230 Unit 2

Risk for injury Self-care deficit, bathing, and hygiene Knowledge, deficient Nonadherence (No rationale.)

A client diagnosed with bipolar disorder has a nursing care plan that includes several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4). Knowledge, deficient Self-care deficit, bathing, and hygiene Nonadherence Risk for injury

hypertensive crisis. (Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.)

A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: hypotensive shock. cardiac dysrhythmia. hypertensive crisis. cardiogenic shock.

Ch. 13: Bipolar and Related Disorders

Ch. 13: Bipolar and Related Disorders

Affect flat; mood depressed (Mood refers to a person's self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others. When there is no evidence of emotion in a person's expression, the affect is flat.)

During a psychiatric assessment, the nurse observes a patient's facial expression is without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How will the nurse document the patient's affect and mood? Affect depressed; mood flat Affect labile; mood euphoric Affect flat; mood depressed Affect and mood are incongruent.

bipolar I disorder. (Bipolar I is a mood disorder characterized by excessive activity and energy. Psychosis (hallucinations, delusions, and dramatically disturbed thoughts) may occur during manic episodes. A patient with bipolar I disorder is more unstable than a patient diagnosed with bipolar II, cyclothymic disorder, or dysthymic disorder.)

Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with: bipolar I disorder. bipolar II disorder. dysthymic disorder cyclothymic disorder.

Block the reuptake of neurotransmitters at nerve endings (The SSRIs block the reuptake of serotonin. The TCAs block the reuptake of norepinephrine and serotonin. The monoamine oxidase inhibitors (MAOIs) inhibit the MAO enzyme that stops the actions of neurotransmitters such as dopamine, serotonin, and norepinephrine. Amphetamines stimulate areas of the brain associated with mental alertness.)

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism? Inhibit an enzyme that stops the action of neurotransmitters Block the reuptake of neurotransmitters at nerve endings Stimulate areas of the brain associated with mental alertness Decrease the catecholamine release into the blood

Hydrocortisone (Severe sepsis may result in adrenal insufficiency. Therefore, low doses of corticosteroids are prescribed in the form of IV hydrocortisone during the treatment to prevent adrenal insufficiency. In hypovolemic shock, adrenal insufficiency may not occur. Milrinone helps in improving contractility, and its administration is not limited to septic shock. Sodium nitroprusside improves myocardial perfusion and is not limited to septic shock. Phenylephrine HCl helps in improving mean arterial pressure and therefore can be prescribed in both septic and hypovolemic patients.)

Which drug is prescribed particularly in patients with septic shock? Milrinone Hydrocortisone Sodium nitroprusside Phenylephrine HCl

Excessive energy Pressured speech Purposeless movement Racing thoughts Distractibility (All these options describe mania. The other options more aptly describe the opposite of what happens in mania.)

Which of the following describe the symptoms of the manic phase of bipolar disorder? Select all that apply. Excessive energy Fatigue and increased sleep Low self-esteem Pressured speech Purposeless movement Racing thoughts Withdrawal from environment Distractibility

Broad-spectrum antibiotics (From the sepsis resuscitation bundle the nurse initiates broad-spectrum antibiotics within 1 hour of establishing diagnosis.A blood transfusion is indicated for low red blood cell count or low hemoglobin and hematocrit. Transfusion is not part of the sepsis resuscitation bundle. Cooling baths neither are indicated because the client is hypothermic nor are this part of the sepsis resuscitation bundle. NPO status neither is indicated for this client nor is it part of the sepsis resuscitation bundle.)

A client is admitted to the hospital with two of the systemic inflammatory response syndrome variables: temperature of 95°F (35°C) and high white blood cell count. Which intervention from the sepsis resuscitation bundle does the nurse initiate? Broad-spectrum antibiotics Blood transfusion Cooling baths NPO status

b. Lactate: 6 mmol/L (A lactate level of 6 mmol/L is high and is indicative of possible shock. A creatinine level of 0.9 mg/dL is normal. A sodium level of 150 mEq/L is high, but that is not related directly to shock. A white blood cell count of 11,000/mm³ is slightly high but is not as critical as the lactate level.)

A nurse is caring for several clients at risk for shock. Which laboratory value requires the nurse to communicate with the health care provider? a. Creatinine: 0.9 mg/dL b. Lactate: 6 mmol/L c. Sodium: 150 mEq/L d. White blood cell count: 11,000/mm³

b. Ensure the client has a patent airway. (Airway is the priority, followed by breathing and circulation (IVs and direct pressure). Obtaining consent is done by the physician.)

A client arrives in the emergency department after being in a car crash with fatalities. The client has a nearly amputated leg that is bleeding profusely. What action by the nurse takes priority? a. Apply direct pressure to the bleeding. b. Ensure the client has a patent airway. c. Obtain consent for emergency surgery. d. Start two large-bore IV catheters.

meals. (Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful.)

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with: meals. an antiemetic. an antacid. a large glass of juice.

b. Anticoagulants (Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed.)

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

c. Sympathetic nervous system (Adrenergic drugs mimic the effects of the sympathetic nervous system.)

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? a. Central nervous system b. Somatic nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

a. Anaerobic metabolism c. Hypotension The common manifestations of shock, no matter the cause, are directly related to the effects of anaerobic metabolism and hypotension. Hyperglycemia, impaired renal function, and increased perfusion are not manifestations of shock.)

The student nurse studying shock understands that the common manifestations of this condition are directly related to which problems? (Select all that apply.) a. Anaerobic metabolism b. Hyperglycemia c. Hypotension d. Impaired renal perfusion e. Increased perfusion

a. The lithium level is therapeutic. (Desirable long-term maintenance lithium levels range between 0.6 and 1.2 mEq/L. The other responses are incorrect.)

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

Grandiosity (Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.)

A 31-year-old patient admitted with acute mania tells the staff and the other patients that he is on a secret mission for the Florida Man. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? Unpredictability Rapid cycling Grandiosity Flight of ideas

"I still feel bad about my sister dying of cancer. I should have done more for her!" (Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.)

A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression? "I still pray and read my Bible every day." "My mother wants to move in with me, but I want to independent." "I still feel bad about my sister dying of cancer. I should have done more for her!" "I've heard others say that depression is a sign of weakness."

Amitriptyline is lethal in overdose. (Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.)

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? Amitriptyline is very expensive, so the patient may have to buy fewer at a time. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. The health care provider wants to see whether any side effects occur within the first week of administration. Amitriptyline is lethal in overdose.

Decreased sleep (Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.)

A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the patient and the family to recognize possible signs of impending mania? Increased appetite Decreased social interaction Increased attention to bodily functions Decreased sleep

"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." (This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.)

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." "I will not take any over-the-counter medication while on the fluoxetine." "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." "I will report increased thirst and urination to my provider."

firmly and neutrally assist the patient with showering. (When patients are unable to perform self-care activities, staff must assist them rather than ignore the issue. Better grooming increases self-esteem. Calmly telling the patient to bathe daily and bringing up the issue at a community meeting are punitive.)

A disheveled patient with severe depression and psychomotor retardation has not showered for several days. The nurse will: bring up the issue at the community meeting. calmly tell the patient, "You must bathe daily." avoid forcing the issue in order to minimize stress. firmly and neutrally assist the patient with showering.

maintain normal salt and fluids in the diet. (Sodium depletion and dehydration increase the chance for development of lithium toxicity. The other options offer inappropriate information.)

A health teaching plan for a patient taking lithium should include instructions to: maintain normal salt and fluids in the diet. drink twice the usual daily amount of fluid. double the lithium dose if diarrhea or vomiting occurs. avoid eating aged cheese, processed meats, and red wine.

Heart failure (The patient with congestive heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.)

A newly diagnosed patient is prescribed lithium. Which information from the patient's history indicates that monitoring of serum concentrations of the drug will be challenging and critical? Arthritis Psoriasis Epilepsy Heart failure

Diaphoresis, weakness, and nausea (Diaphoresis, weakness, and nausea are early signs of lithium toxicity. Problems mentioned in the incorrect options are unrelated to lithium therapy.)

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications? Pharyngitis, mydriasis, and dystonia Diaphoresis, weakness, and nausea Alopecia, purpura, and drowsiness Ascites, dyspnea, and edema

Eyes pointed downward (Nonverbal communication is usually considered more powerful than verbal communication. Downward casted eyes suggest feelings of worthlessness or hopelessness.)

A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate from this patient? Arms crossed Smiling inappropriately Staring at the nurse Eyes pointed downward

Disturbed thought processes Sleep deprivation (People with mania are hyperactive and often do not take time to eat and drink properly. Their high levels of activity consume calories, so deficits in nutrition may occur. Sleep is reduced. Their socialization is impaired but not isolated. Confusion may be acute but not chronic.)

A nurse prepares the plan of care for a patient experiencing an acute manic episode. Which nursing diagnoses are most likely? Select all that apply. Imbalanced nutrition: more than body requirements Disturbed thought processes Sleep deprivation Chronic confusion Social isolation

confers with a pharmacist when selecting over-the-counter medications. (Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.)

A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient: monitors sodium intake and weight daily. wears support stockings and elevates the legs when sitting. can identify foods with high selenium content that should be avoided. confers with a pharmacist when selecting over-the-counter medications.

Mashed potatoes, ground beef patty, corn, green beans, apple pie (The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine. Fresh ground beef and apple pie are safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages/hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.)

A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve? Macaroni and cheese, hot dogs, banana bread, caffeinated coffee Mashed potatoes, ground beef patty, corn, green beans, apple pie Avocado salad, ham, creamed potatoes, asparagus, chocolate cake Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

ineffectiveness and frustration. (Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patient's progress toward health. Unmet expectations result in feelings of ineffectiveness, anger, or frustration. Nurses rarely become over-involved with patients with depression because of the patient's resistance. Guilt and despair might be seen when the nurse experiences the patient's feelings because of empathy. Interest is possible, but not the most likely result.)

A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of: guilt and despair. interest and pleasure. over-involvement. ineffectiveness and frustration.

verbalize realistic positive characteristics about self by (date). (Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept.)

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis "Situational low self-esteem related to feelings of abandonment." The patient will: verbalize realistic positive characteristics about self by (date). agree to take an antidepressant medication regularly by (date). initiate social interaction with another person daily by (date). identify two personal behaviors that alienate others by (date).

"I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you." (Spending time with the patient at intervals throughout the day shows acceptance by the nurse and will help the patient establish a relationship with the nurse. The therapeutic technique is "offering self." Setting definite times for the therapeutic contacts and keeping the appointments show predictability on the part of the nurse, an element that fosters trust building. The incorrect responses would be difficult for a person with profound depression to believe, provide false reassurance, and are counterproductive. The patient is unable to say positive things at this point.)

A patient became severely depressed when the last of the family's six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful? "Things will look brighter soon. Everyone feels down once in a while." "Our staff members care about you and want to try to help you get better." "It is difficult for others to care about you when you repeatedly say the same negative things." "I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

"Take a dose of your antidepressant now and come to the clinic to see the health care provider." (The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.)

A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." The nurse will advise the patient to: "Go to the nearest emergency department immediately." "Do not to be alarmed. Take two aspirin and drink plenty of fluids." "Take a dose of your antidepressant now and come to the clinic to see the health care provider." "Resume taking your antidepressants for 2 more weeks and then discontinue them again."

Vital signs Presence of abdominal pain and diarrhea Hyperactivity or feelings of restlessness (The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. The patient may have urinary retention, but frequency would not be expected.)

A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? Select all that apply. Vital signs Urinary frequency Psychomotor retardation Presence of abdominal pain and diarrhea Hyperactivity or feelings of restlessness

Hold a staff meeting to discuss consistency and limit-setting approaches. (When staff members are at their wits' end, the patient has succeeded in keeping the environment unsettled and avoided outside controls on behavior. Staff meetings can help minimize staff splitting and feelings of anger, helplessness, confusion, and frustration.)

A patient demonstrating behaviors associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially? Confer with the health care provider to consider use of seclusion for this patient. Hold a staff meeting to discuss consistency and limit-setting approaches. Conduct a meeting with all staff and patients to discuss the behavior. Explain to the patient that the behavior is unacceptable.

bring hyperactivity under rapid control. (Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithium's antimanic activity nor minimize the side effects. Lithium will be used for long-term control.)

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen? It will: minimize the side effects of lithium. bring hyperactivity under rapid control. enhance the antimanic actions of lithium. be used for long-term control of hyperactivity.

Risk for injury (Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient's physiological safety. Hyperactivity and poor judgment put the patient at risk for injury.)

A patient diagnosed with acute mania has distributed pamphlets about a new business venture on a street corner for 2 days. Which nursing diagnosis has priority? Risk for injury Ineffective coping Impaired social interaction Ineffective therapeutic regimen management

"Do not hit anyone. If you are unable to control yourself, we will help you." (When the patient is unable to control his or her behavior and violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient, threaten the patient with seclusion as punishment, and ask a rhetorical question.)

A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? "Stop that! No one did anything to provoke an attack by you." "If you do that one more time, you will be secluded immediately." "Do not hit anyone. If you are unable to control yourself, we will help you." "You know we will not let you hit anyone. Why do you continue this behavior?"

Distraction: "Let's go to the dining room for a snack." (The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into power struggles. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed and may incite anger.)

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Which initial approach should the nurse select? Distraction: "Let's go to the dining room for a snack." Humor: "How much are you paying servants these days?" Limit setting: "You must stop ordering other patients around." Honest feedback: "Your controlling behavior is annoying others."

carbamazepine (Tegretol) (Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine and valproate. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients. Phenytoin is also an anticonvulsant but not used for mood stabilization. Risperidone is not an anticonvulsant.)

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? phenytoin (Dilantin) risperidone (Risperdal) clonidine (Catapres) carbamazepine (Tegretol)

Euphoric (The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria. Irritability, belligerence, excessive happiness, and confidence are not the best terms for the patient's mood. Suspiciousness is not evident.)

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here; they are my gift to you." How should the nurse document the patient's mood? Euphoric Suspicious Irritable Confident

"Taking the medication every day helps reduce the risk of a relapse." (Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences. Helping the patient understand this need will promote medication compliance.)

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse's appropriate response. "You will be able to stop the medication in about 1 month." "Taking the medication every day helps reduce the risk of a relapse." "Usually patients take medication for approximately 6 months after discharge." "It's unusual that the health care provider hasn't already stopped your medication."

Attending psychoeducation sessions (During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode. After hospital discharge, treatment focuses on maintaining medication compliance and preventing relapse, both of which are fostered by ongoing psychoeducation.)

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient's family during this phase of treatment? Attending psychoeducation sessions Increasing food and fluids Decreasing physical activity Meeting self-care needs

reporting increased suicidal thoughts. (Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.)

A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about: restricting sodium intake to 1 gram daily. minimizing exposure to bright sunlight. reporting increased suicidal thoughts. maintaining a tyramine-free diet.

There is a risk of toxicity when this medication is taken with alcohol. (There is an increased risk of toxicity with TCAs when taken with alcohol and a high rate of morbidity.)

A patient diagnosed with depression is being discharged with a prescription for TCAs after no improvement of symptoms on an SSRI. Which instruction should the nurse include about this new medication? This drug does not cause problems with sleep, constipation, or low blood pressure. Take St. John's wort every day to minimize the adverse effects of the medication. There is a risk of toxicity when this medication is taken with alcohol. There are no drug or food contraindications with this medication.

Urinary retention (All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues.)

A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? Dry mouth Nasal congestion Blurred vision Urinary retention

Risk for suicide (A patient diagnosed with depression who feels so worthless as to believe cancer is deserved is at risk for suicide. Safety concerns take priority over the other diagnoses listed.)

A patient diagnosed with depression repeatedly tells staff, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. Powerlessness Stress overload Risk for suicide Spiritual distress

teach the patient strategies to manage postural hypotension. (Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing this information may convince the patient to continue the medication. Activity is an important aspect of the patient's treatment plan and should not be limited to activities that can be done in a sitting position. Withholding the drug, forcing oral fluids, and notifying the health care provider are unnecessary actions. Independent nursing action is called for. Updating a mental status examination is unnecessary.)

A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will: limit the patient's activities to those that can be performed in a sitting position. withhold the drug, force oral fluids, and notify the health care provider. teach the patient strategies to manage postural hypotension. update the patient's mental status examination.

explain the time lag before antidepressants relieve symptoms. (Escitalopram is an SSRI antidepressant. One to three weeks of treatment is usually necessary before symptom relief occurs. This information is important to share with patients.)

A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be to: discuss with the health care provider the need to increase the dose. reassure the patient that the medication will be effective soon. explain the time lag before antidepressants relieve symptoms. critically assess the patient for symptoms of improvement.

Make observations. (Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations for answers on the patient. Acceptance and support are shown by the nurse's presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialogue. Platitudes are never acceptable. They minimize patient feelings and can increase feelings of worthlessness.)

A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective? Make observations. Ask the patient direct questions. Phrase questions to require yes or no answers. Frequently reassure the patient to reduce guilt feelings.

Temporary memory impairments and confusion may occur with electroconvulsive therapy. (Recent memory impairment and/or confusion is often present during and for a short time after electroconvulsive therapy. An inappropriate business decision might be made because of forgotten important details. The rationales are untrue statements in the incorrect responses. The patient needing time to reorient to a pressured work schedule is less relevant than the correct rationale.)

A patient diagnosed with major depression received six electroconvulsive therapy sessions and aggressive doses of antidepressant medication. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. Antidepressant medications alter catecholamine levels, which impairs decision-making abilities. Antidepressant medications may cause confusion related to limitation of tyramine in the diet. Temporary memory impairments and confusion may occur with electroconvulsive therapy. The patient needs time to readjust to a pressured work schedule.

Milk (Milk is the only beverage listed that provides protein, fat, and carbohydrates. In addition, milk is fortified with vitamins.)

A patient diagnosed with major depression refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient? Tomato juice Hot tea Orange juice Milk

"You're wearing a new shirt." (Patients with depression usually see the negative side of things. The meaning of compliments may be altered to "I didn't look nice yesterday" or "They didn't like my other shirt." Neutral comments such as making an observation avoid negative interpretations. Saying, "You look nice" or "I like your shirt" gives approval (non-therapeutic techniques). Saying "You must be feeling better today" is an assumption, which is non-therapeutic.)

A patient diagnosed with major depression says, "No one cares about me anymore. I'm not worth anything." Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient? "You look nice this morning." "I like the shirt you are wearing." "You're wearing a new shirt." "You must be feeling better today."

Offer laxatives if needed. Monitor food and fluid intake. Provide a quiet sleep environment. (The correct options promote a normal elimination pattern. Although excessive intake of stimulants such as caffeine may make the patient feel jittery and anxious, small amounts may provide useful stimulation. No indication exists that processed foods should be restricted.)

A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply. Offer laxatives if needed. Monitor food and fluid intake. Provide a quiet sleep environment. Eliminate all daily caffeine intake. Restrict intake of processed foods.

"Let's look at one bad thing that happened to see if another explanation exists." (By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact. The incorrect responses cast doubt but do not require the patient to evaluate the statement.)

A patient diagnosed with major depression tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization? "I really doubt that one person can be blamed for all the bad things that happen." "Let's look at one bad thing that happened to see if another explanation exists." "You are being extremely hard on yourself. Try to have a positive focus." "Are you saying that you don't have any good things happen?"

Provide a subdued environment. (All the options are reasonable interventions with a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping to balance activity and rest.)

A patient experiencing acute mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation? Monitor physiological functioning. Supervise personal hygiene. Provide a subdued environment. Observe for mood changes.

clear the room of all other patients. (Safety is of primary importance. Once other patients are out of the room, a plan for managing this patient can be implemented.)

A patient experiencing acute mania is dancing atop a pool table in the recreation room. The patient waves a cue in one hand and says, "I'll throw the pool balls if anyone comes near me." To best assure safety, the nurse's first intervention is to: tell the patient, "You need to be secluded." clear the room of all other patients. help the patient down from the table. assemble a show of force.

putting a blanket around the patient and walking with the patient to a quiet room. (Patients must be protected from the embarrassing consequences of their poor judgment whenever possible. Protecting the patient from public exposure by matter-of-factly covering the patient and removing him or her from the area with a sufficient number of staff to avoid argument and provide control is an effective approach.)

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by: quietly asking the patient, "Why don't you put your clothes on?" firmly telling the patient, "Stop dancing and put on your clothing." putting a blanket around the patient and walking with the patient to a quiet room. letting the patient stay in the group room and moving the other patients to a different area.

c. Cardiac dysrhythmias (Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.)

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication." (Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect.)

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended." (The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate.)

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

anhedonia. (Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymia is a diagnosis. Euphoria refers to an elated mood. Anergia means "without energy.")

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of: dysthymia. euphoria. anhedonia. anergia.

Powerlessness Chronic low self-esteem (Chronic low self-esteem and powerlessness are interwoven in the patient's statements. No data support the other diagnoses.)

A patient tells the nurse, "I'm ashamed of being bipolar. When I'm manic, my behavior embarrasses everyone. Even if I take my medication, there are no guarantees. I'm a burden to my family." These statements support which nursing diagnoses? Select all that apply. Powerlessness Defensive coping Chronic low self-esteem Impaired social interaction Risk-prone health behavior

January (The days are short in January, so the patient would have the least exposure to sunlight. Seasonal affective disorder is associated with disturbances in circadian rhythm. Days are longer in spring, summer, and fall.)

A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute? January April June September

invites the patient to sit together and look at new fashion magazines. (Situations such as this offer an opportunity to use the patient's distractibility to staff's advantage. Patients become frustrated when staff deny requests that the patient sees as entirely reasonable. Distracting the patient can avoid power struggles. Suggesting that a friend do the shopping would not satisfy the patient's need for immediacy and would ultimately result in the extravagant expenditure. Asking whether the patient has enough money would likely precipitate an angry response.)

A patient waves a newspaper and says, "I must have my credit card and use the computer right now. A store is having a big sale, and I need to order 10 dresses and four pairs of shoes." Select the nurse's appropriate intervention. The nurse: suggests the patient have a friend do the shopping and bring purchases to the unit. invites the patient to sit together and look at new fashion magazines. tells the patient computer use is not allowed until self-control improves. asks whether the patient has enough money to pay for the purchases.

St. John's wort (Serotonin syndrome may occur with SSRIs when they are combined with herbal products such as St. John's wort.)

A patient who is prescribed duloxetine (Cymbalta) comes to the medical clinic complaining of restlessness, sweating, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which herbal product or dietary supplement? Zinc St. John's wort Glucosamine chondroitin Vitamin E

Avoid eating aged cheese. (Eating foods high in tyramine, including aged cheese, can cause a hypertensive crisis in patients taking MAOIs.)

A patient with a diagnosis of depression is being discharged with a prescription for an MAOI. Which instruction should the nurse include for this medication? Emphasize that tremors are a common adverse effect. Avoid eating aged cheese. Explain the symptoms of tardive dyskinesia. Encourage use of fiber supplements.

arrange for one-on-one supervision. (A patient who repeatedly disrobes despite verbal limit setting needs more structure. One-on-one supervision may provide the necessary structure. Directing the patient to wear clothes at all times has not proven successful, considering the behavior has continued. Asking if the patient is bothered by clothing serves no purpose. Telling the patient that others are embarrassed will not make a difference to the patient whose grasp of social behaviors is impaired by the illness.)

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should: direct the patient to wear clothes at all times. ask if the patient finds clothes bothersome. tell the patient that others feel embarrassed. arrange for one-on-one supervision.

Consider the need to check the lithium level. The patient may not be swallowing medications. (The patient is continuing to exhibit manic symptoms. The lithium level may be low from "cheeking" (not swallowing) the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased. Monitoring the patient does not address the problem.)

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behavior? Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. Continue to monitor and document the patient's speech patterns and motor activity. Ask the health care provider to prescribe an increased dose and frequency of lithium. Consider the need to check the lithium level. The patient may not be swallowing medications.

Hyperactivity; not eating and sleeping (Hyperactivity, poor nutrition, hydration, and not sleeping take priority in terms of the needs listed above because they threaten the physical integrity of the patient. The other behaviors are less threatening to the patient's life.)

A person was directing traffic on a busy street, rapidly shouting, "To work, you jerk, for perks" and making obscene gestures at cars. The person has not slept or eaten for 3 days. Which assessment findings will have priority concern for this patient's plan of care? Insulting, aggressive behavior Pressured speech and grandiosity Hyperactivity; not eating and sleeping Poor concentration and decision making

Poor judgment and hyperactivity (Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government websites) are characteristic of manic episodes. The distracters do not specifically apply to mania.)

A person was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident? Increased muscle tension and anxiety Poor judgment and hyperactivity Vegetative signs and poor grooming Cognitive deficits and paranoia

Imbalanced nutrition: less than body requirements Sexual dysfunction Self-care deficit Insomnia (Vegetative signs of depression are alterations in body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than diagnoses associated with feelings about self.)

A student nurse caring for a patient diagnosed with depression reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply. Imbalanced nutrition: less than body requirements Chronic low self-esteem Sexual dysfunction Self-care deficit Powerlessness Insomnia

Social skills training (Social skill training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and development of a patient's support system. Use of complementary therapy refers to adjunctive therapies such as herbals, which would be less helpful than social skill training. Assertiveness would be of greater value than relaxation training because passivity was a concern. Desensitization is used in treatment of phobias.)

An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? Social skills training Desensitization techniques Relaxation training classes Use of complementary therapy

have someone bring the patient to the clinic immediately. (The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment. Because neurological symptoms are present, the patient should not drive and should be accompanied by another person. The incorrect options will not ameliorate the patient's symptoms.)

An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, "I've had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse will advise the patient to: restrict food and fluids for 24 hours and stay in bed. have someone bring the patient to the clinic immediately. drink a large glass of water with 1 teaspoon of salt added. take one dose of an over-the-counter antidiarrheal medication now.

Neutral walls with pale, simple accessories (The environment for a manic patient should be as simple and non-stimulating as possible. Manic patients are highly sensitive to environmental distractions and stimulation.)

At a unit meeting, the staff discusses decor for a special room for patients with acute mania. Which suggestion is appropriate? An extra-large window with a view of the street Neutral walls with pale, simple accessories Brightly colored walls and print drapes Deep colors for walls and upholstery

Depression: youtu.be/tOVJgYHj6kc Bipolar: youtu.be/BC3csSM6G-s Shock 101: youtu.be/AvtS_IrlbYk Shock diagnosis/treatment: youtu.be/_eBq2hRETmA Hypovolemic shock: youtu.be/wbfDqHk-ryM Septic Shock: youtu.be/emOgJCoUy6Q Septic shock diagnosis/treatment: youtu.be/ExJC8AoAczE

Depression: youtu.be/tOVJgYHj6kc Bipolar: youtu.be/BC3csSM6G-s Shock 101: youtu.be/AvtS_IrlbYk Shock diagnosis/treatment: youtu.be/_eBq2hRETmA Hypovolemic shock: youtu.be/wbfDqHk-ryM Septic Shock: youtu.be/emOgJCoUy6Q Septic shock diagnosis/treatment: youtu.be/ExJC8AoAczE

distorted thought self-control. (The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.)

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on: developing an optimistic outlook. interest in the environment. distorted thought self-control. sleep pattern stabilization.

several factors, including genetics, are implicated. (The best explanation at this time is that bipolar disorder is most likely caused by interplay of complex independent variables. Various theories implicate genetics, endocrine imbalance, environmental stressors, and neurotransmitter imbalances.)

The exact cause of bipolar disorder has not been determined; however, for most patients: several factors, including genetics, are implicated. brain structures were altered by stress early in life. excess sensitivity in dopamine receptors may trigger episodes. inadequate norepinephrine reuptake disturbs circadian rhythms.

Muscle cramps of the head and neck (Dystonia, or sudden and painful muscle spasms, is the only extrapyramidal adverse effect listed. The other adverse effects also occur but are not extrapyramidal effects.)

The nurse is monitoring a patient taking an antipsychotic medication for extrapyramidal symptoms. Which clinical finding indicates an adverse effect of this drug? Presence of myoglobin in the blood Muscle cramps of the head and neck Dry mouth and constipation Blood pressure of 80/50 mm Hg

within therapeutic limits. (Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.)

The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. This result is: within therapeutic limits. below therapeutic limits. above therapeutic limits. invalid because of the time lapse since the last dose.

Provide a structured environment for the patient. Ensure that the patient's nutritional needs are met. (People with mania are hyperactive, grandiose, and distractible. It's most important to ensure the patient receives adequate nutrition. Structure will support a safe environment. Touching the patient may precipitate aggressive behavior. Leading a community meeting would be appropriate when the patient's behavior is less grandiose. Activities that require concentration will produce frustration.)

The plan of care for a patient in the manic state of bipolar disorder should include which interventions? Select all that apply. Touch the patient to provide reassurance. Invite the patient to lead a community meeting. Provide a structured environment for the patient. Ensure that the patient's nutritional needs are met. Design activities that require the patient's concentration.

"A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder." (Evidence of genetic transmission is supported when twins or relatives of patients with a particular disorder also show an incidence of the disorder that is higher than the incidence in the general public. The incorrect options do not support the theory of genetic transmission and other factors involved in the etiology of bipolar disorder.)

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide? "A high proportion of patients with bipolar disorders are found among creative writers." "A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder." "Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress." "More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." (Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect.)

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c. "It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

drink six servings of a high-calorie, high-protein drink each day. (High-calorie, high-protein food supplements will provide the additional calories needed to offset the patient's extreme hyperactivity. Sitting with others or asking for assistance does not mean the patient ate or drank. The other indicator is unrelated to the nursing diagnosis.)

This nursing diagnosis applies to a patient with acute mania: Imbalanced nutrition: less than body requirements related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select an appropriate outcome. The patient will: ask staff for assistance with feeding within 4 days. drink six servings of a high-calorie, high-protein drink each day. consistently sit with others for at least 30 minutes at meal time within 1 week. consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

"I might be a little dizzy or have a mild headache after each procedure." (Transcranial Magnetic Stimulation (TCM) treatments take about 30 minutes. Treatments are usually 5 days a week. Patients are awake and alert during the procedure. After the procedure, patients may experience a headache and lightheadedness. No neurological deficits or memory problems have been noted. The patient will be able to care for children.)

Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depression. Which comment by the patient indicates teaching about the procedure was effective? "They will put me to sleep during the procedure so I won't know what is happening." "I might be a little dizzy or have a mild headache after each procedure." "I will be unable to care for my children for about 2 months." "I will avoid eating foods that contain tyramine."

Supporting physiological stability (During the immediate post-treatment period, the patient is recovering from general anesthesia; hence, the priority need is to establish and support physiological stability. Reducing disorientation and confusion is an acceptable intervention but not the priority. Assisting the patient in identifying and testing negative thoughts is inappropriate in the immediate post-treatment period because the patient may be confused.)

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment? Nutrition and hydration Supporting physiological stability Reducing disorientation and confusion Assisting the patient to identify and test negative thoughts

Suicidal ideation (Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.)

What is the major reason for the hospitalization of a depressed patient? Inability to go to work Suicidal ideation Loss of appetite Psychomotor agitation

Set limits on patient behavior as necessary. (This intervention provides support through the nurse's presence and provides structure as necessary while the patient's control is tenuous. Acting out may lead to loss of behavioral control. The patient will probably be unable to focus on instructions and comply. Restraint is used only after other interventions have proved ineffective.)

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? Allow the patient to act out feelings. Set limits on patient behavior as necessary. Provide verbal instructions to the patient to remain calm. Restrain the patient to reduce hyperactivity and aggression.

b. Decreased paranoia and delusions (The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect.)

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

cognitive behavioral therapy. (Cognitive behavioral therapy attempts to alter the patient's dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The patient is also taught the connection between thoughts and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new connections between nerve cells in the brain and that it is at least as effective as medication. Evidence is not present to support superior outcomes for the other psychotherapeutic modalities mentioned.)

When counseling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using: psychoanalytic therapy. desensitization therapy. cognitive behavioral therapy. alternative and complementary therapies.

Bipolar disorder (Lithium is a mood-stabilizing drug for the treatment of manic episodes associated with bipolar disorders.)

When doing an admission drug history, the nurse notes that the patient has a prescription for lithium (Lithobid). The nurse suspects that this patient has been diagnosed with which condition? Paranoid schizophrenia Absence seizures Obsessive-compulsive disorder Bipolar disorder

The client may be at high risk for self-harm. (Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.)

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility? The client is getting better and is able to be assertive. The client may be at high risk for self-harm. The client is probably experiencing transference. The client may be angry at someone else and projecting that anger to staff.

Broiled chicken breast on a roll, an ear of corn, and an apple (These foods provide adequate nutrition, but more important they are finger foods that the hyperactive patient could "eat on the run." The foods in the incorrect options cannot be eaten without utensils.)

Which dinner menu is best suited for a patient with acute mania? Spaghetti and meatballs, salad, and a banana Beef and vegetable stew, a roll, and chocolate pudding Broiled chicken breast on a roll, an ear of corn, and an apple Chicken casserole, green beans, and flavored gelatin with whipped cream

Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. (Sleeping 6 hours, participating with a group, and anticipating an event are all positive events. All the other options show at least one negative finding.)

Which documentation for a patient diagnosed with major depression indicates the treatment plan was effective? Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. Slept 10 hours uninterrupted. Attended craft group; stated "project was a failure, just like me." Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, "I feel tired all the time."

"Converses with few interruptions; clothing matches; participates in activities." (The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior.)

Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective? "Converses with few interruptions; clothing matches; participates in activities." "Irritable, suggestible, distractible; napped for 10 minutes in afternoon." "Attention span short; writing copious notes; intrudes in conversations." "Heavy makeup; seductive toward staff; pressured speech."

Disturbed sleep pattern (Patients with mood disorders, both depression and mania, experience sleep pattern disturbances. Assessment data should be routinely gathered about this possible problem. Deficient diversional activity is more relevant for patients with depression. Defensive coping is more relevant for patients with mania. Fluid volume excess is less relevant for patients with mood disorders than is deficient fluid volume.)

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression as well as one experiencing acute mania? Deficient diversional activity Fluid volume excess Disturbed sleep pattern Defensive coping

Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. (Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide.)

Which of the following is true of the relationship between bipolar disorder and suicide? Patients need to be monitored only in the depressed phase because this is when suicides occur. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Patients with bipolar disorder are not considered high risk for suicide. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

Limit credit card access. Provide a structured environment. Monitor the patient's sleep patterns. (A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is over-stimulated by a busy environment. Providing structure would help the patient maintain appropriate behavior. Financial irresponsibility may be avoided by limiting access to cash and credit cards. Continued decline in sleep patterns may indicate the condition has evolved to full mania. Group socialization should be kept to a minimum to reduce stimulation. A full leave of absence from work will be necessary to limit stimuli and prevent problems associated with poor judgment and inappropriate decision making that accompany hypomania.)

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply. Limit credit card access. Provide a structured environment. Encourage group social interaction. Suggest limiting work to half-days. Monitor the patient's sleep patterns.

b. Self-injury or suicidal tendencies (In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect.)

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

Ch. 14: Depressive Disorders

Ch. 14: Depressive Disorders

a. Apply personal protective equipment. (The nurse's priority is to care for the client. Since the client has gunshot wounds and is bleeding, the nurse applies personal protective equipment (i.e., gloves) prior to care. This takes priority over calling law enforcement. Requesting blood bank products can be delegated. The nurse may or may not have to prepare the client for emergency surgery.)

A client has been brought to the emergency department after being shot multiple times. What action should the nurse perform first? a. Apply personal protective equipment. b. Notify local law enforcement officials. c. Obtain "universal" donor blood. d. Prepare the client for emergency surgery.

c. Report of chest heaviness (Chest heaviness or pain indicates myocardial ischemia, a possible adverse effect of dopamine. While taking dopamine, the oxygen requirements of the heart are increased due to increased myocardial workload, and may cause ischemia. Without knowing the client's previous blood pressure or pedal pulses, there is not enough information to determine if these are an improvement or not. A urine output of 32 mL/hr is acceptable.)

A client in shock has been started on dopamine. What assessment finding requires the nurse to communicate with the provider immediately? a. Blood pressure of 98/68 mmHg b. Pedal pulses 1+/4+ bilaterally c. Report of chest heaviness d. Urine output of 32 mL/hr

a. Offer to remain with the client for awhile. (The nurse's presence will be best to reassure this client. Antianxiety medication is not warranted as this will lower the client's blood pressure. Using all four siderails on a hospital bed is considered a restraint in most facilities, although the nurse should ensure the client's safety. Telling a confused client that everything is being done is not the most helpful response.)

A client in shock is apprehensive and slightly confused. What action by the nurse is best? a. Offer to remain with the client for awhile. b. Prepare to administer antianxiety medication. c. Raise all four siderails on the client's bed. d. Tell the client everything possible is being done.

b. "I hope I can get my water turned back on when I get home." (All these statements indicate a potential for leading to infection once the client gets back home. A large party might include individuals who are themselves ill and contagious. Having litter boxes in the home can expose the client to microbes that can lead to infection. Small children often have upper respiratory infections and poor hand hygiene that spread germs. However, the most worrisome statement is the lack of running water for handwashing and general hygiene and cleaning purposes.)

A client is being discharged home after a large myocardial infarction and subsequent coronary artery bypass grafting surgery. The client's sternal wound has not yet healed. What statement by the client most indicates a higher risk of developing sepsis after discharge? a. "All my friends and neighbors are planning a party for me." b. "I hope I can get my water turned back on when I get home." c. "I am going to have my daughter scoop the cat litter box." d. "My grandkids are so excited to have me coming home!"

Ask family members to stay with the client. Remain with the client. Reassure the client that everything is being done for him or her. (To support the psychosocial integrity of a client in early shock, the nurse would have a familiar person nearby to comfort the client. The nurse would also remain with the client and offer genuine support to reassure the client that everything is being done for her.The health care provider would be notified, and increasing IV and oxygen rates may be needed, but these actions do not support the client's psychosocial integrity.)

A client is exhibiting signs and symptoms of early shock. What is important for the nurse to do to support the psychosocial integrity of the client? Select all that apply. Ask family members to stay with the client. Call the health care provider. Increase IV and oxygen rates. Remain with the client. Reassure the client that everything is being done for him or her.

a. "High glucose is common in shock and needs to be treated." (High glucose readings are common in shock, and best outcomes are the result of treating them and maintaining glucose readings in the normal range. Medications and IV solutions may raise blood glucose levels, but this is not the most accurate answer. The stress of the illness has not "made" the client diabetic.)

A client is in shock and the nurse prepares to administer insulin for a blood glucose reading of 208 mg/dL. The spouse asks why the client needs insulin as the client is not a diabetic. What response by the nurse is best? a. "High glucose is common in shock and needs to be treated." b. "Some of the medications we are giving are to raise blood sugar." c. "The IV solution has lots of glucose, which raises blood sugar." d. "The stress of this illness has made your spouse a diabetic."

a. Bringing the client warm blankets d. Reorienting the client as needed e. Sitting with the client for reassurance (The student can bring the client warm blankets, reorient the client as needed to decrease anxiety, and sit with the client for reassurance. The client should be NPO at this point, so hot tea is prohibited. Massaging the legs is not recommended as this can dislodge any clots present, which may lead to pulmonary embolism.)

A client is in the early stages of shock and is restless. What comfort measures does the nurse delegate to the nursing student? (Select all that apply.) a. Bringing the client warm blankets b. Giving the client hot tea to drink c. Massaging the client's painful legs d. Reorienting the client as needed e. Sitting with the client for reassurance

a. Alert and oriented, answering questions (Normal cognitive function is a good indicator that the client is receiving the benefits of norepinephrine. The brain is very sensitive to changes in oxygenation and perfusion. Norepinephrine can cause chest pain as an adverse reaction, so the absence of chest pain does not indicate therapeutic effect. The IV site is normal. The urine output is normal, but only minimally so.)

A client is receiving norepinephrine (Levophed) for shock. What assessment finding best indicates a therapeutic effect from this drug? a. Alert and oriented, answering questions b. Client denial of chest pain or chest pressure c. IV site without redness or swelling d. Urine output of 30 mL/hr for 2 hours

Temperature (A postoperative client's temperature may differentiate pulmonary embolism from early sepsis when the client complains of feeling light-headed and anxious. A sign of early sepsis is low-grade fever. Both early sepsis and thrombus may cause tachycardia (pulse), tachypnea (respiration), and hypotension (blood pressure).)

A client recovering from an open reduction of the femur suddenly feels light-headed, with increased anxiety and agitation. Which key vital sign differentiates a pulmonary embolism from early sepsis? Temperature Pulse Respiration Blood pressure

Bumetanide (Bumex) 1 mg IV (The prescription order the nurse questions is Bumetanide (Bumex0 1 mg IV). A diuretic such as bumetanide will decrease blood volume in a client who is already hypovolemic. This order must be questioned because this is not an appropriate action to expand the client's blood volume.The orders other than Bumetanide are appropriate for improving blood pressure in shock and do not need to be questioned.)

A client with hypovolemic shock has these vital signs: temperature 97.9°F (36.6°C) pulse 122 beats/min blood pressure 86/48 mmHg respirations 24 breaths/min urine output 20 mL for last 2 hours skin cool and clammy. Which prescription order for this client does the nurse question? Dopamine (Intropin) 12 mcg/kg/min Dobutamine (Dobutrex) 5 mcg/kg/min Plasmanate 1 unit Bumetanide (Bumex) 1 mg IV

Tremors Hepatoxicity Weight gain (Common adverse effects of valproic acid (Depakote) include drowsiness; nausea, vomiting, and other gastrointestinal disturbances; tremor; weight gain; and transient hair loss. The most serious adverse effects are hepatotoxicity and pancreatitis. It is not known to cause hypoglycemia.)

A patient receiving valproic acid (Depakote) should be monitored for which adverse effects? (Select all that apply.) Tremors Insomnia Hepatoxicity Weight gain Hypoglycemia

Blood pressure 90/60 mm Hg and mean arterial pressure 70 mmHg (A positive outcome of a Dopamine infusion started on a client with septic shock is a blood pressure of 90/60 mm Hg and a mean arterial pressure of 70 mm Hg. Dopamine improves blood flow by increasing peripheral resistance, which increases blood pressure. Urine output less than 30 mL/hr or 0.5 mL/kg/hr and elevations in serum creatinine indicate poor tissue perfusion to the kidney and are a negative consequence of shock, not a positive response. Although a blood glucose of 245 mg/dL (13.6 mmol/L) is an abnormal finding, dopamine increases blood pressure and myocardial contractility, not glucose levels.)

A client with septic shock has been started on dopamine (Intropin) at 12 mcg/kg/min. Which response indicates a positive outcome? Hourly urine output 10 to 12 mL/hr Blood pressure 90/60 mm Hg and mean arterial pressure 70 mmHg Blood glucose 245 mg/dL (13.6 mmol/L) Serum creatinine 3.6 mg/dL (318 mcmol/L)

Monoamine oxidase inhibitors (MAOIs) (Adrenergic drugs combined with MAOIs may cause a possibly life-threatening hypertensive crisis. All of the other drugs listed are used to treat hypertension.)

A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with which of the following drug classes? Alpha₁ blockers Direct renin inhibitors Monoamine oxidase inhibitors (MAOIs) Beta blockers

c. Notify the health care provider immediately. (This client has several indicators of sepsis with systemic inflammatory response. The nurse should notify the health care provider immediately. Documentation needs to be thorough but does not take priority. The client may appreciate warm blankets, but comfort measures do not take priority. The client may or may not need insulin.)

A nurse caring for a client notes the following assessments: white blood cell count 3800/mm³ blood glucose level 198 mg/dL temperature 96.2° F (35.6° C) What action by the nurse takes priority? a. Document the findings in the client's chart. b. Give the client warmed blankets for comfort. c. Notify the health care provider immediately. d. Prepare to administer insulin per sliding scale.

b. Measure urine output from the catheter. (Urine output changes are a sensitive early indicator of shock. The nurse should delegate emptying the urinary catheter and measuring output to the UAP as a baseline for hourly urine output measurements. The UAP cannot assess for pain. Repositioning may or may not be effective for decreasing restlessness, but does not take priority over physical assessments. Reassurance is a therapeutic nursing action, but the nurse needs to do more in this situation.)

A nurse is caring for a client after surgery who is restless and apprehensive. The unlicensed assistive personnel (UAP) reports the vital signs and the nurse sees they are only slightly different from previous readings. What action does the nurse delegate next to the UAP? a. Assess the client for pain or discomfort. b. Measure urine output from the catheter. c. Reposition the client to the unaffected side. d. Stay with the client and reassure him or her.

b. Assess the client's tissue perfusion further. (Signs of the earliest stage of shock are subtle and may manifest in slight increases in heart rate, respiratory rate, or blood pressure. Even though these readings are not out of the normal range, the nurse should conduct a thorough assessment of the client, focusing on indicators of perfusion. The client may need pain medication, but this is not the priority at this time. Documentation should be done thoroughly but is not the priority either. The nurse should not increase the rate of the IV infusion without an order.)

A nurse is caring for a client after surgery. The client's respiratory rate has increased from 12 to 18 breaths/min and the pulse rate increased from 86 to 98 beats/min since they were last assessed 4 hours ago. What action by the nurse is best? a. Ask if the client needs pain medication. b. Assess the client's tissue perfusion further. c. Document the findings in the client's chart. d. Increase the rate of the client's IV infusion.

b. Drink fluids on a regular schedule. (Preventing dehydration in older adults is important because the age-related decrease in the thirst mechanism makes them prone to dehydration. Having older adults drink fluids on a regular schedule will help keep them hydrated without the influence of thirst (or lack of thirst). Telling clients not to get dehydrated is important, but not the best answer because it doesn't give them the tools to prevent it from occurring. Older adults should seek attention for lacerations, but this is not as important an issue as staying hydrated. Taking medications as prescribed may or may not be related to hydration.)

A nurse works at a community center for older adults. What self-management measure can the nurse teach the clients to prevent shock? a. Do not get dehydrated in warm weather. b. Drink fluids on a regular schedule. c. Seek attention for any lacerations. d. Take medications as prescribed.

Plasma (The ideal intervention for restoring osmotic pressure in a patient with normal hematocrit and hemoglobin is plasma. Plasma protein fractions and synthetic plasma expanders are used to increase fluid volume. Whole blood is suitable for replacing large blood losses in patients with a decrease in hemoglobin and hematocrit levels. Ringer's lactate does not restore oncotic pressure; it is a crystalloid that restores fluid volume and is used in instances where the patient needs volume expansion and correction of acidosis. Packed red cells are chosen for moderate blood losses when the patient needs red blood cells without added fluid volume.)

A patient in hypovolemic shock presents with a normal hematocrit and hemoglobin. What type of fluid should the nurse anticipate the health care provider will prescribe to restore oncotic pressure? Plasma Whole blood Ringer's lactate Packed red cells

Wash the dishes in the dishwasher. (Dishes should be washed in hot, soapy water or in a dishwasher to thoroughly cleanse them; there is no need to use disposable tableware. Water that has been standing longer than 15 minutes should be discarded; however, bottled water is not necessary. The patient may be in the same room as, as well as touch, the family pet (with the exception of changing a litterbox—this should not be done); however, the patient should wash the hands thoroughly with an antimicrobial soap after touching pets.)

A patient is receiving antineoplastic chemotherapy. Which measure does the nurse teach that will help prevent infection and sepsis? Drink only bottled water. Use disposable dishes. Wash the dishes in the dishwasher. Avoid being in the same room as the family pet.

30 mL/hr (The patient's weight of 176 lb is converted to kilograms by dividing 176 by 2.2, which equals 80 kg. 5 mcg/kg/min multiplied by 80 kg equals 400 mcg, or 0.4 mg/min. Dividing 0.4 mg/min by 400 mg/500 mL = 0.5 mL/min, which when multiplied by 60 minutes = 30 mL/hour.)

A patient weighing 176 lb is to receive a dopamine (Intropin) continuous intravenous (IV) infusion at 5 mcg/kg/min. The solution strength available is dopamine 400 mg in 500 mL D5W. The nurse will infuse the medication at which rate? 20 mL/hr 30 mL/hr 40 mL/hr 50 mL/hr

a. Agitation c. Tremors e. Sweating (Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others.)

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

Measure hourly urine output. (The nurse delegates to an experienced ICU UAP the measurement of hourly urine output on a client with hypovolemic shock. Monitoring hourly urine output is included in nursing assistant education and does not require special clinical judgment. The nurse will evaluate the results.Obtaining vital signs, monitoring oxygen saturation, and assessing mental status in critically ill clients requires the clinical judgment of the critical care nurse because immediate intervention may be needed.)

A postoperative client is admitted to the intensive care unit (ICU) with hypovolemic shock. Which nursing action does the nurse delegate to an experienced unlicensed assistive personnel (UAP)? Obtain vital signs every 15 minutes. Measure hourly urine output. Check oxygen saturation. Assess level of alertness.

b. Lower blood volume lowers MAP. (Lower blood volume will decrease MAP. The other answers are not accurate.)

A student is caring for a client who suffered massive blood loss after trauma. How does the student correlate the blood loss with the client's mean arterial pressure (MAP)? a. It causes vasoconstriction and increased MAP. b. Lower blood volume lowers MAP. c. There is no direct correlation to MAP. d. It raises cardiac output and MAP.

c. Removing the IV bag from the brown plastic cover (Nitroprusside degrades in the presence of light, so it must be protected by leaving it in the original brown plastic bag when infusing. The other actions are correct, although a "smart" pump is not necessarily required if the facility does not have them available. The drug must be administered via an IV pump, although the programmable pump is preferred for safety.)

A student nurse is caring for a client who will be receiving sodium nitroprusside (Nipride) via IV infusion. What action by the student causes the registered nurse to intervene? a. Assessing the IV site before giving the drug b. Obtaining a programmable ("smart") IV pump c. Removing the IV bag from the brown plastic cover d. Taking and recording a baseline set of vital signs

Cyanosis (Cyanosis appears later, in the progressive stage of hypovolemic shock. Earlier signs and symptoms of the nonprogressive stage include restlessness, increased respiratory rate, and decreased urine output.)

After teaching a patient's family members about hypovolemic shock, the nurse asks them about the early signs and symptoms that appear in the nonprogressive stage. What symptom identified by a family member requires further teaching? Cyanosis Restlessness Increased respiratory rate Decreased urine output

b. Increased cardiac output (For a patient in shock, a primary benefit of an adrenergic agonist drug is to increase cardiac output. A drug in this category should not be used in place of volume restoration, nor does it provide volume restoration (IV fluids do this). Adrenergic agonists may enhance urine output if cardiac output and perfusion to the kidneys increase. These drugs do not reduce anxiety.)

An adrenergic agonist is ordered for a patient in shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? a. Volume restoration b. Increased cardiac output c. Decreased urine output d. Reduced anxiety

Ch. 16: Psychotherapeutic Drugs

Ch. 16: Psychotherapeutic Drugs

Ch. 18: Adrenergic Drugs

Ch. 18: Adrenergic Drugs

Ch. 37: Care of Patients with Shock

Ch. 37: Care of Patients with Shock

lamotrigine (Lamictal) (The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs.)

Consider these three anticonvulsant medications: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which medication also belongs to this classification? clonazepam (Klonopin) lamotrigine (Lamictal) risperidone (Risperdal) aripiprazole (Abilify)

Lactate 81 mg/dL (9.0 mmol/L) (The client with septic shock and a lactate level of 81 mg/dL (0.9 mmoL/L) indicates that severe tissue hypoxia is present. Poor tissue oxygenation at the cellular level causes anaerobic metabolism, with the by-product of lactic acid. Elevated partial pressure of carbon dioxide occurs with hypoventilation, which may be related to respiratory muscle fatigue, secretions, and causes other than hypoxia. Coagulation times reflect the ability of the blood to clot, not oxygenation at the cellular level. Elevation in potassium appears in septic shock due to acidosis, but this value is decreased and is not consistent with septic shock.)

How does the nurse caring for a client with septic shock recognize that severe tissue hypoxia is present? PaCO₂ 58 mmHg Lactate 81 mg/dL (9.0 mmol/L) Partial thromboplastin time 64 seconds Potassium 2.8 mEq/L (2.8 mmol/L)

Mean arterial pressure (MAP) 70 mmHg (A MAP of 70 mm Hg means that a positive outcome has occurred when plasma protein fraction (Plasmanate) has been administered. Plasmanate expands the blood volume and helps maintain MAP greater than 65 mm Hg, and a desired outcome in shock.Urine output needs to be 0.5 mL/kg/hr, or greater than 30 mL/hr. Albumin levels reflect nutritional status, which may be poor in shock states due to an increased need for calories. Plasmanate expands blood volume by exerting increasing colloid osmotic pressure in the bloodstream, pulling fluid into the vascular space and does not improve an abnormal hemoglobin.)

How does the nurse recognize that a positive outcome has occurred when administering plasma protein fraction (Plasmanate)? Urine output 20 to 30 mL/hr for the last 4 hours Mean arterial pressure (MAP) 70 mmHg Albumin 3.5 g/dL (5.0 mcmol/L) Hemoglobin 7.6 g/dL (76 mmol/L)

Situational low self-esteem (The patient's statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of situational low self-esteem. Insufficient information exists to lead to other diagnoses.)

Major depression resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies? Powerlessness Situational low self-esteem Defensive coping Disturbed personal identity

careful unobtrusive observation around the clock. (Approximately two-thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regular planned observations of the patient diagnosed with depression may prevent a suicide attempt on the unit.)

Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include: distracting the patient from self-absorption. careful unobtrusive observation around the clock. allowing the patient to spend long periods alone in meditation. opportunities to assume a leadership role in the therapeutic milieu.

Instilling a sense of hopefulness Assisting with self-care activities Accommodating psychomotor retardation (Anergia refers to a lack of energy. Anhedonia refers to the inability to find pleasure or meaning in life; thus, planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations.)

The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan? Select all that apply. Channeling excessive energy Reducing guilty ruminations Instilling a sense of hopefulness Assisting with self-care activities Accommodating psychomotor retardation

International normalized ratio (INR) 7.9 (A client with a prolonged INR of 7.9 places a client at risk for hemorrhagic shock. Prolonged INR indicates that blood takes longer than normal to clot and increases the risk for bleeding. PTT of 12.5 seconds is low and puts this client at risk for clotting. A platelet value of 170,000/mm³ (170 × 10⁹/L) is normal and poses no risk for bleeding. Although a hemoglobin of 8.2 g/dL (82 mmol/L) is low, the client could have severe iron deficiency or could have received medication affecting the bone marrow.)

The client with which laboratory result is at risk for hemorrhagic shock? International normalized ratio (INR) 7.9 Partial thromboplastin time (PTT) 12.5 seconds Platelets 170,000/mm³ (170 × 10⁹/L) Hemoglobin 8.2 g/dL (82 mmol/L)

Esophageal varices (The client with esophageal varices is at highest risk for hypovolemic shock. Esophageal varices are caused by portal hypertension where the portal vessels are under high pressure. With this high pressure, the portal vessels are prone to rupture, causing massive upper gastrointestinal tract bleeding and hypovolemic shock.As the kidneys fail, fluid is typically retained, causing fluid volume excess, not hypovolemia. Arthritis and daily acetaminophen use do not cause GI bleeding and hypovolemia. Nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen may predispose the client to gastrointestinal (GI) bleeding and hypovolemia. Although a kidney stone may cause hematuria, massive blood loss or hypovolemia generally does not occur.)

The client with which problem is at highest risk for hypovolemic shock? Esophageal varices Kidney failure Arthritis and daily acetaminophen use Kidney stone

Fluid replacement (Dopamine increases blood pressure secondary to vasoconstriction, which has a limited effect if there is not enough volume within the circulatory system.)

The health care provider has prescribed dopamine (Intropin) to treat the patient's hypovolemic shock secondary to severe blood loss. For the medication to be effective, the health care provider must also prescribe which treatment? Fluid replacement Temporary pacing Beta-stimulating drugs Induced hypothermia

Phentolamine (Regitine) (Phentolamine is an alpha blocker that causes vasodilation, thus counteracting the vasoconstrictive effects of the infiltrated dopamine. The vasodilation will increase blood flow to the site and decrease the risk of tissue necrosis.)

The nurse assesses the patient's IV site, and it has infiltrated during the infusion of dopamine (Intropin). The nurse will prepare which medication to treat this infiltration? Naloxone (Narcan) Lidocaine (Xylocaine) Phentolamine (Regitine) Nitroprusside (Nipride)

a. Assessing and identifying clients at risk c. Performing proper hand hygiene d. Removing invasive lines as soon as possible e. Using aseptic technique during procedures (Assessing and identifying clients at risk for shock is probably the most critical action the nurse can take to prevent shock from occurring. Proper hand hygiene, using aseptic technique, and removing IV lines and catheters are also important actions to prevent shock. Monitoring laboratory values does not prevent shock but can indicate a change.)

The nurse caring for hospitalized clients includes which actions on their care plans to reduce the possibility of the clients developing shock? (Select all that apply.) a. Assessing and identifying clients at risk b. Monitoring the daily white blood cell count c. Performing proper hand hygiene d. Removing invasive lines as soon as possible e. Using aseptic technique during procedures

a. Altered mobility/immobility b. Decreased thirst response c. Diminished immune response d. Malnutrition (Immobility, decreased thirst response, diminished immune response, and malnutrition can place the older adult at higher risk of developing shock. Overhydration is not a common risk factor for shock.)

The nurse caring frequently for older adults in the hospital is aware of risk factors that place them at a higher risk for shock. For what factors would the nurse assess? (Select all that apply.) a. Altered mobility/immobility b. Decreased thirst response c. Diminished immune response d. Malnutrition e. Overhydration

a. Client with a blood pressure change of 128/74 to 110/88 mmHg (This client has a falling systolic blood pressure, rising diastolic blood pressure, and narrowing pulse pressure, all of which may be indications of the progressive stage of shock. The nurse should assess this client first. The client with the unchanged oxygen saturation is stable at this point. Although the client with a change in pulse has a slower rate, it is not an indicator of shock since the pulse is still within the normal range; it may indicate the client's pain or anxiety has been relieved, or he or she is sleeping or relaxing. A urine output of 40 mL/hr is only slightly above the normal range, which is 30 mL/hr.)

The nurse gets the hand-off report on four clients. Which client should the nurse assess first? a. Client with a blood pressure change of 128/74 to 110/88 mmHg b. Client with oxygen saturation unchanged at 94% c. Client with a pulse change of 100 to 88 beats/min d. Client with urine output of 40 mL/hr for the last 2 hours

Discussion with family and provider regarding palliative care (When caring for a client in the refractory stage of cardiogenic shock the nurse considers discussing palliative care with the family and provider. In this irreversible phase, therapy is not effective in saving the client's life, even if the cause of shock is corrected and mean arterial pressure temporarily returns to normal. A discussion on palliative care would be considered. Rehabilitation or returning home is unlikely. The client with sustained tissue hypoxia is not a candidate for organ transplantation.)

The nurse is caring for a client in the refractory stage of cardiogenic shock. Which intervention does the nurse consider? Admission to rehabilitation hospital for ambulatory retraining Collaboration with home care agency for return to home Discussion with family and provider regarding palliative care Enrollment in a cardiac transplantation program

a. Administer antibiotics. b. Draw serum lactate levels. e. Obtain blood cultures. (Within the first 3 hours of suspecting severe sepsis, the nurse should draw (or facilitate) serum lactate levels, obtain blood cultures (or other cultures), and administer antibiotics (after the cultures have been obtained). Infusing vasopressors and measuring central venous pressure are actions that should occur within the first 6 hours.)

The nurse is caring for a client with suspected severe sepsis. What does the nurse prepare to do within 3 hours of the client being identified as being at risk? (Select all that apply.) a. Administer antibiotics. b. Draw serum lactate levels. c. Infuse vasopressors. d. Measure central venous pressure. e. Obtain blood cultures.

Tachycardia (Tachycardia is an early symptom of shock. Heart and respiratory rates increased from the client's baseline level or a slight increase in diastolic blood pressure may be the only objective manifestation of this early stage of shock. Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal. Early in shock, the client displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock; they are related to lack of oxygen to the heart.Catecholamine release occurs early in shock as a compensation for fluid loss; blood pressure will be normal and not abnormally low. Early in shock, the client displays rapid, not slow, respirations. Dysrhythmias are a late sign of shock and are related to lack of oxygen to the heart.)

The nurse is caring for postoperative clients at risk for hypovolemic shock. Which condition represents an early symptom of shock? Hypotension Bradypnea Heart blocks Tachycardia

d. Continuous IV infusion with an infusion pump (Dopamine is available only as an IV injectable drug and is given by continuous infusion, using an infusion pump. The other options are incorrect.)

The nurse is preparing to administer dopamine. Which is the correct technique for administering dopamine? a. Orally b. Intravenous (IV) push injection c. Intermittent IV infusions (IV piggyback) d. Continuous IV infusion with an infusion pump

Acidosis Hyperkalemia (In the compensatory (nonprogressive) stage of shock, tissue hypoxia leads to acidosis because of changes in anaerobic metabolism. Hyperkalemia occurs as well from the changes in metabolism. The patient is acidotic, not alkalotic. Hypovolemic shock is associated with vasoconstriction, not vasodilation.)

What metabolic changes occur as a result of tissue ischemia during the compensatory stage of hypovolemic shock? Select all that apply. Acidosis Alkalosis Hypokalemia Hyperkalemia Vasodilatation

a. Dilation of bronchioles d. Increased heart rate e. Dilated pupils g. Glycogenolysis (Stimulation of the sympathetic nervous system causes bronchodilation, increased heart rate, pupil dilation, and glycogenolysis as well as many other effects. The other responses are effects that occur as a result of the stimulation of the parasympathetic nervous system.)

The nurse is presenting information to a class of students about adrenergic drugs. Which are the effects of drugs that stimulate the sympathetic nervous system? (Select all that apply.) a. Dilation of bronchioles b. Constriction of bronchioles c. Decreased heart rate d. Increased heart rate e. Dilated pupils f. Constricted pupils g. Glycogenolysis

c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. (Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.)

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

c. Salami and Swiss cheese sandwich (Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine.)

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

Ensure that blood cultures were drawn. (The nurse's first action when planning to administer an antibiotic to a newly admitted patent in septic shock is to ensure that blood cultures were drawn. Cultures must be taken to identify the organism for more targeted antibiotic treatment before antibiotics are administered. Antibiotics are not administered until after all cultures are taken.A signed consent is not needed for medication administration. Monitoring the client's vital signs is important, but the antibiotic must be administered within 1 to 3 hours, because timing is essential.)

The nurse plans to administer an antibiotic to a client newly admitted with septic shock. What action does the nurse take first? Administer the antibiotic immediately. Ensure that blood cultures were drawn. Obtain signature for informed consent. Take the client's vital signs.

c. Beta₂ adrenergic (Stimulation of beta2-adrenergic receptors results in bronchodilation. The other choices are incorrect.)

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? a. Dopaminergic b. Beta₁ adrenergic c. Beta₂ adrenergic d. Alpha₁ adrenergic

Notify anesthesia for endotracheal intubation. (The nurse must first notify anesthesia for endotracheal intubation for this client with hemorrhagic shock. Establishing an airway is the priority in all emergency situations.Although administering Plasmanate and normal saline, and typing and cross matching for 4 units of PRBCs are important actions, airway always takes priority.)

The nurse reviews the medical record of a client with hemorrhagic shock, which contains the following information: Physical Assessment Findings: Pulse 140 beats/min and thready Blood pressure 60/40 mm Hg Respirations 40/min and shallow Diagnostic Findings: ABG respiratory acidosis Lactate level 63 mg/dL(7 mmol/L) All of these provider prescriptions are given for the client. Which does the nurse carry out first? Notify anesthesia for endotracheal intubation. Give Plasmanate 1 unit now. Give normal saline solution 250 mL/hr. Type and crossmatch for 4 units of packed red blood cells (PRBCs).

Compare these vital signs with the last several readings. (The supervising nurse will take the vital sign trends into consideration. A BP of 90/60 mmHg may be normal for this client.Calling the surgeon is not necessary at this point, and increasing IV fluids is not indicated. The same equipment must be used when vital signs are taken postoperatively.)

The unlicensed assistive personnel (UAP) is concerned about a postoperative client with: blood pressure (BP) of 90/60 mmHg heart rate of 80 beats/min respirations of 22 breaths/min. What does the supervising nurse do? Compare these vital signs with the last several readings. Request that the surgeon see the client. Increase the rate of intravenous fluids. Reassess vital signs using different equipment.

Smoking cessation (Zyban is a sustained-release form of bupropion that is useful in helping patients to quit smoking.)

What is another approved and indicated use for the antidepressant bupropion (Zyban)? Tourette's syndrome Orthostatic hypotension Smoking cessation Nocturnal enuresis

Tachypnea and tachycardia (Early signs/symptoms of systemic inflammatory response syndrome include rapid respiratory rate, leukocytosis, and tachycardia. The early stage of septic shock precedes sepsis.In the early stage of septic shock, the client is usually warm and febrile. Hypotension does not develop until later in septic shock due to compensatory mechanisms. Respiratory alkalosis and not acidosis occurs early in shock because of an increased respiratory rate.)

What typical sign/symptom indicates the early stage of septic shock? Pallor and cool skin Blood pressure 84/50 mm Hg Tachypnea and tachycardia Respiratory acidosis

a. Increased heart rate (Increased heart rate is one of the effects of adrenergic drugs. Sympathetic nervous system stimulation also results in bronchodilation, dilated pupils, and decreased gastrointestinal mobility, depending upon which receptors are stimulated.)

When a patient is taking an adrenergic drug, the nurse expects to observe which effect? a. Increased heart rate b. Bronchial constriction c. Constricted pupils d. Increased intestinal peristalsis

a. Positive inotropic (An increased force of contraction is known as a positive inotropic effect.)

When an adrenergic drug stimulates beta₁-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? a. Positive inotropic b. Anti-adrenergic c. Negative dromotropic d. Positive chronotropic

A positive inotropic, positive chronotropic, and positive dromotropic effect (Adrenergic stimulation of the beta₁-adrenergic receptors on the myocardium and in the conduction system of the heart results in an increased heart rate (positive chronotropic effect), increased contractility (positive inotropic effect), and increased conductivity (positive dromotropic effect).)

When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce which effect on the heart? A positive inotropic, positive chronotropic, and positive dromotropic effect A positive inotropic, negative chronotropic, and negative dromotropic effect A negative inotropic, positive chronotropic, and positive dromotropic effect A negative inotropic, negative chronotropic, and negative dromotropic effect

Check the airway and respiratory status. (The nurse's first action when caring for an obtunded client admitted with shock is to check the client's airway and respiratory status. When caring for any client, determining airway and respiratory status is the priority.The airway takes priority over obtaining IV access, applying the blood pressure cuff, and assessing for changes in the client's mental status.)

When caring for an obtunded client admitted with shock of unknown origin, which action does the nurse take first? Obtain IV access and hang prescribed fluid infusions. Apply the automatic blood pressure cuff. Assess level of consciousness and pupil reaction to light. Check the airway and respiratory status.

Hemophilia Malnutrition Diuretic therapy (Specific risk factors for hypovolemic shock include hemophilia, malnutrition, and diuretic therapy. Hypovolemia can be caused by impaired clotting in patients with hemophilia and malnourishment. Excessive diuresis due to diuretic therapy can also cause reduction in blood volume. Patients with spinal cord injury have distributive shock in which the total blood volume is not reduced but fluid shifts from the central vascular space. In patients with myocardial infarction, cardiac function is impaired which causes cardiogenic shock.)

Which are risk factors for hypovolemic shock? Select all that apply. Hemophilia Malnutrition Diuretic therapy Spinal cord injury Myocardial infarction

Unrestrained client in a motor vehicle collision (MVC) Surgical intensive care unit (SICU) client 85-year-old with gastrointestinal (GI) virus (Clients who are immediate risk for hypovolemic shock include: the unrestrained client in a (MVC), the SICU client, and the 85-year-old client with GI virus. The client who is unrestrained in a MVC is prone to multiple trauma and bleeding. Surgical clients are at high risk for hypovolemic shock owing to fluid loss and hemorrhage. Older adult clients are prone to shock, especially if a gastrointestinal virus is present that results in fluid losses.Unless injured or working in excessive heat, the construction worker and the athlete are not at risk for hypovolemic shock. They may, however, be at risk for dehydration.)

Which clients are at immediate risk for hypovolemic shock? Select all that apply. Unrestrained client in a motor vehicle collision (MVC) Construction worker Athlete Surgical intensive care unit (SICU) client 85-year-old with gastrointestinal (GI) virus

Low-grade fever and mild hypotension (Low-grade fever and mild hypotension in a postoperative client indicate very early sepsis. With treatment, the probability of recovery is high.Localized erythema and edema indicate local infection. A low oxygen saturation rate and decreased cognition indicate severe sepsis. Reduced urinary output and increased respiratory rate indicate active (not early) sepsis.)

Which clinical symptoms in a postoperative client indicate early sepsis with an excellent recovery rate if treated? Localized erythema and edema Low-grade fever and mild hypotension Low oxygen saturation rate and decreased cognition Reduced urinary output and increased respiratory rate

Decreased segmented neutrophil count (A decreased segmented neutrophil count is indicative of late sepsis. The segmented neutrophils (segs) may no longer be elevated because prolonged sepsis may have exceeded the bone marrow's ability to keep producing and releasing new mature neutrophils.Serum lactate is increased, not decreased, in late sepsis. Monocytosis is usually seen in diseases such as tuberculosis and Rocky Mountain spotted fever. An increased platelet count does not indicate sepsis. Late in sepsis, platelets may decrease due to consumptive coagulopathy.)

Which laboratory result is seen in late sepsis? Decreased serum lactate Decreased segmented neutrophil count Increased numbers of monocytes Increased platelet count

Hydrocortisone Fludrocortisone (During severe sepsis, the body's immune response can become self-destructive if not controlled. Drugs that provide adrenal support during severe sepsis are IV hydrocortisone and oral fludrocortisone. IV penicillin, levofloxacin, and vancomycin are antibiotics that help to kill the bacteria causing the sepsis.)

Which medications are often used to provide adrenal support for the patient with severe sepsis? Select all that apply. Penicillin Levofloxacin Hydrocortisone Fludrocortisone Vancomycin

Kidney (Kidneys can tolerate hypoxia for 1 hour without permanent damage, but beyond this time the patient is at the risk of kidney failure. The liver, brain, and heart cannot tolerate hypoxia; it will lead to organ dysfunction.)

Which organ can tolerate hypoxia for 1 hour without permanent damage in a patient with hypovolemic shock? Liver Brain Heart Kidney

Client with severe ascites (A client with severe ascites best demonstrates the problem with the highest risk for hypovolemic shock. Fluid shifts from vascular to intraabdominal may cause decreased circulating blood volume and poor tissue perfusion.The client receiving a blood transfusion does not have as high a risk as the client with severe ascites. Myocardial infarction results in tissue necrosis in the heart muscle, but no blood or fluid losses occur. Owing to excess antidiuretic hormone secretion, the client with SIADH will retain fluid and therefore is not at risk for hypovolemic shock.)

Which problem in the clients below best demonstrates the highest risk for hypovolemic shock? Client receiving a blood transfusion Client with severe ascites Client with myocardial infarction Client with syndrome of inappropriate antidiuretic hormone (SIADH) secretion

Post kidney transplant (A client with post kidney transplant is the highest risk for sepsis. This client will need to take lifelong immune suppressant therapy and is at risk for infection from internal and external organisms.Pernicious anemia is related to lack of vitamin B12, not to bone marrow failure (aplastic anemia), which would place the client at risk for infection. Inflammation of the pericardial sac is an inflammatory condition that does not pose a risk for septic shock. Although owning pets, especially cats and reptiles, poses a risk for infection, the immune-suppressed kidney transplant client has a greater risk for infection, sepsis, and death.)

Which problem places a client at highest risk for sepsis? Pernicious anemia Pericarditis Post kidney transplant Client owns an iguana

40% burn injury (A client with 40% burn injury is at highest risk for septic shock and possible death. The skin forms the first barrier to prevent entry of organisms into the body.Although the client with kidney failure has an increased risk for infection, his skin is intact, unlike the client with burn injury. Although the liver acts as a filter for pathogens, the client with cirrhosis has intact skin, unlike the burned client. The client with lung cancer may be at risk for increased secretions and infection, but risk is not as high as for a client with open skin.)

Which problem places a person at highest risk for septic shock? Kidney failure Cirrhosis Lung cancer 40% burn injury

Hypovolemic shock (Hypovolemic shock results in a decrease of total body fluids. Cardiogenic shock is indicated by direct pump failure. In distributive shock, the fluid shifts from the central vascular space. In obstructive shock, cardiac function is decreased due to indirect pump failure.)

Which shock results in a decrease of total body fluids? Cardiogenic shock Distributive shock Obstructive shock Hypovolemic shock

Progressive stage (The progressive stage of shock is a medical emergency that requires immediate intervention because compensatory mechanisms may be unable to deliver an adequate amount of oxygen to the vital organs. If this condition is left untreated even for an hour, it will lead to multiple organ dysfunction syndrome and even death. At the initial stage, the compensatory mechanisms are efficient enough to maintain normal oxygenation and perfusion rates of the vital organs; thus, immediate interventions are not required. The refractory stage involves excessive cell damage and tissue death, because tissue perfusion is blocked at this stage due to an excessive decrease in mean arterial pressure. The nonprogressive stage is not a medical emergency. If supportive interventions are performed, a patient can remain in the nonprogressive stage for hours without any damage to the vital organs.)

Which stage of hypovolemic shock is a medical emergency and requires immediate intervention? Initial stage Refractory stage Progressive stage Nonprogressive stage

c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. (During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs.)

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur.