MH

A 7-year-old child is taking methylphenidate twice daily. The nurse should instruct the parent that the second dose should be administered: 1. before 4 PM. 2. 2 hours after the first dose. 3. at bedtime. 4. at any time; timing is not relevant because of the long half-life.

1

A college student being treated for depression reports taking a 30-day supply of antidepressant drugs at one time. Which antidepressant is the most dangerous in overdose? 1. Venlafaxine 2. Fluoxetine 3. Paroxetine 4. Sertraline

1

A major difference between paraldehyde and other CNS depressants is its: 1. poisoning profile. 2. site of action. 3. primary effect. 4. route of elimination.

1

A nurse assesses a newly admitted hospital patient. Which finding should alert the nurse that the patient may be experiencing major depression? The patient who: 1. reports sleeping 14 to 16 hours per day for the past 3 months. 2. states, "I realize I'm not able to play 18 holes of golf anymore. Now I play 9." 3. comments, "I have asked my sister to help me at home until I am feeling stronger." 4. says, "I've asked my supervisor to reduce my work schedule to 20 hours a week."

1

A nurse compares the actions of benzodiazepines with those of buspirone. Which statement is correct regarding buspirone? 1. It is not a CNS depressant. 2. The effects are more rapid. 3. It is suitable for PRN use. 4. There is a higher abuse potential.

1

A nurse counsels a patient with bipolar disorder, manic phase, who recently started on a mood stabilizer and an antipsychotic. The patient questions the rationale for the antipsychotic drug. Select the nurse's best response. 1. "The antipsychotic drug reduces mania while waiting for the lithium to take effect." 2. "Antipsychotics are long-term components of therapy for bipolar disorder." 3. "Antipsychotics allow higher levels of lithium without signs of toxicity." 4. "The antipsychotic drug is actually the mainstay of bipolar disorder therapy."

1

A patient in the emergency department is being treated for amphetamine toxicity. The nurse plans to administer: 1. an alpha-adrenergic blocker. 2. an alpha agonist. 3. a calcium channel blocker. 4. an ACE inhibitor.

1

A toddler is brought to the emergency department after an accidental ingestion. Because the child exhibited stiffness in the face and neck before tonic contraction of all involuntary muscles, ingestion of which agent is suspected? 1. Strychnine 2. Cocaine 3. Methamphetamine 4. Modafinil

1

An important component of education for a patient on buspirone is to: 1. not take the medication with grapefruit juice. 2. avoid alcohol-containing products. 3. never take the medication with food. 4. beware of signs of dependence and abuse.

1

As a group of agents, benzodiazepines differ from one another in terms of: 1. onset and duration of action. 2. depth of CNS depression. 3. pharmacologic actions. 4. side effects.

1

Fluoxetine achieves its effects by: 1. selectively inhibiting serotonin reuptake. 2. blocking the uptake of monoamines. 3. inhibiting MAO-A in nerve terminals. 4. direct stimulation of serotonin receptors.

1

For how long after an acute episode of psychosis should a nurse expect a patient to take an antipsychotic medication? 1. At least 12 months 2. Life 3. 2 weeks 4. 6 months

1

Most barbiturates are considered nonselective CNS depressants. The major exception is: 1. phenobarbital. 2. thiopental. 3. secobarbital. 4. butabarbital.

1

The nurse assesses a patient who is actively hallucinating and delusional. Which term would most accurately document these findings? 1. Positive symptoms 2. Negative symptoms 3. Affective flattening 4. Attention impairment

1

The only benzodiazepine commonly used to relieve muscle spasm is: 1. diazepam. 2. lorazepam. 3. estazolam. 4. clonazepam

1

When considering an antipsychotic agent for a patient with a cardiac disorder, which characteristic would most affect the decision to use haloperidol rather than risperidone? 1. Second-degree AV block 2. Positive symptoms 3. Hypertension 4. Tachypnea

1

Which statement about chloral hydrate use in practice is accurate? 1. The drug has an abuse pattern similar to that of the barbiturates. 2. It allows for prolonged use without the development of tolerance. 3. Addiction potential is low. 4. There are no gastrointestinal adverse effects.

1

The client diagnosed with severe major depression has been taking Lexapro 10 mg (escitalopram) daily for the past 2 weeks. Which of the following parameters should the nurse monitor most closely at this time? 1. Suicidal ideation. 2. Sleep. 3. Appetite. 4. Energy level.

1. After about 2 weeks of medication therapy, the nurse should expect improvements in sleep, appetite and energy though mood may not have improved significantly yet. The increased energy related to better sleep and food intake gives the client the ability to act on thoughts to harm self (suicide) since the depressed mood has not completely lifted.

What symptoms must be present during the same 2 week period in order to diagnose Major Depressive Disorder?

1. Depressed mood 2. Loss of interest or pleasure (1 or 2 must be at least one of the sx) 3. Significant change in weight (+ or -) or change in appetite (+ or -) 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue/loss of energy 7. Feelings of worthlessness/excessive guilt 8. Inability to concentrate 9. Recurrent thoughts of death/suicide/suicide attempts

What criteria must be present to diagnose a child with Disruptive Mood Dysregulation Disorder?

1. Severe recurrent outbursts grossly out of proportion to the situation 2. Outbursts are inconsistent with developmental level (regression) 3. Outbursts occur 3 or more times a week 4. Mood between outbursts is angry and observable by others 5. Criteria are present for 12 or more months with no more than 3 months without symptoms 6. Criteria are present in at least 2 settings and is severe in at least 1 7. Child should not be diagnosed before age 6 or after age 18

What is the dosage of lithium for acute mania? Maintenance dose?

1.0-1.5 mEq/L 0.6-1.2 mEq/L

How should light therapy be performed?

10 to 15 minute sessions with client sitting in front of lamp with eyes open, but not looking into the lights

. Patients starting treatment with an SSRI should be told to expect an initial response in about: 1. 1-2 days. 2. 1-2 weeks. 3. 2-4 weeks. 4. 4-6 weeks.

2

. Which category of drugs is used for all types of anxiety disorders? 1. Benzodiazepines 2. Selective serotonin reuptake inhibitors 3. Barbiturates 4. Anticonvulsants

2

A depot preparation of an antipsychotic drug is prescribed. What information would the nurse include in counseling this patient? 1. Depot agents are associated with a higher rate of relapse. 2. The drug will be administered by injection every 2 to 4 weeks. 3. There is an increased incidence of neuroleptic malignant syndrome. 4. This agent may be associated with a higher incidence of tardive dyskinesia.

2

A patient complains of feelings of helplessness and fear after being stranded on a rooftop for 3 days after a major hurricane. Which diagnosis is the most likely? 1. Generalized anxiety disorder 2. Post-traumatic stress disorder 3. Obsessive-compulsive disorder 4. Panic disorder

2

A patient complains of lightheadedness on standing since the initiation of an antipsychotic drug. Select the nurse's best response. 1. "This is an unfortunate and permanent effect of this class of drugs." 2. "Get up slowly. Tolerance to this effect should develop in 2 to 3 months." 3. "The drug must be discontinued immediately to avoid injury." 4. "This probably means that you are not getting enough of the drug."

2

A patient is brought to the ED after taking a 30-day supply of benzodiazepines at one time. Which drug should the nurse have available to administer? 1. Naloxone 2. Flumazenil 3. Calcium carbonate 4. Magnesium sulfate

2

A patient reports awakening at 1 AM after only 2 hours of sleep and being unable to return to sleep for several hours. The patient is becoming increasingly anxious and requests a sleeping medication that will not cause a hangover. The nurse anticipates that which drug will be prescribed? 1. Zolpidem 2. Zaleplon 3. Flurazepam 4. Trazodone

2

An adult patient suddenly cries out. The nurse sees the patient's head twisted to the side, the back arched, and the eyes rolled up. The patient has been newly diagnosed with schizophrenia, and therapy with a traditional antipsychotic medication was started yesterday. Select the next nursing action. 1. Obtain the patient's vital signs and pulse oximetry. 2. Administer a PRN dose of diphenhydramine. 3. Administer a PRN dose of haloperidol. 4. Explore the patient's feelings about the new diagnosis.

2

As part of the discharge teaching for a patient taking amitriptyline, the nurse should instruct the patient on the importance of avoiding: 1. caffeine. 2. alcohol. 3. cheese products. 4. exercise.

2

Barbiturates should not be used in patients with: 1. a history of anxiety. 2. suicidal tendencies. 3. an allergy to benzodiazepines. 4. a history of drowsiness with the use of these agents.

2

Clozapine is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient? 1. Strategies to manage breast enlargement and nipple discharge 2. The importance of promptly reporting flulike symptoms 3. Contraceptive measures and expected changes in menstruation 4. The meaning of various components of a white blood cell count

2

In contrast to the barbiturates, the benzodiazepines: 1. cannot cross the blood-brain barrier. 2. have a built-in limit to the depth of CNS depression that they can produce. 3. are not lipid soluble. 4. have more difficulty affecting the CNS.

2

Monoamine oxidase inhibitor antidepressants are: 1. used first-line in the treatment of depression. 2. reserved for patients who have not responded to SSRIs and TCAs. 3. used in patients who have developed serotonergic syndrome. 4. indicated for patients who have difficulty sleeping.

2

Quetiapine (Seroquel) has been associated with the development of: 1. breast cancer. 2. cataracts. 3. ovarian hypertrophy. 4. multiple sclerosis.

2

The actions of zolpidem are similar to the benzodiazepines, although this agent will not: 1. induce sleep. 2. reduce anxiety. 3. affect REM sleep patterns. 4. prolong sleep duration

2

The nurse cares for a patient on an antipsychotic drug who develops acute dystonia. Which drug will most likely be prescribed for this reaction? 1. 5-HT3 blocker 2. Anticholinergic 3. Neuroleptic 4. Tricyclic

2

The parents of a child who has been prescribed methylphenidate (Ritalin) for ADHD should be educated that: 1. hypersomnolence is a major side effect. 2. long-term use does not usually affect the adult height that the child will attain. 3. drug holidays are not warranted. 4. allergic reactions are common.

2

When a patient is taught about the extrapyramidal effects of antipsychotic drugs, information about what symptoms that may develop early in therapy should be included? 1. Severe spasms of the muscles of the tongue, face, neck, or back 2. Pacing and squirming 3. Involuntary upward deviation of the eyes 4. Cramping causing joint dislocation

2

When teaching a patient who has been prescribed modafinil, the nurse should explain that this drug differs from the more traditional amphetamines in that it: 1. has a higher abuse potential. 2. will not disrupt nighttime sleep. 3. is safer for patients with liver disease. 4. is approved for narcolepsy.

2

Which agent is a tricyclic antidepressant with weak anticholinergic properties? 1. Amitriptyline 2. Desipramine 3. Fluvoxamine 4. Citalopram

2

Which antidepressant would be the most useful for a depressed patient with insomnia? 1. Venlafaxine 2. Mirtazapine 3. Bupropion 4. Phenelzine

2

Which drug has replaced lithium as the treatment of choice for bipolar disorder? 1. Clonidine 2. Valproic acid 3. Olanzapine 4. Risperidone

2

Which information would be used by the nurse and multidisciplinary team to evaluate whether the prescribed medication regimen is the most effective one for a patient with bipolar disorder? 1. The patient's report of compliance with the regimen 2. Evidence and acuity of symptoms of the disease 3. Weight changes and daily blood glucose values 4. Serum blood levels of the medication

2

Which statement is correct regarding IV amphetamines? 1. They are indicated for severe hypotension. 2. They are not legally available. 3. They are used in patients unable to take PO medications. 4. They are contraindicated in patients with heart failure.

2

Zaleplon is best suited for patients who: 1. cannot maintain sleep. 2. need or want to fall asleep quickly. 3. are also taking cimetidine. 4. require an agent with a long half-life.

2

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

2 weeks

A patient is being treated in the emergency department for barbiturate toxicity. Select the findings in the "triad" of symptoms seen in this situation. You may select more than one answer. 1. Tachycardia 2. Pinpoint pupils 3. Unresponsiveness 4. Hypertension 5. Respiratory depression

235

Select the accurate statement(s) about differences between bupropion and SSRIs. You may select more than one answer. 1. Bupropion is more likely to cause weight gain. 2. Bupropion will increase seizure activity in a patient with epilepsy. 3. Bupropion is less likely to cause sexual dysfunction. 4. SSRIs are an effective aid to smoking cessation. 5. Bupropion is less likely to cause weight gain.

235

A patient takes amphetamines. Which assessment finding(s) would the nurse expect? You may select more than one answer. 1. Increased fatigue 2. Insomnia 3. Increased appetite 4. Tachycardia 5. Restlessness

245

A nurse counsels a patient who has just started taking buspirone. When should the nurse instruct the patient to expect to see an effect from the drug? 1. 1 hour 2. 24-48 hours 3. 1 week 4. 8-12 weeks

3

A nurse monitors a patient with bipolar disorder who has taken carbamazepine for 2 years. Which laboratory value requires the most diligent surveillance? 1. Serum urea nitrogen 2. Direct bilirubin 3. Complete blood count 4. Thyroid function studies

3

A patient diagnosed with panic disorder is placed on a tricyclic antidepressant. The nurse should counsel the patient to expect full benefit from the drug in: 1. 5-6 days. 2. 2-3 weeks. 3. 1-2 months. 4. 6 months.

3

A patient on an antipsychotic agent suddenly becomes febrile, develops "lead-pipe" rigidity, and appears confused. The nurse should suspect: 1. tardive dyskinesia. 2. acute dystonia. 3. neuroleptic malignant syndrome. 4. Parkinsonism.

3

A patient taking fluoxetine informs a nurse, "I started taking St. John's wort to help my depression." The nurse should: 1. add the herbal preparation to the medications listed in the patient's chart. 2. assess the patient for signs of hypotensive crisis. 3. explain the risk of serotonin syndrome and discourage the use of the herbal preparation. 4. recommend that the patient stop both medications.

3

A patient with bipolar disorder has been on lithium therapy for 3 years. The patient develops hypertension. Which drug added for treatment of the hypertension would cause the most concern? 1. An ACE inhibitor 2. A vasodilator 3. A diuretic 4. A calcium channel blocker

3

A patient with bipolar disorder takes lamotrigine. Which complaint by the patient would prompt the nurse to hold the drug and refer the patient to the physician for further assessment? 1. "I get a little dizzy sometimes." 2. "I had a headache last week that lasted for about an hour." 3. "I've broken out in a rash on my chest and back." 4. "Last night I woke up twice with a bad dream."

3

A patient with major depression is started on sertraline. Which statement by the patient shows a correct understanding of the possible side effects of this medicine? 1. "I may have trouble with stiff muscles." 2. "I need to have frequent, complete blood tests." 3. "I may feel nervous and have trouble sleeping." 4. "I should drink 8 to 10 glasses of water daily."

3

A patient's lithium level is 0.6 mEq/L. The nurse's accurate understanding of lithium therapeutics is best reflected by which statement? 1. The patient's plasma level is below the toxic level of 3.0 mEq/L and is considered therapeutic. 2. The patient's plasma level exceeds 0.5 mEq/L and is therefore toxic. 3. The patient's plasma level is between 0.4 and 1.0 mEq/L and is considered therapeutic. 4. The patient's plasma level is below the 2.5-mEq/L level that would indicate toxicity

3

Haloperidol is classified as: 1. a low-potency antipsychotic drug. 2. a medium-potency antipsychotic drug. 3. a high-potency antipsychotic drug. 4. an atypical antipsychotic drug.

3

How long should patients generally continue antidepressant medications? 1. Until their symptoms have resolved 2. Until side effects develop 3. For 6-12 months after symptoms have resolved 4. For 1 month after symptoms have improved

3

The nurse counsels an 8-year-old child and the parents about the methylphenidate (Concerta) that was just prescribed for ADHD. What information should the nurse give regarding the administration of the drug? 1. Chew one tablet twice daily. 2. Dissolve a tablet in juice or milk in the AM. 3. Swallow the tablet whole once in the AM. 4. Swallow one tablet every 6 hours.

3

The nurse monitors a patient on clozapine. Which laboratory parameter is the most crucial to monitor on a weekly basis? 1. Renal function studies 2. Hepatic function studies 3. Complete blood count 4. Serum clozapine levels

3

The preferred agent for the treatment of Tourette's syndrome is: 1. loxapine. 2. chlorpromazine. 3. haloperidol. 4. perphenazine

3

Which agent is an alternative to SSRIs for obsessive-compulsive disorder? 1. Fluoxetine 2. Amitriptyline 3. Clomipramine 4. Desipramine

3

Which benzodiazepine is preferred in the elderly because it is the least likely to accumulate with repeated dosing? 1. Diazepam 2. Clonazepam 3. Lorazepam 4. Estazolam

3

Which statement is correct about caffeine? 1. Caffeine in cola drinks is limited to the amount derived from the cola nut. 2. Caffeine can counteract CNS depression caused by alcohol. 3. Large amounts of caffeine may cause convulsions. 4. Caffeine causes vasodilation of blood vessels throughout the body.

3

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.

. Alprazolam is prescribed for an adult with panic attacks. The nurse recognizes that this drug works on which neurotransmitter? 1. Norepinephrine 2. Acetylcholine 3. Serotonin (5-HT) 4. Gamma-aminobutyric acid (GABA)

4

A current indication for CNS stimulants is: 1. depression. 2. to counteract poisoning by CNS depressants. 3. appetite stimulation. 4. narcolepsy.

4

A nurse assesses a newly admitted patient with pneumonia. The patient reports, "I've been taking some medicine to help me sleep. I can't remember the name, but it makes me have a bitter taste in my mouth." Which drug would the nurse suspect the patient has been taking? 1. Chloral hydrate 2. Meprobamate 3. Paraldehyde 4. Eszopiclone

4

A nurse assesses a patient receiving perphenazine, a traditional antipsychotic medication. The nurse notices the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. Select the most accurate term for the documentation of these findings. 1. Dystonia 2. CNS effects 3. Alexithymia 4. Akathisia

4

A nurse prepares to collect a health history for a patient with narcolepsy. Which strategy should be used to complete this assessment? 1. Provide a structured form for the patient to complete in writing. 2. Seek information from significant others rather than the patient. 3. Use the patient's past medical records to locate important information. 4. Use short, focused interview sessions with active participation by the patient.

4

A nurse wants to find a description of the diagnostic criteria for depressive disorders. Which resource would have the most complete information? 1. A psychiatric nursing textbook 2. Journal of Mental Health and Psychosocial Nursing 3. Taber's Cyclopedic Medical Dictionary 4. Diagnostic and Statistical Manual of Mental Disorders

4

A patient being treated for anxiety with a selective serotonin reuptake inhibitor antidepressant drug asks about the rationale for the use of this agent rather than a benzodiazepine. Select the nurse's best response. 1. "The SSRI antidepressants are better for the control of somatic symptoms than the benzodiazepines." 2. "The SSRI antidepressants provide a more rapid and durable response to the uncomfortable anxiety symptoms." 3. "The benzodiazepines currently have no role in the treatment of anxiety." 4. "The SSRI antidepressants are better for decreasing the cognitive and psychic symptoms of anxiety than the benzodiazepines."

4

A patient being treated with drug therapy for panic disorder asks the nurse, "How long will I need to take the medication?" How should the nurse respond? 1. "At least one week after the last attack." 2. "Indefinitely." 3. "Just take the medication when you are feeling anxious." 4. "Usually 6 to 9 months or more."

4

A patient has difficulty sleeping well. The patient says, "I wake up a lot during the night and feel tired when I get up in the morning." Which finding best indicates that interventions to improve sleep were effective? 1. The patient is compliant with self-administration of hypnotic medications. 2. The patient has not experienced any falls or injuries. 3. The patient verbalizes an understanding of the causes of insomnia. 4. The patient reports an increased sense of feeling rested.

4

A patient has taken a benzodiazepine for 2 years. With which condition is tolerance to the agent likely to develop? 1. Anxiety 2. Insomnia 3. Sedation 4. Seizures

4

A patient is brought to the emergency department in a state of extreme, uncontrolled anxiety. Why would a benzodiazepine be the drug of choice in this situation? 1. It also helps treat associated depression. 2. There is no risk of physical dependence. 3. This is a drug category shown to cure the disorder. 4. It has a rapid onset of action.

4

A patient on fluphenazine elixir should be instructed that: 1. the drug can be diluted in any beverage. 2. it is acceptable to mix the drug with apple juice. 3. mixing the drug with tea can decrease some of the side effects. 4. water or orange juice can be used to dilute the elixir.

4

A patient takes 300 mg of lithium carbonate 4 times a day. The serum lithium level yesterday was 1.8 mEq/L. The nurse should: 1. continue administering the drug as prescribed. 2. increase the dose to 450 mg. 3. decrease the dose to 150 mg. 4. hold the next dose and notify the prescriber.

4

Blurred vision, dry mouth, and constipation are adverse effects of antidepressants such as amitriptyline. How are these adverse effects classified? 1. Akathisia symptoms 2. Cholinergic effects 3. Tardive dyskinesia symptoms 4. Anticholinergic effects

4

For a patient taking an MAOI, which breakfast choice would indicate the need for additional teaching? 1. Orange juice 2. Sausage 3. Fried eggs 4. Cheese omelet

4

If taken alone, large doses of oral benzodiazepines: 1. cause significant toxicity. 2. antagonize the effects of other CNS drugs. 3. cause profound respiratory depression. 4. are rarely lethal.

4

In patients treated with MAOIs, the nurse should be particularly concerned about the risk of hypertensive crisis in response to: 1. an overdose of the drug. 2. stress. 3. vasodilation. 4. food containing tyramine.

4

When comparing the effects and efficacy of valproic acid with those of lithium, the nurse should understand that valproic acid: 1. does not have gastrointestinal side effects. 2. does not cause weight gain. 3. is associated with unintentional weight loss. 4. has a greater therapeutic index.

4

When comparing the effects of olanzapine with those of clozapine, which statement is correct? 1. Olanzapine produces more tardive dyskinesia. 2. Olanzapine does not cause somnolence. 3. Clozapine has fewer serious side effects. 4. The drugs are similar in structure and actions.

4

Which action would be produced by the administration of caffeine? 1. Vasodilation of blood vessels in the CNS 2. Elevated levels of serum sodium 3. Promotion of fluid retention 4. Bronchodilation

4

Which agent stands out from the other antipsychotics in that it causes less weight gain? 1. Thioridazine (Mellaril) 2. Quetiapine (Seroquel) 3. Olanzapine (Zyprexa) 4. Ziprasidone (Geodon)

4

Which statement is accurate in reference to the use of antidepressants in a breast-feeding mother? 1. No drugs are safe for a breast-feeding mother and the baby. 2. MAOIs are the safest category for the patient population. 3. None of the SSRIs can be used in pregnant or breast-feeding women. 4. Desipramine and nortriptyline have been safely used.

4

Which statement is correct regarding the use of atypical antipsychotic agents? 1. They affect only the positive symptoms of schizophrenia. 2. They affect only the negative symptoms of schizophrenia. 3. They cause more extrapyramidal symptoms. 4. They commonly cause weight gain.

4

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.

The nurse assesses a patient for possible lithium toxicity. Which finding(s) would be consistent with excessive levels of lithium? You may select more than one answer. 1. Weight gain 2. Decreased urine output 3. Constipation 4. ECG changes 5. Ataxia

45

Facts about suicide

8 out of 10 give cues before committing Ambivalent about committing Only suicidal for short period-not forever Most occur within 3 months of "improvement" Not inherited Although very unhappy, suicidal clients are not psychotic or mentally ill All suicidal behavior must be taken seriously Gunshot wounds are leading cause of death by suicide 50 to 80% of those successful had a history of previous attempts

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? A. Tell the client she cannot wear this outfit while she is in the hospital B. Do nothing and allow the client to learn from the responses of her peers C. Quietly walk with her back to her room and help her change into something more appropriate D. Explain to her that if she wears this outfit she must remain in her room

A

A client experiencing acute mania has been taking lithium carbonate 600 mg PO 3 times a day for 14 days. The client's serum lithium level is 1.8 mEq/L. The nurse should: A. Call the physician, hold the next dose of lithium, and push fluids B. Call the physician, start an IV, and put the client on bed rest C. Call the physician, then transfer the client to the ICU D. Inform the client that the lithium level is within normal limits

A

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

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 is planning care for a client being admitted to the unit who attempted suicide. Which of the following priority nursing interventions would the nurse include in the plan of care? A. 1:1 suicide precautions B. Suicide precautions with 30 minute checks C. Checking the whereabouts of the client every 15 minutes D. Asking the client to report suicidal thoughts immediately

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 diagnosed with severe major depression has been taking Lexapro 10 mg daily for the past 2 weeks. Which of the following parameters should the nurse monitor most closely at this time? A. Suicidal ideation B. Sleep C. Appetite D. Energy level

A

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

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 nurse is teaching 2 nursing assistants who are new to the inpatient unit about caring for a client who is suicidal. The nurse determine that additional teaching is needed when which of the following statements is made? A. I need to check the client precisely at 15 minute intervals B. Documenting suicidal checks is absolutely necessary C. Clients on one-to-one suicide precautions can never be left alone D. All clients using razors must be supervised by staff

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

The physician orders mirtazapine (Remeron) 30 mg PO at bedtime for a client diagnosed with depression. The nurse should: A. Give the medication as ordered B. Question the physician's order C. Request to give the medication in the morning D. Give the medication in 3 divided doses

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)

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

A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply. A. Slumped Posture B. Delusional Thinking C. Feelings of Despair D. Feels Best in AM, Worsening Through Day E. Anorexia

A, B, C, E

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

The client with bipolar disorder, manic phase, has a valproic acid (Depakote) level of 15 ug/mL. Which of the following client behaviors should the nurse judge to be due to his level of valproic acid? Select all that apply. A. Irritability B. Grandiosity C. Anhedonia D. Hypersomnia E. Flight of Ideas

A, B, E

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply. A. Olanzepine (Zyprexa) B. Paroxetine (Paxil) C. Carbamazepine (Tegretol) D. Gabapentin (Neurontin) E. Tranylcypromine (Parnate)

A, C, D

A patient is being treated for muscle spasms. A nurse is preparing to administer a prn medication for this patient. The nurse is aware that the only benzodiazepine commonly used to relieve muscle spasm is which of the following? a. Diazepam (Valium) b. Lorazepam (Ativan) c. Estazolam (Prosom) d. Clonazepam (Klonopin)

ANS: A A benzodiazepine (diazepam) is used to relive muscle spasm and spasticity. Lorazepam's primary indication is as an antianxiety medication or to manage status epileptics. Estazolam is used primarily to manage sleep disturbances. Clonazepam is used primarily to manage panic disorders.

A toddler is brought to the emergency department by ambulance. The parents state that they think the child "got into something" at a friend's house. The nursing assessment reveals stiffness in the face and neck and hyperreflexes. The nurse is correct to suspect ingestion of which of the following agents? a. Strychnine b. Cocaine c. Methamphetamine d. Modafinil (Provigil)

ANS: A A common cause of strychnine poisoning is accidental ingestion from strychnine-based rodenticides. The first manifestation of poisoning is stiffness in the muscles of the face and neck, followed by a generalized increase in reflex excitability. The assessment findings are inconsistent with cocaine or methamphetamine overdose. The assessment findings are not consistent with modafinil overdose or ingestion.

A nurse has just admitted a female patient to the medical-surgical unit for a recurrent urinary tract infection. Which finding should alert the nurse that the patient may be experiencing major depression? a. A patient who reports sleeping 14 to 16 hours per day for the past 3 months. b. A patient who states, "I feel pretty emotional about once a month." c. A patient who comments, "I have asked my sister to help me at home until I am feeling stronger." d. A patient who says, "I'm a bit of a loner. I love to read and surf the Internet."

ANS: A A major depressive episode may manifest as hypersomnia or insomnia; these patients also take no pleasure or interest in their usual activities or pastimes. Feeling emotional once a month may be premenstrual syndrome and is not indicative of major depression. Asking a sister to assist at home is a positive action and not indicative of major depression. Being a loner is not problematic, especially when the person is interested in other pastimes; therefore, this is not indicative of major depression.

A patient taking amitriptyline (Elavil) is brought to the emergency department confused and agitated. As time progresses, her assessment reveals a heart rate of 120/minute, temperature 104° F, flushing, mydriasis, and blood pressure 170/90. Based on her assessment, which of the following would be the nurse's priority action? a. Gastric lavage, activated charcoal, and physostigmine b. Epinephrine and propranolol (Inderal) c. Gastric lavage, activated charcoal d. Cool IV fluids and a cooling blanket

ANS: A Amitriptyline overdose should be suspected based on the patient's assessment findings. The patient should be treated with gastric lavage, followed by ingestion of activated charcoal, which will bind with the medication so that it is removed from the body. Physostigmine is given to counteract the anticholinergic actions of the amitriptyline. Epinephrine and propranolol are not indicated as treatment for amitriptyline overdose. There is no reason to suspect that alcohol toxicity is the issue. Physostigmine should be included as part of the management of amitriptyline overdose. Bringing down the patient's temperature is not indicated for amitriptyline overdose.

A patient is brought to the emergency department by friends, who say that they were all partying with alcohol and a mix of barbiturates and benzodiazepines. They state that the patient had "a lot to drink and took a handful of pills a couple of hours ago." Upon assessment, the patient is nonresponsive and has pinpoint pupils and respirations of 6/minute. After oxygen is administered, the nurse should prepare the patient for which of the following interventions? a. Both gastric lavage and hemodialysis b. Both naloxone (Narcan) and a cathartic c. Both activated charcoal and flumazenil (Romazicon) d. Both a central nervous system stimulant and IV fluids

ANS: A Because over 2 hours have elapsed, enough medication is present in the system to warrant elimination by hemodialysis, and the remainder in the stomach may be eliminated by gastric lavage. Naloxone, a narcotic antagonist, is not effective for barbiturates and benzodiazepines. Although activated charcoal may assist in absorption of medication in the gut, flumazenil will be effective only for the benzodiazepines. A central nervous system stimulant is contraindicated, and intravenous fluids do not address the overdose.

A nurse compares the actions of benzodiazepines with those of buspirone (BuSpar). Which statement is correct regarding buspirone (BuSpar)? a. Buspirone is not a central nervous system depressant. b. The effects of buspirone are more rapid than those of benzodiazepines. c. Buspirone is suitable for an as-needed medication use. d. The potential for abuse is higher with buspirone than with the benzodiazepines.

ANS: A Buspirone is not a central nervous system depressant. The effects of buspirone manifest less rapidly than those of the benzodiazepines. Buspirone is not suitable for an as-needed medication because of the delay in therapeutic effects. The potential for abuse is lower with buspirone than with the benzodiazepines.

A nurse is providing education to nurses in the psychiatric unit on antidepressant medications. To evaluate their learning, the educator asks one of the nurses, "How does fluoxetine (Prozac) achieve its effects?" The nurse would be correct to state that fluoxetine (Prozac) achieves its effects by which of the following mechanisms of action? a. Selectively inhibiting serotonin reuptake b. Blocking the uptake of monoamines c. Inhibiting monoamine oxidase-A in nerve terminals d. Direct stimulation of serotonin receptors

ANS: A Fluoxetine produces selective inhibition of serotonin reuptake and intensifies transmission at serotonergic synapses. Fluoxetine does not act by blocking uptake of monoamines or inhibiting monoamine oxidase-A nerve terminals, nor does it directly stimulate serotonin receptors.

A patient is being discharged from the hospital on buspirone (BuSpar). A nurse is providing education on the effects and side effects of the medication. What statement made by the patient would most concern the nurse? a. "I will take the medication with grapefruit juice." b. "I will limit alcohol-containing products." c. "I can take the medication with food." d. "This drug is not addicting."

ANS: A Grapefruit juice can increase levels of buspirone, which can cause drowsiness and dysphoria; this statement indicates a need for further teaching. The patient is correct in stating that alcohol-related products should be limited. The patient is correct that the medication may be taken with food. The patient is correct in stating that buspirone is not addicting.

A patient who just returned from a war-torn country is admitted to the hospital with post-traumatic stress disorder. A nurse anticipates that the prescriber will order which of the following medications for the patient? a. Paroxetine (Paxil) b. Alprazolam (Xanax) c. Clomipramine (Anafranil) d. Venlafaxine (Effexor XR)

ANS: A Paroxetine is approved by the FDA for post-traumatic stress disorder. Alprazolam is used to treat anxiety. Clomipramine is used to treat obsessive-compulsive disorder. Venlafaxine is used to treat anxiety.

A nurse assesses a patient who is actively hallucinating and delusional. Which term would most accurately describe these findings? a. Positive symptoms b. Negative symptoms c. Affective flattening d. Attention impairment

ANS: A Positive symptoms can be viewed as an exaggeration or distortion of normal psychological function. Positive symptoms include hallucination, delusions, agitation, tension, and paranoia. Negative symptoms can be viewed as a loss or diminution of normal function. Negative symptoms include a lack of motivation, poverty of speech, blunted affect, poor self-care, and social withdrawal. Affective flattening is not descriptive of hallucinations or delusion. Hallucinations and delusions are not described by attention impairment.

A patient taking fluoxetine (Prozac) complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a "drug holiday"? a. Don't take the medication on Friday and Saturday. b. Cut the tablet in half anytime to reduce the dosage. c. Take the drug every other day. d. Discontinue the drug for 1 week.

ANS: A Sexual dysfunction may be managed by having the patient take a "drug holiday" which involves discontinuing medication on Fridays and Saturdays. Cutting the tablet in half any time to reduce the dosage is an inappropriate way to effectively manage drug administration. In addition, it does not describe a "drug holiday." The patient should not take the drug every other day, nor should it be discontinued for a week at a time as this will diminish the therapeutic levels of the drug, thereby minimizing the therapeutic effects. In addition, neither option describes a "drug holiday."

A 7-year-old child is to begin taking methylphenidate (Ritalin SR) twice daily. The nurse should teach the parents to monitor the child closely for which of the following side effects of methylphenidate? a. Insomnia b. Lethargy c. Increased appetite d. Urticaria

ANS: A Side effects of methylphenidate include insomnia, reduced appetite, and emotional lability. Lethargy, increased appetite, and urticaria are not side effects of methylphenidate.

A nurse is making patient rounds and determines that one of her patients is having paradoxical symptoms related to the use of benzodiazepines. Which of the following symptoms would the patient manifest? a. Insomnia, excitation, euphoria, and rage b. Laryngeal edema, hypotension, and wheals c. Vasodilation, flushing, and orthostatic hypotension d. Confusion, central nervous system depression, and disorientation

ANS: A The paradoxical symptoms manifested by someone using benzodiazepines are insomnia, excitation, euphoria, and rage. Laryngeal edema, hypotension, and wheals are manifestations of anaphylaxis. Vasodilation, flushing, and orthostatic hypotension indicate an adverse reaction to the medication. Confusion, central nervous system depression, and disorientation may be manifestations of a benzodiazepine overdose.

A nurse is assessing a patient on benzodiazepines who exhibits drowsiness, lethargy, and confusion, and has respirations of 11/minute. The nurse recognizes these signs and symptoms and should prepare to administer which drugs ordered by the prescriber? a. Flumazenil (Romazicon) b. Naloxone (Narcan) c. Epinephrine (adrenaline) d. Atropine (AtroPEN)

ANS: A The patient exhibits signs and symptoms of benzodiazepine overdose, therefore the nurse should administer an antagonist such as flumazenil. Naloxone is indicated for narcotic overdose. Epinephrine is indicated for anaphylaxis. Atropine is indicated for cholinergic overdose.

A patient taking fluoxetine (Prozac) complains of insomnia. The nurse reports the patient's complaint to the prescriber and should anticipate that which of the following medications would be ordered? a. Trazodone (Desyrel) b. Ramelteon (Rozerem) c. Diphenhydramine (Nytol) d. Zolpidem (Ambien)

ANS: A Trazodone is especially useful for treating insomnia resulting from the use of antidepressants that cause significant central nervous system stimulation. Ramelteon is indicated for long-term therapy of insomnia. Diphenhydramine and zolpidem are not indicated for antidepressant insomnia.

A college student is brought into the emergency department for treatment after friends say that she took at least 20 antidepressant pills all at once. A nurse should be most concerned that of all the antidepressants, which of the following could lead to the worst outcome for the patient? a. Venlafaxine (Effexor) b. Fluoxetine (Prozac) c. Paroxetine (Paxil) d. Sertraline (Zoloft)

ANS: A Venlafaxine can cause dose-related, sustained diastolic hypertension, a medical crisis for the patient. Fluoxetine, paroxetine, and sertraline, all selective serotonin reuptake inhibitors, may do harm to the patient when taken in such a large dose, but death by overdose is extremely rare.

A nurse is providing patient education for a patient just starting therapy with an antipsychotic agent. The nurse teaches the patient about the extrapyramidal effects of antipsychotic drugs, and provides information about symptoms that may develop early in therapy. The patient demonstrates understanding when he identifies which of the following as early extrapyramidal symptoms? a. Mild spasms of the muscles of the tongue, face, neck, or back b. Pacing and squirming c. Involuntary upward deviation of the eyes d. Cramping that causes joint dislocation

ANS: B Akathisia is characterized by pacing and squirming, which are extrapyramidal symptoms brought on by an uncontrollable need to be in motion. Mild spasms of the muscles of the tongue, face, neck, and back are not associated with acute dystonia; the symptoms would be severe. Involuntary upward deviation of the eyes, also known as oculogyric crisis, is another symptom of acute dystonia, but it is not an early extrapyramidal symptom. Cramping that causes joint dislocation is associated with opisthotonus, which is consistent with acute dystonia but is not an early extrapyramidal symptom.

Since the initiation of an antipsychotic drug, a patient complains of light-headedness and dizziness upon standing. Select the most appropriate comment the nurse can offer the patient. a. "This is an unfortunate and permanent effect of this class of drugs." b. "Get up slowly. Tolerance to this effect should develop in 2 to 3 months." c. "The drug must be discontinued immediately to avoid injury." d. "We need to increase your fluid intake, which should fix the problem."

ANS: B Antipsychotic drugs promote orthostatic hypotension, which causes blood pressure to fall when the patient stands because of vasodilation; this results in light-headedness and dizziness. The effect is not permanent and subsides within 2 to 3 months as the patient develops tolerance. The effects described by the patient are not permanent, and the use of the words "this is an unfortunate..." is nontherapeutic. The drug does not need to be discontinued. Tolerance to the orthostatic hypotension should develop in 2 to 3 months. Increasing fluid intake may help, but the most appropriate response from the nurse provides the patient with better information on what to anticipate.

Two nursing students studying pharmacology are discussing the contraindications to the use of barbiturates. Which statement made by one of the students best demonstrates an understanding of the use of barbiturates? a. "Barbiturates should not be used in patients with a history of delirium." b. "Barbiturates should not be used in patients with suicidal tendencies." c. "Barbiturates should not be used in patients with an allergy to benzodiazepines." d. "Barbiturates should not be used in patients with a history of drowsiness with the use of these agents."

ANS: B Barbiturates have a low therapeutic index; overdose may rapidly lead to death. Because of their toxicity, barbiturates frequently are used as a means of suicide and should not be prescribed to patients with suicidal tendencies. Barbiturates may be used in patients with a history of delirium. Barbiturates may be used in patients with a history of allergy to benzodiazepines. Central nervous system depression and drowsiness may be side effects of barbiturates; therefore, if the drugs have been used previously, these would be expected findings.

A nurse is caring for a patient taking chlorpromazine (Thorazine) who is to be discharged from the hospital. What information about chlorpromazine (Thorazine) would be most important for the nurse to include in the discharge teaching? a. Do not drive for 6 months. b. Avoid excessive exposure to sunlight and wear sunscreen. c. This medication may actually enhance your libido. d. Monitor your blood pressure frequently to avoid hypertension.

ANS: B Drugs in the phenothiazine class, such as chlorpromazine, can sensitize the skin to ultraviolet light and increase the risk of severe sunburn. Patients should be instructed to avoid excessive exposure to sunlight, to apply sunscreen, and to wear protective clothing when outside. Chlorpromazine has no effect on a patient's ability to drive a car. Antipsychotic agents, such as chlorpromazine, can actually impair the libido, orgasm, and ejaculation. Orthostatic hypotension, not hypertension, is a side effect of antipsychotics such as chlorpromazine.

A patient with a history of gastric ulcers is admitted to the unit. A nurse reviews the admission medications. During the health history, the nurse notes that the patient has been taking nonsteroidal anti-inflammatory drugs and fluoxetine (Prozac). Which of the following laboratory tests would be the priority for the nurse to make sure that the prescriber has ordered? a. Sodium level b. Platelet level c. Fluoxetine (Prozac) level d. Potassium level

ANS: B Fluoxetine and other selective serotonin reuptake inhibitors can increase the risk of bleeding in the gastrointestinal tract, and caution is advised in patients taking nonsteroidal anti-inflammatory drugs; together, these drugs put this patient, who has a history of ulcers, at great risk for bleeding episodes. Sodium, fluoxetine, and potassium levels are not indicated as a priority for this patient.

A patient recently diagnosed with bipolar disorder has been admitted to the unit with severe mania. Home medications include valproic acid (Depakene). An antipsychotic medication is added to the medication regimen as a STAT order. After the new medication is explained to the patient, he states, "I'm not crazy. Why am I receiving this antipsychotic medication?" What is the nurse's most appropriate response to the patient? a. "The antipsychotic drug reduces your manic episode." b. "The antipsychotic will help control symptoms during severe manic episodes." c. "The antipsychotic allows higher levels of valproic acid without signs of toxicity." d. "The antipsychotic is actually the primary drug therapy for bipolar disorder."

ANS: B In patients with bipolar disorder, antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. The antipsychotic drugs usually are given in combination with a mood stabilizer. The antipsychotic drug addresses the symptoms, not the duration, of the manic episode. Antipsychotic medications do not affect valproic acid levels. Antipsychotics are not the primary therapy for bipolar disorder.

A nurse is checking on her patients during the night shift. One of the patients admitted with major depression complains of insomnia. The nurse should notify the patient that she will discuss the insomnia with the prescriber, but she suspects that the prescriber may order which of the following drugs? a. Venlafaxine (Effexor) b. Mirtazapine (Remeron) c. Bupropion (Wellbutrin) d. Phenelzine (Nardil)

ANS: B Mirtazapine may cause somnolence and aid sleeping, because it has an increased release of serotonin. Venlafaxine may actually contribute to the patient's insomnia and therefore would not be recommended for this patient. Bupropion has the side effects of agitation, excitability, and insomnia and therefore would not be recommended for this patient. Phenelzine can cause insomnia as a side effect and therefore would not be recommended for this patient.

While providing patient education for a patient who has been prescribed modafinil (Provigil), the nurse should explain that this drug differs from the more traditional amphetamines in which of the following ways? a. Modafinil has a higher potential for abuse. b. Modafinil will not disrupt nighttime sleep. c. Modafinil is safer for patients with liver disease. d. Modafinil is approved for narcolepsy.

ANS: B Modafinil does not disrupt nighttime sleep, a side effect often seen with other amphetamines. Modafinil has a lower potential for abuse than traditional amphetamines. Modafinil is eliminated primarily by the liver, therefore it would not be safer for patients with liver disease. As can most amphetamines, modafinil can be prescribed for narcolepsy.

A patient is to continue taking sustained-released benzodiazepines at home. A nurse has provided patient education about the medication. Which statement made by the patient demonstrates the need for further teaching? a. "I can take my medicine with food to reduce stomach upset." b. "I should take two pills if I miss a dose." c. "I should not crush or chew my pills." d. "I should try not to drive if I am sleepy during the day."

ANS: B Patients should be warned not to increase the dose or discontinue treatment of benzodiazepines without consulting the prescriber. Benzodiazepines may be taken with food to reduce gastrointestinal or stomach upset. Benzodiazepines should not be crushed or chewed. Driving should be avoided when the patient is sleepy or has residual effects associated with benzodiazepines.

Clozapine (Clozaril) is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient? a. Strategies to manage breast enlargement and nipple discharge b. The importance of promptly reporting flulike symptoms c. Contraceptive measures and expected changes in menstruation d. Proper technique for measuring blood pressure

ANS: B Patients taking clozapine should be informed about the risk of agranulocytosis and must have a weekly blood test. They should be instructed to inform their primary health care provider immediately about any early signs of infection (e.g., fever, sore throat, fatigue, mucous membrane ulceration). Breast enlargement and nipple discharge are not adverse effects of clozapine. Changes in menstruation are important to include in patient education, but this is not the most important information. Changes in blood pressure are not adverse effects of clozapine.

A patient discloses feelings of helplessness and fear after being stranded on a rooftop for 3 days after a major hurricane. Which nursing diagnosis would be most appropriate for this patient? a. Ineffective coping related to generalized anxiety disorder b. Fear related to post-traumatic stress disorder c. Alteration in activities of daily living related to obsessive-compulsive disorder d. Fear secondary to panic disorder

ANS: B Post-traumatic stress disorder develops after a traumatic event that elicited an immediate reaction of fear, helplessness, or horror. This patient's fear is directly related to the traumatic event experienced. This patient is not experiencing generalized anxiety, therefore this is an inappropriate nursing diagnosis. This patient is not experiencing obsessive-compulsive disorder, therefore this is an inappropriate nursing diagnosis. Although the patient is experiencing panic and fear, the symptoms are directly related to post-traumatic stress disorder, therefore panic disorder is not an appropriate nursing diagnosis.

The nurse is providing patient education on quetiapine (Seroquel). The nurse correctly tells the patient that she should be closely monitored for the development of what health condition secondary to the use of quetiapine? a. Breast cancer b. Cataracts c. Hypertension d. Multiple sclerosis

ANS: B Quetiapine may pose a risk for the development of cataracts. The patient's eyes should be examined prior to the initiation of treatment and at least every 6 months during treatment. Quetiapine is not associated with the development of breast cancer. Quetiapine is not associated with hypertension; to the contrary, it causes orthostatic hypotension. Quetiapine is not associated with the development of multiple sclerosis.

A nurse is acting as a preceptor to a graduate nurse. They are discussing the differences between various medications. The nurses understand that, in contrast to the barbiturates, the benzodiazepines have which principal mechanism of action? a. They cannot pass the blood-brain barrier. b. They have limited central nervous system depression effects. c. They are not lipid soluble. d. They have more difficulty affecting the central nervous system.

ANS: B The ability of benzodiazepines to depress central nervous system function is low. Because of their high lipid solubility, benzodiazepines readily cross the blood-brain barrier to reach sites in the central nervous system. Benzodiazepines readily cross the blood-brain barrier. Benzodiazepines are highly lipid soluble. Benzodiazepines do not have more difficulty affecting the central nervous system than barbiturates do.

An adolescent has been prescribed atomoxetine (Strattera) for attention-deficit/hyperactivity disorder. During the health history, the parents state that they hope this medication will improve the girl's ability to make friends, because at times she seems so sad. In providing discharge instructions to the patient and family, what teaching would be most important for the nurse to include? a. Atomoxetine can cause nausea and vomiting. b. Atomoxetine can cause suicidal thinking. c. Atomoxetine can cause difficulty sleeping. d. Atomoxetine can cause euphoria.

ANS: B The adolescent patient should be monitored for suicidal thinking. Although the incidence is low, a social history should be obtained, and the patient should be closely monitored, because cases of suicide have been reported for adolescents take atomoxetine. Nausea, vomiting, and difficulty sleeping also can occur, but these are not the most important considerations for adolescents with an increased risk of suicidal ideation. Atomoxetine does not cause euphoria.

A nurse is reviewing a patient's antidepressant medications. The nurse understands that the monoamine oxidase inhibitor antidepressants are typically used for which patient? a. A patient who has just started on antidepressants b. A patient who has not responded to selective serotonin reuptake inhibitors and tricyclic antidepressants c. A patient who has developed serotonin syndrome d. A patient who has difficulty sleeping

ANS: B The monoamine oxidase inhibitors are the second or third choice of antidepressants for most patients, after selective serotonin reuptake inhibitors and tricyclic antidepressants. Monoamine oxidase inhibitors are not used as first-line agents for the treatment of depression. Monoamine oxidase inhibitors are not used in patients who have serotonin syndrome or difficulty sleeping.

An adult patient suddenly cries out. A nurse sees the patient's head twisted to the side, arched back, and the eyes rolled up. The patient has been newly diagnosed with schizophrenia, and therapy with a traditional antipsychotic medication was started yesterday. Based on the nurse's assessment, what would be the next nursing action? a. Obtain the patient's vital signs and pulse oximetry. b. Administer a PRN dose of diphenhydramine (Benadryl). c. Administer a PRN dose of haloperidol (Haldol). d. Obtain a serum drug level and reassure the patient.

ANS: B The patient is displaying symptoms of intense dystonia, a crisis that can occur after administration of an antipsychotic medication. The crisis should be managed with a dose of diphenhydramine. Vital signs may be obtained after the initial management of the physiological crisis. Haloperidol is not indicated for the treatment of acute dystonia; in fact, it is an adverse effect of haloperidol. Obtaining a serum drug level is not an immediate concern.

A nurse is caring for a patient who just started on an antipsychotic drug and begins to complain of severe muscle spasms of the tongue, face, and back. Based on these manifestations, which class of drugs should the nurse anticipate that the prescriber will order? a. Narcotic antagonist b. Anticholinergic agent c. Neuroleptic agent d. Tricyclic agent

ANS: B The patient shows clear evidence of extrapyramidal symptoms involving acute dystonia, such as severe spasms of the muscles of the tongue, face, neck, and back. A narcotic antagonist is indicated only for a narcotic overdose. A neuroleptic agent is not indicated in this situation. A tricyclic antidepressant is not indicated in this situation.

A patient reports awakening at 1 AM after only 2 hours of sleep and is unable to return to sleep for several hours. The patient is becoming increasingly anxious and requests a sleeping medication that will not cause a "hangover." The nurse would anticipate the prescriber to order which one of the following drugs? a. Zolpidem (Ambien) b. Zaleplon (Sonata) c. Flurazepam (Dalmane) d. Trazodone (Desyrel)

ANS: B Zaleplon does not produce next day sedation or a "hangover" feeling and therefore would be the expected medication for the prescriber to order. Zolpidem, flurazepam, and trazodone may cause next day sedation and/or a "hangover" feeling and therefore would not be appropriate for this patient. DIF: Cognitive Level: Application REF: p. 373 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

In a review class on medications, nurses are discussing the actions of zolpidem (Ambien) and benzodiazepines. A nurse correctly states that the actions of zolpidem (Ambien) do not produce which of the following effects that benzodiazepines do? a. Induce sleep. b. Reduce anxiety. c. Affect REM sleep. d. Prolong sleep duration.

ANS: B Zolpidem does not reduce anxiety, as the benzodiazepines do. Both zolpidem and benzodiazepines induce sleep, affect REM sleep, and prolong the duration of sleep. DIF: Cognitive Level: Application REF: p. 372 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse recognizes that the actions of benzodiazepines include which of the following findings? (Select all that apply.) a. Sleep deprivation b. Relief of general anxiety c. Suppression of seizures and/or seizure activity d. Development of tardive dyskinesia e. Increase in muscle spasms

ANS: B, C Benzodiazepines are indicated to relieve the symptoms of general anxiety and to suppress the central nervous system, thereby suppressing seizures and/or seizure activity. Benzodiazepines cause sleepiness, not sleep deprivation. Benzodiazepines do not cause tardive dyskinesia. Benzodiazepines relax muscles, they do not increase muscle spasms.

A nurse assesses the patient for possible lithium toxicity when the serum lithium level reaches 2.5 mEq/L. Which clinical manifestations would the nurse anticipate with lithium toxicity? (Select all that apply.) a. Hyperactivity b. Slurred speech c. Constipation d. Muscle twitching e. Ataxia f. Hypertension

ANS: B, D, E A patient with lithium toxicity is hyponatremic, which may be manifested by slurred speech, muscle twitching, and mild to moderate ataxia. Hyperactivity, constipation, and hypertension are not manifestations associated with lithium toxicity.

A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which of the following answers? (Select all that apply.) a. Amphetamines increase fatigue. b. Amphetamines suppress the perception of pain. c. Amphetamines increase appetite. d. Amphetamines increase the heart rate. e. Amphetamines elevate mood.

ANS: B, D, E At customary doses, amphetamines increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Amphetamines also suppress appetite and the perception of pain and increase the heart rate. Amphetamines do not increase fatigue or appetite.

A nurse is reviewing laboratory findings for a patient with bipolar disorder. The patient is to be started on carbamazepine (Tegretol). Which laboratory value should the nurse be prepared to obtain as a baseline level? a. Blood urea nitrogen b. Direct bilirubin c. Complete blood count d. Thyroid function studies

ANS: C A complete blood count should be obtained at baseline and periodically thereafter. Carbamazepine can cause changes in hematological laboratory values. Blood urea nitrogen, direct bilirubin, and thyroid function studies are not adversely effected by carbamazepine.

A patient with a history of bipolar disorder has been on lithium therapy for 3 years. The patient begins to develop hypertension. Which class of drugs, if given concurrently with lithium, would result in an adverse drug-to-drug interaction? a. ACE inhibitors b. Vasodilators c. Diuretics d. Calcium channel blockers

ANS: C Diuretics promote sodium loss and thereby can increase the risk of lithium toxicity. Toxicity occurs because in the presence of low sodium, renal excretion of lithium is reduced, which causes lithium levels to rise. There are no adverse drug-to-drug interactions between lithium and ACE inhibitors, vasodilators, and calcium channel blockers, therefore any of them can be given to treat the patient's hypertension.

A patient with bipolar disorder takes lamotrigine (Lamictal). Which statement made by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? a. "I get a little dizzy sometimes." b. "I had a headache last week that lasted for about an hour." c. "I've broken out in a rash on my chest and back." d. "Last night I woke up twice with a bad dream."

ANS: C Evidence of a rash in a patient taking lamotrigine requires further assessment, because this may indicate the development of Stevens-Johnson syndrome. Although dizziness and headaches are side effects of lamotrigine, they are not potentially life-threatening. A bad dream is not necessarily related to the lamotrigine.

A patient taking an antipsychotic agent begins to drool and displays tremors, rigidity, and a shuffling gait. The nurse is correct to suspect that the patient is experiencing extrapyramidal symptoms that are consistent with assessment findings for which of the following disorders? a. Akathisia b. Tourette's syndrome c. Parkinsonism d. Tardive dyskinesia

ANS: C Extrapyramidal symptoms are movement disorders resulting from the effects of antipsychotic drugs on the extrapyramidal motor system. The patient's symptoms are consistent with parkinsonism, because they mirror the symptoms that patients with Parkinson's disease exhibit, such as tremors, rigidity, shuffling gait, and a masklike face. Akathisia is characterized by pacing and squirming. Tourette's syndrome is manifested by uncontrollable motor tics, barking cries, grunts, and outbursts of obscene language. Tardive dyskinesia is characterized by involuntary twisting, writhing, and wormlike movements.

A nurse is discussing lithium levels with another nurse. As they review the laboratory findings, they discover a lithium level of 0.6 mEq/L. Which statement made by one of the nurses best demonstrates an understanding of lithium levels? a. The patient's plasma level is below the toxic level of 3 mEq/L and is considered therapeutic. b. The patient's plasma level exceeds 0.5 mEq/L and is therefore toxic. c. The patient's plasma level is between 0.4 and 1 mEq/L and is considered therapeutic. d. The patient's plasma level is below the 2.5 mEq/L level that would indicate toxicity.

ANS: C For maintenance therapy, lithium levels should range from 0.4 to 1 mEq/L. Lithium toxicity is defined as a level above 1.5 mEq/L. A lithium level of 0.5 mEq/L is considered therapeutic. Lithium toxicity is defined as a level above 1.5 mEq/L.

Haloperidol (Haldol Decanoate) has been ordered for a patient admitted with schizophrenia. A nurse understands that this drug should be administered at what intervals? a. Twice per day b. Once per week c. Every 2 to 4 weeks d. As needed

ANS: C Haloperidol should be administered in a dosing interval of 2 to 4 weeks. These dosing intervals are incorrect.

A patient has been admitted to the hospital for complications associated with obesity. The nurse has received an order for the patient for dextroamphetamine sulfate 15 mg, given intravenously every 6 hours. Based on this situation, the nurse's next action would be which of the following interventions? a. Call the prescriber, because the medication is not indicated for obesity. b. Administer the medication as ordered. c. Call the prescriber and clarify the route of administration of the drug. d. Check the patient's vital signs prior to administration.

ANS: C In clinical practice, amphetamines are given orally. These drugs are not approved for intravenous administration. Amphetamines are indicated for obesity. The medication should not be administered as ordered. Obtaining vital signs is important, but not as important as questioning the route of administration ordered for the medication.

A nurse has just administered a barbiturate to an elderly debilitated patient. The nurse understands that the patient is likely to exhibit a. suicidal tendencies. b. hangover effects. c. paradoxical excitement. d. hyperalgesia.

ANS: C In some patients, including the elderly and debilitated individuals, barbiturates may cause excitation, a paradoxical response. Suicidal tendencies are not commonly associated with barbiturate use in the elderly. Hangover and hyperalgesia are not specific to the elderly debilitated patient as they relate to barbiturate use.

A nurse counsels an 8-year-old child and the parents about the methylphenidate (Concerta LD) that was just prescribed for attention-deficit/hyperactivity disorder. What information should the nurse provide regarding administration of the drug? a. "Chew one tablet twice daily." b. "Dissolve a tablet in juice or milk in the morning." c. "Do not crush or chew the medication." d. "Crush the medicine and mix it in apple sauce."

ANS: C Methylphenidate tablets must be swallowed whole. Methylphenidate tablets should not be crushed, chewed, or dissolved in liquids

A nurse is checking on his patients. He enters the room of a patient who takes an antipsychotic agent. The patient is confused, has a sudden fever, and develops "lead-pipe" rigidity. The nurse recognizes these symptoms as which of the following? a. Tardive dyskinesia b. Acute dystonia c. Neuroleptic malignant syndrome d. Parkinsonism

ANS: C Neuroleptic malignant syndrome is rare but serious. The primary symptoms are "lead-pipe" rigidity, sudden high fever, and confusion. Tardive dyskinesia is manifested by involuntary twisting, writhing, and wormlike movements. Acute dystonia is manifested by severe spasm of the muscles of the tongue, face, neck, and back. Other manifestations include oculogyric crisis and opisthotonus. Parkinsonism is manifested by tremors, rigidity, shuffling gait, and a masklike face.

A patient with major depression is started on sertraline (Zoloft). A nurse is providing patient education. Which statement by the patient best demonstrates understanding of the possible side effects of sertraline (Zoloft)? a. "I may have trouble with stiff muscles." b. "I need to have frequent, complete blood tests." c. "I may feel nervous and have trouble sleeping." d. "I should drink 8 to 10 glasses of water daily."

ANS: C The patient is correct to state that nervousness and insomnia may be experienced, because these are common side effects of sertraline. Stiff muscles are not a side effect of sertraline therapy. There is no need for the patient to have frequent complete blood tests. There is no need to increase fluid intake in a patient on sertraline therapy.

A patient diagnosed with panic disorder is placed on a tricyclic antidepressant. The patient asks a nurse when the medication will take full effect. The nurse's best response would be which of the following time frames? a. 3 to 7 days b. 1 to 3 weeks c. 1 to 2 months d. 6 months

ANS: C Tricyclic antidepressants, similar to other classes of antidepressants, have initial responses that develop in approximately 1 to 3 weeks. Maximal responses may take up to 1 to 2 months to develop. These time frames are incorrect.

A patient comes to the clinic complaining of insomnia. In his health history, the patient reveals that he works in a coffee shop, and as a snack he has been eating a cup of chocolate-covered coffee beans daily in the late afternoon. Based on the patient's statement, the nurse should assess for what other clinical manifestations? (Select all that apply.) a. Vasodilation of blood vessels in the central nervous system b. Elevated serum sodium levels c. Diuresis d. Bronchodilation e. Nervousness

ANS: C, D, E Caffeine, which the patient is ingesting from the coffee beans daily, causes relaxation of bronchial smooth muscle, which promotes bronchodilation, nervousness, and diuresis secondary to vasodilation of the blood vessels in the peripheral vascular system. Caffeine causes vasoconstriction of the blood vessels in the central nervous system. Caffeine does not elevate serum sodium levels.

A nurse assesses a patient receiving perphenazine (Trilafon), a traditional antipsychotic medication. The nurse notices that the patient is squirming and pacing. When composing his nurse's notes, the nurse would describe his assessment findings by which terminology? a. Dystonia b. Central nervous system effects c. Parkinsonism d. Akathisia

ANS: D Akathisia is characterized by pacing and squirming brought on by an uncontrollable need to be in motion. Dystonia is manifested by severe spasms of the muscles of the face, neck, tongue, or back. "Central nervous system effects" is a very vague description, because many types of effects can occur; therefore, this would not be appropriate in the nurse's notes. Parkinsonism is characterized by bradykinesia, a masklike face, drooling, tremor, and rigidity.

A nurse provides education for a patient who has just started taking buspirone (BuSpar). The patient asks the nurse, "When should I expect to see an effect from the medication?" The nurse's best response would be based on the understanding that the effects of buspirone begin in most patients during which time frame? a. 3 days b. 24 to 48 hours c. 1 day d. 4 to 6 weeks

ANS: D Although an initial response to buspirone may occur as early as 1 week, it may take up to 4 to 6 weeks for peak results of the medication to occur. One to 3 days is too short an interval to expect the effects of buspirone to develop.

A patient on triazolam (Halcion) begins to complain of forgetfulness. The nurse should consider the possibility that which of the following effects may be occurring? a. Retrograde amnesia b. Toxicity c. The expected effect d. Anterograde amnesia

ANS: D Anterograde amnesia has been assessed in patients taking triazolam. Triazolam does not cause retrograde amnesia. The patient shows no evidence of triazolam toxicity. Forgetfulness in not an expected effect of medications, including triazolam.

A nurse is providing nursing education about the use of atypical antipsychotic agents and their effects on the body. Which statement made by a nurse best demonstrates an accurate understanding of the effects of atypical antipsychotic agents? a. They cause a higher rate of relapse. b. They affect only the negative symptoms of schizophrenia. c. They cause more extrapyramidal symptoms. d. They pose a risk of weight gain and diabetes mellitus.

ANS: D Atypical antipsychotics pose a risk of weight gain and the development of diabetes mellitus. Atypical antipsychotics result in a lower rate of relapse. Atypical antipsychotic agents have the same effect as conventional antipsychotic agents on positive symptoms of schizophrenia, and they have a greater effect on negative symptoms and cognitive dysfunction. Atypical antipsychotics cause fewer extrapyramidal symptoms.

A patient who is also a nurse is being treated for anxiety with a selective serotonin reuptake inhibitor. She asks about the rationale for use of this agent rather than a benzodiazepine. Which of the following is the nurse's best response? a. "Selective serotonin reuptake inhibitors are better for the control of bodily symptoms than benzodiazepines." b. "Selective serotonin reuptake inhibitors provide a more rapid and durable response to the uncomfortable anxiety symptoms." c. "Benzodiazepines currently have no role in the treatment of anxiety." d. "Selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety than benzodiazepines."

ANS: D Compared with benzodiazepines, selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety, but not the somatic symptoms. Selective serotonin reuptake inhibitors are not better than benzodiazepines for reducing somatic symptoms of anxiety. Selective serotonin reuptake inhibitors have a delayed response to uncomfortable anxiety symptoms. Benzodiazepines are used in the treatment of anxiety.

A nurse is assessing a patient taking a monoamine oxidase inhibitor who complains of a headache, nausea, and vomiting. The patient's vital signs are pulse 128/minute, blood pressure 194/106, and, respiration 30/minute. The patient confesses to the nurse that she has been drinking a glass of red wine with dinner each night. The nurse would be correct to suspect the patient is experiencing which of the following health alterations? a. Allergic reaction b. Reflex tachycardia c. Rebound hypertension d. Hypertensive crisis

ANS: D Hypertensive crisis is characterized by hypertension, headache, tachycardia, nausea, and vomiting; it can be brought on if the patient eats foods rich in tyramine, such as aged cheese and wine, while taking a monoamine oxidase inhibitor to manage depression. The patient's cluster of symptoms is not indicative of an allergic reaction, reflex tachycardia, or rebound hypertension

A nurse understands that a central nervous system (CNS) stimulant would be indicated for a patient with which of the following health alterations? a. Depression b. Opiate overdose c. Poor appetite d. Narcolepsy

ANS: D Narcolepsy can be treated with a CNS stimulant, which can promote arousal and thereby relieve symptoms. Depression is not an indication for the use of CNS stimulants. Antidepressants are the drugs of choice for depression. CNS stimulants do not abate opiate overdoses. Narcan is the drug of choice for that purpose. CNS stimulants reduce appetite and therefore would not be recommended for a patient with a poor appetite.

Two nurses are debating the effects of olanzapine (Zyprexa) and clozapine (Clozaril). When comparing the effects of olanzapine with those of clozapine, which statement is correct? a. Olanzapine produces more tardive dyskinesia than clozapine. b. Olanzapine does not cause somnolence, as clozapine does. c. Clozapine has fewer serious side effects than olanzapine. d. Olanzapine has a higher risk of diabetes.

ANS: D Olanzapine increases the risk of the development of diabetes mellitus, which clozapine does not. Olanzapine and clozapine produce a similar number of tardive dyskinesia symptoms. Olanzapine and clozapine cause a similar degree of somnolence. Clozapine has more serious side effects than olanzapine, including agranulocytosis.

A drug representative is providing education on barbiturates to the nurses on a unit. The drug representative correctly explains that most barbiturates are considered nonselective central nervous system depressants, with the exception of a. thiopental. b. secobarbital (Seconal). c. butabarbital (Butisol). d. phenobarbital (Luminal).

ANS: D Phenobarbital is considered a selective central nervous system depressant. Thiopental, secobarbital, and butabarbital are considered nonselective central nervous system depressants.

A nurse prepares to collect a health history from a patient with narcolepsy. Which of the following is the most appropriate way for the nurse to facilitate acquisition of the health history from this patient? a. A structured form the patient can complete in writing b. Information from significant others rather than the patient c. The patient's past medical records d. Short, focused interview sessions that require the patient's active participation

ANS: D Short, focused interview sessions are the best means of obtaining an accurate health history from a patient with narcolepsy. The patient could stay awake for short intervals and hopefully be focused enough to get through them. The patient's focus is likely to be poor for a prolonged period, therefore use of a structured written form is not the best method. Patient information is privileged and cannot be obtained from another source, including family members, without the patient's written consent. Past medical records may not be available for this patient, or they may be outdated or not pertinent to this diagnosis.

A nurse is reviewing a patient's laboratory findings prior to medication administration. The most recent serum lithium level is 2.2 mEq/L and was drawn yesterday. The patient takes 300 mg of lithium carbonate 4 times a day. Which of the following is the nurse's most appropriate action? a. Administer the drug as prescribed. b. Recognize that the dose is subtherapeutic. c. Administer half of the dose. d. Hold the next dose and notify the prescriber.

ANS: D The lithium level is toxic, therefore the dose should be held and the prescriber notified. The drug should not be administered as prescribed, because it will increase the toxicity. The dose is not subtherapeutic; rather, the patient's lithium level indicates toxicity. It is up to the prescriber to change the dosage ordered. Changing the dosage without discussing it with the prescriber is a violation of the Nurse Practice Act, because nurses do not prescribe.

A patient is brought to the emergency department in a state of extreme uncontrolled anxiety. The prescriber orders a benzodiazepine. A nurse understands that benzodiazepines are used in this clinical situation based on which of the following principles? a. Benzodiazepines have a very short half-life. b. There is no risk of physical dependence when taking benzodiazepines. c. Benzodiazepines are known to cure generalized anxiety. d. Benzodiazepines have a rapid onset of action.

ANS: D The patient is clearly in a state of extreme uncontrolled anxiety. Benzodiazepines are the drug of choice for acute episodes of anxiety because of their rapid onset of action. Benzodiazepines do not have a very short half-life. Benzodiazepines are associated with physical dependence. Benzodiazepines do not cure generalized anxiety, nor do any other drugs.

A patient taking amitriptyline (Elavil) complains of having blurred vision and dry mouth, and he states that he hasn't had a bowel movement in 3 days, whereas he normally has one daily. His vital signs are temperature 97.6° F, pulse 78/minute, blood pressure 130/79, and respirations 20/minutes. Based on this assessment, the nurse should suspect which of the following causes? a. Possible toxicity b. Cholinergic effects c. Dehydration d. Anticholinergic effects

ANS: D The signs and symptoms displayed by the patient are consistent with the anticholinergic effects common in patients taking amitriptyline. There is no evidence of amitriptyline toxicity. The patient is displaying anticholinergic, not cholinergic, signs and symptoms,. The patient's findings are not consistent with dehydration, because his pulse rate is within normal limits and he is not hypotensive.

A nurse is reviewing medications for a patient with bipolar disorder. The nurse has received an order to discontinue the lithium and begin valproic acid (Depakene). The nurse understands the prescriber's change of order based on which mechanism of action? a. Valproic acid works slower and has a lower therapeutic index. b. Valproic acid has no serious side effects. c. Valproic acid does not require plasma drug levels. d. Valproic acid works faster and has a higher therapeutic index.

ANS: D Valproic acid works faster and has a higher therapeutic index than lithium, as well as a better side effect profile. This is incorrect; in fact, valproic acid works faster and has a higher therapeutic index than lithium. Valproic acid can have serious side effects. Any anticonvulsant, including valproic acid, when used in a patient with bipolar disorder requires monitoring with periodic plasma drug levels.

A patient comes to the clinic for a routine blood pressure check. After reviewing the patient's medications, a nurse recognizes that the patient is taking a monoamine oxidase inhibitor. The nurse provides patient education regarding diet. Which breakfast choice made by the patient would indicate the need for additional teaching? a. Orange juice b. Carbonated beverages c. Fried eggs d. Yogurt

ANS: D Yogurt, aged cheeses, chocolate, red wine, and other foods with tyramine are contraindicated in patients taking monoamine oxidase inhibitors, because they can precipitate a hypertensive crisis. Orange juice, carbonated beverages, and fried eggs are not contraindicated in patients taking monoamine oxidase inhibitors.

An obesity-prone patient who takes an antipsychotic agent has been trying diligently to lose weight. The patient expresses her concern to the nurse and asks, "Is there a medication that I can take that causes less weight gain than the others? The nurse would be correct to suggest to the patient that she discuss with the prescriber the possibility of switching to which drug to address her concern? a. Thioridazine (Mellaril) b. Quetiapine (Seroquel) c. Olanzapine (Zyprexa) d. Ziprasidone (Geodon)

ANS: D Ziprasidone (Geodon) has been shown to cause only a small weight gain compared to other antipsychotic medications. Thioridazine and quetiapine cause moderate weight gain. Olanzapine causes high weight gain.

What interventions should be performed by the nurse if the client is prescribed lithium?

Accurate I&O, daily weight

What is the focus of therapy with depressed children?

Alleviate symptoms and strengthen the child's coping skills

What occurs in the 1st phase of individual psychotherapy?

Assess the client Give the client complete information If severe depression, combine with antidepressants Encourage client to participate in regular activities Agree on a contract for safety

How long does a manic episode last? How long does a hypoactive episode last?

At least 1 week At least 4 days

What are the characteristics of cyclothymic disorder?

At least 2 yrs duration Numerous pds of elevated mood that do not meet criteria for hypomania Numerous pds of depressed mood that do not meet criteria for MDD Never w/o symptoms for more than 2 months Impair normal functioning

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)

A client diagnosed with bipolar disorder asks the nurse why it is necessary to have a serum lithium level drawn every 3 to 4 months. The nurse's response should be based on which of the following? A. To monitor compliance with the medication B. To prevent toxicity related to the drug's therapeutic range C. To monitor the client's white blood cell count D. To comply with the drug manufacturer's requirements

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 client with depression who is taking doxepin (Smequan) 100 mg PO at bedtime has dizziness on arising. Which of the following suggestions is most appropriate? A. Try taking a hot shower B. Get up slowly and dangle your feet before standing C. Stay in bed until you are feeling better D. You need to limit the fluids you drink

B

A nurse is assessing a client with hypomania who wants to stop her mood stabilizing medications because she is "feeling good", has a high energy level, and thinks she is productive at work. Which response by the nurse is most appropriate? A. Maybe you really don't need your medications anymore B. I believe you were hospitalized the last time you stopped your medications C. If you stop your medications, your behavior will quickly spiral out of control D. Why don't you cut your medication dosage in half for a while and see how you respond?

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

A young adult diagnosed with bipolar disorder has been managing the disorder effectively with meds and treatment for several years. The client suddenly becomes manic. The nurse reviews the client's medication record. Which of the following medication may have contributed to the development of his manic state? A. Elevil (amitriptyline) B. Prednisone C. Buspar (buspirone) D. Neurotonin (gabapentin)

B

After the nurse teaches a client with bipolar disorder about lithium therapy, which of the following client statements indicates the need for additional teaching? A. It's important to keep using a regular amount of salt in my diet B. It's okay to double to my next dose of lithium if I forget a dose C. I should drink 8 to 10 glasses of water a day D. I need to take my medication at the same time each day

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

Margaret, a 68 year old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the ED by her sister. Margaret yells, "my sister is jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of a: A. Delusion of grandeur B. Delusion of persecution C. Delusion of reference D. Delusion of control or influence

B

Margaret, a 68 year old widow, is brought to the ED by her sister. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. She is pacing, agitated, demanding, and speaking very loudly. Her sister reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's just going to collapse." Margaret is admitted to the psychiatric unit. The priority nursing diagnosis for Margaret is: A. Imbalanced Nutrition: Less than Body Requirements r/t Not Eating B. Risk for Injury r/t Hyperactivity C. Disturbed Sleep Pattern r/t Agitation D. Ineffective Coping r/t Denial of Depression

B

The client has been hospitalized for major depression and suicidal ideation. Which of the following statements indicates to the nurse that the client is improving? A. I couldn't kill myself because I don't want to go to hell B. I don't think about killing myself as much as I used to C. I'm of no use to anyone anymore D. I know my kids don't need me anymore

B

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 client with recurrent depression and suicidal ideation tell the nurse, "I can't afford this medicine anymore. I know I'll be okay without it." The nurse should: A. Inform the physician of the client's statement B. Ask the social worker to find assistance for the client C. Schedule a follow up appointment in 3 months D. Ask the client whether a family member could help

B

The history of a female client who has just been admitted to the unit and is very depressed reveals a weight loss of 10 lb in 2 weeks, sleeping 3 hours a night, and poor hygiene. The client states, "I'm no good to anyone. Everyone would be better off without me." Which of the following questions should the nurse ask first? A. What do you mean? B. Are you thinking about hurting yourself? C. Doesn't your family care about you? D. What happened to make you think that?

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 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

The physician orders setraline (Zoloft) 50 mg PO BID for Margaret, a 68 year old woman with major depressive disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? A. Cheer up, Margaret. You have so much to be happy about B. Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms C. I'll report that to the physician, Margaret. Maybe he needs to order something different D. Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the day room?

B

When assessing a client for suicidal risk, which of the following methods of suicide should the nurse identify as most lethal? A. Aspirin Overdose B. Use of a Gun C. Acetaminophen Overdose D. Wrist-Cutting

B

When teaching the client with atypical depression about food to avoid while taking phenelizine (Nardil), which of the following should the nurse include? A. Roasted chicken B. Salami C. Fresh fish D. Hamburger

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

What are the symptoms of hypertensive crisis (often seen with MAOI contraindications)?

BCCMP BP VERY HIGH Chest Pain Coma Meningococcal sx (severe HA, nuchal rigidity, n/v, fever, sweating) Palpitations

Which antianxiety medications are classified as benzodiazepines?

BEANS Xanax (surround ana by ex's so she won't fart) Librium (jack and the beanstalk is in the library) Klonopin (pinto beans are not in klondike bars) Tranxene (go into trance after eating too many) Valium (valiant to eat lots of beans and not be afraid to fart) Ativan (that's the van that transports beans)

What are the symptoms of lithium toxicity?

Blurred vision, ataxia, tinnitus, persistent n/v/d, excessive urination, increased tremors, confusion, psychomotor retardation, nystagmus, impaired consciousness, seizures, coma, arrythmias, MI, cardiovascular collapse

A 62 year old female client with severe depression and psychotic symptoms is scheduled for ECT tomorrow morning. The client's daughter asks the nurse, "how painful will the procedure be for mom?" The nurse should respond by stating: A. Your mother will be given pain medication before the treatment B. The physician will make sure your mother doesn't suffer needlessly C. Your mother will be asleep during the procedure and feel no pain D. Your mother will be able to talk and tell us if she's in pain

C

A child with bipolar disorder also has ADHD. How would these comorbid conditions most likely be treated? A. No medication would be given for either condition B. Medication would be given for both conditions simultaneously C. The bipolar condition would be stabilized first before medication for the ADHD would be given D. The ADHD would be treated before consideration of the bipolar disorder

C

A client is brought to the ED by the police and admitted involuntarily. She is diagnosed with bipolar disorder, manic phase. The physician orders lithium 300 mg PO 3 times a day. The client refuses her morning dose of lithium. The nurse should next: A. Force the client to take the lithium because of the lithium because of the client's involuntary status B. Contact the dr to change the lithium order to be given IM C. Inform the client that she has the right to refuse medication despite her involuntary status D. Tell the client that certain privileges will be revoked if she does not take the medication

C

A client who overdosed on barbiturates is being transferred to the inpatient psychiatric unit from the ICU. Assessing the client for which of the following needs should be a priority for the nurse receiving the client in the ICU? A. Nutrition B. Sleep C. Safety D. Hygiene

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

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? A. Antidepressants, particularly the SSRI group, offer the best treatment for your dysthymia B. Doctors recommend that clients experiencing dysthymia receive ECT to treat it C. Because you have a mild, though long lasting dysthymic mood, psychotherapy can usually bring improvement with less likelihood of the need for medication D. Since your dythymia indicates a long lasting mild depression, long term psychoanalysis would be the best treatment for you

C

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

Joanie is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't anything more to live for." She has been hospitalized with major depressive disorder. The priority nursing diagnosis for Margaret would be: A. Imbalanced nutrition: less than body requirements B. Complicated grieving C. Risk for suicide D. Social Isolation

C

Margaret, age 68, is diagnosed with Bipolar 1 disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to: A. Sit with her during meals to ensure that she eats everything on her tray B. Have her sister bring all her food from home because she knows Margaret's likes and dislikes C. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat on the run D. Tell Margaret that she will be on room restriction until she starts gaining weight

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 client with acute mania has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as ordered by the dr. The client states "I don't need that stuff." Which response by the nurse is best? A. You can't refuse to take this medication B. If you don't take it orally, I will give you a shot C. The medication will make you feel calmer D. I'll get some written information about the medication for you

C

The husband of a client to be discharged from the hospital after an episode of major depression and a suicide attempt asks, "What can I do if she tries to kill herself again?" Which of the following responses is most appropriate? A. Don't worry. She'll be okay as long as she takes her medication B. She told me she wants to live so I don't think she'll try again C. Let's talk about some behavioral clues and resources that can help D. Tell her about your concern and just take care of her

C

The physician orders determination of the serum lithium level tomorrow for a client with bipolar disorder, manic phase, who has been receiving lithium 300 mg PO 3 times a day for the past 5 days. At which of the following times should the nurse plan to have the blood specimen obtained? A. Before bedtime B. After lunch C. Before breakfast D. During the afternoon

C

The physician orders valproic acid (Depakene) for a client with bipolar disorder who has achieved limited success with lithium carbonate (Lithane). Which of the following should the nurse include in the client's medication teaching plan? A. Follow-up blood tests are unnecessary B. The tablet can be crushed if necessary C. Drowsiness and upset stomach are common side effects D. Consumption of a moderate amount of alcohol is safe

C

When developing a teaching plan for a client about the medications prescribed for depression, which of the following components is most important for the nurse to include? A. Pharmacokinetics of the medication B. Current research related to the medication C. Management of common adverse effects D. Dosage regulation and adjustment

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 activities should the nurse recommend to the client on an inpatient unit when thoughts of suicide occur? A. Keeping track of feelings in a journal B. Reading a magazine C. Talking with the nurse D. Playing a card game with the other clients

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

You administer the first dose of an antidepressant to your inpatient client with major depression. The client asks, "Is this medicine going to fix my depression?" Your accurate response includes which of the following? (Select all that apply) A. This medication will decrease the available dopamine, which is associated with psychotic thinking in major depression B. In addition, we are going to assist you in regulating your circadian rhythms, which should improve your depression C. It should help your depression, and you should feel the full therapeutic effect in 2 to 4 weeks D. This medication should increase the availability of neurotransmitters in your brain E. This medication should increase the production of serotonin in your brain

C, D

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)

What are the characteristics of Generalized Anxiety Disorder?

Chronic disorder Persistent, unrealistic, and excessive anxiety that has occurred for at least 6 months Significant impairment in function Often avoid activities or events that may result in negative outcomes or spends excessive time preparing Often results in procrastination Often seek reassurance from others Depression is common

Which drugs are classified as psychotherapeutic combinations?

Combos=good couples Symbyax (symbiotic yaks get along well) Limbitrol (trolls live together under limbs of trees) Etrafon (extra cute fawns get along well)

Which hormones/endocrines/electrolytes are increased in depression?

Cortisol Acetylcholine Estrogen Calcium Magnesium Sodium

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

A client taking mirtazipine (Remeron) is disheartened about a 20 lb weight gain over the past 3 months. The client tells the nurse, "I stopped taking my Remeron 15 days ago. I don't want to get depressed again, but I feel awful about my weight." Which response by the nurse is most appropriate? A. Focusing on diet and exercise alone should control your weight B. Your depression is much better now, so your medication is helping you C. Look at all the positive things that have happened to you since you started Remeron D. I hear how difficult this is for you and will help you approach the doctor about it

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 client who is depressed states, "I'm an awful person. Everything about me is bad. I can't do anything right." Which of the following responses by the nurse is most therapeutic? A. Everyone here likes you B. I can see many good qualities in you C. Let's discuss what you've done correctly D. You were able to bathe today

D

A client with acute mania is to receive lithium carbonate 600 mg PO 3 times a day and 2 mg of haloperidol (Haldol) PO at bedtime. The nurse should: A. Refuse to give the medications as ordered B. Give the lithium only C. Request a decreased dose of lithium D. Give the medications as ordered

D

A client with depression is exhibiting a brighter effect, ability to attend to hygiene and grooming tasks, and beginning to participate in group activities. The nurse asks the client to identify 3 of her strengths. After much hesitation and thinking, the client can state she is usually a nice person, good cook, and a hard worker. Which of the following should the nurse do next? A. Ask the client to identify an additional 3 strengths B. Volunteer the client to lead the cooking group later in the day C. Educate the client about the importance of medication D. Reinforce the client for identifying and sharing her strengths

D

A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client? A. Future plans for going back to work B. A conflict encountered with another client C. Results of psychological testing D. Medication management with outpatient follow-up

D

A depressed client is receiving an ECT treatment. In the treatment room, the anesthesiologist administers methohexital sodium (Brevital) followed by IV succinylcholine (Anectine). The purposes of these medications are to: A. Decrease secretions and increase heart rate B. Prevent nausea and induce a calming effect C. Minimize memory loss and stabilize mood D. Induce anesthesia and relax muscles

D

A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming an hygiene. Which of the following nursing actions is most appropriate? A. Explaining the importance of hygiene to the client B. Asking the client if he is ready to shower C. Waiting until the client's family can participate in the client's care D. Stating to the client that it's time for him to take a shower

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

John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every 3 days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes to the clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change? A. The sertraline is taking effect B. He is no longer in need of antidepressant medication C. He has completed the grief response over loss of his wife D. He may have decided to carry out his suicide plan

D

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

The client diagnosed with bipolar disorder, manic phase, states to the nurse, "I'm the Queen of England. Bow before me." The nurse interprets this statement as important to document as which of the following areas: A. Psychomotor behavior B. Mood and affect C. Attitude towards the nurse D. Thought content

D

The client with rapid-cycling bipolar disorder who is about to receive his 5 pm dose of carbamazepine (Tegretol) tells the nurse he has a sore throat and chills. Which of the following should the nurse do next? A. Administer the next dose of carbamazepine B. First, give the client acetaminophen (Tylenol) as ordered PRN C. Report the symptoms to the physician in the morning D. Call the physician to report the symptoms

D

The most common comorbid condition for children with bipolar disorder is: A. Schizophrenia B. Substance Disorder C. Oppositional Defiant Disorder D. ADHD

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 amounts of medications is appropriate for a client who is being treated with imipramine (Tofranil) on an outpatient basis for recurring depression and suicidal ideation to have at one time? A. A 22 day supply B. A 14 day supply C. A 10 day supply D. A 3 day suppy

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

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

What neurotransmitter is associated with OCD and trichotillomania?

Decreased serotonin

How is hypertensive crisis (often seen in contraindications with MAOI's) treated?

Discontinue drug immediately. Alert physician. Monitor vital signs and administer short acting antihypertensive

What commonly occurs in the first stage of mania (hypomania)?

Disturbances are not severe enough to impair function Cheerful mood with rapid irritability (volatile) Exalted perception of self Very extroverted and sociable

What interventions should be implemented for the suicidal client?

Do not leave alone No-suicide contract established (once lapsed, create new. No guarantee or legal credibility) Ensure home environment is safe Daily appts until acute phase is over No more than 3 day supply of antidepressants Rehearse cognitive reconstruction (ways of positive thinking)

What hormones/endocrines/electrolytes are decreased in depression?

Dopamine Serotonin Potassium

When should lithium levels be drawn?

Draw 12 hours after last dose

Which mood stabilizing agents are classified as anticonvulsants?

Earthquake Klonopin (klondike bars do not survive) Tegretol (decreased integrity take a toll on buildings during) Depakote*(johnny depo takes acid and protects self woth a coat) Neurontin (neurotic people panic) Lamictal (laminated floors are destroyed) Topamax (max quakes top the scale) Trileptal (trip due to quaking)

What are the characteristics of a manic episode?

Elevated, expansive, or irritable mood Marked impairment in functioning May require hospitalization to prevent harm Excessive/frenzied motor activity Psychotic features may be present Increased self esteem or grandiosity Decreased need to sleep Increased need to talk (pressured) Flight of ideas, racing thoughts Distractibility Increased goal directed activity Excessive involvement in high risk activities

What education should be provided to the patient prescribed lithium pertaining to diet?

Ensure adequate sodium in diet Ensure 2500 to 3000 mL fluids per day (8 to 10 glasses)

What are the characteristics of Bipolar I Disorder?

Experienced at least 1 manic episode Experience episodes of depression Psychotic or catatonic features may be present

When is light therapy often needed in those with Seasonal Affective Disorder and Depression?

Fall/Winter

What occurs during phase 2 of individual psychotherapy?

Focus on helping the client to resolve complicated grief reactions: Resolve ambivalence with lost relationships Serve as subsitute role for lost client relationship Assist client with establishing new relationships

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 are the deviations in biochemical and neurotransmitters associated with panic disorders?

Increased lactate and norepinephrine Decreased serotonin and GABA

What symptoms should patients receiving calcium channel blocker therapy be instructed to report to the physician?

Irregular heartbeat, SOB, edema, pronounced dizziness, chest pain, profound mood swings, severe persistent HA

Which mood stabilizing agent is classified as an antimanic?

Lithium carbonate

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)

What are the differences between MDD and Dysthymia?

MDD has been present for at least 2 weeks, causes impaired functioning, and can have psychotic features Dysthymia has been present for at least 2 years, does not impair functioning, and has no psychotic features

What is the relationship between the neurotransmitters in bipolar disorder?

Mania: Increased dopamine and norepinephrine Decreased serotonin and acetylcholine Depression: Increased acetylcholine Decreased serotonin, dopamine, and norepinephrine

What commonly occurs during the 2nd stage of mania (acute mania)?

Marked impairment in function that may require hospitalization Continuous high with frequent variation Perception is fragmented and often psychotic Disorganized, incoherent speech Hallucinations and delusions are common Very manipulative, sexually uninhibited, extremely extroverted

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

Melatonin

What is the first line treatment for bipolar disorder in children?

Monotherapy with mood stabilizers (lithium, carbamazepine) or atypical antipsychotics (olanzepine, risperidone) Meds are tapered or discontinued after remission achieved for at least 12 to 24 months

What symptoms characterize bipolar disorder?

Mood swings from euphoria (mania) to depression with periods of normalcy between Can have delusions/hallucinations May reflect seasonal pattern

How often should lithium levels be monitored?

Once or twice a week until dosage and levels stabilize, then monthly

When is treatment for phobias usually sought out?

Only when it interferes with ability to function

When are phobias diagnosed?

Only when they interfere with functioning and restrict activities

Who is at the highest risk demographically for suicide?

Over 50 or adolescent White>Native American>Black Single, divorced, or widowed Highest or lowest socioeconomic status Health care personnel and business execs Firearms>OD No religious affiliation Family history of suicide (makes them sad, not genetic)

Symptoms of a panic attack (at least 4 must be present)

Palpitations, tachycardia, sweating, trembling, SOB, choking, chest pain, nausea, dizziness, chills or hot flashes, paresthesias, derealization or depersonalization, fear of losing control or going crazy, fear of dying

What 3 medications might the anesthesiologist administer IV before treatment? Why?

Propofol (Diprivan) & etomidate (Amidate) are used for short-acting anesthesia Anectine is a muscle relaxant given to prevent severe muscle contractions (hyperoxygenate because it paralyzes respiratory muscles)

Which mood stabilizing agents are classified as antipsychotics?

Psychotic murderers Abilify (must have ability to fight and survive) Zyprexa (extra zap of energy when chased) Seroquel (sequels are common) Risperdal (make sure you whisper to your pal so you don't get caught) Geodon (must know geographical area to get away)

What are the characteristics of Bipolar II Disorder?

Recurrent MDD w/ episodic hypomania Never experienced manic episodes Psychotic or catatonic features may be present

Characteristics of panic disorder

Recurrent panic attacks Feelings of intense fear or terror and impending doom Symptoms come on unexpectedly without triggers Depression and agoraphobia are common Average onset in late 20s Frequency and severity vary

What symptoms are seen in serotonin syndrome?

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

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)

What class of drugs is commonly prescribed to patients with OCD and trichotillomania?

SSRI's

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 commonly occurs in the 3rd stage of mania (delirious mania)?

Severe clouding of consciousness and intense symptoms Must be hospitalized-will die without intervention Rare with availability of antipsychotic medications Very labile mood Panic anxiety is common Extremely distractible and incoherent with sometimes stupored state Auditory and visual hallucinations common Frenzied, agitated movements

What symptoms should patients receiving anticonvulsants be instructed to report to the physician?

Skin rash, bleeding/bruising, sore throat, yellowed skinor eyes, fever, malaise, dark urine

What symptoms should patients receiving antipsychotic therapy be instructed to report to the physician?

Sore throat, fever, malaise, unusual bleeding/bruising, persistent n/v, severe HA, tachycardia, difficulty urinating, tremors, dark urine, excessive urination & hunger & thirst, weakness, pallor, yellowed skin and eyes, skin rash

What symptoms should clients taking antidepressants be instructed to contact the physician about immediately?

Sore throat, fever, malaise, yellowed skin, unusual bleeding/bruising, persistent n/v, severe HA, tachycardia, difficulty urinating, weight loss w/o dieting, seizure, nuchal rigidity, chest pain

Use of what herbal remedy is contraindicated while taking antidepressants?

St john's wort

What medication can commonly cause mania?

Steroids

What are the characteristics of bipolar disorder in children?

Symptoms occur most days of the week, 3 or more times a day, for 4 or more hours and are severe enough to cause extreme disturbance in functioning Psychotic symptoms such as hallucinations or delusions are common

What should be included in the education of the family and the child with bipolar disorder?

Symptoms, course of the disorder, impact of the disorder, and available treatment options

What are the 2 most common side effects of ECT?

Temporary memory loss Confusion

How is serotonin syndrome treated?

The medication should be stopped immediately. Alert the physician. Cyproheptadine or Periactin may be given to relieve hyperthermia and muscle rigidity and prevent seizures, but condition often resolves itself with little intervention

What occurs in phase 3 of individual psychotherapy?

The therapeutic alliance is terminated The client should recover enhanced social functioning

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

What are the 4 types of depression?

Transient Mild Moderate Severe

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)

A client diagnosed with mahor depression spends most of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse is most therapeutic? A. Wait for the client to begin the conversation B. Initiate contact with the client frequently C. Sit outside the client's room D. Question the client until he responds

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 assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the client that requires the nurse's immediate intervention is the client's: A. Outlandish behaviors and inappropriate dress B. Nonstop physical activity and poor nutritional intake C. Grandiose delusions of being a royal descendent of King Arthur D. Constant incessant talking that includes sexual innuendoes and teasing the staff

B

A nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client? A. Chess B. Writing C. Ping Pong D. Basketball

B

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

A client hospitalized with severe depression and suicidal ideation refuses to talk with the nurse. The nurse recognizes that the suicidal client has difficulty: A. Expressing feelings of low self worth B. Discussing remorse and guilt for actions C. Displaying dependence towards others D. Expressing anger towards others

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 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

The client is having ECT for treatment of severe depression. Which of the following indicates that the client's ECT has been effective? A. The client loses consciousness B. The client vomits C. The client's ECG indicates tachycardia D. The client has a grand mal seizure

D

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.

During a group session, a client who is depressed tells the group that he lost his job. Which of the following responses by the nurse is best? 1. "It must have been very upsetting for you." 2. "Would you tell us about your job." 3. "You'll find another job when you're better." 4. "You were probably too depressed to work."

1. By stating, "It must have been very upsetting for you," the nurse conveys empathy to the client by recognizing the underlying meaning of a painful occurrence. The nurse's statement invites the client to verbalize feelings and thoughts and lets the client know that the nurse is listening to and respects the client. Telling the client to talk about the job disregards the client's feelings and is nontherapeutic for the depressed client because of underlying feelings of worthlessness and guilt that are commonly present. Telling the client that he will find another job when he is better or that he was probably too depressed to work is inappropriate because it disregards the client's feelings and may promote additional feelings of failure and inadequacy in the client.

The client is receiving 6 mg of selegiline transdermal system (Emsam) every 24 hours for major depression. The nurse should judge teaching about Emsam to be effective when the client makes which statement? 1. "I need to avoid using the sauna at the gym." 2. "I can cut the patch and use a smaller piece." 3. "I need to wait until the next day to put on a new patch if it falls off." 4. "I might gain at least 10 lb from Emsam."

1. Selegiline transdermal system is the first transdermal monoamine oxidase inhibitor. The client on Emsam needs to avoid exposing the application site to external sources of direct heat, such as saunas, heating lamps, electric blankets, heating pads, heated water beds, and prolonged direct sunlight because heat increases the amount of selegiline that is absorbed, resulting in elevated serum levels of selegiline. Cutting the patch and using a smaller piece will result in a decreased amount of medication absorption, most likely leading to a worsening of the symptoms of depression. The client should apply a new patch as soon as possible if one falls off to ensure an adequate amount of medication absorption. Emsam is not associated with significant weight gain, although a weight gain of 1 to 2 lb (2.2 to 4.4 kg) is possible.

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.

When developing the teaching plan for the family of a client with severe depression who is to receive electroconvulsive therapy (ECT), which of the following information should the nurse include? 1. Some temporary confusion and disorientation immediately after a treatment is common. 2. During an ECT treatment session, the client is at risk for aspiration. 3. Clients with severe depression usually do not respond to ECT. 4. The client will not be able to breathe independently during a treatment.

1. The family needs to be informed that some confusion and disorientation will occur as the client emerges from anesthesia immediately after ECT, to lessen their fear and anxiety about the procedure. The nurse will assist the client with reorientation (time, person, and place) and will give clear, simple instructions. The client may need to lie down after ECT because of the effects of the anesthesia. Informing the family that there is a danger of aspiration during ECT is inappropriate and unnecessary. The risk of aspiration occurring during ECT is minimal because food and fluids are withheld for 6 to 8 hours before the treatment. In addition, the client receives atropine to inhibit salivation and respiratory tract secretions. Telling the family that the client will not be able to breathe independently during ECT may frighten them unnecessarily. If asked, the nurse should inform the family that the anesthesiologist mechanically ventilates the client with 100% oxygen immediately before the treatment. The client with severe depression responds to ECT. Usually, ECT is used for those who are severely depressed and not responding to pharmacotherapy and for those who are highly suicidal.

The client exhibits a flat affect, psychomotor retardation, and depressed mood. The nurse attempts to engage the client in an interaction but the client does not respond to the nurse. Which response by the nurse is most appropriate? 1. "I'll sit here with you for 15 minutes." 2. "I'll come back a little bit later to talk." 3. "I'll find someone else for you to talk with." 4. "I'll get you something to read."

1. The most appropriate action is for the nurse to remain with the client even if the client does not engage in conversation with the nurse. A client with severe depression may be unable to engage in an interaction with the nurse because the client feels worthless and lacks the necessary energy to do so. However, the nurse's presence conveys acceptance and caring, thus helping to increase the client's self-worth. Telling the client that the nurse will come back later, stating that the nurse will find someone else for the client to talk with, or telling the client that the nurse will get her something to read conveys to the client that she is not important, reinforcing the client's negative view of herself. Additionally, such statements interfere with the client's development of a sense of security and trust in the nurse.

The client is taking 50 mg of lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? 1. Report the rash to the physician. 2. Explain that the rash is a temporary adverse effect. 3. Give the client an ice pack for his arm. 4. Question the client about recent sun exposure.

1. The nurse should immediately report the rash to the physician because lamotrigine can cause Stevens-Johnson syndrome, a toxic epidermal necrolysis. The rash is not a temporary adverse effect. Giving the client an ice pack and questioning the client about recent sun exposure are irresponsible nursing actions because of the possible seriousness of the rash.

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 female client with severe depression and weight loss has not eaten since admission to the hospital 2 days ago. Which of the following approaches should the nurse include when developing this client's plan of care to ensure that she eats? 1. Serving the client her meal trays in her room. 2. Sitting with the client and spoon-feeding if required. 3. Calling the family to bring the client food from home. 4. Explaining the importance of nutrition in recovery.

2. A depressed client commonly is not interested in eating because of the psychopathology of the disorder. Therefore, the nurse must take responsibility to ensure that the client eats, including spoon-feeding the client (placing the food on the spoon, putting the food near the client's mouth, and asking her to eat) if necessary. Serving the client her tray in her room does not ensure that she will eat. Calling the family to bring the client food from home usually is allowed, but it is still the nurse's responsibility to ensure that the client eats. Explaining the importance of nutrition in recovery is not helpful. The client may intellectually know that eating is important but may not be interested in eating or want to eat.

A client with major depression and psychotic features is admitted involuntarily to the hospital. He will not eat because his "bowels have turned to jelly," which the client states is punishment for his wickedness. The client requests to leave the hospital. The nurse denies the request because commitment papers have been initiated by the physician. Which of the following should the nurse identify as a criterion for the client to be legally committable? 1. Evidence of psychosis. 2. Being gravely disabled. 3. Risk of harm to self or others. 4. Diagnosis of mental illness

2. Criteria for commitment include being gravely disabled and posing a harm to self or others. This client is not threatening to harm himself in the form of suicide or to harm others. The client is gravely disabled because of his inability to care for himself- namely, not eating because of his delusion. Evidence of psychosis or psychotic symptoms or diagnosis of a mental illness alone does not make the client legally eligible for commitment.

A client with depression who is taking doxepin (Sinequan) 100 mg P.O. at bedtime has dizziness on arising. Which of the following suggestions is most appropriate? 1. "Try taking a hot shower." 2. "Get up slowly and dangle your feet before standing." 3. "Stay in bed until you are feeling better." 4. "You need to limit the fluids you drink."

2. Doxepin and other tricyclic antidepressants may cause postural hypotension, especially in the morning. Postural hypotension occurs because the tricyclic antidepressant inhibits the body's natural vasoconstrictive reaction when a person stands. The nurse regularly monitors the client's vital signs, both lying and standing. The nurse should instruct the client to rise slowly and dangle his feet before standing. Advising the client to take a hot shower is detrimental to the client's safety. Heat causes vasodilation, which could further exacerbate the dizziness, placing the client at risk for falls and subsequent injury. Telling the client to stay in bed until he is feeling better is not helpful and is impractical. The client with depression would rather stay in bed and withdraw from others. Placing the client on fluid restriction is detrimental to the client with depression whose fluid and food intake may be inadequate.

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.

When teaching the client with atypical depression about foods to avoid while taking phenelzine (Nardil), which of the following should the nurse include? 1. Roasted chicken. 2. Salami. 3. Fresh fish. 4. Hamburger.

2. Phenelzine is a monoamine oxidase inhibitor (MAOI). MAOIs block the enzyme monoamine oxidase, which is involved in the decomposition and inactivation of norepinephrine, serotonin, dopamine, and tyramine (a precursor to the previously stated neurotransmitters). Foods high in tyramine- those that are fermented, pickled, aged, or smoked- must be avoided because, when they are ingested in combination with MAOIs, a hypertensive crisis occurs. Some examples include salami, bologna, dried fish, sour cream, yogurt, aged cheese, bananas, pickled herring, caffeinated beverages, chocolate, licorice, beer, Chianti, and alcohol-free beer.

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.

During an interaction with the nurse, a client states, "My husband has supported me every time I've been hospitalized for depression. He'll leave me this time. I'm an awful wife and mother. I'm no good. Nothing I do is right." Based on this information, which of the following nursing diagnoses should the nurse identify when developing the client's plan of care? 1. Impaired social interaction related to unsatisfactory relationships as evidenced by withdrawal. 2. Chronic low self-esteem related to lack of self-worth as evidenced by negative statements. 3. Risk for self-directed violence related to feelings of guilt as evidenced by statements of suicidal ideation. 4. Ineffective coping related to hospitalizations as evidenced by impaired judgment.

2. The client's negative thinking and statements are directly related to the psychopathology of depression. The client's views and feelings about herself reflect low self-esteem. Although Impaired social interaction, Risk for self-directed violence, and Ineffective coping are possible nursing diagnoses, there are insufficient data to support these diagnoses. Further assessment is needed to identify supportive data.

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 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.

A client diagnosed with major depression spends most of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse is most therapeutic? 1. Wait for the client to begin the conversation. 2. Initiate contact with the client frequently. 3. Sit outside the client's room. 4. Question the client until he responds.

2. The nurse should initiate brief, frequent contacts throughout the day to let the client know that he is important to the nurse. This will positively affect the client's self-esteem. The nurse's action conveys acceptance of the client as a worthwhile person and provides some structure to the seemingly monotonous day. Waiting for the client to begin the conversation with the nurse is not helpful because the depressed client resists interaction and involvement with others. Sitting outside of the client's room is not productive and not necessary in this situation. If the client were actively suicidal, then a one-on-one client-to-staff assignment would be necessary. Questioning the client until he responds would overwhelm him because he could not meet the nurse's expectations to interact.

A client diagnosed with major depression has sleep and appetite disturbances, a flat affect and is withdrawn. The client has been taking fluvoxamine (Luvox) 50 mg twice daily for 5 days. Which client behavior is most important to report to the next shift? 1. Client's flat affect. 2. Client's interacting with a visitor. 3. Client sleeping from 11 p.m. to 6 a.m. 4. Client spending the entire evening in her room.

3. The most important behavior to report to the next shift is that the client was able to sleep from 11 p.m. to 6 a.m. This indicates that improvement in the symptoms of depression is occurring as a result of pharmacologic therapy. The nurse would expect to observe improvement in sleep, appetite, and psychomotor behavior first before improvement in cognitive symptoms. The client's flat affect is still a symptom of depression. The fact that the client had a visitor is not as important as changes in the client's behavior. Spending the evening in the room is a continuation of the client's withdrawn behavior and is important to report but not as important as the improvement in sleep.

A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member's statement indicates a need for additional teaching? 1. "My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks." 2. "My wife will need to take her antidepressant medicine and go to group to stay well." 3. "My son will only need to attend outpatient appointments when he starts to feel depressed again." 4. "My mother might need help with grocery shopping, cooking, and cleaning for a while."

3. Additional teaching is needed for the family member who states her son will only need to attend outpatient appointments when he starts to feel depressed again. Compliance with medication and outpatient follow-up are key in preventing relapse and rehospitalization. The statements expressing expectations of feeling better as medication takes effect, needing medicine and group therapy to stay well, and needing help with grocery shopping, cooking, and cleaning for a while indicate the families' understanding of depression, medication, and follow-up care.

When developing a teaching plan for a client about the medications prescribed for depression, which of the following components is most important for the nurse to include? Create 1. Pharmacokinetics of the medication. 2. Current research related to the medication. 3. Management of common adverse effects. 4. Dosage regulation and adjustment.

3. Compliance with medication therapy is crucial for the client with depression. Medication noncompliance is the primary cause of relapse among psychiatric clients. Therefore, the nurse needs to teach the client about managing common adverse effects to promote compliance with medication. Teaching the client about the medication's pharmacokinetics may help the client to understand the reason for the drug. However, teaching about how to manage common adverse effects to promote compliance is crucial. Current research about the medication is more important to the nurse than to the client. Teaching about dosage regulation and adjustment of medication may be helpful, but typically the physician, not the client, is the person in charge of this aspect

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.

A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, "I want to know why I'm so depressed." Which of the following statements by the nurse is most helpful? 1. "I know you'll get better with the right medication." 2. "Let's discuss possible reasons underlying your depression." 3. "Your depression is most likely caused by a brain chemical imbalance." 4. "Members of your family seem very supportive of you."

3. Endogenous depression (depression coming from within the person) is biochemical in nature. The biologic theory of depression indicates a neurotransmitter imbalance involving serotonin, norepinephrine, and possibly dopamine. Reactive depression is caused by the occurrence of something happening outside the body, such as the death of a loved one or another significant loss. Stating that the client will improve with the right medication or that family members seem supportive does not address the client's immediate concerns of not knowing the cause of the depression. Discussing possible reasons for the client's depression is nontherapeutic because the depression is endogenous and biochemically based.

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.

The client with recurring depression will be discharged from the psychiatric unit. Which suggestion to the family is best to help them prepare for the client's return home? 1. Discourage visitors while the client is at home. 2. Provide for a schedule of activities outside the home. 3. Involve the client in usual at-home activities. 4. Encourage the client to sleep as much as possible.

3. It is best to involve the client in usual at-home activities as much as the client can tolerate them. Discouraging visitors may not be in the client's best interest because visits with supportive significant others will help reinforce supportive relationships, which are important to the client's self-worth and self-esteem. Providing for a schedule of activities outside the home may be overwhelming for the client initially. Involving the client in planning for outside activities would be appropriate. Encouraging the client to sleep as much as possible is nontherapeutic and promotes withdrawal from others.

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

A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client's daughter asks the nurse, "How painful will the treatment be for Mom?" The nurse should respond by saying which of the following? 1. "Your mother will be given something for pain before the treatment." 2. "The physician will make sure your mother doesn't suffer needlessly." 3. "Your mother will be asleep during the treatment and will not be in pain." 4. "Your mother will be able talk to us and tell us if she's in pain."

3. The nurse should explain that ECT is a safe treatment and that the client is given an ultra- short-acting anesthetic to induce sleep before ECT and a muscle relaxant to prevent musculoskeletal complications during the convulsion, which typically lasts 30 to 60 seconds to be therapeutic. Atropine is given before ECT to inhibit salivation and respiratory tract secretions and thereby minimize the risk of aspiration. Medication for pain is not necessary and is not given before or during the treatment. Some clients experience a headache after the treatment and may request and be given an analgesic such as acetaminophen (Tylenol). Telling the daughter that the physician will ensure that the client does not suffer needlessly would not provide accurate information about ECT. This statement also implies that the client will have pain during the treatment, which is untrue

A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta) twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first? 1. Refer the client to the dual diagnosis program at the clinic. 2. Share the information at the next interdisciplinary treatment conference. 3. Report the client's beer consumption to the physician. 4. Teach the client relaxation exercises to perform before bedtime.

3. The nurse should report the client's beer consumption to the physician. Duloxetine should not be administered to a client with renal or hepatic insufficiency because the medication can elevate liver enzymes and, together with substantial alcohol use, can cause liver injury. Referring the client to the dual diagnosis program, sharing information at the next interdisciplinary treatment conference, and teaching the client relaxation exercises are helpful interventions for the nurse to implement. However, reporting the findings to the physician is most important.

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 who is depressed states, "I'm an awful person. Everything about me is bad. I can't do anything right." Which of the following responses by the nurse is most therapeutic? 1. "Everybody around here likes you." 2. "I can see many good qualities in you." 3. "Let's discuss what you've done correctly." 4. "You were able to bathe today."

4. By saying, "You were able to bathe today," the nurse is pointing out a visible accomplishment or strength, thereby increasing the client's feelings of self-worth and self-esteem. Stating that "everybody around here likes you" or discussing what the client has done correctly is inappropriate because although the client may agree with the nurse, the client still may be depressed. Stating that the nurse sees many good qualities in the client is not helpful because a person's feeling of self-worth is generally determined by accomplishments. Intellectual understanding does not help the client with severe depression. Additionally, the nurse cannot talk a client out of depression because major depression is endogenous and biochemical in nature. Medication should restore the neurotransmitter balance and relieve the depression.

The nurse is distinguishing between delusions experienced by a client diagnosed with major depression with psychotic features and the delusions of a client diagnosed with schizophrenia. The essential difference is: 1. Major depression delusions are more likely to be negative than schizophrenic delusions. 2. Major depression delusions clear up less quickly than schizophrenic delusions. 3. Major depression delusions are more likely than schizophrenic delusions to require long-acting depot antipsychotic medication given intramuscularly. 4. Major depression delusions are more mood congruent than schizophrenic delusions.

4. Delusions occurring in schizophrenia tend to be more mood incongruent and more bizarre than delusions experienced with depression. Schizophrenic delusions clear up less quickly and are more likely to require depot antipsychotic medication, which are administered intramuscularly. Delusions in major depression match the client's mood, are somewhat more reality based, and tend to resolve once the client is properly medicated.

The nurse is planning care with a Mexican-American client who is diagnosed with depression. The client believes in "mal ojo" (the evil eye), and uses treatment by a root healer. The nurse should do which of the following? 1. Avoid talking to the client about the root healer. 2. Explain to the client that Western medicine has a scientific, not mystical, basis. 3. Explain that such beliefs are superstitious and should be forgotten. 4. Involve the root healer in a consultation with the client, physician and nurse.

4. Including the root healer gives credibility and respect to the client's cultural beliefs. Avoiding talking about the healer demonstrates either ignorance or disregard for the client's cultural values. Negative comparison of root healing with Western medicine not only denigrate the client's beliefs, but are likely to alienate him or her and cause them to end treatment.

A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client? 1. Future plans for going back to work. 2. A conflict encountered with another client. 3. Results of psychological testing. 4. Medication management with outpatient follow-up.

4. Medication management with outpatient follow-up is of vital importance to discuss with the client before discharge. The nurse teaches and clarifies any questions related to medication and outpatient treatment. The client also has the opportunity to voice feelings related to medication and treatment. The goal is to assist the client in making a successful transition from hospital to home with optimal functioning outside the hospital for as long as possible. The nurse may also need to assist with decreasing any anxiety the client may have related to discharge. Discussing future plans for returning to work or employment is not as immediate a concern as assisting with medication and treatment compliance. Noncompliance with medication is a primary cause of relapse in a client with a psychiatric disorder. Reviewing a conflict the client had encountered with another client is not appropriate or therapeutic at this time unless the client brings it to the nurse's attention. The conflict should have been dealt with and resolved when it occurred. Reviewing the results of psychological testing is the responsibility of the physician if he chooses.

A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which of the following nursing actions is most appropriate? 1. Explaining the importance of hygiene to the client. 2. Asking the client if he is ready to shower. 3. Waiting until the client's family can participate in the client's care. 4. Stating to the client that it's time for him to take a shower.

4. The client with depression is preoccupied, has decreased energy, and cannot make decisions, even simple ones. Therefore, the nurse presents the situation, "It's time for a shower," and assists the client with personal hygiene to preserve his dignity and self-esteem. Explaining the importance of good hygiene to the client is inappropriate because the client may know the benefits of hygiene but is too fatigued and preoccupied to pay attention to self-care. Asking the client if he is ready for a shower is not helpful because the client with depression commonly cannot make even simple decisions. This action also reinforces the client's feeling about not caring about showering. Waiting for the family to visit to help with the client's hygiene is inappropriate and irresponsible on the part of the nurse. The nurse is responsible for making basic decisions for the client until the client can make decisions for himself.

A client taking mirtazapine (Remeron) is disheartened about a 20 lb weight gain over the past 3 months. The client tells the nurse, "I stopped taking my Remeron 15 days ago. I don't want to get depressed again, but I feel awful about my weight." Which response by the nurse is most appropriate? 1. "Focusing on diet and exercise alone should control your weight." 2. "Your depression is much better now, so your medication is helping you." 3. "Look at all the positive things that have happened to you since you started Remeron." 4. "I hear how difficult this is for you and will help you approach the doctor about it."

4. The nurse should express concern for the client and offer to help the client speak with the physician which will lend support to the client's concerns. The client who has stopped the medication must be taken seriously because medication non-compliance could result in a recurrence of symptoms of depression. Telling the client to focus on diet and exercise ignores the client's feelings and subtly implies the weight gain is the client's fault. Pointing out that the medication has helped and that positive things have happened since the depression lifted may be true, but it does not address the client's current feelings or needs.

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.

After a few minutes of conversation, a female client who is depressed wearily asks the nurse, "Why pick me to talk to? Go talk to someone else." Which of the following replies by the nurse is best? 1. "I'm assigned to care for you today, if you'll let me." 2. "You have a lot of potential, and I'd like to help you." 3. "I'll talk to someone else later." 4. "I'm interested in you and want to help you."

4. The nurse tells the client that the nurse is interested in her to increase the client's sense of importance, worth, and self-esteem. Also, stating that the nurse wants to help conveys to the client that she is worthwhile and important. Telling the client that the nurse is assigned to care for her is impersonal and implies that the client is being uncooperative. Telling the client that the nurse is there because the client has potential for improvement will not help the client with low self-esteem because most people develop a sense of self-worth through accomplishment. Simply saying that the client has a lot of potential will not convince her that she is worthwhile. Telling the client that the nurse will talk to someone else later is not client-focused and does not address the client's question or concern.

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 a history of alcohol abuse tells a nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with him, the client dresses and begins to walk out of the hospital room. The appropriate nursing action is to: A. Call the nursing supervisor B. Call security to block all exits C. Restrain the client until the physician can be reached D. Tell the client that he cannot return to the hospital again if he leaves now

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

Select the nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior. Select all that apply. A. Communicate expected behaviors to the client B. Ensure the client knows that he or she is 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 nonpunitive manner E. Enforce rules and inform the client that he or she will not be allowed to attend therapy groups F. Be clear with the client regarding the consequences of exceeding limits that have been set regarding behavior

A, C, D, F

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 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 is admitted to the mental health unit with a diagnosis of depression. A nurse develops a plan of care for the client and includes which appropriate activity in the plan? A. Reading and writing most of the day B. Several activities from which the client can choose C. Nothing until the client chooses to participate in milieu D. A structured program of activities in which the client can participate

D

A client is admitted with bipolar affective disorder. The nurse acknowledges that which medication is used to treat this disorder for some clients in place of lithium? A. Thiopental B. Gingko Biloba C. Fluvoxamine (Luvox) D. Divalproex (Depakote)

D

A client with a diagnosis of major depression who has attempted suicide says to a nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." The therapeutic response to the client is: A. I don't see you as a failure B. You have everything to live for C. Feeling like this is all part of being ill D. You've been feeling like a failure for a while?

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 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

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

You are the triage nurse in the ER. Your initial assessment indicates that depression may be part of the client's problem. Which of the following nursing actions is essential? A. Within 1 week, telephone the client to ensure their mood has improved B. Redirect the client to discuss the stated reason for the visit C. Explore the client's perceptions regarding the severity of the stated reason for the visit D. Ask about depression and suicidal ideation directly

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

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.

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.

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

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

The client is taking 50 mg of Lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? A. Report the rash to the physician B. Explain that the rash is a temporary adverse reaction C. Give the client an ice pack for his arm D. Question the client about recent sun exposure

A.

The police arrive at the ED with a client who has seriously lacerated both wrists. The initial nursing action is to: A. Administer an antianxiety agent B. Examine and treat the client's wounds C. Place the client in a room with 1:1 observation D. Explain to the client that once his wounds are repaired he must go with the police to jail

B

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 behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal? A. The client runs out of the therapy group, swears at the group leader, and runs to her room B. The client gives away a prized CD and cherished autographed picture of her favorite performer C. The client becomes angry while speaking on the phone and slams down the receiver D. The client gets angry when her roommate borrows her clothes without asking

B

A client who has had 3 episodes of recurrent endogenous depression within the past 2 years states to the nurse, "I want to know why I'm so depressed." Which of the following statements by the nurse is most helpful? A. I know you'll get better with the right medication B. Let's discuss possible reasons underlying your depression C. Your depression is most likely caused by a brain chemical imbalance D. Members of your family seem very supportive of you

C

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 moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to a nurse, "I'm finally cured." The nurse interprets this behavior as a cue to modify the treatment plan by: A. Suggesting a reduction of medication B. Allowing increased in-room activities C. Increasing the level of suicide precautions D. Allowing the client off-unit priveleges as needed

C

A nurse is caring for a client with anorexia nervosa. The nurse is monitoring the behavior of the client and understands that a client with anorexia nervosa manages anxiety by: A. Engaging in immoral acts B. Always reinforcing self-approval C. Observing rigid rules and regulations D. Having the need to make the right decision

C

A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member's statement indicates the need for additional teaching? A. My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks B. My wife will need to take her antidepressant medicine and go to group to stay well C. My son will only need to attend outpatient appointments when he starts to feel depressed again D. My mother might need help with grocery shopping, cooking, and cleaning for a while

C

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

The client states, "Many of the people in my family experience similar symptoms with each depressive episode. Does that mean we have the same genetic defect?" Your best response includes which of the following? A. Related symptoms are probably due to being raised in the same family and learning the same behavioral responses B. Most current theories focus on electrolyte disturbances, particularly the reversal of sodium and potassium in the neruons of depressed individuals C. With the wide variety of mood disorders, a biologic basis is not likely. Therefore, pharmacological treatments for your family members should be individualized D. Heredity does seem to play a role in mood disorders. You and your family members may have the same biologic predisposition E. There are probably several genetic or biologic abnormalities associated with depression

E

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

The client is having ECT for treatment of severe depression. Prior to the ECT the nurse should: A. Apply a tourniquet to the patient's arm B. Administer an anticonvulsant medication C. Ask the client if he is allergic to shell fish D. Apply a blood pressure cuff to the arm

B

The physician orders mirtazapine (Remeron) 30 mg P.O. at bedtime for a client diagnosed with depression. The nurse should: 1. Give the medication as ordered. 2. Question the physician's order. 3. Request to give the medication in the morning. 4. Give the medication in three divided doses.

1. The nurse should give the medication as ordered. Mirtazapine is given once daily, preferably at bedtime to minimize the risk of injury resulting from postural hypotension and sedative effects. The usual dosage ranges from 15 to 45 mg. There is no reason to question the physician's order. The nurse should administer the medication as ordered. Requesting to give the medication in three divided doses is inappropriate and demonstrates the nurse's lack of knowledge about the drug.

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.

Which of the following behaviors exhibited by a client with depression should lead the nurse to determine that the client is ready for discharge? 1. Interactions with staff and peers. 2. Sleeping for 4 hours in the afternoon and 4 hours at night. 3. Verbalization of feeling in control of self and situations. 4. Statements of dissatisfaction over not being able to perform at work.

3. The client who verbalizes feeling in control of self and situations no longer feels powerless to affect an outcome but realizes that one's actions can have an impact on self and situations. It is common for the client with depression to feel powerless to affect an outcome and to feel a lack of control over a situation. Although interacting with staff and peers is a positive action, the client could be conversing in a negative or nontherapeutic manner. Sleeping 4 hours in the afternoon and 4 hours at night is evidence of symptomatology and does not indicate improvement or recovery. Verbalizing dissatisfaction over not being able to perform at work indicates that the client is most likely focusing on shortcomings and powerlessness.

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

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 taking tranylcypromine sulfate (Parnate) for depression. What advice should the nurse include in the teaching plan for this medication? A. Warn of severe hypotension B. Avoid beer and cheddar cheese C. Encourage ginseng and ephedra D. Encourage fruit such as bananas

B

A depressed client verbalizes feelings of low self esteem and self worth typified by statements such as "I'm such a failure. I can't do anything right." The best nursing response would be to: A. Tell the client that this is not true, we all have a purpose in life B. Identify recent behaviors or accomplishments that demonstrate the client's skills C. Reassure the client that you know how the client is feeling and that things will get better D. Remain with the client and sit in silence. This will encourage the client to verbalize feelings

B

A client is admitted to the mental health unit after an attempt of suicide by hanging. A nurse's most important aspect of care is to maintain client safety. This is accomplished best by: A. Requesting that a peer remain with the client at all times B. Removing the client's clothing and placing them in a gown C. Assigning a staff member to the client who will remain with the client at all times D. Admitting the client to a seclusion room where all potentially dangerous articles are removed

C

The nurse is distinguishing between delusions experienced by a client diagnosed with major depression with psychotic features and the delusions of a client diagnosed with schizophrenia. The essential difference is: A. Major depression delusions are more likely to be negative than schizophrenic delusions B. Major depression delusions clear up less quickly than schizophrenic delusions C. Major depression delusions are more likely than schizophrenic delusions to require long acting depot antipsychotic medication given IM D. Major depression delusions are more mood congruent than schizophrenic delusions

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