H&I N430 Exam 3

What is normal ICP in infants?

1.5-6 mmHg

What is normal ICP in adults?

5-15 mmHg

A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse? A. "I get upset once in a while, too." B. "I know just how you feel. I'd feel the same way in your situation." C. "I worry, too, when I think people are talking about me." D. "At times, it's normal not to trust anyone."

A. "I get upset once in a while, too." Sharing a benign, non-threatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Identify with the client symptoms he experiences when he or she begins to feel anxious around others. Increased anxiety can intensify agitation, aggressiveness, and suspiciousness. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices.

A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate? A. "Your behavior won't be tolerated. Go to your room immediately." B. "You're just doing this to get back at me for making you come to therapy." C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." D. "I'm disappointed in you. You can't control yourself even for a few minutes."

A. "Your behavior won't be tolerated. Go to your room immediately." The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended. Maintain a consistent approach, employ consistent expectations, and provide a structured environment. Clear and consistent limits and expectations minimize the potential for client's manipulation of staff.

Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions? A. Antipsychotic-induced akathisia and anxiety. B. The manic phase of bipolar illness as a mood stabilizer. C. Delusions for clients suffering from schizophrenia. D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior.

A. Antipsychotic-induced akathisia and anxiety. Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic-induced akathisia and anxiety. Off-label use of propranolol includes the use in performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system.

Ramsay is diagnosed with schizophrenia paranoid type and is admitted to the psychiatric unit of Nurseslabs Medical Center. Which of the following nursing interventions would be most appropriate? A. Establishing a non-demanding relationship. B. Encouraging involvement in group activities. C. Spending more time with Ramsay. D. Waiting until Ramsay initiates interaction.

A. Establishing a non-demanding relationship. Rationale: A non-threatening, non-demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Use a non-judgemental, respectful, and neutral approach with the client. There is less chance for a suspicious client to misinterpret intent or meaning if content is neutral and approach is respectful and non-judgemental.

A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? A. Ineffective protection related to blood dyscrasias B. Urinary frequency related to adverse effects of antipsychotic medication C. Risk for injury related to a severely decreased level of consciousness D. Risk for injury related to electrolyte disturbances

A. Ineffective protection related to blood dyscrasias Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Leukopenia, thrombocytopenia, and blood dyscrasia are rare side effects of treatment with FGAs.

A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms? A. benztropine (Cogentin) B. dantrolene (Dantrium) C. clonazepam (Klonopin) D. diazepam (Valium)

A. benztropine (Cogentin) Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson's disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.

Which of the following syndromes is not a true SCI? A. Central Cord Syndrome B. Brown-Sequard Syndrome C. Conus Medullaris Syndrome D. Cauda Equina Syndrome E. Anterior Cord Syndrome

Answer: D. Cauda Equina Syndrome

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A. The absence of anticholinergic effects. B. A lower incidence of extrapyramidal effects. C. Photosensitivity and sedation. D. No incidence of neuroleptic malignant syndrome.

B. A lower incidence of extrapyramidal effects. Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. SGAs have loose binding to D2 receptors and can quickly dissociate from the receptor, potentially accounting for the lower likelihood of causing extrapyramidal symptoms (EPS). Moreover, SGAs have agonism at the 5HT1A receptor. Serotonin and norepinephrine reuptake inhibition are potential mechanisms by which risperidone is postulated to produce antidepressant effects. The improvement of positive symptoms is thought to be accomplished through the blockade of D2 receptors specifically in the mesolimbic pathway.

A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response? A. Say, "You know it's your medicine." B. Allow him to open the individual wrappers of the medication. C. Say, "Don't worry about what is in the pills. It's what is ordered." D. Ignore the comment because it's probably a joke.

B. Allow him to open the individual wrappers of the medication. This is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Talk openly with the client about their beliefs and thoughts, showing empathy and support. Help build trust and rapport with clients. Paranoid clients may be more reluctant to trust anyone, but open communication generally offers more cooperation. Explain all procedures clearly and carefully, and their purpose, before starting them. Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps develop trust.

The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate? A. Helping the client to participate in social interactions. B. Establishing a one-on-one relationship with the client. C. Establishing alternative forms of communication. D. Allowing the client to decide when he wants to participate in verbal communication with the nurse.

B. Establishing a one-on-one relationship with the client. By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. Assess if incoherence in speech is chronic or if it is more sudden, as in an exacerbation of symptoms. Establishing a baseline facilitates the establishment of realistic goals, the foundation for planning effective care.

The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine, and benztropine. Why is benztropine administered? A. To reduce psychotic symptoms. B. To reduce extrapyramidal symptoms. C. To control nausea and vomiting. D. To relieve anxiety.

B. To reduce extrapyramidal symptoms Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Consequently, it reduces central cholinergic effects by blocking muscarinic receptors that appear to improve the symptoms of Parkinson's disease. Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson's disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: A. Deeper sleep than CNS depressants. B. Greater sedation than CNS depressants. C. A calming effect from which the client is easily aroused. D. More prolonged sedative effects, making the client more difficult to arouse.

C. A calming effect from which the client is easily aroused. Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination. The precise mechanism of action exhibited by phenothiazines is not entirely known. Yet, phenothiazines act primarily through inhibiting the dopamine receptor at the mesolimbic pathway with a selective activity at the D2 receptor. This inhibition antagonizes the hyperactivity of dopamine at the synapse and reduces positive symptoms such as delusions and hallucinations associated with schizophrenia.

The etiology of schizophrenia is best described by: A. Genetics due to a faulty dopamine receptor. B. Environmental factors and poor parenting. C. Structural and neurobiological factors. D. A combination of biological, psychological, and environmental factors.

D. A combination of biological, psychological, and environmental factors. A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia.

Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the shower-head. They'll kill me if I take a shower." Which nursing action is most appropriate? A. Dismantling the shower-head and showing the client that there is nothing in it. B. Explaining that other clients are complaining about the client's body odor. C. Asking a security officer to assist in giving the client a shower. D. Accepting these fears and allowing the client to take a sponge bath.

D. Accepting these fears and allowing the client to take a sponge bath. By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies. Recognize the client's delusions as the client's perception of the environment. Recognizing the client's perception can help you understand the feelings he or she is experiencing.

Which factor is associated with increased risk for schizophrenia? A. Alcoholism B. Adolescent pregnancy C. Overcrowded schools D. Poverty

D. Poverty Low socioeconomic status or poverty is an identified environmental factor associated with an increased incidence of schizophrenia. A criticism of this research field, which is in fact a criticism relevant to much social science research, is that the investigation of socio-environmental factors in the environment invariably focuses on poverty and deprivation to the exclusion of other important variables. One such variable is income inequality. Income inequality is a measure of the 'rich-poor gap' in any given society and therefore it exists at the ecological level.

Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? A. Hypertension B. Respiratory arrest C. Tourette syndrome D. Retinal pigmentation

D. Retinal pigmentation Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The development of pigmentary retinopathy is a unique adverse manifestation associated with thioridazine, and not with other antipsychotics. Patients may have nonspecific symptoms while taking thioridazine, such as dry mouth, dry eyes, sedation, weight gain, dizziness, erectile dysfunction, pruritus, photosensitivity, and constipation. Other rare and more unique side effects of thioridazine include irreversible retinal pigmentation, poikilothermia, and agranulocytosis.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated? A. Several minutes B. Several hours C. Several days D. Several weeks

D. Several weeks Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear. It can take a few days for chlorpromazine to take effect. It's difficult to determine how long one can expect to wait, as the medication affects each person differently. Ideally, the client should stay on an antipsychotic medication for four to six weeks before deciding whether to continue taking it in the long term. This gives the medication a chance to build up in the system and to begin delivering its full effects.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development? A. Autonomy versus shame and doubt B. Generativity versus stagnation C. Integrity versus despair D. Trust versus mistrust

D. Trust versus mistrust This client's paranoid ideation indicates difficulty trusting others. Erikson believed that early patterns of trust help children build a strong base of trust that's crucial for their social and emotional development. If a child successfully develops trust, they will feel safe and secure in the world. You're essentially shaping their personality and determining how they will view the world.

How do we calculate cerebral perfusion pressure?

MAP - ICP

What is normal ICP in children?

3-7 mmHg Once a child hits 15 mmHg then we worry about ICR problems.

What is normal cerebral perfusion pressure?

60-100

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply. A. Analyzing family issues and past problems B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment E. Treating family members affected by the illness F. Participating in in-depth psychoanalytical counseling

B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client's development of skills in the here and now; consequently, psychoanalytic counseling is not part of the approach.

A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects? A. guanethidine (Ismelin) B. droperidol (Inapsine) C. lithium carbonate (Lithonate) D. Alcohol

B. droperidol (Inapsine) When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. Despite being a low-potency drug, chlorpromazine can still cause extrapyramidal side effects (EPS) such as acute dystonia, akathisia, parkinsonism, and tardive dyskinesia (TD). The evolution of EPS side effects can occur through hours to days. Acute dystonia refers to muscle stiffness or spasm of the head, neck, and eye muscles that can start hours after starting the medication. Akathisia includes restlessness and fast pacing. Parkinsonism includes bradykinesia, "cogwheel" rigidity, and shuffling gait.

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A. Take the medication 1 hour before a meal. B. Decrease the dosage if signs of illness decrease. C. Apply sunscreen before being exposed to the sun. D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

C. Apply sunscreen before being exposed to the sun. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, "V" area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas. Two major mechanisms mediating drug induced photosensitivity reactions are phototoxic and photoallergic responses.

All of the following are part of the Monroe-Kellie Doctrine except? A. Blood B. CSF C. Lymph D. Brain

C. Lymph Rationale: Brain, Blood, and CSF are all part of the MKD.

The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite? A. Conclusive evidence indicates a specific gene transmits the disorder. B. Incidence of this disorder is variable in all families. C. There is a little evidence that genes play a role in transmission. D. Genetic factors can increase the vulnerability for this disorder.

D. Genetic factors can increase the vulnerability for this disorder. Rationale: Research shows that family history statistically increases the risk for the development of schizophrenia. Genetics also play a fundamental role - there is a 46% concordance rate in monozygotic twins and a 40% risk of developing schizophrenia if both parents are affected. The gene neuregulin (NGR1) which is involved in glutamate signaling and brain development has been implicated, alongside dysbindin (DTNBP1) which helps glutamate release, and catecholamine O-methyltransferase (COMT) polymorphism, which regulates dopamine function.

Upon Sam's admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in the room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time? A. Anxiety B. Decisional conflict C. Self-care deficit D. Social isolation

D. Social isolation These behaviors indicate the client's withdrawal from others and possible fear or mistrust of relationships. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices. If a client is unable to respond verbally or in a coherent manner, spend a frequent, short period with clients. An interested presence can provide a sense of being worthwhile.

A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Tardive dyskinesia (TD) is a syndrome which includes a group of iatrogenic movement disorders caused due to a blockade of dopamine receptors. The movement disorders include akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics and other abnormal involuntary movements which are commonly caused by the long-term use of typical antipsychotics.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? A. chlorpromazine (Thorazine) B. imipramine (Tofranil) C. lithium carbonate (Lithane) D. fluphenazine decanoate (Prolixin Decanoate)

D. fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Fluphenazine is a typical antipsychotic used for symptomatic management of psychosis in patients with schizophrenia. There is a long-acting fluphenazine decanoate formulation that is used primarily as maintenance therapy for chronic schizophrenia and related psychotic disorders in patients who do not tolerate oral formulations or in patients where medication compliance is of concern.

what processes are affected by injury to the prefrontal cortex?

control over more cognitive functions (judgement, reasoning, and our concern for others)

What processes are affected by injury to wernicke's area?

language development and comprehension of speech

What processes are affected by injury to the temporal lobe?

memory and interpretation of auditory stimuli

What processes are affected by injury to the parietal lobe?

sensory function; ability to discriminate between hot/cold, sharp/soft, 2-point discrimination (shapes)

What processes are affected by injury to Broca's area?

speech production

What processes are affected by injury to the Frontal lobe?

speech, thought, learning, emotion, and voluntary movement

What processes are affected by injury to the occipital lobe?

vision