Ch 31
During pregnancy, alcohol withdrawal may be treated using what? 1 Disulfiram (Antabuse) 2 Corticosteroids 3 Benzodiazepines 4 Aminophylline
Benzodiazepines Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids are not used to treat alcohol withdrawal. Aminophylline is not used to treat alcohol withdrawal.
Which are significant barriers to receiving necessary treatment of substance abuse when pregnant? 1 Social stigma, labeling, and guilt 2 Financial barriers 3 Mental and physical barriers 4 Religious and spiritual barriers
Social stigma, labeling, and guilt Significant barriers to receiving necessary treatment for substance abuse when pregnant include social stigma, labeling, and guilt.
The nurse is caring for a lactating client who is on lithium carbonate (Eskalith). Which signs would the nurse be aware to watch for in the newborn? Select all that apply. 1 Increased muscle tone Correct 2 Abnormal heart rate Correct 3 Decreased body temperature Correct 4 Presence of a bluish tint on the skin 5 Presence of pinkish cheeks
Abnormal heart rate Decreased body temperature Presence of a bluish tint on the skin Lithium carbonate (Eskalith) is given for the treatment of bipolar disorder. It is excreted in the breast milk and may cause electrocardiogram abnormalities, hypothermia, and cyanosis in the newborn upon breastfeeding. Lithium may also cause abnormal heart rate, decreased body temperature, and a bluish tint on the newborn's skin. The medication may cause hypotonia (a condition characterized by decreased muscle tone), but not hypertonia. A pinkish complexion of the infant's cheeks is a normal finding and it is not related to the lithium carbonate (Eskalith).
The nurse is caring for a lactating client who is on lithium carbonate (Eskalith). Which signs would the nurse be aware to watch for in the newborn? Select all that apply. 1 Increased muscle tone 2 Abnormal heart rate 3 Decreased body temperature 4 Presence of a bluish tint on the skin 5 Presence of pinkish cheeks
Abnormal heart rate Decreased body temperature Presence of a bluish tint on the skin Lithium carbonate (Eskalith) is given for the treatment of bipolar disorder. It is excreted in the breast milk and may cause electrocardiogram abnormalities, hypothermia, and cyanosis in the newborn upon breastfeeding. Lithium may also cause abnormal heart rate, decreased body temperature, and a bluish tint on the newborn's skin. The medication may cause hypotonia (a condition characterized by decreased muscle tone), but not hypertonia. A pinkish complexion of the infant's cheeks is a normal finding and it is not related to the lithium carbonate (Eskalith).
While assessing a postpartum client 3 weeks after delivery, the nurse finds that the client has insomnia, pressured speech, flight of ideas, and distractibility. Which treatment strategy does the nurse expect to be most effective to alleviate the client's symptoms? 1 Performing acupuncture 2 Performing aromatherapy 3 Administering lithium (Eskalith) 4 Administering diazepam (Valium)
Administering lithium (Eskalith) Insomnia, pressured speech, flight of ideas, and distractibility are the symptoms of postpartum psychosis. Lithium (Eskalith) is the first-line medication that is prescribed for the treatment of psychosis in client and postpartum patients. Acupuncture alleviates the symptoms of depression, but does not reduce hallucination and treat psychosis. Aromatherapy reduces stress and provides relaxation, but does not alleviate symptoms of psychosis. Diazepam (Valium) is a benzodiazepine that alleviates symptoms of anxiety, but not psychosis.
of these are perinatal mood disorders (PMDs)? Select all that apply. Correct 1 Anxiety Correct 2 Depression 3 Schizophrenia Correct 4 Postpartum psychosis Correct 5 Obsessive-compulsive disorder Correct 6 Posttraumatic stress disorder (PTSD)
Anxiety Depression Postpartum psychosis Obsessive-compulsive disorder Posttraumatic stress disorder (PTSD) PMDs are a set of disorders that can occur any time during pregnancy as well as in the first year postpartum. These include: anxiety, depression, postpartum psychosis, obsessive-compulsive disorder, and PTSD. Schizophrenia is not one of the perinatal mood disorders
The nurse is caring for a client who is a smoker and also has placenta previa. After delivery, the nurse finds that the client's newborn has low birth weight. Which other complications may be possible in the newborn in the future? Select all that apply. 1 Asthma 2 Obesity 3 Bowlegs 4 Poor vision 5 Infantile colic
Asthma Obesity Infantile colic Clients who smoke during pregnancy may have placenta previa. Placenta previa is characterized by implantation of the placenta in the lower uterine segment. Other complications related to maternal tobacco use are asthma due to immature lungs, childhood obesity, and infantile colic. The child may have bowlegs due to calcium or vitamin D deficiency. Poor vision may be caused by vitamin A deficiency. These are not complications associated with maternal tobacco use.
A client who used cocaine during pregnancy asks the nurse about feeding the infant. The infant is being treated for cocaine withdrawal symptoms. After further discussion, the nurse finds that the client is not willing to participate in the drug rehabilitation program and still uses cocaine frequently. What does the nurse instruct the client related to infant nutrition? 1 "Breastfeeding may be good for the child." 2 "Avoid using infant formulas for the child." 3 "Avoid breastfeeding the child." 4 "The child needs parenteral nutrition."
Avoid breastfeeding the child." The nurse instructs the parent to avoid breastfeeding the infant, because significant amounts of cocaine are found in breast milk. Breastfeeding may expose the child to further complications. The nurse encourages the parent to use infant formulas, because they are safe for the infant. Parenteral nutrition is not needed unless the infant is unable to feed orally.
The nurse is caring for a pregnant client who is addicted to heroin. Which medication does the nurse expect to be most beneficial for the fetus? 1 Diazepam (Valium) 2 Disulfiram (Antabuse) 3 Methadone (Dolophine) 4 Buprenorphine (Subutex)
Buprenorphine (Subutex) Buprenorphine (Subutex) is a synthetic opioid and is the first-line treatment of heroin addiction. Diazepam (Valium) is a benzodiazepine used to treat alcohol withdrawal symptoms in pregnant clients. Diazepam (Valium) does not help alleviate the symptoms of heroin addiction or their effect on the fetus. Disulfiram (Antabuse) is a teratogenic agent. Therefore, its use in treating addiction in pregnant women is not recommended. Methadone (Dolophine) is also used to treat heroin addiction. However, studies have proven that it is less efficient than buprenorphine (Subutex).
What adverse effects and birth defects are caused by selective serotonin reuptake inhibitors (SSRIs) during pregnancy? 1 Cardiac defects 2 Neonatal seizures 3 Normal physical formations 4 Poor neonatal adaptation syndrome 5 Intrauterine fetal demise and miscarriage 6 Persistent pulmonary hypertension of the newborn (PPHN)
Cardiac defects Neonatal seizures Poor neonatal adaptation syndrome Intrauterine fetal demise and miscarriage Persistent pulmonary hypertension of the newborn (PPHN) The adverse effects and birth defects caused from SSRIs during pregnancy include: cardiac defects, neonatal seizures, physical malformations (not normal physical formations), poor neonatal adaptation syndrome, intrauterine fetal demise and miscarriage, and persistent pulmonary hypertension of the newborn (PPHN).
A postpartum client has decreased appetite and increased yearning for sleep. The client has irritability and tells the nurse, "My baby cries all the time and I feel like hitting her." Which medication would initially be prescribed to treat this patient? 1 Citalopram (Celexa) 2 Clonazepam (Klonopin) 3 Chlordiazepoxide (Librium) 4 Carbamazepine (Tegretol XR)
Citalopram (Celexa) Low appetite, increased yearning for sleep, and irritability indicate that the client has postpartum depression. Selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), are prescribed initially for the treatment of postpartum depression. Clonazepam (Klonopin) and chlordiazepoxide (Librium) are benzodiazepines that alleviate symptoms of anxiety, but not postpartum depression. Carbamazepine (Tegretol XR) is a mood stabilizer that helps alleviate symptoms of mania, but not depression.
Which medication may cause extrapyramidal side effects in a client? 1 Sertraline (Zoloft) 2 Fluvoxamine (Luvox) 3 Clomipramine (Anafranil) 4 Tranylcypromine (Parnate)
Clomipramine (Anafranil) Clomipramine (Anafranil) is a tricyclic antidepressant that blocks dopamine receptors in the brain and causes extrapyramidal side effects. Sertraline (Zoloft) and fluvoxamine (Luvox) are selective serotonin reuptake inhibitors (SSRIs). They do not block dopamine receptors and do not cause extrapyramidal side effects. Tranylcypromine (Parnate) is a monoamine oxidase inhibitor; it does not decrease dopamine levels and cause extrapyramidal side effects.
The nursing instructor is teaching nursing students about the treatment of posttraumatic stress disorder (PTSD). Which student statements indicate effective teaching? Select all that apply. 1 "PTSD can be completely treated by antidepressants." 2 "Cognitive therapy is the first choice of treatment for social phobia." 3 "Social phobia caused by PTSD can be treated by antidepressants." 4 "A patient with a specific phobia is mostly treated with medications." 5 "A patient with PTSD is unresponsive to focused desensitization psychotherapy."
Cognitive therapy is the first choice of treatment for social phobia." "Social phobia caused by PTSD can be treated by antidepressants Clients with posttraumatic stress disorder (PTSD) have social phobia as well, which can be successfully treated with cognitive therapy. Social phobia caused by PTSD can be treated with antidepressants such as selective serotonin reuptake inhibitors (SSRIs). They help reduce anxiety and fear. PTSD cannot be treated completely by antidepressants, because the client may also have impaired thinking and decision-making ability. Therefore, antidepressants should be given in combination with other treatments, like cognitive therapy. Desensitization psychotherapy, rather than medications, is highly effective for the treatment of specific phobias. This helps increase the client's self-esteem and also reduces the symptoms of anxiety and fear. Focused desensitization psychotherapy would be effective for the treatment of posttraumatic stress disorder.
Where do most deliveries for pregnant women who have mental health issues take place? 1 Mental health hospital setting. 2 Midwife assisted births 3 Community hospital settings 4 Psychiatric hospitals on locked units
Community hospital settings Most pregnant women who have mental health issues receive care and deliver in community settings. Although midwives are trained to provide obstetrical care, they typically do not take care of complex patients, and a woman who has a diagnosed mental health issue would be classified as a complex patient. Unless there is some specific psychiatric mental health issue that requires a client being on a locked unit, most pregnant women who have mental health issues deliver in community settings.
The nurse is caring for a pregnant client who has frequent mood swings and seems to be acting erratically. The nurse finds that the client is addicted to cocaine. Which may be the best method to determine the gestational age of the fetus? 1 Conducting a blood test 2 Conducting an ultrasound scan 3 Instructing the client to count fetal movements 4 Asking the client the date of her last menstrual period
Conducting an ultrasound scan Clients who are addicted to morphine and cocaine may have frequent mood swings and reduced cognition and may therefore not be unable to recall the date of conception. To determine the gestational age of the fetus in such clients, the nurse may need to conduct initial and serial ultrasound studies. A blood test helps confirm the pregnancy; it does not help find the gestational age of the fetus. Clients who have a substance abuse problem have reduced concentration and may not be able to count fetal movements. Furthermore, fetal movements are not felt during early pregnancy, and counting fetal movements does not help find the exact gestational age of the fetus. A client with a substance abuse problem may not be able to remember the exact date of her last menstrual period. Moreover, she may have amenorrhea. Hence, it is not the best way to determine the gestational age in clients who have a substance abuse problem.
After reviewing the laboratory reports of a pregnant client with a history of depression, the nurse concludes that the client is at risk of postpartum depression. Which laboratory findings support the nurse's assumptions? Select all that apply. Incorrect 1 Increase in estrogen levels Correct 2 Decrease in thyroxine levels Incorrect 3 Increase in progesterone levels Correct 4 Increase in blood glucose levels 5 Decrease in thromboplastin levels
Decrease in thyroxine levels Increase in blood glucose levels Diabetes mellitus and thyroid disorders increase the risk of postpartum depression in the client. Therefore, a decrease in the thyroxine levels indicates that the patient has hypothyroidism and an increased risk of postpartum depression. A decrease in estrogen and progesterone levels results in hypogonadism and increases the risk of postpartum depression. Thromboplastin helps in blood clotting, but does not play a role in postpartum depression.
What are some strategies for preventing postpartum depression? Select all that apply. 1 Take care of everyone else and cook for them. 2 Exercise on a monthly basis, at least 60 minutes a month. 3 Don't place unrealistic expectations on yourself; no mother is perfect! 4 Share knowledge about postpartum emotional problems with close family and friends. 5 Sleep as much as possible; make a promise to yourself to try to sleep when the baby sleeps. 6 At least once each day or every other day, purposely relax for 15 minutes: deep-breathing, meditating, taking a hot bath.
Don't place unrealistic expectations on yourself; no mother is perfect! Share knowledge about postpartum emotional problems with close family and friends. Sleep as much as possible; make a promise to yourself to try to sleep when the baby sleeps. At least once each day or every other day, purposely relax for 15 minutes: deep-breathing, meditating, taking a hot bath Strategies for preventing postpartum depression include: take care of yourself by eating a balanced diet (not take care of everyone else and cook for them); exercise on a regular basis, at least 30 minutes a day, (not exercise on a monthly basis, at least 60 minutes a month); don't place unrealistic expectations on yourself (no mother is perfect); share knowledge about postpartum emotional problems with close family and friends; sleep as much as possible and make a promise to yourself to try to sleep when the baby sleeps; and at least once each day or every other day, purposely relax for 15 minutes by deep-breathing, meditating, or taking a hot bath.
What are the side effects of anticholinergic medications? Select all that apply. 1 Insomnia 2 Diarrhea 3 Dry mouth 4 Blurred vision 5 Difficulty voiding
Dry mouth Blurred vision Difficulty voiding Anticholinergic medications reduce salivary secretions, causing dry mouth. Anticholinergics also cause pupil dilatation, due to which the client may have blurred vision. Anticholinergics may also cause urinary retention, due to which the client may have difficulty voiding. Unlike tricyclic antidepressants, anticholinergic medications do not cause insomnia. Anticholinergics reduce gastric motility, due to which the client may have constipation rather than diarrhea.
The nursing instructor is teaching a group of student nurses about postpartum depression assessment tools. Which statement by a student nurse needs correction? 1 "Edinburgh Postnatal Depression Scale (EPDS) is a 35 item Likert response scale." 2 "A client who gets a score ≥12 on EPDS requires treatment for depression." 3 "The Postpartum Depression Screening Scale (PDSS) assesses seven dimensions of depression." 4 "PDSS assess sleeping or eating disturbances, anxiety, and emotional liability."
Edinburgh Postnatal Depression Scale (EPDS) is a 35 item Likert response scale." Unlike Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS) is not a 35 item Likert response scale; rather it has 10 statements about common symptoms of depression. A maximum score on EPDS is 30 and a client with a score ≥12 requires treatment for depression. The Postpartum Depression Screening Scale (PDSS) assesses seven dimensions of depression. These seven dimensions include sleeping or eating disturbances, anxiety, emotional liability, mental confusion, loss of self, guilt or shame, and suicidal thoughts.
A pregnant client experiences fear of fetal death, headache, and muscle tension at 30 weeks of gestation. The primary health care provider prescribes alprazolam (Xanax) therapy to alleviate the client's symptoms. Which medication-related complication may occur in the client's newborn? 1 Floppy infant syndrome 2 Extrapyramidal side effects 3 Deficiency of P-450 isoenzyme 4 Neonatal withdrawal syndrome
Floppy infant syndrome Fear of fetal death, headache, and muscle tension indicate that the client has generalized anxiety. Alprazolam (Xanax) is a benzodiazepine that causes muscle relaxation and hypotonia, resulting in floppy infant syndrome in the newborn. Alprazolam (Xanax) does not block dopamine receptors and does not cause extrapyramidal side effects like clomipramine (Anafranil) would. Unlike selective serotonin reuptake inhibitors (SSRIs), alprazolam (Xanax) does not decrease the synthesis of P-450 isoenzyme. Sudden withdrawal of alprazolam (Xanax) may result in neonatal withdrawal syndrome. However, because the given scenario does not indicate that the client has discontinued taking alprazolam (Xanax), the nurse does not expect to find neonatal withdrawal syndrome in the newborn.
The nurse is caring for a client who became pregnant following a rape. The nurse finds that the client is sad and unwilling to undergo a prenatal examination. Which intervention does the nurse perform in this situation? 1 Gently discuss the client's current situation with her 2 Suggest that the client abort the child 3 Avoid conducting prenatal examinations for a few days 4 Inform the client's family about the patient's condition
Gently discuss the client's current situation with her If a client becomes pregnant as a result of a rape, the client may be unwilling to undergo prenatal examination, because it may trigger memories related to the trauma. Therefore, to reduce the client's anxiety and prevent posttraumatic stress disorder, the nurse should help the client cope by gently discussing the situation. The nurse should not be judgmental and should not suggest that the client abort the child, because this could make the client feel rejected. Prenatal care is essential to assess the well-being of the fetus and to make an appropriate care plan to help prevent complications in the pregnancy. Therefore, the nurse should not postpone prenatal examination. The client's family may feel anxious or panic due to the client's condition. Hence, the nurse should inform the primary health care provider rather than informing the client's family.
While caring for a client with postpartum depression, the nurse discerns that the client has suicidal intentions. Which intervention followed by the nurse helps to provide safety to the client and the newborn? 1 Encourage the client to verbalize her feelings. 2 Help the client's family to develop a plan for maternal supervision. 3 Assess the symptoms and signs of depression before discharging the client. 4 Maintain frequent contact with the client by visiting her home after discharge.
Help the client's family to develop a plan for maternal supervision. A client with postpartum depression has suicidal intention and is at risk of injury. Therefore, the nurse should help the client's family members develop a plan for maternal and infant supervision. Encouraging the client to verbalize her feelings helps the client develop a trusting relationship with the nurse. Maintaining frequent contact with the client helps to determine if further interventions are necessary for the client. Assessing the symptoms and signs of depression helps prevent postpartum depression in the client, but does not prevent risk of injury.
The nurse is caring for a breastfeeding client who is prescribed valproic acid (Depakene) for anxiety. Which function does the nurse regularly monitor in the newborn to ensure safety? 1 Pulmonary 2 Hepatic 3 Cardiac 4 Renal
Hepatic Valproic acid (Depakene) is excreted in breast milk and has the potential to cause infant hepatotoxicity. Therefore, the nurse should regularly monitor hepatic function in the newborn. Valproic acid (Depakene) does not interfere with the infant's pulmonary, cardiac, or renal function. Therefore, it is not essential to monitor pulmonary, cardiac and renal function in the newborn.
Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? 1 Heroin 2 Alcohol 3 Phencyclidine palmitate (PCP) 4 Cocaine
Heroin Opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. Alcohol, PCP, and cocaine are not opiates.
While collecting the medication history of a pregnant client, a student nurse first checks for the over-the-counter and prescribed medications taken by the client. The nurse then asks the client if she uses cocaine, heroin, or marijuana. Following this, the nurse asks the client whether she drinks alcohol. Finally, the nurse documents the approximate frequency and amount of each drug used. Which intervention by the student nurse needs correction? 1 Asking the client about legal and illicit drugs 2 Inquiring about the use of cocaine before alcohol 3 Checking the list of over-the-counter medications first 4 Documenting the approximate frequency and dose of each drug used
Inquiring about the use of cocaine before alcohol Usually client avoid reporting the details of substance abuse. In such a situation, the nurse should be nonjudgmental and show empathy while collecting the medication history. This helps create a comfortable atmosphere for the client to inform the nurse about the details of the substance abuse. The nurse should first ask about legal drugs, such as caffeine and alcohol, before assessing the client's use of illicit drugs such as cocaine, heroin, and marijuana. The topic of illicit drugs may make the client feel uncomfortable, causing the client to go silent and avoid answering further questions from the nurse. Therefore, this intervention of the nurse needs correction. In order to provide the client with effective treatment, the nurse can inquire whether the client takes legal and illicit drugs. The nurse should check the over-the-counter and prescribed medications to prevent teratogenic effects. The nurse should document the approximate frequency and amount of each drug used by the client to ensure safety.
The nurse is teaching self-management techniques to a client after delivery. What does the nurse include in the lesson to prevent postpartum depression? 1 "Interact with other new mothers." 2 "Spend most of your time with the baby." 3 "Avoid accepting help from family members." 4 "Try to become a perfect mother to your child."
Interact with other new mothers." After childbirth, a client may need assistance and guidance for breastfeeding and to provide better care to her child. Inability to provide better care to her newborn may make her feel incompetent, helpless, and depressed. Therefore, to prevent depression, the nurse advises the client to contact support groups and interact with other new mothers. It helps the client exchange ideas and experiences. The nurse should encourage the client to go out for walks and spend time participating in recreational activities rather than caring for the baby all the time. The nurse should suggest that the client accept the help of family members to perform household work. It helps the client rest for a while. The nurse should advise the client to avoid having unrealistic expectations both for herself and for the child. Inability to achieve those expectations can make the client feel depressed. Therefore, the nurse should not advise the client to try to become a perfect mother.
To provide adequate postpartum care, of what should the nurse be aware regarding postpartum depression (PPD) with psychotic features? 1 Is more likely to occur in women with more than two children 2 Is rarely delusional and then usually about someone trying to harm her (the mother) 3 Although serious, is not likely to need psychiatric hospitalization 4 Is typified by auditory or visual hallucinations
Is typified by auditory or visual hallucinations Hallucinations are present in 25% of women with PPD, paranoid or grandiose delusions, elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity that may contribute to risks of suicide or infanticide. PPD is more likely to occur in first-time mothers. Delusions may be present in 50% of women with PPD, usually about something being wrong with the infant. PPD with psychosis is a psychiatric emergency that requires hospitalization.
A pregnant client with anxiety has been prescribed diazepam (Valium). During the follow-up visit, the nurse finds that the primary health care provider has reduced the dose of the medication. How would this action help the client? 1 It would prevent neonatal abstinence syndrome. 2 It would prevent sudden infant death syndrome. 3 It would prevent neonatal withdrawal syndrome. 4 It would prevent neuroleptic malignant syndrome
It would prevent neonatal withdrawal syndrome. Diazepam (Valium) belongs to the benzodiazepine class of drugs and is prescribed for the treatment of anxiety. If the client continues taking the same dose of diazepam (Valium) as before delivery, it may cause floppy infant syndrome in the newborn. However, discontinuing medication such as diazepam (Valium) suddenly during pregnancy may cause neonatal withdrawal syndrome. This condition manifests as depression of the central nervous system in the neonate. Therefore, to prevent neonatal withdrawal syndrome, the dose of the medicine should be decreased gradually. Opioids have the potential to cause neonatal abstinence syndrome. Tobacco consumption during pregnancy may lead to sudden infant death syndrome. Neuroleptic malignant syndrome is due to antipsychotic medication. Therefore, reducing the dose of diazepam (Valium) does not prevent neonatal abstinence syndrome, sudden infant death syndrome, or neuroleptic malignant syndrome.
Which drug is used as a first-line medication for the treatment of psychosis during pregnancy? 1 Lithium (Eskalith) 2 Paroxetine (Paxil) 3 Imipramine (Tofranil) 4 Flurazepam (Dalmane)
Lithium (Eskalith) Lithium (Eskalith) treats and prevents manic episodes in psychotic clients. Therefore, lithium (Eskalith) is used as a first-line medication for the treatment of psychosis during pregnancy. Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSIR) that helps to alleviate symptoms of depression; therefore, it cannot be prescribed as a first-line medication for the treatment of psychosis during pregnancy. Imipramine (Tofranil) is a tricyclic antidepressant that alleviates symptoms of depression, but not mania. Flurazepam (Dalmane) is a benzodiazepine that alleviates symptoms of anxiety, but not mania
Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance? 1 Methamphetamine is a depressant. 2 All methamphetamines are vasodilators. 3 Methamphetamine users are extremely psychologically addicted. 4 Rehabilitation is usually successful.
Methamphetamine users are extremely psychologically addicted. Methamphetamine users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain. This substance is relatively inexpensive and easy to obtain. Methamphetamines are vasoconstrictors. The rate of relapse for methamphetamine users is very high.
What are the symptoms of generalized anxiety disorder? Select all that apply. 1 Hypotension 2 Constipation 3 Muscle tension 4 Abdominal pain 5 Difficulty voiding
Muscle tension Abdominal pain Generalized anxiety disorder is associated with an increase in excitatory neurotransmitter and muscle contraction, which causes muscle tension and abdominal pain in the client. Anxiety causes vasoconstriction and hypertension, but not hypotension. Anxiety may cause diarrhea in a client, but it does not generally cause constipation. Anxiety does not relax urinary sphincter muscles or cause difficulty in voiding.
What nursing intervention is important to implement when caring for a substance-abusing client? 1 Nurses must confront the substance-abuse client and force him or her into treatment. 2 Nurses should try to understand that substance abusers are just like any other client and should be treated the same. 3 Nurses should get a nurse who is recovering from substance abuse to care for the substance-abuse client, so the nurse will understand the client. 4 Nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary.
Nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary The most important nursing intervention to implement when caring for a substance-abuse client is that nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary. The interventions that nurses must confront the substance-abuse client and force him or her into treatment; nurses should try to understand that substance abusers are just like any other client and should be treated the same; and nurses should get a nurse who is recovering from substance abuse to care for the substance-abuse client are not appropriate interventions to implement.
Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps-Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. Which of the following is included in the 4 Ps-Plus screening tool? Select all that apply.
Partner Past Pregnancy Parents The first P is Parents. The woman should be asked, "Did either of your parents have a problem with alcohol or drugs?" The second P is Partner. "Does your partner have a problem with alcohol or drugs?" The third P is Past. "Have you ever had any beer, wine, or liquor?" The fourth P is Pregnancy. "In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?" Present is not one of the four Ps.
The nurse is admitting a client who is 38 weeks pregnant. The nurse is using the 4Ps Plus screening tool. What is the 4Ps Plus screening tool? Select all that apply. 1 Past: Have you ever had any beer, or wine, or liquor? 2 Present: Are you or your partner currently using alcohol or drugs? 3 Partner: Does your partner have a problem with alcohol or drugs? 4 Profile: How many partners have had a problem with alcohol or drugs? 5 Parents: Did either of your parents ever have a problem with alcohol or drugs? 6 Pregnancy: In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?
Past: Have you ever had any beer, or wine, or liquor? Partner: Does your partner have a problem with alcohol or drugs? Parents: Did either of your parents ever have a problem with alcohol or drugs? Pregnancy: In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink? The 4Ps Plus is a screening tool designed specifically to identify pregnant women who need in-depth assessment. The 4Ps Plus tool includes: Past: Have you ever had any beer or wine or liquor? Partner: Does your partner have a problem with alcohol or drugs? Parents: Did either of your parents ever have a problem with alcohol or drugs? Pregnancy: In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?
A nurse is advising a pregnant client who has a substance abuse problem about a contingency management program. Which statement identifies an aspect of this type of program? 1 Pregnant woman are confined to an inpatient treatment method during their pregnancy. 2 Pregnant woman are given biofeedback modalities as stimulus responses to control their addition. 3 Pregnant woman are given motivational incentives as a primary approach to stop their drug abuse problem. 4 Pregnant woman are placed on a strict medication nutritional program during the course of their pregnancy.
Pregnant woman are given motivational incentives as a primary approach to stop their drug abuse problem. A contingency management program utilizes a motivational incentive approach with clients in response to their efforts to maintain abstinence. This may include small cash amounts, privileges, or prizes. Contingency management programs are not limited to inpatient settings and do not include biofeedback modalities or medication nutritional programs.
The primary health care provider has asked a client to stop taking valproic acid (Depakote) for the treatment of bipolar disorder after a positive pregnancy test. A few weeks after stopping the medication, the client has a relapse of the symptoms related to bipolar disorder. Which treatment is best suited for the client? 1 Prescribing a high dose of desipramine (Norpramin) 2 Prescribing a low dose of lithium carbonate (Eskalith) 3 Prescribing the same dose of divalproex sodium (Depakote) 4 Prescribing herbal medication for treating bipolar disorder II
Prescribing a low dose of lithium carbonate (Eskalith) A client who is on divalproex sodium (Depakote) or antipsychotic medications may have a relapse of symptoms upon discontinuing the medication. In such conditions, a low dose of lithium carbonate (Eskalith) should be prescribed to the client to prevent further worsening of the symptoms. Lithium carbonate (Eskalith) is considered the first-line medication for the treatment of psychosis during pregnancy. Desipramine (Norpramin) is an antidepressant agent and may not be helpful for the treatment of bipolar disorder II. Divalproex sodium (Depakote) is a category D drug and may cause teratogenic effects when prescribed in the same dose. Herbal medications are not clinically tested and are not safe to prescribe to client.
The nurse is assessing a postpartum client who is on tranylcypromine (Parnate) therapy. Upon reviewing the client's dietary habits, the nurse discovers that the client consumes cheese, chicken, and smoked fish regularly. Which complications does the nurse expect to find in the client? Select all that apply. Incorrect 1 Shivering Incorrect 2 Hyperreflexia 3 Depression Correct 4 Retroorbital pain Correct 5 Occipital headache
Retroorbital pain Occipital headache Tranylcypromine (Parnate) is a monoamine oxidase inhibitor (MAOI). Foods that are rich in tyramine, such as cheese, chicken, and smoked fish, interact with MAOIs and cause hypertensive crisis, resulting in retroorbital pain and occipital headache. Shivering and hyperreflexia are symptoms of serotonin syndrome, which is caused by selective serotonin reuptake inhibitors (SSRIs), but not MAOIs. MAOIs are antidepressant medications that treat depression, but do not cause depression in clients
A client with postpartum depression is taking antidepressant medications. After reviewing the prescription, the nurse advises the client to avoid taking cough preparations that contain dextromethorphan (Benylin). Which antidepressant medication cannot be given with dextromethorphan? Correct 1 Sertraline (Zoloft) 2 Phenelzine (Nardil) 3 Nortriptyline (Pamelor) 4 Clomipramine (Anafranil)
Sertraline (Zoloft) Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that reduces symptoms of depression. SSRIs interact with dextromethorphan (Benylin), trigger serotonin syndrome, and cause hyperreflexia, shivering, and diarrhea in clients. In order to prevent serotonin syndrome, the nurse advises the client to avoid taking cough preparations that contain dextromethorphan (Benylin). Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI). It does not interact with dextromethorphan (Benylin). Nortriptyline (Pamelor) and clomipramine (Anafranil) are tricyclic antidepressants. They are relatively safer than SSRIs and do not interact with dextromethorphan (Benylin).
A client with postpartum depression has been prescribed a monoamine oxidase inhibitor (MAOI). On assessing the client's dietary habits, the nurse finds that the client eats preserved meats and liver frequently. Which complications could these dietary choices pose to the client? Select all that apply. 1 Stiff neck 2 Flushing 3 Back pain 4 Chest pain 5 Abdominal pain
Stiff neck Flushing Chest pain Monoamine oxidase inhibitors (MAOIs) interact with food substances that contain tyramine, such as preserved meat and chicken or beef liver. This may result in hypertensive crisis, which is characterized by stiff neck, flushing, and chest pain. Back pain and abdominal pain are not associated with hypertensive crisis. They are symptoms of generalized anxiety disorder.
The nurse is caring for a client in the first trimester of pregnancy. The nurse finds that the client has severe anxiety and is extremely worried about the health of the fetus. Which nursing interventions would be beneficial for the client? Select all that apply. 1 Suggesting that the client listen to light music 2 Teaching the client guided imagery 3 Teaching the client deep breathing exercises 4 Administering benzodiazepines to the client 5 Initiating psychotherapy for the client
Suggesting that the client listen to light music Teaching the client guided imagery Teaching the client deep breathing exercises Clients with anxiety may excessively worry about fetal health. The nurse should teach the client relaxation techniques like music therapy, guided imagery, and deep breathing exercises. These interventions help alleviate anxiety. Medications such as benzodiazepines, and antipsychotic medications should be avoided during the first trimester, because they may cause teratogenic effects. Therefore, administering benzodiazepines and initiating psychotherapy may not be beneficial to the client.
The nurse is caring for a pregnant client who has a cough, diarrhea, agitation, and shivering. On reviewing the client's medication history, the nurse finds that the client is taking a selective serotonin reuptake inhibitor (SSRI) to treat depression. Which client action could have resulted in the client's current symptoms? 1 Taking the medication after meals 2 Taking the medication by dissolving it in water 3 Taking the medication after taking cough syrup 4 Taking vitamin A supplements while taking the medication
Taking the medication after taking cough syrup Cough syrups contain dextromethorphan, which has a sedative effect. If the SSRI is taken along with cough syrup, then it may cause serotonin syndrome due to synergistic action, leading the client to have agitation, hyperreflexia, shivering, and diarrhea. Taking the medication after meals prevents gastric irritation and would not cause agitation, shivering, and diarrhea. Dissolving the medication in water may decrease the therapeutic effectiveness of the drug but does not cause serotonin syndrome. Vitamin A supplements do not have a sedative effect. Therefore, they do not cause synergistic action with SSRIs.
Which of these medications would be classified as a Category X substance and not used during pregnancy? 1 Lorazepam (Ativan) 2 Alprazolam (Xanax) 3 Chlordiazepoxide (Librium) 4 Temazapam(Restoril)
Temazapam(Restoril) Restoril is classified as a Category X drug and is contraindicated during pregnancy based on clinical studies. Ativan is classified as a Category D drug and as such would not be given during pregnancy unless benefits to risks ratio was established. Xanax is classified as a Category D drug and as such would not be given during pregnancy unless benefits to risks ratio was established. Librium would be classified as a Category D drug and as such would not be given during pregnancy unless benefits to risks ration was established
While reviewing the dietary habits of a pregnant client, the nurse believes the client has an increased risk of postpartum depression. Which finding supports nurse's assumption? 1 The client eats foods rich in folic acid. 2 The client eats foods rich in vitamin K. 3 The client avoids foods rich in sodium. 4 The client avoids foods rich in vitamin B12.
The client avoids foods rich in vitamin B12 Vitamin B12 is essential for the synthesis of serotonin and other neurotransmitters. Deficiency of vitamin B12 can decrease serotonin levels, increase the risk of major depressive episode, and increase the risk of postpartum depression. Folic acid plays a role in the synthesis of serotonin. Therefore, intake of foods rich in folic acid does not increase the risk of depression in the client. Vitamin K plays a role in the formation of clotting factors, but not serotonin. Therefore, foods rich in vitamin K do not alter serotonin levels or increase risk of postpartum depression. High sodium content causes hypertension. Decrease in sodium levels does not cause depression.
A nursing student is helping to care for a client after delivery. Upon observing the client's behavior, the student suspects that the client is experiencing "baby blues." Which client characteristics or behaviors support this assumption? Select all that apply. 1 The client is euphoric. 2 The client has a loss of appetite. 3 The client has difficulty sleeping. 4 The client has difficulty breastfeeding. 5 The client frequently cries without any reason.
The client has a loss of appetite The client has difficulty sleeping The client frequently cries without any reason After labor women experience changes in hormonal levels, which may make many clients experience depression, or "baby blues." During this postpartum period, the client may experience loss of appetite, difficulty sleeping, and may cry frequently without. During this period, the client would feel sad rather than euphoric. It is common for clients to have difficulty breastfeeding initially as they adjust to the process, but this is not related to "baby blues."
The nurse is assessing a postpartum client 5 days after delivery. The client's partner tells the nurse that the client does not eat properly, starts crying suddenly for no reason, and has difficulty sleeping. What does the nurse infer from these symptoms? 1 The client is experiencing postpartum blues. 2 The client is experiencing postpartum anxiety. 3 The client is experiencing postpartum psychosis. 4 The client is experiencing postpartum depression.
The client is experiencing postpartum blues. Loss of appetite, insomnia, and crying suddenly for no reason indicate that the client is experiencing postpartum blues. These symptoms diminish in few days or a week. The symptoms of anxiety are abdominal pain, restlessness, muscle tension, and irritability. The client with postpartum psychosis has suicidal intention and hallucinations. If the client experiences the symptoms of postpartum blues for more than 2 weeks, it indicates that the client has postpartum depression.
While assessing a pregnant client, the nurse finds that the client is sad and depressed after a family member's death. Which complication may be possible in the client and the newborn? 1 The client may have post-term delivery. 2 The client's newborn may have low birth weight. 3 The client may have may have maternal hypotension. 4 The client's newborn may have respiratory depression.
The client's newborn may have low birth weight. If a client is depressed during pregnancy, it affects fetal growth and development. This can lead to low birth weight in the newborn. Depression may lead the client to have preterm labor rather than postterm childbirth. Depression may also lead to preeclampsia, which is characterized by an increase in blood pressure. Therefore, the client would not have maternal hypotension. Respiratory depression in the newborn is caused by maternal alcohol use, not depression.
While preparing a diet plan for a pregnant client, the nurse includes foods rich in folate, vitamin B2, vitamin B6, and omega-3 fatty acids. Why does the nurse include these dietary supplements in the client's diet? 1 They help prevent postpartum depression. 2 They help prevent generalized anxiety disorder. 3 They help prevent uterine hypertrophy. 4 They help prevent postpartum hemorrhage.
They help prevent postpartum depression. Dietary supplements play a role in preventing postpartum depression. Folate, vitamin B2, vitaminB6, and omega-3 fatty acids are needed for the synthesis of serotonin and other neurotransmitters. This helps prevent depression. Generalized anxiety disorder is characterized by excessive worrying. This can be prevented by reducing stress and making the client feel comfortable. Uterine hypertrophy is a normal physiologic change that takes place during pregnancy and is not related to diet. Postpartum hemorrhage is characterized by loss of blood. This cannot be prevented by dietary modifications.
After discharge from the hospital, the nurse frequently visits a client who has postpartum depression and also interacts with the client frequently over the telephone. What is the reason behind this intervention? 1 To assess the client's home environment 2 To prevent the client from becoming lonely and bored 3 To determine the need for further care and treatment 4 To develop a therapeutic relationship with the client
To determine the need for further care and treatment After discharging a client with postpartum depression, the nurse should frequently contact the client and interact with her over the telephone, or visit the client's home. It helps the nurse evaluate the client's feelings and perception. Frequently contacting the client helps the nurse determine whether the client requires further care and treatment. The nurse does not assess the client's home environment after discharge; this should be done during the course of the therapy. To prevent loneliness and boredom, the nurse should suggest recreational activities and support groups to the client. To develop a therapeutic relationship with the client, the nurse should be nonjudgmental and follow therapeutic communication methods. Developing a therapeutic relationship with the client is not the main objective of frequent home visits and follow-up care.
What are the most common antidepressants prescribed during pregnancy? Select all that apply. 1 Tricyclic antidepressants (TCAs) 2 Monoamine oxidase inhibitors (MAOIs) 3 Norepinephrine reuptake inhibitors (NRIs) 4 Serotonin modulators and stimulators (SMSs) 5 Selective serotonin reuptake inhibitors (SSRIs) 6 Serotonin/norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs) Monoamine oxidase inhibitors (MAOIs Selective serotonin reuptake inhibitors (SSRIs) Serotonin/norepinephrine reuptake inhibitors (SNRIs) The most commonly used antidepressant drugs are often divided into four groups: TCAs, MAOIs, SSRIs, and SNRIs. NRI and SMS antidepressants are not commonly used in the treatment of depression during pregnancy.
On reviewing the laboratory reports of a postpartum client with depression, the nurse finds that the client has postpartum hypogonadism. Which findings in the lab reports enabled the nurse to arrive at this conclusion? Select all that apply. 1 Unusually low estrogen levels 2 Unusually low prostaglandin levels 3 Unusually low calcitonin levels 4 Unusually low progesterone levels 5 Unusually low testosterone levels
Unusually low estrogen levels Unusually low progesterone levels In clients with postpartum hypogonadism, estrogen and progesterone levels fall to much lower levels. Due to this, the client may also experience postpartum depression. The reduction in estrogen and progesterone levels may be caused by reduced functioning of the ovaries. Prostaglandins are synthesized from fatty acids; they are not secreted by the ovaries. Therefore, a decrease in prostaglandin levels does not indicate that the client has hypogonadism. Calcitonin is secreted by the parafollicular cells of the thyroid gland and helps regulate calcium levels. A decrease in calcitonin levels does not indicate that the client has hypogonadism. Testosterone is a male steroidal hormone, and its levels are very low in females. A decrease in testosterone levels does not indicate that the client has hypogonadism.
Which of the following statements about the prevalence of perinatal mental health problems is true? Select all that apply. 1 The World Health Organization (WHO) recognizes postpartum depression as the leading cause of disability in women. 2 Up to a quarter of pregnant women will experience some aspect of depression during their pregnancy. 3 Income status plays a significant role in the presentation of perinatal mental health problems. 4 Higher incidence of postpartum depression (PPD) is found in about 50% of the population. 5 Between 30 and 50 billion dollars accounts for productivity and direct medical costs related to depression in women.
Up to a quarter of pregnant women will experience some aspect of depression during their pregnancy. Income status plays a significant role in the presentation of perinatal mental health problems Between 30 and 50 billion dollars accounts for productivity and direct medical costs related to depression in women. Between 14 and 23% of women will experience some aspect of depression during their pregnancy. Low income plays a significant factor in the presentation of perinatal mental health problems. The economic costs related to depression treatment in women are extremely costly, ranging between 30 and 50 billion dollars. The WHO recognizes depression as the leading cause of disability in women. Higher incidence of PPD is found in about 25% of women.
Which clinical tests does the nurse evaluate to assess the health status of a pregnant client who abuses substances? Select all that apply. 1 Urine toxicologic testing 2 Meconium testing 3 Glycosylated hemoglobin A1c 4 Complete blood count 5 Tuberculosis screening
Urine toxicologic testing Meconium testing Complete blood count Tuberculosis screening Urine toxicologic testing helps assess for illicit drug use in a pregnant client. Meconium from the neonate helps determine past drug use over a longer period. A complete blood count helps assess any deficiency in the client. Tuberculosis screening is important so that the infection, if present, can be prevented from progressing. Glycosylated hemoglobin A1c levels are assessed in a patient with diabetes to assess recent glycemic control.
The 5 A's Screening Intervention tool is based on client response. What is it used to help? 1 Used to help a person quit alcohol intake 2 Used to implement smoking cessation 3 Used to help a person quit methamphetamine use 4 Used to wean a person off of heroin
Used to implement smoking cessation The 5 A's Screening Intervention tool is based on client response and is used to implement smoking cessation only, not to help a person quit alcohol, methamphetamines, or heroin.
Which medication causes poor neonatal adaptation syndrome? 1 Paroxetine (Paxil) 2 Venlafaxine (Effexor) 3 Mirtazapine (Remeron) 4 Dextromethorphan (Benylin)
Venlafaxine (Effexor) Venlafaxine (Effexor) is a serotonin/norepinephrine reuptake inhibitor (SNRIs) that causes poor muscle tone, respiratory distress, and hypoglycemia, resulting in poor neonatal adaptation syndrome. Paroxetine (Paxil) causes cardiac disorders, such as ventricular septal defects, in the newborn. Mirtazapine (Remeron) affects fetal growth and increases the risk of preterm birth. Dextromethorphan (Benylin) worsens the symptoms of serotonin syndrome
The nurse is caring for a postpartum client with acute psychosis who is prescribed haloperidol (Haldol). Which factor does the nurse monitor to ensure the client's safety? 1 Prothrombin time 2 Blood platelet count 3 Red blood cell count 4 White blood cell count
White blood cell count Haloperidol (Haldol) is an antipsychotic drug. Antipsychotic drugs are associated with tachycardia, urinary retention, weight gain, and agranulocytosis. Agranulocytosis is characterized by a decrease in white blood cell count. Therefore, the nurse should monitor the client's white blood cell count to ensure safety and to prevent adverse effects of the medication. Antipsychotic drugs do not alter clotting factors or platelet count. Therefore, the nurse is not required to monitor prothrombin time or platelet count. Antipsychotic drugs do not decrease the red blood cell count. Hence, the nurse need not monitor the client's red blood cell count.
The nurse is caring for a breastfeeding client who smokes. What advice does the nurse give the client to minimize the amount of nicotine in the milk and to improve the let-down reflex? 1 "You should stop breastfeeding the baby." 2 "You should avoid smoking for 2 hours before feeding the baby." 3 "You should use nicotine patches while feeding the baby." 4 "You should chew gum or eat candy after smoking."
You should avoid smoking for 2 hours before feeding the baby." The nurse should advise the client to avoid smoking for 2 hours before breastfeeding the infant. This helps reduce the nicotine content in the milk and improves the let-down reflex. Breast milk enhances immunity and helps in proper growth and development of the newborn. Therefore, the nurse should not advise the client to avoid breastfeeding the infant. Using nicotine patches will not help minimize the amount of nicotine in the milk or improve the let-down reflex. The nurse can advise the client to chew gum after smoking to mask the odor and taste. However, this does not improve the let-down reflex or reduce the nicotine content of the breast milk.