Exam 1 Mental Health

Which statement most accurately describes a nurses role regarding psychopharmacology?

"You will need to frequently make decisions regarding the administration of PRN medications to help the client manage anger"

The teaching pain for a patient beginning Xanax (alprazolam) should include what instructions? Select all that apply

-Avoid discontinuing the drug abruptly -avoid herbal preparations

A patient diagnosed with mild lithium toxicity with a serum level of 1.6 mEq/ L. Which assessment findings are most likely and will require nursing attention? select all that apply.

-Dizziness -Coarse hand tremor -coordination problems

Which changes in psychiatric nursing practice are directly attributable to events occurring during the decade of the brain? select all that apply

-Nurses upgraded knowledge of psychopharmacology. -nurses provided psycho-education to pt and families -nurses viewed psychiatric symptoms as resulting from brain irregularities.

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

0.8 mEq/L

Which patient receiving fluphenazine should be monitored most closely for extrapyramidal side effects (EPSEs)?

74 year old woman

Which patient would be most at risk for adverse reactions when administered a highly protein bound medication?

A 76-year old pt that is malnourished

When teaching about the monoamine oxidase inhibitor (MAOI) tranylcypromine, the nurse should consider it a priority to provide what information?

A list of tyramine foods

A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicated an understanding of the teaching? (Select All that Apply) A.)"To assess cognitive ability, I should ask the client to count backward by sevens." B.) "To assess affect, I should observe the client's facial expression." C.) "To assess language ability, I should instruct the client to write a sentence." D.) "To assess remote memory, I should have the client repeat a list of objects." E.) "To assess the client's abstract thinking, I should ask the client to identify our most recent presidents."

A,B,C

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply.) A.) Auditory hallucinations B.) Withdrawal from social situations C.) Delusions of grandeur D.) Severe agitation E.) Anhedonia

A,C,D

A patient has taking perphenazine for a year. The nurse observes lip smacking and grinding teeth. Which tool should the nurse use to complete the clients assessment?

AIMS

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching TV. The nurse should use which term to document these findings?

Akathisia

An outpatient diagnosed with schizophrenia has been omitting doses of medication. Which questions should the clinic nurse asks to determine the reason for this problem? select all that apply

All of the choices are correct: -"are you experiencing any troublesome side effects?" -"is the medicine affecting your sexual performance?" -"does the medicine make you think slower?" -"do you believe your dose is too low?" -"do you believe you have an illness?"

Which individual should the nurse assess as having the highest risk for homelessness?

An adult with serious mental illness and no family

A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? A.) The client has a family history of seasonal pattern depression. B.) The client currently smokes 1.5 packs of cigarettes per day. C.) The client had a motor vehicle crash last year and sustained a head injury. D.) The client has a BMI of 25 and has gained 10 lb over the last year.

C

The cerebrum is divided into four lobes which are separated by three deep grooves that allow each lobe to carry out an individual function. What are the names of the grooves that separate each lobe of the cerebrum?

Central sulcus, lateral sulcus, and the parieto-occipital sulcus

A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? A.) Three to six weeks of treatment is required to achieve therapeutic benefit. B.) Combining alcohol with alprazolam will produce a paradoxical response. C.) Alprazolam has a lower risk for dependence than other anti-anxiety medications. D.) Report confusion as a potential indication of toxicity.

D

What is the term for the area of the temporal lobe that is involved in complex visual processing, such as facial recognition?

Fusiform Gyrus

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

Hallucinations

Which statement forms the foundation upon which a nurse should base the implementation of psychotherapeutic management to the care of a patient with mental illness?

Omitting any one component will compromise the effectiveness of the treatment.

A nurse, preparing a community presentation, should indicate what information concerning the most accurate characterization of treatment of the mentally ill prior to the Period of Pre/Enlightenment?

Patients were often displayed for public amusement

By what mechanisms does lorazepam reduce anxiety?

Potentiating gamma aminobutyric acid (GABA)

A patient diagnosed with depression has taken a selective serotonin reuptake inhibitor (SSRI) for 1 month. The nurse should use direct questions to evaluate which potential side effect?

Sexual Dysfunction

Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of which electrolyte?

Sodium

This area of the brain receives signals from the third neuron in a sensory pathways and receives signals to the upper and lower brain areas. It is commonly known as the warehouse for the CNS. What is this are of the brain called?

Thalamus

Which everyday household invention had direct negative effects on the overall population sleep quality?

The lightbulb

True or False: The nucleus accumbens is innervated by dopamine releasing neurons from the brainstem and is responsible for sensations of reward and pleasure?

True

Maintaining and using information that was just received, such as taking notes in a classroom, is which of the following processes?

Working memory

A nurse assesses a newly hospitalized patient with a long history of serious and persistent mental illness. What is the priority assessment information regarding medication safety?

adverse reactions to drugs taken previously

A patient has taken lithium 300mg three times daily for 1 week. The patient reports the presence of fine hand tremors and thirst. What is the nurses priority action to these assessment findings?

comfort the pt that these effects will probably decrease over time

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

extrapyramidal side effects

A patient is prescribed donepezil for Alzheimer disease (AD). Vital signs for this patient are: temperature 98.2F, blood pressure 135/82mm Hg; pulse 54 bests/mins; respirations 18 breaths/min. Which variance should the nurse consider most likely attributable to donepezil therapy?

pulse rate

A patient started diazepam 5 mg twice daily 6 months ago. Now the patient requires 10 mg to achieve the same effect. What phenomenon is responsible for this situation?

tolerance

The family of a patient diagnosed with Alzheimer Dementia asks the nurse, "How can drugs help our parent?" Which reply provides the most realistic expectations for medication therapy?

"Drugs can help preserve mental abilities for a time."

A patient taking a psychotropic medication reports, "This medicine isn't working right for me. It is causing side effects." selects the nurses nest comment to further assess the scenario.

"tell me more about how the medication is affecting you"

What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder to community based care? Select all that apply.

-Severity of the patients illness -Presence of suicidal or homicidal ideation -amount of supervision required by the pt.

A patient reports frequent sleep disturbances. Which preparations could be considered to help improve the patients sleep pattern? select all that apply.

-melatonin -valerian

A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A.) "This medication increases the release of serotonin and norepinephrine." B.) "I should tell the client about the likelihood of insomnia while taking this medication." C.) " This medication is contraindicated for clients who have an eating disorder." D.) " Sexual dysfunction is a common adverse effect of this medication."

A

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A.) Administer the next dose of lithium carbonate as scheduled. B.) Prepare for administration of aminophylline. C.) Notify the provider for a possible increase in the dosage of lithium carbonate. D.) REquest a stat repeat of the client's lithium blood level.

A

A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following? A.) AST/ALT and LDH B.) Creatinine and BUN C.) WBC and granulocyte counts D.) Blood sodium and potassium

A

A nurse is caring for a client who takes paroxetine to treat post traumatic stress disorder. The client states, "I grind my teeth during the night, which causes pain in my mouth." The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply.) A.) Concurrent administration of buspirone B.) Administration of a different SSRI C.) Use of mouth guard D.) Changing to a different class of anti-anxiety medication E.) Increasing the dose of paroxetine

A,C,D

A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A.) Olanzapine B.) Quetiapine C.) Aripiprazole D.) Clozapine E.) Asenapine

A,C,D,E

A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (Select all that apply) A.) Void just before taking the medication B.) Increase the dietary intake of potassium C.) Wear sunglasses when outside D.) Change positions slowly when getting up E.) Chew sugarless gum

A,C,E

A patient serum lithium level is 1.8 mEq/L. What is the nurses priority action related to this evidence?

Assess for signs of toxicity.

when considering environmental aspects of milleu management, which intervention has the highest priority for a client admitted after a failed suicide attempt?

Assigning a staff member to one-on-one observation of the client.

A nurse if providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates understanding of the teaching? A.) "I can expect to experience diarrhea while taking this medication." B.) "I may feel drowsy for a few weeks after starting this medication." C.) "I cannot eat my favorite pizza with pepperoni while taking this medication." D.) "This medication will help me lose the weight that I have gained over the last year."

B

A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority? A.) Coordinate holistic care with social services. B.) Identify the client's perception of their mental health status. C.) Include the client's family in the interview. D.) Teach the client about their current mental health disorder.

B

A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A.) " That is a good choice. Ibuprofen does not interact with lithium." B.) " Regular aspirin would be a better choice than ibuprofen." C.) " Lithium decreases the effectiveness of ibuprofen." D.) " The ibuprofen will make your lithium level fall too low."

B

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? A.) Administer flumazenil B.) Identify the client's level of orientation C.) Infuse IV fluids D.) Prepare the client for gastric lavage

B

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A.) Decreased level of consciousness B.) Drooling C.) Involuntary arm movements D.) Urinary retention E.) Continual pacing

B,C,E

A nurse is caring for a client who is taking phenelzine. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (Select all that apply.) A.) Elevated blood glucose level B.) Orthostatic hypotension C.) Priapism D.) Hypomania E.) Bruxism

B,D

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply.) A.) Constipation B.) Polyuria C.) Rash D.) Muscle Weakness E.) Tinnitus

B,D

A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply.) A.) Hypothermia B.) Hallucinations C.) Muscular flaccidity D.) Diaphoresis E.) Agitation

B,D,E

A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Which of the following information is appropriate to include in the discussion? (Select all that apply.) A.) The DSM-5 includes client education handouts for mental health disorders. B.) The DSM-5 establishes diagnostic criteria for individual mental health disorders. C.) The DSM-5 indicates recommended pharmacological treatment for mental health disorders. D.) The DSM-5 assists nurses in planning care for client's who have mental health disorders. E.) The DSM-5 indicates expected assessment finding of mental health disorders.

B,D,E

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

BP, pulse, respirations

A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the pt comes to the ER in distress. What is the nurses priority action?

Begin seizure precautions

A patient who has taken three doses of haloperidol suddenly cries out for help. The nurse observes that the patient eyes are rolled upward in a fixed gaze. The nurse should administer which drug from the patients PRN list?

Benztropine

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications? A.) Chlorpromazine B.) Thiothixene C.) Risperidone D.) Haloperidol

C

A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statement indicates the client understand the use of this medication? A.) "I will take the medication at bedtime." B.) "I will follow a low-sodium diet while taking this medication." C.) "I will need to discontinue this medication slowly." D.) "I will be at risk for weight loss with long-term use of this medication."

C

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A.) " I will be able to stop taking this medication as soon as I feel better." B.) " If I feel drowsy during the day, I will stop taking this medication and call my provider." C.) " I will be careful not to gain too much weight while taking this medication." D.) " This medication is highly addictive and must be withdrawn slowly."

C

Which patient behavior should the nurse identify as the greatest risk for overdose with a benzodiazepine?

Combing the drug with alcohol

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? A.) " Current medical conditions include diabetes that is controlled by diet." B.) " Recent medications include a course of prednisone for acute bronchitis." C.) " Current vaccinations include a flu vaccine last month." D.) " Current medications include furosemide for congestive heart failure."

D

A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention? A.) Assist the client with systematic desensitization therapy. B.) Teach the client to appropriate coping mechanisms. C.) Assess the client for comorbid health conditions. D.) Monitor the client for adverse effects of the medications.

D

A patients haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessment question demonstrates the nurses understanding of the resulting needs of the client?

Have you begun experiencing any forms of hallucinations?

The inability to recognize stimulation on one side of the body after a cerebral injury to the opposite side?

Hemiangnosia

An adult diagnosed with schizophrenia was started on clozapine 4 days ago. At 2100 today, the patients VS are temp. 101F, pulse 143 BPM; RR 20, BP 100/60 mm Hg. What is the nurses best action regarding the 2100 dose of clozapine?

Hold the medication and notify the health care provider.

If a patient were to have damage to their cerebellum, what would be a sign specific to this injury?

Intentional Tremors

When a nurse working in a well-child clinic asks a parent's address, the parent responds, "My children and I are homeless." The nurse can assess this response as:

It is a common occurrence, because 1 out of 50 children are homeless.

A patient with which disorder would most likely benefit from taking St. John wort?

Mild depressive symptoms

A secondary amine tricyclic antidepressant is prescribed for a patient. the medications will significantly increase the availability of which neurotransmitter?

Norepinephrine

What is a realistic patient-focused outcome of patient teaching regarding psychotropic medications?

Stating the purpose, dose, and significant side effects of each drug prescribed.

Upon assessment of a hypervigilant patient, the nurse notices that the patients pupils are dilated and their heart rate is above normal range. What system reaction is the patient experiencing?

Sympathetic

A patient who takes a traditional antipsychotic medication says "I feel shaky and very warm." The patient is diaphoretic. What is the nurses best first action when suspecting that a patient is experiencing neuroleptic malignant syndrome (NMS)?

Take the patients vital signs

A football player is admitted to the ER. He complains of memory loss after the past couple of practices where he admitted to being hit very hard in the head. The doctor diagnoses him with CNS trauma to the brain. His symptoms indicate, which lobe was affected?

The temporal lobe

A patient diagnosed with depression is prescribed the tricyclic antidepressant (TCA) bupropion. What is the benefit of this medication for non-hospitalized patients?

There is reduced potential for lethal overdose.

A 64 year old woman was diagnosed with Alzheimer disease. Early in the disease process, the nurse can expect their patient to demonstrate which symptoms related to memory loss?

Unable to recall facts

The patient will report improvement in which area when taking valerian?

Undisturbed sleep throughout the night

A 75 year old patient with a long history of depression begins amitriptyline (Elavil) 100 mg/day. The patient also takes a diuretic daily for hypertension. What is the highest priority nursing diagnosis this patient is at a risk for?

falls related to dizziness and orthostatic hypotension

Which medication from a patients pharmacologic profile is most likely to precipitate neuroleptic malignant syndrome (NMS)?

haloperidol

A person says, "What mental health issues are a major concern for the general population." The nurses reply should be based on what confirmed fact concerning mental health issues?

major depression is very prevalent among the adult population.