Chapter 2 PrepU 220
A nurse is caring for an older adult client with a psychiatric disorder who has been prescribed several medications. When educating the client on the medications, which explanation would be most appropriate?
"Because of your age and related changes in liver functioning, you may have medication levels in your system with the potential to be toxic." Explanation: The activity of hepatic enzymes slows with age. As a result, the ability of the liver to metabolize medications may slow to as much as a fourfold decrease between the ages of 20 and 70 years. Thus, the client is at increased risk for toxicity. Gastric pH increases, and gastric emptying and motility decrease, which can influence absorption.
After teaching a client who is prescribed imipramine, a tricyclic antidepressant (TCA), about the drug, the nurse determines that the education was effective when the client makes what statement?
"I need to be careful because the drug can make me sleepy." Explanation: Imipramine is a TCA and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high-fiber intake would be appropriate to decrease possible constipation.
A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating?
"Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." Explanation: Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite. Serotonin also controls food intake, irritability, sleep and wakefulness, compulsiveness, temperature regulation, pain control, sexual behaviors, and regulation of emotions. Norepinephrine, histamine, and dopamine are not correct. Lack of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Lack of histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Lack of dopamine may lead to imbalance difficulties, speech problems, and postural changes.
A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?
"Make sure that you don't drink any alcohol when you're taking this medication." Explanation: Interactions between benzodiazepines and alcohol can be lethal. Drowsiness, not insomnia, is likely. There are not dietary restrictions normally associated with benzodiazepine use, and these drugs are not a common cause of neuromuscular effects.
The nurse provides a client education regarding the role of serotonin within the body. Which statement by the nurse regarding this role is accurate?
"Serotonin concentrations decrease during rapid eye movement (REM) sleep." Explanation: Serotonin concentrations decrease during REM sleep; therefore, this statement is accurate. Serotonin is primarily an excitatory, not inhibitory, neurotransmitter that is diffusely distributed within the cerebral cortex, limbic system, and basal ganglia of the central nervous system (CNS). The potency of some new medications for migraine headaches is related to their ability to block, not shunt, serotonin transmission in the cranial blood vessels. Melatonin is derived from serotonin, not vice versa.
A client states to the nurse, "I have been on so many antidepressants over the years. They work well for a while but never long term. I don't understand why this is happening?" Which response by the nurse is accurate?
"Some drugs can negatively affect receptors, which affects effectiveness." Explanation: Drugs can affect the sensitivity of the receptor by altering the strength of attraction of a receptor for the neurotransmitter, by changing the efficiency with which the receptor activity translates the message inside the receiving cell, or by decreasing over time the number of receptors. These mechanisms may account for the loss of effectiveness of a given medication. Telling the client there is no reason for the decreased effectiveness is not accurate. Although it is important to take medications as prescribed, this response is not therapeutic and does not accurately address the client's question.
A client admitted for depression and anxiety is being assessed for thyroid abnormalities. The client asks why they need to get their thyroid checked. Which statement made by the nurse would indicate accurate teaching?
"Some psychiatric conditions have been associated with thyroid dysfunction." Explanation: The hypothalamus-pituitary-thyroid axis (HPA) regulates the release of thyroid hormone by the thyroid gland using thyrotropin-releasing hormone from the hypothalamus to the pituitary and thyroid-stimulating hormone (TSH) from the pituitary to the thyroid. Some psychiatric disorders have been associated with endocrine system dysfunction, making the nurse's statement of "Some psychiatric conditions have been associated with thyroid dysfunction" correct teaching. The nurse's statement "I am not sure; there is no correlation with thyroid function and psychiatric symptoms" is not a true statement. The nurse's statements of "What are your specific concerns about the thyroid testing?" and "Have you been experiencing other symptoms such as constipation and lethargy?" do not indicate client teaching.
The nurse has provided teaching regarding diet selections with a client diagnosed with depression and anxiety. Which statement made by the client would require further teaching?
"The foods that I eat can increase certain neurotransmitters but will not affect my brain function." Explanation: The gut-brain axis defines the relationship among the central nervous system (CNS) and the neuroendocrine and neuroimmune systems. The enteric nervous system (ENS) governs function over the gastrointestinal (GI) system and operates independently and interdependently with the CNS. Gut microbiota is essential for metabolic, immune, brain development, and neurogenesis and has a role in mental illnesses. Gut bacteria can respond and produce neurotransmitters, such as the dopamine, norepinephrine, and serotonin, which do impact brain function. The client's statement, "The foods that I eat can increase certain neurotransmitters but will not affect my brain function" would need further teaching.
A client receiving an antipsychotic agent develops acute extrapyramidal symptoms. Which response by the nurse would be most appropriate?
"These are the results of the drug and can be treated; your illness is not getting worse." Explanation: Individuals with acute extrapyramidal symptoms need frequent reassurance that these are not a worsening of their psychiatric condition but instead are treatable side effects of the medication. They also need validation that what they are experiencing is real and that the nurse is concerned and will be responsive to changes in these symptoms. Extrapyramidal symptoms are not indicative of an allergy. Photosensitivity occurs with antipsychotic agents and sunlight.
An older adult reporting concerns of anxiety is prescribed diazepam (Valium) by a health care provider. The provider asks the office nurse to explain the problematic side effects of this medication to the client. Which instruction is most important for the nurse to emphasize about this drug?
"You may feel dizzy and be prone to falls after taking this medication." Explanation: Diazepam (Valium) is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client.
A client is newly prescribed a medication that will block the effects of histamine postsynaptically for the treatment of a mental health disorder. The client asks, "What side effects should I anticipate with this new medication?" Which response by the nurse is accurate?
"You should expect to feel drowsy." Explanation: The function of histamine is not well known, but it appears to have a role in autonomic and neuroendocrine regulation. Many psychiatric medications can block the effects of histamine postsynaptically and produce side effects such as hypotension, sedation, and weight gain. Based on this information, the response by the nurse that is accurate is "You should expect to feel drowsy." This is due to the sedative effect. Blood pressure decreases, not increases. Sedation is a side effect; therefore, insomnia is not anticipated. Weight gain, not loss, is another anticipated side effect.
The prescription of clozapine requires weekly blood samples for at least:
6 months. Explanation: Although agranulocytosis can occur with any antipsychotic, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment, then every 2 weeks for the next 6 months if the absolute neutrophil count (ANC) stays normal. If treatment with clozapine continues after 1 year and the ANC remains normal, the client is then tested monthly for as long as the drug is taken.
A nurse administers a prescribed dose of lithium at 8 p.m. The nurse should schedule a specimen to be obtained for a blood level at which time?
8 a.m. Explanation: Blood levels should be monitored 12 hours after the last dose of medication.
Which client is most likely to benefit from treatment with an antiparkinsonism agent?
A client who has a medication-induced movement disorder Explanation: Antiparkinsonism agents have been used to treat medication-induced movement disorders, such as neuroleptic-induced parkinsonism. The presence of lithium toxicity or the use of antidepressants or ECT is not likely to necessitate the use of antiparkinsonism agents.
Clients diagnosed with myasthenia gravis have a decrease in which receptor?
Acetylcholine Explanation: Clients diagnosed with myasthenia gravis, a neuromuscular disorder, have a decreased amount of acetylcholine. Acetylacholine is a neurotransmitter found in the brain, spinal cord, and peripheral nervous system, particularly at the neuromuscular junction of the skeletal muscle. Dysfunction of dopamine is associated with with schizophrenia and other psychoses as well as Parkinson's disease. Serotonin plays an important role in anxiety, mood disorders, and schizophrenia. Norepinephrine dysfunction is implicated in several anxiety disorders, deficits may contribute to memory loss, social withdrawal, and depression.
A client who has been taking clozapine for 6 weeks visits the clinic reporting fever, sore throat, and mouth sores. The nurse notifies the client's provider because the nurse suspects which condition?
Agranulocytosis. Explanation: High fever, sore throat, and mouth sores are indicative of infection secondary to agranulocytosis, which has been associated with clozapine. The medication can suppress the bone marrow and cause a significant decrease in white blood cells. The client's signs and symptoms do not suggest anemia, neuroleptic malignant syndrome, or encephalitis.
A hospitalized client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. The client tells the nurse, "I just cannot sit still." The nurse documents this finding as which condition?
Akathisia. Explanation: The client's inability to "sit still" and/or frequent pacing is termed "akathisia," an extrapyramidal effect of the antipsychotic medication. Akinesia is slowed movements. Dystonia involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles. Pseudoparkinsonism includes rigidity, slowed movements, and tremor.
Which medication classification blocks serotonin reuptake?
Antidepressant Explanation: The medication classification, selective serotonin reuptake inhibitors, blocks the reuptake of serotonin. Antianxiety, antibiotic, and antimanic medications do not block the reuptake of serotonin.
During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate?
Assessing the client for target symptoms and side effects Explanation: During stabilization, the medication dosage is adjusted or titrated to achieve the maximum amount of improvement with a minimum of side effects. Psychiatric-mental health nurses assess target symptoms, looking for changes or improvements and side effects. Education about relapse prevention and target symptoms and assessing if the medication is losing its effect occur during the maintenance phase. Tapering occurs during the discontinuation phase.
Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)?
Atypical antipsychotics block both serotonin and dopaminergic receptors. Explanation: Typical antipsychotics do have side effects, often lead to weight gain, and, in rare cases, cause dysrhythmias and kidney failure. Thus, atypical antipsychotics block both serotonin and dopaminergic receptors is the correct answer.
What is the difference between traditional and atypical antipsychotics?
Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade. Explanation: Atypical antipsychotics work on dopamine receptors and serotonin receptors, thus affecting both positive and negative symptoms of schizophrenia.
A client is currently experiencing a situational crisis and is experiencing shock and anxiety symptoms. The client is prescribed lorazepam as needed for anxiety. What would the nurse teach the client regarding the medication?
Avoid alcoholic beverages. Explanation: Medications cannot resolve a crisis but can decrease the emotional intensity the client is experiencing. Lorazepam is a benzodiazepine that may be prescribed. Education by the nurse includes: take the medication exactly as prescribed, do not abruptly stop the medication, avoid alcohol or other central nervous system depressants, avoid driving or other activities that require alertness, notify the prescriber before taking any other medications, change positions slowly, and report adverse reactions to the provider. Education to limit sun exposure, avoid grapefruit juice, and drink 3 liters of water a day do not pertain to lorazepam medication.
A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?
Call the client's psychiatrist because her symptoms are indicative of moderate toxicity Explanation: The client's complaints indicate lithium toxicity and should be reported to the client's physician for possible adjustment of the medication.
The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain?
Cerebellum Explanation: The cerebellum controls and guides movements, as well as maintains muscle tone. The cerebrum is composed of the frontal, parietal, occipital, and temporal regions and contributes to intellectual function, including learning, judgment, reasoning, and memory. The medulla oblongata controls respiration, gastrointestinal motility, and circulation. The hippocampus is part of the limbic system.
What part of the brain would be responsible for activities such as walking and dancing?
Cerebellum Explanation: The cerebellum, which is located behind and below the cerebrum, controls and coordinates muscle movement integral to physical activities such as walking and dancing. Cerebrum, midbrain, and brain stem are incorrect.
A nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the client will have difficulty with which function?
Concept formation Explanation: Working memory is an important aspect of frontal lobe function. The nurse can anticipate that the client will have difficulty with concept formation, insight, judgment, and reasoning. The temporal lobes contain the primary auditory and olfactory areas. Wernicke's area, located at the posterior aspect of the superior temporal gyrus, is primarily responsible for receptive speech.
The psychiatric-mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply. Contraindications Adverse reactions Indications for use Food and drug interactions Cost of the medication
Contraindications Adverse reactions Indications for use Food and drug interactions Explanation: When responsible for the administration of medications, the psychiatric-mental health nurse needs to have a basic understanding of factors affecting pharmacodynamics and pharmacokinetics that include individual drugs' contraindications, adverse reactions, indications for use, and food and drug interactions. Cost of medication is useful knowledge for cost containment; however, it does not impact client safety. Therefore, it is not considered a priority with regard to medication knowledge.
A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms?
Damage to the hippocampus Explanation: Damage to the hippocampus causes short-term memory loss and lack of motivation. Damage of the nucleus accumbeus does not cause memory loss. Damage to the thalamus results in obsessive-compulsive behavior or decreased ability to experience pleasure. Damage to the medulla affects circulation and respiration.
A client has been diagnosed with Parkinson's disease. His symptoms of spasticity are related to a decrease in which neurotransmitter?
Dopamine Explanation: A client with Parkinson's disease develops symptoms of spasticity related to a decrease in dopamine. A client with Parkinson's disease will have an increase in acetylcholine. Adrenocorticotropic hormone and serotonin will not be influenced in relation to the disease process.
A client with Parkinson's disease is hospitalized on a medical unit. The nurse would be correct in identifying which neurotransmitter decreased in this disease?
Dopamine Explanation: Parkinson's disease develops from decreased availability of dopamine, while acetylcholine binding to muscle cells is impaired in myasthenia gravis. Therefore acetylcholine, neurontin, and serotonin are incorrect.
Typical antipsychotics work by blocking which receptor?
Dopamine Explanation: Typical or traditional antipsychotic agents (neuroleptics) block dopamine receptors in the brain, thus altering the release and turnover of dopamine. Typical psychotropic agents do not play a role in the blockade of serotonin or norepinephrine.
Extrapyramidal side effects are characterized by a triad of symptoms, including what?
Dystonia, akathisia, and pseudoparkinsonism Explanation: Extrapyramidal side effects do not influence a client's affect. They include pseudoparkinsonism, dystonia, and akathisia.
All but which are currently used neuroimaging techniques?
Electrocardiogram (ECG) Explanation: Current neuroimaging techniques include computed axial tomography (CAT) scan, positron-emission tomography (PET) scan, single-photon emission tomography (SPECT) scan, magnetic resonance imaging (MRI), electroencephalogram (EEG), angiography, ultrasonography, and polysomnography.
A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment?
Ensuring the client's blood levels reach a therapeutic and safe dose Explanation: Lithium has few side effects if maintained within a therapeutic range. Adverse reactions begin to occur with toxic levels.
While discussing the CNS, the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what?
Explanation: Gamma-aminobutyric acid (GABA), which is found in the brain, inhibits nerve activity and is important in preventing over excitability or stimulation such as seizure activity. Acetylcholine, dopamine, and serotonin are not the major inhibitory neurotransmitter in the CNS.
When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible?
Frontal lobes Explanation: Frontal lobe damage shows symptoms that include loss of emotional control, rage, violent behavior as well as changes in mood and personality and uncharacteristic behavior. Thus, when a client who is generally pleasant and cooperative begins to show aggressive behavior toward most members of the milieu, the nurse suspects the client has experienced cerebral trauma to the frontal lobe. Temporal, occipital, and limbic lobe damage do not exhibit aggressive behavior or personality changes.
The client cannot remember anything before an accident yesterday. Which brain structure might be injured?
Hippocampus Explanation: The hippocampus, part of the limbic system, controls emotions, memory, and learning. It is also thought to mediate feelings of aggression, sexual impulses, and submissive behavior. The midbrain is vital to life. It is the only brain area maintaining heart and lung function in an otherwise comatose person with no higher-level capacities. The reticular formation controls sleep and wakefulness and directs visual and auditory reflexes. The basal ganglia assume motor skills that have become automatic and also initiate and control activities and muscle tone.
Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?
Hypertensive crisis Explanation: Normally, MAO breaks down tyramine; however, because MAOIs inhibit MAO, tyramine can accumulate in the bodies of clients taking these drugs and eating tyramine-rich foods. Tyramine also releases norepinephrine from nerve endings. These metabolic actions can precipitate a hypertensive crisis.
A client is returning from military service and has been diagnosed with post-traumatic stress disorder (PTSD). Dysfunction in which brain structure contributes to the rage and fear experienced in PTSD?
Hypothalamus Explanation: The hypothalamus is a part of the limbic system, which is sometimes called the emotional brain. The hypothalamus is involved in impulsive behavior associated with feelings of anger, rage, or excitement. The pons connects the cerebellum and the brainstem. The basal ganglia initiates motor function. The corpus callosum is the pathway that connects the two hemispheres of the brain.
A client in the operating room goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is what?
Hypothalamus Explanation: The hypothalamus plays an important role in the endocrine system because it regulates the pituitary secretion of hormones that influence metabolism, reproduction, stress response, and urine production. It works with the pituitary to maintain fluid balance through hormonal release and maintains temperature regulation by promoting vasoconstriction or vasodilatation. In addition, the hypothalamus is the site of the hunger center and is involved in appetite control.
Which reason do clients cite most frequently as the cause for self-discontinuation of medication?
Intolerable side effects Explanation: Clients may have many reasons for failing to adhere to medication regimens. The most frequent reason is adverse effects, many of which are debilitating and difficult to manage.
A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?
Intramuscularly Explanation: If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly. Antipsychotic medications are not normally administered by the intravenous or subcutaneous routes, and oral administration is more challenging when a client is noncompliant with treatment.
A nursing student is learning about the neurotransmitter, dopamine, that is involved with psychiatric conditions. Which statement(s) does the student identify as correct regarding dopamine? Select all that apply. It is decreased in schizophrenia. It is decreased in Parkinson disease. It is an excitatory neurotransmitter. It produces a calming effect. It produces physical symptoms of anxiety. It may explain addictive behaviors.
It is decreased in Parkinson disease. It is an excitatory neurotransmitter. It may explain addictive behaviors. Explanation: Dopamine is an excitatory neurotransmitter that is found in distinct regions of the central nervous system and is involved in cognition, motor, and neuroendocrine functions. Dopamine produces a feeling of euphoria by stimulating the body's reward pathways, which may explain addictive behaviors. Dopamine is increased, not decreased, in schizophrenia, and is decreased in Parkinson disease. It does not produce a calming effect like what is caused by the gamma-aminobutyric acid (GABA) neurotransmitter. It does not produce the physical symptoms associated with anxiety, which are caused by the norepinephrine neurotransmitter.
A 46-year-old client sustained a closed-head injury 4 hours ago. The client now presents to the emergency department because the client is having difficulty breathing. This is a result of swelling surrounding which brain structure?
Medulla oblongata Explanation: The hindbrain, which runs from the top of the spinal cord into the midbrain, is the most primitive area of the brain and contains the brain stem, where the pons and medulla oblongata are located. These areas of the brain control basic, vital functions, such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; the swallowing center, which coordinates the complex swallowing reflex; and the reticular activating system (RAS), which controls arousal and awareness of stimuli and contains the sleep center.
The brain stem consists of which structure?
Midbrain Explanation: The brain stem consists of the midbrain, pons, and medulla.
Dietary modifications are most likely necessary when a client is being treated with which antidepressant?
Monoamine oxidase inhibitors (MAOIs) Explanation: MAOIs are antidepressants that are well known for their multiple drug and food interactions. As such, dietary modifications are necessary. Such modifications are not normally necessary when a client is receiving SSRIs, tricyclic antidepressants, or atypical antidepressants.
A nurse is teaching a patient about how impulses are transmitted and describes the factors that can impact this transmission. Which factor would the nurse most likely identify as increasing synaptic transmission?
Neurotransmitter Explanation: As the electrical action potential reaches the ends of the axons, called terminals, calcium ion channels are opened, allowing an influx of Ca++ ions into the neuron. This increase in calcium stimulates the release of neurotransmitters into the synapse. Rapid signaling among neurons requires a ready supply of neurotransmitter. These neurotransmitters are stored in small vesicles grouped near the cell membrane at the end of the axon. When stimulated, the vesicles containing the neurotransmitter fuse with the cell membrane, and the neurotransmitter is released into the synapse. The neurotransmitter then crosses the synaptic cleft to a receptor site on the postsynaptic neuron and stimulates adjacent neurons.
A drug that is an antagonist functions to do what?
Prevent natural or other substances from activating cell function Explanation: Drug antagonists block the actions of everything in the agonist spectrum. These chemicals bind to and block a receptor, producing no response and preventing agonists from binding or attaching to the receptor.
A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?
Pseudoparkinsonism Explanation: Symptoms of pseudoparkinsonism include the classic triad of Parkinson's disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. Dystonia is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating use of an antipsychotic. NMS is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever.
A nurse is aware that the likelihood a client will be in adherence with psychotropic medications is affected by what?
Receiving education and information about the medication. Explanation: Understanding the rationale and anticipated results of medications prescribed increases the patient's insight into the importance of treatment. Client history of medication compliance, number of medications prescribed, and support at home influence compliance but are not the most important factors.
A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter?
Serotonin Explanation: Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone.
In the discharge instructions for a client who is taking alprazolam, the nurse should include what?
Sudden cessation of alprazolam can cause rebound insomnia and nightmares. Explanation: Clients who are taking alprazolam need to be taught that this medication must not be stopped abruptly. Frequently, abrupt cessation will cause severe rebound insomnia as well as nightmares.
A college student wakes up and notices a racing heart and dilated pupils. The student is scheduled to write an exam later that morning. Which system is responsible for this physiological response?
Sympathetic nervous system Explanation: The sympathetic nervous system is stimulated by physical or emotional stress, such as strenuous exercise or work, pain hemorrhage, intense emotions, and temperature extremes. The specific body responses include: increased arterial blood pressure and cardiac output and pupil dilation to aid vision. The autonomic nervous system affects the cardiovascular function to decrease heart rate responses. The patient does not suffer from a cardiac irregularity. The release of dopamine will not affect pupillary response.
After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid consuming which food or beverage?
Tap beers Explanation: Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine, such as tap beers, matured and aged cheeses, dried aged and fermented meats, broad bean pods, concentrated yeast extract, sauerkraut, and soy sauce.
The nurse is administering a sedative drug to a client before the magnetic resonance imaging (MRI) procedure. What are the possible reasons for which the nurse had to sedate the client? Select all that apply. The client may have claustrophobia. The client may have high blood pressure. The client may have severe anxiety. The client has a pacemaker. The client has not given consent for having the MRI.
The client may have claustrophobia. The client may have severe anxiety. Explanation: The MRI procedure requires the client to lie down in a small closed chamber and be motionless for approximately 45 minutes. A client who has claustrophobia or severe anxiety may not be able to cooperate during the procedure. Thus, such clients require sedation. Clients with high blood pressure can undergo this procedure safely. High blood pressure is not an indication for the client to be sedated before procedure. Pacemakers are contraindicated for MRI. If the client has not given consent for MRI, the procedure should not be performed.
An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply. The client often smacks lips when at rest The client reports nightmares and frequent awakenings at night The client makes repetitive movements with the fingers The client recently fainted after getting up quickly from a chair The client exhibits delusional thinking that is uncharacteristic
The client often smacks lips when at rest The client makes repetitive movements with the fingers Explanation: Tardive dyskinesia is usually characterized by repetitive involuntary movements. Syncope, sleep disturbances, and symptom exacerbation are not suggestive of tardive dyskinesia.
Benzodiazepines work by the following mechanism of action:
They act directly on GABA receptors and are thought to increase the amount of GABA available. Explanation: Benzodiazepines act directly on GABA receptors and are thought to increase the quantity of GABA available to dampen neural overstimulation.
The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?
White blood cell count Explanation: Use of clozapine requires weekly monitoring of white blood cell (WBC) counts to assess for agranulocytosis. Clozapine suppresses the development of WBCs in 1 to 2% of all clients who take it. If WBC levels decrease significantly from baseline, immediate discontinuation of clozapine is recommended. Clients should never use clozapine with other agents that suppress WBC production, such as carbamazepine.
A nurse is gathering client information for a study being conducted in a community health clinic. The study is evaluating the risk of developing a depressive disorder in children raised in different environments. Which type of study does the nurse identify that is being conducted?
adoption study Explanation: Adoption studies compare the risk for the illness developing in offspring raised in different environments, which is the study being conducted in the scenario. Twin studies analyze the presence of the disorder in pairs of twins, not in different environments. Family studies analyze the occurrence of a disorder in relatives. Chronobiology analyzes the dysfunction of biologic rhythms on the development of mental illnesses, which does not apply to the study being conducted in the scenario.
A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?
agranulocytosis Explanation: Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a reduction in neutrophils in the blood, to develop. While the remaining options are potential side effects of antipsychotics, agranulocytosis is both life threatening and specific to clozapine.
Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of:
cardiac or seizure disorders. Explanation: Antidepressants, especially tricyclic antidepressants, can cause cardiac dysrhythmias.
The nurse is caring for a client diagnosed with Parkinson's disease. How would the nurse explain which transmitter is increased by taking antiparkinson's medication?
dopamine Explanation: Dopamine, a neurotransmitter, is involved in the control of complex movements. Dopamine is implicated in movement disorders such as Parkinson's disease. Dopamine levels are decreased in Parkinson's disease, and abnormally high activity of dopamine has been associated with schizophrenia. Norepinephrine, serotonin, and epinephrine are not correct. Norepinephrine increases alertness and arousal, and speeds reaction time. Serotonin is believed to help regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function. Commonly known as adrenaline, epinephrine is a hormone secreted by the medulla of the adrenal glands. Strong emotions such as fear or anger cause epinephrine to be released into the bloodstream, which causes an increase in heart rate, muscle strength, blood pressure, and sugar metabolism.
In which way do neurons communicate through the use of synapses?
electrochemically Explanation: Norepinephrine, a neurotransmitter, belongs to a group of structurally related chemicals called catecholamines that also includes dopamine, serotonin, and epinephrine. Neurons do not communicate indirectly, excitatorily, or inhibitorily.
One of the most common ways in which neurotransmitters are deactivated within the nervous system at the neuronal level is:
enzymatic degradation, primarily by monoamine oxidase (MAO). Explanation: Neurotransmitters are deactivated in one of two ways. They are either broken down by enzymes, primarily the enzyme MAO, or they are returned back into the neuron--a process known as reuptake.
The nurse provides care to a client who is diagnosed with a traumatic brain injury (TBI) because of a motor vehicle accident. The client is noted to have mood and affect changes, specifically impulsive behavior. Which lobe of the brain is likely affected based on the client's symptoms?
frontal Explanation: Symptoms vary widely from individual to individual with frontal lobe syndrome. In general, after damage to the dorsolateral (upper and outer) areas of the frontal lobes, the symptoms include a lack of drive and spontaneity. With damage to the most anterior aspects of the frontal lobes, the symptoms tend to involve more changes in mood and affect, such as impulsive and inappropriate behavior. The client's presentation does not support injury to the parietal, occipital, or temporal lobes of the brain.
A client with a history of a traumatic brain injury is admitted for personality changes and labile mood. Upon assessment, the client has difficulty with problem solving and impaired working memory. The nurse identifies that which part of the brain was affected by the previous injury?
frontal lobe Explanation: Each hemisphere of the brain is divided by four lobes including the frontal, parietal, occipital, and temporal. The lobes work in coordinated ways, but each lobe is responsible for specific functions. The frontal lobes are responsible for working memory, insight, judgment, reasoning, self-evaluation, problem-solving, concept formation, and mood and personality. The parietal lobes are responsible for sensory function and spatial relationships. The temporal lobes are responsible for auditory and olfactory areas. The occipital lobes are responsible for vision. The client experiencing labile mood and personality changes likely has had damage to their frontal lobe(s).
A nurse is reviewing the medical records of several clients receiving antipsychotic agents. Which factor(s), if noted, should the nurse identify as placing a client at greater risk for tardive dyskinesia? Select all that apply. male sex age 30 to 45 years history of depression short duration of treatment presence of brain damage
history of depression presence of brain damage Explanation: Risk factors for tardive dyskinesia include age older than 50 years; female sex; affective disorders, particularly depression; brain damage or dysfunction; increased duration of treatment; standard antipsychotic medication; and possibly higher doses of antipsychotic agents.
The function of the thalamus and the hypothalamus is to coordinate:
internal and external responses. Explanation: The thalamus and hypothalamus coordinate internal and external responses and direct information into the cerebral cortex.
The nurse provides care to a client who experiences a left hemisphere frontal lobe stroke. Which finding should the nurse anticipate on assessment of this client? Select all that apply. flat affect memory issues expressive aphasia coordination issues facial recognition issues
memory issues expressive aphasia Explanation: In general, the left hemisphere of the brain is involved with verbal language function, including areas for receptive and expressive speech control. Additionally, the left hemisphere of the brain also provides strong contributions to temporal order and sequencing, numeric symbols, and verbal learning and memory. The frontal lobe contains the Broca area, which controls the motor function of speech, and damage here causes expressive aphasia. The right hemisphere, not left hemisphere, provides input into receptive nonverbal communication, spatial orientation and recognition, intonation of speech and aspects of music, facial recognition and facial expression of emotion, and nonverbal learning and memory.
The nurse provides care to a client who presents to the emergency department (ED) with symptoms indicative of a traumatic brain injury (TBI). The client states, "I am unable to see anything. I think I am blind now!" Which area of the cerebrum should the nurse suspect the TBI affected based on the client's statement?
occipital lobe Explanation: The primary visual area is in the most posterior aspect of the occipital lobes. Damage to this area results in a condition called cortical blindness. In other words, the retina and optic nerve remain intact, but the individual cannot see. The nurse does not suspect injury to the frontal, parietal, and temporal lobes based on this finding because these areas of the cerebrum do not play a specific role in vision.
After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid what food(s)? Select all that apply. fresh cottage cheese cooked sliced ham tap beers soy milk sauerkraut
tap beers sauerkraut Explanation: Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine such as tap beers; matured and aged cheeses; air-dried, aged, and fermented meats; broad bean pods; concentrated yeast extract; sauerkraut; and soy sauce.
