NCLEX ?s

Acute mania

The client is demonstrating an expansive mood, high-energy level, racing thoughts, and disjointed thinking. Any type of stimulation will distract the client from the current conversation. This behavior is indicative of the acute manic phase of mania.

A nurse is teaching a psychiatric client about his ordered drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs?

The client is experiencing less psychosis and a decrease in extrapyramidal symptoms.

The nurse is caring for an elderly client with depression who is being treated with a tricyclic antidepressant (TCA). What are clinical manifestations that would alert the nurse that the client is experiencing a complication of treatment with the TCA?

The client reports dizziness with movement from a sitting to standing position. • The client describes voiding frequently, with a feeling of the inability to completely drain her bladder.

what would the nurse assess with opioid withdrawal

The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation.

A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?

The student accepts a referral to a substance abuse counselor.

A client with a diagnosis of depression is started on imipramine, 75 mg by mouth at bedtime. The nurse should tell the client that:

this medication may initially cause tiredness, which should become less bothersome over time.

Chlorpromazine

used to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis.

Benztropine

used to treat extrapyramidal symptoms associated with antipsychotic therapy.

The client with acute mania states to the nurse, "I am the prince of peace and can save the world. Those against me will find me and take me to another world. They will come. I know it." The client is beginning to scan the room and starts to repeat his delusion. Which response by the nurse is most therapeutic?

walk around the unit for awhile

A nurse is preparing discharge instructions for a client with resistant depression who was prescribed a new medication regimen that includes phenelzine (Nardil). If the teaching was successful, what foods should the client state that he needs to avoid?

• Aged cheese. • Wine. • Salami. Phenelzine is an MAO inhibitor. MAO is an enzyme responsible for metabolizing neurotransmitters, serotonin and norepinephrine. This drug requires being on a tyramine-free diet

The nurse is admitting a client with a panic attack to the emergency department. Which findings should the nurse anticipate?

• Chest pain, palpitations, vertigo • Sweating, tremors, nausea • Hot flashes, abdominal distress, chills

Characteristics that predispose a client to alcohol abuse

• Low self-esteem and depression • Family history of alcoholism antisocial and borderline personality also, due to the impulsive nature

Common symptoms of PTSD

• PTSD is characterized by nightmares and flashbacks. • Hypervigilance is characteristic of clients with PTSD. • Substance abuse is a common coping mechanism used by clients with PTSD. • Psychotic episodes can occur in clients with PTSD. • Clients with PTSD may complain of feeling empty inside.

A nurse is caring for a client with borderline personality disorder. Which interventions are appropriate for clients with this disorder?

• Providing emotional consistency. • Ensuring the client's safety. • Promoting gradual separation and individuation. • Exploring anger in appropriate ways.

physiological symptom is suggestive of cocaine intoxication

• Psychomotor agitation • Cardiac arrhythmias • Respiratory depression • Dilated pupils

A client has been diagnosed with an adjustment disorder with mixed anxiety and depression. What are the primary nursing diagnoses the nurse would associate with this type of adjustment disorder?

• Risk for situational low self-esteem. • Impaired social interaction.

tranylcypromine foods to avoid

Cheese and yeast products contain tyramine, which the client should avoid to prevent a negative interaction with tranylcypromine, a monoamine oxidase (MAO) inhibitor. Sodium will not interact with tranylcypromine, and neither exercise nor sugar needs to be limited. can lead to hypertensive crisis

Chlordiazepoxide

Chlordiazepoxide and other sedatives help reduce the symptoms of alcohol withdrawal but don't decrease cravings.

A client with a diagnosis of major depression is ordered clonazepam for agitation in addition to an antidepressant. Client teaching should include which statement?

Clonazepam may have a slight depressant effect.

naltrexone

Naltrexone is a drug that can decrease alcoholic cravings.

A nurse in a psychiatric care unit finds that a client with psychosis has become violent and has struck another client in the unit. What action should the nurse take in this case?

Restrain the client, as he is harmful to the other clients.

A client is prescribed bupropion to treat depression. The nurse should monitor the client for which adverse reactions associated with bupropion therapy?

Seizures • Anxiety • Insomnia

A client who is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mm Hg, and pulse is 92 bpm. Which medication should the nurse expect to administer?

lorazepam The benzodiazepine substitutes for the alcohol to suppress withdrawal symptoms. The client experiences symptoms of withdrawal because of the "rebound phenomenon" when sedation of the central nervous system (CNS) from alcohol begins to decrease.

When assessing a client with possible alcohol poisoning, the nurse should investigate the client's use of which substance while drinking alcohol?

marijuana

Haloperidol

may be given to treat clients with psychosis, severe agitation, or delirium.

A client is brought in by police to a mental health clinic for admission for bipolar disorder. During the initial phase of the client's treatment, which of the following interventions would benefit the client in the manic phase of bipolar disorder? Select all that apply.

Communication with the client should be clear and direct. • Encourage the client to avoid extraneous environmental stimuli. • Provide the client with frequent, small meals in the form of finger foods.

the nurse is admitting a client in methamphetamine withdrawal. Which findings should the nurse anticipate?

Fatigue, mental depression, and confusion

The nurse is assessing a client with depression. Which of the following findings should the nurse anticipate?

Major depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities, with signs and symptoms recurring for at least 2 weeks. Symptoms of this illness include the following: anergia, depressed mood, sleep disturbances, difficulty in functioning at work, grooming, and problems concentrating and making decisions.

A nurse is planning care for a regressed, chronically ill client diagnosed with schizophrenia. What is the most appropriate milieu?

Nurturance and supportive interaction focusing on individual needs.

How long to stop taking phenelzine before beginning fluoxetine

Phenelzine is a monoamine oxidase inhibitor (MAOI), and fluoxetine is a selective serotonin receptor inhibitor (SSRI). A period of 14 days is required between stopping an MAOI and starting an SSRI to decrease the likelihood of "serotonin syndrome," a potentially lethal consequence.

Bipolar manic symptoms

Symptoms of pressured speech, grandiose mood, delusions, and flight of ideas

Paroxetine

is a selective serotonin reuptake inhibitor antidepressant that also can be used to treat anxiety. Improved concentration, verbalization of feelings, and decreased agitation or pacing are signs of improvement.

A serious, life-threatening reaction to MAO

is hypertensive crisis. Although this medication usually reduces blood pressure, it can, in combination with too much tyramine (present in other drugs and foods), cause blood pressure to rise to a dangerous level

Tardive dyskinesia

occurs with long-term use of antipsychotic agents. It's characterized by irregular, repetitive, involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, and rapid blinking.

A client has been taking carbamazepine for 2 years. The nurse should assess the client for which of the following?

Bruising. • Sore throat. signs of hepatic dysfunction, such as light-colored stool or dark-colored urine. bone marrow depression used to treat seizures and nerve pain

Behavioral clues that suggest the potential for violence in antisocial personality disorder

include a rigid posture, restlessness, glaring, a change in usual behavior, clenched hands, overtly aggressive actions, physical withdrawal, noncompliance, overreaction, hostile threats, recent alcohol ingestion or drug use, talk of past violent acts, inability to express feelings, repetitive demands and complaints, argumentativeness, profanity, disorientation, inability to focus attention, hallucinations or delusions, paranoid ideas or suspicions, and somatic complaints. Violent clients rarely exhibit depression, silence, or hypervigilance.

symptoms of depression

include depressed mood, anhedonia, appetite disturbance, sleep disturbance, psychomotor disturbance, fatigue, feelings of worthlessness, excessive or inappropriate guilt, decreased concentration, and recurrent thoughts of death or suicide

severe toxicity

Symptoms of severe lithium toxicity include ataxia, giddiness, blurred vision, and severe hypotension.

A woman has become increasingly afraid to ride in elevators. While in an elevator one morning, she experiences shortness of breath, palpitations, dizziness, and trembling. A physician can find no physiological basis for these symptoms and refers her to a psychiatric clinical nurse specialist for outpatient counseling sessions. Which type of therapy is most likely to reduce the client's anxiety level?

Systematic desensitization

The physician has placed a client who has suffered the loss of a child on a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse is aware that the greatest risk for suicide would be during which time period?

Ten to fourteen days after the initial medication regime is implemented

For the client with a substance abuse problem, which intervention would be most helpful to aid the client in dealing with feelings and concerns related to alcohol and drugs?

group therapy

A client with mania

has inflated self-esteem, and displays an abnormal and persistently elevated, expansive, and irritable mood.

Hypomania

is a mania phase characterized by an abnormally elevated mood, signs of inflated self-esteem, decreased sleep, flight of ideas, and pleasure-seeking behaviors. This phase lasts for 4 days or less. The delirious mania phase is when the client exhibits signs and symptoms of mania and delirium.

Magnesium sulfate

other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

The physician orders haloperidol, 5 mg I.M for a client experiencing hallucinations. The nurse understands that this drug is used in this client to treat:

psychosis

Normal lithium levels

range from 0.6 to 1.2 mEq/L. Blood work should be done at least 12 hours after a client's last dose of lithium. administered only in oral form

Psychomotor agitation

seen in depression constant motion, such as pacing, wringing hands, biting nails, and other types of energetic body movements.

symptoms of delirium withdrawal

symptoms of agitation, elevated pulse, and perceptual distortions

What information should the nurse plan to include when teaching the client and family about a substance abuse problem?

the physical, physiologic, and psychological effects of substances

Naloxone

used in opioid overdose to reverse the CNS depression caused by the opioid.

he client with dual diagnoses of major depression and alcohol abuse states, "I only drink when I can't sleep." Which outcome is important for the client to achieve first?

verbalize the desire to stop drinking

The nurse is assessing a 38-year-old client at risk for suicide. What assessment data would determine whether a client will require hospitalization?

• Being intoxicated with alcohol • A description of command hallucinations • Having an organized plan

The client with depression who is taking imipramine states to the nurse, "My health care provider (HCP) wants me to have an electrocardiogram (ECG) in 2 weeks, but my heart is fine." Which response by the nurse is most appropriate?

"It is routine practice to have an ECG periodically because there is a slight chance that the drug may affect the heart."

The nurse is assessing a 38-year-old client at risk for suicide. Which of the following are significant assessment data when determining whether a client will require hospitalization?

"You told me you got fired from your last job for missing too many days after taking drugs all night." Encouraging the client to elaborate about his experience while getting high may reinforce his abusive behavior.

The nurse is counseling a client regarding treatment of the client's newly diagnosed depression. The nurse emphasizes that full benefit from antidepressant therapy usually takes how long?

2-4 wks

A nurse is teaching new staff members about groups considered at highest risk for suicide. Which group should the nurse emphasize?

Adolescents, men older than age 45, and persons who are unemployed

A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis?

Alprazolam, 0.25 mg orally every 8 hours Alprazolam's antianxiety properties make it the most appropriate medication for this client. It should only be given very short term because of its addictive a potential and the client should be weaned off from it.

lithium toxicity

Findings include coarse hand tremors, muscle twitching, and mental confusion.

A client is diagnosed with dependent personality disorder. Which behavior is most likely to be evidence of Ineffective coping?

Inability to make choices and decisions without advice Individuals with dependent personality disorder typically show indecisiveness, submissiveness, and clinging behaviors so that others will make decisions for them. These clients feel helpless and uncomfortable when alone and don't show interest in solitary activities.

A client is prescribed buspirone 5 mg two times a day. Which statements indicate that the client has understood the nurse's teaching about this drug?

Buspirone is aserotonin agonist. Serotonin is the neurotransmitter implicated in depression. Buspirone reduces symptoms of worry, apprehension, difficulty with concentration, and irritability. It does not produce dependence, withdrawal, or tolerance. Full therapeutic benefit takes 3 to 6 weeks.

A client has been receiving chlorpromazine, an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?

Tremors, shuffling gait, and masklike face

The nurse is caring for a client with an irritable mood, grandiose thinking, impulsive hyperactive behaviors, and little sleep. Which of the following is the nurse's best initial approach?

Use a calm but firm approach with the client

When teaching a client with bipolar disorder, mania, who has started to take valproic acid about possible side effects of this medication, the nurse should include which of the following in the teaching plan?

Valproic acid causes sedation as well as nausea, vomiting, and indigestion. Sedation is important because the client needs to be cautioned about driving or operating machinery that could be dangerous while feeling sedated from the medication.

client has been taking phenelzine for atypical depression. The primary care provider is discontinuing the phenelzine and initiating therapy with fluoxetine. The nurse should instruct the client to:

Wait 14 days after stopping phenelzine before starting fluoxetine.

Which characteristic is most common among suicidal clients?

ambivelance

When developing appropriate assignments for the staff, which client should the nurse manager judge to be at highest risk for suicide completion?

an 85-year-old Caucasian man who lives alone after his wife's death

Buspirone

antianxiety agent but takes several weeks before it is effective in reducing anxiety. Thus it would not help this client who needs immediate assistance.

The nurse observes that a client on a psychiatric unit is looking around the room with eyes darting to a chair in the corner. The client grimaces then states, "Bastard," under his breath. Which of the following nursing actions is most appropriate?

approach the client and interrupt the hallucinations

Which condition is commonly seen in clients who abuse cocaine?

bipolar crying

amitriptyline hydrochloride s/e's

blurred vision, dry mouth, and constipation, urinary retention

meds to help OCD

clomipramine or fluoxetine

side effects of lithium

diarrhea and electrolyte imbalances

Schizophrenia is characterized by:

disturbances in affect, perception, and thought content and form.

A client diagnosed with major depression has started taking amitriptyline hydrochloride, a tricyclic antidepressant. What is a common adverse effect of this drug?

dry mouth