.Neuro-Antipsychotics & Anti-seizure

An adolescent client diagnosed with a psychosis is having difficulty maintaining friendships at school. Which behavior does the nurse suspect is the cause of the client's difficulty with peer relationships? 1. Laughing inappropriately at sad events 2. Tremors and contraction of the extremities, drooling, and eyes rolling back in the head 3. Tremors, palpitations, diaphoresis, and tachycardia 4. Lack of energy, sleepiness, inability to concentrate, and inability to perform activities of daily living

Correct Answer: 1 Rationale 1: Laughing inappropriately at sad events is a symptom of a psychotic episode. Rationale 2: Tremors and contraction of the extremities, drooling, and eyes rolling back in the head are signs of a seizure. Rationale 3: Tremors, palpitations, diaphoresis, and tachycardia are signs of an anxiety attack. Rationale 4: Lack of energy, sleepiness, inability to concentrate, and inability to perform activities of daily living are signs of depression. Global Rationale: Laughing inappropriately at sad events is a symptom of a psychotic episode. Tremors and contraction of the extremities, drooling, and eyes rolling back in the head are signs of a seizure. Tremors, palpitations, diaphoresis, and tachycardia are signs of an anxiety attack. Lack of energy, sleepiness, inability to concentrate, and inability to perform activities of daily living are signs of depression.

A client is treated in the emergency department for injuries received after running through thick brush in the woods. The client relates being followed by a large man in dark clothing. A witness to this event claims there was no one chasing the client into the woods. Which item should the nurse further assess this client for based on the information provided? 1. A list of current prescription medications 2. Symptoms of depression 3. Family members' interpretation of the event 4. Whether the client might require restraints

Correct Answer: 1 Rationale 1: Reviewing a list of current medications might help to determine whether the client is being treated for a psychosis. Rationale 2: There is nothing in the scenario that indicates the client needs screening for depression. Rationale 3: Family members may or may not have witnessed the event. Rationale 4: There is nothing in the scenario that indicates the client needs restraining devices. Global Rationale: Reviewing a list of current medications might help to determine whether the client is being treated for a psychosis. There is nothing in the scenario that indicates the client needs screening for depression. Family members may or may not have witnessed the event. There is nothing in the scenario that indicates the client needs restraining devices.

The client is receiving carbamazepine (Tegretol) for control of seizures. The client tells the nurse she plans to become pregnant. Which response by the nurse is the most appropriate? 1. "Please talk to your doctor; this drug is contraindicated in the pregnancy." 2. "Your medication dose will need to be decreased during your pregnancy." 3. "Your medication dose will need to be increased during your pregnancy." 4. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)."

Correct Answer: 1 Rationale 1: Carbamazepine (Tegretol) falls under pregnancy category D and is contraindicated in pregnancy. Rationale 2: The medication does not need to be decreased; it might need to be stopped. Rationale 3: The medication does not need to be increased; it might need to be stopped. Rationale 4: Valproic acid (Depakene) is also a pregnancy category D drug and is contraindicated during pregnancy. Global Rationale: Carbamazepine (Tegretol) falls under pregnancy category D and is contraindicated in pregnancy. The medication does not need to be decreased or increased; it might need to be stopped. Valproic acid (Depakene) is also a pregnancy category D drug and is contraindicated during pregnancy.

The client says to the nurse, "My doctor said that I will always have to take medicine to control the seizures from my epilepsy. Is that so?" What is the best response by the nurse? 1. "You will need to take medication on a continuous basis to control the seizures." 2. "You will have to take the medication until your seizures are cured." 3. "You will need to take the medication unless you are willing to make some very difficult lifestyle changes." 4. "After you have been seizure free for 1 year, you can stop taking medication."

Correct Answer: 1 Rationale 1: Epilepsy is a disease where seizures occur on a chronic basis. Once seizures are controlled, clients are continued indefinitely on the antiseizure drug. Rationale 2: Epilepsy and associated seizures are not curable with medications. Rationale 3: The seizures associated with epilepsy are not lifestyle dependent and cannot be cured or controlled by changes of lifestyle. Rationale 4: After the client has been seizure free for 3 years, the health care provider may recommend a slow withdrawal from medication. Global Rationale: Epilepsy is a disease where seizures occur on a chronic basis. Once seizures are controlled, clients are continued indefinitely on the antiseizure drug. Epilepsy and associated seizures are not curable with medications. The seizures associated with epilepsy are not lifestyle dependent and cannot be cured or controlled by changes of lifestyle. After the client has been seizure free for 3 years, the health care provider may recommend a slow withdrawal from medication.

A client prescribed olanzapine (Zyprexa) for mania associated with bipolar disorder is being discharged. Which client statement indicates more teaching is necessary about this medication? 1. "I take St. John's wort at bedtime to help me go to sleep." 2. "I'm going to weigh myself weekly to check for weight gain." 3. "I need to report symptoms of extreme thirst, insatiable hunger with weight loss, and increased urination." 4. "I might need to increase my intake of fiber and fluids."

Correct Answer: 1 Rationale 1: Increased central nervous system depression can occur if atypical antipsychotics are taken with St. John's wort or valerian. Rationale 2: Weight gain is a frequent adverse effect of atypical antipsychotics. Rationale 3: The risk of developing type 2 diabetes is greater with this medication, so it is important to assess for symptoms. Rationale 4: Constipation is a frequent adverse effect of atypical antipsychotics. Global Rationale: Increased central nervous system depression can occur if atypical antipsychotics are taken with St. John's wort or valerian. Weight gain and constipation are frequent adverse effects of atypical antipsychotics. The risk of developing type 2 diabetes is greater with this medication, so it is important to assess for symptoms.

A client is experiencing fever, diaphoresis, muscle rigidity, and tachycardia for 4 hours. Current medications include aripiprazole (Abilify), enalapril (Vasotec), and atenolol (Tenormin). What will the nurse prepare to administer to this client? 1. Antipyretics, electrolytes, and muscle relaxants 2. Antipyretics, intravenous fluids, and lorazepam (Ativan) 3. Antipyretics, electrolytes, and a cooling blanket 4. Antipyretics, intravenous fluids, and Atropine

Correct Answer: 1 Rationale 1: Quick, aggressive treatment is required for symptoms of neuroleptic malignant syndrome with antipyretics, electrolytes, and muscle relaxants. Rationale 2: Giving Ativan might mask the symptoms and allow the disorder to worsen. Rationale 3: A muscle relaxant is needed to halt the muscle rigidity. Rationale 4: Giving Atropine would increase the heart rate even more. Global Rationale: Quick, aggressive treatment is required for symptoms of neuroleptic malignant syndrome with antipyretics, electrolytes, and muscle relaxants. Giving Ativan might mask the symptoms and allow the disorder to worsen. A muscle relaxant is needed to halt the muscle rigidity. Giving Atropine would increase the heart rate even more.

A client prescribed haloperidol (Haldol) is not demonstrating an improvement of psychotic behavior after taking the medication for 5 days. The nurse would anticipate which dose change for the medication? 1. No changes are necessary, as it might take 2-4 weeks for significant improvement to be noted. 2. The dose of Haldol might be increased. 3. The order for Haldol might be discontinued. 4. Xanax might be added to improve the symptoms of psychotic behavior.

Correct Answer: 1 Rationale 1: The pharmacotherapy of psychosis is a long-term process, with symptoms resolving gradually. It could take 2-4 weeks before a significant change in behavior is noted. Rationale 2: Haldol is a high-potency drug that controls symptoms in small doses. Increasing the dose would cause severe side effects. Rationale 3: The Haldol has not been taken long enough to warrant discontinuation, and there is no information indicating that it should be discontinued due to side effects. Rationale 4: The addition of a benzodiazepine would cause added CNS depression. Global Rationale: The pharmacotherapy of psychosis is a long-term process, with symptoms resolving gradually. It could take 2-4 weeks before a significant change in behavior is noted. Haldol is a high-potency drug that controls symptoms in small doses. Increasing the dose would cause severe side effects. The Haldol has not been taken long enough to warrant discontinuation, and there is no information indicating that it should be discontinued due to side effects. The addition of a benzodiazepine would cause added CNS depression.

The nurse is instructing a client on the medication risperidone (Risperdal). What should be included in this teaching? 1. Do not use alcohol while on this medication. 2. Watch for abnormal bruising, bleeding of the gums, blood in the feces, or any other abnormal bleeding. 3. Do not eat grapefruit or take grapefruit juice while on this medication. 4. Monitor for extreme thirst, hunger with weight loss, and increased urination.

Correct Answer: 1 Rationale 1: The use of alcohol can cause additive CNS depression. Rationale 2: Risperidone does not cause agranulocytosis. Rationale 3: There is no indication that risperidone reacts adversely with grapefruit. Rationale 4: There is no indication that this medication causes diabetes. Global Rationale: The use of alcohol can cause additive CNS depression. Risperidone does not cause agranulocytosis. There is no indication that risperidone reacts adversely with grapefruit or causes diabetes.

A client is prescribed haloperidol decanoate (Haldol LA) IM to be administered once a month for treatment of schizophrenia. The nurse will instruct the client to notify the health care provider for which manifestation? 1. Involuntary, unusual tongue and face movements, such as lip smacking or rapid eye blinking 2. Nausea, sometimes accompanied with vomiting 3. Weight gain of 5 pounds or more in 2 weeks 4. Constipation and dry mouth

Correct Answer: 1 Rationale 1: Unusual tongue and face movements are signs of tardive dyskinesia, and if the medication is not discontinued immediately, the symptoms could persist for months or years. Rationale 2: Nausea and vomiting are common side effects. The health care provider would not need to be notified unless the vomiting is severe enough to cause dehydration and/or interruption in the client's lifestyle. Rationale 3: Weight gain is an undesirable side effect but does not need to be reported immediately to the health care provider. Rationale 4: The client can be taught to change dietary habits and increase fluid intake for constipation and to suck on sugarless hard candy for the dry mouth. Global Rationale: Unusual tongue and face movements are signs of tardive dyskinesia, and if the medication is not discontinued immediately, the symptoms could persist for months or years. Nausea and vomiting are common side effects. The health care provider would not need to be notified unless the vomiting is severe enough to cause dehydration and/or interruption in the client's lifestyle. Weight gain is an undesirable side effect but does not need to be reported immediately to the health care provider. The client can be taught to change dietary habits and increase fluid intake for constipation and to suck on sugarless hard candy for the dry mouth.

A client being treated with antipsychotic medication for schizophrenia is overheard telling family that the problem has improved because the new medication is given at a low dose. How should the nurse respond to this client's comment? Standard Text: Select all that apply. 1. "The new medication has a higher potency, and a lower dose is needed." 2. "The symptoms can be controlled with a lower dose." 3. "The other medication was not working." 4. "It is always better to start a new medication with a lower dose." 5. "The other medication was too much for you since your symptoms are almost gone."

Correct Answer: 1,2 Rationale 1: High-potency drugs control symptoms at lower doses. Rationale 2: High potency drugs are able to control symptoms with a lower dose. Rationale 3: There is not enough information to determine if the previous medication was not effective at controlling symptoms. Rationale 4: This is not necessarily true and does not address the potency of the new medication. Rationale 5: There is not enough information to determine if the client's symptoms are almost gone. Global Rationale: High-potency drugs control symptoms at lower doses. There is not enough information to determine if the previous medication was not effective at controlling symptoms. It is not always better to start a medication at a lower dose and this response does not address the potency of the new medication. There is not enough information to determine if the client's symptoms are almost gone.

The family of a client being treated for schizophrenia asks the nurse why the client's medication was changed to a new type just out on the market. Which responses by the nurse are appropriate? Standard Text: Select all that apply. 1. "The newer medications have fewer adverse effects." 2. "Many clients prefer the new medication." 3. "The newer medications cost less." 4. "The newer medications are easier to get from the pharmacy." 5. "The client's health care provider likes to try new medications."

Correct Answer: 1,2 Rationale 1: The second-generation atypical antipsychotic medications have a lower incidence of serious adverse effects. Rationale 2: The second-generation atypical antipsychotic medications have become the drugs of choice for many clients. Rationale 3: The second-generation atypical antipsychotic medications are more expensive. Rationale 4: This is not a reason for prescribing a newer medication. Rationale 5: This may or may not be the reason for the new medication being prescribed. Global Rationale: The second-generation atypical antipsychotic medications have become the drugs of choice for many clients and they have a lower incidence of serious side effects. The second-generation atypical antipsychotic medications are more expensive. The newer medications may be easier to get from the pharmacy but this is not the reason for prescribing a new medication. Having a health care provider who likes to try new medications may or may not be the reason the medication is prescribed.

The family of a client diagnosed with schizophrenia asks why medications are needed to help control the client's symptoms. Which responses by the nurse are appropriate in this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Medications for schizophrenia work on the basal ganglia of the brain." 2. "Most antipsychotic drugs block dopamine receptors to reduce the symptoms of the disorder." 3. "They help correct the genetic component of the disorder." 4. "They are really sedatives to stop the client from causing harm." 5. "They stimulate dopamine receptors to reduce the symptoms of the disorder."

Correct Answer: 1,2 Rationale 1: There is a theory that overactive dopaminergic pathways in the basal ganglia are associated with the symptoms of schizophrenia. Rationale 2: Most antipsychotic drugs act by entering dopaminergic synapses and competing with dopamine. By blocking dopamine receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Rationale 3: Antipsychotic medications do not correct the genetic component of schizophrenia. Rationale 4: Antipsychotic medications are not sedatives. Rationale 5: Antipsychotic medications do not stimulate dopamine receptors. Global Rationale: There is a theory that overactive dopaminergic pathways in the basal ganglia are associated with the symptoms of schizophrenia. Most antipsychotic drugs act by entering dopaminergic synapses and competing with dopamine. By blocking dopamine receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Antipsychotic medications do not correct the genetic component of schizophrenia; they are not sedatives; and they do not stimulate dopamine receptors.

The nurse completes education to the parents of a child newly diagnosed with tonic-clonic seizures. Which comments made by the parents would the nurse evaluate as indicating the need for further education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Some of the times when I thought he was ignoring me may have actually been seizure activity." 2. "He just needs to focus more to prevent these attacks." 3. "I know he will outgrow these seizures with time." 4. "I hope we can help our son identify his seizure aura." 5. "We will watch for the development of status epilepticus."

Correct Answer: 1,2,3 Rationale 1: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure. Rationale 2: The client who suffers seizure disorder cannot prevent seizure occurrence by focusing harder. Rationale 3: The client with tonic-clonic seizure disorder is less likely to outgrow them than the client with absence seizure disorder. Rationale 4: Many clients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the client to move to a safe area, notify another person of the impending seizure, and to prepare. Rationale 5: Status epilepticus is a medical emergency that may occur in the client who suffers tonic-clonic seizure disorder. Global Rationale: Behavior that manifests as the child ignoring outside stimuli is most likely absence seizure, which is different from tonic-clonic seizure. The client who suffers seizure disorder cannot prevent seizure occurrence by focusing harder. The client with tonic-clonic seizure disorder is less likely to outgrow them than the client with absence seizure disorder. Many clients experience an aura prior to the tonic-clonic phase. Identifying the aura can provide time for the client to move to a safe area, notify another person of the impending seizure, and to prepare. Status epilepticus is a medical emergency that may occur in the client who suffers tonic-clonic seizure disorder.

A client being treated for schizophrenia admits to occasionally skipping medication doses. Based on this information, what will the nurse include in the client assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Use of alcohol 2. Intensity of side effects 3. Understanding of the health problem 4. Belief that the medication is poison 5. Cost of the medication

Correct Answer: 1,2,3,4 Rationale 1: A factor in nonadherence with antipsychotic medication is the desire to drink alcohol. Rationale 2: Even motivated clients may have difficulty tolerating the side effects of antipsychotic medications. Rationale 3: A lack of insight into the illness may cause some clients to believe their behavior is normal and does not need to be treated with medication. Rationale 4: Clients with paranoia may feel that drug therapy is a plot to poison them. Rationale 5: The cost of antipsychotic medication is not a factor in client nonadherence. Global Rationale: A factor in nonadherence with antipsychotic medication is the desire to drink alcohol. Even motivated clients may have difficulty tolerating the side effects of antipsychotic medications. A lack of insight into the illness may cause some clients to believe their behavior is normal and does not need to be treated with medication. Clients with paranoia may feel that drug therapy is a plot to poison them. The cost of antipsychotic medication is not a factor in client nonadherence.

A client prescribed antipsychotic medication for chronic schizophrenia abruptly stops taking the medication and is in the emergency department. Which findings does the nurse anticipate when assessing this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nausea 2. Sweating 3. Vomiting 4. Salivation 5. Paralysis

Correct Answer: 1,2,3,4 Rationale 1: Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including nausea. Rationale 2: Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including sweating. Rationale 3: Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including vomiting. Rationale 4: Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including salivation. Rationale 5: Paralysis is not a symptom of withdrawal from antipsychotic medication. Global Rationale: Abrupt cessation of some antipsychotic medication can cause serious withdrawal symptoms, including nausea, sweating, vomiting, and salivation. Paralysis is not a symptom of withdrawal from antipsychotic medication.

The nurse is concerned that a client being treated with antipsychotic medication for schizophrenia is developing extrapyramidal symptoms. Which assessment findings support the nurse's concern? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Neck spasms 2. Fidgeting and rocking back and forth in the chair 3. Shuffling gait 4. Lip smacking and rapid eye blinking 5. Diaphoresis and muscle rigidity

Correct Answer: 1,2,3,4 Rationale 1: Acute dystonia involves severe muscle spasms of the neck. Rationale 2: Akathisia, the inability to rest or relax, is a common extrapyramidal symptom. Rationale 3: Parkinsonism induced by antipsychotic medications may include a shuffling gait. Rationale 4: Tardive dyskinesia is characterized by involuntary lip smacking and rapid eye blinking. Rationale 5: These are not extrapyramidal symptoms. Global Rationale: Muscle spasms, akathisia, Parkinsonism, and tardive dyskinesia are all examples of extrapyramidal symptoms. Diaphoresis and muscle rigidity are not extrapyramidal symptoms.

The nurse is instructing a client on the importance of having routine blood work preformed while taking a prescribed antipsychotic medication. Which symptoms would warrant the client to notify the health care provider immediately? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Abdominal pain 2. Change in stool color 3. Increased thirst and urination 4. Frequent infections 5. Dry mouth

Correct Answer: 1,2,3,4 Rationale 1: Antipsychotic drugs can cause hepatotoxicity as an adverse effect. Rationale 2: Antipsychotic drugs can cause hepatotoxicity as an adverse effect. Rationale 3: Antipsychotic drugs can cause increased glucose levels. Increased thirst and urination could be symptoms of hyperglycemia. Rationale 4: Antipsychotic drugs can cause bone marrow depression, which could affect the client's white and red blood cell counts. Rationale 5: A dry mouth is an anticholinergic effect of the medication and does not need to be immediately reported to the health care provider. Global Rationale: Antipsychotic drugs can cause hepatotoxicity as an adverse effect. Abdominal pain and changes in stool color are indicative of hepatotoxicity. Antipsychotic drugs can cause increased glucose levels. Increased thirst and urination could be symptoms of hyperglycemia. Antipsychotic drugs can cause bone marrow depression, which could affect the client's white and red blood cell counts. A dry mouth is an anticholinergic effect of the medication and does not need to be immediately reported to the health care provider.

A client with a history of suicidal behavior and schizophrenia stopped taking clozapine (Clozaril) after four weeks of therapy. The client is currently experiencing a return of hallucinations. What might the nurse assess when determining the reason the client stopped taking the medication? Standard Text: Select all that apply. 1. Feeling sedated all the time 2. Significant weight gain 3. Agitation 4. Fatigue and headache 5. Lack of desire to consume alcohol

Correct Answer: 1,2,3,4 Rationale 1: Clients do not like the side effect of being sedated all the time. Rationale 2: Substantial weight gain has been reported in some clients taking this medication. This is a reason some stop taking the medication. Rationale 3: Agitation may be an extrapyramidal symptom of treatment with this medication and is an unwanted adverse effect. Rationale 4: Fatigue and headache are possible side effects of this medication. Rationale 5: The desire to drink alcohol would be a reason for the client to stop taking this medication. Global Rationale: Clients do not like the side effect of being sedated all the time. Substantial weight gain has been reported in some clients taking this medication. This is a reason some stop taking the medication. Agitation may be an extrapyramidal symptom of treatment with this medication and is an unwanted adverse effect. Fatigue and headache are possible side effects of this medication. The desire to drink alcohol would be a reason for the client to stop taking this medication.

A client being treated for chronic schizophrenia develops tardive dyskinesia. Which interventions will the nurse prepare to perform for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Administering a prescribed lower dose of the antipsychotic medication 2. Administering a benzodiazepine as prescribed 3. Administering tapered doses of the antipsychotic medication 4. Administering a newly prescribed atypical antipsychotic medication 5. Administering a higher dose of the currently prescribed antipsychotic medication

Correct Answer: 1,2,3,4 Rationale 1: For some clients, decreased doses of the antipsychotic medication help with the symptoms of tardive dyskinesia. Rationale 2: For some clients, a benzodiazepine helps with the symptoms of tardive dyskinesia. Rationale 3: For some clients, a gradual withdrawal of the antipsychotic medication helps with the symptoms of tardive dyskinesia. Rationale 4: For some clients, switching to an atypical antipsychotic medication helps with the symptoms of tardive dyskinesia. Rationale 5: A higher dose of the current antipsychotic medication will make the symptoms of tardive dyskinesia worse. Global Rationale: For some clients, decreased doses of the antipsychotic medication, administering a benzodiazepine, gradually withdrawing the medication, or switching to an atypical mediation may help with the symptoms of tardive dyskinesia. A higher dose of the current antipsychotic medication will make the symptoms of tardive dyskinesia worse.

During an assessment, the nurse determines a client is demonstrating symptoms of a psychosis. Which clinical manifestations did the nurse find during the assessment of this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client says, "The servants need to be disciplined." 2. The client says, "The voice told me to cut myself." 3. The client laughs when asked about the health of a family member hospitalized for cancer treatment. 4. The client asks to close the room door so "that man can't get to me." 5. The client says, "I have not been able to get any sleep for months."

Correct Answer: 1,2,3,4 Rationale 1: This statement is an example of a grandiose delusion. Rationale 2: This statement is an example of an auditory hallucination. Rationale 3: During a psychotic episode, the client's mood and affect may vary widely and be inappropriate, such as laughing at sad events. Rationale 4: This statement is an example of a delusion in which someone is trying to harm the client. Rationale 5: The lack of sleep is not a symptom of psychosis. Global Rationale: The lack of sleep is not a symptom of psychosis. All other findings indicate symptoms of psychoses including grandiose delusion, auditory hallucination, and inappropriate responses.

A client prescribed aripiprazole (Abilify) for schizophrenia is experiencing signs of hypotension with certain activities since starting this medication. What should the nurse teach the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Avoid being outside in the heat of the day. 2. Avoid hot baths or hot showers. 3. Avoid caffeine-containing preparations. 4. Change positions slowly, especially from lying or sitting to standing. 5. Take frequent naps during the day.

Correct Answer: 1,2,4 Rationale 1: The client should avoid any situation that might cause overheating, especially in hot weather, to reduce the risk of hypotension. Rationale 2: Hot baths and hot showers should be avoided to decrease the chance of hypotension. Rationale 3: Caffeine products are more likely to produce anxiety or palpitations. Rationale 4: Changing positions slowly will help reduce orthostatic hypotension. Rationale 5: Frequent naps will not affect the symptoms of hypotension. Global Rationale: The client should avoid any situation that might cause overheating, especially in hot weather, to reduce the risk of hypotension. Hot baths and hot showers should be avoided to decrease the chance of hypotension. Changing positions slowly will help reduce orthostatic hypotension. Caffeine products are more likely to produce anxiety or palpitations. Frequent naps will not affect the symptoms of hypotension.

A client is being evaluated for appropriate medication treatment for a new onset of psychosis. Which information in the history would indicate that haloperidol (Haldol) is contraindicated for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Current treatment for Parkinson disease 2. History of seizure disorder 3. Malnourished 4. Currently prescribed lithium 5. Drinks a six-pack of beer every day

Correct Answer: 1,2,4,5 Rationale 1: This medication is contraindicated in those with Parkinson disease. Rationale 2: This medication is contraindicated in those with a seizure disorder. Rationale 3: This medication is not contraindicated for a client who is malnourished. Rationale 4: Because this medication and lithium have been implicated in brain damage in a few clients, the two medications should not be taken together. Rationale 5: This medication should not be taken by clients with a history of alcoholism. Global Rationale: Haloperidol would be contraindicated for those with Parkinson disease or a seizure disorder; concurrent use of lithium; and those with a history of alcoholism. This medication is not contraindicated for a client who is malnourished.

The nurse is performing the initial assessment on a client admitted to the psychiatric unit. The client hears voices saying to cut the client's arms with razor blades until they bleed. What should the nurse assess this client for based on these initial findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Family history of first-degree relative with schizophrenia 2. Use of illegal substances 3. Recent episodes of anxiety 4. Family history of heart disease 5. History of a dysfunctional family

Correct Answer: 1,2,5 Rationale 1: A person has a 5-10 times greater risk of getting schizophrenia if a first-degree relative has the disorder. Rationale 2: Use of drugs such as cocaine can produce hallucinations or paranoia. Rationale 3: A history of anxiety has no connection to the development of schizophrenia. Rationale 4: A family history of heart disease has no connection to the development of schizophrenia. Rationale 5: Family dynamics can affect coping skills, which can influence the onset of schizophrenia. Global Rationale: A person has a 5-10 times greater risk of getting schizophrenia if a first-degree relative has the disorder. Use of drugs such as cocaine can produce hallucinations or paranoia. Family dynamics can affect coping skills, which can influence the onset of schizophrenia. A history of anxiety and a family history of heart disease have no connection to the development of schizophrenia.

While conducting a health history, the nurse notes that the client is demonstrating positive signs of schizophrenia. Which clinical manifestations did the nurse find during the assessment of this client? Select all that apply. 1. Disorganized sentence structure 2. Kicking the nurse 3. Not responding to questions 4. Difficulty following instructions 5. Stating that God wants the client to go home

Correct Answer: 1,2,5 Rationale 1: Disorganized speech is a positive symptom of schizophrenia. Rationale 2: Combativeness is a positive symptom of schizophrenia. Rationale 3: Lack of responsiveness is a negative symptom of schizophrenia. Rationale 4: Difficulty following instructions is not a positive symptom of schizophrenia. Rationale 5: A delusion is a positive symptom of schizophrenia. Global Rationale: Disorganized speech, combativeness, and delusion are all positive symptoms of schizophrenia. Lack of responsiveness is a negative symptom of schizophrenia. Difficulty following instructions is not a positive symptom of schizophrenia.

The nurse is teaching a class for clients who recently have been diagnosed with epilepsy. The nurse determines that learning has occurred when the clients make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Epilepsy can be caused by a head injury." 2. "With some cases of epilepsy, the cause is never determined." 3. "Excessive stress levels cause disruptions in how the brain receives oxygen, leading to epilepsy." 4. "Eating disorders like anorexia nervosa increase the risk for developing epilepsy." 5. "A stroke, or brain attack, could increase the risk for developing epilepsy."

Correct Answer: 1,2,5 Rationale 1: Head trauma is a known cause of seizures. Rationale 2: Epilepsy is a disorder where seizures occur on a chronic basis. In some cases, the exact etiology cannot be identified. Rationale 3: Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur. Rationale 4: There is no known correlation with anorexia nervosa and the development of epilepsy. Rationale 5: Changes in cerebral perfusion such as hypotension, strokes or brain attacks, and shock can be causes of seizures. Global Rationale: Epilepsy is a disorder where seizures occur on a chronic basis. In some cases, the exact etiology cannot be identified. Head trauma, changes in cerebral perfusion such as hypotension, strokes or brain attacks, and shock are all known cause of seizures. Excessive levels of stress cannot disrupt cerebral oxygen to the extent that epilepsy would occur. There is no known correlation with anorexia nervosa and the development of epilepsy.

The nurse is assessing a female client who is prescribed chlorpromazine for schizophrenia. Based on this information, what will the nurse include in the client assessment? Standard Text: Select all that apply. 1. Perform an eye exam and ask if there have been changes in vision. 2. Draw blood to check a lipid profile. 3. Ask the client questions regarding amount of alcohol intake. 4. Determine the date of her last menstrual period. 5. Draw blood to check thyroid function.

Correct Answer: 1,3,4 Rationale 1: Chlorpromazine accumulates in the eye, and there is a risk of phototoxicity, blurred vision, dry eyes, and glaucoma. Rationale 2: Treatment with chlorpromazine would not be a reason to check the client's lipid levels, and there is no information given to indicate the need to check a lipid profile. Rationale 3: It is important to assess for alcohol use, as this could cause excessive drowsiness. Rationale 4: It is important to assess for pregnancy as this drug is pregnancy category C. Rationale 5: There is no indication that antipsychotics affect thyroid function, and nothing in the scenario indicates the need to check thyroid function. Global Rationale: Chlorpromazine accumulates in the eye, and there is a risk of phototoxicity, blurred vision, dry eyes, and glaucoma. It is important to assess for alcohol use, as this could cause excessive drowsiness and to assess for pregnancy because this drug is a pregnancy category C. Treatment with chlorpromazine would not be a reason to check the client's lipid levels, and there is no information given to indicate the need to check a lipid profile. There is no indication that antipsychotics affect thyroid function, and nothing in the scenario indicates the need to check thyroid function.

The nurse is planning educational sessions for a client regarding the use of a newly prescribed antiepileptic drug (AED). Which topics should be included in these sessions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client should take the medication at the same time every day. 2. If the client forgets a dose of medication, wait until the next dose is due and take both doses together. 3. The client should take an additional dose of medication upon experiencing a seizure aura. 4. If the client experiences side effects of the medication, the client should skip the next dose to see if the side effects lessen. 5. The client should avoid using dietary supplements containing kava when on this medication.

Correct Answer: 1,5 Rationale 1: Stable blood levels of medication are important in the control of seizure activity. In order to achieve this stability, the medication should be taken at the same time every day. Rationale 2: The client should take the dose as soon as it is remembered but should not take two doses at the same time or close together. Rationale 3: Oral medications are not delivered rapidly to the system, so taking an additional dose of medication when an aura occurs is not effective in controlling the impending seizure. Rationale 4: The client should never abruptly discontinue taking these medications and should not skip doses. Rationale 5: Kava interferes with many AEDs, often adding to their sedative effects. Global Rationale: Stable blood levels of medication are important in the control of seizure activity. In order to achieve this stability, the medication should be taken at the same time every day. Kava interferes with many AEDs, often adding to their sedative effects. The client should take the dose as soon as it is remembered but should not take two doses at the same time or close together. Oral medications are not delivered rapidly to the system, so taking an additional dose of medication when an aura occurs is not effective in controlling the impending seizure. The client should never abruptly discontinue taking these medications and should not skip doses.

A client's medication regimen is being determined by the health care provider. Currently, the medications haloperidol (Haldol), a high-potency drug, and chlorpromazine, a low-potency drug, are being considered. Which doses of the medications does the nurse anticipate for this client? 1. 2 mg of chlorpromazine and 2 mg of haloperidol (Haldol). 2. 100 mg of chlorpromazine and 2 mg of haloperidol (Haldol). 3. 100 mg of chlorpromazine and 100 mg of haloperidol (Haldol). 4. 2 mg of chlorpromazine and 100 mg of haloperidol (Haldol).

Correct Answer: 2 Rationale 1: 2 mg of chlorpromazine and 2 mg of Haldol would make both high-potency drugs. Rationale 2: Low-potency drugs are those that require higher doses, and high-potency drugs are those that are able to control symptoms with low doses. Rationale 3: 100 mg of chlorpromazine and 100 mg of Haldol would make both low-potency drugs. Rationale 4: Chlorpromazine is a low-potency drug and requires a higher dose than the high-potency drug Haldol. Global Rationale: Low-potency drugs are those that require higher doses, and high-potency drugs are those that are able to control symptoms with low doses. 2 mg of chlorpromazine and 2 mg of Haldol would make both high-potency drugs. 100 mg of chlorpromazine and 100 mg of Haldol would make both low-potency drugs. Chlorpromazine is a low-potency drug and requires a higher dose than the high-potency drug Haldol.

A client is prescribed aripiprazole (Abilify) to treat both the positive and negative symptoms of schizophrenia. What will the nurse explain as the medication's mechanism of action? 1. Increasing norepinephrine activity by blocking its synaptic reuptake 2. Partial agonist activity at dopamine type 2 (D2 and D3) and serotonin type 2 3. Inhibiting the reuptake of serotonin at the synapse 4. Binding to the GABA receptor

Correct Answer: 2 Rationale 1: Antipsychotics do not increase norepinephrine activity. Rationale 2: By blocking D2 receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Rationale 3: Antipsychotics do not inhibit the reuptake of serotonin. Rationale 4: Antipsychotics do not bind to the GABA receptor. Global Rationale: By blocking D2 receptors, antipsychotic drugs reduce the symptoms of schizophrenia. Antipsychotics do not increase norepinephrine activity, inhibit the reuptake of serotonin, or bind to the GABA receptor.

The elderly client is prescribed phenobarbital for seizure control. What is most important intervention for the nurse to add to the client's care plan? 1. Monitor for signs of electrolyte imbalance. 2. Assess respiratory rate and depth every hour. 3. Track nutritional intake. 4. Measure and record all fluid intake and output.

Correct Answer: 2 Rationale 1: Barbiturates do not affect electrolyte balance. Rationale 2: Elderly clients are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Rationale 3: Nutritional status is important with elderly clients but is not the primary concern. Rationale 4: Alteration of fluid balance is not a side effect of barbiturates. Global Rationale: Elderly clients are at risk for cumulative effects of barbiturates due to diminished hepatic and renal function. Barbiturates do not affect electrolyte balance. Nutritional status is important with elderly clients but is not the primary concern. Alteration of fluid balance is not a side effect of barbiturates.

A client who was prescribed trifluoperazine (Stelazine) 2 days ago presents with muscle spasms of the tongue. The health care provider orders diphenhydramine (Benadryl) 50 mg IV. What is the rationale for this medication? 1. To decrease saliva and mucous secretions 2. To reverse the acute dystonia 3. To prevent anaphylaxis 4. To sedate the client

Correct Answer: 2 Rationale 1: Decreasing secretions is not the reason for administering this medication to a client with dystonia. Rationale 2: Diphenhydramine (Benadryl) is used to reverse the acute dystonia before the client has respiratory distress caused by laryngospasms. Rationale 3: The client does not display symptoms of anaphylaxis. Rationale 4: Sedation will not help the client with dystonia. Global Rationale: Diphenhydramine (Benadryl) is used to reverse the acute dystonia before the client has respiratory distress caused by laryngospasms. Decreasing secretions is not the reason for administering this medication to a client with dystonia. The client does not display symptoms of anaphylaxis. Sedation will not help the client with dystonia.

A preschool-age client is diagnosed with epilepsy. The child's mother is crying as she tells the nurse, "I know that this is my fault. I did drugs before I knew I was pregnant." Which response by the nurse is the most appropriate? 1. "That is most likely not the reason your child has epilepsy." 2. "The most important thing now is getting good care for your child." 3. "Women who take drugs during pregnancy have to realize they are possibly hurting their baby." 4. "Medical testing can tell when the damage occurred."

Correct Answer: 2 Rationale 1: Epilepsy could be caused by exposure to substances prenatally. The nurse does not know that is not the case in this situation. Rationale 2: The reason the child has epilepsy is not as important as obtaining appropriate care for the child today. Rationale 3: While it is true that women should realize that actions taken in pregnancy can affect the child, this is not the therapeutic response to this mother. Rationale 4: Medical testing cannot tell when the damage occurred, and this statement reinforces the blame-placing and guilt expressed by the mother's statements. Global Rationale: The reason the child has epilepsy is not as important as obtaining appropriate care for the child today. Epilepsy could be caused by exposure to substances prenatally. The nurse does not know that is not the case in this situation. While it is true that women should realize that actions taken in pregnancy can affect the child, this is not the therapeutic response to this mother. Medical testing cannot tell when the damage occurred, and this statement reinforces the blame-placing and guilt expressed by the mother's statements.

A client with a history of benign prostatic hyperplasia is beginning treatment for schizophrenia. Which medication might be contraindicated for this client? 1. Fluphenazine 2. Chlorpromazine 3. Aripiprazole (Abilify) 4. Risperidone (Risperdal)

Correct Answer: 2 Rationale 1: Fluphenazine produces less sedation and fewer anticholinergic effects than chlorpromazine. Rationale 2: Chlorpromazine should be used with caution in clients with benign prostatic hyperplasia because it can cause urinary retention. Rationale 3: Abilify was specifically formulated to eliminate or minimize anticholinergic effects. Rationale 4: The incidences of anticholinergic effects with Risperdal are low. Global Rationale: Chlorpromazine should be used with caution in clients with benign prostatic hyperplasia because it can cause urinary retention. Fluphenazine produces less sedation and fewer anticholinergic effects than chlorpromazine. Abilify was specifically formulated to eliminate or minimize anticholinergic effects. The incidences of anticholinergic effects with Risperdal are low.

A parent says to the nurse, "The doctor prescribed ethosuximide (Zarontin) for my child, who has absence seizures. What does this mean?" Which response by the nurse is the most appropriate? 1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." 2. "Your child's seizures manifest as a staring into space for a few seconds. Ethosuximide (Zarontin) is a good medication for this type of seizure." 3. "Explaining the types of seizure activity is complicated. Have you spoken to your doctor about it?" 4. "Are you sure your doctor prescribed ethosuximide (Zarontin)? Phenobarbital is used more frequently with children."

Correct Answer: 2 Rationale 1: Grand mal or tonic-clonic seizures are different from absence or petite mal seizures; they are different forms of epilepsy. Rationale 2: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder. Rationale 3: It is the responsibility of the RN to educate the client, not just refer questions to the health care provider. Rationale 4: Ethosuximide (Zarontin), not phenobarbital, is the drug of choice for absence seizures. Global Rationale: Absence seizures, formerly known as petit mal, last a few seconds and are seen most often in children. Ethosuximide (Zarontin) is a drug of choice for this type of seizure disorder. Grand mal or tonic-clonic seizures are different from absence or petite mal seizures; they are different forms of epilepsy. It is the responsibility of the RN to educate the client, not just refer questions to the health care provider. Ethosuximide (Zarontin), not phenobarbital, is the drug of choice for absence seizures.

The client has epilepsy and is prescribed phenytoin (Dilantin). The client has been seizure free and asks the nurse why he still needs blood tests when he is not having seizures. Which response by the nurse is the most appropriate? 1. "Dilantin can cause blood thinning in some people." 2. "There is a narrow range between a helpful dose of this medication and a dose that could make you feel sicker." 3. "Dilantin tends to lower blood levels of potassium." 4. "This medication can cause a severe skin reaction called Steven-Johnson syndrome if doses are too high."

Correct Answer: 2 Rationale 1: Phenytoin (Dilantin) is not an anticoagulant and does not cause thinning of the blood. Rationale 2: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. Rationale 3: There is no evidence that phenytoin (Dilantin) causes potassium depletion. Rationale 4: Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests. Global Rationale: Phenytoin (Dilantin) has a very narrow range between a therapeutic dose and a toxic dose; blood levels must be monitored to ensure a therapeutic level and to prevent toxicity. It is not an anticoagulant and does not cause thinning of the blood. There is no evidence that phenytoin (Dilantin) causes potassium depletion. Stevens-Johnson syndrome is a severe skin reaction that can be an adverse outcome with phenytoin (Dilantin), but it is monitored by skin assessment, not blood tests.

A client was prescribed olanzapine (Zyprexa) four weeks ago to treat symptoms of schizophrenia. The client's family has noted only a small improvement in symptoms and asks about changing to another treatment. Which response by the nurse is the most appropriate? 1. "The client will need to see a psychotherapist in conjunction with the medication for there to be a major improvement in symptoms." 2. "It might take 6-8 weeks to see definite improvement in most symptoms." 3. "It might take 8-12 weeks to begin seeing improvement on this therapy." 4. "There should have been improvement within 1-2 weeks."

Correct Answer: 2 Rationale 1: Psychotherapy is an essential component of treatment for clients with psychosis to return to society, but this is not the best answer. There should be a major improvement in symptoms with medication alone. Rationale 2: By 6-8 weeks, definite improvement should be noted in most symptoms. Rationale 3: After 8-12 weeks of therapy, if there has not been substantial improvement, the health care provider will need to explore reasons for lack of response and might need to change the medication. Rationale 4: After 2-4 weeks (not 1-2 weeks), there is usually improvement in mood, socialization, and ability to provide self-care. Global Rationale: By 6-8 weeks, definite improvement should be noted in most symptoms. Psychotherapy is an essential component of treatment for clients with psychosis to return to society, but this is not the best answer. There should be a major improvement in symptoms with medication alone. After 8-12 weeks of therapy, if there has not been substantial improvement, the health care provider will need to explore reasons for lack of response and might need to change the medication. After 2-4 weeks (not 1-2 weeks), there is usually improvement in mood, socialization, and ability to provide self-care.

The client is prescribed phenobarbital for seizure control. The client asks the nurse how this little pill can stop seizures. What response by the nurse is the most appropriate? 1. "The pill helps to decrease the calcium in your brain, which is responsible for your seizures." 2. "This medication increases a chemical called GABA that calms down the excitability in your brain that causes your seizures." 3. "Phenobarbital increases a chemical called glutamate, which calms down the excitability in your brain that causes your seizures." 4. "It helps by decreasing the sodium in your brain, which is responsible for the seizures."

Correct Answer: 2 Rationale 1: Succinimides, not phenobarbital, suppress calcium influx. Rationale 2: Phenobarbital acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Rationale 3: Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. Rationale 4: Hydantoins and phenytoin-like drugs, not phenobarbital, suppress sodium influx. Global Rationale: Phenobarbital acts biochemically in the brain by enhancing the action of the neurotransmitter GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Succinimides, not phenobarbital, suppress calcium influx. Glutamate is the primary excitatory neurotransmitter in the brain; enhancing this neurotransmitter will increase the likelihood of seizures. Hydantoins and phenytoin-like drugs, not phenobarbital, suppress sodium influx

The nurse is preparing discharge instructions for a client being treated with medication and psychotherapy for schizophrenia. What should the nurse address with the client prior to discharge? 1. The client smokes 1-3 cigarettes per day. 2. The client drinks 1-3 beers before bedtime per day. 3. The client likes to eat grapefruit for breakfast. 4. The client drinks 1-3 caffeinated sodas per day.

Correct Answer: 2 Rationale 1: The client should be encouraged to quit smoking, but this is not the most important issue. Rationale 2: Alcohol taken with antipsychotic medications can cause additive CNS depression, which could be fatal. Rationale 3: Only a few antipsychotic medications are affected by grapefruit juice. The nurse would need to know which medication the client is prescribed before teaching the client not to take it with grapefruit. Rationale 4: The client should be encouraged to drink more water and fewer caffeinated sodas, but this is not the most important issue. Caffeine is not restricted because of the use of antipsychotic drugs. Global Rationale: Alcohol taken with antipsychotic medications can cause additive CNS depression, which could be fatal. The client should be encouraged to quit smoking, but this is not the most important issue. Only a few antipsychotic medications are affected by grapefruit juice. The nurse would need to know which medication the client is prescribed before teaching the client not to take it with grapefruit. The client should be encouraged to drink more water and fewer caffeinated sodas, but this is not the most important issue. Caffeine is not restricted because of the use of antipsychotic drugs.

The client tells the nurse that she has been prescribed phenytoin (Dilantin) for 2 years and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse? 1. "This is the best medication for you; we can add another medication to decrease the side effects associated with phenytoin (Dilantin)." 2. "Please do not stop the medication abruptly, as you will have withdrawal seizures." 3. "You have probably been on the medication long enough; I'll let your doctor know you are stopping it." 4. "Side effects are a problem, but they are not as bad as the seizures you were having."

Correct Answer: 2 Rationale 1: There is no other medication that can be added to decrease the side effects associated with phenytoin (Dilantin). Rationale 2: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6-12 weeks. Rationale 3: The nurse does not know if the client has been on the medication long enough, and the client must be informed of the consequences of abruptly stopping the medication. Rationale 4: Telling a client that medication side effects are not as bad as seizures is an inappropriate and nontherapeutic response that does not address the client's concerns. Global Rationale: Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6-12 weeks. There is no other medication that can be added to decrease the side effects associated with phenytoin (Dilantin). The nurse does not know if the client has been on the medication long enough, and the client must be informed of the consequences of abruptly stopping the medication. Telling a client that medication side effects are not as bad as seizures is an inappropriate and nontherapeutic response that does not address the client's concerns.

The nurse is speaking before a group of elementary school teachers on the topic of seizure control medications. Which behaviors should the nurse advise the teachers to watch for in children who are taking levetiracetam (Keppra)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Sleepiness after lunch 2. Fighting at recess 3. Inability to sit still 4. Tearfulness 5. Difficulty in seeing the blackboard

Correct Answer: 2,3,4 Rationale 1: Levetiracetam (Keppra) would be more likely to cause children to be agitated. Rationale 2: Levetiracetam (Keppra) can cause hostility in some children and may manifest as inability to get along with others. Rationale 3: Hyperkinesis is a common side effect of levetiracetam (Keppra). Rationale 4: Depression is a common side effect of levetiracetam (Keppra). Rationale 5: There is no indication that difficulty seeing the blackboard is associated with levetiractam (Keppra). Global Rationale: Levetiracetam (Keppra) can cause hostility in some children and may manifest as inability to get along with others. Hyperkinesis and depression are also common side effects of levetiracetam (Keppra). Levetiracetam (Keppra) would be more likely to cause children to be agitated rather than sleepy. There is no indication that difficulty seeing the blackboard is associated with levetiractam (Keppra).

The nurse suspects a client is demonstrating negative symptoms of schizophrenia and will be a challenge to treat because of which barriers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client feels that the symptoms are normal. 2. Family members feel the client is going through a period of depression. 3. The client is suspicious of the motives of the health care provider. 4. Family members have labeled the client as lazy. 5. The client is indifferent to obtaining help.

Correct Answer: 2,4,5 Rationale 1: Clients with a psychosis rather than the negative symptoms of schizophrenia are often unaware that their bizarre behavior is not normal. Rationale 2: Negative symptoms of schizophrenia are often mistaken for depression. Rationale 3: Suspicion that someone is trying to do harm is characteristic of delusions. Rationale 4: Negative symptoms of schizophrenia are often mistaken for laziness. Rationale 5: Negative symptoms are characteristic of the indifferent personality typical of many clients with schizophrenia. Global Rationale: Negative symptoms of schizophrenia are often mistaken for depression or laziness and are characteristic of the indifferent personality typical of many clients with schizophrenia. Clients with a psychosis rather than the negative symptoms of schizophrenia are often unaware that their bizarre behavior is not normal. Suspicion that someone is trying to do harm is characteristic of delusions.

The client states, "I can't swallow those capsules," so the nurse plans to open the carbamazepine (Carbitrol) for administration. Which foods found on the client's lunch tray are appropriate for the nurse to use for administration of this medication? Select all that apply. 1. A hamburger patty 2. Citrus salad 3. Applesauce 4. Mashed potatoes 5. Green beans

Correct Answer: 3,4 Rationale 1: A hamburger patty requires chewing, which is contraindicated in this administration method. Rationale 2: Carpamazepine should not be taken with grapefruit, which is a component of citrus salad. Rationale 3: Applesauce is soft and can be swallowed without chewing. Rationale 4: Mashed potatoes are soft and can be swallowed without chewing. Rationale 5: Green beans require chewing, which is contraindicated in this administration method. Global Rationale: Applesauce and mashed potatoes are soft and can be swallowed without chewing. A hamburger patty and green beans require chewing, which is contraindicated in this administration method. Carpamazepine should not be taken with grapefruit, which is a component of citrus salad.

The nurse is talking with a client who was just prescribed zonisamide (Zonegran). Which client statement should the nurse immediately discuss with the client's health care provider? Select all that apply. 1. "Did I mention that I used to take phenobarbital for my seizures?" 2. "I forgot to tell the doctor that I am allergic to sulfa drugs." 3. "I have lactose intolerance, so I can't drink milk." 4. "My husband and I plan to have a baby in a couple of years." 5. "My husband and I are leading a 20-mile bicycle tour next weekend for the company we have just started."

Correct Answer: 2,5 Rationale 1: There is no indication that previous phenobarbital use is problematic with the use of zonisamide (Zonegran). Rationale 2: Zonisamide (Zonegran) is an oral sulfonamide. Rationale 3: There is no indication that inability to drink milk is problematic with the use of zonisamide (Zonegran). Rationale 4: Zonisamide (Zonegran) is pregnancy category C. Rationale 5: The most common adverse effects of zonisamide (Zonegran) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring. Global Rationale: Zonisamide (Zonegran) is an oral sulfonamide. Since the client has an allergy to sulfa, the nurse would need to report this to the health care provider. The most common adverse effects of zonisamide (Zonegran) include dizziness, ataxia, and fatigue. These effects may be problematic for the owner of a company that promotes bicycle touring. There is no indication that previous phenobarbital use or the inability to drink milk is problematic with the use of zonisamide (Zonegran). Zonisamide (Zonegran) is pregnancy category C.

The health care provider has prescribed 5 mg of intravenous diazepam (Valium) to treat the client in status epilepticus. The client's IV bag is labeled "1,000 mL D5NS with 20,000 units Heparin." Which nursing interventions are necessary to safely administer this diazepam (Valium)? Select all that apply. 1. Use a large bore needle to access the IV port. 2. Flush the intravenous (IV) line with saline. 3. Administer the diazepam (Valium) directly into a vein in the client's hand. 4. Dilute the diazepam (Valium) with xylocaine prior to administration. 5. Observe the IV tubing for cloudiness while administering the diazepam (Valium).

Correct Answer: 2,5 Rationale 1: There is no need to use a large bore needle. Most IV administration is done using a needleless system. Rationale 2: The IV line should be well flushed with saline to remove any residual Heparin, which will precipitate with the diazepam (Valium). Rationale 3: Direct administration of IV medication is not recommended. The client receiving IV diazepam (Valium) should have an IV established for possible emergency use. Rationale 4: Diazepam (Valium) precipitates with many drugs and should not be mixed for infusion. Rationale 5: Diazepam (Valium) precipitates with many drugs. The nurse should watch the IV tubing just above the injection site for cloudiness or development of precipitate during administration and should discontinue the administration if this situation occurs. Global Rationale: The IV line should be well flushed with saline to remove any residual Heparin, which will precipitate with the diazepam (Valium). Direct administration of IV medication is not recommended. The client receiving IV diazepam (Valium) should have an IV established for possible emergency use. There is no need to use a large bore needle. Most IV administration is done using a needleless system. Diazepam (Valium) precipitates with many drugs and should not be mixed for infusion. The nurse should watch the IV tubing just above the injection site for cloudiness or development of precipitate during administration and should discontinue the administration if this situation occurs.

A client with acute symptoms of schizophrenia is prescribed ziprasidone (Geodon) IM. Which rhythm will the nurse assess this client for prior to administering the medication? 1. Normal sinus rhythm 2. Sinus irregularity 3. Increase in QT interval 4. Premature atrial contractions

Correct Answer: 3 Rationale 1: A normal sinus rhythm is expected. Rationale 2: Sinus irregularity with an otherwise normal rhythm does not usually present adverse effects. Rationale 3: Geodon has the possibility of prolonging the QT interval, causing potentially fatal dysrhythmias. Rationale 4: Premature atrial contractions would not present an immediate threat to the client. Global Rationale: Geodon has the possibility of prolonging the QT interval, causing potentially fatal dysrhythmias. A normal sinus rhythm is expected and would not alter the course of treatment. Sinus irregularity with an otherwise normal rhythm does not usually present adverse effects. Premature atrial contractions would not present an immediate threat to the client.

A client is prescribed fluphenazine (Prolixin) and is experiencing muscle spasms of the neck. The client is grimacing and having difficulty speaking. Which action should the nurse take? 1. Call the health care provider and prepare to give chlorpromazine (Thorazine) IM. 2. Distract the client to confirm the client is not faking a muscle spasm. 3. Call the health care provider and prepare to give diphenhydramine (Benadryl). 4. Engage the client in open-ended conversation to find out why the client is having difficulty speaking.

Correct Answer: 3 Rationale 1: Chlorpromazine (Thorazine) is not used to treat dystonia. Rationale 2: Muscle spasms are difficult to fake. Rationale 3: Signs of acute dystonia associated with fluphenazine include severe muscle spasms of the back, neck, tongue, and face. It can be so severe as to cause laryngospasm. When treated with diphenhydramine (Benadryl), it can be reversed within minutes. Rationale 4: The client is having difficulty speaking. This would not be an appropriate action. Global Rationale: Signs of acute dystonia associated with fluphenazine include severe muscle spasms of the back, neck, tongue, and face. It can be so severe as to cause laryngospasm. When treated with diphenhydramine (Benadryl), it can be reversed within minutes. Chlorpromazine (Thorazine) is not used to treat dystonia. Muscle spasms are difficult to fake. The client is having difficulty speaking; therefore, engaging the client in a conversation would not be an appropriate action.

The nurse is caring for a client with severe cardiovascular disease and schizophrenia. Which antipsychotic medication would be the safest treatment for this client? 1. Ziprasidone (Geodon) 2. Paliperidone (Invega) 3. Risperidone (Risperdal) 4. Aripiprazole (Abilify)

Correct Answer: 3 Rationale 1: Geodon has the possibility of prolonging the QT interval and should not be given to those with cardiovascular disease. Rationale 2: Invega causes most common side effects, such as orthostatic hypotension, syncope, and increased risk of death due to heart failure in older adults. Rationale 3: Risperdal should be used with caution in dysrhythmias but is not specifically listed as a risk in cardiovascular disease. Rationale 4: Abilify must be administered with caution to persons with cardiovascular disease that predisposes them to hypotension. Global Rationale: Risperdal should be used with caution in dysrhythmias but is not specifically listed as a risk in cardiovascular disease. Geodon has the possibility of prolonging the QT interval and should not be given to those with cardiovascular disease. Invega causes most common side effects, such as orthostatic hypotension, syncope, and increased risk of death due to heart failure in older adults. Abilify must be administered with caution to persons with cardiovascular disease that predisposes them to hypotension.

The client is prescribed valproic acid (Depakene) for treatment of seizures. The client has also been taking a daily 81 mg aspirin tablet prophylactically for a cardiac condition. Because of the use of these two drugs, the nurse closely observes the client for which occurrence? 1. Increase in seizure activity 2. Migraine headaches and generalized irritability 3. Bleeding from the gums and bruising of the skin 4. Stevens-Johnson syndrome

Correct Answer: 3 Rationale 1: Increased seizure activity is not associated with valproic acid (Depakene). Rationale 2: Migraine headaches and generalized irritability do not result from valproic acid (Depakene) and aspirin use. Rationale 3: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding. Rationale 4: Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is not increased with concomitant aspirin use. Global Rationale: Valproic acid (Depakene) can prolong bleeding time; concomitant aspirin use can cause severe bleeding. Increased seizure activity, migraine headaches and generalized irritability are not associated with the combination of valproic acid (Depakene) and aspirin. Stevens-Johnson syndrome is a side effect of valproic acid (Depakene); its occurrence is not increased with concomitant aspirin use.

A parent tells the nurse, "The doctor says my son has epilepsy, but he has never had a convulsion. How can that be?" Which response by the nurse to the parent is the most appropriate? 1. "He will probably develop convulsions as he gets older." 2. "Some epileptics do not have seizures." 3. "Convulsions are not part of all epileptic conditions." 4. "The convulsions common in young boys are usually silent."

Correct Answer: 3 Rationale 1: Most children with absence seizures (seizures without convulsions) will "outgrow" the disorder and not progress to tonic-clonic seizure activity. Rationale 2: All epileptics have seizures, but not all seizures manifest as convulsions. Rationale 3: Some epileptic conditions manifest seizure activity that does not include the tonic-clonic convulsion. An example of this type of seizure is the absence seizure, which is most often seen in children. Rationale 4: Young boys may have absence seizures that are "silent" or do not manifest in convulsions, but they may also have classic tonic-clonic seizure activity. Global Rationale: Some epileptic conditions manifest seizure activity that does not include the tonic-clonic convulsion. An example of this type of seizure is the absence seizure, which is most often seen in children. Most children with absence seizures (seizures without convulsions) will "outgrow" the disorder and not progress to tonic-clonic seizure activity. All epileptics have seizures, but not all seizures manifest as convulsions. Young boys may have absence seizures that are "silent" or do not manifest in convulsions, but they may also have classic tonic-clonic seizure activity.

The parents of a pediatric client diagnosed with epilepsy have decided to try a ketogenic diet to control their child's epilepsy. Which food should the nurse teach these parents to include in their child's diet? 1. Mashed potatoes with gravy 2. Baked chicken 3. Salad with vinegar and oil dressing 4. Roast beef

Correct Answer: 3 Rationale 1: The carbohydrates in mashed potatoes and gravy are not included in the ketogenic diet. Rationale 2: The ketogentic diet is low protein, and baked chicken includes significant protein. Rationale 3: Salad is low in calories, and the oil dressing is high fat. The ketogenic diet carefully controls calories, but is a high-fat diet. Rationale 4: The ketogenic diet is low protein and roast beef includes significant protein. Global Rationale: Salad is low in calories, and the oil dressing is high fat. The ketogenic diet carefully controls calories, but is a high-fat diet. The carbohydrates in mashed potatoes and gravy are not included in the ketogenic diet. The ketogentic diet is low protein, and baked chicken and roast beef include significant protein.

The nurse is providing discharge instructions to a client who is prescribed ziprasidone (Geodon) for acute mania associated with bipolar disorder. Which statement by the client indicates the need for further education regarding this medication? 1. "I need to report severe muscle spasms, especially of the neck, back, tongue, or face." 2. "I sure hate it that I can't have a beer with my buddies anymore." 3. "I hope that I can discontinue this medicine after I go back to see my doctor." 4. "I need to let the doctor know immediately if I begin to have dizziness, lightheadedness, or shortness of breath with an irregular heartbeat."

Correct Answer: 3 Rationale 1: This medication can cause extrapyramidal symptoms. Rationale 2: Taking alcohol along with this medication can cause additive CNS depression. Rationale 3: The majority of clients must maintain drug therapy for a lifetime, or symptoms will return. Rationale 4: It is possible for this medication to prolong the QT interval, thereby causing syncopal episodes, dizziness, lightheadedness, and shortness of breath. Global Rationale: The majority of clients must maintain drug therapy for a lifetime, or symptoms will return. This medication can cause extrapyramidal symptoms. Taking alcohol along with this medication can cause additive CNS depression. It is possible for this medication to prolong the QT interval, thereby causing syncopal episodes, dizziness, lightheadedness, and shortness of breath.

An emergency department (ED) client's wife says, "I couldn't wake my husband up this morning. He was snoring so loudly. Why, he was so asleep he urinated in the bed. He has never done anything like this before and he is okay now." Which question is the priority for the nurse to ask the client's wife? 1. "Does your husband have diabetes?" 2. "Was your husband especially active yesterday?" 3. "Has your husband ever had a seizure?" 4. "What kind of street drugs did your husband take last night?"

Correct Answer: 3 Rationale 1: While high blood glucose levels might result in a comatose state, it would be unlikely for the client to be "okay" without intervention. Rationale 2: The occurrences described by this client's wife are unlikely to be a result of simple exhaustion. Rationale 3: Being difficult to awaken and sonorous respirations are findings associated with the postictal state common after seizure activity. Persons experiencing seizures may be incontinent of urine or stool. When the postictal state passes, the client may appear normal or "okay." Rationale 4: Confronting the wife with an accusation that her husband uses illegal drugs may shut down the communication necessary to determine the etiology of the client's illness. Global Rationale: Being difficult to awaken and sonorous respirations are findings associated with the postictal state common after seizure activity. Persons experiencing seizures may be incontinent of urine or stool. When the postictal state passes, the client may appear normal or "okay." While high blood glucose levels might result in a comatose state, it would be unlikely for the client to be "okay" without intervention. The occurrences described by this client's wife are unlikely to be a result of simple exhaustion. Confronting the wife with an accusation that her husband uses illegal drugs may shut down the communication necessary to determine the etiology of the client's illness.

The client who is prescribed valproic acid (Depakote) for seizure control would like to have a baby. Which statements should the nurse include in a discussion with this client? Select all that apply. 1. "Since your epilepsy may flare up during pregnancy, your doctor will likely have you take a second antiepileptic medication." 2. "Thankfully, most modern antiepileptic medications will not interfere with your getting pregnant." 3. "Your current antiepileptic medication should not be used when you are pregnant." 4. "Folic acid supplementation is important for you." 5. "You should consider adopting a baby instead since there are so many problems associated with epilepsy and pregnancy."

Correct Answer: 3,4 Rationale 1: Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant clients. Rationale 2: Women who have epilepsy have a reduced fertility rate, and some do not ovulate. Rationale 3: Valproic acid (Depakote) is pregnancy category D. Rationale 4: Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency. Rationale 5: Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this client, but should provide information to the client and then support the client's choice. Global Rationale: Valproic acid (Depakote) is pregnancy category D. Folic acid supplementation is important for all women who are, or wish to become, pregnant. This is especially true of women who are epileptic because many antiepileptic medications cause folic acid deficiency. Since there are many side effects to antiepileptic medications, single drug therapy is the goal for pregnant clients. Women who have epilepsy have a reduced fertility rate, and some do not ovulate. Women who are epileptic can and do conceive and deliver healthy babies. The nurse should not discourage this client, but should provide information to the client and then support the client's choice.

A client prescribed an atypical antipsychotic medication for bipolar disorder reports difficulty sleeping. What might the nurse want to discuss with the client? 1. Using alcohol to aid with sleep 2. Increasing fluid intake 3. Trying St. John's wort to help with sleeping 4. Avoiding the use of valerian

Correct Answer: 4 Rationale 1: Alcohol is a central nervous system depressant and should not be taken with this medication. Rationale 2: There is no reason to increase fluid intake just because of the antipsychotic medication. Rationale 3: Increased central nervous system depression may occur if this medication is taken with St. John's wort. Rationale 4: Increased central nervous system depression may occur if used with valerian. Global Rationale: Increased central nervous system depression may occur if used with valerian. Alcohol is a central nervous system depressant and should not be taken with this medication. There is no reason to increase fluid intake just because of the antipsychotic medication. Increased central nervous system depression may occur if this medication is taken with St. John's wort.

The health care provider has ordered intravenous (IV) diazepam (Valium) for the client in status epilepticus. During administration, it is most important for the nurse to assess for which result from this drug? 1. Tachycardia 2. Level of consciousness 3. Hypotension 4. Respiratory depression

Correct Answer: 4 Rationale 1: Although tachycardia is an effect of intravenous diazepam (Valium), it is not the top priority. Rationale 2: Assessing respirations is a higher priority than assessing the level of consciousness. Rationale 3: Although hypotension is an effect of intravenous diazepam (Valium), it is not the top priority. Rationale 4: Respiratory depression is common when diazepam is given intravenously (IV). Respiratory assessment is the priority. Global Rationale: Respiratory depression is common when diazepam is given intravenously (IV). Respiratory assessment is the priority. Although tachycardia is an effect of intravenous diazepam (Valium), it is not the top priority. Assessing respirations is a higher priority than assessing the level of consciousness. Although hypotension is an effect of intravenous diazepam (Valium), it is not the top priority.

A client in the emergency department tells the nurse about being chased by a "serial killer." The client is currently paranoid and is aggressively fighting against any treatment. Which medication does the nurse anticipate will be prescribed for this client? 1. Clozapine (Clozaril) in intramuscular (IM) form 2. Risperidone (Risperdal) IM 3. Loxapine (Loxitane) IM 4. Lorazepam (Ativan) IM

Correct Answer: 4 Rationale 1: Clozaril is given only by mouth and if there is no response to safer drugs. Rationale 2: The intramuscular form of risperidone takes three weeks to produce a therapeutic response. Rationale 3: Even though Loxitane may be given intramuscularly, it is restricted to treating mental illness refractory to treatment with safer drugs. Rationale 4: Benzodiazepines such as Ativan may be administered intramuscularly during the initial treatment period; they provide sedation for agitated clients. Global Rationale: Benzodiazepines such as Ativan may be administered intramuscularly during the initial treatment period; they provide sedation for agitated clients. Clozaril is given only by mouth and if there is no response to safer drugs. The intramuscular form of risperidone takes three weeks to produce a therapeutic response. Even though Loxitane may be given intramuscularly, it is restricted to treating mental illness refractory to treatment with safer drugs.

A young adult client is demonstrating a lack of interest in personal hygiene and routine social activities, a sudden drop in school grades, and a recent unwillingness to get out of bed to go to school. The nurse will assess for which health problem? 1. Depression and positive symptoms of schizophrenia 2. Depression and post-traumatic stress syndrome 3. Depression and insomnia 4. Depression and negative symptoms of schizophrenia

Correct Answer: 4 Rationale 1: The client has symptoms suggestive of depression, but positive symptoms of schizophrenia would include such actions as hallucinations, delusions, and disorganized thoughts. Rationale 2: Post-traumatic stress syndrome presents with symptoms such as hallucinations and anxiety. Rationale 3: Lack of sleep can cause a person to be sleepy and sluggish, but should not diminish desire to carry out normal activities of daily living. Rationale 4: The client has symptoms suggestive of depression and the negative symptoms of schizophrenia. Global Rationale: The client has symptoms suggestive of depression and the negative symptoms of schizophrenia. Positive symptoms of schizophrenia would include such actions as hallucinations, delusions, and disorganized thoughts. Post-traumatic stress syndrome presents with symptoms such as hallucinations and anxiety. Lack of sleep can cause a person to be sleepy and sluggish, but should not diminish desire to carry out normal activities of daily living.

A client prescribed clozapine (Clozaril) for treatment of schizophrenia is complaining of drowsiness after the first 2 weeks of therapy. Which response by the nurse is the most appropriate for this situation? 1. "Take the medication exactly as prescribed, and do not discontinue it without the health care provider's approval." 2. "Tell the health care provider that you cannot tolerate the drowsiness caused by the medication." 3. "It may take 6-8 weeks for the drowsiness to subside." 4. "Try taking the medication at bedtime."

Correct Answer: 4 Rationale 1: This response does not address the client's drowsiness. Rationale 2: This response does not help the client with the drowsiness now. Rationale 3: Even though it might take several weeks for symptoms to subside, this is not the best answer. Rationale 4: This is the best answer when the client has only taken the medication for 2 weeks. Taking the medication at bedtime should reduce drowsiness. Global Rationale: Taking the medication at bedtime should reduce drowsiness. This is the best answer when the client has only taken the medication for 2 weeks. Taking the medication at bedtime should reduce drowsiness. Telling the client to take the medication as prescribed and not to discontinue it does not address the client's drowsiness. Having the client tell the healthcare provider about the drowsiness also does not help the client with the drowsiness. Even though it might take several weeks for symptoms to subside, this is not the best answer.

Treatment with an antipsychotic medication is being considered for an older adult client with dementia-related psychosis. Which medication would not be appropriate for this client? 1. Olanzapine (Zyprexa) 2. Clozapine (Clozaril) 3. Loxapine (Loxitane) 4. Aripiprazole (Abilify)

Correct Answer: 4 Rationale 1: Zyprexa is used to treat behavioral symptoms associated with dementia of Alzheimer disease. Rationale 2: Clozapine is approved for dementia-related behavioral disorder. Rationale 3: Loxapine is used off-label to treat severe behavioral disturbances associated with Alzheimer disease. Rationale 4: Older adult clients with dementia-related psychosis have an increased risk of death due to stroke and other cardiovascular disorders when taking Abilify. Global Rationale: Older adult clients with dementia-related psychosis have an increased risk of death due to stroke and other cardiovascular disorders when taking Abilify. Zyprexa is used to treat behavioral symptoms associated with dementia of Alzheimer disease. Clozapine is approved for dementia-related behavioral disorder. Loxapine is used off-label to treat severe behavioral disturbances associated with Alzheimer disease.

A mother phones the clinic and tells the nurse, "My 5-year-old son had a fever seizure this morning." She adds that this is the child's first seizure experience. The nurse responds by asking the mother to bring the child in to be seen today. What other information should the nurse offer? Select all that apply. 1. "Febrile seizures are uncommon in boys." 2. "High temperatures generally induce seizures." 3. "Five-year-olds are too old for febrile seizures." 4. "Febrile seizures occur in up to 5% of children." 5. "Seizure medications are usually not necessary for febrile seizures."

Correct Answer: 4,5 Rationale 1: Febrile seizures occur in both genders. Rationale 2: Many children experience high temperatures without experiencing seizures. Rationale 3: Febrile seizures are most common in the 3-month to 5-year range. Rationale 4: Up to 5% of children experience seizure activity related to temperature elevation. Rationale 5: The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever. Global Rationale: Up to 5% of children experience seizure activity related to temperature elevation. The best course of action for febrile seizures is prevention by using acetaminophen to prevent onset of fever. Febrile seizures occur in both genders. Many children experience high temperatures without experiencing seizures. Febrile seizures are most common in the 3-month to 5-year range.