NCLEX 3500 Mental Health Tiger Virgo

A client is prescribed sertraline (Zoloft), a selective serotonin reuptake inhibitor. Which information about this drug's adverse effects would the nurse include when creating a medication teaching plan 1. Agitation 2. Agranulocytosis 3. Sleep disturbance 4. Intermittent tachycardia 5. Dry mouth 6. Seizures

Answer: 1,3,5 RATIONALES: Common adverse effects of sertraline are agitation, sleep disturbance, and dry mouth. Agranulocytosis, intermittent tachycardia, and seizures are adverse effects of clozapine (Clozaril)

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction? 1. Ataxia 2. Hepatomegaly 3. Urticaria 4. Rash

Answer: 1RATIONALES: Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, they aren't dose-related.

After interviewing a client diagnosed with recurrent depression, the nurse determines the client's potential to commit suicide. Which factors would the nurse consider as contributors to the client's potential for suicide? 1. Psychomotor retardation 2. Impulsive behaviors 3. Overwhelming feelings of guilt 4. Chronic, debilitating illness 5. Decreased physical activity 6. Repression of anger

Answer: 2,3,4,6RATIONALES: Impulsive behavior, overwhelming guilt, chronic illness, and anger repression are factors that contribute to suicide potential. Psychomotor retardation and decreased activity are symptoms of depression but don't typically lead to suicide because the client doesn't have the energy to harm himself.

The nurse is caring for a client with anorexia nervosa who has a nursing diagnosis of Imbalanced nutrition: Less than body requirements related to dysfunctional eating patterns. Which of the following interventions would be supportive for this client? 1. Provide small, frequent meals. 2. Monitor weight gain. 3. Allow the client to skip meals until the antidepressant levels are therapeutic. 4. Encourage the client to keep a journal. 5. Monitor the client during meals and for 1 hour after meals.

Answer 1,2,4,5RATIONALES: Because of self-starvation, the client with anorexia nervosa rarely can tolerate large meals three times per day. Small, frequent meals may be tolerated better by the client, and they provide a way to gradually increase daily caloric intake. The nurse should monitor the client's weight carefully because she may try to hide weight loss. The client may be emotionally restrained and afraid to express her feelings; keeping a journal can serve as an outlet for these feelings, which can assist recovery. A client with anorexia nervosa is already underweight and shouldn't be permitted to skip meals.

The nurse is assessing a client for dementia. What findings would the nurse expect a client with dementia? 1. There is a slow progression of symptoms. 2. The client admits to feelings of sadness. 3. The client acts apathetic and pessimistic. 4. The family can't determine when the symptoms first appeared. 5. There are changes in the client's basic personality. 6. The client has great difficulty paying attention to others.

Answer 1,4,5,6RATIONALES: A common characteristic of dementia is a slow onset of symptoms, which makes it difficult to determine when symptoms first occurred. It progresses to noticeable changes in the individual's personality and impaired ability to pay attention to other people. Feelings of sadness, apathy, and pessimism are symptoms of depression.

When teaching a client about lithium (Lithobid), the nurse should instruct the client to: 1. drink at least six to eight glasses of water per day and avoid caffeine. 2. limit the use of salt in his diet. 3. discontinue medicine when feeling better. 4. increase the amount of sodium in his diet.

Answer 1: RATIONALES: Caffeine should be avoided because it increases urine output. Clients need to maintain adequate fluid intake to avoid lithium toxicity. Don't limit or increase salt intake because the kidneys will hold onto lithium or excrete it if salt intake varies. Clients should remain on medication even though they are feeling better.

Discharge instructions for clients receiving tricyclic antidepressants include which of following information? 1. Don't consume alcohol. 2. Discontinue if dry mouth and blurred vision occur. 3. Restrict fluid and sodium intake. 4. It's safe to continue taking during pregnancy.

Answer 1: RATIONALES: Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. Fluid and sodium intake must be monitored during lithium (Lithobid) treatment. Safe use during pregnancy and breast-feeding hasn't been established.

An elderly client's lithium (Lithobid) level is 1.4 mEq/L. She complains of diarrhea, tremors, and nausea. The nurse's first action is to: 1. hold the lithium and notify the physician. 2. reassure the client that these are normal adverse effects 3. administer another lithium dose. 4. discontinue the lithium.

Answer 1: RATIONALES: The client has symptoms of lithium toxicity. Therefore, her lithium should be held and the physician notified immediately. These aren't normal adverse effects, and administering another dose would increase the toxic effects. A nurse can't discontinue a medication without a physician's order.

The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid: 1. has a more predictable onset of action. 2. produces fewer anticholinergic effects. 3. produces fewer drug interactions. 4. has a longer duration of action.

Answer 1:RATIONALES: A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.

Clients receiving monoamine oxidase inhibitor antidepressants must avoid tyramine, a compound found in which of the following foods? 1. Aged cheese and Chianti wine 2. Green leafy vegetables 3. Figs and cream cheese 4. Fruits and yellow vegetables

Answer 1:RATIONALES: Aged cheese and Chianti wine contain high concentrations of tyramine. The other foods listed are low in tyramine.

A client diagnosed with major depression has started taking amitriptyline (Elavil), a tricyclic antidepressant. What is a common adverse effect of this drug? 1. Weight loss 2. Dry mouth 3. Hypertension 4. Muscle spasms

Answer 2:RATIONALES: Tricyclic antidepressants can have anticholinergic adverse effects, with dry mouth being the most common. Hypotension would be expected, rather than hypertension. Weight gain — not loss — is typical when taking this medication. Muscle spasms aren't an adverse effect of tricyclic antidepressants.

Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following? 1. Occurrence of increased libido due to medication adverse effects 2. Increased incidence of dysmenorrhea while taking the drug 3. Continuing previous use of contraception during periods of amenorrhea 4. Instruction that amenorrhea is irreversible

Answer 3:RATIONALES: Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation; therefore, the client can still become pregnant. The client should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and libido generally decreases because of the depressant effect.

The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is: 1. Benztropine (Cogentin). 2. Diphenhydramine (Benadryl). 3. Propranolol (Inderal). 4. Haloperidol (Haldol).

Answer: 1 RATIONALES: Benztropine, trihexyphenidyl, or amantadine are prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.

The nurse has developed a relationship with a client who has an addiction problem. Which information would indicate that the therapeutic interaction is in the working stage? 1. The client addresses how the addiction has contributed to family distress. 2. The client reluctantly shares the family history of addiction. 3. The client verbalizes difficulty identifying personal strengths. 4. The client discusses the financial problems related to the addiction. 5. The client expresses uncertainty about meeting with the nurse. 6. The client acknowledges the addiction's effects on the children.

Answer: 1, 3 ,6 RATIONALES: Options 1, 3, and 6 are examples of the nurse-client working phase of an interaction. In the working phase, the client explores, evaluates, and determines solutions to identified problems. Options 2, 4 and 5 address what happens during the introductory phase of the nurse-client interaction.

A client with the nursing diagnosis of Fear, related to being embarrassed in the presence of others, exhibits symptoms of social phobia. What should the goals be for this client? 1. Manage her fear in group situations. 2. Develop a plan to avoid situations that may cause stress. 3. Verbalize feelings that occur in stressful situations. 4. Develop a plan for responding to stressful situations. 5. Deny feelings that may contribute to irrational fears. 6. Use suppression to deal with underlying fears.

Answer: 1,3,4 RATIONALES: Improving stress management skills, verbalizing feelings, and anticipating and planning for stressful situations are adaptive responses to stress. Avoidance, denial, and suppression are maladaptive defense mechanisms.

A client with schizophrenia is taking the atypical antipsychotic medication clozapine (Clozaril). Which signs and symptoms indicate the presence of adverse effects associated with this medication? 1. Sore throat 2. Pill-rolling movements 3. Polyuria 4. Fever 5. Polydipsia 6. Orthostatic hypotension

Answer: 1,4RATIONALES: Sore throat, fever, and sudden onset of other flulike symptoms are signs of agranulocytosis, a condition in which there is an insufficient number of granulocytes (a type of white blood cell [WBC]), which causes the individual to be susceptible to infection. The client's WBC count should be monitored at least weekly throughout the course of treatment. Pill-rolling movements can occur in clients experiencing adverse extrapyramidal effects associated with antipsychotic medication that has been prescribed for much longer than a medication such as clozapine. Polydipsia (excessive thirst) and polyuria (increased urine output) are common adverse effects of lithium therapy. Orthostatic hypotension is an adverse effect of tricyclic antidepressant therapy.

A delusional client approaches the nurse, stating, "I am the Easter bunny," and insisting that the nurse refer to him as such. The belief appears to be fixed and unchanging. Which nursing interventions should the nurse implement when working with this client? 1. Consistently use the client's name in interaction. 2. Smile at the humor of the situation. 3. Agree that the client is the Easter Bunny. 4. Logically point out why the client couldn't be the Easter Bunny. 5. Provide an as-needed medication. 6. Provide the client with structured activities.

Answer: 1,6RATIONALES: Continued reality-based orientation is necessary, so it's appropriate to use the client's name in any interaction. Structured activities can help the client refocus and resolve his delusion. The nurse shouldn't contribute to the delusion by going along with the situation. Logical arguments and an as-needed medication aren't likely to change the client's beliefs.

A client is admitted to the emergency department with chest pain, palpitations, vertigo, and diaphoresis. When initial assessment shows no physiological basis for these complaints, the client is referred to a psychiatric clinical nurse-specialist. After determining that the client has had four similar episodes in the last month, the specialist suspects that the client has: 1. panic disorder. 2. depression. 3. schizophrenia. 4. obsessive-compulsive disorder.

Answer: 1RATIONALES: This client has classic signs and symptoms of panic disorder, which results from acute anxiety. Panic disorder also may cause dyspnea, choking, feelings of unreality, hot and cold flashes, and shaking or trembling. Panic disorder is confirmed by a history of three or more panic attacks within 3 weeks that are unrelated to extreme physical exertion or life-threatening situations. Depression may cause psychomotor agitation, feelings of worthlessness, difficulty concentrating, energy loss, and fatigue. Schizophrenic disorders are marked mainly by withdrawal and failure to distinguish reality from fantasy. Obsessive-compulsive disorder wouldn't cause the physiological manifestations seen in this client.

A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect? 1. Tardive dyskinesia 2. Dystonia 3. Neuroleptic malignant syndrome 4. Akathisia

Answer: 1RATIONALES: Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? 1. The absence of anticholinergic effects 2. A lower incidence of extrapyramidal effects 3. Photosensitivity and sedation 4. No incidence of neuroleptic malignant syndrome

Answer: 2 RATIONALES: Risperdal has a lower incidence of extrapyramidal effects than do the typical antipsychotics. Risperdal does produce anticholinergic effects, and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.

The nurse notices that a depressed client taking amitriptyline (Elavil) for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client 1. is responding to the antipsychotic. 2. may be experiencing increased energy and is at an increased risk for suicide. 3. is ready to be discharged from treatment. 4. is experiencing a split personality.

Answer: 2 RATIONALES: As antidepressants take effect, individuals suffering from depression may begin to feel energetic enough to mobilize a suicide plan. Option 1 is incorrect because Elavil is an antidepressant, not an antipsychotic. The client shouldn't be discharged until the risk of suicide has diminished. The elevated mood is a response to the antidepressant, not a split personality

A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should: 1. administer the medication as prescribed. 2. question the physician about the order. 3. administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n. 4. administer the medication as prescribed but observe the client closely for adverse effects

Answer: 2 RATIONALES: The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately, before the client's health is jeopardized.

The nurse is explaining the Bill of Rights for psychiatric patients to a client who has voluntarily sought admission to an inpatient psychiatric facility. Which of the following rights should the nurse include in the discussion? 1. Right to select health care team members 2. Right to refuse treatment 3. Right to a written treatment plan 4. Right to obtain disability 5. Right to confidentiality 6. Right to personal mail

Answer: 2,3,4,6RATIONALES: An inpatient client usually receives a copy of the Bill of Rights for psychiatric patients, where they would find options 2, 3, 5, and 6 in writing. However, a client in an inpatient setting can't select health team members. A client may apply for disability as a result of a chronic, incapacitating illness; however, disability isn't a patient right, and members of a psychiatric institution don't decide who should receive it.

The physician orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse would be most appropriate? 1. "Take this medication. It will reduce your anxiety." 2. "Do you have any concerns about taking the medication?" 3. "Trust us. This medication has helped many people. We wouldn't have you take it if it were dangerous." 4. "How can we help you if you won't cooperate?"

Answer: 2RATIONALES: Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option 1, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option 3, or threatening the client, as in option 4, would increase anxiety

Additive central nervous system (CNS) depression can occur when combining a sedative-hypnotic with which drug? 1. Methylphenidate (Ritalin) 2. Cocaine 3. Amitriptyline (Elavil) 4. Amphetamine (Adderall)

Answer: 3 RATIONALES: Additive effects occur with concomitant use of CNS depressants, antihistamines, antidepressants, and antipsychotics. Elavil is an antidepressant and the only correct answer. All the other drugs are classified as stimulants.

Physical tolerance and withdrawal symptoms can occur with stimulants. Stimulant withdrawal is characterized by which of the following symptoms? 1. Rhinorrhea, dilated pupils, and abdominal cramps 2. Increased motor activity and tachycardia 3. Fatigue, mental depression, and confusion 4. Tremors, nausea, vomiting, and diaphoresis

Answer: 3 RATIONALES: Withdrawal from stimulants results in central nervous system depression, including fatigue, depression, and confusion. Rhinorrhea, dilated pupils, and abdominal cramps are symptoms of opioid withdrawal. Increased motor activity and tachycardia are symptoms of sedative withdrawal. Tremors, nausea, vomiting, and diaphoresis are symptoms of alcohol withdrawal

After taking an overdose of phenobarbital (Barbita), a client is admitted to the emergency department. The physician prescribes activated charcoal (Charcocaps) to be administered by mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What is the usual minimum dose of activated charcoal? 1. 5 g mixed in 250 ml of water 2. 15 g mixed in 500 ml of water 3. 30 g mixed in 250 ml of water 4. 60 g mixed in 500 ml of water

Answer: 3 RATIONALES: The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the drug or chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses less than this will be ineffective; doses greater than this can increase the risk of adverse reactions, although toxicity doesn't occur with activated charcoal, even at the maximum dose

Low doses of central nervous system (CNS) depressants produce an initial excitatory response. This reaction is caused by: 1. a stimulating effect on the CNS. 2. the depression of acetylcholine. 3. the stimulation of dopamine by depressant drugs. 4. inhibitory synapses in the brain being depressed before excitatory synapses.

Answer: 4 RATIONALES: Excitation can occur when inhibitory synapses are depressed. The other options are incorrect because depressants don't stimulate the CNS or dopamine and don't depress acetylcholine.

A young man brought to the emergency department by a police officer states, "I don't know who or where I am." He has no identification but appears to be in good physical health. Physical examination reveals no evidence of trauma or other abnormal findings. He is admitted to the psychiatric unit for further evaluation and treatment. The nurse anticipates that the client will react to his inability to recall his identity by exhibiting: 1. an intense preoccupation with discovering who he is. 2. depression. 3. anger and frustration. 4. complacency.

Answer: 4 RATIONALES: Because a client with psychogenic amnesia is successfully blocking a traumatic or severe anxiety-producing event, he is likely to react to his inability to recall his identity with complacency. He won't have an intense desire to discover who he is because learning his identity would force him to remember the event and confront the anxiety. For the same reason, he won't exhibit depression or anger, both of which are associated with anxiety-producing events.

A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance? 1. Alcohol 2. Cannabis 3. Cocaine 4. Opioid

Answer: 4RATIONALES: The symptoms listed are specific to opioid withdrawal. A client with alcohol withdrawal would show elevated vital signs. There is no real withdrawal from cannabis. Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

Which adverse reaction to lithium should the client with bipolar disorder report? 1. Black tongue 2. Increased tearing 3. Periods of disorientation 4. Persistent GI upset

Answer: 4RATIONALES: Persistent GI upset indicates a mild to moderate toxic reaction that should be reported. Black tongue is an adverse reaction to mirtazapine (Ramaron), not lithium. Increased tearing isn't an adverse reaction to lithium. Periods of disorientation don't occur with lithium use.

Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect? 1. Seizures 2. Shivering 3. Anxiety 4. Chest pain

Answer 1:RATIONALES: Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions? 1. Antipsychotic-induced akathisia and anxiety 2. The manic phase of bipolar illness as a mood stabilizer 3. Delusions for clients suffering from schizophrenia 4. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior

Answer 1:RATIONALES: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic-induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.

The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam (Ativan), 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to: 1. avoid caffeine. 2. avoid aged cheeses. 3. stay out of the sun. 4. maintain an adequate salt intake.

Answer 1: RATIONALES: Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.

A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see: 1. tension and irritability. 2. slow pulse. 3. hypotension. 4. constipation.

Answer 1:RATIONALES: An amphetamine is a nervous system stimulant that is subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Options 2 and 3 are incorrect because amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. Diarrhea is a common adverse effect, so option 4 is incorrect.

A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? 1. Ineffective protection related to blood dyscrasias 2. Reflex urinary incontinence related to adverse effects of antipsychotic medication 3. Risk for injury related to a severely decreased level of consciousness 4. Risk for injury related to electrolyte disturbances

Answer 1:RATIONALES: Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Reflex urinary incontinence isn't an adverse effect of these medications. Although antipsychotic medications may cause sedation, they don't severely decrease the level of consciousness, eliminating option 3. These drugs don't cause electrolyte disturbances, eliminating option 4.

Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions? 1. Use sunscreen because of photosensitivity. 2. Take the antipsychotic medication with food. 3. Have routine blood tests to determine levels of the medication. 4. Abstain from eating aged cheese.

Answer 1:RATIONALES: Antipsychotics such as haloperidol increase photosensitivity; therefore, clients taking these medications should be warned about the possibility of sunburns. Routine blood work isn't necessary. Food restrictions are necessary with monoamine oxidase inhibitors, not antipsychotics such as haloperidol. Antipsychotic medications can be taken without regard to food intake.

Which of the following statements describes how elderly clients react to medications? 1. At risk for increased adverse effects 2. Tolerate medication better because they are less active 3. Metabolize medications quickly 4. Need higher doses than younger clients to respond to the same medication

Answer 1:RATIONALES: As individuals become older, their livers metabolize drugs at a slower rate. Cumulative effects can occur and increase the risk of adverse effects. Elderly clients typically need lower doses, not higher. Level of activity typically doesn't affect a person's reaction to medication.

The nurse is caring for a client who has been diagnosed with delirium. Which statement about delirium is true? 1. It's characterized by an acute onset and lasts about 1 month. 2. It's characterized by a slowly evolving onset and lasts about 1 week. 3. It's characterized by a slowly evolving onset and lasts about 1 month. 4. It's characterized by an acute onset and lasts hours to a number of days.

Answer 4: RATIONALES: Delirium has an acute onset and typically can last from several hours to several days.

A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer as ordered to minimize extrapyramidal symptoms? 1. benztropine (Cogentin) 2. dantrolene (Dantrium) 3. clonazepam (Klonopin) 4. diazepam (Valium)

Answer 1:RATIONALES: Benztropine is an anticholinergic administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine, is administered to reduce anxiety.

A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use? 1. Coronary artery spasm 2. Bradyarrhythmias 3. Neurobehavioral deficits 4. Panic disorder

Answer 1:RATIONALES: Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction, dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at postsynaptic receptor sites. Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias. Although neurobehavioral deficits are common in neonates born to cocaine users, they are rare in adults. As craving for the drug increases, a person who's addicted to cocaine typically experiences euphoria followed by depression, not panic disorder.

Hormonal effects of the antipsychotic medications include which of the following? 1. Retrograde ejaculation and gynecomastia 2. Dysmenorrhea and increased vaginal bleeding 3. Polydipsia and dysmenorrhea 4. Akinesia and dysphasia

Answer 1:RATIONALES: Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Polydipsia, akinesia, and dysphasia aren't hormonal effects.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? 1. Dystonia 2. Akinesia 3. Akathisia 4. Tardive dyskinesia

Answer 1:RATIONALES: Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.

Which of the following groups of characteristics would the nurse expect to see in the client with schizophrenia? 1. Loose associations, grandiose delusions, and auditory hallucinations 2. Periods of hyperactivity and irritability alternating with depression 3. Delusions of jealousy and persecution, paranoia, and mistrust 4. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss

Answer 1:RATIONALES: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren't able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.

Lorazepam (Ativan) is often given along with a neuroleptic agent. What is the purpose of administering the drugs together? 1. To reduce anxiety and potentiate the sedative action of the neuroleptic 2. To counteract extrapyramidal effects of the neuroleptic 3. To manage depressed clients 4. To increase the client's level of awareness and concentration

Answer 1:RATIONALES: Lorazepam, when given with a neuroleptic such as haloperidol (Haldol), potentiates the sedating effect and is used to treat severely agitated clients. Haloperidol places the client at risk for extrapyramidal effects and, therefore, wouldn't be used to treat extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. Concentration would be decreased because of the depressant effect.

Which of the following statements should be included when teaching clients about monoamine oxidase (MAO) inhibitor antidepressants? 1. Don't take prescribed or over-the-counter medications without consulting the physician. 2. Avoid strenuous activity because of the cardiac effects of the drug. 3. Have blood levels screened weekly for leukopenia. 4. Don't take with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

Answer 1:RATIONALES: MAO inhibitors when combined with a number of drugs can cause life-threatening hypertensive crisis. It's imperative that a client check with his physician and pharmacist before taking any other medications. Activity doesn't need to be limited. Blood dyscrasias aren't a common problem with MAO inhibitors. Aspirin and NSAIDs are safe to take with MAO inhibitors

Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, the nurse should incorporate which of the following instructions in her teaching plan? 1. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants. 2. Avoid taking antianxiety drugs at bedtime. 3. Avoid taking antianxiety drugs on an empty stomach. 4. Avoid consuming aged cheese when taking antianxiety agents.

Answer 1:RATIONALES: Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium.

Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? 1. Hypertension 2. Respiratory arrest 3. Tourette syndrome 4. Retinal pigmentation

Answer 4: RATIONALES: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options don't occur as a result of exceeding this dose.

One of the causes of schizophrenia involves an overstimulation of what neurotransmitter? 1. Dopamine 2. Epinephrine 3. Norepinephrine 4. Serotonin

Answer 1:RATIONALES: Studies of the role of neurotransmitters in schizophrenia have shown that the disease results (at least in part) from an overactive dopamine system in the brain. Excessive dopamine activity may be responsible for such symptoms as hallucinations, agitation, delusional thinking, and grandiosity — forms of hyperactivity that have been linked to excessive dopamine activity. Epinephrine, norepinephrine, and serotonin are neurotransmitters, but they're not implicated in schizophrenia.

Which assessment finding is most consistent with early alcohol withdrawal? 1. Heart rate of 120 to 140 beats/minute 2. Heart rate of 50 to 60 beats/minute 3. Blood pressure of 100/70 mm Hg 4. Blood pressure of 140/80 mm Hg

Answer 1:RATIONALES: Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don't receive treatment. The nurse should monitor the client's vital signs carefully throughout the entire alcohol withdrawal process.

Which medications have been found to help reduce or eliminate panic attacks? 1. Antidepressants 2. Anticholinergics 3. Antipsychotics 4. Mood stabilizers

Answer 1:RATIONALES: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn't clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don't relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks aren't psychotic. Mood stabilizers aren't indicated because panic attacks are rarely associated with mood changes.

The nurse is monitoring a client who appears to be hallucinating. The nurse notes paranoid content in the client's speech, and he appears agitated. The client is gesturing at a figure on the television. Which nursing interventions are appropriate? 1. In a firm voice, instruct the client to stop the behavior. 2. Reinforce that the client is not in any danger. 3. Acknowledge the presence of the hallucinations. 4. Instruct other team members to ignore the client's behavior. 5. Immediately implement physical restraint procedures. 6. Use a calm voice and simple commands.

Answer 2,3,6:RATIONALES: Using a calm voice, the nurse should reassure the client that he is safe. The nurse shouldn't challenge the client; rather, she should acknowledge his hallucinatory experience. It isn't appropriate to request that the client stop the behavior. Implementing restraints isn't warranted at this time. Although the client is agitated, no evidence exists that the client is at risk for harming himself or others.

A client has been diagnosed with an adjustment disorder with mixed anxiety and depression. What are the primary nursing diagnoses associated with an adjustment disorder? 1. Activity intolerance 2. Impaired social interaction 3. Situational low self-esteem 4. Disturbed personal identity 5. Acute confusion 6. Impaired memory

Answer 2,3: RATIONALES: A client with an adjustment disorder is likely to have impaired social interaction and situational low self-esteem. Activity intolerance, disturbed personal identity, acute confusion, and impaired memory aren't related to the diagnosis of adjustment disorder.

The nurse notices that a depressed client taking amitriptyline (Elavil) for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client: 1. is responding to the antipsychotic. 2. may be experiencing increased energy and is at an increased risk for suicide. 3. is ready to be discharged from treatment. 4. is experiencing a split personality.

Answer 2: RATIONALES: As antidepressants take effect, individuals suffering from depression may begin to feel energetic enough to mobilize a suicide plan. Option 1 is incorrect because Elavil is an antidepressant, not an antipsychotic. The client shouldn't be discharged until the risk of suicide has diminished. The elevated mood is a response to the antidepressant, not a split personality.

A client seeks care because she feels depressed and has gained weight. To treat her atypical depression, the physician prescribes tranylcypromine sulfate (Parnate), 10 mg by mouth twice per day. When this drug is used to treat atypical depression, what is its onset of action? 1. 1 to 2 days 2. 3 to 5 days 3. 6 to 8 days 4. 10 to 14 days

Answer 2: RATIONALES: Monoamine oxidase inhibitors such as tranylcypromine have an onset of action of approximately 3 to 5 days. A full clinical response may be delayed for 3 to 4 weeks. The therapeutic effects may continue for 1 to 2 weeks after discontinuation.

Nursing implications for a client taking central nervous system (CNS) stimulants include monitoring the client for which of the following conditions? 1. Hyperpyrexia, slow pulse, and weight gain 2. Tachycardia, weight loss, and mood swings 3. Hypotension, weight gain, and listlessness 4. Increased appetite, slowing of sensorium, and arrhythmias

Answer 2: RATIONALES: Stimulants produce mood swings, anorexia and weight loss, and tachycardia. The other symptoms indicate CNS depression.

Which of the following tests are useful in diagnosing depression? 1. Coagulation profile and protein uptake test 2. Dexamethasone suppression test (DST) 3. Amitriptyline level 4. Creatinine and thyroid-stimulating hormone levels

Answer 2: RATIONALES: The DST is a blood test that determines the serum cortisol level after administration of dexamethasone (Decadron), an agent that usually suppresses the serum cortisol level. The DST has gained considerable attention in the mental health field as a diagnostic marker for endogenous depression as well as for its implications for the treatment and prognosis of this disorder. Most studies have found that 40% to 50% of clients with endogenous depression or major depression with melancholia don't have a suppressed late-afternoon serum cortisol level after dexamethasone administration. Amitriptyline levels are followed when a client is receiving the drug to treat depression. They aren't helpful in diagnosing depression. The other options aren't useful in diagnosing depression.

A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects? 1. guanethidine (Ismelin) 2. droperidol (Inapsine) 3. lithium carbonate (Lithonate) 4. alcohol

Answer 2: RATIONALES: When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. The other options are incorrect.

The nurse is administering atropine sulfate to a client about to undergo electroconvulsive therapy (ECT). Which assessment indicates that the medication is effective? 1. The client's heart rate is 48 beats/minute. 2. The client states that his mouth is dry. 3. The client appears calm and relaxed. 4. The client falls asleep.

Answer 2: RATIONALES: Atropine sulfate is administered approximately 30 minutes before ECT to reduce oral secretions; therefore, the client's mouth would feel dry. Atropine also blocks the vagal stimulation of the heart, causing a rise in heart rate (much higher than 48 beats/minute). Atropine sulfate isn't given to make the client feel calm and relaxed, nor does it induce sleep.

A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect? 1. Phenytoin (Dilantin) 2. Amantadine (Symmetrel) 3. Benztropine (Cogentin) 4. Diphenhydramine (Benadryl)

Answer 2:RATIONALES: An antiparkinsonian agent such as amantadine may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.

During a shift report, the nurse learns that she will be providing care for a client who's vulnerable to panic attack. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as: 1. barbiturates. 2. antianxiety drugs. 3. depressants. 4. amphetamines.

Answer 2:RATIONALES: Antianxiety drugs provide symptomatic relief. Barbiturates and amphetamines can precipitate panic attacks. Depressants aren't appropriate for treating panic attacks.

A client has been taking imipramine (Tofranil), 125 mg by mouth daily, for 1 week. Now the client reports wanting to stop taking the medication because he still feels depressed. At this time, what is the nurse's best response? 1. "Imipramine may not be the most effective medication for you. You should call your physician for further evaluation." 2. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression." 3. "The physician may need to increase the dosage for you to get the medication's maximum benefit." 4. "Don't stop taking the medication abruptly because you may develop serious adverse effects."

Answer 2:RATIONALES: Antidepressant agents such as imipramine don't produce antidepressant effects until they reach a therapeutic level in the blood, usually about 2 to 3 weeks after the initial dose. Therefore, the nurse should encourage the client to continue therapy at least until the drug reaches that level. After this time, if the client's depression doesn't abate, the nurse may use the other responses.

The nurse is aware that antipsychotic medications may cause which of the following adverse effects? 1. Increased production of insulin 2. Lower seizure threshold 3. Increased coagulation time 4. Increased risk of heart failure

Answer 2:RATIONALES: Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents.

During the manic phase of bipolar disorder, a client's lithium carbonate (Lithonate) level measures 0.15 mEq/L. The client dresses flamboyantly, acts provocatively, and has seriously impaired judgment. What is the nurse's first priority when planning this client's care? 1. Administer lithium carbonate I.M. 2. Observe the client's behavior closely in the milieu. 3. Begin aversion therapy to extinguish undesirable behaviors. 4. Initiate suicide precautions because the client's judgment is impaired.

Answer 2:RATIONALES: Because a client with manic symptoms has impaired judgment, the nurse should observe closely to prevent the client from acting on dangerous impulses. Although lithium carbonate is used to control mania, it's available only in oral form. Aversion therapy is inappropriate because the client can't control the behavior. Suicide precautions also are inappropriate because the client hasn't displayed suicidal intentions.

During the client-teaching session, which instruction should the nurse give to a client receiving the second-generation antidepressant paroxetine (Paxetil)? 1. "Be aware that your vision may become blurred." 2. "Include high-fiber foods in your diet." 3. "Report polyuria to the physician immediately." 4. "Avoid tyramine-rich foods such as red wine."

Answer 2:RATIONALES: Because constipation may occur with paroxetine therapy, the client should eat foods rich in fiber. Blurred vision and polyuria aren't common adverse reactions to paroxetine. Avoiding tyramine-rich foods is an important instruction for a client taking a monoamine oxidase inhibitor — not a second-generation antidepressant such as paroxetine.

The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered? 1. To reduce psychotic symptoms 2. To reduce extrapyramidal symptoms 3. To control nausea and vomiting 4. To relieve anxiety

Answer 2:RATIONALES: Benztropine is an anticholinergic medication administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting.

Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction? 1. prochlorperazine (Compazine) 2. diphenhydramine (Benadryl) 3. haloperidol (Haldol) 4. midazolam (Versed)

Answer 2:RATIONALES: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.

What medication would probably be ordered for the acutely aggressive schizophrenic client? 1. chlorpromazine (Thorazine) 2. haloperidol (Haldol) 3. lithium carbonate (Lithonate) 4. amitriptyline (Elavil)

Answer 2:RATIONALES: Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression

A dystonic reaction can be caused by which medication? 1. Diazepam (Valium) 2. Haloperidol (Haldol) 3. Amitriptyline (Elavil) 4. Clonazepam (Klonopin)

Answer 2:RATIONALES: Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Diazepam and clonazepam are benzodiazepines, and amitriptyline is a tricyclic antidepressant. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.

At night, a geriatric client with senile dementia wanders into other clients' rooms, awakening them. What is the best nursing intervention for dealing with the client's insomnia and nocturnal roaming? 1. Administer a benzodiazepine at bedtime as prescribed. 2. Administer a phenothiazine at bedtime as prescribed. 3. Administer a barbiturate at bedtime as prescribed. 4. Lock the client's door at bedtime.

Answer 2:RATIONALES: In geriatric clients, phenothiazines are preferred for sedation and thought clearing. Benzodiazepines usually are avoided because of the risk of addiction, cardiovascular complications, and impaired motor coordination. Barbiturates also are avoided because they may cause delirium, confusion, excitement, and addiction. Locking the door is inappropriate and would violate the client's rights

For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take? 1. Give the next dose of fluphenazine, call the physician, and monitor vital signs. 2. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. 3. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation. 4. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake.

Answer 2:RATIONALES: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher.

Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by: 1. decreasing the anxiety causing muscle rigidity. 2. blocking the cholinergic activity in the central nervous system (CNS). 3. increasing the level of acetylcholine in the CNS. 4. increasing norepinephrine in the CNS.

Answer 2:RATIONALES: Option 2 is the action of benztropine. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS.

A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which common assessment finding indicates that the client may have ingested PCP? 1. Dilated pupils 2. Nystagmus 3. Paranoia 4. Altered mood

Answer 2:RATIONALES: Phencyclidine is an anesthetic with severe psychological effects. It blocks the reuptake of dopamine and directly affects the midbrain and thalamus. Nystagmus and ataxia are common physical findings of PCP use. Dilated pupils are evidence of LSD ingestion. Paranoia and altered mood occur with both PCP and LSD ingestion.

A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to: 1. reassure the client and administer as-needed lorazepam (Ativan) I.M. 2. administer an as-needed dose of benztropine (Cogentin) I.M. as ordered. 3. administer an as-needed dose of benztropine (Cogentin) by mouth as ordered. 4. administer an as-needed dose of haloperidol (Haldol) by mouth.

Answer 2:RATIONALES: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.

The nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor? 1. Hypotensive episodes 2. Hypertensive crisis 3. Muscle flaccidity 4. Hypoglycemia

Answer 2:RATIONALES: The most serious adverse reaction associated with high doses of MAO inhibitors is hypertensive crisis, which can lead to death. Although not a crisis, orthostatic hypotension is also common and may lead to syncope with high doses. Muscle spasticity (not flaccidity) is associated with MAO inhibitor therapy. Hypoglycemia isn't an adverse reaction of MAO inhibitors.

The nurse is assigned to a client who, after a medication teaching session with the nurse, began receiving amitriptyline (Elavil) 1 week ago to treat depression. The client now refuses to take the medication, stating that it has caused blurred vision, dry mouth, and constipation, but hasn't improved the mood. Which nursing diagnosis is most appropriate for this client? 1. Noncompliance (treatment regimen) related to treatment resistance 2. Deficient knowledge (treatment regimen) related to inadequate understanding of teaching 3. Anxiety related to unconscious conflict 4. Ineffective coping related to personal vulnerability

Answer 2:RATIONALES: The nurse should assume that the client doesn't have the information necessary to make an informed decision about using the medication. Therefore, Deficient knowledge related to inadequate understanding of teaching is the most appropriate nursing diagnosis. The nurse also should assume that the client wants to feel better; a nursing diagnosis of noncompliance related to treatment resistance would imply that the client is deliberately choosing to be ill. No data support a nursing diagnosis of anxiety related to unconscious conflict or ineffective coping related to personal vulnerability.

A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan? 1. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur 2. Sitting up for a few minutes before standing to minimize orthostatic hypotension 3. Notifying the physician if her thoughts don't normalize within 1 week 4. Expecting symptoms of tardive dyskinesia to occur and to be transient

Answer 2:RATIONALES: The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may take several weeks to appear. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately.

Which is the drug of choice for treating Tourette syndrome? 1. Fluoxetine (Prozac) 2. Fluvoxamine (Luvox) 3. Haloperidol (Haldol) 4. Paroxetine (Paxil)

Answer: 3 RATIONALES: Haldol is the drug of choice for treating Tourette syndrome. Prozac, Luvox, and Paxil are antidepressants and aren't used to treat Tourette syndrome.

Which nursing intervention would be most appropriate if a client were to develop orthostatic hypotension while taking amitriptyline (Elavil)? 1. Consulting the physician about substituting a different type of antidepressant 2. Advising the client to sit up for 1 minute before getting out of bed 3. Instructing the client to double the dosage until the problem resolves 4. Informing the client that this adverse reaction should disappear within 1 week

Answer 2:RATIONALES: To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant. Orthostatic hypotension disappears only when the drug is discontinued.

A man brings his wife to the facility. He reports that since the death of their 7-month-old daughter 8 weeks ago, his wife has been neglecting her housework and family, has lost 20 lb (9.1 kg) from not eating, and hasn't left the house. She is admitted to the psychiatric unit with a diagnosis of depression. The nurse helps the client settle in. While observing her unpack, the nurse expects her to exhibit: 1. fast movements. 2. slow movements. 3. a desire to initiate a conversation with her roommates. 4. a desire to unpack and arrange her belongings without assistance.

Answer 2:RATIONALES: Typically, a depressed client exhibits slow movements and fatigue. Such a client also has difficulty interacting, making decisions, and initiating independent actions. Nursing interventions should be planned to assist and support the client, as needed, to meet needs. Although a client with agitated depression (depression with frantic pacing) may exhibit increased activity, this behavior is more common in a client with mania.

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? 1. Calcium 2. Sodium 3. Chloride 4. Potassium

Answer 2RATIONALES: Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes are important for normal body functions but sodium is most important to the absorption of lithium.

Which of the following drugs may be abused because of tolerance and physiologic dependence. 1. lithium (Lithobid) and divalproex (Depakote). 2. verapamil (Calan) and chlorpromazine (Thorazine) 3. alprazolam (Xanax) and phenobarbital (Luminal) 4. clozapine (Clozaril) and amitriptyline (Elavil)

Answer 3: RATIONALES: Both benzodiazepines such as alprazolam and barbiturates such as phenobarbital are addictive, controlled substances. All the other drugs listed aren't addictive substances.

The physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the past 6 months. The nurse should take which action? 1. Administer the medication as ordered. 2. Discontinue the medication. 3. Question the order with the physician. 4. Inform the client that he should discuss the MI with the physician.

Answer 3: RATIONALES: Cardiovascular toxicity is a problem with tricyclic antidepressants, and the nurse should question their use in a client with cardiac disease. Administering the medication would be an act of negligence. A nurse can't discontinue a medication without a physician's order. It's the nurse's responsibility, not the client's, to discuss questions of care with the physician.

The nurse is administering venlafaxine (Effexor), 75 mg by mouth daily, to a client diagnosed with depression. What type of agent is venlafaxine? 1. Monoamine oxidase inhibitor 2. Tricyclic antidepressant 3. Second-generation antidepressant 4. Lithium derivative

Answer 3: RATIONALES: Physicians prescribe venlafaxine to treat depressive disorders; the drug is a second-generation antidepressant agent

A client with bipolar disorder is being treated with lithium for the first time. The nurse should observe the client for which common adverse effect of lithium? 1. Sexual dysfunction 2. Constipation 3. Polyuria 4. Seizures

Answer 3: RATIONALES: Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Sexual dysfunction isn't a common adverse effect of lithium; it's more common with sedatives and tricyclic antidepressants. Diarrhea, not constipation, occurs with lithium. Constipation can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures may be a later sign of lithium toxicity

What herbal medication for depression, widely used in Europe, is now being prescribed in the United States? 1. Ginkgo biloba 2. Echinacea 3. St. John's wort 4. Ephedra

Answer 3: RATIONALES: St. John's wort has been found to have serotonin-elevating properties, similar to prescription antidepressants. Ginkgo biloba is prescribed to enhance mental acuity. Echinacea has immune-stimulating properties. Ephedra is a naturally occurring stimulant that is similar to ephedrine.

A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug? 1. clozapine (Clozaril) 2. thiothixene (Navane) 3. lorazepam (Ativan) 4. lithium carbonate (Eskalith)

Answer 3: RATIONALES: The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren't used to manage alcohol withdrawal syndrome.

The nurse is providing care for a female client with a history of schizophrenia who's experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse's best action? 1. Administer the haloperidol orally if the client agrees to take it. 2. Call the physician to clarify whether the haloperidol should be given orally or I.M. 3. Call the physician to clarify the order because the dosage is too high. 4. Withhold haloperidol because it may worsen hallucinations.

Answer 3: RATIONALES: The dosage is too high (normal dosage ranges from 5 to 10 mg daily). Options 1 and 2 may lead to an overdose. Option 4 is incorrect because haloperidol helps with symptoms of hallucinations.

A client with major depression must take tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor (MAOI). During medication teaching, the nurse should instruct the client to avoid consuming: 1. free-range poultry. 2. whole grain bread. 3. aged cheese. 4. fresh fish.

Answer 3: RATIONALES: When taking an MAOI, the client should avoid consuming high-tyramine foods, such as aged cheese, because the interaction may cause a life-threatening hypertensive crisis. The client may safely consume low-tyramine foods, such as poultry, whole grain bread, and fresh fish.

Which term refers to the primary unconscious defense mechanism that keeps intense, anxiety-producing situations out of a person's conscious awareness? 1. Introjection 2. Regression 3. Repression 4. Denial

Answer 3: RATIONALES: Repression, the unconscious exclusion from awareness of painful or conflicting thoughts, impulses, or memories, is the primary ego defense. Other defense mechanisms tend to reinforce anxiety. Introjection is an intense identification in which one incorporates another person's or group's values or qualities into one's own ego structure. Regression is a retreat to an earlier level of developmental behavioral during a time of stress. Denial is the avoidance of unpleasant realities by ignoring them.

A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation? 1. Ask the client to sit still or leave the room because he is distracting the other clients. 2. Ask the client if he is nervous or anxious about something. 3. Give an as needed dose of a prescribed anticholinergic agent to control akathisia. 4. Administer an as needed dose of haloperidol to decrease agitation.

Answer 3:RATIONALES: Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can't control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn't address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn't stop them from occurring. Giving more antipsychotic medication would worsen akathisia.

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? 1. Assume that the client is posturing. 2. Tell the client to lie down and relax. 3. Evaluate the client for adverse reactions to haloperidol. 4. Put the client on the list for the physician to see tomorrow.

Answer 3:RATIONALES: An antipsychotic agent such as haloperidol can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? 1. Take the medication 1 hour before a meal. 2. Decrease the dosage if signs of illness decrease. 3. Apply a sunscreen before exposure to the sun. 4. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

Answer 3:RATIONALES: Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it.

An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat: 1. dyskinesia. 2. dementia. 3. psychosis. 4. tardive dyskinesia.

Answer 3:RATIONALES: By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.

A client with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which of the following statements? 1. Clonazepam may interact with organ meats. 2. The medications shouldn't be taken together. 3. Clonazepam is a minor depressant and may aggravate symptoms of depression. 4. The order needs to be clarified; call the physician.

Answer 3:RATIONALES: Clonazepam is a central nervous system depressant and can aggravate symptoms in depressed clients. It doesn't interact with organ meats and can be taken with antidepressant medication. There is no need to call the physician; the medications can be safely taken together.

Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered? 1. Phencyclidine (PCP) intoxication 2. Alcohol withdrawal 3. Opioid withdrawal 4. Cocaine withdrawal

Answer 3:RATIONALES: Clonidine is used as adjunctive therapy in opioid withdrawal. Benzodiazepines such as chlordiazepoxide (Librium) and neuroleptic agents such as haloperidol are used to treat alcohol withdrawal. Benzodiazepines and neuroleptic agents are typically used to treat PCP intoxication. Antidepressants and medications with dopaminergic activity in the brain, such as fluoxetine (Prozac), are used to treat cocaine withdrawal.

A client has been severely depressed since her husband died 6 months ago. Her physician prescribes amitriptyline (Elavil), 50 mg by mouth daily. Before administering amitriptyline, the nurse reviews the client's medical history. Which preexisting condition would require cautious use of this drug? 1. Hiatal hernia 2. Hypernatremia 3. Hepatic disease 4. Hypokalemia

Answer 3:RATIONALES: Conditions requiring cautious use of amitriptyline include pregnancy, breast-feeding, suicidal tendencies, cardiovascular disease, and impaired hepatic function. Hiatal hernia, hypernatremia, and hypokalemia don't affect amitriptyline therapy.

Which nonantipsychotic medication is used to treat some clients with schizoaffective disorder? 1. phenelzine (Nardil) 2. chlordiazepoxide (Librium) 3. lithium carbonate (Lithane) 4. imipramine (Tofranil)

Answer 3:RATIONALES: Lithium carbonate, an antimania drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including maniclike activity. Lithium helps control the affective component of this disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification.

The nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia. The client's husband expresses concern over whether his wife will continue to take her daily prescribed medication. The nurse should inform him that: 1. his concern is valid, but his wife is an adult and has the right to make her own decisions. 2. he can easily mix the medication in his wife's food if she stops taking it. 3. his wife can be given a long-acting medication that is administered every 1 to 4 weeks. 4. his wife knows she must take her medication as prescribed to avoid future hospitalizations.

Answer 3:RATIONALES: Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic. A client has the right to refuse medication, but this issue isn't the focus of discussion at this time. Medication should never be hidden in food or drink to trick the client into taking it; in addition to destroying the client's trust, doing so would place the client at risk for overmedication or undermedication because the amount administered is hard to determine. Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic.

The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: 1. barbiturates. 2. amphetamines. 3. methadone. 4. benzodiazepines.

Answer 3:RATIONALES: Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.

A client with major depression sleeps 18 to 20 hours per day, shows no interest in previously enjoyed activities, and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to prescribe: 1. Phenelzine (Nardil). 2. Thiothixene (Navane). 3. Nortriptyline (Pamelor). 4. Trifluoperazine (Stelazine).

Answer 3:RATIONALES: Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't prescribed initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, are inappropriate for clients with uncomplicated depression

A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? 1. Restlessness, difficulty sitting still, and pacing 2. Involuntary rolling of the eyes 3. Tremors, shuffling gait, and masklike face 4. Extremity and neck spasms, facial grimacing, and jerky movements

Answer 3:RATIONALES: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and "pill rolling." Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: 1. deeper sleep than CNS depressants. 2. greater sedation than CNS depressants. 3. a calming effect from which the client is easily aroused. 4. more prolonged sedative effects, making the client more difficult to arouse.

Answer 3:RATIONALES: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent? 1. Combativeness, sweating, and confusion 2. Agitation, hyperactivity, and grandiose ideation 3. Emotional lability, euphoria, and impaired memory 4. Suspiciousness, dilated pupils, and increased blood pressure

Answer 3:RATIONALES: Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory. Phencyclidine overdose can cause combativeness, sweating, and confusion. Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation. Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure

Which drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)? 1. benztropine (Cogentin) and diphenhydramine (Benadryl) 2. chlordiazepoxide (Librium) and diazepam (Valium) 3. fluvoxamine (Luvox) and clomipramine (Anafranil) 4. divalproex (Depakote) and lithium (Lithobid)

Answer 3:RATIONALES: The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Librium and Valium may be helpful in treating anxiety related to OCD but aren't drugs of choice to treat the illness. The other medications mentioned aren't effective in the treatment of OCD.

The nurse is assessing a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find? 1. Tachycardia 2. Warm, flushed extremities 3. Parotid gland tenderness 4. Coarse hair growth

Answer: 3RATIONALES: Frequent vomiting causes tenderness and swelling of the parotid glands. The reduced metabolism that occurs with severe weight loss produces bradycardia and cold extremities. Soft, downlike hair (called lanugo) may cover the extremities, shoulders, and face of an anorexic client.

A busy attorney with a successful law practice is admitted to an acute care facility with epigastric pain. Since admission, the client has called the nurse every 15 minutes with one request or another. This client is most likely exhibiting: 1. repression. 2. somatization. 3. regression. 4. conversion.

Answer 3:RATIONALES: The client is exhibiting the defense mechanism regression, a return to behavior that is characteristic of an earlier developmental level. Dependent, attention-seeking behavior is an attempt to relieve anxiety. Repression manifests as a denial of the symptoms. Somatization is the channeling of anxiety into a preoccupation with physical complaints. Conversion involves the transfer of a mental conflict into a physical symptom to relieve anxiety.

A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction: 1. tardive dyskinesia. 2. dystonia. 3. neuroleptic malignant syndrome. 4. akathisia.

Answer 3:RATIONALES: The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.

Most antipsychotic medications exert which of following effects on the central nervous system (CNS)? 1. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. 2. Sedate the CNS by stimulating serotonin at the synaptic cleft. 3. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. 4. Depress the CNS by stimulating the release of acetylcholine.

Answer 3:RATIONALES: The exact mechanism of antipsychotic medication action is unknown, but these drugs appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.

A client enters the crisis unit complaining of increased stress from her studies as a medical student. She states that she has been increasingly anxious for the past month. Her physician prescribes alprazolam (Xanax), 25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when given concomitantly with alprazolam? 1. Levodopa (Dopar) 2. Famotidine (Pepcid) 3. Diphenhydramine (Benadryl) 4. Norgestrel (Ovrette)

Answer 3:RATIONALES: The major drug interactions relate to the use of benzodiazepines with other central nervous system depressants such as diphenhydramine, producing additive effects. Alprazolam doesn't cause clinically significant drug interactions with levodopa, famotidine, or hormonal contraceptives such as norgestrel.

To treat acute mania in a client with bipolar disorder, the physician prescribes lithium. During lithium carbonate (Lithonate) therapy, this client's serum lithium level should be maintained within which range? 1. 0.2 to 1.6 mEq/L 2. 0.8 to 1.2 mEq/L 3. 1 to 1.4 mEq/L 4. 10 to 15 mEq/L

Answer 3:RATIONALES: To treat acute mania, the client's serum lithium level should range from 1 to 1.4 mEq/L. To prevent or control mania, the serum lithium level should measure 0.8 to 1.2 mEq/L. The serum lithium level shouldn't exceed 2 mEq/L. The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy.

The nurse is assessing a client with a history of multiple substance abuse. The client reports that he's been experiencing nausea, vomiting, and diarrhea. The nurse observes flushing, piloerection, increased lacrimation, and rhinorrhea. These signs and symptoms most likely indicate withdrawal from what substance? 1. Alcohol 2. Amphetamines 3. Opioids 4. Cocaine

Answer 3:RATIONALES: Typical symptoms of opioid withdrawal include flushing, piloerection, nausea, vomiting, abdominal cramps, increased lacrimation, and rhinorrhea. The nurse must be aware of symptoms of opioid withdrawal because of the risk in the abuse of opioids, such as heroin and hydrocodone. Alcohol withdrawal symptoms include tachycardia, disorientation, confusion, agitation, and inability to sleep. Cocaine withdrawal symptoms include depression with possible suicidal ideation, sleep disturbances, poor concentration, and cocaine craving. Amphetamine withdrawal symptoms are similar to those of cocaine but not as pronounced.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated? 1. Several minutes 2. Several hours 3. Several days 4. Several weeks

Answer 4: RATIONALES: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)? 1. "Discontinue the medication immediately if you experience nausea." 2. "Notify the physician if you experience urine retention." 3. "Apply sunscreen to prevent photosensitivity." 4. "Inform the physician if you become pregnant or intend to do so."

Answer 4: RATIONALES: Because alprazolam is contraindicated during pregnancy, the client should be instructed to inform the physician if she becomes pregnant. Nausea, urine retention, and photosensitivity are adverse reactions that may occur, but aren't contraindicated.

How long after amitriptyline (Elavil) therapy begins can the nurse expect the client to show improved psychological symptoms? 1. 2 to 4 days 2. 4 to 6 days 3. 6 to 8 days 4. 10 to 14 days

Answer 4: RATIONALES: Because tricyclic antidepressants have long half-lives, a noticeable response may not occur for 10 to 14 days; a full response may take up to 30 days.

Important teaching for a client receiving risperidone (Risperdal) would include advising the client to: 1. double the dose if missed to maintain a therapeutic level. 2. be sure to take the drug with a meal because it's very irritating to the stomach. 3. discontinue the drug if the client reports weight gain. 4. notify the physician if the client notices an increase in bruising.

Answer 4: RATIONALES: Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Don't double the dose. This drug doesn't irritate the stomach, and weight gain isn't a problem with risperidone therapy.

A client diagnosed with anxiety disorder is prescribed buspirone (BuSpar). Teaching instructions for newly prescribed buspirone should include which of the following? 1. A warning that immediate sedation can occur with a resultant drop in pulse 2. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug 3. A warning about the incidence of neuroleptic malignant syndrome (NMS) 4. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days

Answer 4: RATIONALES: The client should be informed that the drug's therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Blood level checks aren't necessary. NMS hasn't been reported with this drug, but tachycardia is frequently reported.

Your client is taking clozapine (Clozaril) and complains of a sore throat. This symptom may be an indication of which adverse reaction? 1. Extrapyramidal reaction 2. Tardive dyskinesia 3. Reye's syndrome 4. Agranulocytosis

Answer 4: RATIONALES: The complaint of a sore throat may indicate an infection caused by agranulocytosis, a depletion of white blood cells. Although extrapyramidal reaction and tardive dyskinesia may occur, a sore throat isn't an indication of these conditions. Reye's syndrome is caused by a virus unrelated to clozapine.

A 59-year-old client is scheduled for cardiac catheterization the next morning. His physician prescribed secobarbital sodium (Seconal), 100 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that: 1. sedatives cause predictable responses; hypnotics cause unpredictable ones. 2. sedatives interact with few drugs; hypnotics interact with many. 3. sedatives don't depress respirations; hypnotics do. 4. sedatives reduce excitement; hypnotics induce sleep.

Answer 4: RATIONALES: Sedatives are drugs that act to reduce activity or excitement, calming a client. Hypnotics induce a state resembling natural sleep.

The nurse observes that a client diagnosed with schizophrenia is staring into space and doesn't acknowledge the presence of others. At times, the client moves rapidly but then stops and remains in one posture for long periods. What form of schizophrenia is the nurse observing? 1. Paranoid 2. Disorganized 3. Undifferentiated 4. Catatonic

Answer 4:RATIONALES: A client with catatonic schizophrenia shows a lack of responsiveness to the environment. The client may move rapidly or slowly, often alternating between patterns of movement. In many cases, he then poses and appears rigid. The other forms of schizophrenia — paranoid, disorganized, undifferentiated, and residual — are associated with different patterns of behavior and responses. However, disruption of motor behavior in conjunction with a lack of responsiveness to the immediate environment occurs only in the catatonic form of schizophrenia.

A client on the behavioral health unit tells the nurse that she experiences palpitations, trembling, and nausea while traveling alone, outside her home. These symptoms have severely limited her ability to function and have caused her to avoid leaving home whenever possible. The nurse recognizes that this client has symptoms of what disorder? 1. Thanatophobia 2. Aerophobia 3. Hodophobia 4. Agoraphobia

Answer 4:RATIONALES: Agoraphobia is a phobia, or fear, and avoidance of open spaces accompanied by the concern that escape to safety would be difficult or embarrassing. It's commonly accompanied by physical symptoms, such as palpitations, trembling, nausea, and shortness of breath. It's also commonly accompanied or preceded by panic attacks. Thanatophobia is the fear of death; aerophobia, the fear of air; and hodophobia, the fear of traveling.

A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? 1. Dystonia 2. Akathisia 3. Pseudoparkinsonism 4. Tardive dyskinesia

Answer 4:RATIONALES: An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Dystonia refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease.

When discharging a client after treatment for a dystonic reaction, the emergency department nurse must ensure that the client understands which of the following? 1. Results of treatment are rapid and dramatic but may not last. 2. Although uncomfortable, this reaction isn't serious. 3. The client shouldn't buy drugs on the street. 4. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms.

Answer 4:RATIONALES: An oral anticholinergic agent such as benztropine (Cogentin) is commonly prescribed to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn't appropriate.

A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior? 1. Word salad 2. Tangential 3. Perseveration 4. Avolition

Answer 4:RATIONALES: Avolition refers to impairment in the ability to initiate goal-directed activity. Word salad is a behavior in which a group of words are put together in a random fashion without logical connection. A person exhibiting tangential behavior never gets to the point of the communication. In perseveration, a person repeats the same word or idea in response to different questions.

A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal? 1. Naloxone (Narcan) 2. Haloperidol (Haldol) 3. Magnesium sulfate 4. Chlordiazepoxide (Librium)

Answer 4:RATIONALES: Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Haloperidol (Haldol) may be given to treat clients with psychosis, severe agitation, or delirium. Naloxone (Narcan) is administered for opioid overdose. Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by: 1. blocking dopamine receptors in the central nervous system (CNS). 2. blocking acetylcholine in the CNS. 3. activating norepinephrine in the CNS. 4. activating dopamine receptors in the CNS.

Answer 4:RATIONALES: Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity. They don't affect norepinephrine or acetylcholine.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? 1. Chlorpromazine (Thorazine) 2. Imipramine (Tofranil) 3. Lithium carbonate (Lithane) 4. Fluphenazine decanoate (Prolixin Decanoate)

Answer 4:RATIONALES: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

The physician prescribes lithium carbonate (Eskalith) for a client who has just been diagnosed with bipolar disorder. Now the nurse is teaching the client about signs and symptoms of lithium toxicity, which include: 1. skeletal muscle contractions, cogwheel rigidity, and a thick tongue. 2. dry mouth, blurred vision, and urine retention. 3. edema, orthostatic hypotension, and rash. 4. lethargy, vomiting, and diarrhea.

Answer 4:RATIONALES: Lethargy is an early sign of lithium toxicity; if it goes undetected, vomiting and diarrhea soon develop. Lithium doesn't cause extrapyramidal effects, such as skeletal muscle contractions, cogwheel rigidity, and a thick tongue, or cholinergic effects, such as dry mouth, blurred vision, and urine retention. The drug also doesn't cause edema, orthostatic hypotension, or rash.

A client with bipolar disorder has been taking lithium carbonate (Lithonate), as prescribed, for the past 3 years. Today, family members brought this client to the hospital. The client hasn't slept, bathed, or changed clothes for 4 days; has lost 10 lb (4.5 kg) in the last month; and woke the entire family at 4 a.m. with plans to fly them to Hawaii for a vacation. Based on this information, what can the nurse assume? 1. The family isn't supportive of the client. 2. The client has stopped taking the prescribed medication. 3. The client hasn't accepted the diagnosis of bipolar disorder. 4. The lithium level should be measured before the client receives the next lithium dose.

Answer 4:RATIONALES: Measuring the lithium level is the best way to evaluate the effectiveness of lithium therapy and begin to assess the client's current status. The other options may contribute to the client's manic episode, but the nurse can't assume them to be true until after assessing the client and family more fully

A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is: 1. impending coma. 2. manipulating behavior. 3. suppression. 4. perceptual disorders.

Answer 4:RATIONALES: Perceptual disorders, especially frightening visual hallucinations, are very common with alcohol withdrawal. Coma isn't an immediate consequence. Manipulative behaviors are part of the alcoholic client's personality but aren't signs of alcohol withdrawal. Suppression is a conscious effort to conceal unacceptable thoughts, feelings, impulses, or acts and serves as a coping mechanism for most alcoholics.

A client with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that: 1. this medication may be habit forming and will be discontinued as soon as the client feels better. 2. this medication has no serious adverse effects. 3. the client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication. 4. this medication may initially cause tiredness, which should become less bothersome over time.

Answer 4:RATIONALES: Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops. Antidepressants aren't habit forming and don't cause physical or psychological dependence. However, after a long course of high-dose therapy, the dosage should be decreased gradually to avoid mild withdrawal symptoms. Serious adverse effects, although rare, include myocardial infarction, heart failure, and tachycardia. Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic antidepressant.

A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase. The physician decides to start the client on lithium carbonate (Lithonate) therapy. One week after this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the nurse do? 1. Call the physician immediately to report the laboratory result. 2. Observe the client closely for signs and symptoms of lithium toxicity. 3. Withhold the next dose and repeat the laboratory test. 4. Continue to administer the medication as ordered.

Answer 4:RATIONALES: The serum lithium level should be maintained between 1 and 1.4 mEq/L during the acute manic phase; therefore, the nurse should continue to administer the medication as ordered. Unless the client has signs or symptoms of lithium toxicity, the nurse has no need to call the physician, withhold the medication, or repeat the laboratory test. Nonetheless, the nurse should continue to monitor the client's serum lithium level and watch for indications of toxicity if the level begins to rise.

When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe: 1. norepinephrine (Levophed) and lidocaine (Xylocaine). 2. nifedipine (Procardia) and lidocaine. 3. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc). 4. nifedipine and nitroglycerin.

Answer 4:RATIONALES: This client requires a vasodilator such as nifedipine to treat hypertension, and a beta-adrenergic blocker such as esmolol to reduce the heart rate. Lidocaine, an antiarrhythmic, isn't indicated because the client doesn't have an arrhythmia. Although nitroglycerin may be used to treat coronary vasospasm, it isn't the drug of choice in hypertension.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development? 1. Autonomy versus shame and doubt 2. Generativity versus stagnation 3. Integrity versus despair 4. Trust versus mistrust

Answer 4:RATIONALES: This client's paranoid ideation indicates difficulty trusting others. The stage of autonomy versus shame and doubt deals with separation, cooperation, and self-control. Generativity versus stagnation is the normal stage for this client's chronologic age. Integrity versus despair is the stage for accepting the positive and negative aspects of one's life, which would be difficult or impossible for this client.

On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to: 1. avoid all products containing alcohol. 2. adhere to concomitant vitamin B therapy. 3. return for monthly blood drug level monitoring. 4. limit alcohol consumption to a moderate level.

Answer: 1 RATIONALES: To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.

A client is brought to the crisis intervention center by his wife, who states that he has been increasingly listless and less involved with his family recently. She reports that he sleeps poorly, eats little, and can barely perform basic self-care activities. She also reveals that 3 months ago he was in a car accident in which his best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: 1. Paroxetine (Paxil), 20 mg by mouth (P.O.) every morning. 2. Amitriptyline (Elavil), 20 mg P.O. daily. 3. Doxepin (Sinequan), 500 mg daily. 4. Imipramine (Tofranil), 500 mg daily.

Answer: 1 RATIONALES: All of the drugs listed are antidepressants that may be prescribed for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg.

The nurse is assisting in the discharge planning for a client with alcoholism. Which of the following should be included in the discharge plan? 1. Strongly encourage participation in Alcoholics Anonymous (AA). 2. Provide nutritional information and counseling. 3. Establish an exercise program. 4. Discuss relapse prevention. 5. Have the client introduce himself slowly to people from his former lifestyle.

Answer: 1,2,3,4RATIONALES: AA is an outpatient support group for recovering alcoholics. It allows clients to share their problems and gain support from members of the group to avoid further alcohol abuse. Strongly encourage participation in this support group. Provide the client with nutritional information and counseling, particularly if the client is underweight or malnourished. Establish an exercise program appropriate for the client's physical health. Discourage the client from reestablishing relationships with former "drinking friends," because this could lead to relapse.

The nurse recognizes improvement in a client with the nursing diagnosis of Ineffective role performance related to the need to perform rituals. Which of the following behaviors indicates improvement? 1. The client refrains from performing rituals during stress. 2. The client verbalizes that he uses "thought stopping" when obsessive thoughts occur. 3. The client verbalizes the relationship between stress and ritualistic behaviors. 4. The client avoids stressful situations. 5. The client rationalizes ritualistic behavior. 6. The client performs ritualistic behaviors in private.

Answer: 1,2,3RATIONALES: Refraining from rituals demonstrates that the client manages stress appropriately. Using "thought stopping" demonstrates the client's ability to employ appropriate interventions for obsessive thoughts. Verbalizing the relationship between stress and behaviors indicates that the client understands the disease process. Avoiding, rationalizing, and hiding behaviors demonstrate maladaptive methods for managing stress and anxiety.

The nurse is assessing a client who talks freely about feeling depressed. During the interaction, the nurse hears the client state, "Things will never change." What other indications of hopelessness would the nurse look for? 1. Bouts of anger 2. Periods of irritability 3. Preoccupation with delusions 4. Feelings of worthlessness 5. Self-destructive behaviors 6. Auditory hallucinations

Answer: 1,2,4,5,RATIONALES: Clients who are depressed and feeling hopeless are often irritable and express inappropriate anger and suicidal thoughts. In addition, they may have feelings of worthlessness and demonstrate self-destructive behaviors. Preoccupation with delusions and auditory hallucinations are generally seen in clients with schizophrenia or other psychotic disorders rather than in those expressing hopelessness.

When assessing a client diagnosed with impulse control disorder, the nurse observes violent, aggressive, and assaultive behavior. Which assessment is the nurse also likely to find? 1. The client functions well in other areas of his life. 2. The degree of aggressiveness is out of proportion to the stressor. 3. The violent behavior is most often justified by a stressor. 4. The client has a history of parental alcoholism and chaotic abusive family life. 5. The client has no remorse about the inability to control his behavior.

Answer: 1,2,4RATIONALES: A client with an impulse control disorder who displays violent, aggressive, and assaultive behavior generally functions well in the other areas of his life. The degree of aggressiveness is out of proportion to the stressor and he frequently has a history of parental alcoholism and a chaotic family life. The client often verbalizes sincere remorse and guilt for the aggressive behavior.

In the emergency department, a client reveals to the nurse a lethal plan for committing suicide and agrees to a voluntary admission to the psychiatric unit. Which information will the nurse discuss with the client to answer the question, "How long do I have to stay here?" 1. "You may leave the hospital at any time unless you are suicidal." 2. "Let's talk more after the health team has assessed you." 3. "Once you've signed the papers, you have no say." 4. "Because you could hurt yourself, you must be safe before being discharged." 5. "You need a lawyer to help you make that decision." 6. "There must be a court hearing before you leave the hospital."

Answer: 1,2,4RATIONALES: A person who is admitted to a psychiatric hospital on a voluntary basis may sign out of the hospital unless the health care team determines that the person is harmful to himself or others. The health care team evaluates the client's condition before discharge. If there is reason to believe that the client is harmful to himself or others, a hearing can be held to determine if the admission status should be changed from voluntary to involuntary. Option 3 is incorrect because it denies the client's rights; option 5 is incorrect because the client doesn't need a lawyer to leave the hospital; and option 6 is incorrect because a hearing isn't mandated before discharge. A hearing is held only if the client remains unsafe and requires further treatment.

A recent diagnosis of cancer has caused a client severe anxiety. The nursing care plan should include which interventions? 1. Maintain a calm, nonthreatening environment. 2. Teach relevant aspects of chemotherapy. 3. Encourage the client to verbalize her concerns regarding the diagnosis. 4. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress. 5. Provide distractions for the client during periods of stress. 6. Teach the stages of grieving.

Answer: 1,3,4 RATIONALES: During acute stress, interventions that help the client regain control will help the client master this new threat. Providing a calm, accepting attitude and encouraging verbalization of concerns will help the client face the unknown. Relaxation techniques have a physiologic and psychological effect in calming the client, which in turn allows further exploration of thoughts and feelings, as well as problem solving. Learning is limited during extreme stress, so teaching wouldn't be effective at this stage. Providing distractions would be ineffective at this point in the grief process. Teaching about the stages of grieving isn't appropriate at this time.

A client is receiving chlordiazepoxide (Librium) to control the symptoms of alcohol withdrawal. The chlordiazepoxide has been ordered as needed. Which symptom may indicate the need for an additional dose of this medication? 1. Tachycardia 2. Mood swings 3. Elevated blood pressure and temperature 4. Piloerection 5. Tremors 6. Increasing anxiety

Answer: 1,3,5,6RATIONALES: Benzodiazepines are usually administered based on elevations in heart rate, blood pressure, and temperature as well as on the presence of tremors and increasing anxiety. Mood swings are expected during the withdrawal period and aren't an indication for further medication administration. Piloerection isn't a symptom of alcohol withdrawal.

The nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to prescribe which psychotropic drug regimen on a short-term basis? 1. Diazepam (Valium), 5 mg orally three times per day 2. Benztropine (Cogentin), 2 mg orally twice per day 3. Chlorpromazine (Thorazine), 25 mg orally three times per day 4. Clozapine (Clozaril), 200 mg orally twice per day

Answer: 1RATIONALES: Diazepam is the most appropriate medication for this client because of its antianxiety properties. Benztropine is an antiparkinsonian agent used to control the extrapyramidal effects of such antipsychotic agents as chlorpromazine hydrochloride and thioridazine hydrochloride. Chlorpromazine is used to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis. Clozapine is used to manage symptoms of schizophrenia in clients who don't respond to other antipsychotic drugs.

Erikson described the psychosocial tasks of the developing person in his theoretical model. He proposed that the primary developmental task of the young adult (ages 18 to 25) is: 1. intimacy versus isolation. 2. industry versus inferiority. 3. generativity versus stagnation. 4. trust versus mistrust.

Answer: 1RATIONALES: The primary developmental task of the young adult is to develop intimacy with another person while making choices about relationships and career. Industry, a task associated with children ages 6 to 12, involves active socialization as the child moves from the family into society; much of the child's energy is focused on acquiring competency. Generativity is associated with middle age and is characterized by parental responsibility and concern for future generations. Developing trust is the task of the infant; it's accomplished when the infant receives adequate mothering and satisfaction of oral needs.

A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to: 1. not occur at all because the time period for their occurrence has passed. 2. begin anytime within the next 1 to 2 days. 3. begin within 2 to 7 days. 4. begin after 7 days.

Answer: 2 RATIONALES: Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Alcohol withdrawal delirium may occur 2 to 4 days — even up to 7 days — after the last drink.

Which sign should the nurse expect in a client with known amphetamine overdose? 1. Hypotension 2. Tachycardia 3. Hot, dry skin 4. Constricted pupils

Answer: 2 RATIONALES: Amphetamines are central nervous system stimulants. They cause sympathetic stimulation, including hypertension, tachycardia, vasoconstriction, and hyperthermia. Hot, dry skin is seen with anticholinergic agents such as jimsonweed. Pupils will be dilated, not constricted.

A 23-year-old client in the manic phase of bipolar disorder is admitted to the facility. Which agents would be appropriate for this client? 1. Bupropion (Wellbutrin) and lithium (Lithobid) 2. Lithium (Lithobid) and valproic acid (Depakote) 3. Haloperidol (Haldol) and fluphenazine (Prolixin) 4. Risperidone (Risperdal) and clozapine (Clozaril)

Answer: 2 RATIONALES: Lithium and valproic acid are the drugs of choice for manic depression. Bupropion is an antidepressant, not an antimanic. Haloperidol, fluphenazine, clozapine, and risperidone are antipsychotic agents.

A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from: 1. acetate accumulation. 2. thiamine deficiency. 3. triglyceride buildup. 4. a below-normal serum potassium level.

Answer: 2 RATIONALES: Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake. Treatment includes reducing alcohol intake, correcting nutritional deficiencies through diet and vitamin supplements, and preventing such residual disabilities as foot and wrist drop. Acetate accumulation, triglyceride buildup, and a below-normal serum potassium level are unrelated to the client's symptoms.

An adolescent, age 17, rarely expresses feelings and usually remains passive. However, when angry, her face becomes flushed and her blood pressure rises to 170/100 mm Hg. Her parents are passive and easygoing. The adolescent may be using which defense mechanism to handle anger? 1. Displacement 2. Introjection 3. Projection 4. Sublimation

Answer: 2 RATIONALES: The adolescent may be introjecting (assuming as her own) her parents' belief that anger shouldn't be outwardly expressed. She may also be holding in and somatizing her angry feelings, as evidenced by her increased blood pressure. (A blood pressure rise is a common physiological reaction to the fight-or-flight response that may be brought on by strong emotions. Habitual failure to express anger may contribute to hypertension.) Displacement is the discharge of negative feelings onto another person or an object. Projection is the attribution of one's own thoughts or impulses to another person. Sublimation is the channeling of unbearable or socially unacceptable behaviors into more socially acceptable outlets.

A physician starts a client on the antipsychotic medication haloperidol (Haldol). The nurse is aware that this medication has adverse extrapyramidal effects. Which nursing measures should be taken during haloperidol administration? 1. Review subcutaneous (S.C.) injection technique. 2. Closely monitor vital signs, especially temperature. 3. Provide the client with the opportunity to pace. 4. Monitor blood glucose levels. 5. Provide the client with hard candy. 6. Monitor the client for signs and symptoms of urticaria.

Answer: 2,3,5RATIONALES: Neuroleptic malignant syndrome is a life-threatening adverse extrapyramidal effect of antipsychotic medications such as haloperidol. It's associated with a rapid increase in temperature. The most common adverse extrapyramidal effect, akathisia, is a form of psychomotor restlessness that can often be relieved by pacing. Haloperidol and the anticholinergic medications that are provided to alleviate its extrapyramidal effects can result in dry mouth. Providing the client with hard candy to suck on can help alleviate this problem. Haloperidol isn't given S.C. and doesn't affect blood glucose level. Urticaria isn't usually associated with haloperidol administration

A physician prescribes lithium for a client diagnosed with bipolar disorder. The nurse needs to provide appropriate education for the client receiving this drug. Which topics should the nurse cover? 1. The potential for addiction 2. Signs and symptoms of drug toxicity 3. The potential for tardive dyskinesia 4. Information regarding a low-tyramine diet 5. The need to report for laboratory testing to monitor blood levels. 6. Changes in his mood may take 7 to 21 days

Answer: 2,5,6RATIONALES: Client education should cover the signs and symptoms of drug toxicity as well as the need to report them to the physician. The client should be instructed to report for follow-up laboratory studies to monitor his lithium level to avoid toxicity. The nurse should explain that 7 to 21 days may pass before the client notes a change in his mood. Lithium doesn't have addictive properties. Tyramine is a potential concern for clients taking monoamine oxidase inhibitors.

Which foods are contraindicated for a client taking tranylcypromine (Parnate)? 1. Whole grain cereals and bagels 2. Chicken livers, Chianti wine, and beer 3. Oranges and vodka 4. Chicken, rice, and apples

Answer: 2RATIONALES: A client taking a monoamine oxidase inhibitor antidepressant such as tranylcypromine (Parnate) shouldn't eat foods containing tyramine. Such foods include chicken livers, Chianti wine, beer, ale, aged game meats, broad beans, aged cheeses, sour cream, avocados, yogurt, pickled herring, yeast extract, chocolate, excessive caffeine, vanilla, and soy sauce. The client also must refrain from taking cold and hay fever preparations that contain vasoconstrictive agents.

Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? 1. Monthly blood tests will be necessary. 2. Report a sore throat or fever to the physician immediately. 3. Blood pressure must be monitored for hypertension. 4. Stop the medication when symptoms subside.

Answer: 2RATIONALES: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine therapy. Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/μl, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client expects the resident to prescribe: 1. haloperidol (Haldol). 2. lorazepam (Ativan). 3. bupropion (Wellbutrin). 4. paroxetine (Paxil).

Answer: 2RATIONALES: Lorazepam is a schedule IV drug used to treat anxiety. Reducing the client's anxiety will help her cope with stress. Haloperidol is an antipsychotic agent. Bupropion is an antidepressant. Paroxetine is a selective serotonin reuptake inhibitor used to treat depression.

The nurse is evaluating a client's ECG taken in the morning. Which ECG change can result from amitriptyline (Elavil) therapy? 1. Presence of U waves 2. Depressed ST segment 3. Widening QT interval 4. Prolonged PR interval

Answer: 3 RATIONALES: Amitriptyline therapy may cause a conduction delay, demonstrated by a widening QT interval on the ECG. U waves, a depressed ST segment, and a prolonged PR interval aren't typically induced by amitriptyline therapy.

A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? 1. Hepatitis 2. Infection 3. Granulocytopenia 4. Systemic dermatitis

Answer: 3 RATIONALES: Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions of clozapine therapy.

Which commonly administered psychiatric medication is prescribed in individualized dosages according to the blood levels of the drug? 1. Chlorpromazine (Thorazine) 2. Alprazolam (Xanax) 3. Lithium carbonate (Lithane) 4. Thioridazine (Mellaril)

Answer: 3 RATIONALES: Dosages for lithium, an antimania drug, usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEq/L. The maximum daily dosage of thioridazine, an antipsychotic agent, is 800 mg. Dosages exceeding this amount are associated with retinitis pigmentosa, an irreversible condition that can be avoided by observing dosage limits. The recommended maintenance dosage range for thioridazine is 300 to 800 mg/day. Recommended dosage ranges for chlorpromazine, an antipsychotic agent, and alprazolam, an antianxiety agent, are 300 to 1,400 mg/day and 0.5 to 4 mg/day, respectively.

For which adverse reaction should the nurse monitor a client during the initial phase of lithium carbonate (Lithonate) therapy? 1. Anemia 2. Dehydration 3. Nausea and vomiting 4. Decreased cerebral perfusion

Answer: 3 RATIONALES: During the initial phase of lithium therapy, the nurse should monitor the client for GI symptoms such as nausea and vomiting, which occur most frequently in the initial stages of therapy and after dosage adjustments. GI symptoms are associated with increasing blood levels of lithium. Lithium therapy may cause leukocytosis, not anemia. The drug isn't associated with dehydration or decreased cerebral perfusion. Although lithium toxicity may cause confusion, it isn't due to decreased cerebral perfusion.

A client is undergoing treatment for an anxiety disorder. Such a disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least: 1. 2 months. 2. 12 months. 3. 6 months. 4. 4 months.

Answer: 3 RATIONALES: For generalized anxiety disorder, the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist on a majority of days.

Which medication can control the extrapyramidal effects associated with antipsychotic agents? 1. Perphenazine (Trilafon) 2. Doxepin (Sinequan) 3. Amantadine (Symmetrel) 4. Clorazepate (Tranxene)

Answer: 3RATIONALES: Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia. Other anticholinergic agents used to control extrapyramidal reactions include benztropine mesylate (Cogentin), trihexyphenidyl (Artane), biperiden (Akineton), and diphenhydramine (Benadryl). Perphenazine is an antipsychotic agent; doxepin, an antidepressant; and chlorazepate, an antianxiety agent. Because these medications have no anticholinergic or neurotransmitter effects, they don't alleviate extrapyramidal reactions.

A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis? 1. Schizophrenia 2. Paranoid personality 3. Bipolar illness 4. Obsessive-compulsive disorder (OCD)

Answer: 3RATIONALES: Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania. Schizophrenia doesn't exhibit mood swings from depression to euphoria. Paranoia is characterized by unrealistic suspiciousness and is often accompanied by grandiosity. OCD is a preoccupation with rituals and rules.

Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication acts as: 1. an antianxiety agent. 2. a central nervous system (CNS) depressant. 3. a CNS stimulant. 4. a mood stabilizer

Answer: 3RATIONALES: Dextroamphetamine is a psychostimulant and acts on the CNS. It would increase anxiety and elevate mood. CNS depressants and antianxiety agents would worsen the symptoms of narcolepsy. Mood stabilizers aren't indicated for narcolepsy

A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The ECG shows a 1-mm ST-segment elevation in the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe: 1. lidocaine (Xylocaine). 2. procainamide (Pronestyl). 3. nitroglycerin (Nitro-Bid IV). 4. epinephrine.

Answer: 3RATIONALES: The elevated ST segments in this client's ECG indicate myocardial ischemia. To reverse this problem, the physician is most likely to prescribe an infusion of nitroglycerin to dilate the coronary arteries. Lidocaine and procainamide are cardiac drugs that may be indicated for this client at some point but aren't used for coronary artery dilation. If a cocaine user experiences ventricular fibrillation or asystole, the physician may prescribe epinephrine. However, this drug must be used with caution because cocaine may potentiate its adrenergic effects.

A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone (BuSpar), 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs? 1. Beta-adrenergic blockers 2. Antineoplastic drugs 3. Antiparkinsonian drugs 4. Monoamine oxidase (MAO) inhibitors

Answer: 4 RATIONALES: Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.

Before the nurse administers the first dose of lithium carbonate (Lithonate) to a client, she reviews information about the drug. Which statement accurately describes the metabolism and excretion of lithium? 1. It's metabolized in the liver and excreted in the feces. 2. It's metabolized and excreted by the kidneys. 3. It isn't metabolized and is excreted unchanged by the kidneys. 4. It's metabolized in the liver and excreted by the kidneys.

Answer: 4 RATIONALES: Lithium isn't metabolized and is excreted unchanged by the kidneys.

A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy? 1. Agranulocytosis 2. Extrapyramidal effects 3. Anticholinergic effects 4. Neuroleptic malignant syndrome (NMS)

Answer: 4 RATIONALES: NMS is a rare but potentially fatal condition of antipsychotic medication. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism.

The physician orders lithium carbonate (Lithonate) for a client who's in the manic phase of bipolar disorder. During lithium therapy, the nurse should watch for which adverse reactions? 1. Weakness, tremor, and urine retention 2. Anxiety, restlessness, and sleep disturbance 3. Constipation, lethargy, and ataxia 4. Nausea, diarrhea, tremor, and lethargy

Answer: 4 RATIONALES: The most common adverse effects of lithium are nausea, diarrhea, tremor, and lethargy. Lithium doesn't cause weakness, tremor, urine retention, anxiety, restlessness, sleep disturbance, constipation, or ataxia

The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include: 1. dilated pupils and slurred speech. 2. rapid speech and agitation. 3. dilated pupils and agitation. 4. euphoria and constricted pupils.

Answer: 4 RATIONALES: Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.

Which classification of drugs is the most potentially fatal if the client takes an overdose? 1. Antihistamines 2. Dopaminergics 3. Phenothiazine antipsychotics 4. Tricyclic antidepressants

Answer: 4 RATIONALES: Tricyclic antidepressants can create fatal cardiac arrhythmias. Overdose of the other medications is rarely fatal.

The nurse interviews the family of a client hospitalized with severe depression and suicidal ideation. What family assessment information is essential in formulating an effective care plan? 1. Physical pain 2. Personal responsibilities 3. Employment skills 4. Communication patterns 5. Role expectations 6. Current family stressors

Answer: 4,5,6RATIONALES: When working with the family of a depressed client, it's helpful for the nurse to be aware of the family's communication style, the role expectations for its members, and current family stressors. This information can help to identify family difficulties and teaching points that could benefit the client and the family. Information concerning physical pain, personal responsibilities, and employment skills wouldn't be helpful because these areas aren't directly related to their experience of having a depressed family member.

A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition? 1. Vomiting, diarrhea, and bradycardia 2. Dehydration, temperature above 101° F (38.3° C), and pruritus 3. Hypertension, diaphoresis, and seizures 4. Diaphoresis, tremors, and nervousness

Answer: 4RATIONALES: Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability. Although diarrhea may be an early sign of alcohol withdrawal, tachycardia — not bradycardia — is associated with alcohol withdrawal. Dehydration and an elevated temperature may be expected, but a temperature above 101° F indicates an infection rather than alcohol withdrawal. Pruritus rarely occurs in alcohol withdrawal. If withdrawal symptoms remain untreated, seizures may arise later.

A client visits the physician's office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse suspects: 1. cyclothymic disorder. 2. atypical affective disorder. 3. major depression. 4. dysthymic disorder.

Answer: 4RATIONALES: Dysthymic disorder is marked by feelings of depression lasting at least 2 years, accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, and hopelessness. These symptoms may be relatively continuous or separated by intervening periods of normal mood that last a few days to a few weeks. Cyclothymic disorder is a chronic mood disturbance of at least 2 years' duration marked by numerous periods of depression and hypomania. Atypical affective disorder is characterized by manic signs and symptoms. Major depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities, with signs and symptoms recurring for at least 2 weeks.