Mental health

Which drugs are classified as SSRI's?

CLPPZ (clips) Celexa (celebrate 1st haircut) Lexapro (alexa is a pro haircutter) Prozac (only let pro's cut your hair) Paxil (hair salons are often packed) Zoloft (the zohan cuts hair)

Which drugs are classified as SNRI's?

SNRI=total SNORES Cymbalta (cymbal players bored in band class) Effexor (waiting forever for drugs to take effect) Pristiq (cleaning your home to pristine condition is boring)

Which class of antidepressants is commonly used to treat children with Disruptive Mood Dysregulation Disorder?

SSRI's

What 2 classes of antidepressants may cause insomnia and should be administered in the morning?

SSRI's and SNRI's

What hormone is SAD thought to be related to a decrease of?

Melatonin

The client states to the nurse, "I take citalopram (Celexa) 40 mg every day like my physician prescribed. I have also been taking St. John's wort 750 mg daily for the past 2 weeks." Which of the following indicate that the client is developing serotonin syndrome? Select all that apply. 1. Confusion. 2. Restlessness. 3. Constipation. 4. Diaphoresis. 5. Ataxia.

1, 2, 3, 5, . Serotonin syndrome can occur if a selective serotonin reuptake inhibitor is combined with a monoamine oxidase inhibitor, a tryptophan-serotonin precursor, or St. John's wort. Signs and symptoms of serotonin syndrome include mental status changes, such as confusion, restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps, and hyperreflexia. Constipation is not associated with serotonin syndrome.

A client who is experiencing a panic attack has just arrived at the ED. Which is the priority nursing intervention for this client? A. Stay with the client and reassure of safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down D. Encourage the client to talk about what triggered the attack

A

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduces the probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept

A

The physician orders fluoxetine (Prozac) orally every morning for a 72 year old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? A. Nausea B. Dizziness C. Sedation D. Dry Mouth

B

Annie has hair-pulling disorder. She is receiving treatment at the mental health facility with habit-reversal therapy. Which of the following elements would be included in this therapy? Select all that apply. A. Awareness training B. Competing response therapy C. Social support D. Hypnotherapy E. Aversive therapy

A, B, C

When a client is taking an antidepressant, what should the nurse do? Select all that apply. A. Monitor the client for suicidal tendencies B. Observe the client for orthostatic hypotension C. Teach the client to take the drug with food if GI distress occurs D. Tell the client that the drug may not have full effectiveness for 1 to 2 weeks E. Advise the client to maintain adequate fluid intake of 2 L/day

A, B, C, D

Which milieu activity should the nurse recommend to a client with acute mania? Select all that apply. A. Scheduled rest periods B. Relaxation exercises C. Listening to soft music D. Watching TV E. Aerobic exercises

A, B, C, E

A nurse is preparing a client who is a possible candidate for ECT and providing information about the treatments. The nurse may do which of the following? Select all that apply. A. Encourage the client to express fears about getting ECT B. Discuss with the client and family the possibility of short term memory loss C. Remind the client and family that injury from the induced seizure is common D. Monitor for any cardiac alterations (current and past) to avoid possible negative outcomes E. Ensure the client that he will be awake during the entire procedure

A, B, D

The client states to the nurse, "I take citalopram (Celexa) 40 mg every day like my physician prescribed. I have also been taking St. John's Wort 750 mg daily for the past 2 weeks." Which of the following indicate that the client is developing serotonin syndrome? Select all that apply. A. Confusion B. Restlessness C. Constipation D. Diaphoresis E. Ataxia

A, B, D, E

What two medications are administered IM 30 mins prior to ECT? Why?

Atropine and Robinul Decrease secretions and counteract bradycardia produced by vagal stimulation

Which drugs are classified as Heterocyclics (Atypicals)?

Atypical Hetero Couples Remeron (morons married to smart people) Trazodone (travel lovers married to zoning lovers) Wellbutrin (well matched but weirdo couples)

When planning the discharge of a client with chronic anxiety, a nurse directs the goals at promoting a safe environment at home. The appropriate maintenance goal should focus on which of the following? A. Ignoring the feelings of anxiety B. Identifying the anxiety-producing situations C. Continued contact with a crisis counselor D. Eliminating all anxiety from daily situations

B

Which of the following comments indicates that a client understands the nurse's teaching about sertraline (Zoloft)? A. Zoloft will probably cause me to gain weight B. This medicine can cause delayed ejaculations C. Dry mouth is a permanent side effect of Zoloft D. I can take my medication with St. John's Wort

B

In teaching a client about his antidepressant medication, Fluoxetine, which of the following would the nurse include? Select all that apply. A. Don't eat chocolate while taking this medication B. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect C. Don't take this medication with the migraine drugs "triptans" D. Go to the lab each week to have your blood drawn for therapeutic level of this drug E. This drug causes a high degree of sedation, so take it just before bedtime

B, C

A client will be discharged on lithium carbonate 600 mg 3 times a day. When teaching the client and his family about lithium therapy, the nurse determines that teaching has been effective if the client and family state that they will notify the prescribing physician immediately if which of the following occur? Select all that apply. A. Nausea B. Muscle Weakness C. Vertigo D. Fine Hand Tremors E. Vomiting F. Anorexia

B, C, E

The client with depression has been consistent with taking 12.5 mg of paroxetine (Paxil) extended release daily. The nurse judges the client to be benefiting from this drug therapy when the client demonstrates which of the following behaviors? Select all that apply. A. Takes 2 hour naps daily B. Completes homework assignment C. Decreases pacing D. Increases somatization E. Verbalizes feelings

B, C, E

A client comes to the emergency department after an assault and is extremely agitated, trembling, and hyperventilating. The appropriate initial nursing action would be to: A. Encourage the client to discuss the assault B. Place the client in a quiet room alone to decrease stimulation C. Remain with the client until the anxiety decreases D. Begin to teach relaxation techniques

C

A client is admitted to the a medical nursing unit with a diagnosis of acute blindness. Many tests are performed, and there seems to be no organic reason why this client can not see. The client became blind after witnessing a hit and run car accident where a family of three was killed. A nurse suspects that the client may be experiencing a: A. Psychosis B. Repression C. Conversion Disorder D. Dissociative Disorder

C

A client with OCD says to the nurse, "I've been here for 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill at ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention to the ritualistic behaviors each time they occur and point out their inappropriateness B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement C. Set limits on the amount of time Sandy may engage in the ritualistic behavior D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior

C

Which drugs are classified as MAOI's?

MAOI = MOO (cows) Marplan (moozipans are marzipan cows on viva pinata) Nardil (cows are hardy) Parnate (cows live in the barn)

A nurse is preparing to care for a dying client, and several family members are at the client's bedside. Select the therapeutic techniques that the nurse would use when communicating with the family. Select all that apply. A. Discourage reminiscing B. Make the decisions for the family C. Encourage expression of feelings,concerns, and fears D. Explain everything that is happening to all family members E. Touch and hold the client's or family members' hands if appropriate F. Be honest and let the client and family know that they will not be abandoned by the nurse

C, E, F

A nurse is conducting a group therapy session. During the session, a client with mania consistently talks and dominates the group session, and this behavior is interrupting group interactions. The nurse would initially: A. Ask the client to leave the group session B. Ask another nurse to escort the client out of the group session C. Tell the client that she will not be able to attend any future group sessions D. Tell the client that she needs to allow the other clients in the room time to talk

D

When is the use of antidepressants contraindicated?

In the acute recovery phase following an MI and in those with narrow angle closure glaucoma

How is it thought that ECT works?

Increase in circulating levels of serotonin, norepinephrine, and dopamine are demonstrated after the grand mal seizure is produced

What symptoms are seen in serotonin syndrome?

SMARTS Sweating Myoclonus (involuntary jerks) ANS instability (tachy w/ labile BP) Rigidity Temp ^ (shivering) Seizures

Use of what herbal remedy is contraindicated while taking antidepressants?

St john's wort

What are the 2 most common side effects of ECT?

Temporary memory loss Confusion

How do TCA's, Heterocyclics, SSRI's, and SNRI's work?

They block the reuptake of serotonin, norepinephrine, and dopamine by the neurons in the brain

What is the indication for antidepressants?

They elevate mood and alleviate symptoms associated with moderate to severe depression

What is the action of antidepressants?

They increase the concentration of serotonin, norepinephrine, and dopamine in the body

How do MAOI's work?

They inhibit the action of monoamine oxidase (inactivates serotonin, norepinephrine, and dopamine) at various sites in the brain

Foods high in what substance can lead to hypertensive crisis if eaten while taking MAOI's?

Tyramine (alcohol, cheeses, chocolate, raisins, smoked meats, MSG, caffeinated drinks)

How long should clients wait to take another type of antidepressant after stopping use of an MAOI?

2 weeks

A 16 year old client is prescribed 10 mg of paroxetine (Paxil) at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect? A. Headache B. Nausea C. Fatigue D. Agitation

D

The client with major depression and suicidal ideation has been taking bupropion (Wellbutrin)100 mg PO 4 times a day for 5 days. Assessment reveals the client to be somewhat less withdrawn, able to perform ADL's, and eating 50% of each meal. At this time, the nurse should monitor the client specifically for which of the following behaviors? A. Seizure activity B. Suicide attempt C. Visual disturbances D. Increased libido

B

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the client's bathroom locked so she cannot wash her hands all of the time B. Structure the client's schedule so that she has plenty of time for washing her hands C. Place the client in isolation until she promises to stop washing her hands so much D. Explain the client's behavior to her, since she is probably unaware that it is maladaptive

B

The nurse is conducting an intake interview with an Asian American female who reports sadness, physical and mental fatigue, anxiety, and sleep disturbance. Prior to the client's time with the physician, it is important for the nurse to obtain information about the client's use of which of the following? Select all that apply. 1. Tea. 2. Herbal medicine. 3. Breathing exercise. 4. Massage. 5. Folk healer.

1, 2, 5. It is important for the nurse to obtain information about the client's use of tea, herbal medicine, and a folk healer because the information is critical to the safe prescription of psychotropic medication. Breathing exercises, massage, and acupuncture are also traditional therapies used by the Asian American population, but do not interfere with the use of medications.

The client with depression who is taking imipramine (Tofranil) states to the nurse, "My doctor wants me to have an electrocardiogram (ECG) in 2 weeks, but my heart is fine." Which response by the nurse is most appropriate? 1. "It's routine practice to have ECGs periodically because there is a slight chance that the drug may affect the heart." 2. "It's probably a precautionary measure because I'm not aware that you have a cardiac condition." 3. "Try not to worry too much about this. Your doctor is just being very thorough in monitoring your condition." 4. "You had an ECG before you were prescribed imipramine and the procedure will be the same."

1. Telling the client that ECGs are done routinely for all clients taking imipramine, a tricyclic antidepressant, is an honest and direct response. Additionally, it provides some reassurance for the client. Commonly, a client with depression will ruminate, leading needlessly to increased anxiety. Tricyclic antidepressants may cause tachycardia, ECG changes, and cardiotoxicity. Telling the client that it's probably a precautionary measure because the nurse is not aware of a cardiac condition instills doubt and may cause undue anxiety for the client. Telling the client not to worry because the doctor is very thorough dismisses the client's concern and does not give the client adequate information. Explaining that the client had an ECG before initiating therapy with imipramine and that the procedure will be the same does not answer the client's question.

After administering a prescribed medication to a client who becomes restless at night and has difficulty falling asleep, which of the following nursing actions is most appropriate? 1. Sitting quietly with the client at the bedside until the medication takes effect. 2. Engaging the client in interaction until the client falls asleep. 3. Reading to the client with the lights turned down low. 4. Encouraging the client to watch television until the client feels sleepy.

1. To promote adequate rest (6 to 8 hours per night) and to eliminate hyposomnia, the nurse should sit with the client at the bedside until the medication takes effect. The presence of a caring nurse provides the client with comfort and security and helps to decrease the client's anxiety. Engaging the client in interaction until the client falls asleep, reading to the client, or encouraging the client to watch television may be too stimulating for the client, consequently increasing rather than decreasing the client's restlessness.

The client with depression has been consistent with taking 12.5 mg of paroxetine (Paxil) extended release daily. The nurse judges the client to be benefiting from this drug therapy when the client demonstrates which of the following behaviors? Select all that apply. 1. Takes 2-hour evening naps daily. 2. Completes homework assignments. 3. Decreases pacing. 4. Increases somatization. 5. Verbalizes feelings.

2, 3, 5. Symptoms of depression include depressed mood, anhedonia, appetite disturbance, sleep disturbance, psychomotor disturbance, fatigue, feelings of worthlessness, excessive or inappropriate guilt, decreased concentration, and recurrent thoughts of death or suicide. Paroxetine is a selective serotonin reuptake inhibitor antidepressant that also can be used to treat anxiety. Improved concentration, verbalization of feelings, and decreased agitation or pacing are signs of improvement. Taking 2-hour evening naps daily is still a sign of fatigue or lack of energy, and the increased use of somatization (bodily complaints) could be signs of continued symptoms of depression.

A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first three doses, the client tells the nurse that the medication upsets his stomach. Which of the following instructions should the nurse give to the client? 1. "Take the medication an hour before breakfast." 2. "Take the medication with some food." 3. "Take the medication at bedtime." 4. "Take the medication with 4 oz of orange juice."

2. Nausea and gastrointestinal upset is a common, but usually temporary, side effect of paroxetine (Paxil). Therefore, the nurse would instruct the client to take the medication with food to minimize nausea and stomach upset. Other more common side effects are dry mouth, constipation, headache, dizziness, sweating, loss of appetite, ejaculatory problems in men, and decreased orgasms in women. Taking the medication an hour before breakfast would most likely lead to further gastrointestinal upset. Taking the medication at bedtime is not recommended because Paxil can cause nervousness and interfere with sleep. Because orange juice is acidic, taking the medication with it, especially on an empty stomach, may lead to nausea or increase the client's gastrointestinal upset.

A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, "My boss was wonderful! He was understanding and a really nice man." The nurse interprets the client's statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse? 1. "But, I don't understand, wasn't he the one who fired you?" 2. "Tell me more about having to work while not being able to sleep or concentrate." 3. "It must have been hard to leave a boss like that." 4. "It sounds like he would hire you back if you asked.

2. Option 1 casts doubt on the client's perception, which is likely to increase the client's anxiety and make the client feel defensive. Options 3 & 4 further the client's unrealistic perception of the situation. Option 2 focuses on the client and her feelings which is the most effective approach to help her realistically consider her situation and decrease the anxiety that led the client to use the defense mechanism of reaction formation.

Which of the following comments indicates that a client understands the nurse's teaching about sertraline (Zoloft)? 1. "Zoloft will probably cause me to gain weight." 2. "This medicine can cause delayed ejaculations." 3. "Dry mouth is a permanent side effect of Zoloft." 4. "I can take my medicine with St. John's wort."

2. Sertraline, like other selective serotonin reuptake inhibitors (SSRIs), can cause decreased libido and sexual dysfunction such as delayed ejaculation in men and an inability to achieve orgasm in women. SSRIs do not typically cause weight gain but may cause loss of appetite and weight loss. Dry mouth is a possible side effect, but it is temporary. The client should be told to take sips of water, suck on ice chips, or use sugarless gum or candy. St. John's wort should not be taken with SSRIs because a severe reaction could occur.

A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The physician prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerfully greets the nurse. He appears to be relaxed and joins the group for community meeting before supper. What should the nurse interpret as the most likely cause of the client's behavior? 1. The Effexor is helping the client's symptoms of depression significantly. 2. The client's sudden improvement calls for close observation by the staff. 3. The staff can decrease their observation of the client. 4. The client is nearing discharge due to the improvement of his symptoms.

2. The client's sudden improvement and decrease in anxiety most likely indicates that the client is relieved because he has made the decision to kill himself and may now have the energy to complete the suicide. Symptoms of severe depression do not suddenly abate because most antidepressants work slowly and take 2 to 4 weeks to provide a maximum benefit. The client will improve slowly due to the medication. The sudden improvement in symptoms does not mean the client is nearing discharge and decreasing observation of the client compromises the client's safety.

The nurse is reviewing the laboratory report with the client's lithium level taken that morning prior to administering the 5 pm dose of lithium. The lithium level is 1.8 mEq/L. The nurse should: A. Administer the 5 pm dose of lithium B. Hold the 5 pm dose of lithium C. Give the client 8 oz of water with the lithium D. Give the lithium after the client's supper

B

The client with major depression and suicidal ideation has been taking bupropion (Wellbutrin) 100 mg P.O. four times daily for 5 days. Assessment reveals the client to be somewhat less withdrawn, able to perform activities of daily living with minimal assistance, and eating 50% of each meal. At this time, the nurse should monitor the client specifically for which of the following behaviors? 1. Seizure activity. 2. Suicide attempt. 3. Visual disturbances. 4. Increased libido.

2. The nurse must monitor the client for a suicide attempt at this time when the client is starting to feel better because the depressed client may now have enough energy to carry out an attempt. Bupropion inhibits dopamine reuptake; it is an activating antidepressant and could cause agitation. Although bupropion lowers the seizure threshold, especially at doses greater than 450 mg/ day, and visual disturbances and increased libido are possible adverse effects, the nurse must closely monitor the client for suicide attempt. As the client with major depression begins to feel better, the client may have enough energy to carry out an attempt.

The physician orders fluoxetine (Prozac) orally every morning for a 72-year-old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? 1. Nausea. 2. Dizziness. 3. Sedation. 4. Dry mouth.

2. The presence of dizziness could indicate orthostatic hypotension, which may cause injury to the client from falling. Nausea, sedation, and dry mouth do not require immediate intervention by the nurse.

After a period of unsuccessful treatment with Elavil (amitriptyline), a woman diagnosed with depression is switched to Parnate (tranylcypromine). Which statement by the client indicates the client understands the side effects of Parnate? 1. "I need to increase my intake of sodium." 2. "I must refrain from strenuous exercise." 3. "I must refrain from eating aged cheese or yeast products." 4. "I should decrease my intake of foods containing sugar."

3. Cheese and yeast products contain tyramine which the client should avoid to prevent a negative interaction with Parnate, a monoamine oxidase (MAO) inhibitor. Sodium will not interact with Parnate and neither exercise nor sugar needs to be limited.

A nurse is educating a client who has been diagnosed with dysthymia about possible treatment for the disorder. Which response by the nurse is most appropriate? 1. "Antidepressants, particularly the SSRI group, offer you the best treatment for your dysthymia." 2. "Doctors recommend that clients experiencing dysthymia receive electroconvulsive therapy (ECT) to treat their disorder." 3. "Because you have a mild, though long-lasting dysthymic mood, psychotherapy can usually bring improvement with less likelihood of the need for medication." 4. "Since your dysthymia indicates a long-lasting mild depression, long-term psychoanalysis would be the best treatment for you."

3. Dysthymia is a milder, persistent type of depression in which sufferers are able to minimally carry on their work (Option 3). Options 1 and 2 are treatments used for occurrences of major depression with ECT being used as a last resort when several medications fail. Psychoanalysis is a very involved, long-term treatment rarely used now due to its cost and the long period of treatment required for results.

When preparing a teaching plan for a client about imipramine (Tofranil), which of the following substances should the nurse tell the client to avoid while taking the medication? 1. Caffeinated coffee. 2. Sunscreen. 3. Alcohol. 4. Artificial tears.

3. Imipramine, a tricyclic antidepressant, in combination with alcohol will produce additive central nervous system depression. Although caffeinated coffee is safe to use when the client is taking imipramine, it is not recommended for a client with depression who may be experiencing sleep disturbances. Imipramine may cause photosensitivity so the client would be instructed to use sunscreen and protective clothing when exposed to the sun. Reduced lacrimation may occur as a side effect of imipramine. Therefore, the use of artificial tears may be recommended.

Ms. T. has been diagnosed with Agoraphobia. Which behavior would be most characteristic of this disorder: A. Ms. T. experiences panic anxiety when she encounters snakes B. Ms. T. refuses to fly in an airplane C. Ms. T. will not eat in a public place D. Ms. T. stays in her home for fear of being in a public place from which she cannot escape

D

Which of the following statements by a client taking trazodone (Desyrel) as prescribed by the physician indicates to the nurse that further teaching about the medication is needed? 1. "I will continue to take my medication after a light snack." 2. "Taking Desyrel at night will help me to sleep." 3. "My depression will be gone in about 5 to 7 days." 4. "I won't drink alcohol while taking Desyrel."

3. Symptom relief can occur during the 1st week of therapy, with optimal effects possible within 2 weeks. For some clients, 2 to 4 weeks is needed for optimal effects. The client's statement that the depression will be gone in 5 to 7 days indicates to the nurse that clarification and further teaching is needed. Trazodone should be taken after a meal or light snack to enhance its absorption. Trazodone can cause drowsiness, and therefore the major portion of the drug should be taken at bedtime. The depressant effects of central nervous system depressants and alcohol may be potentiated by this drug

The client who has been taking venlafaxine (Effexor) 25 mg P.O. three times a day for the past 2 days states, "This medicine isn't doing me any good. I'm still so depressed." Which of the following responses by the nurse is most appropriate? 1. "Perhaps we'll need to increase your dose." 2. "Let's wait a few days and see how you feel." 3. "It takes about 2 to 4 weeks to receive the full effects." 4. "It's too soon to tell if your medication will help you."

3. The client needs to be informed of the time lag involved with antidepressant therapy. Although improvement in the client's symptoms will occur gradually over the course of 1 to 2 weeks, typically it takes 2 to 4 weeks to get the full effects of the medication. This information will help the client be compliant with medication and will also help in decreasing any anxiety the client has about not feeling better. The client's dose may not need to be increased; it is too early to determine the full effectiveness of the drug. Additionally, such a statement may increase the client's anxiety and diminish self-worth. Telling the client to wait a few days discounts the client's feelings and is inappropriate. Although it is too soon to tell whether the medication will be effective, telling this to the client may cause the client undue distress. This statement is somewhat negative because it is possible that the medication will not be effective, possibly further compounding the client's anxiety about not feeling better

Which of the following is the best predictor of a client's favorable response to the choice of an antidepressant? 1. The drug's side effect profile. 2. The client's age at diagnosis. 3. The cost of the medication. 4. A favorable response by a family member.

4. A favorable response by a family member to a medication and a previous response to medication are good predictors of a favorable client response to a medication because the illness is genetic and hereditary. Although the side effects of the drug, the client's age at diagnosis, and the cost of the medication are important factors to consider when choosing antidepressant therapy, this information does not necessarily predict how a client will respond to a specific drug.

When assessing a client who is receiving tricyclic antidepressant therapy, which of the following should alert the nurse to the possibility that the client is experiencing anticholinergic effects? Analyze 1. Tremors and cardiac arrhythmias. 2. Sedation and delirium. 3. Respiratory depression and convulsions. 4. Urine retention and blurred vision.

4. Anticholinergic effects, which result from blockage of the parasympathetic (craniosacral) nervous system, include urine retention, blurred vision, dry mouth, and constipation. Tremors, cardiac arrhythmias, and sexual dysfunction are possible side effects, but they are caused by increased norepinephrine availability. Sedation and delirium are not anticholinergic effects. Sedation may be a therapeutic effect because many clients with depression experience agitation and insomnia. Delirium, typically not a side effect, would indicate toxicity, especially in elderly clients. Respiratory depression, convulsions, ataxia, agitation, stupor, and coma indicate tricyclic antidepressant toxicity.

A client taking paroxetine (Paxil) 40 mg P.O. every morning tells the nurse that her mouth "feels like cotton." Which of the following statements by the client necessitates further assessment by the nurse? 1. "I'm sucking on ice chips." 2. "I'm using sugarless gum." 3. "I'm sucking on sugarless candy." 4. "I'm drinking 12 glasses of water every day."

4. Dry mouth is a common, temporary side effect of paroxetine. The nurse needs to further assess the client's water intake when the client states she is drinking lots of water. Excessive intake of water could be harmful to the client and could lead to electrolyte imbalance. Dry mouth is caused by the medication, and drinking a lot of water will not eliminate it. Sucking on ice chips or using sugarless gum or candy is appropriate to ease the discomfort of dry mouth associated with paroxetine.

Which of the following outcomes should the nurse include in the initial plan of care for a client who is exhibiting psychomotor retardation, withdrawal, minimal eye contact, and unresponsiveness to the nurse's questions? 1. The client will initiate interactions with peers. 2. The client will participate in milieu activities. 3. The client will discuss adaptive coping techniques. 4. The client will interact with the nurse.

4. In the initial plan of care, the most appropriate outcome would be that the client will interact with the nurse. First, the client would begin interacting with one individual, the nurse. The nurse would gradually assist the client to engage in interactions with other clients in one-on-one contacts, progressing toward informal group gatherings and eventually taking part in structured group activities. The client needs to experience success according to the client's level of tolerance. Initiating interactions with peers occurs when the client can gain a measure of confidence and self-esteem instead of feeling intimidated or unduly anxious. Discussing adaptive coping techniques is an outcome the client may be able to reach when symptoms are not as severe and the client can concentrate on improving coping skills.

A 16-year-old client is prescribed 10 mg of paroxetine (Paxil) at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect? 1. Headache. 2. Nausea. 3. Fatigue. 4. Agitation.

4. The nurse closely monitors the client taking paroxetine for the development of agitation, which could lead to self-harm in the form of a suicide attempt. Headache, nausea, and fatigue are transient adverse effects of paroxetine.

A client is taking phenelzine (Nardil) 15 mg P.O. three times a day. The nurse is about to administer the 1 p.m. dose when the client tells the nurse that about having a throbbing headache. Which of the following should the nurse do first? 1. Give the client an analgesic ordered p.r.n. 2. Call the physician to report the symptom. 3. Administer the client's next dose of phenelzine. 4. Obtain the client's vital signs.

4. The nurse should first take the client's vital signs because the client could be experiencing a hypertensive crisis, which requires prompt intervention. Signs and symptoms of a hypertensive crisis include occipital headache, a stiff or sore neck, nausea, vomiting, sweating, dilated pupils and photophobia, nosebleed, tachycardia, bradycardia, and constricting chest pain. Giving this client an analgesic without taking his vital signs first is inappropriate. After the client's vital signs have been obtained, then the nurse would call the physician to report the client's complaints and vital signs. Administering the client's next dose of phenelzine before taking his vital signs could result in a dangerous situation if the client is experiencing a hypertensive crisis.

A client is unwilling to out of the house for fear of "doing something crazy in public." Because of this fear, the client remains homebound except when accompanied outside by the spouse. Based on these data, a nurse determines that the client is experiencing: A. Agoraphobia B. Social Phobia C. Claustrophobia D. Hypochondriasis

A

A client on the psych unit is in an uncontrollable rage and is threatening other clients and staff. What is the most appropriate action for the nurse to take? A. Call security for assistance and prepare to sedate the client B. Tell the client to calm down and ask him if he would like to play cards C. Tell the client that if he continues his behavior will be punished D. Leave the client alone until he calms down

A

A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? A. Blue cheese, red wine, raisins B. Black beans, garlic, peas C. Pork, shellfish, egg yolks D. Milk, peanuts, tomatoes

A

A nurse employed in the mental health clinic is greeted by a neighbor in a local store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is being seen at your clinic every week." The appropriate nursing response would be which of the following? A. I cannot discuss any client situation with you B. If you want to know about Carol, you will need to ask her yourself C. I'm not supposed to discuss this, but since you are my neighbor I can tell you she is doing great! D. I think I remember her adding you to her list of people to contact in case of an emergency last night, so I can tell that she is doing very well

A

An SSRI is prescribed for a client. The nurse knows that which drug is an SSRI? A. Paroxetine (Paxil) B. Amitriptyline (Elavil) C. Divalproex Sodium (Depakote) D. Bupropion HCl (Wellbutrin)

A

The client scheduled for ECT tells the nurse, "I'm so afraid. What will happen to me during treatment?" Which of the following statements is most therapeutic for the nurse to make? A. You will be given medicine to relax you during treatment B. The treatment will produce a controlled grand mal seizure C. The treatment might produce nausea and a headache D. You can expect to be sleepy and confused for a time after the treatment

A

The nurse is preparing a patient for ECT. About 30 minutes prior to the treatment the nurse administers Atropine sulfate 0.4 mg IM. Rationale for this order is: A. To decrease secretions and increase heart rate B. To relax muscles C. To produce a calming effect D. To induce anesthesia

A

The physician orders lithium carbonate 600 mg TID for a newly diagnosed client with bipolar 1 disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is: A. 1.0 to 1.5 B. 10 to 15 C. 0.5 to 1.0 D. 5 to 10

A

Which of the following questions should the nurse ask to best determine the seriousness of a client's suicidal ideation? A. How are you planning on harming yourself? B. Have you made out a will? C. Have you attempted suicide before? D. How long have you been thinking about harming yourself?

A

Which drugs are classified as Tricyclics?

A SEVANT rides a tricycle Anafril (little ana has a frilly tricycle) Norpramin (baby outgrew the pram and ready for a tricycle) Tofranil (ride your tricycle to fran's house) Aventyl (ride your tricycle to the advent) Elavil (kids grow up and begin riding tricycles) Vivactil (vivacious kids love tricycles) Surmantil (kids mount their tricycles)

A client is taking lithium. The nurse should be aware of the importance of which nursing intervention(s)? Select all that apply. A. Observe the client for motor tremors B. Monitor the client for orthostatic hypotension C. Draw lithium blood levels immediately after a dose D. Advise the client to drink 750 mL/day of fluid in hot weather E. Advise the client to avoid caffeinated foods and beverages, such as coffee, tea, colas, and chocolate F. Teach the client to take lithium with meals to decrease gastric irritation

A, B, E, F

A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first 3 doses, the client tells the nurse that the medication upsets his stomach. Which of the following instructions should the nurse give to the client? A. Take the medication an hour before breakfast B. Take the medication with some food C. Take the medication at bedtime D. Take the medication with 4 oz of orange juice

B

A client who was recently discharged from the psychiatric unit calls the nurse and states that she took her children to her neighbors' home and has turned on the gas to kill herself. She is home alone and gives the nurse her address. Which of the following actions should the nurse do next? A. Refer the caller to a 24 hour suicide hotline B. Tell the caller that another nurse will call the police C. Ask the caller whether she called her physician D. Instruct the caller to call her family for help

B

A home health nurse visits a client at home and determines that the client is dependent on drugs. Which of the following assessment questions would assist the nurse to provide appropriate nursing care? A. Why did you get started on these drugs? B. How much did you use and what effect does it have on you? C. How long did you think you could take these drugs without someone finding out? D. The nurse should not ask questions for fear that the client may be in denial and will throw the nurse out of the home

B

A nure is providing care for a client admitted to the hospital with a diagnosis of acute anxiety disorder. The client says to the nurse, "I have a secret that I want to tell you. You won't tell anyone about it, will you? The appropriate nursing response would be which of the following? A. No, I won't tell anyone B. I cannot promise to keep a secret C. If you tell me the secret, I will need to tell it to your doctor D. If you tell me the secret, I will need to document it in your record

B

A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on alert for? A. Fever, sore throat, malaise B. Tinnitus, severe diarrhea, anorexia C. Occipital headache, palpations, chest pain D. Skin rash, marked rise in BP, bradycardia

B

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to the nurse, "why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? A. Xanax is not effective for generalized anxiety disorder B. Buspirone must be taken daily in order to be effective C. I will ask the doctor if he will change your dose of Buspirone to PRN so that you don't have to take it every day D. Your friend really should be taking the Xanax every day

B

After receiving 3 ECT treatments, a client says to the nurse, "I feel so much better, but I'm having trouble remembering some things that happened this last week." The nurse's best response would be: A. Don't worry about that. Nothing important happened B. Memory loss is just something you have to put up with in order to feel better C. Memory loss is a side effect of ECT, but it is only temporary. Your memory should return within a few weeks D. Forget about last week, Mr. C. You need to look forward from here

C

ECT is thought to effect a therapeutic response by: A. Stimulation of the CNS B. Decreasing the levels of acetylcholine and monoamine oxidase C. Increasing the levels of serotonin, norepinephrine, and dopamine D. Altering sodium metabolism within nerve and muscle cells

C

The client who has been taking vanlafaxine (Effexor) 25 mg PO 3 times a day for the past 2 days states, "This medicine isn't doing me any good. I'm still depressed." Which of the following responses by the nurse is most appropriate? A. Perhaps we'll need to increase your dose B. Let's wait a few days and see how you feel C. It takes about 2 to 4 weeks to receive the full effects D. It's too soon to tell if your medication will help you

C

The nurse realizes that some herbs interact with SSRI's. Which herb interaction may cause serotonin syndrome? A. Feverfew B. Ma-huang C. St. John's Wort D. Gingko Biloba

C

When preparing a teaching plan for a client about imipramine (Tofranil), which of the following substances should the nurse tell the client to avoid while taking the medication? A. Caffeinated coffee B. Sunscreen C. Alcohol D. Artificial tears

C

Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10 mg valium QID B. Group therapy with other agoraphobics C. Facing her fear in a gradual step progression D. Hypnosis

C

Which of the following statements by a client taking trazodone (Desyrel) as prescribed by the physician indicates to the nurse that further teaching about the medication is needed? A. I will continue to take my medication after a light snack B. Taking Desyrel at night will help me to sleep C. My depression will be gone in about 5 to 7 days D. I won't drink alcohol while taking Desyrel

C

A client experiencing a great deal of stress and anxiety is being taught to use self-control therapy. Which statement by the client indicates a need for further teaching about the therapy? A. An advantage of this technique is that change is likely to last B. This form of therapy can be applied to new situations C. Talking to onself is a basic component of this form of therapy D. It provides a negative reinforcement when the stimulus is produced

D

A client taking paroxetine (Paxil) 40 mg PO every morning tells the nurse that her mouth "feels like cotton." Which of the following statements by the client necessitates further assessment by the nurse? A. I'm sucking on ice chips B. I'm using sugarless gum C. I'm sucking on sugarless candy D. I'm drinking 12 glasses of water every day

D

A client walks into the clinic and tells the nurse she wants to die because her boyfriend broke up with her. The client states, "I'll show him. He'll be sorry." The nurse notes which of the following as the underlying theme and method to deal with the client? A. Sadness-ask the client to reveal how long she has felt this way B. Escape-ask the client to indicate from what she wants to escape C. Loneliness-ask the client to state who she believes to be her friends D. Retaliation-ask the client about her specific plans to harm herself and/or her boyfriend

D

A nurse is caring for a client who is scheduled for ECT. The nurse notes that an informed consent has not been obtained for the procedure. On review of the record, the nurse notes that the admission was involuntary. Based on this information, the nurse determines: A. That the doctor will provide the informed consent B. That an informed consent does not need to be obtained C. That an informed consent should be obtained from the family D. That an informed consent needs to be obtained from the client

D

A nurse is caring for a suicidal client. The appropriate nursing intervention in dealing with this client is to: A. Demonstrate confidence in the client's ability to deal with stressors B. Provide hope and reassurance that the problems will resolve themselves C. Display an attitude of detachment, confrontation, and efficacy D. Provide authority, action, and participation

D

A nurse is developing a plan of care for a client experiencing anxiety after the loss of a job. The client is verbalizing concerns regarding the ability to meet role expectations and financial obligations. The appropriate nursing diagnosis for this client is: A. Dysfunctional family process B. Disturbed thought processes C. Risk for anxiety D. Ineffective coping

D

Education for the client who is taking MAOI's should include which of the following? A. Fluid and sodium replacement when appropriate, frequent blood drug levels, signs and symptoms of toxicity B. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks C. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at the end of treatment D. Tyramine-restricted diet, prohibitive concurrent use of OTC medications without physician notification

D

When assessing a client who is receiving tricyclic antidepressant therapy, which of the following should alert the nurse to the possibility that the client is experiencing anticholinergic effects? A. Tremors and cardiac arrhythmias B. Sedation and delirium C. Respiratory depression and convulsions D. Urine retention and blurred vision

D

Which of the following is the best predictor of a client's favorable response to the choice of an antidepressant? A. The drug's side effect profile B. The client's age at diagnosis C. The cost of the medication D. A favorable response by a family member

D

Which statement is true concerning lithium? A. The maximum dose is 3.4 G/day B. The therapeutic drug range is 2.5 to 3.5 mEq/L C. Lithium increases receptor sensitivity to GABA D. Concurrent NSAIDs may increase lithium levels

D

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation

D

Your client with intense suicidal ideation has been hospitalized for 1 week, during which time he has received a SSRI. He reports "no change" in suicidal ideation, although he demonstrates a wider range of affect and takes more initiative in self-care. The health care is considering his imminent discharge. It is essential to consider which of the following factors? A. For 1 week of pharmacotherapy, the client has been free of untoward side effects B. The health care team has to plan for discharge from the day of admission C. The client will continue to improve because the medication has not yet exerted full therapeutic effect D. The client may have enough energy to plan and complete a suicide attempt

D