CH 11 PrepU

The nurse has been asked to explain electroconvulsive therapy to a client and his family. Which of the following statements made by the nurse would be correct?

"A tapering schedule may be used to end your treatments to try to prevent rehospitalization."

In the process of electroconvulsive therapy, what is electricity used to induce?

A seizure

A client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence?

Changing the client's medication route to intramuscular depot

A client begins taking 40 mg of fluoxetine daily. The next day the client calls complaining of restlessness. Which interventions should the nurse advocate for to the client's prescribing physician first?

Decrease the dosage of the medication.

Which is the most commonly seen adverse side effect of typical antipsychotics?

Extrapyramidal symptoms and tardive dyskinesia

The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?

White blood cell count

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

agranulocytosis

Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of:

cardiac or seizure disorders.

Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply.

dry mouth constipation urinary retention

The therapeutic level of lithium range includes what?

1 to 1.5 mEq/L

Vagus nerve stimulation has been used as a treatment for ...

Depression

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The nurse is teaching about effective administration of methylphenidate to the parents. What education given by the nurse is appropriate?

"Administer the drug early in the morning."

When a client who is considering electroconvulsive therapy (ECT) asks the nurse how this treatment will improve his depression, the most appropriate response is ...

"Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours."

A client with a diagnosis of depression has not seen her mood and affect improve with the use of antidepressants, and the worsening of her symptoms has prompted her physician to order ECT. Which of the nurse's following teaching points about the procedure is most accurate?

"Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective."

When a client's family member questions the likelihood of long-term memory loss for a client scheduled for electroconvulsive therapy (ECT), the psychiatric nurse replies ...

"He may not immediately remember some of the events surrounding the treatment but his memory will return in a matter of hours to just weeks."

You are working with a 56-year-old female who is a candidate for ECT. The client states, "I would think about doing this ECT, but I heard that I won't remember anything after I wake up, and that scares me very much." The most therapeutic nursing response to the client's statement is what?

"I understand your concern. You may experience some short-term memory loss right after the procedure, but it is not a long-term effect."

An adult client has been taking citalopram for 4 months and notices a change in mood that is "better than it's been for years." The client has told the nurse, "I'm going to stop taking it, because I just don't think I need medication anymore." What is the nurse's best response?

"It's excellent that you're feeling better, but that's not a good idea because the drug is likely responsible for your improvement in mood."

A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?

"Make sure that you don't drink any alcohol when you're taking this medication

A nurse is talking with a group of parents who have children diagnosed attention deficit-hyperactivity disorder (ADHD). The children are receiving psychostimulant therapy as part of the treatment plan. During the discussion, each of the child's parents reports side effects. Which statement about side effects would the nurse expect to hear?

"Our child just doesn't seem to have any appetite."

A client with depression has a history of discontinuing medications and relapsing, often using alcohol and other substances to self-medicate. A new nurse case manager is evaluating the treatment plan developed to enhance the client's ability to manage the medication regimen. The case manager determines that the plan has been effective when the client makes which statement?

"The medicine doesn't seem to be working. I called my therapist and made an appointment to discuss other medications. In the meantime, I'm still taking this medication."

After being presented with the potential benefits of ECT, a client has replied, "I've seen enough movies to know there's no way I'm going to have any shock therapy." Which response by the nurse would be most appropriate to address the client's concerns?

"The movies often exaggerate things. ECT has been shown to be safe and very effective."

A nurse is leading a medication education group for clients with depression. A client states he has read that herbal treatments are just as effective as prescription medications. The best response is ...

"We need to look at the research very closely to see how reliable the studies are."

A client who is taking lithium is scheduled to come to the community mental health center to have a blood level obtained. The client takes the last dose of lithium each day at 10 p.m. The nurse tells the client to hold the morning dose. At which time would the nurse tell the client to come to the center to have the specimen drawn?

10 am

The prescription of clozapine requires weekly blood samples for which time frame?

6 months

Which client is most likely to benefit from treatment with an antiparkinsonism agent?

A client who has a medication-induced movement disorder

An adult client has just been prescribed paroxetine by his primary care provider. When assessing the client prior to the beginning of drug therapy, the nurse should include what assessment?

An adult client has just been prescribed paroxetine by his primary care provider. When assessing the client prior to the beginning of drug therapy, the nurse should include what assessment?

Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)?

Atypical antipsychotics block both serotonin and dopaminergic receptors.

What is the difference between traditional and atypical antipsychotics?

Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade.

The psychiatric-mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply.

Contraindications Adverse reactions Indications for use Food and drug interactions

A client with a history of depression has been receiving outpatient treatment for several months but the client's partner has now brought the client to the emergency department. The partner states that the client had visual hallucinations earlier in the day. The client has an unstable gait and vomited on the way to the hospital. In addition to monitoring the client's vital signs, the care team should prioritize what action?

Discontinuing the client's SSRI

Which of the following is the most effective treatment available for refractory major depression?

Electroconvulsive therapy (ECT)

A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment?

Ensuring the client's blood levels reach a therapeutic and safe dose

Which would not be included as a target symptom for antidepressant medications?

Euthymic mood

When teaching a client about restrictions for tranylcypromine, the nurse will tell the client to avoid which food?

Fava beans

When discussing the effects of a newly prescribed psychotropic drug with the client, the nurse explains the process of clearance as

How much of the drug is excreted out of the body in a specific period of time.

Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?

Hypertensive crisis

A nurse is administering an MAOI to a client with depression. Which information would the nurse most likely include in the teaching plan? Select all that apply.

Hypertensive crisis if food with tyramines are ingested Interaction with other MAOI's and antidepressants Risk for decreased libido and impotence

A client is receiving risperidone as part of the treatment plan for schizophrenia. Assessment reveals breast enlargement and evidence of galactorrhea. The nurse interprets this effect as due to which occurrence?

Increased prolactin levels

A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?

Intramuscularly

Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug?

Its ability to block the reuptake of serotonin

Which of the following is a common complementary and alternative medicine (CAM) modality used in the treatment of depression?

Light therapy

A psychiatric-mental health nurse is assessing a patient with bipolar disorder who is prescribed lithium. The nurse is evaluating the patient for compliance with therapy. The nurse woud be especially alert for complaints of which effect as most likely contributing to noncompliance? Select all that apply.

Poor ability to concentrate Memory problems

The nurse is caring for a client who suffers from anxiety. The client informs the nurse that he has been taking the herb kava. What should the nurse be aware that kava is associated with?

Liver damage

What is electroconvulsive therapy the most effective treatment available for?

Major depression that has not responded to medication

A client comes to the clinic for an evaluation. During the interview, the client describes the frequent travel required by the job and feelings of being jet lagged all the time. The client asks, "Is there any supplement that I could use that might be helpful? Which suggestion would the nurse most likely include in the response?

Melatonin

A client is undergoing ECT. The nurse would be correct to inform the client of which aspect prior to the ECT?

NPO will be employed 8 hours prior to the procedure.

A client has begun taking 1 mg of eszopiclone at bedtime, a dose which is considered to be equivalent to a 3.75-mg dose of her previous hypnotic, zopiclone. This comparison of the relative dosages of these two drugs is referred to as what?

Potency

A drug that is an antagonist functions to do what?

Prevent natural or other substances from activating cell function

A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?

Pseudoparkinsonism

Mrs. Taylor's psychiatrist has explained the potential benefits of ECT in the treatment of her depression. Which of the following nursing diagnoses is most likely to apply to a client who is scheduled to soon begin ECT?

Risk for anxiety

Prior to undergoing ECT, brief general anesthesia is given to prevent which of the following?

Severe muscle contractions

Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?

Sexual dysfunction

A 52-year-old woman is seeing a nurse therapist for moderate depression. The client has been taking fluoxetine (Prozac) for 3 weeks, but her mood has not improved. She states, "I need more than this to get better. I'm taking St. John's wort, too." Why does the nurse tell the client to immediately stop taking St. John's wort?

St. John's wort with fluoxetine may lead to serotonin syndrome.

In the discharge instructions for a client who is taking alprazolam, the nurse should include what?

Sudden cessation of alprazolam can cause rebound insomnia and nightmares.

A client with a history of depression and use of antidepressant therapy is brought to the emergency department for evaluation. After assessing the client, the nurse suspects serotonin syndrome. Which finding would the support the nurse's suspicion? Select all that apply.

Tachycardia Hyperreflexia Vomiting Hallucinations

Though the client does not exhibit any signs or symptoms of depression, a client's physician has prescribed a low dose of the antidepressant mirtazapine. What is the most likely rationale for the physician's action?

To make use of an off-label application of the medication

In providing post-op care for the client who has just undergone ECT, which of the following findings would indicate that ECT has been effective and the client is displaying normal sequelae of this procedure?

The client cannot remember to which inpatient unit he or she is returning.

An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply.

The client often smacks lips when at rest The client makes repetitive movements with the fingers

The psychiatric nurse is preparing to provide education to a client who has recently been prescribed lithium. The nurse should include which information? Select all that apply.

The intended outcome of the therapy will be the prevention of manic behavior. The drug appears to balance the neurotransmission of serotonin. Blood levels of the drug should be monitored at least monthly with a sample drawn 12 hours after a dose. Your health care provider should be notified immediately of any vomiting, diarrhea, or profuse perspiration.

A client is admitted to the psychiatric unit with a diagnosis of major depression with psychotic features. When the client does not respond to antidepressant medications, ECT is ordered. What is the mechanism of action of this therapy?

The mechanism of action of ECT remains unknown.

When referring to the pharmacodynamics of a medication, what is the result of an agonistic effect?

The target receptors are stimulated

When explaining the term "pharmacokinetics" to a client who is being educated on a newly prescribed medication, it would be appropriate to define it as

The way the body handles the medication

Benzodiazepines work by the following mechanism of action:

They act directly on GABA receptors and are thought to increase the amount of GABA available.

A mental health nurse is teaching a client with depression about ECT. The nurse understands that treatments are typically given how often?

Twice a week

During which phase of drug treatment does the prescriber adjust or titrate the medication dosage to achieve the maximum amount of improvement with a minimum of side effects?

stabilization

A nurse is assessing a client with schizophrenia who is receiving antipsychotic drug therapy. A change in which finding would the nurse correlate with the drug's effectiveness on the target symptoms?

hallucinations delusions

A client is being seen in the mental health clinic. The client has been on haloperidol for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. A nurse would document this chronic syndrome as:

tardive dyskinesia.