Psych Nursing Quiz 4

What is the basic functional unit of the nervous system? · Neuron · Synapse · Receptor · Neurotransmitter

Neuron Rationale Neurons are nerve cells. These cells are the basic unit of function in the nervous system. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface. p. 37

A client reports being unable to sleep and is startled easily. What type of drug does the nurse most expect the health care provider to prescribe? · A drug that inhibits dopamine activity · A drug that inhibits histamine activity · A drug that inhibits substance P activity · A drug that inhibits norepinephrine activity

· A drug that inhibits norepinephrine activity Rationale The client is extremely alert and is startled every time the nurse enters the room. This indicates that the client has high levels of norepinephrine, which can create a feeling of hyperarousal. Therefore, this client should be prescribed a drug that inhibits norepinephrine activity, such as atomoxetine. Dopamine is involved in fine muscle movement and integration of emotions and thoughts, and it is inhibited by drugs such as amineptine. Histamine is involved in the inflammatory process and stimulates gastric secretion. It is inhibited by drugs such as fexofenadine. Substance P is associated with the modulation of pain sensation. p. 41

Which is the priority nursing intervention when administering risperidone? · Monitoring blood levels to avoid toxicity · Monitoring for abnormal involuntary movements · Observing for secondary mania · Observing for memory changes

· Monitoring for abnormal involuntary movements Rationale Risperidone has a high rate of extrapyramidal side effects (EPSs), even at doses only slightly higher than the effective dose, thus making it imperative to monitor for EPSs. Risperidone administration does not require monitoring blood levels and it does not cause mania or memory changes. p. 48

Which imaging techniques require an injection of a substance that is then traced to gather data regarding brain function? Select all that apply. · Electroencephalograph (EEG) · Computerized axial tomography (CT) · Magnetic resonance imaging (MRI) · Positron emission tomography (PET) · Single photon emission computed tomography (SPECT)

· Positron emission tomography (PET) · Single photon emission computed tomography (SPECT) Rationale PET uses an injected radioactive substance (tracer) that travels to the brain and shows up as bright spots on the scan. Data collected by the detectors are relayed to a computer. Similar to PET, SPECT uses radionuclides that emit g-radiation (photons). This allows for the measuring of various aspects of brain functioning and provides images of multiple layers of the central nervous system (CNS). No injection is required for an EEG, CT, or MRI. p. 38

The health care provider is working with a client suspected of having obsessive compulsive disorder. The provider says, "We want to do an imaging study that will tell us which parts of your brain are particularly active." from this comment, what test will the nurse expect the provider to order? · Computed tomography (CT) scan · Positron emission tomography (PET) scan · Ventriculogram · Electroencephalogram (EEG)

· Positron emission tomography (PET) scan Rationale A PET scan detects brain activity. CT scans, ventriculograms, and electroencephalograms are limited to visualization of structures. p. 37

A client has a diagnosis of schizophrenia. The nurse knows this is likely attributed to which imbalance? · Increased dopamine · Increased serum potassium · Increased gamma-aminobutyric acid (GABA) · Decreased number of glutamate receptors

Increased dopamine Rationale Norepinephrine and dopamine are increased in schizophrenia. GABA is decreased in schizophrenia. Glutamate and potassium are not neurotransmitters associated with schizophrenia.

Citalopram exerts its antidepressant effect by selectively blocking the reuptake of which neurotransmitter? · Gamma aminobutyric acid (GABA) · Serotonin · Glutamate · Dopamine

Serotonin Rationale Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, preferentially block the reuptake and degradation of serotonin, thereby improving depression. GABA is involved in anxiety responses. Glutamate regulation is involved in memory and learning. Dopamine regulation is involved in thought processes and movement.

Which of the identified areas on the graphic of the brain is responsible for regulating skeletal muscle coordination? · 1 · 2 · 3 · 4

4 Rationale The cerebellum is involved primarily in the regulation of skeletal muscle coordination and contraction and the maintenance of equilibrium. It plays a crucial role in coordinating contractions so that movement is accomplished in a smooth and directed manner. Muscle coordination is not associated directly with the midbrain, pons, or medulla. The midbrain is involved with pupillary reflex and eye movement. The pons is the major processing station in auditory pathways. The medulla contains reflex centers that control balance, heart rate, and respiration. p. 37

A nurse is caring for a client diagnosed with severe depression. Which abnormality in the levels of the neurotransmitters are the possible causes of depression? Select all that apply. · Deficient production of norepinephrine · Excess transmission of dopamine · Deficient production of gamma-aminobutyric acid (GABA) · Deficient production of serotonin · Excessive production of glutamate

Deficient production of norepinephrine · Deficient production of serotonin Rationale A deficiency of norepinephrine and/or serotonin can cause depression. Excess transmission of dopamine causes schizophrenia. Deficient production of gamma- aminobutyric acid (GABA) decreases neuronal excitability and causes anxiety. Glutamate will directly influence the activity of dopamine-releasing cells. Excess glutamate production would cause excess production of dopamine, which can cause psychosis.

A client diagnosed with a tumor of the cerebellum is likely to demonstrate which dysfunction of which process? · Disequilibrium · Abnormal eye movement · Impaired social judgment · Blood pressure irregularities

Disequilibrium Rationale The cerebellum is the organ primarily responsible for maintaining equilibrium. Eye movements are controlled by the midbrain. The frontal lobe controls social judgment. The medulla maintains blood pressure. p. 37

Which anticonvulsant mood stabilizer often prescribed for bipolar disorder carries a black box warning that includes pancreatitis? Ramelteon Lamotrigine Valproic acid Carbamazepine

Valproic acid Rationale Valproic acid (Depakene) is helpful in bipolar patients unresponsive to lithium. Black box warnings for valproic acid include hepatotoxicity, tetratogenicity, and pancreatitis. Ramelteon is a melatonin receptor agonist that works as a hypnotic. The use of lamotrigine may trigger a severe allergic skin reaction called Stephens-Johnson syndrome (SMS). The use of carbamazepine warrants a periodic complete blood count due to rare, but serious blood dyscrasias (e.g., aplastic anemia and agranulocytosis). p. 46

A client has been prescribed a sedative drug. The client reports to the nurse that he or she erroneously took the drug in the morning. What instruction should the nurse give the client in such a situation? · "Do not sleep right away." · "Do not drive right away." · "Do not eat food for two hours." · "Do not take a bath right away."

· "Do not drive right away." Rationale Sedative hypnotic drugs blunt the alertness of a client. Therefore, the client is cautioned against performing high-precision activities like driving after taking the drug. lithe client drives after taking the drug, accidents can occur. The client would feel drowsy after the drug, and sleeping would not harm the client in any way. The client can eat food after taking the drug, because the food would not interact with the drug and cause any effects. Taking a bath immediately after taking the drug would not harm the client. p. 35

A client is taking medication that acts by blocking reuptake of both serotonin and norepinephrine. Which client action suggests that the treatment is successful? · The client reports feeling more hopeful. · The client exercises a sore shoulder. · The client is able to write his or her telephone number · The client goes to his or her room to "calm down."

· The client reports feeling more hopeful. Rationale Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation, indicated by more hopeful feelings. Blocking serotonin and norepinephrine would not have an effect on a client's muscle soreness or memory. Blocking these chemicals is a treatment for depression, which is not characterized by a need to calm oneself. p. 44

According to the monograph a psychotropic drug enhances the gamma-aminobutyric (GABA) receptor activity. What effect would the drug have on the client? · The drug has a sedative effect. · The drug has a pain-relieving effect. · The drug stimulates gastric secretion. · The drug helps in improving cognitive performance.

· The drug has a sedative effect. Rationale Drugs that stimulate the GABA receptors produce a sedative, hypnotic effect on the brain. Stimulation of GABA receptor activity does not cause pain relief, increase gastric secretion, or improve cognitive performance. Pain relief is caused by increased receptor activity of substance P. Gastric secretion is increased by enhanced activity of histamine receptors. Cognitive performance is improved by increased activity of glutamate receptors. p. 45

Antidepressant medication is prescribed for a client who has high levels of cytochrome P-450 (CYP) enzymes. Which outcome is most likely? · The rate of drug absorption will be high. · The rate of drug absorption will be low. · The rate of drug metabolism will be quick. · The rate of drug metabolism will be slow.

· The rate of drug metabolism will be quick. Rationale The level of cytochrome P-450 (CYP) alters drug metabolism. High levels of CYP increase the metabolism of antidepressant drugs. CYP levels do not affect drug absorption, so they would not make it too low or too high. Low levels of CYP decrease the metabolism of the drugs. p. 43

Which structure associated with the brain responds to stimuli, conducts electrical impulses, and releases neurotransmitters? · Neuron · Synapse · Cerebellum · Receptor

Neuron Rationale Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events. Electrical signals within neurons are converted at synapses into chemical signals. The cerebellum is an area of the brain that contributes to both motor control and cognitive processing. Receptors are located on cell surfaces and receive electrical impulses. p. 37

A client tells the community mental health nurse, "I told my health care provider I was having trouble sleeping, and I got a prescription for trazodone 50 mg every night. I read on the internet that this drug is an antidepressant, but I'm not depressed. What should I do?" Which of the nurse's responses is most appropriate? · "I will help you contact your health care provider for clarification regarding this new prescription." · "Insomnia and depression usually go hand-in-hand. If your depression is relieved, your sleep will improve." · "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur." · "Information on the internet is often misleading and incorrect. It's more important to trust the judgment of your health care provider."

· "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur." Rationale The nurse can tell the client that trazodone helps relieve insomnia and loses its antidepressant effects in low doses. Contacting the health care provider for clarification is unnecessary, because the nurse can provide the appropriate client education to the client. Responding that insomnia and depression go hand-in-hand, and the relief of one is helpful to the other is not necessarily true, because the prescribed drug treats insomnia without treating depression at the lower dose. Although the Internet can be misleading to clients, they are also encouraged to ask for more information, and the nurse can provide clarification without dismissing the client's concerns. p. 45

The nurse is caring for a client who is taking amitriptyline for depression. Which instruction should the nurse prioritize in the teaching of this client? · "If chest pain occurs, an over-the-counter pain reliever should help." · "Nasal congestion indicates a respiratory virus is beginning." · "Measure and record your blood pressure daily." · "Adverse effects will subside as you adjust to the medication."

· "Measure and record your blood pressure daily." Rationale Because MAOIs block the enzyme that metabolizes monoamines, they may occasionally be used to increase the levels of serotonin and norepinephrine in intractable depression. However, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRls) are the more commonly used antidepressants because of the vasopressor effects that occur when MAOIs are combined with other sympathomimetics (amines that stimulate the sympathetic nervous system). The most feared vasopressor effect is the hypertensive crisis that can result if a client takes over-the-counter medications with pseudoephedrine or consumes the adrenergic monoamine tyramine, commonly found in aged foods, fermented foods, and certain beverages. Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs to allow the body to resynthesize the MAO enzyme. pp. 43—44

A client asks, "What exactly are neurotransmitters?" How does the nurse best answer the client's question? · "Neurotransmitters are chemical messengers in the brain that help regulate specific functions." · "Neurotransmitters are too complicated to explain easily. just know that the medication will help your mood." · "Neurotransmitters are the reason you are depressed." · "I will ask your health care provider to give you a more in-depth explanation on neurotransmitters and their effects."

· "Neurotransmitters are chemical messengers in the brain that help regulate specific functions." Rationale Neurotransmitters are chemicals released from neurons that function as neuromessengers and influence brain functions. Telling the client that the answer is too complicated belittles the client by implying he or she cannot understand, and this does not answer the question. Stating that neurotransmitters are the reason the client is depressed is too simplistic and does not answer the question of what neurotransmitters are. Asking the health care provider to give the education abdicates the nurse's responsibility to provide client education. pp. 37-39

A client prescribed a second-generation antipsychotic (SGA) asks why the medication is referred to using that term. What will the nurse include what information in a response? Select all that apply. · "Some SGAs may cause excessive salivation and diarrhea." · "SGAs are capable of treating a larger variety of mental illnesses." · "It's used to identify the newer form of antipsychotic medications." · "SGAs produce fewer side effects than the first-generation formulations do." · "They contain a higher ratio of serotonin to dopamine than first-generation forms do."

· "SGAs are capable of treating a larger variety of mental illnesses." · "It's used to identify the newer form of antipsychotic medications." · "SGAs produce fewer side effects than the first-generation formulations do." · "They contain a higher ratio of serotonin to dopamine than first-generation forms do." Rationale Several SGAs have been FDA approved to treat bipolar disorder and depression. Furthermore, because of their different binding receptor profiles, the SGAs have fewer extrapyramidal side effects (EPS). The term "second-generation antipsychotic" is a term to identify the newer form of antipsychotic medications. An SGA has a higher ratio of serotonin (5-HT2) to dopamine D2-receptor blockade than first-generation forms. Some SGAs may have significant anticholinergic and antihistamine activity, so some of the side effects may include a dry mouth and constipation rather than salivation and diarrhea. p. 48

A client has demonstrated behaviors suggestive of schizophrenia. As part of the diagnostic process, the nurse prepares the client for a functional magnetic resonance imaging study (PMRI). Which statement by the nurse best addresses the client's concerns about the purpose of this test? · "It's a painless way to see inside the brain and view its structures." · "It's a series of cross-sectional pictures of the structure of your brain." · "This method reduces the brain's exposure to x-rays and radioactive isotopes." · "The study will show how well the blood is flowing to active areas of your brain."

· "The study will show how well the blood is flowing to active areas of your brain." Rationale A functional MRI is capable of providing a high resolution, 3D-like cross-section of the brain. Such a view would allow an evaluation of the blood flow to the ventricles, which is usually impaired in clients diagnosed with schizophrenia. Explaining that an MRI is a painless way to see inside the brain does not fully address why it is used in diagnosing schizophrenia, as does explaining it as a series of cross-sectional pictures of the structure of the brain. Explaining that an MRI reduces the brain's exposure to x- rays and radioactive isotopes explains why it is safe but not why it is being done.

A client diagnosed with major depressive disorder is reluctant to agree to medication therapy stating, "I don't see how medication that affects my brain is going to make me less depressed." Which statement by the nurse best addresses the client's concern? · "While the brain is a very complex organ, it does respond very well to this medication." · "Are you afraid of taking this medication because of what your friends and family may thinks" · "Your brain controls your emotions; this medication will help the brain do that more effectively." · "The staff has your best interests in mind and know that this medication is very effective in treating depression."

· "Your brain controls your emotions; this medication will help the brain do that more effectively." Rationale Explaining that the brain controls emotions and the medication can help facilitate that clarifies for the client how medication therapy can help him or her. Stating that the brain will respond to the medication does not tell the client how that will happen. There is nothing to indicate the client is afraid to take the medication, and asking if he or she fears the stigma may imply that there is a reason to be afraid. While the staff should have the client's best interests in mind, telling the client this does not explain why the medication will be helpful.

Based on the current understanding of neurotransmitters, what event is responsible for a client's symptoms of profound depression? · An increase in dopamine level · A decrease in serotonin level · An increase in norepinephrine level · A decrease in acetylcholine level

· A decrease in serotonin level Rationale A decreased serotonin level is highly associated with depression. Increased dopamine, increased norepinephrine, and decreased acetylcholine levels are not associated with depression. p. 42

A client begins a new prescription for risperidone. Which intervention should the nurse include in the plan of care? · Monitor intake and output daily · Educate the client about foods that contain tyramines · Assess sitting, standing, and lying blood pressure daily · Administer the drug with food to reduce gastrointestinal irritation

· Assess sitting, standing, and lying blood pressure daily Rationale Risperidone blocks α1 and H1 receptors and can cause orthostatic hypotension and sedation, which can lead to falls, so the nurse should monitor the client's sitting, standing, and lying blood pressure daily. A side effect of sympathomimetics is weight loss, so clients using these drugs should be monitored for intake and output. A client taking monoamine oxidase inhibitors (MAOIs) needs education about tyramines to avoid possible hypertensive crises. Gastrointestinal irritation is not a typical side effect of risperidone. pp. 36, 44, 48

A client diagnosed with anxiety is prescribed diazepam. What specific instruction should the nurse give to minimize the client's risk of experiencing excessive central nervous system (CNS) depression? · Take the drug before going to sleep. · Avoid consuming alcohol while on the drug. · It is fine to take the drug before driving to work. · Take the drug in conjunction with a tricyclic antidepressant.

· Avoid consuming alcohol while on the drug. Rationale Diazepam is a benzodiazepine drug. If benzodiazepines are combined with other CNS depressants such as alcohol, then the inhibitory actions of the benzodiazepines can lead to life-threatening CNS depression such as coma. Taking the drug before going to sleep, avoiding activities requiring a high degree of alertness like driving, or taking the drug in conjunction with a tricyclic antidepressant are not instructions given to avoid CNS depression. The drug should ideally be taken before going to sleep so that drowsiness does not affect daily activities. However, this does not have to do with CNS depression. Benzodiazepines impair alertness; therefore, it should not be taken while doing activities that require a high degree of attention such as driving a car. Benzodiazepines should never be consumed with tricyclic antidepressants drugs, because their interaction may cause serious CNS depression symptoms, such as coma and respiratory distress.

A nurse plans care for an adult who is diagnosed with a tumor in the cerebellum. The nurse should focus initial interventions on the client's anticipated problems with which function(s)? · Social judgment · Balance and equilibrium · Proprioception and body awareness · Regulation of pupil size and reflexes

· Balance and equilibrium Rationale The cerebellum is involved primarily in regulation of skeletal muscle coordination and contraction as well as maintenance of equilibrium. It coordinates muscle contractions, so movement is smooth and purposeful. The frontal lobe manages social judgment. The parietal lobe directs proprioception and body awareness. The midbrain regulates pupil size and reflexes. pp. 35, 37

When interviewing a client who is prescribed psychotropic drugs, the nurse finds that the client has side effects such as dry mouth, constipation, and blurred vision. What is the most likely cause of these side effects? · Blocking of alpha (α)1 receptors · Blocking of acetylcholine (ACh) receptors · Blocking of serotonin (5-HT 2) receptors · Blocking of histamine (H 1) receptors

· Blocking of acetylcholine (ACh) receptors Rationale The blocking of acetylcholine (ACh) receptors causes symptoms such as dry mouth, constipation, and blurred vision. Therefore, the drug most likely blocks the ACh receptors. Side effects of α1 receptor blockers include postural hypotension, dizziness, reflex tachycardia, and memory dysfunction. Drugs that block 5-HT2 receptors may cause side effects such as hypotension and ejaculatory dysfunction. Drugs that block H1 receptors cause sedation or drowsiness, hypotension, and weight gain. p. 47

Which neuroimaging techniques demonstrate structural rather than functional problems? Select all that apply. · Computed tomography (CT) · Electroencephalograph (EEG) · Magnetic resonance imaging (MRI) · Positron emission tomography (PET) · Single photon emission computed tomography (SPECT)

· Computed tomography (CT) · Magnetic resonance imaging (MRI) Rationale CT and MRI scans show brain structure with overall images and layers of the brain. EEG shows electrical activity. Functional imaging techniques such as PET and SPECT reveal physiological activity in the brain. p. 38

A client being evaluated for a possible diagnosis of schizophrenia has been referred for a positron emission tomography (PET) scan. What findings in the PET scan would confirm the diagnosis in this client? · Reduction of the temporal lobe · Enlargement of the third ventricle · Enlargement of the prefrontal lobe · Decreased glucose utilization in the frontal lobes

· Decreased glucose utilization in the frontal lobes Rationale A PET scan is a functional imaging technique that reveals the physiological activity of the brain. In a client with schizophrenia, the scan would reveal decreased metabolic activity in the frontal lobes. Reduction of the temporal lobe and enlargement of the third ventricle are findings associated with schizophrenia, but these are revealed by structural imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). The prefrontal lobe is atrophied in schizophrenia; an enlarged prefrontal lobe is not a finding associated with schizophrenia. p. 38

A client who is taking olanzapine is experiencing nocturia and increased thirst. Based upon the client's symptoms, the nurse suspects that the client has developed which of these problems? · Diabetes mellitus · Renal calculi · Urinary obstruction · Hyperthyroidism

· Diabetes mellitus Rationale Olanzapine, a derivative of clozapine, has comparable receptor occupancies and similar metabolic side effects, such as weight gain. Metabolic monitoring for all patients receiving SGA (atypicals) is recommended, although risperidone (Risperdal) and quetiapine (Seroquel) have a lower weight gain and ziprasidone (Geodon) and aripiprazole (Ability) are considered weight neutral. Metabolic monitoring usually includes measurements of body weight, body mass index (BMI), waist circumference, fasting plasma glucose level, and fasting lipid profile. p. 48

Upon studying the medical records of a client diagnosed with anxiety, the nurse finds that the client has been prescribed diazepam. How does this drug relieve anxiety? · Diazepam binds with alpha (α) receptors. · Diazepam binds with serotonin (5HT1) receptors. · Diazepam binds with gamma aminobutyric acid (GABA) receptors. · Diazepam binds with dopamine (D2) receptors.

· Diazepam binds with gamma aminobutyric acid (GABA) receptors. Rationale Diazepam belongs to the class of benzodiazepines. These drugs relieve anxiety by binding to GABA receptors. GABA is the major inhibitory neurotransmitter in the central nervous system. Therefore, blocking the GABA receptors would prevent inhibition of the central nervous system and relieve anxiety. Diazepam does not bind with alpha (α), serotonin (5HT1). or dopamine (D2) receptors. Blocking α and 5HT1 receptors (norepinephrine and serotonin receptors) would cause depression. Blocking D2 receptors for dopamine would relieve symptoms of schizophrenia, such as hallucinations and delusions. p. 45

Which of the following neurotransmitters are destroyed by being taken back into the presynaptic cell in the process referred to as reuptake? Select all that apply. · Acetylcholine · Dopamine · Norepinephrine · Serotonin

· Dopamine · Norepinephrine · Serotonin Rationale There are two basic mechanisms by which neurotransmitters are destroyed. Some neurotransmitters (e.g., norepinephrine, dopamine, serotonin) are taken back into the presynaptic cell from which they originally were released by a process called cellular reuptake; they are either reused or destroyed by intracellular enzymes. Other neurotransmitters (e.g., acetylcholine) are destroyed by specific enzymes at the postsynaptic cell.

Which neurotransmitters are responsible for the hallucinations, anxiety, and altered thought processes being experienced by a client experiencing a schizophrenic psychotic episode? Select all that apply. · Dopamine (DA) · Norepinephrine (NE) · Serotonin (5-HT) · Gamma aminobutyric acid (GABA) · Acetylcholine (ACh)

· Dopamine (DA) · Norepinephrine (NE) · Gamma aminobutyric acid (GABA) Rationale The characteristic increases in DA and NE in combination with a decrease in GABA are responsible for the classic symptoms of a schizophrenic psychotic episode. 5-HT and ACh are not related to this disorder. p. 42

An adult reports frequent anxiety. Which neurotransmitter is most closely related to this symptom? · Dopamine · Glutamate · Monoamine oxidase · Gamma aminobutyric acid (GABA)

· Gamma aminobutyric acid (GABA) Rationale The neurotransmitter GABA plays a role in modulating neuronal excitability and anxiety. Many antianxiety (anxiolytic) drugs increase the effectiveness of this neurotransmitter, primarily by increasing receptor responsiveness. Dopamine is involved in thought processes and regulation of movement. Glutamate is associated with memory and learning. Monoamine oxidase is an enzyme involved in regulating metabolism of norepinephrine. p. 42

A client is prescribed a drug that blocks the 5-HT2 and acetylcholine receptors. Based on this information, which side effects should the nurse include when providing medication education to the client? Select all that apply. · Tachycardia · Hypotension · Dry mouth · Urinary retention · Gastric disturbances · Ejaculatory dysfunction

· Hypotension · Dry mouth · Urinary retention · Ejaculatory dysfunction Rationale The antidepressant effects of the drug are due to blockage of the 5-HT 2 receptors. The drug also blocks acetylcholine receptors. Hypotension is a side effect associated with 5-HT2 receptor blocking. Dry mouth is a side effect associated with blockage of acetylcholine receptors. Urinary retention is a side effect associated with blocking the acetylcholine receptors. Ejaculatory dysfunction is a possible side effect of blocking the 5-HT 2 receptors. Tachycardia and gastric disturbances are not side effects associated with this antidepressant drug. Tachycardia is a side effect of drugs that cause norepinephrine reuptake inhibition. Gastric disturbance is a side effect of drugs that inhibit 5-HT reuptake.

A client is prescribed clonazepam. Which documented change in behavior would suggest that the treatment is successful? · Less anxiety · Normal appetite · Improved sleep pattern · Reduced auditory hallucinations

· Less anxiety Rationale Clonazepam is in the class of drugs known as benzodiazepines, which are the most commonly used antianxiety agents. Reporting less anxiety is a desired outcome of this therapy. This drug would not affect the client's appetite, sleep pattern, or auditory hallucinations. p. 45

A nurse administering ramelteon should understand that therapeutic effects result from potentiating which neurotransmitter? · Gamma aminobutyric acid (GABA) · Serotonin · Melatonin (MT) · Norepinephrine

· Melatonin (MT) Rationale Melatonin is a hormone excreted only at night as part of the normal circadian rhythm, and ramelteon is an MT receptor agonist. It has a high selectivity and potency at the MT receptor sites, which regulate sleepiness and circadian rhythms. Potentiating action of GABA reduces anxiety. Potentiating actions of serotonin and norepinephrine improve depression. p. 46

The nurse recognizes imbalance of a client's hypothalamus when including which intervention for a specific client? · Sleep hygiene measures for a 40-year-old diagnosed with major depressive disorder (MDD) · Limit setting for a 14-year-old diagnosed with oppositional defiance disorder (ODD) · Staff to accompany a 30-year-old diagnosed with anorexia nervosa to the bathroom · Frequent reorientation to time and place for a 79-year-old diagnosed with dementia

· Sleep hygiene measures for a 40-year-old diagnosed with major depressive disorder (MDD) Rationale The hypothalamus maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms, such as sleep and wakefulness, so improving sleep hygiene measures for a client with MDD indicates a hypothalamus imbalance. Hypothalamus dysfunction is not associated with ODD, anorexia nervosa, or dementia. p. 35

Which priority teachings should the nurse include for a client that is beginning therapy with a monoamine oxidase inhibitor (MAOI) medication? Select all that apply. · Take the medication at bedtime. · Monitor blood pressure. · Report double vision. · Reduce tyramine intake. · Do not take over-the-counter medication without provider approval.

· Monitor blood pressure. · Reduce tyramine intake. · Do not take over-the-counter medication without provider approval. Rationale Because MAOIs block the enzyme that metabolizes monoamines, they may occasionally be used to increase the levels of serotonin and norepinephrine in intractable depression. However, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRls) are the more commonly used antidepressants because of the vasopressor effects that occur when MAOIs are combined with other sympathomimetics (amines that stimulate the sympathetic nervous system). The most feared vasopressor effect is the hypertensive crisis that can result if a client takes over-the-counter medications with pseudoephedrine or consumes the adrenergic monoamine tyramine, commonly found in aged foods, fermented foods, and certain beverages. Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs to allow the body to resynthesize the MAO enzyme.

The nurse understands that which neurotransmitters are decreased with a diagnosis of depression? · Epinephrine, norepinephrine, and acetylcholine · Norepinephrine, dopamine, and serotonin · Acetylcholine, gamma-aminobutyric acid, and serotonin · Gamma-aminobutyric acid (GABA), dopamine, and epinephrine

· Norepinephrine, dopamine, and serotonin Rationale Norepinephrine, dopamine, and serotonin are all neurotransmitters involved in a diagnosis of depression. Acetylcholine is increased with depression, and GABA is associated with anxiety. p. 42

Systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels would be most important for a client beginning a new prescription for which medication? · Aripiprazole · Olanzapine · Ziprasidone · Cariprazine

· Olanzapine Rationale Because olanzapine has metabolic side effects such as weight gain, clients beginning a new prescription of olanzapine should undergo systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels. Aripiprazole does not require the same systematic monitoring. Ziprasidone can cause dizziness and sedation, so a nurse may monitor a client on this drug for balance and a risk of falls. Clients beginning Cariprazine would not need these systematic measurements. pp. 48, 49

Which statements regarding the effects of pharmacogenetics on medication administration-related nursing care are true? Select all that apply. · Pharmacogenetics makes the prescribing of medications more client-specific · Pharmacogenetics focuses on how genes affect individual responses to medicines · In the future, cardiac enzymes may be used to determine a client-specific medication dosage. · Genetic variations in a group of cytochrome enzymes can exist in various ethnic populations. · Cytochrome P-450 (CYP) enzymes are involved in the metabolizing of most antidepressant medications.

· Pharmacogenetics makes the prescribing of medications more client-specific · Pharmacogenetics focuses on how genes affect individual responses to medicines · Genetic variations in a group of cytochrome enzymes can exist in various ethnic populations. · Cytochrome P-450 (CYP) enzymes are involved in the metabolizing of most antidepressant medications. Rationale By understanding how genes influence drug responses, clinicians may one day be able to prescribe drugs best suited for each individual, in other words, in a more client- specific way. The relatively new field of pharmacogenetics focuses on how genes affect individual responses to medicines. An important variation that impacts the ability to metabolize drugs relates to the more than 20 CYP enzymes present in human beings. Genetic variations in these enzymes may alter drug metabolism, and these variations tend to be propagated through racial and ethnic populations. CYP enzymes metabolize most antidepressants and antipsychotics. One purpose of genetic testing in the future will be to enable clinicians to determine correct drugs and dosage using liver enzymes, not cardiac enzymes.

Which imaging technique can provide information about brain function? · Computed tomography (CT) scan · Positron emission tomography (PET) scan · Magnetic resonance imaging (MRI) scan · Skull radiograph

· Positron emission tomography (PET) scan Rationale PET scans provide information about brain function. CT scans, MRI scans, and skull radiographs provide information about brain structure, not function.

The nurse is providing education for a client who is going to begin therapy with clozapine. Which of these will the nurse prioritize in the care of this client? · Weekly liver function tests · Daily PT and INR · Monthly creatinine levels · Regular complete blood counts

· Regular complete blood counts Rationale Clozapine, the first of the atypicals, is several times more potent in blocking serotonin 5-HT2 receptors than dopamine D2 receptors. It also has binding activity at a variety of other receptors, which may account for its advantages in treating patients who respond poorly to other antipsychotics. Clozapine is not a first-line treatment because it may suppress bone marrow, resulting in agranulocytosis, a rare but serious decrease in granulated white blood cells (WBCs). p. 48

A nurse adds this outcome to the plan of care: "Within one week, the client will stay awake for an entire group session." Which part of the nervous system is related most to this outcome? · Amygdala · Hippocampus · Temporal lobe · Reticular activating system (RAS)

· Reticular activating system (RAS) Rationale Through projections of the reticular activating system (RAS), the brainstem regulates the entire cycle of sleep and wakefulness and the ability of the cerebrum to carry out conscious mental activity. The amygdala and hippocampus are involved in emotions, learning, memory, and basic drives. The temporal lobe is involved in language comprehension and memory storage. p. 35

Based on current understanding of brain physiology, which of the following neurotransmitters should the nurse expect to see targeted with the medication prescribed for the treatment of depression? · Dopamine · Gamma-amino butyric acid (GABA) · Serotonin · Histamine

· Serotonin Rationale Antidepressant medication targets serotonin and norepinephrine. Dopamine is implicated in schizophrenia (increase) and Parkinson disease (decrease). GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer disease, Huntington disease, and Parkinson disease. Histamine is associated with allergic reactions. p. 42

A client is taking lithium for bipolar disorder. The nurse understands that which lab values should be assessed for this client? · Hematocrit · Sodium level · Hemoglobin · Anion gap

· Sodium level Rationale Primarily because of its effects on electrical conductivity, lithium has a low therapeutic index (the ratio of the lethal dose to the effective dose); therefore, it is important to monitor blood lithium levels, which are dependent on kidney function. Changes in sodium and hydration can affect the amount of lithium salts excreted. When sodium is depleted, the kidneys attempt to retain lithium and this may result in toxicity. Conversely, excessive sodium lowers lithium. Long-term use of lithium increases the risk of both kidney and thyroid disease. p. 46

The nurse is admitting a client to the hospital who is taking amitriptyline for depression. Which should the nurse prioritize in this client's assessment? Select all that apply. · Suicidal ideation · Physical pain · Affect · Family responsibilities · Constipation

· Suicidal ideation · Affect · Constipation Rationale Multiple pharmacological mechanisms of TCAs have proven beneficial in treating difficult cases of depression and chronic pain. However, multiple actions on several receptors also earned TCAs the name "dirty drugs" because of their many side effects. For example, to varying degrees TCAs block muscarinic receptors that normally bind acetylcholine, leading to anticholinergic effects. Again to varying degrees, TCAs block H 1 receptors, causing sedation and weight gain. Strong binding at adrenergic receptors causes dizziness and hypotension, thereby increasing the risk for falls. Pharmacokinetics must be considered in TCA overdose fatalities because TCAs are highly lipid soluble and rapidly absorbed. This may result in cardiotoxicity and death before the client can reach a hospital, especially if the client is an older adult with a slower rate of drug elimination. p. 44

A client who has experienced a traumatic brain injury is demonstrating abnormally fluctuating emotions. The client's history and symptoms suggest injury to which lobe of the cerebral cortex? · Frontal · Temporal · Occipital · Parietal

· Temporal Rationale The temporal lobe connects to the limbic system to allow expression of emotions. Any injury to the temporal lobe would result in abnormally fluctuating emotions. This lobe is also responsible for language comprehension. The frontal lobe is chiefly responsible for initiating voluntary activities. The occipital lobe interprets visual images and stores visual memories. The parietal lobe is chiefly concerned with the perception of sensations.

What anatomic characteristic of the brain promotes development of ataxia as a side effect of the temazepam? · The cerebellum has numerous glutamate receptors. · The frontal lobe has numerous glutamate receptors. · The cerebellum has numerous gamma-aminobutyric acid (GABA) receptors. · The frontal lobe has numerous gamma-aminobutyric acid (GABA) receptors.

· The cerebellum has numerous gamma-aminobutyric acid (GABA) receptors. Rationale Temazepam is a benzodiazepine drug that enhances the activity of the GABA receptors and causes sedation. There are numerous GABA receptors in the cerebellum that are stimulated by benzodiazepine drugs, causing ataxia. Increased glutamate receptor activity has an excitatory effect on the central nervous system. This can cause neurodegeneration in Alzheimer disease. Benzodiazepines do not act on glutamate receptors (NMDA and AMPA receptors). Ataxia is a movement disorder caused by cerebellar dysfunction; frontal lobe dysfunction does not cause ataxia.