Ch.19 OTC Drugs
A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an acute care mental health facility who has fallen several times while running down the hallway B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia C. A client in a day treatment program who says he is becoming more anxious during group therapy D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months
A. A client in acute care who has been running and falling should be helped by the treatment team on her unit. B. CORRECT: An ACT group works with clients who are nonadherent with traditional therapy, such as the client in a home setting who keeps "forgetting" his injection. C. A client who has anxiety might be referred to his counselor or mental health provider. D. A client who is grieving for her husband who died 3 months ago is currently involved in an appropriate intervention.
A nurse is working in a community mental health facility. Which of the following services does this type of program provide? (Select all that apply.) A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Family therapy
A. CORRECT: Educational groups are services provided in a community mental health facility. B. CORRECT: Medication dispensing programs are services provided in a community mental health facility. C. CORRECT: Individual counseling programs are services provided in a community mental health facility. D. Detoxification programs are services provided in a partial hospitalization program. E. CORRECT: Family therapy is a service provided in a community mental health facility
A nurse in an acute mental health facility is assisting with discharge planning for a client who has a severe mental illness and requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following strategies should the nurse suggest as appropriate follow‑up care? A. Receiving daily care from a home health aide B. Having a weekly visit from a nurse case worker C. Attending a partial hospitalization program D. Visiting a community mental health center on a daily basis
A. Daily care provided by a home health aide will not provide adequate supervision for this client. B. Weekly visits from a case worker will not provide adequate care and supervision for this client. C. CORRECT: A partial hospitalization program can provide treatment during the day while allowing the client to spend nights at home, as long as a responsible family member is present. D. Daily visits to a community mental health center will not provide consistent supervision for this client.
A nurse is caring for several clients who are attending community‑based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home B. A client who requests that her antipsychotic medication be changed due to some new adverse effects C. A client who says he is hearing a voice that tells him he is not worthy of living anymore D. A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview
A. T his client has needs that should be met, but there is another client whom the nurse should see first. B. T his client has needs that should be met, but there is another client whom the nurse should see first. C. CORRECT: A client who hears a voice telling him he is not worthy is at greatest risk for self‑harm, and the nurse should visit this client first. D. T his client has needs that should be met, but there is another client whom the nurse should see first.
A community mental health nurse is planning care to address the issue of depression among older adult clients in the community. Which of the following interventions should the nurse plan as a method of tertiary prevention? A. Educating clients on health promotion techniques to reduce the risk of depression B. Performing screenings for depression at community health programs C. Establishing rehabilitation programs to decrease the effects of depression D. Providing support groups for clients at risk for depression
A. T his intervention is an example of primary prevention. B. T his intervention is an example of secondary prevention. C. CORRECT: Rehabilitation programs are an example of tertiary prevention. Tertiary prevention deals with prevention of further problems in clients already diagnosed with mental illness. D. T his intervention is an example of primary prevention.
Which intervention is an example of a complementary and alternative medicine therapy? a. Acupuncture b. Bright-light therapy c. Electroconvulsive therapy d. Repetitive transcranial magnetic stimulation
ANS: A Acupuncture is considered a complementary and alternative therapy. The other therapies are accepted by Western medicine.
A patient diagnosed with a history of depression disorder tells the nurse, "My primary-care provider told me to start taking fish oil capsules to prevent heart disease. Will it cause problems with my mental illness?" Select the nurse's best response. a. "It will not cause problems. It may actually help with your depressed feelings." b. "I cannot discuss recommendations you received from another health care provider." c. "It would be better for you to take vitamins C and E. I will notify your primary-care provider." d. "Please have your primary-care provider call me so we can discuss issues related to this preparation."
ANS: A Fish oil capsules supplement omega-3 and omega-6 fatty acids. These substances not only provide cardiovascular benefits; studies have demonstrated positive results in ameliorating depression after 2 or more weeks of omega-3.
For which patient co-morbid diagnosis would it be most important for the nurse to urge the patient to immediately discontinue using kava-kava? a. Cirrhosis b. Osteoarthritis c. Multiple sclerosis d. Chronic back pain
ANS: A Kava-kava should be used with caution in patients with liver disease because of its potentially hepatotoxic effects. The other health problems do not pose immediate dangers.
A neighbor asks a nurse, "Are there any resources that would help me get reliable information about alternative and complementary therapies?" Which resource should the nurse recommend? a. National Center for Complementary and Alternative Medicine b. American Psychiatric Association c. American Medical Association d. Centers for Disease Control and Prevention
ANS: A The National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health, has responsibility for providing information to the public regarding the safety and efficacy of alternative therapies and for funding research for these therapies.
A patient who takes phenytoin (Dilantin) regularly has begun taking valerian. Patient teaching should focus on which possible consequence of the patient's action? a. Breakthrough seizures b. Spontaneous bleeding c. Impaired dentition d. Gum disease
ANS: A Valerian is thought to negate the effects of several drugs, including phenytoin, making an increase in seizures probable.
Which important points should the nurse teach a patient about using herbal preparations? Select all that apply. a. Check active and inactive ingredients. b. Discontinue use if side effects or adverse effects occur. c. Buying from online sources is preferable and cheaper. d. Avoid herbals during pregnancy and breast-feeding. e. Inform your health care provider about the use of herbals.
ANS: A, B, D, E All of the instructions are correct except the one regarding purchase of herbals. Internet purchasing of herbals might not be the best plan unless the reputation of the firm can be confirmed.
An anxious patient diagnosed with diabetes says, "I'm considering taking angelica to help me relax." Select the best outcome for the plan of care. The patient will: a. report subjective feelings of improved sleep. b. identify other options to manage anxiety. c. monitor fingerstick blood glucose daily. d. rate anxiety as 5 or less on a scale of 10.
ANS: B Angelica is contraindicated in diabetes. The patient should identify other strategies to manage anxiety.
Select the example of complementary therapy. a. St. John's wort used with valerian b. Acupuncture used with disulfiram (Antabuse) c. Fluoxetine (Prozac) used with lorazepam (Ativan) d. Propranolol (Inderal) used with systematic desensitization
ANS: B Complementary therapy is an alternative therapy used in conjunction with conventional Western medicine. Acupuncture is an alternative therapy, and disulfiram is a Western medical therapy for alcohol abuse.
During an admission interview, a patient who reports high levels of anxiety says, "I've been using kava-kava for about a week to relieve anxiety." When the nurse assesses mental status, expected findings would be: a. reduced coordination and slurred speech. b. intact cognitive functioning. c. slow response times. d. paranoid thinking.
ANS: B Kava-kava relieves anxiety without producing cognitive impairment, reducing mental acuity, or affecting coordination. Kava-kava is known to have an affinity for benzodiazepine receptors.
A patient tells the nurse, "I've been having problems with my memory. I read some information on the Internet and started taking gingko." Select the nurse's best response. a. "The Internet does not have reliable health information." b. "More recent studies indicate that gingko does not help memory problems." c. "SAM-e has been shown to have better effects for treating memory problems." d. "Your memory problems are related to your mental illness. Herbs will not help."
ANS: B Recent studies indicate that gingko does not help with cognition or memory problems. SAM-e is useful for treating mild depression.
Select the desired outcome for a patient who uses valerian. The patient will report: a. a lower stress level. b. undisturbed sleep throughout the night. c. an increased interest in recreational activities. d. awakening without an alarm clock in the morning.
ANS: B Valerian decreases sleep latency and nocturnal awakening, and it leads to a subjective sense of good sleep. Sleeping through the night is the best indicator that the herb was effective.
A patient takes valerian. Which instruction should the nurse provide? a. Store the herb in a cool place. b. Store the herb in a dry, dark place. c. This herb loses potency after 30 days. d. Avoid crushing the herb before taking it.
ANS: B Valerian must be protected from light and moisture.
A patient reports taking melatonin daily. Which aspect of the patient's health and function would be most important for the nurse to assess? a. Urinary and bowel elimination b. Energy and activity tolerance c. Sleep hygiene and patterns d. Memory and cognition
ANS: C Melatonin is used to reduce sleep-onset latency and decrease the number of nocturnal awakenings. The nurse should assess the patient's sleep patterns and hygiene
A patient with which disorder would most likely benefit from taking St. John's wort? a. Suicidal depression b. Hypomanic symptoms c. Mild depressive symptoms d. Panic disorder with agoraphobia
ANS: C Research has found St. John's wort to be effective in treating mild to moderate depression. St. John's wort has not been found to be effective in treatment of severe depression, bipolar disorder, or anxiety disorders.
A patient diagnosed with depression tells the nurse, "I've been supplementing my paroxetine (Paxil) with St. John's wort, and it has helped a great deal." What is the nurse's priority action? a. Assess changes in the patient's level of depression. b. Remind the patient to use a secondary form of birth control. c. Educate the patient about the risks of serotonin syndrome. d. Suggest adding valerian to the treatment regimen to further improve results.
ANS: C Research has suggested that St. John's wort inhibits serotonin reuptake by elevating extracellular sodium; thus it may interact with medication, particularly selective serotonin reuptake inhibitors, to produce serotonin syndrome.
A patient reports frequent sleep disturbances. Which preparations could be considered to help improve the patient's sleep pattern? Select all that apply. a. Yohimbine b. Vitamin C c. Melatonin d. Valerian e. SAM-e
ANS: C, D Melatonin and valerian have relaxant effects that help sleep. Yohimbine can actually cause insomnia. SAM-e may help with mild depression. Vitamin C has no effect on sleep.
Alternative therapy refers to: a. any natural therapy without a research basis. b. evidence-based pharmacologic use of plant products. c. therapies used in conjunction with Western medicine. d. therapies not generally accepted by Western medicine.
ANS: D Alternative therapies are therapies that are not generally accepted by mainstream Western medicine—for example, herbaceuticals. Some alternative therapies have been researched.
A nurse assesses four new patients. Which statement causes the nurse to suspect the patient may be self-medicating with an alternative therapy? a. "I frequently have skin rashes that itch." b. "Constipation is an everyday problem for me." c. "My computed tomography scan shows that I have uterine fibroid tumors." d. "I've been very depressed and anxious since I lost my job."
ANS: D Herbals are among the most frequently used alternative therapies for depression. Four of the 12 most common herbs are used to treat or prevent psychiatric symptoms.
A patient asks, "I want to consult an herbalist. What should I do to make sure I don't get some impostor?" The nurse should advise the patient to first ask the provider: a. "How much will treatments cost?" b. "Have you treated this condition before?" c. "Do the treatments pose any dangers to me?" d. "What group has certified you in this practice?"
ANS: D The priority question is whether the individual is credentialed to practice via license or certification. Either credential suggests, but does not guarantee, some degree of knowledge and competence.
