NR473 Exam 2 Textbook Questions

Lithium serum monitoring for (1.) initial treatment (2) maintenance (3.) __ long after last dose

1. 1-2x /week 2. monthly 3. 12 hours

Which medication binds to the ANK3 (ankyrin G) protein to prevent manic episodes of bipolar disorder? 1. Verapamil 2. Aripiprazole 3. Carbamazepine 4. Lithium carbonate

Correct: 4

A client is scheduled for individual psychotherapy. What would be the nursing intervention during the first phase of individual psychotherapy? 1. Terminating the therapeutic alliance 2. Assisting in establishing new relationships 3. Helping the client resolve complicated grief reactions 4. Encouraging the client to continue participating in regular activities

Correct: 4 4. During phase I psychotherapy, the client is encouraged to continue working and participating in regular activities.

Which is a side effect of tricyclic antidepressants? 1. Weight loss 2. Abnormal ejaculation 3. Sleep disturbances 4. Urinary retention

Correct: 4 Not: 1, 2, or 3 1. Weight loss usually occurs as a side effect of selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs). 2. Abnormal ejaculation usually occurs as a side effect of SSRIs and SNRIs. 3. Sleep disturbances usually occur as a side effect of SSRIs and SNRIs.

What should the nurse do before administering lithium carbonate to a client for the first time? 1. Check for a history of seizures. 2. Check for a history of diabetes mellitus. 3. Check for a history of glaucoma. 4. Check for a history of prostatic hypertrophy.

Correct: 1 1. The client who has a history of seizures should be cautious while taking lithium carbonate because it may aggravate the condition of seizures.

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply a. Communicate expected behaviors to the client b. Ensure that the client knows that they are not in charge of the nursing unit. c. Assist the client in identifying ways of setting limits on personal behaviors. d. Follow through about the consequences of behavior in a non-punitive manner. e. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups. f. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

A, C, D, F a. Communicate expected behaviors to the client c. Assist the client in identifying ways of setting limits on personal behaviors. d. Follow through about the consequences of behavior in a non-punitive manner. f. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

The nurse is reviewing the medical reports of four clients. Which client does the nurse expect to have complications associated with the medication prescribed? a. 25-year-old schizophrenic client with a health history of migraines, prescribed valproic acid, b. 13-year-old bipolar patient with a history of epilepsy, prescribed lamotrigine c. 30-year-old patient with panic disorder and history of restless leg syndrome, prescribed clonazepam d. 38-year-old bipolar patient with a history of glaucoma, prescribed olanzapine

Correct: B b. Lamotrigine is used to treat epilepsy and it may also be beneficial for clients with bipolar disorder. However, it is contraindicated in clients below 16 years of age.

When teaching the client about bipolar disorder, the nurse knows that which is true? 1. Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population ages 18 and older in a given year. 2. 30% percent of the cases of bipolar disorder are considered severe. 3. The average age of onset for bipolar disorder is 35 years of age, and following the first manic episode, the disorder tends to be recurrent. 4. Bipolar disorder is the ninth leading cause of disability in the middle age group.

Correct: 1 - 82.9 percent of these cases are considered severe (National Institute of Mental Health) - The average age of onset for bipolar disorder is 25 years of age, and following the first manic episode, the disorder tends to be recurrent - Bipolar disorder is the sixth leading cause of disability in the middle age group

The nurse is caring for a client diagnosed with bipolar disorder. On interaction with the client, the nurse suspects that the client is in the delirious mania stage. Which statement of the client supports the nurse's conclusion? Select all that apply. 1. "Go away! Leave me alone." 2. "I don't want to go into that bathroom because somebody is in there and is planning to kill me." 3. "I will kill you if you try to come near me." 4. "I am worthless and I feel like dying." 5. "I saw a demon standing in front me."

Correct: 1, 2, 5 1. The client's statement indicates that the client is having auditory hallucinations. Delirious mania is characterized by auditory or visual hallucinations. 2. The client who is in the delirious mania stage experiences delusions of persecution. The client refuses to go into the bathroom because the client feels threatened. 5. Visual hallucinations are evident in a client who is in a delirious mania stage. The client's statement of seeing a demon standing in front of him or her indicates hallucinations. NOT: 3. A risk of violence or suicidal ideations are uncommon in clients with delirious mania. 4. The feelings of low self-esteem are uncommon in clients with delirious mania.

While educating a client diagnosed with bipolar disorder, the nurse teaches the client to avoid excessive exposure to very high or low temperatures. Which category of medications might be present on the medication list of the client? 1. Antimanic 2. Antipsychotic 3. Anticonvulsant 4. Calcium channel blocker

Correct: 2 2. Antipsychotics may increase skin sensitivity toward extreme temperatures. Therefore, the nurse teaches the client to avoid excessive exposure to very high or low temperatures.

The primary health-care provider prescribes olazanpine to a client who is experiencing acute mania. Which condition in the health history of the client indicates the risk for complications? 1. Goiter 2. Diabetes mellitus 3. Prostatic hypotrophy 4. Left ventricular dysfunction

Correct: 2 2. Olazanpine is an antipsychotic medication administered to treat acute manic episodes. It causes hyperglycemia as a side effect. Therefore, the nurse should check for the presence of diabetes in the client's medical history.

Which medication would be beneficial to a client with autism? 1. Quetiapine 2. Risperidone 3. Ziprasidone 4. Aripiprazole

Correct: 2 2. Risperidone is an antipsychotic that blocks the receptors for dopamine and serotonin and thereby reduces the behavioral problems associated with autism.

Which type of depression involves mood variation that is worse in the morning and gets better as the day progresses? 1. Mild depression 2. Severe depression 3. Moderate depression 4. Transient depression

Correct: 2 2. Severe depression includes physiological changes resulting in mood variation that is worse in the morning and gets better as the day progresses. This mood variation is caused by diurnal variations in the neurotransmitter levels. Not: 3 3. Moderate depression also includes mood variation. However, the client feels better in the morning, and the depression gets worse as the day progresses.

Which medication indicated for attention-deficit/hyperactivity disorder (ADHD) induces mania? 1. Pethidine 2. Bupropion 3. Methamphetamine 4. Methylprednisolone

Correct: 2 Not 3: "Amphetamines such as methamphetamine induce mania, but are not used in the treatment of ADHD."

Which neurotransmitter level in the mesolimbic system of the brain is thought to exert a strong influence over human mood and behavior? 1. Serotonin 2. Dopamine 3. Acetylcholine 4. Norepinephrine

Correct: 2 Not: 1, 3, or 4 1. Serotonin-containing neurons are mainly involved in psychobiological functions. 3. Cholinergic agents such as acetylcholine have a strong effect on electroencephalograms, the neuroendocrine function, and mood. 4. Norepinephrine is known to be a key component in the mobilization of the body to deal with stressful situations.

While caring for the client with extreme hyperactivity associated with mania, the nurse engages the client in physical activities. Which outcome does the nurse expect from this intervention? 1. The client is aware of facility security. 2. The client does physical activities that refresh them. 3. The client minimizes suspiciousness and agitation. 4. The client experiences rapid relief from agitation and hyperactivity.

Correct: 2 2. The client releases pent-up tension by doing physical activities, which are refreshing and rejuvenating. Not 4: "The client experiences rapid relief from agitation and hyperactivity when he or she takes tranquilizing medication."

Which category of drugs has the potential for initiating a manic episode? Select all that apply. 1. Diuretics 2. Sulfonamides 3. Antiulcer agents 4. Antihypertensive agents 5. Nonsteroidal anti-inflammatory drugs

Correct: 2, 3, & 4 2 Sulfonamides are drugs that have the potential for initiating a manic episode due to their effect on the central nervous system. 3 Antiulcer agents are drugs that have the potential for initiating a manic episode due to their effect on the central nervous system. 4 Antihypertensive agents are drugs that have the potential for initiating a manic episode due to their effect on the central nervous system.

A client with mania reports an inability to sleep. What appropriate actions does the nurse take to help the client sleep better? Select all that apply. 1. Provide a low-protein diet. 2. Administer sedative agents as prescribed. 3. Provide a warm bath before sleep. 4. Provide tea or coffee before sleep. 5. Help to perform relaxation exercises before sleep.

Correct: 2, 3, & 5 2. The client with mania suffers from sleep deprivation due to hyperactivity. Administering sedative agents helps the client achieve sleep until a normal sleep pattern is restored. 3. Providing a warm bath to the client before sleep promotes good sleep. 5. The manic client must be provided frequent periods of rest to prevent sleep deprivation. Helping the client perform relaxation exercises before sleep contributes to a more calming environment conducive to sleep.

After assessing a child, the nurse suspects the child has cyclothymic disorder. Which statement of the child's mother supports the nurse's assumption? 1. "My child has a fear of strangers and always locks the door. She never shows interest in mingling with someone new." 2. "My child performs hand washing 20 times a day. She is excessively concerned with cleanliness." 3. "My child has had periods of elevated moods from the age of 5 years. These episodes are more frequent since she turned 8 years old." 4. "My child hoards empty food containers. She always insists on taking them with her wherever she goes."

Correct: 3 3. Cyclothymic disorder is a chronic mood disturbance of at least 2 years' duration. This involves numerous periods of elevated moods. Therefore, the nurse suspects the child has cyclothymic disorder.

The nurse is caring for a client who is a musician and goes into a state of depression after the death of his or her spouse. The nurse tells the client, "It is normal to feel sadness after losing a spouse. It will help if you will refocus on something you love, such as your music." What statement made by the client after a few days indicates effective nursing intervention? 1. "Music was my passion until caring for my spouse started taking up all my time." 2. "I need more time to refocus on music." 3. "I will now be able to record good music for my upcoming album." 4. "God has not helped me to understand the meaning of life."

Correct: 3 3. Nursing intervention to raise the client's hopes about the future is effective.

Which statement of the client with bipolar mania indicates personalizing thought? 1. "Everything I do is great." 2. "My teacher thinks I'm wonderful." 3. "My sister is this happy only when she's with me." 4. "None of those mistakes are really important."

Correct: 3 3. The client relates the happiness of his or her sister to the client's own behavior, though they are not related.

A client diagnosed with bipolar I disorder is on divalproex therapy. During the follow-up visit, the nurse finds elevated mood swings in the client. Which intervention of the primary health-care provider is beneficial in this situation? 1. Reducing the dose of divalproex 2. Switching the client to buproprion therapy 3. Switching the client to olanzapine therapy 4. Changing the route of administration of divalproex

Correct: 3 3. The presence of elevated mood swings in the client indicates that the client is unresponsive to divalproex monotherapy. Switching the client to an alternate monotherapeutic agent is effective in this situation. Therefore, the client should be switched to olanzapine therapy. Divalproex = Sodium valproate = Depakote

Which electrolyte imbalance may be present in a client with depression? 1. Increased levels of sodium 2. Decreased levels of calcium 3. Increased levels of potassium 4. Increased levels of magnesium

Correct: 3 Increased or decreased levels -> depressive symptoms

Which interventions should the nurse implement while caring for a client with mania who is on lithium carbonate therapy? Select all that apply. 1. Monitor serum lithium levels once a week during maintenance therapy. 2. Monitor serum lithium levels once a month after initial treatment. 3. Draw blood samples 12hours after the last dose. 4. Notify the primary health-care provider if the serum lithium level reaches 1.5 mEq/L. 5. Inform the primary health-care provider immediately if the serum lithium levels are 1.2 mEq/L.

Correct: 3, 4 3. The nurse should draw blood samples 12hours after the last dose to monitor the serum lithium levels in the blood serum. 4. The nurse should inform the primary health-care provider if the serum lithium levels reach 1.5 mEq/L because this indicates lithium toxicity. Not: 1, 2, or 5 1. The nurse should monitor the serum lithium levels once a month during the maintenance therapy. 2. The nurse should monitor the serum lithium levels once or twice a week after the initial treatment.

A client with mania has shown progressive improvement with lithium therapy. After successful treatment, the client is discharged. What suggestions should the nurse give to the client? Select all that apply. 1. "Avoid salt in your diet." 2. "Stop taking the medication if there is an excessive weight gain." 3. "Notify the primary health-care provider if pregnancy is planned or suspected." 4. "Contact the primary health-care provider if you have excessive vomiting." 5. "Rise slowly from a sitting or lying position."

Correct: 3, 4 3. The client is advised to notify the primary health-care provider if pregnancy is planned or suspected because lithium causes harm to the fetus. 4. Lithium may cause diarrhea or vomiting, which can increase the risk of lithium toxicity. So, the client should be advised to consult the primary health-care provider. NOT: 1, 2, or 5 - Lithium doesn't cause orthostasis

Which side effect in the client who is on lithium carbonate therapy prompts the primary health-care provider to decrease the dose of the medication? Select all that apply. 1. Drowsiness 2. Weight gain 3. Arrhythmia 4. Fine hand tremors 5. Nausea and vomiting

Correct: 3, 4 3. The nurse should monitor vital signs two or three times a day to monitor the development of arrhythmias - fixed by lowering the dose 4. Fine hand tremors may occur as a side effect of lithium carbonate therapy - fixed with lower doses NOT: 1, 2, or 5 1. Lithium carbonate has a side effect of drowsiness. The primary health-care provider does not decrease the dose of lithium. Instead, the primary health-care provider advises the client to take the medication at bedtime. 2. The primary health-care provider advises the client to consume a low-calorie diet to overcome the problem of weight gain. The primary health-care provider does not decrease the dose of lithium due to weight gain. 5. Nausea and vomiting can be reduced when the medication is taken with food. Therefore, the primary health-care provider does not decrease the dose of the medication due to this side effect.

A client who is treated for acne develops secondary depression. Which medication would the nurse suspect to be the cause of depression in this client? 1. Cimetidine 2. Vincristine 3. Alprazolam 4. Isotretinoin

Correct: 4

What is the daily dose range of lithium carbonate? 1. 100 to 800 mg 2. 200 to 1600 mg 3. 600 to 2400 mg 4. 1800 to 2400 mg

Correct: 4

A client is diagnosed with anaclitic depression. What could be the cause of such a condition? 1. Depression due to loss of interest in sexual activity 2. Depression due to loss of interest in usual activities 3. Depression due to loss of a significant person because of death 4. Separation from the mother for a long period during the first year of life

Correct: 4 4. Anaclitic depression is a childhood disorder that occurs when the child is separated from the mother for a long period during the first year of life.

1. A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen? It will a. Minimize the side effects of lithium b. Bring hyperactivity under rapid control c. Enhance the antimanic actions of lithium d. Be used for long-term control of hyperactivity

Correct: B