Psych Chapter 2

A nurse is administering a monoamine oxidase inhibitor (MAOI) to a client with depression. Prior to administration of the medication, which will the nurse include when providing information? Select all that apply. A. If foods with tyramine are ingested, a hypertensive crisis may occur. B. There may be interactions when taking other MAOIs and antidepressants. C. There is a reduction in suicidal thoughts in clients with depression. D. There is a risk for experiencing decreased libido and impotence. E. Contact the health care provider prior to taking any over-the-counter medications.

ANS(S): A. If foods with tyramine are ingested, a hypertensive crisis may occur. B. There may be interactions when taking other MAOIs and antidepressants. D. There is a risk for experiencing decreased libido and impotence. E. Contact the health care provider prior to taking any over-the-counter medications.

The nurse is educating a client and family about strategies to minimize the side effects of antipsychotic drugs. Which will be included in the plan? Select all that apply. A. Drink plenty of fruit juice. B. Develop an exercise program. C. Increase foods high in fiber. D. Use laxatives as needed. E. Use sunscreen when outdoors. F. Take double the dose at the next scheduled time for missed doses

ANS(S): B. Develop an exercise program. C. Increase foods high in fiber. E. Use sunscreen when outdoors.

The nurse is educating a client with anxiety that is prescribed alprazolam by the health care provider. Which statement made by the client indicates that further education is required? Select all that apply. A. "Taking this medication will alleviate the problems associated with the anxiety." B. "I can still have one or two alcoholic beverages while I am taking this medication." C. "When I am feeling better in a few months, I can stop taking this medication." D. "I may have slower response time while driving or operating heavy machinery." E. "Withdrawing from this medication requires a health care provider's supervision."

ANS: A. "Taking this medication will alleviate the problems associated with the anxiety." B. "I can still have one or two alcoholic beverages while I am taking this medication." C. "When I am feeling better in a few months, I can stop taking this medication."

The nurse is preparing a client for a magnetic resonance imaging (MRI). Which statement(s) by the client would require the nurse to notify the health care provider to cancel the procedure? Select all that apply. A. "I have such terrible anxiety, I don't know if I can remain still throughout the procedure." B. "I had a pacemaker inserted a few years ago because my heart was not beating fast enough." C. "I fell down my basement steps last year and broke my hip and had to have a hip replacement." D. "When I was diagnosed with mitral valve prolapse, they had to replace the valve with a prosthetic valve." E. "I have diabetes mellitus type I and have been taking insulin for many years."

ANS: B. "I had a pacemaker inserted a few years ago because my heart was not beating fast enough." C. "I fell down my basement steps last year and broke my hip and had to have a hip replacement." D. "When I was diagnosed with mitral valve prolapse, they had to replace the valve with a prosthetic valve."

A child with ADHD just started school and the parent discusses medication administration while the child is in school and effectiveness. The parent asks, "Are there any medications that do not require being given at school?" Which is the appropriate response to the parent? A. "Yes, there are medications that are sustained release and would not require being given at school." B. "You will need to speak to the superintendent about medications regarding your child." C. "Only the nurse can administer stimulants to a child during school hours." D. "You child will need to bring their medications to me each day."

ANS: A. "Yes, there are medications that are sustained release and would not require being given at school."

The nurse administers olanzapine pamoate IM to a client with schizophrenia. Which action by the nurse is essential after the administration of the medication to prevent complications from post-injection delirium/sedation syndrome? A. Directly observe the client for 3 hours after injection and do not discharge until symptom free. B. Admit the client to the behavioral health unit for 24 hours to monitor for improvement of hallucinations. C. Administer benztropine to prevent extrapyramidal symptoms after the injection. D. Have the client eat a full meal before discharge to decrease the rate of absorption.

ANS: A. Directly observe the client for 3 hours after injection and do not discharge until symptom free.

A nurse is recording subjective information from the family of a client with aggressive behaviors brought to the ED via ambulance. Family member states the client does not adhere to the prescribed medication regimen. Which statement by the family determines the family member's understanding of the client's illness? A. "We know the intention was not to take medications, as it was relayed medication was no longer needed." B. "Because of mental illness, my sibling cannot think clearly or understand the need for meds." C. "This situation occurs because of thoughts that no one cares and to get attention." D. "This 'mental illness' is used as an excuse to get away with aggressive behavior for years."

ANS: B. "Because of mental illness, my sibling cannot think clearly or understand the need for meds."

The nurse is educating a family member of a client suspected to have Alzheimer's disease. Which statement made by the family member indicates that the education is effective? A. "It is impossible to know for certain that a person has Alzheimer's disease until the person dies and their brain can be examined via autopsy." B. "If we get a positron emission tomography (PET) scan, it may identify amyloid plaques and tangles of Alzheimer's disease." C. "It's possible to diagnose Alzheimer's disease by using chemical markers that demonstrate decreased blood flow to the brain." D. "It will be necessary to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the client has Alzheimer's disease."

ANS: B. "If we get a positron emission tomography (PET) scan, it may identify amyloid plaques and tangles of Alzheimer's disease."

A nurse is instructing a client on taking lithium for bipolar disorder and the need for blood to be drawn every 2 to 3 days initially. The client states, "I am going to have a hard time getting back every 2 days. Why is this important?" Which is the best response by the nurse? A. "We want to determine if there is a rebound effect occurring." B. "It is important to determine if it is having the maximum therapeutic effect." C. "The drug sample will determine the drugs potency and if it is enough for you." D. "We want to determine how long the medication stays in your blood stream."

ANS: B. "It is important to determine if it is having the maximum therapeutic effect."

The nurse is educating the parent of a child being treated with stimulants for attention-deficit hyperactivity disorder (ADHD). The parent states the child's weight and growth are being affected. Which is the best response by the nurse? A. "Encourage the child to sit at the table and eat larger meals until finished." B. "Provide 'drug-holidays' on weekends, holidays, and during summer vacation." C. "This side effect of the medication does not last and the child will catch-up." D. "There may be something else going on with the child that is affecting height and weight."

ANS: B. "Provide 'drug-holidays' on weekends, holidays, and during summer vacation."

When the client asks the nurse how long it will take before the selective serotonin reuptake inhibitor (SSRI) antidepressant medication will be effective, which reply is most accurate and therapeutic? A. "This medication will be effective within 20 minutes of the first dose." B. "You will have gradual improvement in symptoms over the next 4 to 6 weeks." C. "It will probably take months for the medication to work. In the meantime, you should receive psychotherapy." D. "It is dependent on how depressed you are. It takes longer the more depressed you are."

ANS: B. "You will have gradual improvement in symptoms over the next 4 to 6 weeks."

The nurse is assisting a client being treated with phenelzine to choose from a menu for lunch. Which lunch choice will the nurse educate the client to avoid to prevent the potential for complications? A. Baked chicken, mashed potatoes, and green peas B. Lasagna, tossed salad with blue cheese dressing, and garlic bread C. Pork chop with barbecue sauce, baked sweet potato with butter and cinnamon D. Hamburger on a bun, French fries, and green beans

ANS: B. Lasagna, tossed salad with blue cheese dressing, and garlic bread

The nurse is performing a medication reconciliation for a client at a high risk for suicide. Which antidepressant drug identified by the nurse will be best in the treatment of this client and reduces the risk of lethal overdose? A. Tranylcypromine B. Sertraline C. Imipramine D. Phenelzine

ANS: B. Sertraline

The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. Which statement made by the client indicates that teaching is effective? A. "I'm glad I can eat pizza since it's my favorite food." B. "I must follow this diet or I will have severe vomiting." C. "It will be difficult for me to avoid pepperoni." D. "None of the foods that are restricted are part of a regular daily diet."

ANS: C. "It will be difficult for me to avoid pepperoni."

The nurse is educating a client about newly prescribed Asenapine for the treatment of schizophrenia. Which statement made by the client indicates the education is effective? A. "I will swallow the pill and immediately follow with 8 ounces of water or clear fluid." B. "I will come to the office once a month to have injections done so the medication will be more effective." C. "The medication will dissolve under my tongue and I won't eat or drink for 10 minutes after it dissolves." D. "I need to take this medication with a meal to reduce the gastrointestinal side effects."

ANS: C. "The medication will dissolve under my tongue and I won't eat or drink for 10 minutes after it dissolves."

The nurse is assessing a male client taking antipsychotic medication for the treatment of bipolar I and acute mania. The client reports breast tenderness and breast tissue enlargement, erectile dysfunction and an inability to achieve orgasm. Which action will the nurse perform after notifying the health care provider? A. Educate that these symptoms will stop soon after taking the medication. B. Have the client discontinue the use of the medication. C. Obtain a prolactin level and report results to the health care provider. D. Have the client take diphenhydramine to counter the allergic reaction.

ANS: C. Obtain a prolactin level and report results to the health care provider.

A client is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse will assess for which common contributor to nonadherence? A. The client is symptom-free and therefore does not need to adhere to the medication regimen. B. The client cannot clearly see the instructions written on the prescription bottle. C. The client dislikes the weight gain associated with antipsychotic therapy. D. The client sells the antipsychotics to addicts in the neighborhood.

ANS: C. The client dislikes the weight gain associated with antipsychotic therapy.

The nurse is preparing a client for a magnetic resonance imaging (MRI) scan of the head. Which question is a priority for the nurse to ask the client? A. "Have you ever had an allergic reaction to radioactive dye?" B. "Have you had anything to eat in the last 24 hours?" C. "Does your insurance cover the cost of this scan?" D. "Are you anxious about being in tight spaces?"

ANS: D. "Are you anxious about being in tight spaces?"

A client is prescribed a monoamine oxidase inhibitor (MAOI) for treatment of severe depression. Which statement made by the client indicates that there is understanding of education provided by the nurse related to dietary restrictions? A. "I am now allergic to foods that are high in the amino acid tyramine." B. "Certain foods will cause me to have sexual dysfunction when I take this medication." C. "Foods that are high in tyramine will reduce the medication's effectiveness." D. "I will avoid foods that are high in the amino acid tyramine since they can cause severe side effects"

ANS: D. "I will avoid foods that are high in the amino acid tyramine since they can cause severe side effects"

A client diagnosed with bipolar disorder states to the nurse, "Why did I get this illness? I don't want to be sick." Which response will the nurse provide to best response to the client's concern? A. "People who develop mental illnesses often had very traumatic childhood experiences." B. "There is some evidence that contracting a virus during childhood can lead to bipolar disorder." C. "Sometimes people with mental illness have an overactive immune system." D. "The cause is not fully known, but mental illnesses do seem to run in families."

ANS: D. "The cause is not fully known, but mental illnesses do seem to run in families."

A client is prescribed a tricyclic antidepressant for the treatment of depression that has not responded to selective serotonin reuptake inhibitors (SSRI). The client states, "This medication isn't working after 2 weeks of taking it." Which is the best response by the nurse? A. "You should stop taking the medication since it is not working and try electroconvulsive therapy (ECT)." B. "It is likely that you are immune to the medication actions and will need something else." C. "Since you took the SSRIs, this medication may not work as well for you." D. "This medication may take up to 6 weeks to reach the optimum therapeutic response."

ANS: D. "This medication may take up to 6 weeks to reach the optimum therapeutic response."

A nurse is formulating a teaching plan for a client with newly diagnosed depression and the client's family. The teaching plan includes medication, activities, and family support. Which statement made by the client indicates teaching is effective? A. Medication should be taken only when feeling depressed and resists family activities. B. Medication should be taken on schedule only, and activities should be twice a week to prevent weight gain. C. Missed dosages should be taken right away, even when it is close to the next dose time, and activities should be increased. D. It may take a few weeks for the medication to become effective; activity will help to foster compliance

ANS: D. It may take a few weeks for the medication to become effective; activity will help to foster compliance

A client has a lithium level of 1.2 mEq/L (1.2 mmol/L). Which intervention by the nurse is indicated? A. Call the health care provider for an increase in dosage B. Do not give the next dose and call the health care provider C. Increase fluid intake for the next week D. No intervention is necessary at this time

ANS: D. No intervention is necessary at this time

The nurse is assessing a client weaning from a selective serotonin reuptake inhibitor (SSRI) to a monoamine oxidase inhibitor (MAOI) with a heart rate of 104, profuse diaphoresis, temperature 102°F (38.9°C), BP 98/58 mm Hg, and hyperreflexia. Which condition will the nurse educate the client regarding after stabilization of the current acute phase? A. Tardive dyskinesia B. Allergic reaction to the MAOI C. Malignant hyperthermia D. Serotonin syndrome

ANS: D. Serotonin syndrome

A client prescribed disulfiram experiences facial flushing, a throbbing headache, nausea, and vomiting and states to the nurse that "I only drank one beer." Which is the best response by the nurse? A. "This is a mild side effect of the medication, and one beer shouldn't cause the reaction." B. "The reaction that you experienced is an expected response with the ingestion of alcohol." C. "This is an idiosyncratic reaction to the medication and is an expected response to treatment." D. "You must have a severe allergy to disulfiram that you were not aware of and will need to stop the medication."

B. "The reaction that you experienced is an expected response with the ingestion of alcohol."