exam 5 #1

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The nurse is caring for a pt who has been prescribed Oxazepam. What statement by the pt should suggest that the pt is at an increased risk of CNS depression to the nurse? A) I'm also taking baby Aspirin each day for my heart B) I've almost finished my course of antibiotics for this sinus infection C) I take an OTC antihistamine each day for my allergies D) If I get constipated, I sometimes take a stool softener for a couple of days

The nurse is caring for a pt who has bipolar disorder and who receives lithium therapy. When reviewing the pt medication administration record, what drug would cause an increase in the pt risk for lithium toxicity? A) Vitamin B12 B) Levothyroxine C) Indomethacin D) Calcium carbonate

When teaching a group of students about epilepsy, which of the following should the nurse include? A) Always characterized by grand mal seizures B) Only a genetic problem C) The most prevalent neurological disorder D) The name given to one disorder

While caring for a pt receiving antipsychotic therapy, the nurse observes cogwheel rigidity, tremors, and drooling. The nurse interprets this as what? A) Tardive dyskinesia B) Dystonia C) Pseudoparkinsonism D) Akathisia

Select all that apply: A pt has a serum lithium level of 2.2 mEq/L. The nurse should expect to assess what symptoms? A) Epistaxis B) Full body rash C) Hypotension D) Seizures E) Hyperreflexia

C D E; Rash & epistaxis not associated w/ lithium toxicity

Select all that apply: What structures would be associated w/ the hindbrain? A) motor neurons B) spinal nerve roots C) chemoreceptor trigger zone D) cranial nerves E) speech area

C D; motor neurons & speech area is in the cerebrum; spinal nerves are in spinal cord

Your pt, a 6 yr old boy, is starting a regimen of Ritalin (methylphenidate) to control an ADD. Family teaching should include which of the following? A) This drug can be shared w/ other family members who might seem to need it B) This drug may cause insomnia, weight loss, and GI upset C) Do not alert the school nurse to the fact that this drug is being taken because the child could have problems later on D) This drug should not be stopped for any reason for several years

Select all that apply: The nurse provides drug teaching to the pt taking phenytoin and interacts the pt to avoid the use of what herbal therapies? A) Ginkgo B) Black cohosh C) St. John's wort D) Evening primrose E) Cinnamon

A and D

A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug

Which client should the nurse identify as having an absence seizure?

A client whose alterations in consciousness last a few seconds.

"It's important that we list all of your complementary health practices used to provide a full picture of what you do to manage your health."

A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his health care provider to order?

A lower dose of the antidepressant

A pt has been provided with a prescription for Eszopiclone 1 mg PO daily as needed. What education should the nurse provide to the pt? A) Ensure that you don't take this medication more than 3 nights consecutively B) Some pts experience drowsiness after taking this medication, so avoid driving C) Make sure that you go to bed immediately or very shortly after taking the pill D) If you're still feeling anxious after taking the drug for the first week, tell your provider

Select all that apply: A pt has a neurological disorder involving the dorsal root in the spinal cord. What physiological functions are likely to be affected? A) sending messages to the CNS B) stimulating muscles C) regulating emotion D) communicating pain E) coordinating movement

A D

SATA. The nurse is reviewing the signs and symptoms of Benzodiazepine withdrawal in a pt who has taken Diazepam daily for several years. The nurse should described what possible effects of Benzodiazepine withdrawal? A) HA B) Depression C) Urinary retention D) Nausea E) Nightmares

A D E

A pt is experiencing absence seizures and has been prescribed a succinimide. What is the most likely prescription? A) Depakene B) Valium C) Zarontin D) Dilantin

A client with a recent history of seizures has been prescribed carbamazepine. The nurse should recognize that this medication will achieve a therapeutic effect by what means?

Affecting gamma-aminobutyric acid (GABA) levels and blocking sodium channels

A nurse is reading an online journal article about different approaches to health. The nurse is reading about a practice approach that is supported by evidence-based practice and is particularly effective when aggressive treatment is needed in an emergency situation. The nurse is reading about which type of approach?

Allopathic

A pt on the psychiatry unit w/ a long-standing history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize in the care of this pt? A) Monitoring the pt hepatic and renal status B) Monitoring the pt for indications of bone marrow suppression C) Assessment of the pt behaviors and thought processes D) Assessing the pt vital signs

A pts nerve has been stimulated by pain and the resulting electrical action potential has reached the end of the axon? What will happen next? A) the adjacent nerve will be electrically stimulated B) a neurotransmitter will be released into the synaptic cleft C) The signal will cross the synaptic cleft and continue via a new neuron D) the signal will revert back to the neuronal cell body

A signal has reached the terminus of a pts nerve and is in the spine where the nerve is closest to the effector cell in a muscle. At what location is this signal in? A) neuron B) synapse C) soma D) Schwann cell

Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include: A) Insomnia and hypertension B) Dry mouth, hypotension, and glaucoma C) Diarrhea and excessive urination D) Increased sexual drive and improved concentration

An increased dosage of a prescribed Benzodiazepine may be necessary if the pt's current regimen includes what medication? A) Cimetidine B) Theophylline C) Oral contraceptives D) Calcium-channel blockers

At those regions of the nerve membrane where myeline is present there is: A) low resistance to electrical current B) high resistance to electrical current C) high conductance of electrical current D) energy loss for the cell

Neurotransmitters are: A) produced in the muscle to communicate w/ nerves B) the chemicals used to stimulate or suppress effectors at the nerve synapse C) usually found in the diet D) nonspecific in their action on various nerves

The cerebellum: A) initiates voluntary muscle movement B) helps regulate the tone of skeletal muscles C) if destroyed, would result in the loss of all voluntary skeletal activity D) contains the centers responsible for the regulation of body temp

The neurologic nurse is aware that spinal nerves are classified as mixed nerves. This implies what characteristic of spinal nerves? Spinal nerves are: A) are hydrophobic and hydrophilic components B) contain both motor and sensory nerves C) respond to more than one neurotransmitter D) communicate w/ both the central and peripheral nervous system

The neurological nurse cares for several pts who have seizure disorders. Which pt should the nurse monitor most closely fo indications of drug dependence? A) A pt racing ethosuximide for the prevention of absence seizures B) A pt w/ a history of tonic-clonic seizures who take phenobarbital C) A pt w/ a history of myoclonic seizures who takes valproic acid D) A pt taking IV phenytoin to prevent seizures postneurosurgery

The nurse has taught a pt who is receiving lamotrigine about possible adverse effects. The nurse determines that the pt has understood the teaching when the pt identifies a need to promptly report what adverse effect? A) Anorexia B) Rash C) Fatigue D) Signs of upper respiratory infection

The nurse is caring for a child on the pediatric unit who is having difficulty sleeping. What drug would be safest to administer as a first-lime drug to induce sleep? A) Chloral hydrate B) Diphenhydramine C) Diazepam D) Chlordiazepoxide

The nurse is caring for a pt who is receiving an intravenous Barbiturate. What assessment should the nurse prioritize? A) Anaphylaxis B) BP C) Assessment for beedling D) Oxygen saturation

The nurse is planning care of a pt who has been diagnosed w/ schizophrenia and who will begin treatment w/ a typical antipsychotic. The nurse should identify what nursing diagnosis? A) Risk for impaired liver function related to hepatotoxicity B) Risk for injury related to CNS depression C) Bowel incontinence related to GI adverse effects D) Risk for imbalanced body temp related to hypothalamic suppression

The nurse is preparing to perform a neurologic assessment of a new pt. What principle should guide the nurse's care of pts w/ neurologic disorders? A) afferent fibers bring nerve signals from the CNS to the peripheral receptors B) some of the functions of the nervous system are not well understood C) the basic structural unit of the nervous system is the ganglia D) nerves throughout the body are covered in myelin to regulate the transmission of impulses

The nurse is providing health education to a pt who has been prescribed a Barbiturate. The nurse should describe what mechanism of action? A) Enhancement of motor output B) Depression of the cerebral cortex C) Effect on action potentials D) Enhancement of action of GABA

The nurse is reviewing a pt's current drug regimen and notes that the pt take 30 mg Flurazepam daily. The nurse should suspect what health problem? A) Psychosis B) Insomnia C) Bipolar disorder D) Anxiety

The nurse is teaching a pt who is prescribed fluphenazine about this drug. Which pt statement indicates that the pt has understood the instructions? A) "I should call my doctor if I notice any heart irregularities" B) "I shouldn't be alarmed if my urine turns pink or reddish brown" C) "I might get a severely runny nose w/ this drug" D) "I might develop diabetes if I take this drug, but I'll be monitored closely"

The nurse is working w/ a 12-yr old pt who has been diagnosed w/ ADHD and is prescribed methylphenidate. What statement by the pt would suggest the presence of adverse drug effects? A) "Sometimes I just feel so mad at my teacher or my coach" B) "I just don't feel hungry very much these days" C) "I fell asleep on the bus last week and missed by stop" D) "I banged my shin last week and the bruise is still there"

The nurse reviews the pts order for phenytoin and would need to call the physician to question the order if what dosage was ordered? A) 200 mg b.i.d B) 200 mg t.i.d C) 100 mg t.i.d D) 100 mg q.i.d

The pt has recently undergone neurosurgery and is at risk for postoperative seizures. What med, if ordered, would the nurse recognize is to be administered to prevent jesse seizures? A) Clonazepam B) Fosphenytoin C) Ethotoin D) Mephobarbital

Treatment of epilepsy is directed at: A) Blocking the transmission of nerve impulses into the brain B) Stabilizing overexcited nerve membranes C) Blocking peripheral nerve terminals D) Thickening the meninges to dampen brain electrical activity

What best reflects the action of barbiturates when used to control seizures? A) Enhancement of cerebellar functioning B) inhibition of impulse conduction C) Stimulation of motor nerve output D) Stimulation of the cerebral cortex

Which instruction would the nurse encourage a pt receiving an antiepileptic drug to do? A) Give up his or her driver's license B) Wear or carry a MedicAlert identification C) Take antihistamines to help dry up secretions D) Keep the diagnosis a secret to avoid prejudice

Antipsychotic drugs are basically: A) Serotonin reuptake inhibitors B) Norepinephrine blockers C) Dopamine receptor blockers D) Acetylcholine stimulators

Anxiolytic drugs bock the awareness of and reaction to the environment. This effect would not be beneficial: A) To relieve extreme fear B) To moderate anxiety related to unknown causes C) In treating a pt who must drive a vehicle for a living D) In treating a pt who is experiencing a stress rxn

As a result of a drug error, a pt has inadvertently been given an intra-arterial injection of a Benzodiazepine. The care team should monitor closely for what complication? A) Disseminated intravascular coagulation B) Cerebrovascular accident C) Gangrene D) Auditory nerve damage

Focal or partial seizures: A) Start of one point and spread quickly throughout the brain B) Are best treated with benzodiazepines C) Involve only part of the brain D) Are easily diagnosed and recognized

Info has been received by a pts neuron and transmitted into the cell body. What component of the neurologic system performed this function? A) axon B) soma C) dendrite D) ganglia

Lithium toxicity can be dangerous. Pt assessment to evaluate for appropriate lithium levels would look for: A) Serum lithium levels >3 mEq/L B) Serum lithium levels >4 mEq/L C) Serum lithium levels <1.5 mEq/L D) Undetectable serum lithium levels

The limbic system is an area of the brain that: A) is responsible for coordination of movements B) is responsible for the special senses C) is responsible for the expression of emotions D) controls sleep

The nerve synapse: A) is not resistant to electrical current B) cannot become exhausted C) has a synaptic cleft D) transfers info at the speed of electricity

The nurse in a long-term care facility is administering a new prescription of Zolpidem to an older adult pt. What action should the nurse perform related to this pt's drug therapy? A) Monitor the pt for hematuria or decreased urine output B) Monitor the pt for potential seizure activity C) Monitor the pt for excessive unusual effects D) Encourage fluid intake

The nurse is administering a Benzodiazepine IV push when the monitor shows the pt's heart rate decreased to 52 beats per minute. What is the nurse's priority action? A) Should not give the rest of the Benzodiazepine and flush the line B) Call the provider and inform of the pt's reaction to the drug C) Slow the rate of administration of Benzodiazepine D) Document the pt's allergic response to the medication

The nurse is caring for a child w/ febrile seizures who just received a dose of phenobarbital intravenously. If prescribed, the nurse could administer another dose at what time? A) in 12 hrs B) In 15 min C) In 6 hrs D) The drug can be given as a continuous infusion

The nurse is caring for a pt suspected of having a seizure disorder. What test might be ordered for this pt to test brain function? A) Electrocardiogram B) Serum calcium levels C) Electroencephalogram D) Serum phenytoin level

A pt has been taking phenobarbital for the past 3 weeks in combo with phenytoin to control epilepsy and had no seizures until the previous day. Since the previous day, the pt has had 3 seizures. What does the nurse suspect that is causing the sudden return of seizure activity? A) The pt is no longer taking med as prescribed B) The pt has been taking evening primrose C) The pts condition has gotten more serious D) The pt has developed drug tolerance for phenobarbital

A pt is being treated w/ clozapine. What should the nurse monitor most closely? A) AST, ALT, and bilirubin B) Urine quantity and quality C) Cardiac enzymes D) White blood cell count

A pt is experiencing acute anxiety and the nurse has received an order for Diazepam 4 mg PO STAT. What is the nurse's best action? a) Sure Flurazepam is available B) Contact the prescriber to confirm the dose C) Contact the prescriber to confirm the route D) Administer the medication as prescribed

A pt is prescribed methsuximide. The nurse should expect to administer this drug by which route? A) Rectal B) IV C) IM D) PO

A pt is prescribed topiramate. The nurse cautions the pt to avoid the intake of alcohol for which reason? A) A disulfiram-like rxn can occur B) The pts irks for dependence is increased C) The combo many lead to a HTN crisis D) The pt is at risk for increased CNS depression

A pt receives an intravenous dose of Diazepam at 1800. The nurse would expect this drug to exert its peak effects at which time? A) 1930 B) 1900 C) 2000 D) 1830

A pt w/ a history of seizures take phenytoin on a regular basis. What should the nurse teach the pt in order to ensure the pt safety? A) Dp not take OTC meds B) Avoid brewer's yeast C) Do not take garlic or ginger supplements D) Avoid ginkkgo supplements

A pt who admits to having claustrophobia has been scheduled for magnetic resonance imaging for the investigation of an abdominal mass. The nurse should anticipate what med order? A) Eszopiclone 1 mg PO B) Suvorexant 10 mg PO C) Ramelteon 8 mg PO D) Lorazepam 2 mg PO

A pt with convulsions has been admitted to the ER and has been prescribed 200 mg Amobarbital IV STAT. What is the nurse's best action? A) Confirm the dose with the prescriber or a pharmacist B) Question the provider about the route of the medication C) Establish central IV access and administer the medication D) Administer the medication and monitor the pt's status closely

A stroke has caused an infarct in a pts cerebral cortex. What deficit should the nurse anticipate? A) discoordination of voluntary movement B) discoordination of position and posture C) dysregulation of motor function D) diminished processing of intellectual info

ADD (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are most effectively treated with the use of: A) Neuroinhibitors B) Dopamin receptor blockers C) Major tranquilizers D) CNS stimulants

An adult pt underwent diagnostic testing after experiencing an absence seizure for the first time. What aspect of this pts health history may result in impaired drug excretion? A) The pt takes a beta-blocker for the treatment of HTN B) The pt has a history of adhering poorly to prescribed treatment C) The pt is morbidly obese D) The pt has recently been diagnosed w/ diabetic nephropathy

An adult pt w/ a newly diagnosed seizure disorder has been prescribed a hydantoin. The nurse should describe what benefit of hydantoins, compared w/ other anticonvulsants? A) Medical follow-up is often unnecessary B) Blood levels do not have to be monitored C) Some can be administered PO D) They are less sedating

An electrical impulse is being transmitted along a nerve axon. What would resist electrical stimulation? A) nodes of Ranvier B) myelin C) synapse D) Schwann cells

An older adult pt has been prescribed an antiseizure med and is experiencing CNS depression. What is the nurse most appropriate action? A) Monitor vital signs hourly while the pt is awake B) Maintain the pt on bed rest C) Make a referral to occupational therapy D) Implement falls precautions

Drugs that are used to alter a pt's response to the environment are called: A) Hypnotics B) Sedatives C) Antiepileptics D) Anxiolytics

In response to a stimulus, a pts nerve has released a neurotransmitter. From what component of the nerve would the neurotransmitter be released? A) soma B) efferent fibers C) Schwann cell D) axon

Mental disorders are not thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include: A) Depression B) Anxiety C) Seizures D) Schizophrenia

Mr. Jones is the chief executive officer of a large company and has been experiencing acute anxiety attacks. His physical examination was normal, and he was diagnosed with anxiety. Considering his occupation and his need to be alert and present to large groups on a regular basis of the following anxiolytic would be a drug of choice for Mr. Jones: A) Phenobarbital B) Diazepam C) Clorazepate D) Buspirone

The drug of choice for the treatment of absence seizures is: A) Valproic acid B) Methsuximide C) Phensuximide D) Ethosuximide

The nurse is caring for a pt who has been prescribed Suvorexant. The nurse should teach the pt to: A) Wear a medic-alert bracelet B) Report seizure activity promptly C) Avoid daily products for the duration of treatment D) Plan to stay in bed for 7 hours after taking the drug

The nurse questions an order to administer barbiturates to a pt with pain for what reason? A) Barbiturates can exacerbate neuropathic pain B) Barbiturates cannot be given in combination with nonsteroidal anti-inflammatories C) Barbiturates can cause tachypnea in a pt who is in pain D) Barbiturates can cause paradoxical excitement

The nurse's colleague administers an anxiolytic to the pt. The nurse recognizes the colleague needs further teaching on the effects of the medication when the colleague performs what action? A) Places the call light within reach and instructs the pt to call if he or she needs anything B) Raises the side rails and puts the bed in the low position C) Dims the lights, pulls the curtains closed, and turns the volume down on the TV D) Encourages the pt to walk to the bathroom independently

What assessment finding should lead the nurse to suspect that a pt receiving antipsychotic therapy is developing tardive dyskinesia? A) Abnormal eye movements B) Urinary incontinence C) Disorientation D) Lip smacking

What should the nurse include as a possible adverse effect when teaching a pt about phenytoin? A) Physical dependence B) Diarrhea C) Increased white blood cell count D) Liver toxicity

Which nursing diagnosis would be most important for a nurse to include in the plan of care for a pt who is receiving an antiseizure agent and experiencing common adverse effects? A) Impaired skin integrity B) Risk for imbalanced fluid volume C) Ineffective coping D) Risk for injury

Which of the following would the nurse be least likely to include as a type of generalized seizure? A) Petit mall seizures B) Febrile seizures C) Grand mal seizures D) Complex seizures

Select all that apply: The nurse determines the pt may be displaying extrapyramidal effects on the basis of what assessment findings? A) The pt has had uncharacteristic verbal outbursts B) The pt has an aversion to bright lights C) The pt has been experiencing insomnia and early morning awakening D) The pt exhibits hand tremors E) The pt gait is uncoordinated

D E; Insomnia & photophobia are not extrapyramidal; verbal outbursts not related to drug therapy

Which of the following has been known to achieve benefits for clients with cancer through the use of the mind to visualize a positive physiologic effect? a) Humor b) Biofeedback c) Imagery d) Hypnosis

Imagery Explanation: Imagery is a physiologic technique that uses the mind to visualize a positive physiologic effect. When using imagery, clients conjure up mental images of their body waging and winning a battle with the disease process.

A school-aged child has been diagnosed with a seizure disorder and phenytoin has been prescribed. What nursing diagnosis would be most appropriate if the child demonstrated adverse effects to the drug related to cellular toxicity?

Impaired skin integrity related to dermatological effects

Ayurvedic medicine has its roots in which of the following areas?

India

Ayurvedic medicine has its roots in which of the following areas? a) India b) China c) Southeast Asia d) Japan

India Explanation: Ayurvedic medicine has its roots in India.

A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?

Venlafaxine

A client is following a Mediterranean diet to increase heart health. The nurse would offer which items as a snack? Select all that apply.

Whole grain crackers Fruit Carrots with humus

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, "I'm relieved to have some medication to help with my mood, because it's my daughter's wedding next weekend and I'll be feeling better." What is the nurse's best response?

"Antidepressants will help your mood but it usually takes a few weeks to experience the benefits."

When obtaining information for a database, which of the following represents a nurse commitment and interest in reflected integrative medicine (CAM)?

"Do you take any vitamins or minerals, and if so, what?"

The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize?

"How would you describe your mood and energy level today?"

An 11-year-old client has been diagnosed with epilepsy and prescribed phenytoin 100 mg PO b.i.d. What statement by the client's parent suggests an accurate understanding of the client's medication regimen?

"I will make sure my child has routine visits to the dentist."

A patient with dermatitis has sought care from a homeopathic practitioner seeking treatment for dry, itchy, and inflamed skin. Which statement is characteristic of homeopathy?

"I'm going to recommend a diluted solution that is derived from poison ivy."

A pts nerve cells is at rest. What is true of this nerve cell at this time? A) the cell is depolarizing B) the membrane is permeable to potassium ions C) sodium ions are rushing into the cell D) stimulus of sufficient strength is generated

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client is reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective."

Haloperidol is a potent antipsychotic that is associated with: A) Severe extrapyramidal effects B) Severe sedation C) Severe hypotension D) Severe anticholinergic effects

Select all that apply: What statements made by the nurse about pregabalin are accurate? A) Maximum daily administration is 600 mg in divided doses B) Indicated for treatment of fibromyalgia C) Is an older drug, entering the market more than 50 years ago D) Act by increasing GABA levels in the brain E) Pregabalin is used to treat partial seizures

A B E

The nurse in a medical unit is collecting a client's history and asks the client about the use of complementary and alternative therapies. The client asks why the nurse needs to know about this. What is the nurse's best response? a) "I am just curious on what types of treatments are used by people." b) "I want to make sure you understand all the risks of these treatments." c) "It's important that we list all your home care needs for the hospital." d) "It will help me so that I can recommend use of these for other clients."

"It's important that we list all your home care needs for the hospital." Explanation: Nurses need to include complementary and alternative therapy in assessment of the client's current treatments to ensure an understanding of the safety and effectiveness of the treatments, particularly if the client is also receiving allopathic treatment. The nurse would want to be positive with this questioning so that the client is not defensive regarding any complementary and alternative treatments.

A client is prescribed transdermal selegiline. What health education should the nurse provide?

"Place the patch on dry skin on your torso that has no cuts or openings."

The nurse is caring for a client who is prescribed a tricyclic antidepressant for depression. Which teaching will the nurse provide to the client about this medication? Select all that apply.

"Report urinary retention." "Take the medication at bedtime." "Call the health care provider if you experience confusion."

The nurse is caring for a client diagnosed with pancreatic cancer. The client would like to use integrative care as a health care choice. What is the best response by the nurse?

"There are several alternative medicine modalities that could help with pain and relaxation during your treatment. I will get you some information on them."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?

"Use sugarless hard candies and gum to deal with dry mouth."

A client is brought into the emergency department in status epilepticus, and the nurse is administering phenobarbital 300 mg IV as prescribed. Family members ask the nurse how long it will take to stop the seizures. What is the nurse's best response?

"We should see results in 10 to 30 minutes."

A 12 year-old client with depression has been prescribed trazodone 1.5 mg/kg/day in three divided doses. The client weighs 110 lbs. How many 50-mg tablets should the nurse administer for each dose?

0.5

How long does a patient need to wait after stopping a phenelzine before starting paroxetine?

14 days

A child in stats epileptics has been prescribed phenobarbital 15 mg/k/ IV to be administered over 15 min. The child weights 24 big and the drug is added to a 50 mL minibag. At what rate, in mL/hr, should the nurse administer the drug

200 mL/hr

A 14-yr old pt w/ symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The pt weighs 154 lb. How many milligrams of pimozide should the pt be administered?

3.5 mg; 154/2.2 = 70 70 X 0.05 = 3.5

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks

Select all that apply: The blood-brain barrier could be descried by which of the following? A) it is produced by the cells that make up the meninges B) it is regulated by the microglia in the CNS C) it is weaker in certain parts of the brain D) it is uniform in its permeability throughout the CNS E) it is an anatomical structure that can be punctured F) it is more likely to block the entry of proteins into the CNS

A C F

A chid with ADHD has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain? A) It needs to be determined if the child still has symptoms that require treatment B) The risk for cumulative adverse effects is greater if the child doesn't have a break C) The drug likely needs to be switched to another agent that is less toxic D) The drug must be occasionally stopped to prevent anticholinergic effects

A pt has a deficiency in serotonin. What dx would be most likely for this pt? A) Depression B) Tetraplegia C) Stroke D) Seizures

A pt has been prescribed Alprazolam 0.5 mg PO t.i.d for the treatment of anxiety. What statement by the pt demonstrates an accurate understanding of the drug regimen? A) I will make sure not to stop the drug abruptly B) I should temporarily decrease the amount of fiber in my diet C) I can take an OTC antihistamine if I'm still feeling anxious D) I must take the drug on an empty stomach

A pt has suffered an injury to the limbic system. What assessment finding should the nurse attribute to this injury? A) The pt exhibits bizarre behavior and unpredictable emotions B) The pts respiratory rate is irregular C) The pt has short-term memory loss with intact long-term memory D) The pt has an unsteady gait and experiences frequent falls

A pt hs been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? A) Educate the pt about the need to take the pills as scheduled B) Educate the pt about taking the med at the first sign of impending seizure activity C) Establish IV access D) Teach the pt how to self-administer subcutaneous injections

A pt is to receive Diazepam as part of the treatment for status epilepticus. The pt has a peripheral intravenous infusion in the left arm that is being used to administer Phenytoin. Which action would be most appropriate for the nurse to do? A) Start another IV line in the pt's right arm B) Contact the prescriber to question the order C) Add the Diazepam to the current IV infusion D) Wait until the infusion is completed to give the Diazepam

A pt received Lorazepam intravenously at 0900. The nurse should maintain the pt on bedrest until approximately what time? A) 1200 B) 1500 C) 1030 D) 1330

A pt who is being treated w/ a typical antipsychotic reports frequent nasal congestion and urinary hesitation. To what should the nurse most likely attribute these symptoms? A) Anticholinergic effects B) Tardive dyskinesia C) Neuroleptic malignant syndrome D) Extrapyramidal symtoms

A pt who takes lithium for the treatment of bipolar disorder has been experiencing occasional constipation. What should the nurse teach the pt about safely managing this problem? A) "Avoid taking psyllium supplements" B) "Do not take OTC stool softeners under any circumstances" C) "Avoid foods that are high in soluble fiber" D) "Occasional constipation is inevitable during lithium therapy"

A pts left adrenal medulla has injured in a motor vehicle accident. What is the possible implication of this injury? A) Disruptions in the levels of norepinephrine and epinephrine B) Dopamine deficiency C) Impaired action potential D) Disruption of the Na-K pump

A pts nerve impulse is being conducted rapidly between Schwann cells. What component of the neurologic system is facilitating this rapid conduction? A) Nodes of Ranvier B) Neurotransmitters C) Post synapse D) Soma

A pts neuron has repolarized. The nurse understands that this neuron: A) now has more Na ions outside its membrane B) is experiencing an influx of sodium ions C) is under the influence of a neurotransmitter D) is saturated w/ Na ions

Antipsychotic drugs are also known as neuroleptic drugs because: A) They cause numerous neurological effects B) They frequently cause epilepsy C) They are also minor tranquilizers D) They are the only drugs known to directly affect nerves

Barbiturates cause liver enzyme induction, which could lead to: A) Rapid metabolism and loss of effectiveness of other drugs metabolized by those enzymes B) Increased bile production C) CNS depression D) The need to periodically lower the barbiturate dose to avoid toxicity

Drugs that are commonly used to treat grand mal seizures include: A) Barbiturates, benzodiazepines, and hydantoins B) Barbiturates, antihistamines, and local anesthetics C) Hydantoins, phenobarbital, and phensuximide D) Benzodiazepines, phensuximide, and valproic acid

For which pt would the nurse of a benzodiazepine for anxiety out likely to be contraindicated? A) A 32 year old pt who is currently breast-feeding B) An older adult with chronic renal failure C) An adult pt whose anxiety is due to psychosocial, not physiologic, factors D) A 41 year old pt with a diagnosis of generalized anxiety disorder

Nerve stimulation has caused the release of serotonin into many of a pts synaptic clefts, causing stimulation of the effector cell. How will the effector cell be returned to a resting state so that it can be stimulated again? A) Serotonin will be reabsorbed by the axon of the presynaptic nerve B) Serotonin molecules will spontaneously break down in a fraction of a second C) Acetylcholine will be released, which has a contrary effect to serotonin D) Dopamine will be released, which negates the effect of serotonin

One drug that is used alone in the treatment of partial seizures is: A) Carbamazepine B) Topiramate C) Lamotrigine D) Gabapentin

The Benzodiazepines are the most frequently used anxiolytic drugs because: A) They are anxiolytic at doses much lower than those needed for sedation or hypnosis B) They can also be stimulating C) They are more likely to cause physical dependence than older anxiolytic drugs D) They do not affect any neurotransmitters

The Benzodiazepines react with: A) GABA receptor sites in the RAS to cause inhibition of neural arousal B) Norepinephrine receptor sites in the sympathetic nervous system C) Acetylcholine receptor sites in the parasympathetic nervous system D) Monoamine oxidase to increase norepinephrine breakdown

The most primitive area of the brain, the brainstem, contains areas responsible for: A) vomiting, swallowing, respiration, arousal, and sleep B) learning C) motivation and memory D) taste, sight, hearing, and balance

The nurse has just begun administering phenobarbital intravenously to a child in status epileptics. The nurse would expect this drug to begin working within which time frame? A) 5 minutes B) 15-20 minutes C) The time frame depends on the child's body surface area D) 60 seconds

The nurse is caring for a female pt who has taken phenytoin for many years to control her seizures. The pt now wishes to become pregnant and asks the nurse what she should do. What is the nurse's best response? A) "The risk to you and the fetus is greater when stopping the drug during pregnancy than the drug itself." B) "It is important to prevent seizures during pregnancy, so the doctor will likely change you to combo therapy" C) "Women w/ a seizure disorder cannot get pregnant, and you will need to look into other alternatives, such as adoption." D) "The drugs will be stopped until you get pregnant and then resumed when you enter your second trimester."

The nurse is reviewing the newly admitted adult pts prescription for carbamazepine. What prescription would reflect a safe dosage? A) Carbamazepine 200 mg PO q6h B) Carbamazepine 400 mg PO q6h C) Carbamazepine 500 mg PO q8h D) Carbamazepine 150 mg PO q8h

The pt was diagnosed w/ narcolepsy and prescribed modafinil on his last visit. When he returns for follow-up care 2 months later, he reports the he is able to stay away all day but he hates the dry mouth the drug causes. What strategy would the nurse provide this pt to cope w/ this adverse effect? A) Provide sugarless lozenges to suck B) Avoid citrus fruits C) Increase water intake D) Increase salt intake

Which of the following could result in the initiation of an action potential? A) depolarizing the membrane B) decreasing the extracellular potassium concentration C) increasing the activity of the Na-K active transport system D) stimulating the nerve w/ a threshold electrical stimulus during the absolute refractory period of the membrane

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?

A 45-year-old man with liver impairment

Select all that apply: In explaining the importance of a constant blood supply to the brain the nurse would tel the student which of the following? A) energy is needed to maintain nerve membranes and cannot be produced w/o oxygen B) carbon dioxide must constantly be removed to maintain the proper pH C) little glucose is stored in nerve cells, so a constant supply is needed D) the brain needs a constant supply of insulin and thyroid hormone E) the brain swells easily and needs the blood supply to reduce swelling F) circulating aldosterone levels maintain the fluid balance in the brain

A B C

Select all that apply: The nurse administers a med that slows the reuptake of serotonin. What actions will this drug likely have? A) maintaining a healthy mood and affect B) regulating the sleep and wake cycle C) enhancing motivation D) inhibits nerve activity E) facilitating the "fight-or-flight" response

A B C

Select all that apply: Before administering lithium to a pt the nurse should check for the concomitant use of which of the following drugs that could cause serious adverse effects? A) Ibuprofen B) Haloperidol C) Thiazide diuretics D) Antacids E) Ketoconazole F) Theophylline

A B C D

SATA. In assessing a pt who is experiencing anxiety the nurse expect to find which of the following? A) Rapid breathing B) Rapid heart rate C) Fear and apprehension D) Constricted pupils E) Decreased abdominal sounds F) Hypotension

A B C E

Select all that apply: What data should indicate to the nurse that the pt is experiencing encephalopathic syndrome? A) The pt white cell count is greatly elevated B) The pt is much weaker than normal C) The pt is uncharacteristically disoriented D) The pt random blood glucose level is 145 mg/dL E) The pt hands are tremulous when at rest

A B C E

SATA. Your pt has a long history of anxiety and has always responded well to Diazepam. She has just learned that she is pregnant and feels very anxious. She would like a prescription for Diazepam to get her through her early anxiety. What rationale would the nurse use in explaining why this is not recommended? A) This drug is known to cause a predictable syndrome of birth defects, including cleft lip and pyloric stenosis B) Babies born to mothers takin Benzodiazepines may progress through a neonatal withdrawal syndrome C) Cardiac defects and small-brain development may occur if this drug is taken in the first trimester D) This drug almost always causes loss of the pregnancy E) The hormones the body produces during pregnancy will make you unresponsive to Diazepam F) This drug could have adverse effects on your baby; We should explore non drug measures to help you deal with the anxiety

A B C F

Select all that apply: Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the pt receiving antipsychotic drugs should include which of the following: A) Positioning to decrease discomfort of dyskinesias B) Implementing safety measures to prevent injury C) Encouraging the pt to chew tablets to prevent choking D) Careful teaching to alert the pt and family about this adverse effect E) Applying ice to the joints to prevent damage F) Pureeing all food to decrease the risk of aspiration

A B D

Which nursing action is an example of using integrative care? a) A nurse performing a home assessment of an older adult client recommends a referral to social services. b) A nurse monitors the heartbeat of a fetus and charts the height of the mother's fundus on the medical record. c) A nurse provides music therapy along with relaxation techniques for residents of a long-term facility. d) A nurse instructs a laboring woman to use breathing exercises, and assists with the administration of an epidural for her pain.

A nurse instructs a laboring woman to use breathing exercises, and assists with the administration of an epidural for her pain. Explanation: A nurse who uses integrative care uses some combination of allopathic medicine and CAM as seen with the nurse helping the woman in labor.

A nurse is teaching a client with anxiety about the use of meditation. Which of these are important features of meditation? Select all that apply.

A quiet location An open attitude A comfortable position

A client is asking for the nurse to explain acupuncture. What would the nurse tell the client? a) Acupuncture is used to correct disharmony. b) Acupuncture is beneficial to creating a mood of distraction. c) Acupuncture is a dangerous option for the treatment of disease. d) Acupuncture is only done in Eastern countries.

Acupuncture is used to correct disharmony. Explanation: Acupuncture can be used to correct disharmony or prevent disharmony from developing.

A pt has a diagnosis of Parkinson disease, a health problem that affects motor function and cognition. What neurotransmitter is most likely deficient in this pts CNS? A) GABA B) Norepinephrine C) Dopamine D) Acetylcholine

The pt has been taking an atypical antipsychotic med for several years. During annual physical examinations, what assessment best addresses a likely adverse effect? A) Fasting blood glucose level B) BP C) Electrocardiogram D) Assessment of passive range of motion

A; Hypotension and prolonged QT intervals is typical in typical antipsychotics; ROM is unlikely to be affected

After teaching a group of students about major divisions of the brain, the instructor determines that additional teaching is needed when the students identify what as part of the hindbrain? A) hypothalamus B) reticular activating system C) swallowing center D) respiratory control center

A; The rest are part of the hindbrain

The nurse is caring for a pt who is prescribed haloperidol for long term. What assessment should the nurse prioritize? A) Assessment for involuntary movements B) Monitoring the pt white cell differential C) Assessment of the pt skin integrity D) Monitoring the pt CD4 T-cell count

A; associated w/ increased risk of extrapyramidal adverse effects

A pt has anxiety and insomnia and the health care provider believes that this may be a result of a deficiency of inhibitory neurotransmitters. This pt may be lacking in what neurotransmitter? A) gamma-aminobutyric acid B) epinephrine C) dopamine D) acetylcholine

A; dopamine is involved in coordination of motor & intellectual, acetylcholine communicates between nerves & muscles, epinephrine are part of the ANS

The nurse is reviewing the results of a hospital pts serum phenytoin level, which has just become available. The results indicate that the pts phenytoin level is 17.5 mcg/mL. What is the nurse's best action? A) Document the fact that the nurse checked the pts phenytoin levels B) Contact the care provider to communicate this result C) Raise the pts bed rails and maintain the pt on bed rest D) Perform a focused neurological assessment

A; therapeutic range is 10-20 mcg/mL

A pt current drug regimen includes modafinil. When planning this pt care, the nurse should prioritize the pt risk for: A) Injury B) Hallucinations C) Acute confusion D) Hopelessness

A; treatment for narcolepsy which creates significant risk for injury

A school-aged child is brought to the clinic by their parents. The parents state that the child will be engaged in some activity at home and then will just stop suddenly for a few seconds and then pick up the activity again as if there had been no break in what the child was doing. This child should be assessed for what neurological disorder?

Absence seizures

While assessing a client, the client tells the nurse that he is a follower of traditional Chinese medicine and the concept of qi. Based on the nurse's understanding of this concept, which treatment modality would the nurse expect the client to mention?

Acupuncture

Acupuncture Explanation: Acupuncture is based on energy regulation of qi through meridians. It is a core principle in traditional Chinese medicine. Therapeutic Touch (TT) is not a form of traditional Chinese medicine and is based on the consciously directed process of energy exchange. Physiotherapy and allopathy are not based on the concept of qi.

A client is asking for the nurse to explain acupuncture. What would the nurse tell the client?

Acupuncture is used to correct disharmony.

A pt has been admitted to the health care facility w/ myoclonic seizures. Once stabilized, the nurse should anticipate that the pt will be prescribed what med? A) Phenytoin B) Zonisamide C) Valproic acid D) Clonazepam

The client who is newly diagnosed with diabetes mellitus type 2 is concerned about eating products with sugar in them. What information does the nurse explain to the client regarding the use of sugar? a) It assists with cellular absorption of nutrients. b) An excess increases demand on the pancreas. c) Healthy amounts are usually consumed. d) It increases natural bacterial flora in the GI tract.

An excess increases demand on the pancreas. Explanation: Excess sugar increases demand on the pancreas; therefore, less sugar should be used. The client who has diabetes mellitus type 2 already has a compromised pancreas. Further stress to the pancreas can cause further injury to the organ.

Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular?

An extended release form is available.

A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?

Clomipramine

A nurse is caring for a hospitalized client who states: "I feel so sick all the time; my aura must be disturbed by all of these bad force fields." What is an appropriate NANDA-I diagnosis for this client? A. Disturbed energy field. B. Hopelessness. C. Impaired coping. D. Social isolation.

Answer: A Rationale: Defining characteristics of the disturbed energy field relate to movement, sounds, temperature change, visual changes, and disruption. The aura the client is referring to in this scenario is a vague, luminous glow surrounding something that may be an information-containing electromagnetic field, which can be likened to the data contained within a computer. Social isolation would refer to a client who is feeling isolated from others. Impaired coping refers to a client who is having difficulty dealing with a particular situation. Hopelessness refers to a client who feels there is no hope for improvement from an illness or in life in general.

A client comes to the clinic for an evaluation. The client reports that "I have been having such problems with getting to sleep and then staying asleep. But I do not want to take any medications." After a discussion of possible complementary health approaches, the client decides to try aromatherapy. Which essential oil will the nurse suggest addressing the client's problem? A. lavender B. ginger C. lemon D. peppermint

Answer: A Rationale: For insomnia, lavender is appropriate. Ginger, peppermint, and lemon are helpful in controlling nausea.

A nurse is educating a client on meditation techniques to provide mental calmness and physical relaxation. Which nursing intervention facilitates this process? A. helping the client to assume a specific, comfortable posture. B. teaching the client to have multiple focal points. C. promoting a closed attitude to avoid judgments and distractions. D. providing a stimulating environment in which to conduct the meditation.

Answer: A Rationale: Meditation requires a specific, comfortable posture so that a single focal point can easily be established. Depending on the type being practiced, meditation can be done while sitting, lying down, standing, walking, or in other positions. The environment must be quiet, rather than stimulating, in order for meditation to be effective. The client must have an open attitude to avoid judgments and distractions.

The nurse is certified in providing Therapeutic Touch and is preparing to initiate this for a client. What activity should the nurse perform first? A. Requesting the client's permission to touch the body. B. Embracing the client for energy. C. Moving the hands 2 to 6 in (5 to 16 cm) away from the client's skin surface. D. Calling to rebalance the soul.

Answer: A Rationale: Prior to touching the client, the nurse should request permission and explain the process of therapeutic touch. All other interventions would be performed after this occurs.

A client's family member asks the nurse if he or she may bring essential oils for use in the hospital room for the client. What action should the nurse take? A. Provide education and determine if there is a sensitivity to the oils. B. Refuse the use of essential oils in the client's room, because they may be a hazard. C. Inform the client and family that all essential oils are the same. D. Tell the family member that essential oils are not proven to be effective treatment.

Answer: A Rationale: The essential oils of plants can be used as a therapy to improve physical, emotional, and spiritual well-being. The fragrance of these oils is believed to ultimately affect the very sensitive amygdala of the limbic system in the brain, where emotional memories are stored and released. Laboratory and animal studies have shown that certain oils have antibacterial, antiviral, antifungal, calming, and energizing effects. Commonly used essential oils in a health care setting are ginger or peppermint for nausea and lavender or chamomile for insomnia. Essential oils vary in quality and potency depending on the manufacturing processes. If specific essential oils are approved for use in an inpatient setting, the nurse provide education on these oils. Some people are highly sensitive to strong fragrances, particularly concentrated essential oils. This might preclude their use for specific clients.

Which is the most important role of the nurse in using complementary and alternative therapies? A. Educating the public about safety and effectiveness. B. Practicing guided imagery prior to surgery. C. Providing nutrition supplements for weight gain. D. Administering herbal supplements for anxiety.

Answer: A Rationale: The most important role of the nurse in using CAT is educating the public about the safety and effectiveness of using the therapies. Administering herbal supplements for anxiety and providing nutrition supplements for weight gain may be considered part of a treatment plan but they are not the most important aspects of CAT. Guided imagery is one aspect of treatment included in CAT.

Why is Zen meditation effective for a client with generalized anxiety disorder? A. Assists client to enter state of calmness. B. Helps client forget issue causing stress. C. Used to reduce hyperactivity in group therapy. D. Includes yoga exercise for stress relief.

Answer: A Rationale: Zen meditation assists the client to enter a state of calmness to reduce anxiety. Focusing on breathing, posture, and the present, allows the mind to deal properly with intrusive thoughts, bringing a sense of calmness over oneself. Zen meditation doesn't make one forget about stressful thoughts, rather how to manage them effectively. Zen, or mindfulness meditation, is not a group therapy for hyperactivity, Although Yoga and Zen meditation have many similarities, Zen focuses on achieving a higher consciousness.

A nurse practitioner is conducting a presentation at a local community center about complementary health approach. One of the participants asks the nurse practitioner, "Everybody is talking about relaxation. Just how does relaxation help a person?" The nurse responds, integrating which effect as being associated with relaxation? Select all that apply. A. Reduced muscle tension. B. Better sleep and rest. C. Improved sense of well-being. D. Less anxiety. E. Lowered immune response.

Answer: A, B, C, D Rationale: Relaxation can be useful whether a client is experiencing a single stressful event, such as surgery, or chronic stress. Client benefits include reduced anxiety, reduced muscle tension and pain, improved functioning of the immune system, enhanced sleep and rest, and an improved overall sense of well-being.

The nurse is working with a client recently diagnosed with cancer. The client says, "I found this product that I want to use to fight my cancer." Which statements in the product literature should raise suspicion in the nurse? Select all that apply. A. The pharmaceutical industry is trying to hide information about the product. B. It cites personal testimony from a user that it cured her cancer. C. It claims to be an "all-natural" product. D. Vitamins and minerals are listed in the ingredients. E. It contains a secret ingredient known only to the manufacturers.

Answer: A, B, C, E Rationale: Dietary supplements that are "rip-offs" often claim that one product does it all, use personal testimonials as evidence of success, are "all-natural," claim to be a "miracle cure," and claim that the pharmaceutical industry and government are trying to hide information about the product. A product that has vitamins and minerals in the ingredients may be a legitimate method of strengthening the client's nutrition, which will help in cancer treatment.

A nurse is teaching a client with anxiety about the use of meditation. Which of these are important features of meditation? Select all that apply. A. A comfortable position. B. An open attitude. C. Use of music. D. A quiet location. E. A dark room.

Answer: A, B, D Rationale: The use of meditation involves four elements, which include an open attitude, a quiet location, and a comfortable position; all of these contribute to the ability to relax when performing meditation. Use of music and a dark room are not routinely associated with meditation.

A client presents to the clinic with a sprained left wrist. The health care provider suggests alternative therapy. What education will the nurse provide to the client? Select all that apply. A. Physical exercises. B. Guided imagery. C. Rest and fluids. D. Anti-inflammatory diet. E. Meditation.

Answer: A, B, D, E Rationale: Rest and fluids are an alternative therapy for the common cold rather than a musculoskeletal injury. The other selections are all good choices for alternative therapy for the injury.

The nurse is providing client education about the use of herbal medicines. Which statements are accurate? Select all that apply. A. They can be toxic in high doses. B. They are regulated by the government. C. They contain certain amounts of active ingredients. D. They take longer to produce a therapeutic effect. E. They all can safely be taken with other medications.

Answer: A, C, D Rationale: Herbal medicines do take longer to produce a therapeutic effect, can be toxic in high doses, and do contain certain amounts of active ingredients. They are not regulated by the government and many cannot be safely taken with other medications.

A nurse who has incorporated complementary and alternative medicine (CAM) into nursing practice is caring for a client in a short-term care facility. Which examples of nursing interventions are based on CAM? Select all that apply. A. The nurse teaches the client how to meditate. B. The nurse administers pain medication prescribed by the primary care provider. C. The nurse uses guided imagery to relieve client anxiety. D. The nurse investigates herbs that may stimulate the client's immune system. E. The nurse schedules diagnostic tests for the client. F. The nurse encourages a client to join a yoga class.

Answer: A, C, D, F Rationale: The term complementary and alternative medicine refers to interventions that are complementary therapies (CAM—they can be used with traditional medical interventions and thus complement them) as well as alternative modalities (not included in the scope of conventional medical care). Herbal remedies, yoga, meditation, and guided imagery are all forms of CAM. Administering pain medication and scheduling diagnostic tests are traditional allopathic (biomedicine) therapies.

In prenatal classes, the nurse teaches pregnant clients to use meditation during labor contractions to ease the pain. Which elements of meditation are important for the nurse to emphasize? Select all that apply. A. Comfortable position B. Closed attitude. C. Massaging abdomen D. Focus of attention E. Quiet environment

Answer: A, D, E Rationale: There are four elements common to most types of meditation: comfortable position, quiet environment, focus of attention, and open attitude. Closed attitude and massaging abdomen are not elements of meditation.

Answer: B Rationale: Acupuncture is based on energy regulation of qi through meridians. It is a core principle in traditional Chinese medicine. Therapeutic Touch (TT) is not a form of traditional Chinese medicine and is based on the consciously directed process of energy exchange. Physiotherapy and allopathy are not based on the concept of qi.

Answer: B Rationale: Allopathic medicine (or conventional medicine) is evidence-based practice that includes remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches, and diagnostic tools. Allopathic medical care is particularly effective when aggressive treatment is needed in emergency or acute situations. Traditional Chinese medicine uses eight principles to analyze symptoms and categorize conditions, and uses the theory of five elements to explain how the body works. Naturopathy involves the belief that health is a dynamic state of being that provides abundant energy for people to deal with life in our complex society. Ayurveda involves the integration and balance of the body, mind and spirit.

A client asks the nurse about the use of healing touch. Which statement regarding healing touch is accurate? A. Healing touch is too expensive for most clients. B. Supplemental music is used during healing touch. C. Aromatherapy is used in healing touch. D. Healing touch does not use injections.

Answer: D Rationale: Healing touch has been shown to be effective in helping clients relax and improve the healing process. It is not expensive because it involves no special equipment, including insertion of tubes or injections. Aromatherapy and supplemental music are not routinely used in healing touch.

The mind and body are connected in the provision of care. This statement describes: A. allopathic care. B. homeopathic care. C. altruistic care. D. holistic care.

Answer: D Rationale: Holistic interventions focus on the interrelated needs of body, mind, emotions, and spirit.

The nurse explains to the client which statement is true regarding the difference between allopathic therapy and complementary and alternative therapy? A. Allopathic therapy integrates mind and body. Complementary and alternative therapy separates mind and body. B. Allopathic therapy emphasizes treatments for diseases. Complementary and alternative therapy emphasizes treatments for health. C. Allopathic therapy uses herbs to treat. Complementary and alternative therapy uses medications to treat. D. Allopathic therapy is the absence of illness. Complementary and alternative therapy states health is the imbalance of the body systems.

Answer: B Rationale: Allopathic therapy emphasizes treatments for diseases using traditional western medicine provided by an MD or DO. Examples of Allopathic therapy include pharmacotherapy, surgery, and radiology. Alternative medicine and complimentary medicine are terms that describes medical treatments that are used instead of traditional western therapies. Examples of complementary therapy include acupuncture, aromatherapy, homeopathy, and yoga. Alternative therapy includes acupuncture, homeopathy, and eastern oriental practices.

A client comes into the clinic stating he has been experiencing insomnia for a couple of weeks. After a thorough exam revealed no physiological cause for the symptom, the nurse practitioner suggested the use of aromatherapy. Which of the following might the nurse suggest for its use in helping insomnia? A. Peppermint B. Chamomile C. Ginger D. Almond

Answer: B Rationale: Chamomile is used as aromatherapy for insomnia. Peppermint, almond, and ginger have uses as aromatherapy but are not used for insomnia.

Allopathic therapy integrates mind and body. Complementary and alternative therapy separates mind and body. A. Cedarwood B. Ginger C. Chamomile D. Lavender

Answer: B Rationale: Ginger or peppermint is an appropriate essential oil choice for addressing nausea. Chamomile, lavender, and cedarwood are used for insomnia.

A client asks the nurse about taking herbal medications. Which of these is the nurse's best response regarding safety of the herbal medications? A. "Herbal medications are natural products so there are not side effects with these." B. "Name brand products with herbal medications usually are of higher quality." C. "You can take combination products to save money on these medications." D. "Your effects from herbal medications are quicker than with traditional medicine."

Answer: B Rationale: Name brand products with herbal medications tend to be of higher quality so can be best to choose since the industry is not regulated by federal agencies. Herbal medications can have side effects, and many times work slower than traditional medications do, so clients should give them time to help and observe for any side effects. Single products are best, particularly if there are side effects; if there are combinations of medications, it is difficult to tell which caused a problem.

A nurse is teaching a client experiencing stress about how relaxation helps to reduce the effects of stress on the body. Which underlying concept would the nurse integrate into the explanation about how relaxation works? A. Activates natural pleasure centers. B. Helps to increase the effects of parasympathetic nervous system on the mind and body. C. Slows circulation throughout the body. D. Increases the body's natural immunity.

Answer: B Rationale: Relaxation techniques promote parasympathetic nervous system activity, helping to reduce sympathetic activity and restore the balance of the two systems. The ultimate goal is to increase the parasympathetic system influence in the mind-body and thus reduce the effect of stress and stress-related illness on the body. Natural products can boost the body's immunity. Energy healing activates natural pleasure centers. Hands-on techniques such as massage promote circulation throughout the body.

A nurse is teaching an overweight client the holistic approach to choosing foods. Which teaching points would the nurse include? Select all that apply. A. Avoid organically grown foods. B. Replace refined sugars with artificial sweeteners. C. Eat foods that are in season. D. Reduce intake of refined and natural sugars. E. Increase intake of dairy products. F. Consider adopting a vegetarian diet.

Answer: B, C, D Rationale: Eating foods that are in season is suggested because foods produced "out of season" are treated with chemicals to ripen them since they are picked before ripening. Reducing the intake of refined and natural sugars is best because of the negative effects of these substances. A vegetarian diet can be beneficial because animals are increasingly fed antibiotics and potentially contaminated foods. Also, increasingly, fish are being contaminated with mercury and other pollutants.

Ayurvedic medicine has its roots in which of the following areas? A. Southeast Asia B. Japan C. India D. China

Answer: C Rationale: Ayurvedic medicine has its roots in India.

The client who is newly diagnosed with diabetes mellitus type 2 is concerned about eating products with sugar in them. What information does the nurse explain to the client regarding the use of sugar? A. Sugar increases natural bacterial flora in the GI tract. B. Sugar assists with cellular absorption of nutrients. C. Excess sugar increases demand on the pancreas. D. Healthy amounts of sugar are usually consumed.

Answer: C Rationale: Excess sugar increases demand on the pancreas; therefore, less sugar should be consumed. The client who has diabetes mellitus type 2 may have a compromised pancreas. Further stress to the pancreas can cause further injury to the organ.

A client who is receiving chemotherapy and experiencing significant nausea asks the nurse about using aromatherapy to help alleviate the nausea. Which essential oil would the nurse most likely suggest addressing the client's nausea? A. Cedarwood B. Lavender C. Ginger D. Chamomile

Answer: C Rationale: Ginger or peppermint is an appropriate essential oil choice for addressing nausea. Chamomile, lavender, and cedarwood are used for insomnia.

The nurse in a medical unit is collecting a client's history and asks the client about the use of complementary and alternative therapies. The client asks why the nurse needs to know about this. What is the nurse's best response? A. "I am just curious on what types of treatments are used by people." B. "I want to make sure you understand all the risks of these treatments." C. "It will help me so that I can recommend use of these for other clients." D. "It's important that we list all of your complementary health practices used to provide a full picture of what you do to manage your health.

Answer: D Rationale: Nurses need to include complementary and alternative therapy in assessment of the client's current treatments to ensure an understanding of the safety and effectiveness of the treatments, particularly if the client is also receiving allopathic treatment. The nurse would want to be positive with this questioning so that the client is not defensive regarding any complementary and alternative treatments.

A nurse is caring for a client admitted for a prolonged stay on a medical-surgical unit. The client has been having difficulty sleeping and appears depressed. Applying the holistic health model, which action taken by the nurse would be most appropriate? A. Document the observations and encourage the client that he or she will feel better once going home. B. Suggest the client try some meditation and contact the health care provider to request medication to help with sleep. C. Ask the client's family to bring some items from home, such as a blanket, pillow, or pictures. D. Reassure the client how lucky he or she is to have family visit often and reassure the client that he or she will be going home soon.

Answer: C Rationale: Holism is a theory and philosophy that focuses on connections and interactions between parts of the whole, as well as the body's interaction with the environment. Holism recognizes that a person's environment and habits are part of who the person is. The holistic model is not necessarily a counterpoint to the biomedical model. While a focus on the mind is congruent with holism, this does not preclude treatment of bodily symptoms. Reassurance and encouragement may seem necessary but are not components in holistic care and can often feel ingenuine to clients. Suggesting meditation may help the client but is not the most appropriate measure.

Which principle does not encompass the basic goals of integrative medicine? A. Focus on promoting health and preventing illness, as well as treating disease. B. Facilitate the body's innate healing abilities. C. Reject allopathic medicine and embrace CAM practices. D. Establish a partnership between client and practitioner.

Answer: C Rationale: Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, spirit, and community), including all aspects of lifestyle. It does not reject allopathic medicine and CAM practices. It includes establishing a partnership between client and practitioner, facilitating the body's innate healing abilities, and focusing on promoting health and preventing illness, as well as treating disease.

For which client might the nurse need to alter the plan of care based on the principles of the client's chosen medical system? A. A client who visits a chiropractor. B. A client who believes in a strong mind-body connection. C. A client who is being treated by a naturopathic health care provider. D. A client who is being treated by an allopathic health care provider.

Answer: C Rationale: Naturopathic medicine is not only a system of medicine but also a way of life, with emphasis on client responsibility, client education, health maintenance, and disease prevention. Clients who are being treated by a naturopathic health care provider will probably have a different plan of care than those being treated by allopathic health care providers. Chiropractic medicine, a body-mind connection approach, and allopathic medicine are more easily incorporated into the traditional plan of care.

A client suffers from chronic pain. The nurse suggests the client have monthly massages. This is an example of: A. allopathic medicine. B. palliative medicine. C. alternative medicine. D. adjuvant medicine.

Answer: C Rationale: The use of conventional therapy as seen with CAM includes the use of herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy.

On the advice of friends, a client on a palliative care unit has requested acupuncture. What it is the goal of this form of CAM? A. allowing accumulated toxins to be released from the body. B. reconnecting the client's body, spirit, and emotions. C. altering the client's perception and acceptance of reality. D. restoring a healthy flow of energy along the meridians of the body.

Answer: D Rationale: Acupuncture either increases or decreases the flow of qi along the meridians of the body. It does not directly address the relationships between body, spirit, and emotions, nor does it aim to release toxins or change an individual's perception of reality.

The nurse is caring for a client whose treatment has been based on the Ayurveda medical system. Which nursing intervention incorporates this client's beliefs into the nursing plan? A. Including the client's shaman in the plan of care. B. Basing practice on the yin-yang theory. C. Preparing the client for exercises that help him or her regulate qi D. Helping the client to balance his or her dosha

Answer: D Rationale: Central to Ayurvedic medicine is an understanding of the client's basic constitution, or dosha. The three doshas in Ayurvedic medicine are vata (changeable), pitta (intense), and kapha (relaxed). Yin-yang and qi are associated with traditional Chinese medicine. A shaman is associated with shamanism (involves the spirit world).

A nurse can best help a client who is undergoing chemotherapy and using guided imagery with this by doing which of the following? A. Promoting the client's use of imagery only after a stressful event occurs. B. Explaining to the client that it is not a good idea to record their own imagery tape. C. Helping the client learn about the different poses that can be performed. D. Assisting the client to find an appropriate imagery tape to use.

Answer: D Rationale: Clients use imagery to help with relaxation and this can use all five senses. Many times, clients use a guided imagery tape that includes a script to help with imagery; clients also can record their own tape. Clients do not necessarily use poses with this; this would be more related to use of yoga. Guided imagery can help both during and after a stressful event to help the client relax.

A client asks the nurse for information about Traditional Chinese Medicine. The client specifically asks how Traditional Chinese Medicine might help manage one's chronic migraines. Which response by the nurse is best? A. "You might want to consider the use of botanicals, which can take the place of your prescribed medications." B. "Meditation is the only alternative medicine that is recommended for chronic migraines." C. "Therapeutic Touch balances qi, which is part of vital life force, thus relaxing the muscles and increasing relief of migraine headaches." D. "Acupuncture uses fine needles inserted in the skin to stimulate natural painkillers and has proven to be beneficial in treating chronic migraines."

Answer: D Rationale: Diagnosis in Traditional Chinese Medicine is based in the balance, or lack thereof, of Yin and Yang. Yin and Yang are both aspects of qi, which is considered a vital life force. Acupuncture has been shown to be an effective way to manage chronic migraine headaches. Meditation is not the only therapy that can be used to treat chronic migraines, and Therapeutic Touch is not part of Traditional Chinese Medicine. The nurse should not recommend botanicals in place of prescribed medications.

A pt with a a high pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this pt's needs? A) Meprobamate B) Buspirone C) Zaleplon D) Diphenhydramine

The nurse is certified in providing Therapeutic Touch and is preparing to initiate this for a client. What activity should the nurse perform first? A. Embracing the client for energy. B. Calling to rebalance the soul. C. Moving the hands 2 to 6 in (5 to 16 cm) away from the client's skin surface. D. Requesting the client's permission to touch the body.

Answer: D Rationale: Prior to touching the client, the nurse should request permission and explain the process of therapeutic touch. All other interventions would be performed after this occurs.

Which would be the least consistent with the Native American/Canadian Indigenous view of disease? A. Violation of a taboo. B. A result of negative thinking. C. Disharmony with Mother Earth. D. Balance of yin and yang.

Answer: D Rationale: The Native American/Canadian Indigenous view disease as a disharmony with Mother Earth, a result of negative thinking, or violation of a taboo. Chinese medicine proposes that health is the outcome of balancing yin and yang.

Which is the most important role of the nurse in using complementary and alternative therapies? A. Providing nutrition supplements for weight gain. B. Practicing guided imagery prior to surgery. C. Administering herbal supplements for anxiety. D. Educating the public about safety and effectiveness.

Answer: D Rationale: The most important role of the nurse in using CAT is educating the public about the safety and effectiveness of using the therapies. Administering herbal supplements for anxiety and providing nutrition supplements for weight gain may be considered part of a treatment plan but they are not the most important aspects of CAT. Guided imagery is one aspect of treatment included in CAT.

According to survey results, who are the most prevalent users of complementary or alternative therapies? A. Women, ages 25-40, with high school degree, who smoke. B. Men, ages 30-45, with college degree, who recently stopped smoking. C. Men, ages 50-65, with some high school, who smoke. D. Women, ages 35-50, with college degree, former smokers.

Answer: D Rationale: The most prevalent users of CAT are women, ages 35-50, with higher levels of education, who are former smokers.

The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?

Asking the client to sit on the side of the bed for 1 minute before getting up

A client has been administered phenobarbital during seizure activity. When assessing for adverse effects after resolution of the seizure, what assessment should the nurse prioritize?

Assessment of orientation

A client on the psychiatry unit with a longstanding history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize to best evaluate therapeutic effect of the treatment in the care of this client?

Assessment of the client's behaviors and thought processes

A nurse can best help a client who is undergoing chemotherapy and using guided imagery with this by doing which of the following?

Assisting the client to find an appropriate imagery tape to use.

A nurse can best help a client who is undergoing chemotherapy and using guided imagery with this by doing which of the following? a) Assisting the client to find an appropriate imagery tape to use. b) Explaining to the client that it is not a good idea to record their own imagery tape. c) Promoting the client's use of imagery only after a stressful event occurs. d) Helping the client learn about the different poses that can be performed.

Assisting the client to find an appropriate imagery tape to use. Explanation: Clients use imagery to help with relaxation and this can use all five senses. Many times, clients use a guided imagery tape that includes a script to help with imagery; clients also can record their own tape.

Understanding one's dosha, or basic constitution, is central to which type of whole medical system? a) Ayurveda b) Traditional Chinese medicine c) Chiropractic medicine d) Naturopathy

Ayurveda Explanation: Central to Ayurvedic medicine is understanding the client's basic constitution, or dosha. People can display one dosha predominantly or can be a combination of two or three doshas.

A child has been presented for care because he has episodes where he pauses what he is doing for a few seconds, is unresponsive, and then continues on this activity. The nurse should anticipate the administration of what med? A) Felbamate B) Ethosuximide C) Carbamazepine D) Gapapentin

A clinical indication of poor blood supply to the brain, particularly to the higher levels where learning takes place would be: A) loss of long-term memory B) loss of short-term memory C) loss of coordinated movement D) insomnia

A pt asks the nurse, "I've always been told that once you lose brain cells, they're gone forever. Is that true?" What should the nurse teach the pt about neuron regeneration? A) neurons regenerate, but at a far slower rate than other body cells B) some regeneration can occur if the soma and axon hillock are intact C) it was previously believed that neurons did not regenerate, but this has been found to not be the case D) neurons are the only body cells that are wholly incapable of healing or regenerating

A pt has undergone endoscopy following administration of a Benzodiazepine. If prescribed, the nurse should administer what agent to reverse the sedative effects when the procedure is completed? A) Promethazine B) Flumazenil C) Temazepam D) Triazolam

A pt med regimen includes lithium. What assessment finding would suggest a therapeutic effect? A) The pt refrains from aggressive or violent outbursts B) The pt denies severe depressive or manic episodes C) The pt denies audio or visual hallucinations D) The pt states that she now has purpose and direction in her life

Select all that apply: A pt has ben stabilized on phenytoin for several years and has not experienced a grand mal seizure in more than 3 years. The pt decides to stop the drug because it no longer seems to be needed. In counseling the pt the nurse should include which of the following points? A) He will always need this drug B) This drug needs to be slowly tapered to avoid potentially serious adverse effects C) He is probably correct and the drug is not needed D) The drug should not be stopped until appropriate blood tests are done E) Stopping the drug suddenly could precipitate seizures because the nerves will be more sensitive F) His insurance company won't cover any problems that might occur if he stops the drug without physician approval

B & E

Select all that apply: By what routes might the nurse administer phenytoin? A) Rectal B) IV C) PO D) IM E) Subcutaneous

B C

Select all that apply: The most common adverse effects associated w/ antiepileptic therapy reflect the depression of CNS. In assessing a pt on antiepileptic therapy the nurse would monitor the pt for which of the following? A) HTN B) Insomnia C) Confusion D) GI depression E) Increased salivation F) Tachycardia

B C D

SATA. The nurse should question an order for Benzodiazepine for what pts? A pt: A) Who has peptic ulcer disease B) With schizophrenia who is experiencing a psychotic episode C) Who is intoxicated with alcohol D) Who take a sustained serotonin reuptake inhibitor for depression E) With acute narrow-angle glaucoma

B C E

Select all that apply: What electrolytes are crucial to the action potential developed in the neuron? A) Mg B) K C) Na D) Chloride E) Ca

B C E

Select all that apply: The nurse is providing drug teaching for a pt who is newly prescribed a typical antipsychotic med. What teaching points will the nurse include while talking with this pt? A) "Increased appetite can cause obesity, so take care to eat a healthy diet" B) "Inform all health providers of the meds you take" C) "Spending time outside in the sunshine will improve your mood" D) "Avoid use of the herb evening primrose" E) "Never drink alcohol while taking this med"

B D E

A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.

Clomipramine

Comfortable position Quiet environment Focus of attention

A chant is a form of which category of meditation?

Concentrative

A pt is receiving carbamazepine therapy and the pts latest serum level of the drug is 13 mcg/mL. What action is most appropriate? A) Contact the provider to request a one-time supplementary dose B) Anticipate a reduction is dosage C) Assess the pts renal function D) Call an emergency code

B; Therapeutic is 4-12 mcg/mL

Which of the following would be the least consistent with the Native American medicine view of disease? a) Balance of yin and yang b) A result of negative thinking c) Violation of a taboo d) Disharmony with Mother Earth

Balance of yin and yang Explanation: The Native Americans view disease as a disharmony with Mother Earth, a result of negative thinking, or violation of a taboo. Chinese medicine proposes that health is the outcome of balancing yin and yang.

The nurse is educating a client on how to use herbs and supplements as part of an integrated treatment plan. Which teaching points would the nurse include? Select all that apply.

Buy herbs and supplements that are standardized. Give the product adequate time to work. Be knowledgeable about the product and its therapeutic actions.

A pediatric pt is prescribed Phenobarbital preoperatively to relieve anxiety and produce sedation. After giving the injection, you should assess the pt for: A) Acute Stevens-Johnson syndrome B) Bone marrow depression C) Paradoxical excitement D) Withdrawal syndrome

A person who could benefit from an anxiolytic drug for short-term treatment of insomnia would not be prescribed: A) Zolpidem B) Zaleplon C) Buspirone D) Meprobamate

A psychiatric nurse is reviewing various antipsychotic agents. The nurse should identify what drug as having the highest potency? A) Thioridazine B) Prochlorperazine C) Fluphenazine D) Chlorpromazine

Which pt is being treated w/ a typical antipsychotic? A) A pt whose thought disorder requires clozapine 25 mg PO b.i.d B) A pt who recently began taking ziprasidone C) An agitated pt who has been given haloperidol during acute psychosis D) A pt w/ schizophrenia who received paliperidone 6 mg PO daily

C; others are atypical

Which pt has suffered an injury to the forebrain? A) a pt who damaged his thalamus in a MVA B) a pt whose decreased respirations are due to brainstem damage C) a pt whose cerebrum has an infarct from a stroke D) an emotionally volatile client w/ dysfunction of the limbic system

C; thalamus &limbic system is midbrain, brainstem is hindbrain

The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to: A) Perform deep breathing and coughing exercises B) Report any new onset of chest pain promptly C) Stay in bed for the next half hour D) Expect urinary urgency for the next few hours

C; urgency & chest pain are not adverse effects; no need for deep breathing/coughing

A client's seizure activity, which is isolated to facial and neck muscles, has been identified as being caused by one area of the client's brain. The nurse should anticipate the administration of what drug?

Carbamazepine

The nurse is caring for a 4-year-old child diagnosed with a seizure disorder requiring an antiseizure agent. What principle should guide the care team's medication management?

Children often require a larger milligram per kilogram dose than an adult.

Allopathic medicine is less effective in the care of clients with:

Chronic illnesses.

What assessment question should the nurse ask a client whose original selective serotonin reuptake inhibitor (SSRI) has been replaced with venlafaxine to best determine the reason for the change? "Have you been feeling anxious lately?" "How long have you been taking the SSRI?" "Are you feeling more comfortable in social situations now?" "Were you finding it difficult to adhere to your SSRI therapy?"

Correct response: "Have you been feeling anxious lately?" Explanation: Venlafaxine is a standard first-line treatment for depression as well as generalized anxiety disorder, social phobia, and panic disorder. It would be prescribed if the client was now expressing anxiety in addition to depression. The medication would not be prescribed if progress was being made with social phobias. Questions about SSRI therapy would not be relevant.

The nurse is caring for a client whose current drug regimen includes mirtazapine 15 mg PO daily. What assessment question should the nurse prioritize? "How would you describe your mood and energy level today?" "On a scale from zero to ten, how would you rate your anxiety level?" "How are you feeling today?" "Are you feeling happier today than in the past?"

Correct response: "How would you describe your mood and energy level today?" Explanation: Mirtazapine is an antidepressant and it is prudent for the nurse to assess the client's mood and level of energy. Anxiety is not synonymous with depression and is not treated with this medication. Asking a client how the client feels is often too vague and open-ended to obtain meaningful data. Asking a client if she or she feels "happier" is a closed-ended (yes/no) question and could easily be interpreted by the client as downplaying the severity of depression.

A client has been taking fluoxetine (Prozac) for the last ten days. Today the client the clinic reporting not feeling any better. What is the nurse's best response to this client? "It may take another two to three weeks before the medication is completely effective." "I realize this is frustrating but most medications for mood disorders aren't fully effective for two to three months." "I will tell the healthcare provider and see if there is another medication that would be better." "Please come to the clinic immediately so you can be reassessed for suicidal thoughts."

Correct response: "It may take another two to three weeks before the medication is completely effective." Explanation: Fluoxetine may take up to four weeks to be completely effective. It would not be appropriate for the nurse to ask the healthcare provider to change the medication, and the client has not given any indication of suicidal ideation.

A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response? "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." "Herbal remedies often contain unknown doses of the desired ingredient, which can be dangerous." "It's very important that you not take the St. John's wort at the same time of day as your antidepressant." "It's very important that you comply with your prescribed treatment."

Correct response: "There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged." Explanation: The nurse should explain why this combination is not recommended rather than simply telling the client to comply without providing a rationale. It is true that many herbal remedies contain inconsistent doses, but this is not the primary risk of combining SSRIs with St. John's wort. Taking them at different times of day does not mitigate the risks of an unsafe reaction.

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline? "Use sugarless hard candies and gum to deal with dry mouth." "Take the drug daily in the morning for maximum benefit." "Be sure to eat a low fiber diet to prevent diarrhea." "Limit your fluid intake so you don't have to urinate during the night."

Correct response: "Use sugarless hard candies and gum to deal with dry mouth." Explanation: Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged, and would have no benefit. Similarly, a higher fiber diet would be beneficial for maintaining normal bowel function.

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period? 1 week 2 weeks 3 weeks 4 weeks

Correct response: 4 weeks Explanation: It may take up to 4 weeks before the full effect of an SSRI is noted.

The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity? A 44-year-old woman with a seizure disorder A 19-year-old man with organic brain disease A 45-year-old man with angina pectoris A 20-year-old woman with renal dysfunction

Correct response: A 45-year-old man with angina pectoris Explanation: Patients with cardiovascular disease are especially sensitive to the potential cardiotoxicity of nortriptyline and need to be monitored closely. Patients with a history of seizure activity, organic brain disease, and renal dysfunction do not face as high a risk of cardiotoxicity as patients with a preexisting cardiovascular disease.

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse? A 32-year-old man who is obese A 38-year-old woman who has diabetes An 11-year-old child with no other illnesses A 45-year-old man with liver impairment

Correct response: A 45-year-old man with liver impairment Explanation: Caution must be used when administering sertraline in clients with compromised liver function; therefore, the client with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these clients because the drug is extensively metabolized by the liver. The dosing schedule need not be adjusted in children or in clients with obesity or diabetes.

A client is prescribed isocarboxazid. The nurse is teaching the client about foods to avoid. Which would the nurse include in the teaching? (Select all that apply.) Aged blue cheese Red wine Pepperoni Whole milk Fresh shellfish Sour cream

Correct response: Aged blue cheese Red wine Pepperoni Sour cream Explanation: Isocarboxazid is an MAOI, which necessitates avoiding foods containing tyramine such as aged cheeses, red wines, smoked meats (i.e., pepperoni), and sour cream.

A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize? Blood pressure monitoring Pain assessment Pulse oximetry Monitoring the client for tardive dyskinesia

Correct response: Blood pressure monitoring Explanation: The drug-drug interactions that exist with the use of monoamine oxidase inhibitors create a high risk for hypertensive crisis. Blood pressure monitoring is thus among the priority assessments. Tardive dyskinesia is not among the varied signs and symptoms that can result from drug-drug interactions with MAOIs. The nurse should certainly monitor the client's pain and oxygenation, but blood pressure monitoring is the highest priority due to the likelihood and safety risks associated with hypertensive crisis.

A nurse educating a client starting phenelzine should educate the client to avoid which foods? (Select all that apply.) Blue cheese Pepperoni Apples Chocolate Celery

Correct response: Blue cheese Pepperoni Chocolate Explanation: A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid containing tyramine (aged cheese, sour cream, yogurt, beef, chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables, yeast extract, and soy sauce) as the combination can result in a life-threatening hypertensive crisis.

A nurse is caring for a patient with depression. The patient has been prescribed amitriptyline, a tricyclic antidepressant. What should the nurse identify as the effect of this antidepressant on the patient's body? Decreased reuptake of norepinephrine Increased serotonin in the nervous system Increased endogenous norepinephrine Increased endogenous epinephrine

Correct response: Decreased reuptake of norepinephrine Explanation: The nurse should identify decreased reuptake of norepinephrine as the effect of the tricyclic antidepressant on the patient's body. Increased serotonin in the nervous system, increased endogenous norepinephrine, and increased endogenous epinephrine are effects of monoamine oxidase inhibitors.

A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client? It may take up to two more weeks before the client feels better Improvements are likely evident to others even if not to the client The drug requires six to eight weeks before it reaches peak levels The client's pessimism is likely a symptom of the underlying depression

Correct response: It may take up to two more weeks before the client feels better Explanation: It may take up to 4 weeks before the full effect of a SSRI such as escitalopram is noted. This phenomenon is the most likely cause of the client's appraisal, not a lack of perspective or worsening symptoms.

A tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions? Monitor the client closely for bleeding and review coagulation indices when available. Monitor the client for tetany and review serum calcium levels when available. Ask the client at each meal about any episodes of gastroesophageal reflux. Assess the client's blood pressure every six hours for the first week of therapy.

Correct response: Monitor the client closely for bleeding and review coagulation indices when available. Explanation: Combining TCAs with warfarin creates a risk for bleeding, which should be addressed in the nursing care plan. There is no known interaction between TCAs and calcium supplements or bisphosphonates that would create a risk for hypocalcemia. TCAs do not heighten the risk of gastroesophageal reflux. TCAs can affect blood pressure, but this is unrelated to any known drug-drug interactions.

A client is to receive a tricyclic antidepressant. The nurse is reviewing the client's medical record. What would alert the nurse to a possible contraindication? Glaucoma Prostatic hypertrophy Renal dysfunction Recent myocardial infarction

Correct response: Recent myocardial infarction Explanation: A recent myocardial infarction would be a contraindication for use because of the potential occurrence of reinfarction or extension of the infarction due to the drug's cardiac effects. Cautious use and close monitoring would be appropriate for the client with glaucoma and prostatic hypertrophy due to the anticholinergic effects. Cautious use in renal dysfunction also is warranted because the drugs are excreted in the urine.

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication? SSRIs block GABA function. SSRIs prevent serotonin from being reabsorbed. SSRIs increase serotonin synthesis. SSRIs increase serotonin synthesis.

Correct response: SSRIs prevent serotonin from being reabsorbed. Explanation: Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotonin in the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or the number of binding sites. They do not influence the role of GABA

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication? She should have an ultrasound of the liver to check for disease. The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. The client should have monthly evaluation of liver function to monitor the disease progression. The client should not take any medications because of her liver dysfunction.

Correct response: The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects. Explanation: Sertraline should be administered with caution in clients with compromised liver function. Adjustments such as a lower dosage or less-frequent dosing schedule may be made for these clients.

A pt has been prescribed valproic acid for the treatment of myoclonic seizures. When reviewing this pts latest lab results for signs of adverse effects, what results should the nurse prioritize? A) Creatinine clearance B) Electrolytes C) White cell differential D) Liver enzymes

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression? The medications eliminate the risk of suicide during treatment. The onset of action is sooner than with other medications. The medications have no sexual side effects. The medications have fewer anticholinergic effects than alternatives.

Correct response: The medications have fewer anticholinergic effects than alternatives. Explanation: Currently, the selective serotonin reuptake inhibitors (SSRIs) are the first choice for treating depression. They are preferred over the tricyclic drugs and the MAOIs because they can be less damaging to the heart and have minimal anticholinergic and hypotensive effects. The selection of one SSRI over another is based on individual patient response to a drug and prescriber preference. Adverse effects, which are mild and brief, include gastrointestinal distress (anorexia, nausea, vomiting, and diarrhea), headache, fatigue, insomnia, and sexual dysfunction (delayed ejaculation, inability to achieve orgasm). SSRIs do not necessarily eliminate the risk of suicide.

Which medications exert their effects by inhibiting reuptake of norepinephrine and serotonin? Tricyclic antidepressants Selective serotonin reuptake inhibitors Monoamine oxidase inhibitors Atypical antidepressants

Correct response: Tricyclic antidepressants Explanation: Tricyclic antidepressants exert their effects by inhibiting reuptake of norepinephrine and serotonin. Selective serotonin reuptake inhibitors exert their effects by inhibiting reuptake of serotonin. Monoamine oxidase inhibitors, classified as MAOIs inhibit the activity of monoamine oxidase, a complex enzyme system responsible for inactivating certain neurotransmitters. Lithium is not a true antidepressant drug, it is grouped with the antidepressants because of its use in regulating the severe fluctuations of the manic phase of bipolar disorder (a mood disorder characterized by severe swings from extreme hyperactivity to depression).

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client? avoid use of soy sauce in the diet. adhere to combination drug therapy. discuss the cultural significance of taking an MAOI. avoid taking the drug on an empty stomach.

Correct response: avoid use of soy sauce in the diet. Explanation: The client should be instructed to avoid soy sauce, which contains high levels of tyramine. Potentially fatal pharmacodynamic interactions can occur with MAOIs when they are combined with foods rich in tyramine. The client's willingness to adhere to the combination therapy and the cultural significance of taking an MAOI, although important factors to be assessed, are not as important as this safety-related dietary consideration.

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which? dizziness. diarrhea. increased secretions. facial flushing.

Correct response: dizziness. Explanation: The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effects, not diarrhea and increased secretions. Facial flushing is not an identified adverse effect of phenelzine.

What medication is effective in treating enuresis in children older than 6 years of age? amitriptyline duloxetine imipramine venlafaxine

Correct response: imipramine Explanation: Imipramine is approved for treating childhood enuresis in children older than 6 years. Amitriptyline is a tricyclic antidepressant but is not used for childhood enuresis. Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is used for depression. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that is used for depression.

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline? urinary frequency urinary retention visual disturbances orthostatic hypotension

Correct response: orthostatic hypotension Explanation: Orthostatic hypotension, a common cause for falls, is an adverse effect related to tricyclic antidepressants like amitriptyline. Urinary retention (not frequency) is an adverse effect of amitriptyline but is not related to the falls. Visual disturbances are not a common adverse effect.

A client, prescribed fluoxetine 1 week ago, presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety? cardiac rate and rhythm presence of suicidal ideation improvement in the ability to concentrate indications of a type IV hypersensitivity reaction

Correct response: presence of suicidal ideation Explanation: It is essential to assess for suicidal thoughts or plans, especially at the beginning of selective serotonin reuptake inhibitor (SSRI) therapy or when dosages are increased or decreased. This supersedes the need to assess for concentration, cardiac function, or hypersensitivity.

A nurse is reviewing the serum lithium level of a pt w/ bipolar, which is 1.8 mEq/L. What is the nurse's best action? A) Inform the prescriber and perform a focused respiratory assessment B) Facilitate a transfer to the ICU C) Contact the prescriber and request a supplementary one of lithium D) Inform the prescriber and monitor for GI and CNS effects

A nurse is reviewing the structure and function of the blood-brain barrier. This anatomical feature would have the greatest effect on what aspect of nursing care? A) determining the site of damage after a traumatic brain injury B) assessing a pts cranial nerve function C) obtaining accurate electroencephalography readings D) administering antibiotics to treat brain infections

A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?

Dangerous drug interactions

A client is brought to the emergency department in the midst of acute alcohol withdrawal accompanied by seizure activity. What drug is most likely to meet this client's needs?

Diazepam

Disturbed energy field

A nurse is caring for a hospitalized patient who states: "I feel so sick all the time, my aura must be disturbed by all of these bad force fields." What is an appropriate NANDA diagnosis for this patient? a) Impaired coping b) Hopelessness c) Social isolation d) Disturbed energy field

Disturbed energy field Explanation: Defining characteristics of the disturbed energy field relate to movement, sounds, temperature change, visual changes, and disruption. The aura the patient is referring to in this scenario is a vague, luminous glow surrounding something that may be an information containing electromagnetic field, which can be likened to the data contained within a computer.

While writing a care plan for a client newly diagnosed with generalized seizures, the nurse might appropriately choose what nursing diagnosis?

Disturbed thought processes related to central nervous system effects

When teaching a patient on an MAO inhibitor, what would be important to include in the teaching?

Do not take OTC drugs.

The nurse evaluates the client's latest serum phenytoin level which is revealed to be 16 mcg/mL. What is the nurse's best action?

Document the fact that the client's phenytoin level is therapeutic

A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?

Dry mouth

Which of the following has been known to achieve benefits for clients with cancer through the use of the mind to visualize a positive physiologic effect?

Imagery

Which is the most important role of the nurse in using complementary and alternative therapies? a) Practicing guided imagery prior to surgery b) Providing nutrition supplements for weight gain c) Administering herbal supplements for anxiety d) Educating the public about safety and effectiveness

Educating the public about safety and effectiveness\ Explanation: The most important role of the nurse in using CAT is educating the public about the safety and effectiveness of using the therapies. Herbal supplements for anxiety and nutrition supplements may be considered part of a treatment plan but they are not the most important aspects of CAT. Guided imagery is one aspect of treatment included in CAT.

A client with a seizure disorder has had a recent change in medication. What assessments should the nurse perform in order to evaluate the effectiveness of the new drug? Select all that apply.

Evaluate laboratory drug level. C) Assess for adverse effects. D) Assess for change in seizure activity.

True or False: Acetylcholine is classified as a catecholamine.

False

True or False: An agent classified as a hypnotic is used primarily for preventing the feelings of tension or fear

False

True or False: Barbiturates are considered the sedative and hypnotic drugs of choice.

False

True or False: Eszopiclone is thought to react with norepinephrine to achieve its action

False

True or False: Zaleplon stimulates melatonin receptors to promote sleep

False

True or false: The development of diabetes mellitus is associated w/ the use of typical antipsychotics.

False; W/ atypical

True or false: During periods of dehydration, the pt is at risk for lower serum lithium levels.

False; at risk for higher levels

True or False: Dendrites route info away from the nerve cell while axons bring info to the nerve.

False; axons take info from nerve cells, dendrites bring info to the nerve

True or false: A pt w/ schizophrenia will exhibit fluctuations in mood swings from depression to mania.

False; characterized by hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Bipolar is associated w/ this.

A nursing instructor invites a nurse who specializes in healing touch to her classroom to discuss with students the effect healing touch has on pain management. This is an example of what? a) Allowing for discussion about adjuvant therapy b) Familiarizing students with CAM modalities c) Instructing students so they can use healing touch d) Evaluating the effect of healing touch on her students

Familiarizing students with CAM modalities Explanation: Some nurses may choose to become trained in particular CAM modalities and then integrate them into their own practice.

Which agent would a nurse identify as a selective serotonin reuptake inhibitor?

Fluvoxamine

A client is brought in to the emergency department by ambulance in status epilepticus. What drug would best halt this client's seizure activity?

Fosphenytoin

A nurse is teaching a class on holistic nutritional therapy to a group of young and middle-aged adults in the community. The nurse creates a menu of food and beverage choices and asks the group the select the best choices. The nurse determines that the teaching was successful when the group chooses which food? Select all that apply.

Fresh corn on the cob in season Organically grown chicken Bottled spring water

Ginger

A nurse is providing care to a client who has come to the outpatient clinic for chemotherapy. The client tells the nurse that to cope with the stress of chemotherapy, he uses a technique in which he "goes to my happy place, the beach, and I picture myself lying there under the warm sun, with the sound of the waves lapping at the shore." The nurse interprets this as which technique?

Guided imagery

A client is extremely anxious while awaiting the results of a biopsy. What action by the nurse will assist the client with progressive relaxation techniques?

Have the client tighten and release different muscle groups.

A client asks the nurse about the use of healing touch. Which statement regarding healing touch is accurate?

Healing touch does not use injections.

A client asks the nurse about the use of healing touch. Which statement regarding healing touch is accurate? a) Healing touch does not use injections. b) Healing touch is too expensive for most clients. c) Supplemental music is used during healing touch. d) Aromatherapy is used in healing touch.

Healing touch does not use injections. Explanation: Healing touch has been shown to be effective in helping clients relax and improve the healing process. It is not expensive because it involves no special equipment, including insertion of tubes or injections. Aromatherapy and supplemental music are not routinely used in healing touch

The nurse is caring for a patient whose treatment has been based on the Ayurveda medical system. Which nursing intervention incorporates this patient's beliefs into the nursing plan? a) Including the patient's shaman in the plan of care b) Preparing the patient for exercises that help the patient regulate qi c) Basing practice on the yin-yang theory d) Helping the patient to balance his dosha

Helping the patient to balance his dosha Explanation: Central to Ayurvedic medicine is an understanding of th patient's basic constitution, or dosha. The three doshas in Ayurvedic medicine are vata (changeable), pitta (intense), and kapha (relaxed). Yin-yang and qi are associated with traditional Chinese medicine. A shaman is associated with shamanism (involves the spirit world)

A home care nurse delivers care that incorporates a philosophy that focuses on connections and interactions between parts of the whole. Which term best describes this philosophy? a) Complementary therapy b) Holism c) Homeopathy d) Integrative care

Holism Explanation: Holism is a theory and philosophy that focuses on connections and interactions between parts of the whole. Complementary therapy can be used to complement traditional medical interventions. Integrative care often incorporates sharing the responsibility in coordinating the best possible treatment plan for a client, including the client's choices for care and the provider's expertise. Homeopathy is based on the belief of supporting the body while the symptoms are allowed to "run their course."

The nursing instructor is discussing alternative therapy with a group of students. She explains that living organisms are "continuously connecting and interacting with their environment." Furthermore, the connecting and interacting signifies that the human body is a unified dynamic whole. The instructor is describing what theory to the students?

Holism perspective

Holism perspective Explanation: The instructor is describing the definition of holism. Integrative perspective is combining allopathic and complementary and alternative therapy (CAM). The medical system perspective is based on a philosophy and theory about health and illness along with specific types of treatment that may be based in culture. The allopathic perspective is based in biomedicine. Holism is the only perspective that is looking at parts interacting with each other and the environment.

The nurse is caring for a client diagnosed with generalized seizures and will appropriately administer what classifications of medications to this client? Select all that apply.

Hydantoins E) Benzodiazepines Succinimides

A nurse is caring for a client who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Hypertension

A nurse is researching a standardized herbal supplement to help a client with pain. What does the word standardized mean? a) It can be toxic in higher-than-normal doses. b) It is not contaminated by other ingredients. c) It contains a certain amount of an active ingredient. d) It is an all-natural product.

It contains a certain amount of an active ingredient. Explanation: A standardized product means that it contains a certain amount of active ingredient. Since this industry is not regulated, contamination and inconsistency in the amount of product sometimes occur.

It may take up to two more weeks before the client feels better

A client with liver cirrhosis and hepatitis C needs an antiepileptic drug. What drug would be safest for this client?

Levetiracetam

The provider believes that a client with absence seizures would benefit from the administration of ethosuximide or methsuximide. On what basis would ethosuximide be most likely preferred?

Methsuximide has more severe adverse effects than ethosuximide.

Monitor the client closely for bleeding and review coagulation indices when available.

A client, newly diagnosed with a seizure disorder, has been prescribed valproic acid. When assessing for adverse effects, what assessment should the nurse prioritize?

Monitoring the client's liver enzyme levels.

The client has been diagnosed with a disease and is seeking information about naturopathy. The nurse, explaining about naturopathy, encourages the client to do what?

Obtain adequate sleep each night.

Parasympathetic nervous system

An occupational therapist conducts daily relaxation exercises with clients who are receiving treatment on the psychiatric unit of a hospital. Stimulation of which of the following components of the nervous system will result in relaxation for the clients? a) Parasympathetic nervous system b) Autonomic nervous system c) Sympathetic nervous system d) Central nervous system

Parasympathetic nervous system Explanation: Stimulation of the parasympathetic nervous system results in an alleviation of stress. Direct stimulation of the sympathetic nervous system increases stress. The autonomic nervous system encompasses both the sympathetic and parasympathetic divisions. The central nervous system consists of the brain and spinal cord; neither is stimulated to facilitate relaxation.

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)? 14 days 1 day 7 days 10 days

Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.

The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?

Phenelzine

A client is admitted to the emergency department with severe recurrent convulsive seizures. What drug should the nurse expect to be ordered for use in emergency control of status epilepticus?

Phenobarbital

The client, newly diagnosed with epilepsy begins to show signs of seizure activity. What is the nurse's priority action?

Protect the client's safety.

A client at the clinic is considering the use of acupuncture to assist with smoking cessation. When describing this practice, the nurse would explain that which concept is involved as the focus?

A client is to receive a tricyclic antidepressant. The nurse is reviewing the client's medical record. What would alert the nurse to a possible contraindication?

Recent myocardial infarction

The nurse is providing client education for a client newly prescribed a hydantoin antiseizure medication. The nurse has taught the client about the need to taper down the dose of the drug slowly when the provider decides it should be discontinued. What benefit of tapering should the nurse describe?

Reduced risk of status epilepticus

Which principle does not encompass the basic goals of integrative medicine?

Reject allopathic medicine and embrace CAM practices.

Which principle does not encompass the basic goals of integrative medicine? a) Facilitate the body's innate healing abilities. b) Focus on promoting health and preventing illness, as well as treating disease. c) Establish a partnership between client and practitioner. d) Reject allopathic medicine and embrace CAM practices.

Reject allopathic medicine and embrace CAM practices. Explanation: Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, spirit, and community), including all aspects of lifestyle. It does not reject allopathic medicine and CAM practices. It includes establishing a partnership between client and practitioner, facilitating the body's innate healing abilities, and focusing on promoting health and preventing illness, as well as treating disease.

The nurse is caring for a client receiving ethotoin to control seizure activity. When reviewing the client's laboratory results, the nurse learns that the client's serum ethotoin level is 67 mcg/mL. What is the nurse's best action?

Report this to the provider and monitor for signs of toxicity.

A client has been prescribed phenytoin for the treatment of seizures. How should the nurse most accurately determine whether the client has therapeutic levels of the medication?

Review the client's laboratory blood work.

The client's serum levels of phenytoin have been above therapeutic limits several times in the past few months. The nurse should perform what assessments? Select all that apply.

Reviewing the client's liver enzyme levels B) Reviewing the client's levels of formed blood components C) Integumentary assessment blood pressure

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

SSRIs prevent serotonin from being reabsorbed.

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

Salami

Following a thorough health history and assessment, a client's health care provider has diagnosed the client with depression. The nurse should anticipate that the client will likely be prescribed what classification of antidepressant?

Selective serotonin reuptake inhibitor

After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?

Selective serotonin reuptake inhibitors

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time?

Several weeks after stopping the paroxetine

A client taking phenelzine is at a dinner party and has several glasses of red wine. The client begins to feel nauseated and develops a terrible headache. The client is taken to the nearest emergency department. This client might be experiencing a hypertensive crisis. As the nurse in the ED, what other symptoms might the client experience if they are having a hypertensive crisis? (Select all that apply.)

Tachycardia, Stiff neck, Chest pain

The nurse, working in the emergency room, admits an 18-month-old toddler with influenza symptoms reported by the parents to have had a seizure. Further questioning of the parents indicates the toddler likely had a clonic-tonic seizure, which has never happened before. What is the nurse's priority action?

Take the child's temperature.

A client with a history of partial seizures has been taking lamotrigine for the past several days. The client calls the clinic and reports the development of a facial and torso rash to the nurse. What is the nurse's best action?

Tell the client to take no further doses and come be assessed at the clinic immediately.

Which of these assessment findings indicate a positive outcome for a client after acupuncture? a) The client has increased his or her flexibility and strength. b) The client has lost 8 pounds over the last 2 months. c) The client reports a reduction in pain level to 3 out of 10. d) The client has improved balance and coordination.

The client reports a reduction in pain level to 3 out of 10. Explanation: Acupuncture can help with reduction of pain and nausea with clients. It is not a treatment for balance and coordination, strength and flexibility, or weight loss.

A 21-year-old client is distraught about the implications of his recent diagnosis of seizure activity. When addressing this client's most likely psychosocial needs, what topic should the nurse address?

The client's loss of their driver's license

A client has a new diagnosis of a seizure disorder. What aspect of this client's health status would contraindicate the use of carbamazepine?

The client's most recent blood work reveal pancytopenia.

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.

A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication?

The medication should be taken once a day in the morning.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

The medications have fewer anticholinergic effects than alternatives.

The nurse investigates herbs that may stimulate the client's immune system. The nurse encourages the client to join a yoga class. The nurse teaches the client how to meditate. The nurse uses guided imagery to relieve client anxiety.

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient? Drowsiness Extreme sadness Severe headache Dilated pupils

The nurse should monitor the patient for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are the symptoms of hypertensive crisis.

A nurse who "unblocks" and "clears" congested areas of energy in a client's body to promote comfort is applying the phenomenon known as: a) "Unruffling" touch b) Tactile manipulation c) Interpersonal touch d) Therapeutic Touch (TT)

Therapeutic Touch (TT) Explanation: Therapeutic Touch (TT) involves "unruffling," or clearing, congested areas of energy in the body and redirecting this energy. After assessing a client's "energy field," the nurse uses therapeutic touch to promote comfort, relaxation, healing, and a sense of well-being

A holistic nurse is caring for a client experiencing anxiety. The nurse assesses the client's energy field then uses her hands to promote comfort and a feeling of well being. This practice is termed: a) massage therapy. b) hatha yoga. c) aromatherapy. d) Therapeutic Touch (TT).

Therapeutic Touch (TT). Explanation: Therapeutic touch involves "unruffling," or clearing, congested areas of energy in the body and redirecting this energy. After assessing a client's "energy field," the nurse uses therapeutic touch to promote comfort, relaxation, healing, and a sense of well-being. Massage therapy is performed by a licensed massage therapist. Hatha yoga is the practice of slow and balanced postures taught by a yoga instructor. Aromatherapy involves the use of scents, not touch, as therapy.

There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."

What is the major reason that monoamine oxidase inhibitors (MAOs) are rarely used in clinical practice today?

They may cause dangerous interactions with some foods and drugs.

In which CAM modality are the concepts of Yin and Yang important for diagnosis? a) Traditional Chinese Medicine b) Therapeutic Touch (TT) c) meditation d) botanicals

Traditional Chinese Medicine Explanation: Diagnosis in Traditional Chinese Medicine is based in the balance, or lack thereof, of Yin and Yang. Yin and Yang are both aspects of qi, which is considered a vital life force.

True or False: GABA plays an important role in preventing overexcitability

True

True or False: Respiratory distress is a contraindication for the use of barbiturates.

True

True or False: The CNS consists of the brain and spinal cord

True

True or False: The circle of Willis distributes blood to the brain as needed.

True

True or false: Mania is characterized by extreme overactivity and excitement.

True

True or false: Typical antipsychotics block dopamine receptors.

True

According to survey results, who are the most prevalent users of complementary or alternative therapies? a) Women, ages 25-40, with high school degree, who smoke b) Men, ages 50-65, with some high school, who smoke c) Men, ages 30-45, with college degree, who recently stopped smoking d) Women, ages 35-50, with college degree, former smokers

Women, ages 35-50, with college degree, former smokers Explanation: The most prevalent users of CAT are women, ages 30-69, with higher levels of education, who are former smokers.

A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?

Yogurt

The nurse is working with the interdisciplinary team to plan the care of a client newly diagnosed with epilepsy. What factors should the team consider when determining the drug of choice for the client? Select all that apply.

age,culture,type

A client suffers from chronic pain. The nurse suggests the client have monthly massages. This is an example of:

alternative medicine.

The nurse anticipates a reduced dosage of anticonvulsants due to cultural differences when caring for clients from what cultural groups? Select all that apply.

asian and Arab

A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?

avoid use of soy sauce in the diet.

A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?

dizziness

Anticholinergic effects

dry mouth constipation photophobia blurred vision Tachycardia

The mind and body are connected in the provision of care. This statement describes:

holistic care.

The mind and body are connected in the provision of care. This statement describes: a) holistic care. b) altruistic care. c) homeopathic care. d) allopathic care.

holistic care. Explanation: Holistic interventions focus on the interrelated needs of body, mind, emotions, and spirit.

Which laboratory value would prevent a client from being prescribed duloxetine?

increased alanine aminotransferase level (ALT)

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?

orthostatic hypotension

A client prescribed fluoxetine 1 week ago presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety?

presence of suicidal ideation

The nurse is caring for an 84-year-old client in the acute care facility who was newly diagnosed with a seizure disorder. Before starting the client on an antiepileptic medication that will be continued after discharge, what laboratory studies should the nurse assess? Select all that apply.

renal and liver

On the advice of friends, a client on a palliative care unit has requested acupuncture. What it is the goal of this form of CAM?

restoring a healthy flow of energy along the meridians of the body

On the advice of friends, a client on a palliative care unit has requested acupuncture. What it is the goal of this form of CAM? a) allowing accumulated toxins to be released from the body b) altering the client's perception and acceptance of reality c) restoring a healthy flow of energy along the meridians of the body d) reconnecting the client's body, spirit, and emotions

restoring a healthy flow of energy along the meridians of the body Explanation: Acupuncture either increases or decreases the flow of qi along the meridians of the body. It does not directly address the relationships between body, spirit, and emotions, nor does it aim to release toxins or change an individual's perception of reality.

The client has a seizure that causes rhythmic twitching of the left hand for 90 seconds with no loss of consciousness and then stops. The nurse notes this same action repeated many times throughout the day and documents this as what type of seizure?

simple partial seizure

The nurse is educating a client on how to use herbs and supplements as part of an integrated treatment plan. Which teaching points would the nurse include? Select all that apply. a) Whenever possible, buy products with more than one ingredient. b) Take a higher than recommended dose of herbs to initiate the therapeutic effect. c) Be knowledgeable about the product and its therapeutic actions. d) Buy herbs and supplements that are standardized. e) Give the product adequate time to work. f) Use the Internet to buy herbs and supplements.

• Be knowledgeable about the product and its therapeutic actions. • Buy herbs and supplements that are standardized. • Give the product adequate time to work. Explanation: In the United States, FDA classifies herbs as a food and not a drug. This is important because herbs are not regulated for quality and potency as drugs are, and herbal formulas can be sold without being studied to see if they are helpful or harmful. For these reasons, herbs that have a certain degree of standardization should be purchased. There needs to be adequate time given for levels to accumulate in the client's system. Some herbs are either contraindicated or cause a synergistic effect when ingested with certain medications.

In prenatal classes, the nurse teaches pregnant clients to use meditation during labor contractions to ease the pain. What does the nurse explain to the pregnant clients are the elements of meditation? Select all that apply. a) Closed attitude b) Massaging abdomen c) Quiet environment d) Comfortable position e) Focus of attention

• Comfortable position • Quiet environment • Focus of attention Explanation: There are four elements common to most types of meditation: comfortable position, quiet environment, focus of attention, and open attitude. Closed attitude and massaging abdomen are not elements of medication

A nurse is teaching an overweight patient the holistic approach to choosing foods. Which teaching points would the nurse include? (Select all that apply.) a) Reduce intake of refined and natural sugars. b) Consider adopting a vegetarian diet. c) Eat foods that are in season. d) Avoid organically grown foods. e) Replace refined sugars with artificial sweeteners. f) Increase intake of dairy products

• Eat foods that are in season. • Reduce intake of refined and natural sugars. • Consider adopting a vegetarian diet. Explanation: Eating foods that are in season is suggested because foods produced "out of season" are treated with chemicals to ripen them since they are picked before ripening. Reducing the intake of refined and natural sugars is best because of the negative effects of these substances. A vegetarian diet can be beneficial because animals are increasingly fed antibiotics and potentially contaminated foods. Also, increasingly, fish are being contaminated with mercury and other pollutants.

A nurse attempts to integrate complementary and alternative therapies (CAT) into nursing practice. Which of the following are basic principles of CAT? Select all that apply. a) Illness occurs in either the mind or the body, which are separate entities. b) Health is the absence of disease. c) Health is a state characterized by a dynamic balance of mind, body, and spirit. d) Illness is a manifestation of imbalance or disharmony and is a process. e) Curing is accomplished by external agents.

• Health is a state characterized by a dynamic balance of mind, body, and spirit. • Illness is a manifestation of imbalance or disharmony and is a process. Explanation: In CAT, health is a state characterized by a dynamic balance of mind, body, and spirit; illness is a manifestation of imbalance or disharmony and is a process. In this system, healing is a natural, slow process that involves the body, mind, and spirit.

A nurse who has incorporated complementary and alternative medicine (CAM) into nursing practice is caring for a client in a short-term care facility. Which examples of nursing interventions are based on CAM? Select all that apply. a) The nurse encourages the client to join a yoga class. b) The nurse administers pain medication prescribed by the primary care provider. c) The nurse teaches the client how to meditate. d) The nurse investigates herbs that may stimulate the client's immune system. e) The nurse uses guided imagery to relieve client anxiety. f) The nurse schedules diagnostic tests for the client.

• The nurse encourages the client to join a yoga class. • The nurse teaches the client how to meditate. • The nurse investigates herbs that may stimulate the client's immune system. • The nurse uses guided imagery to relieve client anxiety. Explanation: The term complementary and alternative medicine refers to interventions that are complementary therapies (CAM—they can be used with traditional medical interventions and thus complement them) as well as alternative modalities (not included in the scope of conventional medical care). Herbal remedies, yoga, meditation, and guided imagery are all forms of CAM. Administering pain medication and scheduling diagnostic tests are traditional allopathic (biomedicine) therapies

Sarah Stevens is an 85-year-old woman who is in the hospital recovering from hip replacement surgery. She is scheduled to go home in 2 days. According to the Health Belief Model, which factors would be important to assess before Sarah goes home? Select all that apply. a) what she has heard about recovering from this procedure b) her expectations for recovery c) her living environment d) how she has recovered from previous procedures e) whether or not she feels safe in her home

• her expectations for recovery • what she has heard about recovering from this procedure • how she has recovered from previous procedures • her living environment • whether or not she feels safe in her home Explanation: The Health Belief Model asserts that certain factors influence a person's health and the way they respond to illness. These factors include personal expectations in relation to health and illness, earlier experiences with health and illness, sociocultural context, and age and developmental state.

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