness

C. Inappropriate affect Speaking of a sad topic while laughing exemplifies inappropriate affect. Autism is characterized by having little concern for external reality. Ambivalence is the simultaneous presence of opposite emotions. Associative looseness is characterized by stringing unrelated topics together.

A patient is being switched to clozapine from therapy using a traditional antipsychotic. The patient asks, "What's the advantage of the new drug?" What is the nurse's best response? a. "It is much less expensive." b. "It has a lower risk for seizure activity." c. "It is sometimes effective when other drugs fail." d. "It has a lower risk for causing blood abnormalities."

C. It is sometimes effective when other drug fail Clozapine is often effective against refractory schizophrenia. The distracters are incorrect statements.

A patient diagnosed with schizophrenia and well managed with medication therapy tells the clinic nurse, "I stopped taking my antipsychotic medication 2 days ago." What assessment finding would the nurse expect at this visit?

C. No evidence of symptoms Antipsychotic drugs accumulate in fatty tissue and are released slowly. This explains why symptoms might still be controlled for several days after discontinuing the drug.

Which patient receiving antipsychotic medication has the greatest risk for the development of neuroleptic malignant syndrome (NMS) and should be most carefully monitored for this serious adverse reaction? a. One who has a history of hypothermia. b. One with an elevated serum prolactin level. c. One who began treatment with a high-potency drug. d. One whose antipsychotic medication therapy began more than 6 months.

C. One who began treatment with a high-potency drug Neuroleptic malignant syndrome (NMS) is more common among patients receiving high-potency drugs. NMS is associated with hyperthermia and occurs within the first 3 to 9 days of administration. Prolactin levels and NMS are not causally related.

A psychiatric nurse should base care of patients diagnosed with Parkinson's disease and patients demonstrating extrapyramidal side effects (EPSEs) caused by antipsychotic drug therapy on the premise that symptoms: a. are the same for both problems. b. result from deficits in dopamine synthesis. c. result from acetylcholine and dopamine imbalance. d. are produced by neurodegeneration of the substantia migraine

C. Result from acetylcholine and dopamine imbalance In both problems, acetylcholine and dopamine are not in balance. In Parkinson's disease, this results from neurodegeneration of the substantia nigra, and in the case of EPSEs, the cause is blockade of dopamine receptors in the basal ganglia. The other options are not valid premises.

A patient who takes haloperidol 10 mg/day orally developed restlessness, agitation, and an inability to sit still. The nurse then administered a PRN dose of haloperidol 5 mg intramuscularly. One hour later the patient's symptoms were worse. What is the most likely explanation for the increase in symptoms? a. The PRN medication has not yet taken effect. b. The patient needs an increase in the dosage of haloperidol to control the rising agitation. c. The patient was experiencing akathisia, which worsened after receiving the haloperidol medication. d. The nurse should consider an adjunctive dose of an antianxiety drug such as lorazepam.

C. The patient was experiencing Akathisia, which worsened after receiving the haloperidol medication Akathisia is characterized by subjective feelings of restlessness accompanied by the inability to sit still and the need to pace. It is an EPSE of antipsychotic medication, made more intense by higher doses of medication and use of PRN doses. It is unnecessary to change to a more sedating drug. The addition of an antianxiety drug is unnecessary.

A nurse should schedule a weekly complete blood cell count (CBC) for a patient beginning therapy with which antimanic drug?

Carbamazepine (Tegretol) Agranulocytosis is known to be an occasional but potentially dangerous adverse effect of carbamazepine therapy, hence the need for regular CBCs.

A nursing assistant reports to the nurse that a patient diagnosed with AD is experiencing severe diarrhea. Administration of which classification of medication is most associated with this problem?

ChE inhibitor

A patient has mild lithium toxicity with a serum level of 1.6 mEq/L. Which assessment findings are most likely?

Coarse hand tremor, coordination problems, and dizziness The symptoms of mild toxicity are often related to central nervous system disturbance. Difficulty concentrating might also be noted. Mild GI disturbances are also seen.

A patient has taken lithium (Lithobid) 300 mg three times daily for 1 week. The patient reports the presence of fine hand tremors and thirst. Select the nurse's best action.

Comfort the patient that these effects will probably decrease over time. These side effects are common and often decrease or disappear over time with continued lithium therapy. Dietary sodium should remain unchanged to keep the lithium level stable.

A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The nurse observes that the patient's eyes are rolled upward in a fixed gaze. The nurse should assess this finding as: a. akathisia. b. nystagmus. c. tardive dyskinesia. d. an oculogyric crisis.

D. An oculogyric crisis Oculogyric crisis is a specific dystonia in which the eyes roll upward and remain in a fixed position. It results from involuntary muscle spasms and occurs early in the course of treatment. Akathisia refers to motor restlessness. Nystagmus refers to a different type of abnormal eye movements. Tardive dyskinesia refers to abnormal movements primarily of the face and mouth muscles.

After an unsuccessful trial with fluphenazine, a patient's medication was changed to trifluoperazine. Three months later the patient is still hallucinating and delusional. What is the most likely explanation for the persistent symptoms?

D. Both fluphenazine and trifluoperazine are traditional antipsychotics, and the patient does not respond well to this class of drug. When a trial of a drug produces little change in symptoms and a new drug is to be prescribed, the best plan is to use a drug of another class, because the response to a drug of the first class will usually be poor. The other options are misleading.

A newly admitted patient is mute, immobile, and holds a fixed body position for long periods. The nurse caring for this patient should: a. assign unlicensed assistance personnel to feed the patient. b. provide a stimulating, active environment. c. encourage independent social behaviors. d. forewarn the patient before touching.

D. Forewarn the patient before touching Nurses should explain the need for and purpose of touch to patients before actually touching. This is particularly true for patients who are at highest risk for misinterpreting touch: those who are inattentive to reality or those who are suspicious. The environment should be calm and predictable. A patient who is mute and motionless is incapable of independent social behaviors. The patient's oral intake should be monitored, but the correct response also applies to feeding, if it is necessary.

Genetic evidence regarding twins and the risk for schizophrenia supports which fact? a. Identical and fraternal twins are equal in concordancy for schizophrenia. b. Monozygotic twins have a lower concordancy rate for schizophrenia than the general population. c. Fraternal twins have a higher concordancy rate for schizophrenia than monozygotic twins. d. Monozygotic twins are significantly more likely than the general population to be concordant for schizophrenia.

D. Monozygotic twins are significantly more likely than the general population to be concordant for schizophrenia Concordancy rates are 50% for monozygotic twins. This rate is 50 times higher than for the general population. The other options are not accurate representations of research data.

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm" and is observed to be diaphoretic. The nurse should further assess for what complication? a. Acute dystonia b. Tardive dyskinesia c. Drug-induced parkinsonism d. Neuroleptic malignant syndrome (NMS)

D. Neuroleptic malignant syndrome (NMS) NMS is a relatively rare but serious reaction to antipsychotic therapy. It is characterized by muscle rigidity, fever, sweating, autonomic instability, altered levels of consciousness, and possible death. The data given in the scenario are not consistent with other options.

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, concerns for safety and physiologic stability require that the patient be carefully monitored for what antiadrenergic effect? (Select all that apply.) a. Tardive dyskinesia b. Dystonia c. Drug-induced parkinsonian movements d. Orthostatic hypotension e. Reflex tachycardia.

D. Orthostatic hypotension E. Reflex tachycardia Hypotension is the major antiadrenergic effect of antipsychotic drugs. It is related to the blocking of alpha1-receptors on peripheral blood vessels, preventing the vessels from constricting automatically to positional changes. Hypotension is frequently noted following intramuscular administration and is of concern because it relates to patient safety and injury from falls. Hypotension also causes a reflex tachycardia that can cause general cardiovascular inefficiency, and jeopardize the patient's physiologic stability. Drug-induced parkinsonian movements, dystonia, and tardive dyskinesia develop over time are not antiadrenergic in mature.

A patient tells the nurse, "Air Force jets flying overhead are looking for me. They want to capture me." The patient has not previously verbalized this information. The nurse's initial interventions should: a. set firm limits on disruptive behaviors. b. forcefully refute all perceptual distortions. c. encourage complete description of delusions. d. voice doubt about delusions without arguing.

D. Voice doubt about delusions with out arguing A nurse cannot agree with a delusion, but arguing is counterproductive, because it might cause the patient to cling to the idea. Voicing doubt and stating one's own perception of reality is therapeutic. Encouraging discussion of the delusion reinforces it. Because the behavior described is not disruptive, this principle is not relevant.

A patient who has taken lithium for 6 months reports, "I go to the bathroom many times a day and pass large amounts of very pale urine." The nurse's action should be based on the understanding that these symptoms may indicate which problem?

Diabetes insipidus Symptoms of diabetes insipidus include voiding large amounts of dilute urine many times a day. Nephrogenic diabetes insipidus is caused by the inhibition of the cyclic adenosine monophosphate (cAMP)-dependent action of the antidiuretic hormone on the distal-tubule collecting duct cells.

A patient with a long history of multiple sclerosis developed psychosis with acute mania. The nurse should anticipate that the health care provider will probably prescribe which medication to help stabilize the mania?

Divalproex (Depakote) The valproates are first-line drugs for treatment of manic episodes associated with bipolar disorder or resulting from general medical problems. They have a rapid onset and are well tolerated.

Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of: sodium.

It is believed that lithium substitutes for the sodium (Na) ion in neurons. Reductions or increases in Na intake affect the serum lithium level.

A nurse prepares to lead a psychoeducational group for patients who take anticonvulsants to manage bipolar disorder. The nurse should invite patients who take which drugs? Select all that apply.

Lamotrigine (Lamictal) Gabapentin (Neurontin) Carbamazepine (Tegretol) Lamotrigine, carbamazepine, and gabapentin are anticonvulsants

A patient who is to be discharged on a maintenance dose of lithium should be taught to report which symptoms/signs immediately?

Large amounts of dilute urine and blurred vision Patients must be taught the difference between symptoms of minor toxicity and those of major toxicity, such as giddiness, tinnitus, blurred vision, dilute urine, and ataxia.

Select the accurate information about the pharmacokinetics of lithium. Excreted by the kidneys

Lithium is excreted via the kidneys. The other options are incorrect. The nursing implication is that individuals with renal damage should not be given lithium or should be monitored closely if lithium must be administered.

Of the drugs given to treat AD, which one has a potential to slow neurodegeneration?

Memantine (Namenda)

When patients are treated with antipsychotic medications, a variety of side effects and adverse reactions may occur. Sequence the following list in order of intervention priority, beginning with the most urgent: a. Akathisia b. Dystonic reaction c. NMS d. Tardive dyskinesia

NMS is considered a medical emergency requiring immediate intervention to save the patient's life. A dystonic reaction is extremely uncomfortable and requires swift intervention to restore patient comfort. Akathisia is uncomfortable but is not considered an emergency. Tardive dyskinesia is a serious, possibly unremitting problem that might require discontinuing the medication. It develops over weeks, months, or years.

For 2 weeks a patient has taken lithium (Lithane) and risperidone (Risperdal) daily for mania. The patient now reports diarrhea, vomiting, and blurred vision. The nurse observes a coarse hand tremor. Select the nurse's priority action. Notify the prescribing physician immediately.

Notify the prescribing physician immediately. The symptoms the patient is experiencing are consistent with a serum lithium level above the therapeutic level. The nurse should withhold the next dose, arrange for a stat serum lithium level determination, and notify the health care provider.

A patient diagnosed with mania begins lithium therapy on October 1. What is the earliest date a nurse can expect to see clinical improvement in the patient's condition?

October 8 Lithium must be given for 7 to 10 days before clinical improvement is achieved.

Which assessment findings validate that a patient with bipolar disorder is experiencing mania? Select all that apply.

Pacing Agitation Delusional thoughts Agitation, increased motor activity (pacing), and delusional thoughts may all accompany mania.

A patient takes donepezil (Aricept) for AD. Vital signs for this patient are: temperature 98.2°F; blood pressure 135/82 mm Hg; pulse 54 beats/min; respirations 18 breaths/min. Which variance should the nurse consider most likely attributable to donepezil therapy?

Pulse rate

The spouse of a patient diagnosed with bipolar disorder tells the nurse, "Every time my partner recovers from a manic episode, depression follows soon. It's very discouraging." The nurse's reply should include what information?

Recent addition of olanzapine (Zyprexa) to this patient's drug regime can be helpful as a mood stabilizer. Olanzapine, an atypical antipsychotic, has proven effective in controlling mania and acting as a mood stabilizer to reduce depression following treatment for acute mania.

Before beginning lithium therapy, the nurse should educate a patient about laboratory tests to assess for adequate function of which system?

Renal Because lithium is excreted via the kidneys, renal system function must be adequate if lithium toxicity is to be prevented.

A patient diagnosed with bipolar disorder asks the nurse, "Why can't I take my lithium just once a day at bedtime? It's hard to remember to take it three times." The nurse's reply should be based on what information?

The half-life of lithium is short. Lithium has a short half-life, high toxicity, and rapid renal excretion, so multiple daily doses are required.

A 63-year-old woman says, "I want to take estrogen to prevent AD, but my doctor won't prescribe it." Select the nurse's most informative response.

There is conflicting evidence about whether estrogen prevents Alzheimer's disease, but research clearly shows cardiovascular problems with estrogen therapy."

The nurse scheduling the serum lithium level blood draw for a patient should arrange for it to be obtained:

before the first morning dose. Lithium levels should be drawn 8 to 12 hours after the last dose, making premedication morning blood draws optimal.

Most drugs used to treat AD affect:

cholinergic pathways, enzymes, and receptors.

A patient with rapid-cycling bipolar disorder is not responding to lithium therapy. At the next multidisciplinary team meeting, the nurse should point out that many rapid-cycling patients have been effectively treated using:

divalproex (Depakote). Valproates (like divalproex) are considered first-line agents in the treatment of mania. Valproates are especially effective in the treatment of rapid-cycling bipolar disorders.

Which patient would require careful assessment for toxic effects of lithium? The individual taking lithium and:

hydrochlorothiazide (HCTZ). Hydrochlorothiazide is a diuretic used to treat hypertension. The diuretic effect would increase serum concentrations of lithium, potentially producing toxicity.

Which patient should be assessed most carefully for evidence of lithium toxicity? A patient taking lithium (Lithobid) and:

indomethacin (Indocin). The combination of lithium and indomethacin is more likely to produce lithium toxicity than lithium and any other drug listed. Nonsteroidal antiinflammatory drugs reduce renal elimination of lithium, thereby increasing serum lithium levels.

A patient diagnosed with AD is being treated with a ChE inhibitor drug. The patient develops facial flushing, sweating, and leg cramps. The nurse should attribute these symptoms to:

inhibition of butyrylcholinesterase(BChE).

For patients with bipolar disorder, valproate anticonvulsants are likely to help control rapid-cycling episodes by:

inhibition of kindling activity in the brain. The effectiveness of valproate anticonvulsants for management of bipolar disorder may be related to inhibition of kindling activity, which stabilizes neuronal activity and increases the threshold of stimulation necessary for cell firing.

Which statement by a family member of a patient diagnosed with AD demonstrates that medication education was effective? "The medication my parent is receiving:

inhibits breakdown of an important neurotransmitter and may slow disease progression."

Teaching for a patient who is to be discharged on a maintenance dose of lithium should emphasize the importance of:

keeping appointments for serum lithium level testing. Regular evaluation of serum lithium levels will be part of the patient's aftercare for as long as he or she takes lithium.

Select the most realistic short-term goal for the care of a patient with mild AD who takes donepezil (Aricept). The patient will:

maintain present cognitive ability