Mental Health test 2
A buildup of neurofibrillary tangles Dementias, specifically AD, are related to brain atrophy and are characterized by microscopic changes in the cortical neurons and a buildup of neurofibrillary tangles and amyloid plaques. A deficiency in the neurotransmitter acetylcholine also occurs. The neurotransmitter theory of depression states that depression is related to decreased levels of norepinephrine, serotonin, or both. The dopamine hypothesis postulates that schizophrenia results from alterations of levels of brain dopamine.DIF: Cognitive level: Understanding REF: pp. 38-39 TOP: Nursing process: Assessment MSC:Client needs: Psychosocial Integrity Microscopic changes in the cortical neurons Dementias, specifically AD, are related to brain atrophy and are characterized by microscopic changes in the cortical neurons and a buildup of neurofibrillary tangles and amyloid plaques. A deficiency in the neurotransmitter acetylcholine also occurs. The neurotransmitter theory of depression states that depression is related to decreased levels of norepinephrine, serotonin, or both. The dopamine hypothesis postulates that schizophrenia results from alterations of levels of brain dopamine.DIF: Cognitive level: Understanding REF: pp. 38-39 TOP: Nursing process: Assessment MSC:Client needs: Psychosocial Integrity deficiency of acetylcholine Dementias, specifically AD, are related to brain atrophy and are characterized by microscopic changes in the cortical neurons and a buildup of neurofibrillary tangles and amyloid plaques. A deficiency in the neurotransmitter acetylcholine also occurs. The neurotransmitter theory of depression states that depression is related to decreased levels of norepinephrine, serotonin, or both. The dopamine hypothesis postulates that schizophrenia results from alterations of levels of brain dopamine.DIF: Cognitive level: Understanding REF: pp. 38-39 TOP: Nursing process: Assessment MSC:Client needs: Psychosocial Integrity
Dementias, especially Alzheimer's disease (AD), are associated with which characteristics? (Select all that apply). A deficiency of norepinephrine A buildup of neurofibrillary tangles Microscopic changes in the cortical neurons A surplus of dopamine A deficiency of acetylcholine
call the patient by name while letting him/her know that the staff is there to help.
The priority nursing intervention when working with a patient who has entered the escalation phase of the assault cycle is to: call for the staff's help immediately. call the patient by name while letting him/her know that the staff is there to help. administer PRN antianxiety medications by mouth as ordered. assist the patient to identify and eliminate the trigger causing the anger.
Hippocampus
When considering AD, damage to which area of the of the brain results in memory dysfunction? Hypothalamus Frontal lobes Brainstem Hippocampus
absorption.
When discussing pharmacokinetics, a patient experiencing gastrointestinal problems may have a problem with medication: absorption. distribution. metabolism. excretion.
further assess his concerns and history of psychiatric issues.
A 70-year-old man comes to the clinic for his annual physical exam and influenza vaccine. He shares that his "life has no meaning," he "feels tired all the time," and "has lost all hope for the future." The initial nursing intervention is to: ask him to stay in the clinic until a mental health professional arrives to further assess him. alert the physician that he may be depressed and require inpatient treatment. further assess his concerns and history of psychiatric issues. note that the patient is experiencing expected aging processes.
the need for a baseline cardiogram.
A child diagnosed with depression has been prescribed a tricyclic antidepressant when selective serotonin reuptake inhibitors have proven ineffective. Family education regarding this classification of medication will include: the likeihood the child will experience a weight loss. the need to frequently assess the child for suicidal thoughts. strategies for managing night-time bed wetting. the need for a baseline cardiogram.
Asking the patient how long he or she has been taking this particular antidepressant after two years of compliance-- can lead to "poop out"
A chronically depressed patient tells the nurse, "My antidepressant just doesn't seem to be working as well as it did." What is the nurse's initial assessment intervention? Determining whether the patient has been taking the medication as prescribed Asking the patient how long he or she has been taking this particular antidepressant Determining if the patient has been experiencing any physical side effects Asking the patient to describe what he or she means by "not working as well
negative thought reprogramming.
A depressed patient who originally responded to a failure by stating, "I can't do anything right" is overheard telling a staff member, "I've learned that everyone makes mistakes." This is an example of: negative thought reprogramming. positive self-esteem. a sense of personal worth. effective problem solving.
"I'm glad my experience has helped others here who don't have a job."
A group member describes how he felt desperate when he did not have a job and what he did to find employment during a 9-month period. As he receives feedback from the others in the group, he experiences altruism if he states: "I'm glad my experience has helped others here who don't have a job." "It's so important to remain hopeful." "I am thankful not to feel so alone anymore." "You all have given me some great tips on continuing my job search."
assuring the patient that his telephone privileges will be restored in 24 hours.
A hospitalized adolescent is angry when his telephone privileges are taken away for 24 hours when it is determined that he was hiding food in his room. While he admits to knowing breaking a unit rule, he justifies his behavior by stating, "I'm a growing boy, and I get hungry. It's not right that I can't eat when I'm hungry." The nurse manages the immediate situation by: increasing the bedtime snack the patient is given each evening. assuring the patient that his telephone privileges will be restored in 24 hours. referring the patient's complaint to the nursing supervisor for consideration. discussing the reasons why such a unit rule is necessary with the patient.
distract the patient to engage in another activity apart from the group.
A nurse who understands the psychopathology of bipolar disorder is one who will: assist the patient to place numerous phone calls to friends and neighbors while on the inpatient unit. distract the patient with a fashion magazine when she wants to order 15 pairs of shoes from a catalog. provide frequent large meals to the patient who is experiencing flight of ideas. promote the therapeutic relationship with humor and joking behaviors.
"This classification is usually effective and generally causes fewer side effects."
A patient asks why he has been prescribed a selective serotonin reuptake inhibitor (SSRI) rather than one of the other classifications of antidepressants. The nurse addresses the patient's question best when responding: "This classification is usually effective and generally causes fewer side effects." "SSRIs are far less expensive that TCAs or MAOIs." "Your mental health provider has determined that your symptoms will be best managed with this classification of antidepressants." "It sounds like you have some doubts about the effectiveness of this classification of antidepressants."
"Have you experienced thoughts of hurting yourself?"
A patient comes to the clinic for a 4-week follow-up after starting Prozac (fluoxetine). The highest priority question the nurse will ask is: "How have you been doing?" "Who brought you to the clinic today?" "Has your stomach felt uncomfortable?" "Have you experienced thoughts of hurting yourself?"
Psychosis
A patient diagnosed with Parkinson's disease is at risk for demonstrating behaviors associated with which mental health disorder? Psychosis Bipolar II Simple phobia Schizophrenia
Stop talking, and slowly back away from him.
A patient diagnosed with vascular dementia is engaged in a conversation with the nurse in the dayroom. When the nurse observes that he is becoming agitated, which intervention will help deescalate the situation? Joke with the patient to defuse his anger. Bring other staff into the conversation to distract him. Turn the television on while redirecting his attention. Stop talking, and slowly back away from him.
reinforce the delusion.
A patient has been expressing beliefs that are not in touch with reality. The nurse's decision not to argue with the patient concerning these delusions is based on the understanding that to argue would: reinforce the delusion. confuse the patient's sense of reality. increase the risk of psychotic behavior. undermine the patient's sense of self-worth.
Monitor the patient's respiratory status.
A patient has just completed his/her sixth electroconvulsive therapy. Which intervention is most important for the nurse to implement? Observe for disorientation. Ask the patient to state his/her name. Monitor the patient's respiratory status. Document the length of the seizure activity.
distract the patient with a fashion magazine when she wants to order 15 pairs of shoes from a catalog.
A patient in acute mania is inappropriately humorous. Patients and staff are laughing at the patient's expense and embarrassment. The nurse should immediately: distract the patient to engage in another activity apart from the group. confront the group to stop the disrespectful behavior. join the group, and further assess the situation. consult the multidisciplinary team to determine the behavioral consequences for the staff.
"It is known that depression is a result of the imbalance of the neurotransmitters norepinephrine and serotonin." Discussing the fact that the disorder is a result of an imbalance of neurotransmitters constitutes responsive communication that uses layperson terms. It is not responsible communication to postpone a discussion based on the belief that the subject is too difficult for the patient to comprehend. While it is true that education is unique for each patient and that emotions can interfere with the discussion, the discussion should not be postponed.DIF: Cognitive level: Applying REF: p. 46 TOP: Nursing process: Planning MSC: Client needs: Psychosocial Integrity
A patient newly diagnosed with depression tearfully expresses a need to know more about the disorder. The nurse's response to the patient's needs is based on which statement? "The details regarding depression can be difficult to comprehend, especially when one is experiencing the disorder." "It is known that depression is a result of the imbalance of the neurotransmitters norepinephrine and serotonin." "The patient's ability to comprehend the details regarding depression is limited until the tearfulness is managed." "Depression is different for each individual who experiences it, and so discussing it with patients is difficult."
Preparing to wean the patient off of the prescribed TCA medication
A patient on a TCA for chronic depression is recovering from a myocardial infarction. Which intervention will the nurse anticipate as a result of the patient's medical condition? Preparing to wean the patient off of the prescribed TCA medication Increasing the dose of the patient's prescribed TCA medication Adding an MAOI antidpressant medication to the patient's medication regime Discontinuing the patient from all antidepressant medications temporarily
Using a calm voice, asks the patient to end the conversation immediately
A patient with a history of aggressive behavior begins pacing while talking on the telephone. The RN suspects that the patient is in the triggering phases of the assault cycle and implements which intervention? Continues to observe the patient and note additional behavioral changes Alerts the other staff members that the patient is likely to act out Using a calm voice, asks the patient to end the conversation immediately Asks the patient to stop pacing or hang up the telephone
"We are here to keep you safe and stop you from hurting anyone else."
A patient's inability to deescalate his aggressive behavior has resulted in the response team coming to the unit. When the patient demands to know, "Why are all these people here?", the nurse responds most therapeutically when stating: "You are out of control, and they are here to keep everyone safe." "They are here to make sure you are safely placed in the seclusion room." "We are here to keep you safe and stop you from hurting anyone else." "You are likely to hurt someone, and we can't allow that to happen."
Managing the administration of parenteral normal saline
A patient's lithium level is 2.3 mEq/L. Which nursing intervention will the nurse be prepared to implement when ordered? Managing the administration of parenteral normal saline Increasing the daily dose of lithium Limiting the patient's intake of sodium Preparing to administer an oral diuretic
"The pathways used by acetylcholine in the brain will decline over time, leading to a loss of memory."
A son of an AD patient verbalizes the desire to learn more about the physical aspects of the brain changes to be expected in his parent. The nurse will say: "The pathways used by acetylcholine in the brain will decline over time, leading to a loss of memory." "We don't understand very much about the problems that occur in the brain that result in Alzheimer's disease." "There will be a decline in functioning that will occur rapidly." "Neurons are regenerated but are not functional."
"Have you felt as though you could harm yourself?"
A tearful adolescent confides in the school nurse that he is concerned about how anxious he feels and that he "may be depressed." The nurse's next priority is to ask: "How long have you felt this way?" "What do you mean by 'anxious'?" "Have you felt as though you could harm yourself?" "Have you told anyone else?"
"Let's see what we can work on together."
An individual calls the hospital during the night shift in crisis and is considering suicide. The nurse will begin the interaction by saying: "How are you feeling today?" "How long have you been this way?" "Let's see what we can work on together." "Who is there with you right now?"
"How have you been feeling emotionally?"
An older adult is reporting fatigue and periods when breathing is difficult. All examinations, lab, and diagnostic values are in acceptable ranges. The nurse will best initiate a discussion regarding the patient's emotional health by asking: "What do you think is wrong with you?" "Are you depressed?" "How have you been feeling emotionally?" "Do you see yourself as being an anxious person?"
"My tongue and mouth feel different this week."
An older adult patient living in the community is taking an antipsychotic medication. Which statement made by the patient requires the nurse's priority intervention? "I am concerned about how much all these pills cost." "I cleaned my apartment yesterday." "All my medications are in this bag, so you can look at them." "My tongue and mouth feel different this week."
"I will help you look for your purse."
An older adult who is diagnosed with dementia says, "I can't find my purse, and I think someone stole it!" The most therapeutic response is: "How much money did you lose?" "You sound suspicious." "I will help you look for your purse." "Keep looking for it; I am sure you will find it."
assessment of eating and sleeping patterns.
Compare working with patients experiencing depression and those with bipolar disorder. Both groups of patients will require: careful monitoring of environmental stimuli. suicide and escape precautions. fall and seizure precautions. assessment of eating and sleeping patterns.
Children
Growth hormone assessment is a frequently used biologic diagnostic tool to diagnosis depression in which population? Children Adolescents Middle-aged adults Older adults
Providing the opportunity for each member to express his/her feelings
How does the nurse provide a cathartic environment during a group session? Starting and ending the group sessions at the agreed-upon times Role-modeling appropriate social skills for the group's members Recognizing members for their supportive attitudes toward others in the group Providing the opportunity for each member to express his/her feelings
6.25%
If a single dose of a drug is given and the drug has a half-life of 4 hours, what percentage of the drug will remain after 16 hours? 50% 25% 12.5% 6.25%
use a calm and matter-of-fact tone.
In adapting interaction strategies while working with an individual with early Alzheimer's disease, the priority nursing intervention is to: speak loudly and clearly. give instructions slowly and repeatedly. use a calm and matter-of-fact tone. constantly provide reality orientation and reminders.
consider the hepatic and renal functioning of the individual.
In evaluating medication ordered for an older adult experiencing mental illness, the nurse will expect the prescriber to: begin with a near-maximum dose and then titrate down if necessary. consider the hepatic and renal functioning of the individual. avoid the use of medications for depression or anxiety. speak to the caregiver rather than the older adult.
manipulatively praising others.
Manic individuals attempt to control others and to achieve their goals through: displaying tantrumlike behavior. physically aggressive behavior. manipulatively praising others. threatening to physically harm themselves.
Ineffective at planning a family birthday party Frontal lobe blood flow deficits limit critical thinking, planning, and organizing. Memory, associating social boundaries, and physical balance would not be affected by such a condition.DIF: Cognitive level: Applying REF: p. 19 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity
In some patients diagnosed with schizophrenia, blood flow in the frontal lobe is diminished. The nurse would expect such a patient to experience which deficit? Inability to recall a telephone number Ineffective at planning a family birthday party Poor boundaries when socializing with strangers Difficulty balancing when riding a bike
Administering the acetylcholinesterase inhibitor physostigmine (Antilirium)
It has been determined that a patient is experiencing life-threatening toxicity related to TCA use. Which intervention will the nurse anticipate? Frequently assessing for suicidal ideations Administering the acetylcholinesterase inhibitor physostigmine (Antilirium) Inserting an indwelling urinary catheter Preparing the patient for an EEG
Watching for impending signs of relapse such as sleeping difficulties and irritability
It is most important for the nurse to include the significant others for which instruction when teaching a patient who is diagnosed with bipolar disorder? Calling the health care provider when facing a crisis situation Eating a heart-healthy diet and avoiding stress Watching for impending signs of relapse such as sleeping difficulties and irritability Receiving credit counseling in the case of large debt
increased exposure to grief-induced losses.
Later life depression and resulting suicide deaths among the older adult population are believed to be most related to: availability of lethal suicide methods. life experiences that provide improved planning skills. declining cognitive function leading to faulty judgment. increased exposure to grief-induced losses.
"My body treats lithium just like salt."
Medication teaching regarding lithium is regarded as successful when the nurse hears the patient state: "Potassium can be dangerous in my diet." "My body treats lithium just like salt." "A multivitamin each day will be important." "I won't have to see the doctor for 3 months."
The least restrictive option is implemented.
Meeting the immediate safety needs of an aggressive patient is based on which principle of care? The safety of the milieu must be achieved by any means available. The least restrictive option is implemented. Patients in seclusion and/or restraints require intensive nursing care. Safety is a right of all patients.
statins. Research suggests that statins offer protective benefits from AD. No evidence suggests a benefit from aspirin or from vitamins C or K.
One strategy for Alzheimer's disease (AD) prevention that has dual protective benefit is the use of: aspirin. statins. vitamin C. vitamin K.
Anxiety
Screening for symptoms of which mental health disorder is most appropriate for the older adult population? Major depression Anxiety Somatic disorders Phobia
"It is believed that schizophrenia is related to a surplus of a substance in the brain called dopamine. Medications, therapies, and treatments can help manage the disorder." The option that is most responsive in communicating, in layperson terms, current understanding regarding the causation of schizophrenia identifies the role of dopamine. Although a definite cause is still unconfirmed, research has produced several viable theories regarding the cause of schizophrenia. One of those theories includes a possible genetic link.DIF: Cognitive level: Understanding REF: p. 46 TOP: Nursing process: Planning MSC: Client needs: Psychosocial Integrity
Parents are struggling to understand their teen's diagnosis of schizophrenia. In teaching, the nurse will state: "It is believed that schizophrenia is related to a surplus of a substance in the brain called dopamine. Medications, therapies, and treatments can help manage the disorder." "There is little known about what may cause schizophrenia. What is known is that the brain develops in an abnormal manner." "Schizophrenia is not believed to be genetic in nature." "There has been little research in the cause of schizophrenia."
electrocardiogram
Prior to initiating a tricyclic antidepressant (TCA), the nurse will evaluate the patient's: electroencephalogram (EEG). electrocardiogram. lipids. complete blood count (CBC).
"The liver will be harmed by this medication."
Teaching of the family with a member beginning to take Aricept (donepezil) is incomplete if the nurse hears: "The liver will be harmed by this medication." "It will be helpful to give this medication only once a day." "Side effects are few with this medication." "We can give it with or without food."
"What have you learned in this group that has been helpful to you today?"
The RN is leading a group on medication teaching with a diverse group of outpatients. One participant is attentive but does not speak. What could the RN say to encourage this participant to contribute to the group process? "What would you like to add?" "Please share with the group about your medications." "What have you learned in this group that has been helpful to you today?" "Why have you been so quiet today in group?"
Utilizing the television as the individual's major source of entertainment
The caregiver for an older adult diagnosed with a chronic mental illness has implemented the following interventions to help minimize the individual's tendency to become both physically and verbally aggressive Which intervention will the nurse recognize as being ineffective? Minimizing the noise level in the individual's home Redirecting the individual's attention when the aggression first begins Utilizing the television as the individual's major source of entertainment Diverting the individual's initial anger by offering his or her favorite food
withdrawal from and disinterest in the relationship.
The challenge to the nurse inherent in establishing and maintaining a working relationship with a severely depressed patient is the patient's: receptivity in the relationship. gratitude for the time and effort spent. withdrawal from and disinterest in the relationship. marked signs of improvement noted early on.
"I am really enjoying my aerobics dance class."
The patient who will require further teaching while on lithium would state: "I know I need to eat and drink sensibly." "My dietician appointment is next week." "My last lithium level was 0.6." "I am really enjoying my aerobics dance class."
a male young adult with a nicotine addiction.
The depressed patient who could most benefit from a trial of bupropion (Wellbutrin) would be: a female older adult with a history of epilepsy. an underweight prima ballerina. a male young adult with a nicotine addiction. a female young adult taking Risperdal (risperidone).
blood-brain barrier.
The effects of highly lipid-soluble substances such as nicotine, diazepam (Valium), ethanol, caffeine, and heroin are best conceptualized by understanding the function of the: amygdala. blood-brain barrier. hepatic system. renal system.
"We want to learn what we can and focus on getting better together."
The family of a severely suicidal adolescent is seen by the nurse following a diagnosis of major depressive disorder. Which statement by the family member indicates that the family is effectively coping with the crisis and illness? "We were working too much and not paying attention." "What we need to do is have more fun as a family." "I think all families go through this—not just us." "We want to learn what we can and focus on getting better together."
Frontotemporal lobe dementia (FLD; Pick's disease)
The pathophysiology of which diagnosis will be the first to present a need for 24-hour patient care? Alzheimer's disease Parkinson's disease dementia Dementia with Lewy bodies Frontotemporal lobe dementia (FLD; Pick's disease)
an anticonvulsant.
The patient refuses lithium for acute mania but is agreeable to another medication. The nurse will expect the prescriber to order: lithium despite the patient's refusal. a selective serotonin reuptake inhibitor (SSRI). an anticonvulsant. a monoamine oxidase inhibitor (MAOI).
Nursing judgment and facility protocols
What factors determine when seclusion of an aggressive patient is terminated? The patient's expressed wishes and assurances Nursing judgment and facility protocols Staff consensus and patient behavior Patient's ability to self-manage behavior and assured milieu safety
The group member will become aware of the need to be more precise when giving information.
What is the expected therapeutic outcome when a group leader asks a group member to clarify the statement he/she just made? The leader and the group member will enter into an exchange of information. The group member will become aware of the need to be more precise when giving information. The group member will begin to take responsibility for the information given by him/her to the group. The leader identifies topics that need the attention of the group.
Remaining involved with the patient while demonstrating a calm demeanor
What is the initial intervention implemented by the nurse when managing a manic patient whose behavior is disrupting a group therapy session? Setting behavioral limits for the patient that are appropriate and well defined Remaining involved with the patient while demonstrating a calm demeanor Communicating with the patient using brief, simple statements Removing the patient from the group to deescalate the situation
The group's ability to focus on its work is negatively affected.
What is the most negative outcome when hostility expressed by a group member is allowed to go unchecked? The remaining members also become hostile. The leader loses credibility with the remaining group members. The group's ability to focus on its work is negatively affected. The hostile member begins to assume the group's leadership role.
"We generally see symptom improvement in 7 to 10 days after beginning treatment."
What is the nurse's best response when asked by a patient who will begin lithium therapy, "When can I expect to see improvement in my symptoms?" "The response is very individualized and dependent on the severity of the symptoms." "I can see you are anxious; let's talk about what's causing you all the worry." "We generally see symptom improvement in 7 to 10 days after beginning treatment." "Lithium is excellent at managing symptoms like yours; try to be patient."
Chronic depression Significant stress, trauma, maternal behavior, and maltreatment during childhood and adolescence are mental health issues, because they have the potential to permanently alter the structure and chemistry of the brain, which often leads to a life of depression and anxiety. There is currently no research to associate these events with impaired cognition, schizophrenia, or dementia.DIF: Cognitive level: Understanding REF: p. 48 TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity
What is the potential long-term effect of childhood trauma and maltreatment? Impaired cognitive function Chronic depression Early-onset schizophrenia Dementia
Improved medication compliance by the patient
What is the primary expected outcome for the nurse's attention to patient education that focuses on medication understanding? Improved medication compliance by the patient Appropriate attention to nursing responsibilities Effective patient-focused advocacy Reduction of undesired side effects
The narrow therapeutic index of these medications
What is the primary safety concern related to the prescription of tricyclic antidepressants and lithium? Their tendency to affect cognitive function The narrow therapeutic index of these medications Their potential for abuse or dependency The likelihood of a reduction in libido
It supports the expectation that all members are to interact with each other.
What is the rationale for placing chairs in a circle configuration for seating during a support group session? It allows the leader to easily monitor the participation of the members. It minimizes disruption when members enter or leave the session. It supports redirecting by the leader when the members lose focus. It supports the expectation that all members are to interact with each other.
Breastfeeding
What presents the greatest postnatal risk to a newborn whose mother is now managing her bipolar disorder with lithium? Potential maternal neglect Breastfeeding Potential maternal abuse Infections
At first complete blood counts (CBCs) to be scheduled weekly
When a patient is initially prescribed carbamazepine (Tegretol) when lithium is ineffective at managing the symptoms of bipolar disorder, the nurse will include what information in the patient education plan? The possible development of a skin rash Symptom recognition of Stevens-Johnson syndrome May prevent weight loss At first complete blood counts (CBCs) to be scheduled weekly
Sudden, unexpected flailing of an arm Basal ganglia dysfunction can result in hemiballismus (a sudden, wild flailing of one arm), nystagmus (involuntary rapid eye movements), and resting tremor as seen in parkinsonism. A decrease in tendon reflexes unilaterally and a general lack of coordination described as ataxia are related to cerebellar dysfunctions.DIF: Cognitive level: Understanding REF: p. 43 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity Resting tremors in the hands Basal ganglia dysfunction can result in hemiballismus (a sudden, wild flailing of one arm), nystagmus (involuntary rapid eye movements), and resting tremor as seen in parkinsonism. A decrease in tendon reflexes unilaterally and a general lack of coordination described as ataxia are related to cerebellar dysfunctions.DIF: Cognitive level: Understanding REF: p. 43 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity Involuntary, rapid eye movement Basal ganglia dysfunction can result in hemiballismus (a sudden, wild flailing of one arm), nystagmus (involuntary rapid eye movements), and resting tremor as seen in parkinsonism. A decrease in tendon reflexes unilaterally and a general lack of coordination described as ataxia are related to cerebellar dysfunctions.DIF: Cognitive level: Understanding REF: p. 43 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity
When it is documented that a patient has basal ganglia dysfunction, the nurse will expect which assessment findings? (Select all that apply). Select all that apply. Sudden, unexpected flailing of an arm Resting tremors in the hands Involuntary, rapid eye movement Decreased, unilateral tendon reflexes General lack of coordination
Short-term memory
Which area of cognitive function is initially most noticeably affected in a patient diagnosed with dementia? Word finding Short-term memory Concentration Long-term memory
Blood pressure of 180/110 mm Hg The major risk factors for vascular dementia are hypertension, diabetes mellitus, previous stroke, cardiac arrhythmias, coronary artery disease, tobacco use, and alcohol or substance abuse. None of the other options are recognized as risk factors for vascular dementia
Which assessment data represents a risk for vascular dementia? Blood pressure of 180/110 mm Hg Head trauma that resulted in unconsciousness History of Pick's disease Open-angle glucoma
Family report that the mood change occurred gradually over a 5-day period. Manic episodes usually begin suddenly, escalate rapidly, and last from a few days to several months. To meet diagnostic criteria, the symptoms must persist for at least 1 week (or less if hospitalization is required). Manic episodes are characterized by an elevated, expansive, or irritable mood. Judgment is impaired, social blunders occur, and involvement with alcohol and drugs is common.
Which assessment data would be inconsistent with a diagnosis of mania? The patient is demonstrating severe irritability. Family report that the mood change occurred gradually over a 5-day period. The behaviors have increased in severity since onset 2 weeks ago. The patient has been abusing alcohol consistently since onset of symptoms.
Hypomania
Which assessment data would support a diagnosis of bipolar II disorder? Hypomania Behaviors that span at least a 6-day period Paranoia Behaviors requiring hospitalization
"How much coffee do you drink daily?"
Which assessment question will the nurse ask to help identify the cause of a patient's decreased lithium levels? "How much coffee do you drink daily?" "How much salt do you consume daily?" "Have you been prescribed a daily diuretic medication?" "Have you been taking any antiiflammatory medications?"
Regularly engages in limit-testing
Which behavior demonstrated by a child diagnosed with obsessive-compulsive disorder (OCD) would suggest to the nurse that the child is also experiencing a common co-morbid mental health disorder? Pays little attention to details Really enjoys being surprised Regularly engages in limit-testing Is not frightened easily
Consistently insists that a child's doll is a real baby
Which behavior demonstrated by a patient diagnosed with Altzheimer's disease supports the nurse's documentation that the patient is experiencing illusions? Responds to all questions by answering, "I have a headache" Becomes restless and agitated each afternoon just before dinner Consistently insists that a child's doll is a real baby Believes that all strangers are aliens from another planet
He has been hoarding medications and has a large supply of barbiturates.
Which behavior demonstrates the most lethal plan by an individual who has recently expressed suicidal ideations? He drives to the store and buys a bottle of aspirin. He has been hoarding medications and has a large supply of barbiturates. He cuts his wrists, then calls his girlfriend to say goodbye. She calls her therapist threatening to kill herself.
Having to take turns during a class activity triggering an immediate temper tantrum.
Which behavior in a 10-year-old child best supports the diagnosis of bipolar disorder (BPD)? Telling classmates that "I'm this school's best basketball player, ever." Consistently invading classmates' personal space when interacting with them Having to take turns during a class activity triggering an immediate temper tantrum. Being overheard sharing with several classmates that, "I know everything about having sex."
Carbohydrate craving
Which behavior is characteristic of a patient experiencing bipolar depression? Insomnia Weight loss Anorexia Carbohydrate craving
Hepatic
Which body system is at greatest risk for damage related to the metabolism of drugs? Hepatic Renal Circulatory Gastrointestinal
Oatmeal with almonds and milk
Which breakfast selections demonstrate that a patient understands the nurse's dietary instructions while taking monoamine oxidase inhibitor (MAOI) antidepressants? Bacon, eggs, cheddar cheese, and avocado slices in a flour tortilla Banana slices and raisins in whole-grain cereal with milk Blueberry pancakes with yogurt Oatmeal with almonds and milk
Tacrine (Cognex)
Which cholinesterase (ChE) inhibitor is no longer prescribed in the United States for the treatment of AD? Rivastigmine (Exelon) Galantamine (Razadyne) Donepezil (Aricept) Tacrine (Cognex)
Men produce more serotonin. Levels of the neurotransmitter serotonin, a major chemical involved in setting moods, is 52% higher in men than in women, —possibly accounting for the higher incidence of depression in women. While it is true that men have some larger areas in the parietal lobes, whereas women have some larger areas in the frontal lobes and limbic areas, these differences are not known to be associated with the incidence of depression. DIF: Cognitive level: Understanding REF: p. 48 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity
Which difference between male and female brains is possibly associated with the increased incidence of depression in females? Men have larger parietal lobes. Women have larger frontal lobes. Men produce more serotonin. Women have larger limbic areas.
Memantine (Namenda)
Which glutamate-N-methyl-D-aspartate (NDMA) receptor antagonist medication has been approved by the U.S. Food and Drug Administration (FDA) for moderate to severe AD? Rivastigmine (Exelon) Galantamine (Razadyne) Memantine (Namenda) Donepezil (Aricept)
Addressing the patient by Mr, Mrs, or Miss and their last name
Which intervention by the nurse would help establish the nurse-patient relationship when conducting an assessment inteview with a mentally ill older adult? Allowing adequate time for the patient to formulate answers to the questions Asking questions using common words and short sentences Avoiding unnecessary interruptions and distractions Addressing the patient by Mr, Mrs, or Miss and their last name
Assist the patient in identifying personal skills and achievements.
Which intervention will best address the low self-esteem issues experienced by a middle-aged adult who has been unemployed for 2 years? Provide the patient with a regular bathing and grooming schedule. Listen attentively as the patient retells the details of being unemployed. Assist the patient in identifying personal skills and achievements. Encourage the patient to focus on retraining opportunities in the community.
The patient is allowed to listen to his/her personal radio during the isolation process.
Which intervention will not be included in the care plan for a patient who is currently being physically restrained? The release of physical limb restraints is initiated every 2 hours. Ten-minute range-of-motion exercises are implemented for each restrained extremity. The patient is allowed to listen to his/her personal radio during the isolation process. The staff has scheduled regular contact with the patient when restraints are in place.
Dopamine By far the most celebrated and widely known biologic theory for schizophrenia is the dopamine hypothesis. According to this theory, schizophrenia is caused by alterations of dopamine levels in the brain. This theory regarding the cause of schizophrenia is not associated with norepinephrine, serotonin, or acetylcholine.DIF: Cognitive level: Remembering REF: p. 46 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity
Which neurotransmitter is most widely associated with the biologic theory for the development of schizophrenia? Norepinephrine Dopamine Serotonin Acetylcholine
Acetylcholine
Which neurotransmitter is the focus of medication therapy when managing AD? Acetylcholine Dopamine Norepinephrine Serotonin
Provide nutrient-rich finger foods so the patient can eat while walking and talking.
Which nursing intervention is likely to be most helpful in providing adequate nutrition while the patient is experiencing acute mania? Provide nutrient-rich finger foods so the patient can eat while walking and talking. Offer only liquids that are rich in calories. Make food available to the patient knowing he or she will eat when hungry. Insist that the patient join the other patients on the unit during mealtimes.
Asking "Can we talk about what triggered your angry behavior?"
Which nursing intervention is most appropriate for the post-crisis depression phase of the assault cycle? Asking "Can we talk about what triggered your angry behavior?" Applying physical restraints when deemed necessary Directing the client to "Go to your room and calm yourself " Providing perscribed medication
A daily activity schedule
Which nursing intervention would benefit an individual with dementia who experiences short-term memory difficulties? An exercise group A reminiscence group A menu of favorite foods A daily activity schedule
Down-regulation Down-regulation of receptors is an important concept, primarily because chronic exposure to certain psychotropic drugs causes receptors to change. Consistent use of antidepressants causes postsynaptic receptors to decrease in number. Because this down-regulation occurs at about the same time that the antidepressant effect develops (approximately 2 to 4 weeks), it is thought by some that reduction in postsynaptic receptors might provide a better explanation for mood elevation than increases in neurotransmitters. Pharmacodynamic tolerance is a term used to describe a reduction in receptor sensitivity (or desensitization). The affected receptors are no longer responding to the medication in the way a normal person's receptors would respond. Pharmacokinetic interactions occur when one of the four pharmacokinetic processes is inhibited or induced, while pharmacodynamic interactions relate to the synergistic or additive effect drugs have on each other. Neither process is relevant to the effective time frame of antidepressant medication.DIF: Cognitive level: Understanding REF: p. 121 TOP: Nursing process: Assessment MSC: Client needs: Psychosocial Integrity
Which pharmacodynamic effect is thought to be responsible for the 2- to 4-week period required for antidepressant medications to affect mood? Pharmacodynamic tolerance Pharmacodynamic interaction Pharmacokinetic interaction Down-regulation
Orthostatic hypotension resulting in falls
Which side effect of MAOI therapy will the nurse be particular concerned about when this classification of antidepressants is precribed to an older adult patient? Orthostatic hypotension resulting in falls Hypertension-induced strokes Hypertensive crisis resulting from eating tyramine-rich foods Drug-induced reflex tachycardia
"I'm pleased with your contribution to the discussion; now it's time to hear from another member."
Which statement by the nurse is an example of "gate keeping" as a technique to manage a dominant member of a group? "I'm pleased with your contribution to the discussion; now it's time to hear from another member." "I believe you have been given ample opportunity to express your feelings; now it is someone else's turn." "You have given us a very detailed description of your problems; if you need more time, we can provide it at the next session." "It appears that you have a strong need to control the discussion; can you talk to us about why that is so important to you?"
True dementia is chronic in nature, while pseudodementia is highly treatable. Depression that mimics dementia is termed
Which statement is true regarding pseudodementia when compared to true dementia? Pseudodementia symptoms are more severe than those of true dementia. Pseudodementia results in lower functioning abilities than does true dementia. True dementia is chronic in nature, while pseudodementia is highly treatable. True dementia does not always present with a depressed mood, but pseudodementia sometimes does.
Medication dosage is determined by weight.
Which statement regarding medication management goals for children diagnosed with BPD is true? Medication dosage is determined by weight. Age is a factor when determining the need to increase dosage. There are currently only six medications approved by the U.S. Food and Drug Administration (FDA) for such treatment. The initial goal is to manage the hyperactive symptoms being demonstrated.
