Nurs 1023 Mood & Effect EAQ
A client with a history of schizophrenia, who responds poorly to medication, is now being treated for acute depression. Which information would the nurse provide in light of the information elicited from the medication list and laboratory results? Medication: Clozapine and Fluoxetine "Come in for weekly blood tests to monitor for medication-induced agranulocytosis." "Report incidents of unusual bleeding or easy bruising while taking fluoxetine." "Expect to be prescribed only 1 week's supply of fluoxetine at a time." "Consume a high-protein diet to offset the risk of anemia while taking clozapine."
"Come in for weekly blood tests to monitor for medication-induced agranulocytosis." (correct) The antipsychotic medication clozapine poses a risk for the development of agranulocytosis, especially when combined with a selective serotonin reuptake inhibitor such as fluoxetine. The client's neutrophil and white blood cell counts (WBCs) are borderline and therefore suggestive of the disorder. Weekly blood testing to monitor these blood values is required. The client's platelet count is in the low-normal range, but fluoxetine is not generally considered a factor in bleeding disorders. Clozapine, not fluoxetine, would likely be prescribed on a week-by-week basis to both help manage side effects and encourage weekly visits for lab work. Clozapine is not generally considered a factor in the development of anemia.
A client is prescribed a monoamine oxidase inhibitor (MAOI) for depression. The nurse includes teaching on foods and medications known to cause serious adverse effects when used in combination with MAOIs. Which adverse effect would the nurse include in the teaching plan? A serious drop in blood pressure A serious increase in blood pressure A significant increase in liver enzymes A significant increase in cholesterol levels
A serious increase in blood pressure (correct) MAOIS, when taken with foods high in tyramine (e.g., pickled foods, beer, wine, aged cheeses), medications such as antidepressants, certain pain medications, and decongestants can cause a life-threatening increase (not decrease) in blood pressure or hypertensive crisis. For this reason, they are seldom used to treat symptoms of depression. MAOIS do not increase liver enzymes or cholesterol levels.
Which term would be used to document the client's affect, which was observed during the mental status assessment? Depressed Flat Cooperative Resistive
Affect is the observable outward manifestation of a person's mood, feelings, or tone. Common terms to describe affect include inappropriate, flat, or blunted. Mood is a feeling state reported by the client (e.g., sad, depressed, angry, anxious, happy). Attitude relates to the approach or manner of the client during the interaction with the interviewer (e.g., cooperative, resistive, friendly, ingratiating).
Which legal ramification would be indicated when a newly admitted male client diagnosed with bipolar disorder who has a history of hyperactivity and combativeness is found later in the evening beating another client? The client should have been placed in restraints on admission. Keeping the client sedated is necessary for a client who is known to have been combative. A client with bipolar disorder who is in contact with reality does not require supervision. Because it was known that the client was frequently combative, close observation by the nursing staff was indicated.
Because it was known that the client was frequently combative, close observation by the nursing staff was indicated. term-8 A client may be placed in restraints only because of current unsafe behaviors, not because of past history and not because of admission. It is unrealistic to keep a client sedated because of a past history of combativeness; this is termed chemical restraints. All clients should be supervised, especially those who have a history of combativeness and who are newly admitted.
A client with a diagnosis of dementia of the Alzheimer type has been taking donepezil 10 mg/day for 3 months. The client's partner calls the clinic and reports that the client has increasing restlessness and agitation accompanied by nausea. Which advice would the nurse give the partner? Give the medication with food. Administer the medication at bedtime. Omit 1 dose today and start with a lower dose tomorrow. Bring the partner to the clinic for testing and a physical examination.
Bring the partner to the clinic for testing and a physical examination. (correct) Many people with dementia experience physical problems such as urinary tract infections but cannot adequately verbalize what is happening. They may just become more restless and agitated. Because the client has been taking this dose for 3 months, the problems probably are not being caused by the medication. The client should be brought in for an evaluation. Taking the medication with meals is recommended to decrease gastrointestinal side effects, but this client is experiencing more than this. Donepezil can cause insomnia. The client is already restless and agitated. Taking the medication at bedtime will not help. The nurse would not advise a modification of the dosage without consulting the health care provider.
Which cellular process associated with type 1 diabetes mellitus results in increased client fatigue? Increased metabolism at the cellular level Increased glucose absorption from the intestine Decreased production of insulin by the pancreas Decreased glucose secretion into the renal tubules
Decreased production of insulin by the pancreas (correct) Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine.
Which feeling would the nurse anticipate a manic client with bipolar 1 disorder is likely experiencing? Guilt Grandeur Worthlessness Self-deprecation
Grandeur (correct) The nurse would anticipate the client would experience feelings of grandeur. During a manic episode a client has an inflated self-esteem. Feelings of guilt, worthlessness, and self-deprecation are not associated with bipolar disorder, manic episode; these occur during the depressive phase.
Which finding for a client with a head injury indicates increasing intracranial pressure? Polyuria Tachypnea Increased restlessness Intermittent tachycardia.
Increased restlessness indicates a lack of oxygen to the brainstem; cerebral hypoxia impairs the reticular activating system. Urine output is not related to increased intracranial pressure. The respiratory rate will decrease. The pulse will be slow and bounding
Which suicide method would indicate a low threat of lethality? Hanging Ingesting pills Jumping from a tall bridge Poisoning with carbon monoxide
Ingesting pills
Which medication is prescribed to improve the physical manifestations of Parkinson disease? Carbidopa-levodopa Isocarboxazid Dopamine Pyridoxine (vitamin B6)
Levodopa crosses the blood-brain barrier and converts to dopamine, a substance depleted in Parkinson disease. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of psychological symptoms associated with severe depression, not physiological symptoms of Parkinson disease. Dopamine is not prescribed for this purpose because it does not cross the blood-brain barrier. Pyridoxine can reverse the effects of some antiparkinsonian medications and is contraindicated.
Which medication would the nurse recognize as an effective mood-stabilizing medication used in clients with bipolar disorder for the acute treatment of mania and prevention of recurrent mania and depressive episodes? Doxepin Amitriptyline Clozapine Lithium carbonate
Lithium carbonate is often the first choice of treatment, once primary acute mania has been diagnosed, to calm acute manic symptoms and relieve recurrent mania. Doxepin and amitriptyline are antidepressants used to treat depression but not mania. Clozapine is an antipsychotic medication used to control hallucinations and delusions in clients with psychosis but is not a first-line medication because of its side effects, which include seizures and significant weight gain.
A 30-year-old who began lithium carbonate therapy 3 weeks ago is having blood drawn for a lithium medication level. Which range will the nurse recognize as therapeutic? 0.1 to 0.3 mEq/L (0.1-0.3 mmol/L) 0.4 to 1.3 mEq/L (0.4-1.3 mmol/L) 1.5 to 1.9 mEq/L (1.5-1.9 mmol/L) 2.0 to 2.3 mEq/L (2.0-2.3 mmol/L)
Lithium levels of 0.4 to 1.3 mEq/L (0.4-1.3 mmol/L) are therapeutic and effective in treating symptoms of mania. A level below 0.3 mEq/L (0.3 mmol/L) is too low to be therapeutic. At levels above 1.5 mEq/L (1.5 mmol/L), early signs of toxicity may occur; at levels of 2.0 mEq/L (2.0 mmol/L) and higher, severe lithium toxicity may occur, constituting a life-threatening emergency
Which key factor would the nurse consider when assessing how a client will cope with body image changes? Suddenness of the change Obviousness of the change Extent of the change Perception of the change
Perception of the change It is not the reality of the change, but the client's feeling about the change, that is most important in determining a client's ability to cope. Although the suddenness, obviousness, and extent of the body change are relevant, they are not as significant as the client's perception of the change.
A client in the mental health unit is walking swiftly around the room and rubbing their hands together. Which term describes the behavior? Tardive dyskinesia Withdrawal syndrome Psychomotor agitation Psychophysiological insomnia
Psychomotor agitation is constant motion such as pacing, hand wringing, nail biting, and other types of energetic body movements. Tardive dyskinesia is a syndrome of involuntary movements (e.g., oral, buccal, lingual, masticatory) that occur as a result of prolonged treatment with neuroleptic medications that block dopamine type 2 receptors. Withdrawal syndrome includes the signs and symptoms caused by the abrupt cessation of a substance that the client has become dependent on as a result of prolonged use. Psychophysiological insomnia refers to difficulty attaining or maintaining sleep; it is not related to agitated behavior.
Which characteristic mental change occurs with delirium and differentiates it from dementia? Daytime sleepiness Rapid-onset confusion Lasts over several years Progressive deterioration
Rapid-onset confusion The mental changes associated with delirium have a rapid onset and are usually precipitated by an infection or medication change. Clients with dementia may sleep more during the day, and the duration of the disease lasts several years with a progressive deterioration of body systems.
A lactating woman is diagnosed with depression. Which is the medication of choice for this client if she wishes to continue breast-feeding? Sertraline Fluoxetine Sumatriptan Bromocriptine
Sertraline is the medication of choice for lactating women with depression because it does not cause any effects on breast-feeding infants. Fluoxetine should be taken with caution because it may cause adverse effects on the infant at high dosages. Sumatriptan is the medication of choice for lactating women suffering from migraines because it does not adversely affect the fetus. Bromocriptine is contraindicated in lactating woman.
Which side effect would the nurse include when preparing a teaching plan for a client prescribed sertraline? Seizures Agitation Tachycardia Agranulocytosis
Sertraline, a selective serotonin reuptake inhibitor (SSRI), inhibits neuronal uptake of serotonin in the central nervous system, thus potentiating the activity of serotonin. Central nervous system side effects of this medication include agitation, anxiety, confusion, dizziness, drowsiness, and headache. Seizures are a side effect of clozapine, an antipsychotic, not sertraline, which is an antidepressant. Tachycardia is a side effect of tricyclic antidepressants, not sertraline, which is an SSRI antidepressant. A decrease in the production of granulocytes (agranulocytosis) causing a pronounced neutropenia is a side effect of clozapine, not sertraline.
Which intervention would the nurse use to promote the safety of a client experiencing alcohol withdrawal? Infuse intravenous fluids. Monitor the level of anxiety. Obtain frequent vital signs. Administer chlordiazepoxide.
The nurse would administer chlordiazepoxide to prevent injury because alcohol withdrawal can cause seizures and autonomic hyperactivity. Administering intravenous fluids maintains hydration. Monitoring anxiety levels does not affect client safety. Obtaining frequent vital signs allows the nurse to assess for autonomic hyperactivity but does not directly affect client safety.
Which characteristic uniquely associated with psychophysiological disorders would differentiate them from somatic symptom disorders? Emotional cause Feeling of illness Restriction of activities Underlying pathophysiology
Underlying pathophysiology Psychophysiological disorders have an underlying pathophysiology or actual physical cause, whereas somatic symptom disorders usually do not. The psychophysiological response (e.g., hyperfunction or hypofunction) produces actual tissue change. Somatic symptom disorders are unrelated to organic changes. There is an emotional component in both instances. There is a feeling of illness in both instances. There may be a restriction of activities in both instances.
