Psych Prep U Neurobiologic Theories and Psychopharmacology

A Cuban American client has been prescribed an antipsychotic medication. Which response is most important for the nurse to make to this client?

"Call the doctor immediately if you experience any of the side effects we talked about." In general, non-Whites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. While the other options are not inappropriate, they do not address the issue of the client's increased risk for the development of side-effects.

After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states what?

"I need to be careful because the drug can make me sleepy." Imipramine is a tricyclic antidepressant 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 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." 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.

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." 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.

A client is prescribed medication for a psychiatric disorder. After 3 days, the client reports being constipated. Which instruction would the nurse give the client?

"You need to eat more fruits and vegetables and drink more water." The nurse should instruct the client to increase fiber and fluid intake. A mild laxative, exercise, and fiber supplement also may help the client's constipation. High-protein foods would have no effect on constipation. Stool softeners may be appropriate if an increase in fiber and fluids is ineffective. The side effect will not necessarily disappear.

The therapeutic level of lithium range includes what

1 to 1.5 mEq/L Therapeutic levels in acute mania range from 0.8 to 1.4 mEq/L. Therapeutic maintenance doses range from 0.4 to 1 mEq/L.

Which client is most likely to benefit from treatment with an antiparkinsonism agent?

A client who has a medication-induced movement disorder. 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.

Which client would not be able to undergo a magnetic resonance imaging scan (MRI)?

A client with a pacemaker Clients with pacemakers or metal implants, such as heart valves or orthopedic devices, cannot undergo an MRI. There are not contraindications for obese clients can to undergo an MRI. Clients who are claustrophobic or those with anxiety can have an MRI but may need special intervention such as sedation.

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

Agranulocytosis 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

A client who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the client's physician because the nurse suspects what?

Agranulocytosis 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.

Which is not an action expected of a benzodiazepine?

Antidepressant Benzodiazepines do not function as an antidepressant. This drug classification has anticonvulsant, muscle relaxant, and antianxiety properties.

Which medication classification blocks serotonin reuptake?

Antidepressant 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 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. 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. Atypical antipsychotics work on dopamine receptors and serotonin receptors, thus affecting both positive and negative symptoms of schizophrenia.

Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure?

Behavior This part of the brain seems to be largely responsible for the human aspect of brain function. Drug therapy aimed at alleviating emotional disorders, such as depression and anxiety, often involves attempting to alter the levels of epinephrine, norepinephrine, and serotonin.

The use of psychopharmacologic agents in the treatment of mental illness comes from which domain of the biopsychosocial model?

Biologic Neurobiologic theories serve as a basis for understanding and administering pharmacologic agents.

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

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 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

A client exhibiting an uncoordinated gait has presented at the clinic. The nurse knows that what brain structure has the function of balance and coordination?

Cerebellum The cerebellum controls fine movement, balance, position sense, and integration of sensory input. Portions of the pons control the heart, respiration, and blood pressure. Cranial nerves IX through XII connect to the brain in the medulla. Cranial nerves III and IV originate in the midbrain.

You are caring for a mental health client who has developed difficulty with balance and muscle tone after a car accident that involved a head injury. Based on this information, what area of the brain was most likely injured in the accident?

Cerebellum The cerebellum coordinates the voluntary muscles and maintains balance and muscle tone. The diencephalon maintains homeostasis and controls the autonomic nervous system and the pituitary gland. The brain stem connects the cerebrum and diencephalon with the spinal cord. The pons helps regulate respiration

A client is having difficulty standing without assistance and is exhibiting swaying. The client has a history of falls. Which area of the brain is most likely affected?

Cerebellum The cerebellum regulates postural balance and positioning. The hypothalamus regulates temperature. The thalamus functions as a regulatory structure to relay all sensory information, except smell, sent to the central nervous system from the peripheral nervous system. The hippocampus is involved in storing information, especially the emotions attached to memories.

What part of the brain would be responsible for activities such as walking and dancing?

Cerebellum 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 client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence?

Changing the client's medication route to intramuscular depot Depot medications can effectively compensate for a client's lack of adherence and are likely to be more effective in the long term than a system of rewards and consequences. Antipsychotics are not administered intravenously. The use of benzodiazepines will have no effect on adherence.

In which way do neurons communicate through the use of synapses?

Chemically Norepinephrine, a neurotransmitter, belongs to a group of structurally related chemicals called catecholamines that also includes dopamine, serotonin, and epinephrine. Neurons do not communicate electrically, excitatorily, or inhibitorily.

Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells?

Chemically The transmission of information between two nerves or between a nerve and a gland or muscle is chemical. Selectively, excitably, and accessibly are incorrect.

A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter?

Cholinergic The cholinergic system uses acetylcholine as a neurotransmitter. The dopaminergic system uses dopamine as its neurotransmitter. The GABA-ergic system uses GABA as its neurotransmitter. The noradrenergic system uses norepinephrine as its neurotransmitter.

Which is the primary role of neurotransmitters?

Communicate information from one cell or cell group to another Neurotransmitters are referred to as first messengers, which means molecules that communicate information or change from one cell or cell group to another, cause an immediate effect, and are typically found in circuitry that produces behavior.

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 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

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 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.

What is the function of the thalamus and the hypothalamus?

Coordinate internal and external responses The thalamus and hypothalamus coordinate internal and external responses and direct information into the cerebral cortex.

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 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 nurse is studying the positron emission tomography (PET) report of a client with Alzheimer's disease. What findings should the nurse expect to find in the report? Select all that apply

Decreased blood flow to the brain Presence of amyloid plaques and tangles Decreased glucose metabolism in the brain Decreased blood flow to the brain, presence of amyloid plaques and tangles, and decreased glucose metabolism are findings associated with Alzheimer's disease, which could be obtained on a PET scan. Atrophy of the cerebral cortex is also associated with Alzheimer's and its presence could be found in magnetic resonance imaging and computed tomography scans. Enlarged ventricles are not associated with Alzheimer's disease; it is a feature of schizophrenia.

A nurse is studying the positron emission tomography (PET) report of a client with Alzheimer's disease. What findings should the nurse expect to find in the report? Select all that apply.

Decreased blood flow to the brain Presence of amyloid plaques and tangles Decreased glucose metabolism in the brain Decreased blood flow to the brain, presence of amyloid plaques and tangles, and decreased glucose metabolism are findings associated with Alzheimer's disease, which could be obtained on a PET scan. Atrophy of the cerebral cortex is also associated with Alzheimer's and its presence could be found in magnetic resonance imaging and computed tomography scans. Enlarged ventricles are not associated with Alzheimer's disease; it is a feature of schizophrenia.

A client with diminished serotonin levels would likely experience which symptom?

Depression and impulsivity Low levels of serotonin are associated with depression, aggression, suicidality, and impulsivity. High levels of serotonin are associated with anxiety disorders. Sleep disturbances are associated with acetylcholine. The fight-or-flight response is associated with epinephrine.

A client who has been taking paroxetine for 3 years for depression abruptly discontinues the drug. For which signs and symptoms should the nurse monitor the client?

Diarrhea and agitation When a client who has been taking paroxetine for 3 years for depression abruptly discontinues the drug, the psychiatric nurse assesses him frequently for diarrhea and agitation. The signs and symptoms identified in the remaining options are not associated with withdrawal from the abrupt discontinuation of paroxetine.

A client has been diagnosed with Parkinson's disease. His symptoms of spasticity are related to a decrease in which neurotransmitter?

Dopamine 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 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.

Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply.

Dry mouth Constipation Urinary retention Anticholinergic side effects resulting from blockade of acetylcholine are commonly associated with antipsychotic drugs. Others include dry mouth, slowed gastric motility, constipation, urinary hesitancy or retention, and nasal congestion. Diarrhea and a runny nose are not anticholinergic side effects.

Extrapyramidal side effects are characterized by a triad of symptoms, including what?

Dystonia, akathisia, and pseudoparkinsonism 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) 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 Lithium has few side effects if maintained within a therapeutic range. Adverse reactions begin to occur with toxic levels.

Which is the most commonly seen adverse side effect of typical antipsychotics?

Extrapyramidal symptoms and tardive dyskinesia The greatest hazard of typical antipsychotics involves adverse effects, such as extrapyramidal symptoms (EPSs) and tardive dyskinesia. Risk of EPSs and other movement disorders is highest for clients who use older, high-potency neuroleptics, such as haloperidol or perphenazine, for long periods.

Abnormalities in which lobe is believed to be associated with schizophrenia?

Frontal An abnormality in the frontal lobe has been associated with schizophrenia.

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 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.

Benzodiazepines increase which neurotransmitter function?

GABA Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep. Benzodiazepines do not increase the function of serotonin, norepinephrine, or acetylcholine.

A nurse is assessing a child with a diagnosis of autism spectrum disorder. The child has severe uncontrollable temper outbursts and repeatedly bangs the head on the wall or door. When considering medication for treatment, the nurse knows which will be the most effective?

Haloperidol Antipsychotic medication like haloperidol is used to treat specific symptoms such as temper tantrums and stereotypic behavior (repeatedly bangs head on the wall or door). Pemoline and methylphenidate are used to treat attention deficit hyperactivity disorder. Imipramine is used to treat enuresis.

A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs?

Hyperpyrexia, severe hypertension, and diaphoresis Fever, hypertension, and diaphoresis are cardinal symptoms of NMS and should be immediately addressed.

Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?

Hypertensive crisis 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 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 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 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 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.

Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug?

Its ability to block the reuptake of serotonin An SSRI antidepressant drug's primary effect typically involves its ability to block the reuptake of serotonin, not the management of the symptomology related to depression, the inhibition of the hormonal cascase, nor the increase in the number of serotonin receptor sites.

Which is considered the first-line treatment for bipolar disorder?

Lithium Lithium is considered the first-line treatment for bipolar disorder. Lithium is the most established mood stabilizer.

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 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 The brain stem consists of the midbrain, pons, and medulla.

Which structures are components of the brain stem? Select all that apply.

Midbrain Pons Medulla The brain stem, located beneath the thalamus and comprising the midbrain, pons, and medulla, has important life-sustaining functions. The cerebellum and occipital lobes are not part of the brain stem.

Dietary modifications are most likely necessary when a client is being treated with which antidepressant?

Monoamine oxidase inhibitors(MAOIs) 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.

The basic units of structure and function in the nervous system are called what?

Neurons Neurons, or nerve cells, are the basic units of structure and function in the nervous system. Glial cells provide mechanical and metabolic support for neurons. Each neuron consists of a cell body and snakelike extensions called dendrites and axons.

Which is considered an atypical antipsychotic?

Olanzapine Olanzapine is considered an atypical antipsychotic. Haloperidol, thioridazine, and thiothixene are considered conventional antipsychotics

A client with an anxiety disorder is exhibiting agitation after missing some doses of diazepam. The nurse interprets the aggression as relating to which cause?

Paradoxical excitation A rebound phenomenon, referred to as paradoxical excitation, may occur after the abrupt discontinuation of benzodiazepines. The client may become more anxious, exhibit aggressive or antisocial behavior, or experience withdrawal symptoms of confusion, toxic psychosis, convulsions, or a condition resembling delirium tremens. Habituation is a term used to describe a continuous or intermittent craving for a substance to avoid a dysphoric or unpleasant mood state. Addiction is a state of chronic or recurrent drug intoxication, characterized by psychological and physical dependence as well as tolerance. Tolerance refers to the client's ability to obtain a desired effect from a specific dose of a drug.

A drug that is an antagonist functions to do what?

Prevent natural or other substances from activating cell function 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 nurse is involved in gathering information about the inheritance of mental disorders using population genetics. Which would the nurse be least likely to be evaluating?

Risk factor analysis Risk factor analysis is evaluated when determining genetic susceptibility (i.e., predicting who is more likely to experience psychiatric disorders or certain conditions). Population genetics evaluates family studies that analyze the occurrence of a disorder among first-degree relatives, twin studies that analyze the presence (or absences) of a disorder in pairs of twins using concordance rates, and adoption studies that compare the risk of a disorder developing in offspring raised in different environments.

A group of nursing students is reviewing the role of serotonin in psychiatric disorders. The students demonstrate a need for additional study when they identify which disorder as being associated with its dysfunction?

Schizophrenia Schizophrenia is associated with abnormally high activity of dopamine, not serotonin. Whereas depression and insomnia have been associated with decreased levels of 5-HT, mania has been associated with increased 5-HT. Some of the most well-known antidepressant medications, such as fluoxetine and sertraline, function by increasing serotonin concentrations within certain areas of the central nervous system.

A client is brought to the emergency department by her sibling, who reports that the client became very agitated and "started hallucinating." Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The sibling states that the client is taking paroxetine for depression. Which would the nurse most likely suspect?

Serotonin syndrome The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI]) suggest serotonin syndrome. Neuroleptic malignant syndrome and acute dystonic reaction would occur with antipsychotic uses. Hypothyroidism may result from lithium use.

Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?

Sexual dysfunction SSRIs block neuronal transport of serotonin, which stimulates many postsynaptic receptor sites and probably contributes to associated side effects. These include nausea, vomiting, weight changes, agitation or restlessness, and delayed or impaired orgasm.

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. 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 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.

A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what?

Tardive dyskinesia The symptoms of tardive dyskinesia include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Akathisia is reported by the client as an intense need to move about.

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 makes repetitive movements with the fingers Tardive dyskinesia is usually characterized by repetitive involuntary movements. Syncope, sleep disturbances, and symptom exacerbation are not suggestive of tardive dyskinesia

The nurse is assessing a client who is on a psychotropic drug. The client primarily complains about gaining weight and feeling sleepy. Which action of the drug would most likely have caused these effects?

The drug blocks histamine uptake. Some psychotropic drugs like chlorpromazine are known to block histamine uptake. Histamine is responsible for peripheral allergic responses, control of gastric secretions, cardiac stimulation, and alertness. Thus, blocking of histamine receptors would cause weight gain, hypotension, and sedation. The drugs that block serotonin reuptake, such as some antidepressants, cause improved mood. Dopamine is an excitatory neurotransmitter and this action would not lead to sleepiness or weight gain. Excess production of norepinephrine would cause anxiety disorder.

The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?

The foods contain tyramine, which may provoke hypertensive crisis. Monoamine oxidase inhibitors contain tyramine, which can trigger hypertensive crisis. The client must be instructed to avoid all aged foods. None of the other options provide accurate information about the association of the medication and the suggested foods.

The psychiatric nurse is preparing to provide education to a client who has recently been prescribed lithium. The nurse should include which information? Select all that apply

The intended outcome of the therapy will be the prevention of manic behavior. The drug appears to balance the neurotransmission of serotonin. Blood levels of the drug should be monitored at least monthly with a sample drawn 12 hours after a dose. Your physician should be notified immediately of any vomiting, diarrhea, or profuse perspiration. Antimanic agents, or mood stabilizers, refer to agents that prevent or diminish the frequency and intensity of manic behavior, mood swings, aggressive behavior, and dyscontrol syndrome. Lithium has long been considered the treatment of choice for the manic phase of bipolar disorder. It is thought to balance serotonergic neurotransmission, preventing a decreased activity of nerve impulses that causes depression and prevents an increased activity of nerve impulses that causes mania. Blood lithium levels are monitored regularly, with samples taken 12 hours after the previous dose of lithium. Serum lithium concentrations may increase in the presence of extreme vomiting, diarrhea, or perspiration, resulting in lithium toxicity. Lithium can require 3 to 5 weeks before it is effective.

Benzodiazepines work by the following mechanism of action:

They act directly on GABA receptors and are thought to increase the amount of GABA available. Benzodiazepines act directly on GABA receptors and are thought to increase GABA available to dampen neural overstimulation.

Clients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in what?

Tyramine Tyramine has a vasopressor effect that induces hypertension. If an individual ingests food that contains high concentrations of tyramine while taking MAOIs, severe headaches, palpitations, neck stiffness and soreness, nausea, vomiting, sweating, hypertension, stroke, and (in rare instances) death may result. Patients who are taking MAOIs are placed on a low-tyramine diet. Sodium, fat, and sugar are generally not restricted in patients receiving MAOIs.

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).

What is the primary factor that contributes to the high cost of providing mental health care?

most mental illnesses are chronic in nature Psychiatric care is costly because of the long-term nature of the disorders. Medication are only a part of the costs associated with the care of the mentally ill. Most mental illnesses do not result in aggressive behaviors and only a small percentage of those diagnosed with a mental illness are hospitalized.

A client is being seen in the mental health clinic. The client has been on haloperidol for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. A nurse would document this chronic syndrome as:

tardive dyskinesia.

When caring for an older adult taking a psychotropic medication, the psychiatric nurse must be aware that older adults:

usually require a lower dose of these medications than do younger counterparts. The pharmacologic actions of psychotropic medications change dramatically for older persons as a result from differences in drug absorption secondary to diminished gastrointestinal motility, decreased plasma proteins, decreased kidney function, congestive heart failure, or normal age-related changes in body composition, lean body mass, and muscle mass or increased fatty tissue.