Psych Test 3 Chapters 13, 15, 21, 25

48. A client diagnosed with bipolar affective disorder is prescribed divalproex sodium (Depakote). Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply. 1. Platelet count and bleeding time. 2. Aspartate aminotransferase (AST). 3. Fasting blood sugar (FBS). 4. Alanine aminotransferase (ALT). 5. Valproic acid level.

1,2,4,5 Divalproex sodium (Depakote) is classified as an anticonvulsant and used as a mood stabilizer in the treatment of clients diagnosed with bipolar affective disorder. Side effects of this medication include prolonged bleeding times and liver toxicity. 1. Platelet counts and bleeding times need to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effects of blood dyscrasias and prolonged bleeding time. 2. Aspartate aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effect of liver toxicity. 4. Alanine aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effect of liver toxicity. 5. Divalproex sodium (Depakote) levels need to be monitored to determine therapeutic levels and assess potential toxicity. *3. Fasting blood sugar measurements are not affected and are not indicated during treatment with valproic acid.*

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to: 1. Anxiety. 2. Depression. 3. Mania. 4. Alcohol dependency.

1. Clonazepam (Klonopin) is a benzodiazepine that works quickly to relieve anxiety

Which statement is true as it relates to the history of psychopharmacology? 1. Before 1950, only sedatives and amphetamines were available as psychotropics. 2. Phenothiazines were initially used in pain management for their sedative effect. 3. Atypical antipsychotics were the first medications used to assist clients with positive symptoms of schizophrenia. 4. Psychotropic medications have assisted clients in their struggle to cure mental illness.

1. Sedatives and amphetamines were the only medications available before 1950, and they were used sparingly because of their toxicity and addictive properties

Which symptoms would the nurse expect to assess in a client suspected to have serotonin syndrome? 1. Alterations in mental status, restlessness, tachycardia, fluctuating blood pressure, and diaphoresis. 2. Hypomania, akathisia, cardiac arrhythmias, and panic attacks. 3. Dizziness, lethargy, headache, and nausea. 4. Orthostatic hypotension, urinary retention, constipation, and blurred vision.

1.Alterations in mental status, restlessness, tachycardia, fluctuating blood pressure, and diaphoresis all are symptoms of serotonin syndrome. If this syndrome were suspected, the offending agent would be discontinued immediately.

In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.

2 Benzodiazepines are prescribed for short term treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation.used to decrease anxiety symptoms. They are not intended to be prescribed for long-term treatment. They can be prescribed for individuals diagnosed with posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal.

A client prescribed quetiapine (Seroquel) 50 mg bid has a nursing diagnosis of risk for injury R/T sedation. Which nursing intervention appropriately addresses this client's problem? 1. Assess for homicidal and suicidal ideations. 2. Remove clutter from the environment to avoid injury. 3. Monitor orthostatic changes in pulse or blood pressure. 4. Evaluate for auditory and visual hallucinations.

2. Removing clutter from the client's environment would assist the client in avoiding injury due to tripping and falling. It is important for the nurse to ensure the environment is clutter-free, especially when the client may be sedated. Quetiapine (Seroquel) is an atypical antipsychotic used in the treatment of thought disorders. A significant side effect of quetiapine is sedation.

Lithium carbonate (lithium) is to mania as clozapine (Clozaril) is to: 1. Anxiety. 2. Depression. 3. Psychosis. 4. Akathisia.

3. Clozapine (Clozaril), an atypical antipsychotic, is used to treat symptoms of thought disorders, such as, but not limited to, psychoses

Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia? A Age of onset is typical for schizophrenia. B Age of onset is later than usual for schizophrenia. C Age of onset is earlier than usual for schizophrenia. D Age of onset follows no predictable pattern in schizophrenia.

A-Explanation: The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27). Paranoid schizophrenia may sometimes have a later onset. All of the other options are incorrect. *Per PPT typically Males have earlier onset than females (late teens), females (early adult)* *Women can have first time break at menopause*

When developing the plan of care for a client receiving haloperidol, which of the following medications would nurse Monet anticipate administering if the client developed extra pyramidal side effects? A. Benztropine mesylate (Cogentin) B. Lorazepam (Ativan) C. Paroxetine (Paxil) D. Olanzapine (Zyprexa)

A. Benztropine (Cogentin) is an antiparkinsonian agent and is used to assist clients with extrapyramidal symptoms from antipsychotic medications Because of its anti cholinergic properties.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). *The nurse should establish a baseline white blood cell count to evaluate for this side effect if clozapine is being considered as a treatment option. *

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like poison."

ANS: A The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. *Delusions are false personal beliefs* that are inconsistent with the person's intelligence or cultural background.

A patient diagnosed with schizophrenia reveals to the nurse that voices have warned of danger and adds, "They're so loud they frighten me. Do you hear them?" The nurse's best initial response would be: a. "I know these voices are very real to you, but I don't hear them." b. "Don't worry. You're safe in the hospital. I won't let anything happen to you." c. "Tell me more about the voices. Are they men or women? How many are there?" d. "What do you do in order to keep yourself occupied so you don't hear the voices?"

ANS: A When asked, the nurse should point out that he or she is not experiencing the same stimuli but should accept the reality of the hallucinations for the patient. Being able to communicate with the nurse at the time the hallucinations are occurring is helpful to the patient. Interactive discussion of hallucinations is a vital element in the development of reality-testing skills.

When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed oral haloperidol (Haldol), which intervention would promote medication compliance? a. Instructing the patient to have friends monitor his medications b. Beginning administration of haloperidol (Haldol) decanoate c. Writing instructions in detail for the patient to follow d. Changing haloperidol to an atypical antipsychotic

ANS: B Haloperidol *decanoate is a depot medication, given intramuscularly every 2 to 4 weeks*. It is unknown whether the patient has a support system. The patient probably received education, including written instructions prior to discharge. Changing to another classification of medication would not necessarily improve compliance.

A patient who has been hospitalized for 2 days remains anxious and continues to be preoccupied with paranoid delusions. What intervention will best help the patient focus less on the delusions? a. Schedule time for the patient to read and listen to music. b. Plan activities that require physical skills and constructive use of time. c. Begin planning for discharge by engaging the patient in psychoeducation. d. Discuss personal goals related to improved socialization with the patient.

ANS: B Engaging the patient in physical activity will help *distract the patient* and keep the patient from focusing solely on the delusions. The patient would still be able to focus on the delusions while appearing to be reading or listening to music. The latter two activities are better addressed later in the course of treatment. *Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational* Try to distract pt

What is the basis for the reduction in disturbed thought processes when a patient is administered haloperidol (Haldol)? a. Reduction in the number of brain cells that crave dopamine b. Dopamine receptors are blocked, making dopamine less available c. Dopamine receptors are enhanced, making more dopamine available d. Medication causes an increased cellular production of dopamine

ANS: B Excess dopamine is responsible for symptoms of psychosis such as delusions and hallucinations. Blocking dopamine receptors will result in reduction of primary symptoms. The other options do not reflect the action of typical antipsychotic medications.

A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive but the patient continues to have apathy, poverty of thought, and social isolation. The nurse expects a change to which medication? a. haloperidol (Haldol) b. olanzapine (Zyprexa) c. chlorpromazine (Thorazine) d. diphenhydramine (Benadryl)

ANS: B Olanzapine is an atypical antipsychotic medication that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotic agents that target only positive symptoms. Diphenhydramine is an antihistamine.

Because of the cognitive disturbances associated with schizophrenia, which teaching style will be useful as the nurse teaches a patient about self-management? a. Use only verbal instruction. b. Teach material in small segments. c. Offer opportunities for making numerous choices. d. Plan the teaching for a time when the patient has been recently medicated.

ANS: B Patients with cognitive disturbances should be taught small blocks of information at a time and given frequent reinforcement. Both verbal and visual materials should be used since processing of verbal stimuli may be more impaired. Teaching should be scheduled when the patient is most alert. A large number of choices may be confusing for the person, but a few simple choices may be included. *No confusing choices, be patient*

When working with clients of a particular culture, which action should a nurse avoid? A. Maintaining eye contact based on cultural norms B. Assuming that all individuals who share a culture or ethnic group are similar C. Supporting the client in participating in cultural and spiritual rituals D. Using an interpreter to clarify communication

ANS: B The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals. *Per PPT Voodoo is real to those that believe it & is not psychosis*

client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. I don't hear any voices speaking." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination.

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

ANS: C When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol), 50 mg bid; benztropine (Cogentin), 1 mg prn; and zolpidem (Ambien), 10 mg HS. Which client behavior would warrant the nurse to administer *benztropine*? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity. The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol.

What response would be anticipated when a patient who received chlorpromazine (Thorazine) for 10 years to treat schizophrenia is switched to Seroquel (quetiapine)? a. Development of pseudoparkinsonism b. Development of dystonic reactions c. Improvement in tardive dyskinesia

ANS: C Atypical antipsychotics have been noted to block oral dyskinesia and improve tardive dyskinesia as well as improve both positive and negative symptoms of schizophrenia. Pseudoparkinsonism and dystonic reactions are associated with typical antipsychotic medication. *PER PPT TYPICAL IS OLDER- TREATS POSITIVE SYMPTOMS ONLY! MORE S/E*

A nurse observes a patient who is sitting alone in a room muttering, "You don't know what you're talking about! Leave me alone." The nurse attempts to validate whether the patient is: a. seeking the attention of staff. b. inappropriately expressing emotion. c. experiencing auditory hallucinations. d. displaying negative symptoms of schizophrenia.

ANS: C Impulsive activity, talking to people who are not present, and covering the ears are behaviors that may indicate the patient is responding to auditory hallucinations. *per PPT AH occurs more often than not-ask about their 5 senses. This is important to determine what they are experiencing*

. A client states, "I hear voices that tell me that I am evil." Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge? A. The client will verbalize the reason the voices make derogatory statements. B. The client will not hear auditory hallucinations. C. The client will identify events that increase anxiety and illicit hallucinations. D. The client will positively integrate the voices into the client's personality structure.

ANS: C It is unrealistic to expect the client to completely stop hearing voices. Even when compliant with antipsychotic medications, clients may still hear voices. It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. By this recognition the client can anticipate symptoms and initiate appropriate coping skills.

A patient diagnosed with schizophrenia approaches the nurse and says, "I'm cold. Ice cream is cold. Freezers keep ice cream cold." This speech pattern can be assessed as: a. hyperverbosity. b. circumstantiality. c. loose associations. d. expressing delusions.

ANS: C Loose associations reflect a disturbance in thinking in which speech shifts from topic to topic in a random, seemingly unrelated manner. When severe, it results in incoherence.

THIS IS A TOUGH ONE-- A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

ANS: C Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

Which patient behavior would support the diagnosis of schizophrenia with negative symptoms? a. Communicating using only rhyming phases b. Claims that "worms are crawling in my brain" c. Maintaining both arms suspended awkwardly overhead d. Shows no emotion when telling the story of a sister's recent death

ANS: D Blunted affect is considered a negative symptom. The other symptoms would be classified as positive symptoms.

A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in activities. A nurse can best select successful strategies by understanding that these behaviors are due to: a. a lack of self-esteem. b. manipulative tendencies. c. shyness and embarrassment. d. problems in cognitive functioning.

ANS: D The information processing of individuals with schizophrenia may be altered by brain deficits affecting memory and attention that then affect retention, ability to focus, and ability to make decisions. -When cognitive functioning is disrupted, a self-care deficit may also be noted -Patients with disrupted cognitive functioning have difficulty focusing on an activity in a sustained, concentrated fashion. They may need direction. * from ppt-cognitive symptoms are associated with the negative symptoms and difficult to treat*

A client diagnosed with schizophrenia, who has been taking antipsychotic medication for the last 5 months, presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome, treated by discontinuing antipsychotic medications B. Agranulocytosis, treated by administration of clozapine (Clozaril) C. Extrapyramidal symptoms, treated by administration of benztropine (Cogentin) D. Tardive dyskinesia, treated by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

Which nursing diagnosis is appropriate for a patient who insists being called "Your King" and demonstrates loosely associated thoughts? a.Risk for violence b.Defensive coping c.Impaired memory d. Disturbed thought processes

ANS: D Delusions and loose associations suggest disturbed thought processes. The other options are not supported by data in the scenario.

Nurse Amy assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply. A Anhedonia B Delusions C Flat affect D Hallucinations E Loose associations F Social withdrawal

B, D, E Delusions Loose associations Hallucinations *Positive symptoms of schizophrenia represent an excess or distortion of normal function* These are considered positive symptoms of schizophrenia. Options A, C, and F are considered negative symptoms.

A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence D. Risk for injury

C-The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

The nurse must be alert to signs of suicidal thoughts in clients in whom have been diagnosed with schizophrenia because approximately _____ attempt suicide. a. 15% b. 25% c. 30% d. 40%

D-40% schizophrenia pts attempt suicide & 10% are successful. Suicide is leading cause of death for persons dx: schizophrenia (per PPT) This figure makes it vitally important to monitor these individuals for suicidal thoughts.

Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder? 1. Lithium carbonate (lithium), loxapine (Loxitane), and carbamazepine (Tegretol). 2. Gabapentin (Neurontin), thiothixene (Navane), and clonazepam (Klonopin). 3. Divalproex sodium (Depakote), verapamil (Calan), and olanzapine (Zyprexa). 4. Lamotrigine (Lamictal), risperidone (Risperdal), and benztropine (Cogentin).

Divalproex sodium (Depakote), an anticonvulsant, and verapamil (Calan), a calcium channel blocker, are used in the long-term treatment of BPAD. Olanzapine (Zyprexa), an antipsychotic, has been approved by the FDA for the treatment of acute manic episodes.

Neurodevelopmental hypothesis

During adolescence we lose some of our neural connections. Schitzo lose at faster rate

Thought Disturbances: Delusions how to deal with in Nursing

Fixed false beliefs, do not agree with patient but be empathetic

Schizoaffective disorder

Per PPT this mean has components of psychosis (schizo) and mood (affective) disorders. You would treat symptoms ex: may be rx: antipsychotic and mood stabilizer

Dopamine hypothesis

Per ppt-she wants us to know that *increase in dopamine is associated with psychoisis*

Phases of crisis response

Phase 1: The individual is exposed to a stressor. Phase 2: Previous coping and problem-solving strategies fail to relieve the stressor. Phase 3: Resources from within and outside of the individual are mobilized to resolve the problem and to alleviate the discomfort caused by the stressor. Phase 4: The absence of crisis resolution leads to major disorganization such as self-injurious behavior.

A client prescribed lithium carbonate (lithium) 300 mg bid 3 months ago is brought into the hospital emergency department with mental confusion, excessive diluted urine output, and consistent tremors. Which lithium level would the nurse expect? 1. 1.2 mEq/L. 2. 1.5 mEq/L. 3. 1.7 mEq/L. 4. 2.2 mEq/L.

When the serum lithium level is 2.0 to 3.5 mEq/L, the client may exhibit signs such as excessive output of diluted urine, increased tremors, muscular irritability, psychomotor retardation, mental confusion, and giddiness.

Circumstantiality

also called "non-linear thought pattern" and occurs when the focus of a conversation drifts, but often comes back to the point.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, the nurse would anticipate a problem with: auditory hallucinations. bizarre behaviors. ideas of reference. motivation for activities.

motivation for activities. Explanation: In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. The other symptoms listed are the positive symptoms of schizophrenia. *per PPT Apathy, withdrawal, blunted or flat affect, lack of motivation*

Pananoid schizophrenia displays + or - symptoms of schizophrenia? Primary concern?

positive symptoms of schizophrenia Primary concern is SAFETY for others and self