Pharma (Psych & Pain)

Question 1

The client with a major depressive disorder taking the SSRI fluoxetine calls the psychiatric clinic and reports felling confused and restless and having an elevated temperature. Which action should the psychiatric nurse take?
1. Determine if the client has flulike symptoms.
2. Instruct the client to stop taking the SSRI.
3. Recommend the client to take the medication at night.
4. Explain that these are expected side effects.

Answer 1

2. Instruct the client to stop taking the SSRI.

wean off psych meds unless you suspect serotonin syndrome (med emergency)
- risk b/c client is on SSRI
- confusion, restless, elevated T (suggest serotonin syndrome)
- other side effects include HTN, tremors

Question 2

The client diagnosed with a major depressive disorder asks the nurse, “Why did my psychiatrist prescribe an SSRI rather than one of the other types of antidepressants?”. Which statement by the nurse would be most appropriate?
1. “Probably it is the medication that your insurance will pay for.”
2. “You should ask your psychiatrist why the SSRI was ordered.”
3. “SSRIs have fewer side effects than the other classifications.”
4. “The SSRI medications work faster than the other medications.”

Answer 2

3. “SSRIs have fewer side effects than the other classifications.”

• SSRIs are 1st line of treatment for depression
• all psych meds need weeks for therapeutic effects (min 2 weeks, usually 4-6 weeks)

Question 3

The client diagnosed with depression is prescribed phenelzine, a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective?
1. “I am taking the herb ginseng to help my attention span.”
2. “I drink extra fluids, especially coffee and iced tea.”
3. “I am eating three well-balanced meals a day.”
4. “At a family cookout I had chicken instead of hotdog.”

Answer 3

4. “At a family cookout I had chicken instead of hotdog.”

concerned about tyramine (found in hotdog, chicken, yoghurt, wine, coffee, …)

Question 4

The client with major depressive disorder is suicidal. The client was prescribed the TCA imipramine 3 weeks ago. Which priority intervention should the nurse implement?
1. Determine if the client has a plan to commit suicide.
2. Assess if the client is sleeping better at night.
3. Ask the family is the client still wants to kill himself or herself.
4. Observe the client for signs of wanting to commit suicide.

Answer 4

1. Determine if the client has a plan to commit suicide.

check if med has started working: takes at least 2 weeks
- ask if pt has thoughts/plans of harming/killing themselves
- find out if they have a plan (is it realistic)

Question 5

The client with major depressive disorder has been taking amitriptyline, a TCA for more than 1 year. The client tells the psychiatric clinic nurse that the client wants to quit taking the antidepressant. Which intervention is most important for the nurse to discuss with the client?
1. Ask questions to determine if the client is still depressed.
2. Ask the client why he or she wants to stop taking the medication.
3. Tell the client to notify the HCP before stopping the medication.
4. Explain the importance of tapering off the medication.

Answer 5

4. Explain the importance of tapering off the medication.

can’t stop abruptly
- pt will have rebound effect (irritable, increased sleepiness)

Question 6

Which statement indicates the client diagnosed with bipolar disorder who is taking lithium, an anti-mania medication, understands the medication teaching?
1. “I will monitor my daily lithium level.”
2. “I will make sure I do not get dehydrated.”
3. “I need to taper the dose if I quit taking it.”
4. “I need to take the medication on an empty stomach.”

Answer 6

2. “I will make sure I do not get dehydrated.”

lithium:
- 0.6-1.2: therapeutic level
- >1.5: lithium toxicity (can be caused by dehydration and hyponatremia)
- causes gastric irritation (to mucosal lining of stomach): do not take on empty stomach

Question 7

The nurse is preparing to administer lithium, an anti-mania medication, to a client diagnosed with bipolar disorder. The lithium level is 1.4 mEq/L. Which action should the nurse implement?
1. Administer the medication.
2. Hold the medication.
3. Notify the HCP.
4. Verify the lithium level.

Answer 7

1. Administer the medication.

• lithium toxicity is at >1.5
• pt may have other issues/co-morbidities hence why they are taking a higher dose

Question 8

To which client would the nurse question administering lithium, an anti-mania medication?
1. The 54-year-old client on 4g sodium diet.
2. The 23-year-old client taking an antidepressant medication.
3. The 42-year-old client taking a loop diuretic.
4. The 30-year-old client with a urine output of 40 mL/hr.

Answer 8

3. The 42-year-old client taking a loop diuretic.

risk of dehydration d/t fluid loss - can cause lithium toxicity

Question 9

The client with bipolar disorder who is taking lithium, an anti-mania medication, has a lithium level of 3.1 mEq/L. Which treatment would the nurse expect the HCP to prescribe?
1. No treatment because this is within the therapeutic range.
2. Intravenous therapy with an 18-gauge angiocath.
3. Preparation for immediate hemodialysis.
4. The antidote for lithium toxicity.

Answer 9

3. Preparation for immediate hemodialysis.

• to get rid of all the lithium that is causing toxicity
• lithium has no antidote

Question 10

The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine, an atypical antipsychotic. Which laboratory data should the nurse evaluate?
1. The client’s clozapine therapeutic level.
2. The client’s WBC count.
3. The client’s RBC count.
4. The client’s ABGs.

Answer 10

2. The client’s WBC count.

adverse effect: agranulocytosis (increases risk of infection)

Question 11

The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone, an atypical antipsychotic. Which intervention should the nurse implement?
1. Provide the client with a low tyramine diet.
2. Assess the client’s respirations for a full minute.
3. Instruct the client to change positions slowly.
4. Monitor the client’s intake and output.

Answer 11

3. Instruct the client to change positions slowly.

risk of orthostatic hypotension (can cause dizziness, lightheadedness)

Question 12

The client diagnosed with schizophrenia is prescribed clozapine, an atypical antipsychotic. Which information should the nurse discuss with the client concerning this medication?
1. Discuss the need for regular exercise.
2. Instruct the client to monitor for weight loss.
3. Tell the client to take the medication with food.
4. Explain to the client the need to decrease alcohol intake.

Answer 12

1. Discuss the need for regular exercise.

• can cause weight gain (a lot)
• antipsychotics do not cause gastric issues (no need to take them with food)

Question 13

The nurse is discussing the prescribed antipsychotic medication with a family member of a client diagnosed with schizophrenia. Which information should the nurse discuss with the family member?
1. Explain the need for the family member to give the client the medication.
2. Encourage the family member to learn CPR.
3. Discuss the need for the client to participate in a community support group.
4. Teach the family member what to do in case the client has a seizure.

Answer 13

4. Teach the family member what to do in case the client has a seizure.

antipsychotic meds lower the threshold for seizures

Question 14

The client diagnosed with paranoid schizophrenia has been taking haloperidol, a conventional antipsychotic, for several years. Which statement indicates the client needs additional teaching concerning this medication?
1. “I know that if I have any rigidity or tremors I must call my HCP.”
2. “I eat high-fibre foods and drink extra water during the day.”
3. “I am more susceptible to colds and the flu when taking this medication.”
4. “This medication will make my hallucinations and delusions go away.”

Answer 14

3. “I am more susceptible to colds and the flu when taking this medication.”

• rigidity and tremors are EPS
• antipsychotics can cause anticholinergic effects (risk of constipation so eat more fibre and drink more water)

Question 15

The client diagnosed with a general anxiety disorder is prescribed alprazolam, a benzodiazepine. Which information should the clinic nurse discuss with the client?
1. Explain to the client that this medication is for short-term use.
2. Inform the client that rage and excitement are expected side effects.
3. Tell the client to avoid foods that are high in vitamin K.
4. Instruct the client to take the medication with at least 8 ounces of water.

Answer 15

1. Explain to the client that this medication is for short-term use.

• benzodiazepines can cause dependency (that’s why they are only used for short term)
• rage and excitement are paradoxical effects (opposite effects) - benzodiazepines are supposed to calm down

Question 16

The female client taking lorazepam, a benzodiazepine, for panic attacks tells the clinic nurse that she is trying to get pregnant. Which action should the nurse take first?
1. Tell the client to inform the obstetrician of taking Ativan.
2. Instruct the client to quit taking the medication.
3. Determine how long the client has been taking the medication.
4. Encourage the client to stop taking Ativan prior to getting pregnant.

Answer 16

3. Determine how long the client has been taking the medication.

• determine=assess (this will determine HCP’s next course of action)

Question 17

The nurse is preparing to administer the benzodiazepine alprazolam to a client who has a generalized anxiety disorder. Which intervention should the nurse implement prior to administering the medication?
1. Assess the client’s apical pulse.
2. Assess the client’s RR.
3. Assess the client’s anxiety level.
4. Assess the client’s BP.

Answer 17

2. Assess the client’s RR.

this med calms down (do not give for RR < 12)

Question 18

A nurse is administering diazepam to a patient for anxiety management. Which of the following assessments is the priority before giving this medication?
1. Assessing the patient’s RR.
2. Checking the patient’s BP.
3. Monitoring the patient’s weight.
4. Evaluating the patient’s pain level.

Answer 18

1. Assessing the patient’s RR.

• priority: what is going to kill my pt the fastest? RR
• benzodiazepines: downers - depress RS and CVS (RR and BP will go down) - RR will kill pt faster than BP

Question 19

A patient prescribed diazepam for anxiety reports experiencing increased drowsiness and confusion. Which nursing intervention is the most appropriate?
1. Instruct the patient to drink more fluids.
2. Encourage the patient to take the medication with food.
3. Notify the HCP about the patient’s symptoms.
4. Advise the patient to increase physical activity.

Answer 19

3. Notify the HCP about the patient’s symptoms.

• b/c pt is reporting INCREASED (there is a change that is not good) drowsiness and confusion - adverse effects
• only option that actually addresses the issue

Question 20

A nurse is teaching a patient about buspirone for anxiety management. Which statement by the patient indicates a need for further teaching?
1. “I can take this medication as needed for anxiety attacks.”
2. “It may take several weeks to feel the full effects of the medication.”
3. “I should avoid drinking grapefruit juice while on this medication.”
4. “I will let my doctor know if I experience any dizziness.”

Answer 20

1. “I can take this medication as needed for anxiety attacks.”

• this med has to be taken routinely (at frequent intervals)
• not given PRN

Question 21

A patient has been prescribed buspirone for chronic anxiety. Which statement by the patient demonstrates an understanding of the medication’s side effects?
1. “I might experience drowsiness or dizziness.”
2. “I should worry about addiction with this medication.”
3. “It’s okay to stop taking this medication whenever I feel better.”
4. “I should expect immediate relieve of my anxiety symptoms.”

Answer 21

1. “I might experience drowsiness or dizziness.”

• common side effects of this med (pt should not operate heavy machinery)
• takes 3 weeks for therapeutic levels
• does not cause addiction

Question 22

The nurse is providing education to a patient who is considering using kava for anxiety relief. Which of the following statements should the nurse include in the teaching?
1. “Kava is known to be completely safe with no side effects.”
2. “Long-term use of kava may lead to liver damage.”
3. “Kava can be taken with alcohol without any concerns.”
4. “Kava is approved by the FDA for the treatment of anxiety.”

Answer 22

2. “Long-term use of kava may lead to liver damage.”

needs to be metabolized - will affect LFTs

Question 23

A patient is using kava for anxiety and reports experiencing drowsiness and GI upset. Which nursing action is most appropriate?
1. Advise the patient to discontinue kava immediately.
2. Suggest the patient to increase their dosage to relieve symptoms.
3. Educate the patient about potential side effects of kava.
4. Recommend that the patient take kava with food to minimize GI upset.

Answer 23

3. Educate the patient about potential side effects of kava.

• always teach pts about side effects (can affect pt’s thinking, vision, judgment, motor responses)
• GI upset is a side effect

Question 24

A nurse is educating a patient about the use of melatonin for sleep disorders. Which statement by the patient indicates a correct understanding of this supplement?
1. “I can take melatonin anytime I want to fall asleep.”
2. “Melatonin is a hormone that helps regulate my sleep-wake cycle.”
3. “It’s safe to take melatonin with alcohol without any concerns.”
4. “I should expect immediate results from taking melatonin.”

Answer 24

2. “Melatonin is a hormone that helps regulate my sleep-wake cycle.”

• it may take a couple of weeks for melatonin to work

Question 25

A patient asks the nurse about potential side effects of melatonin. Which of the following side effects should the nurse mention? 1. Insomnia 2. Dizziness 3. Increased HR 4. HTN

Answer 25

2. Dizziness - melatonin slows body down: decreases CNS (can cause dizziness, confusion, headaches, sedation)

Question 26

A nurse is preparing to administer an anxiolytic medication to a patient with anxiety. Which of the following nursing interventions should the nurse implement? (SATA) 1. Assess the patient's VS before administration. 2. Monitor the patient for signs of sedation or respiratory depression. 3. Instruct the patient to take the medication with a full glass of water. 4. Educate the patient about potential drug interactions, particularly with alcohol. 5. Administer the medication at bedtime to promote sleep.

Answer 26

1. Assess the patient's VS before administration. 2. Monitor the patient for signs of sedation or respiratory depression. 4. Educate the patient about potential drug interactions, particularly with alcohol. - check pt's HR, RR, BP because the med brings everything down (sedative) - take med with water but no need for full glass - not hypnotic: do not give at HS - anxiolytic is for anxiety: during day

Question 27

When providing care to a patient receiving anxiolytic medications, which interventions should the nurse include in the care plan? (SATA) 1. Encourage the patient to engage in relaxations techniques. 2. Monitor the patient's liver and renal function tests regularly. 3. Advise the patient to discontinue the medication abruptly if feeling better. 4. Provide safety measures to prevent falls. 5. Schedule follow-up appointments to assess anxiety levels and medication effectiveness.

Answer 27

1. Encourage the patient to engage in relaxations techniques. 2. Monitor the patient's liver and renal function tests regularly. 4. Provide safety measures to prevent falls. 5. Schedule follow-up appointments to assess anxiety levels and medication effectiveness. - monitor liver (metabolize) and renal (excreting) function for all meds - may cause drowsiness: can cause falls

Question 28

A nurse assess a patient receiving haloperidol. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? 1. Dystonia 2. Tardive dyskinesia 3. Parkinsonism 4. Akathisia

Answer 28

4. Akathisia - motor restlessness: part of EPS - dystonia = very severe muscle twitching (ex. eyes rolling upwards, tongue protruding) - tardive dyskinesia = involuntary twisting or worm-like movements (ex. lip smacking) - parkinsonism = tremors, rigidity, akathisia, postural instability (risk of falls)

Question 29

The nurse has just administered the first dose of haloperidol to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the HCP before administering the next dose of medication? 1. Dry mouth 2. Temperature of 101 F 3. BP of 104/72 mmHg 4. Drowsiness

Answer 29

2. Temperature of 101 F - suspecting NMS (life-threatening), other symptoms include rigidity, decreased LOC - dry mouth, BP and drowsiness are not a medical emergency

Question 30

The nurse is caring for a patient receiving clozapine. Which assessment finding is most indicative of an adverse effect of this drug? 1. BUN level of 25mg/dL 2. Blood glucose level of 60mg/dL 3. Bilirubin level of 2.5mg/dL 4. WBC count of 2000/mm3

Answer 30

4. WBC count of 2000/mm3 - low WBC: risk of agranulocytosis (life-threatening) - BUN not affected - this med will make BG rise - liver (bilirubin) not affected

Question 31

The nurse is preparing to administer the aripiprazole extended-release 400-mg injection. The nurse is aware that this medication is scheduled to be given how often? 1. Daily 2. Weekly 3. Monthly 4. As needed

Answer 31

3. Monthly given as IM

Question 32

The nurse is preparing to administer quetiapine extended-release 400 mg PO every day as ordered. The available medication is quetiapine 200-mg extended-release tablets. How many tablets should the nurse administer? 1. 0.5 2. 1 3. 2 4. 4

Answer 32

3. 2 200mg + 200mg = 400 mg

Question 33

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine? (SATA) 1. An 85-year-old man with Alzheimer's disease. 2. A 78-year-old man with intractable hiccups. 3. A 76-year-old woman with severe dementia. 4. A 48-year-old woman with schizoaffective disorder. 5. A 30-year-old man with anxiety and depression.

Answer 33

2. A 78-year-old man with intractable hiccups. 4. A 48-year-old woman with schizoaffective disorder. - first generation antipsychotic - do not give antipsychotics to pts with dementia (can be life-threatening) - med used for hiccups and to suppress emesis - used for psychotic disorders (ex. schizophrenia, schizoaffective disorder, bipolar disorder) - not for anxiety or depression

Question 34

The nurse is working with the multidisciplinary HC team to optimize the care of a patient wit schizophrenia. Which concepts will guide the nursing care of this patient? 1. The second-generation antipsychotics generally are more effective than the first-generation agents. 2. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. 3. Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. 4. The lipid levels of patients receiving second-generation antipsychotics should be monitored. 5. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

Answer 34

2. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. 4. The lipid levels of patients receiving second-generation antipsychotics should be monitored. 5. Schizophrenia is characterized by disordered thinking and loss of touch with reality. - second-generation and first-generations agents are equally effective (differ in side effects) - monitor cholesterol, blood sugar (can cause hyperglycemia), weight gain

Question 35

When teaching the patient and family about clozapine, which statements should the nurse include? (SATA) 1. "It is important for you to obtain ordered blood tests when taking this medication." 2. "Most patients who take this medication lose weight, so you should increase the number of calories you consume each day." 3. "If you experience increased urination, increased thirst, or increased appetite, contact your HCP." 4. "Inform your HCP if you are taking any medications to control seizures." 5. "Contact your HCP if you experience any unexplained tiredness, SOB, increased respirations, CP, or heart palpitations."

Answer 35

1. "It is important for you to obtain ordered blood tests when taking this medication." 3. "If you experience increased urination, increased thirst, or increased appetite, contact your HCP." 4. "Inform your HCP if you are taking any medications to control seizures." 5. "Contact your HCP if you experience any unexplained tiredness, SOB, increased respirations, CP, or heart palpitations." - clozapine can cause agranulocytosis: check WBC count - increases blood sugar and cholesterol: increased weight - use with caution in pts with seizures - can cause myocarditis

Question 36

The nurse is planning care for a patient taking imipramine. Which finding, if present, would most likely be an adverse effect of this drug? 1. BP of 160/90 mmHg 2. Insomnia and diarrhea 3. Sedation and dry mouth 4. Tachypnea and wheezing

Answer 36

3. Sedation and dry mouth - this is a TCA: has anticholinergic properties (blurred vision, dry. mouth, urinary retention, constipation, tachycardia) - can cause orthostatic hypotension (BP drops)

Question 37

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline. Which question is most important for the nurse to ask the patient? 1. "Have you noticed dry mouth or blurred vision?" 2. "Have you had any changes in. your urine function?" 3. "When was your last bowel movement?" 4. "Have you had any changes in your mood or anxiety level?"

Answer 37

4. "Have you had any changes in your mood or anxiety level?" - antidepressant - pt is in early phase: risk of suicide (assess)

Question 38

The nurse is caring for a patient receiving fluoxetine for depression. Which adverse effect is most likely associated with this drug? 1. Sexual dysfunction 2. Dry mouth 3. Orthostatic hypotension 4. Bradycardia

Answer 38

1. Sexual dysfunction - SSRI (1st drug of choice for depression): very effects with least side effects - dry mouth: anticholenergic

Question 39

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram. Which is the most likely explanation for these symptoms? 1. Depressive psychosis 2. Serotonin syndrome 3. Escitalopram overdose 4. Cholinergic crisis

Answer 39

2. Serotonin syndrome - this is an SSRI (despite least adverse effects, can cause serotonin syndrome)

Question 40

The nurse is preparing to administer phenelzine to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? 1. It increases the risk of suicide in the early phase. 2. It is less effective than the tricyclic antidepressants. 3. It increases the risk of psychoses and parkinsonism. 4. It has more side effects and drug interactions.

Answer 40

4. It has more side effects and drug interactions. - MAOI: have a lot of side effects and drug interactions - ordered after everything else has been tried (last resort)

Question 41

The nurse in the outpatient psychiatric unit is returning phone calls. Which client should the psychiatric nurse call first? 1. The female client diagnoses with histrionic personality disorder who needs to talk to the nurse about something very important. 2. The male client diagnosed with schizophrenia who is hearing voices telling him to hurt his mother. 3. The male client diagnosed with major depression whose wife called and said he was talking about killing himself. 4. The client diagnosed with bipolar disorder who is manic and has not slept for the last 2 days.

Answer 41

2. The male client diagnosed with schizophrenia who is hearing voices telling him to hurt his mother. - hearing voices = command hallucinations - they have to do it - talking about killing themselves: they are getting their feelings out (they are still priority)

Question 42

The nurse is caring for children in a psychiatric unit. Which client requires immediate intervention by the psychiatric nurse? 1. The 10-year-old child diagnosed with oppositional defiant disorder who refuses to follow the directions of the mental health worker. 2. The 5-year-old child diagnoses with pervasive developmental disorder who refuses to talk to the nurse and will not make eye contact. 3. The 7-year-old child diagnosed with conduct disorder who is throwing furniture against the wall in the day room. 4. The 8-year-old mentally retarded child who is sitting on the playground and eating dirt and sand.

Answer 42

3. The 7-year-old child diagnosed with conduct disorder who is throwing furniture against the wall in the day room. - immediate harm/danger of self or others

Question 43

The male client diagnosed with major depression is returning to the psychiatric unit from a weekend pass with his family. Which intervention should the nurse implement first. 1. Ask the wife for her opinion of how the visit went. 2. Determine whether the client took his medication. 3. Ask the client for his opinion on how the visit went. 4. Check the client for sharps or dangerous objects.

Answer 43

4. Check the client for sharps or dangerous objects. - that places client and others in immediate danger: priority

Question 44

The client on the psychiatric unit is yelling at other clients. throwing furniture, and threatening the staff members. The charge nurse determines the client is at imminent risk of harming the staff/clients and instructs the staff to place the client in seclusion. Which intervention should the charge nurse implement first? 1. Document the client's behaviour in the nurse's notes. 2. Instructor the MHWs to clean up the day room area. 3. Obtain a restraints/seclusion order from the HCP. 4. Ensure that none of the other clients were injured.

Answer 44

3. Obtain a restraints/seclusion order from the HCP. - imminent danger: remove the client to seclusion (need doctor's order): - from least to most invasive: first take them outside, then to room with open door, then restrain one hand - imminent danger means no one is hurt yet

Question 45

A woman comes to the ED and tells the triage nurse she was raped by to men. The woman is crying and disheveled, and has bruises on her face. Which action should the triage nurse implement first? 1. Ask the client whether shw wants the police department notified. 2. Notify a Sexual Assault Nurse Examiner to see the client. 3. Request an ED nurse to take the client to a room and assess for injuries. 4. Assist the client to complete the emergency department admission form.

Answer 45

3. Request an ED nurse to take the client to a room and assess for injuries. - physiological integrity is priority: is she bleeding? Is she stable?

Question 46

The nurse is working in an outpatient mental health clinic and returning phone calls. Which client should the psychiatric nurse call first? 1. The client diagnosed with agoraphobia who is calling to cancel the clinic appointment. 2. The client diagnosed with a somatoform disorder who has numbness in both legs. 3. The client diagnosed with hypochondriasis who is afraid she may have breast cancer. 4. The client diagnosed with PTSD who is threatening his wife.

Answer 46

4. The client diagnosed with PTSD who is threatening his wife. - wife is in immediate danger - somatoform disorder: stress/anxiety/fear manifesting as physical problem

Question 47

The psychiatric nurse is working in an outpatient mental health clinic. Which client should the nurse intervene with first? 1. The client who had a baby 2 months ago and who is sitting alone and looks dejected. 2. The client whose wife just died and who wants to go to heaven to be with her. 3. The client whose mother brought her to the clinic because the mother thinks the client is anorexic. 4. The client who is rocking compulsively back and forth in a chair by the window.

Answer 47

2. The client whose wife just died and who wants to go to heaven to be with her. - immediate danger, wants to kill himself - rocking back and forth: do not make assumptions that the client may want to jump out of window

Question 48

The ED nurse is assessing a female client who has a laceration on the forehead and a black eye. The nurse asks the man who is with the client to please leave the room. The man refuses to leave the room. Which action should the nurse take first? 1. Tell the man the client needs to go to the x-ray department. 2. Notify hospital security and have the man removed from the room. 3. Explain that the man must leave the room while the nurse checks the client. 4. Give the client a brochure with information about a woman's shelter.

Answer 48

1. Tell the man the client needs to go to the x-ray department. - you are expected to lie to get patient away to get pt away from abuser - leave the cellphone at the front or with abuser: abusers will ask to have phone on speaker - ask directly if client is being abused/harmed - give info about shelter + tips: pack overnight bag with important documents, give number for shelter, tell her you are available to help whenever she is ready

Question 49

The charge nurse received laboratory data for clients in the psychiatric unit. Which client data warrants notifying the psychiatric HCP/ 1. The client on lithium whose serum lithium level is 1.0 mEq/L. 2. The client on clozapine whose WBC count is 13,000. 3. The client on alprazolam whose potassium level is 3.7 mEq/L. 4. The client on quetiapine whose glucose level is 128 mg/dL.

Answer 49

2. The client on clozapine whose WBC count is 13,000. - regular range for WBC: 5,000-10,000 - risk of agranulocytosis

Question 50

The client diagnoses with a panic attack disorder in the busy day room of a psychiatric unit becomes anxious, starts to hyperventilate and tremble, and is diaphoretic. 1. Administer the benzodiazepine alprazolam. 2. Discuss what caused the client to have a panic attack. 3. Escort the client from the day room to a quiet area. 4. Instruct the UAP to take the client's VS.

Answer 50

3. Escort the client from the day room to a quiet area. - remove pt from stimulus - pt will not be able to answer any questions during panic attack

Question 51

The client diagnosed with somatization disorder is complaining of vomiting, having diarrhea, and having a fever. Which interventions should the nurse implement first? 1. Assess the client's anxiety level on a scale of 1 to 10. 2. Check the client's VS. 3. Discuss problem-solving techniques. 4. Notify the client's HCP

Answer 51

2. Check the client's VS. - priority is physiological integrity (over anxiety) - risk of dehydration, fluid and electrolyte imbalance

Question 52

Which nursing intervention is priority for the client diagnoses with anorexia who is admitted to an inpatient psychiatric unit? 1. Obtain the client's weight. 2. Assess the client's laboratory values. 3. Discuss family issues and health concerns. 4. Teach the client about SSRIs.

Answer 52

2. Assess the client's laboratory values. - check potassium, sodium, glucose: physiological integrity (priority) - check weight (comes second)

Question 53

Which client should the psychiatric clinic nurse assess first? 1. The client with long-term alcoholism who wants to stop drinking. 2. The client who is a cocaine abuser who is having chest discomfort. 3. The client with OCD who won't quit washing his hands. 4. The client who thinks she was given "the date rape drug" and was raped last night.

Answer 53

2. The client who is a cocaine abuser who is having chest discomfort. - heart is vital organ (risk of heart attack, MI): physiological integrity is priority

Question 54

The client diagnosed with schizophrenia is being seen by the psychiatric clinic nurse for the initial visit. Which intervention should the nurse implement first? 1. Develop a trusting nurse/client relationship. 2. Determine the client's knowledge of medication. 3. Assess the client's support systems. 4. Allow the client to vent their feelings.

Answer 54

1. Develop a trusting nurse/client relationship. - schizophrenia: causes pts to be paranoid - pt needs to trust you to tell you things - be honest

Question 55

The clinical manager assigned the psychiatric nurse a client diagnosed with major depression who attempted suicide and is being discharged tomorrow. Which discharge instruction by the psychiatric nurse would warrant intervention by the clinical manager? 1. The nurse provides the client with phone numbers to call if needing assistance. 2. The nurse makes the client a follow-up appointment in the psychiatric clinic. 3. The nurse gives the client a prescription for a 1-month supply of antidepressants. 4. The nurse tells the client not to take any OTC medications.

Answer 55

3. The nurse gives the client a prescription for a 1-month supply of antidepressants. - most is 1 week supply, usually give 3 days because you want patients to follow-up for meds and assessment in 3-5 days

Question 56

An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide. Which information should the nurse provide the parents? 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. 2. Monitor height and weight to assess that growth is progressing normally. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rick foods in the diet. 4. Avoid dehydration with activities and increase fluid intake.

Answer 56

2. Monitor height and weight to assess that growth is progressing normally. - anti-epileptic drug also used to treat absence seizures - side effects: nausea, anorexia, abdominal pain (all likely causes loss of weight) - does not affect bone growth

Question 57

The nurse is providing education for a 12-year-old client with partial seizures prescribed valproic acid. The nurse will teach the client and the parents to immediately report which symptoms? 1. Increasing or severe abdominal pain. 2. Decreased or foul taste in the mouth. 3. Pruritus and dry skin. 4. Bone and joint pain.

Answer 57

1. Increasing or severe abdominal pain. - adverse effect (increasing or severe: patient is getting worse): pancreatitis (can be life-threatening)

Question 58

The nurse is caring for a 72-year-old client taking gabapentin for a seizure disorder. Because of this client's age, the nurse would establish which nursing diagnosis related to the drug's common adverse effects? 1. Risk for deficient fluid volume. 2. Risk for impaired verbal communication. 3. Risk for constipation. 4. Risk for falls.

Answer 58

4. Risk for falls. - causes CNS depression - in older adults: kidneys and liver don't work the way they used to (risk of toxicity and side effects) - safety risk

Question 59

A client has been taking phenytoin for control of generalized seizures, tonic-clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? 1. The dosage will be increased. 2. The dosage will be decreased. 3. The dosage will remain unchanged; they are symptoms unrelated to phenytoin. 4. The dosage will remain unchanged but and additional anti-seizure medication may be added.

Answer 59

2. The dosage will be decreased. - pt experiencing adverse effects (toxic level)

Question 60

Teaching for a client receiving carbamazepine should include instructions that the client should immediately report which symptoms: 1. Leg cramping 2. Blurred vision 3. Lethargy 4. Blister-like rash

Answer 60

4. Blister-like rash - Steven-Johnson's syndrome is adverse effect (skin is peeling off)

Question 61

Which of the following medications can be used to treat partial seizures? (SATA) 1. Dilantin 2. Depakene 3. Diazepam 4. Tegretol 5. Zarontin

Answer 61

1. Dilantin 2. Depakene 4. Tegretol - diazepam for tonic-clonic seizures and status epilepticus - zarontin treats generalized seizures

Question 62

The nurse reviews the laboratory results of a 16-year-old patient who presents to the clinic with fatigue and pallor. The patient's hematocrit is 26%, and the nurse notes multiple small petechiae and bruises over the arms and legs. This patient has a generalized tonic-clonic seizure disorder that has been managed well on carbamazepine. Relate the drug regiment to this patient's presentation.

Answer 62

- adverse effect is bone marrow suppression - bone marrow: makes RBC (carries oxygen), WBC (risk of infection), platelets (risk of bleeding) - petechiae and bruising: low platelets - Hct: low RBC

Question 63

A 24-year-old woman is brought to the emergency department by her husband. He tells the triage nurse that his wife has been treated for seizure disorder secondary to a head injury she received in an automobile accident. She takes phenytoin 100mg q8h. He relates a history of increasing drowsiness and lethargy in his wife over the past 24 hours. A phenytoin level is performed, and the nurse notes that the results are 24 mcg/dL. What does this result signify and what changes does the nurse anticipate will be made to the patient's treatment?

Answer 63

- 5-20 levels of phenytoin - do not stop med abruptly (it will cause seizures): taper the dose - toxic dose: causes CNS depression (increasing drowsiness and lethargy)

Question 64

The nurse is monitoring the client for early signs of lithium toxicity. Which symptoms, if present, may indicate that toxicity is developing? (SATA) 1. Persistent GI upset (ex. nausea, vomiting) 2. Confusion 3. Increased urination 4. Convulsions 5. Ataxia

Answer 64

1. Persistent GI upset (ex. nausea, vomiting) 2. Confusion 3. Increased urination - n/v, abdominal pain - by the time the patient gets convulsions or has ataxia, the patient has had well-established toxicity: late signs and not early

Question 65

The parents of a young client receiving methylphenidate express concerns that the HCP has suggested the child have a "holiday" from the drug. Wha is the purpose of a drug-free period? 1. To reduce or eliminate the risk of drug toxicity. 2. To allow the child's "normal" behaviour to return. 3. To decrease drug dependence and assess the client's status. 4. To prevent the occurrence of a HTN crisis.

Answer 65

3. To decrease drug dependence and assess the client's status. - can cause dependence - assess your intervention (after you stop the drug) - HTN crisis happens with OD

Question 66

A 16-year-old client has taken and overdosage of citalopram and is brought to the ED. What symptoms would the nurse expect to be present? 1. Seizures, HTN, tachycardia, extreme anxiety. 2. Hypotension, bradycardia, hypothermia, sedation. 3. Miosis, respiratory depression, absent BS, hypoactive reflexes. 4. Manic behaviours, paranoia, delusions, tremors.

Answer 66

1. Seizures, HTN, tachycardia, extreme anxiety. - this is an SSRI: antidepressant (1st drug of choice): highly effective and less side effects - symptoms of serotonin syndrome

Question 67

A 77-year-old female client is diagnosed with depression with anxiety and is started on imipramine. Because of this client's age, the nurse will take precautions for care related to which adverse effects? 1. Dry mouth and photosensitivity 2. Anxiety, headaches, insomnia 3. Drowsiness and sedation 4. Urinary frequency

Answer 67

3. Drowsiness and sedation - this is a TCA - safety (falls) will be concerns with old age - urinary retention is side effect

Question 68

Which of the following would be a priority component of the teaching plan for a client prescribed phenelzine for treatment of depression? 1. Headaches may occur. OTC medications will usually be effective. 2. Hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported. 3. Read labels of food and OTC drugs to avoid those with substances that should be avoided as directed. 4. Monitor BP for hypotension and report as BP below 90/60.

Answer 68

3. Read labels of food and OTC drugs to avoid those with substances that should be avoided as directed. - MAOI: last class of antidepressants tried on pts (lots of adverse effects, interactions) - can cause HTN crisis

Question 69

The nurse determines that the teaching plan for a client prescribed sertraline has been effective when the client makes which statement? 1. "I should not decrease my sodium or water intake." 2. "The drug can be taken concurrently with the phenelzine that I'm taking." 3. "It may take up to a month for the drug to reach full therapeutic effects and I'm feeling better." 4. "There are no other drugs I ned to worry about; sertraline doesn't react with them."

Answer 69

3. "It may take up to a month for the drug to reach full therapeutic effects and I'm feeling better." - can take up to 6 weeks - for all antidepressants it will take at least 2 weeks to feel better

Question 70

The client states that he has not taken his antipsychotic drug fro the past 2 weeks because it was causing sexual dysfunction. What is the nurse's primary concern at this time? 1. A HTN crisis may occur with such abrupt withdrawal of the drug. 2. Significant muscle twitching may occur, increasing fall risk. 3. EPS symptoms such as pseudoparkinsonism are likely to occur. 4. Symptoms of psychosis are likely to return.

Answer 70

4. Symptoms of psychosis are likely to return. - psychosis: out-of-touch with reality - can result in seizures - EPS symptoms if dose too high or for too long

Question 71

A paranoid client presents with bizarre behaviours, neologisms, and thought insertion. Which nursing action should be prioritizes to maintain this client's safety? 1. Assess for medication noncompliance. 2. Note escalating behaviours and intervene immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviours.

Answer 71

2. Note escalating behaviours and intervene immediately. - safety concern - escalating behaviours: ex. pt pacing, clapping, intense eye contact: priority

Question 72

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? 1. The side effects of medications. 2. Deep breathing techniques to decrease stress. 3. How to make eye contact when communicating. 4. How to be a leader.

Answer 72

3. How to make eye contact when communicating. - pt needs social skills training - open body posture

Question 73

A client diagnosed with schizophrenia tells a nurse, "The "Shopatouliens' took my show out of my room last night." Which is an appropriate charting entry to describe this client's statement? 1. "The client is experiencing command hallucinations." 2. "The client is expressing a neologism." 3. "The client is experiencing a paranoid delusion." 4. "The client is verbalizing a word salad."

Answer 73

2. "The client is expressing a neologism." - new word: making up a word that does not exist - command hallucinations: voices in pt's head that tell them to do something - priority if it happens - paranoid delusions: a belief that is not real - word salad: a lot of words together in a sentence that does not make sense

Question 74

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? 1. "Did you take your medicine this morning?" 2. "You are not going to hell. You are a good person." 3. "I'm sure the voices sound scary, but the devil is not talking to you. This is part of your illness." 4. "The devil only talks to people who are receptive to his influence."

Answer 74

3. "I'm sure the voices sound scary, but the devil is not talking to you. This is part of your illness." - most therapeutic response, acknowledge fears and bring the pt back to reality - do not ask yes/no close-ended questions (unless, suicide, abuse, quick question) - do not give validity to pt's illness

Question 75

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? 1. Provide neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

Answer 75

4. Provide personal space to respect the client's boundaries. - pt is acutely agitated - decrease stimulation (decrease sound and lights) - do not get into patient's personal space

Question 76

Which nursing behaviour will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? 1. Establishing personal contact with family members. 2. Being reliable, honest, and consistent during interactions. 3. Sharing limited personal information. 4. Sitting close to the client to establish rapport.

Answer 76

2. Being reliable, honest, and consistent during interactions. - pts with schizophrenia tend to be paranoid: not easy to trust - have to be consistent to build trust

Question 77

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? 1. Magical thinking; administer an antipsychotic medication. 2. Persecutory delusions; orient the client to reality. 3. Command hallucinations; warn the psychiatrist. 4. Altered thought processes; call an emergency treatment team meeting.

Answer 77

3. Command hallucinations; warn the psychiatrist. - command hallucinations are worst type of hallucinations - pt compelled to do what the voices are telling pt

Question 78

Which statement should indicate to a nurse that an individual is experiencing a delusion? 1. "There's an alien growing in my liver." 2. "I see my dead husband everywhere I go." 3. "The IRS may audit my taxes." 4. "I'm not going to eat any food. It smells like brimstone."

Answer 78

1. "There's an alien growing in my liver." - false belief - seeing/hearing something/someone is an hallucination

Question 79

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? 1. Haloperidol to address the negative symptom. 2. Clonazepam to address the positive symptom. 3. Risperidone to address the positive symptom. 4. Clozapine to address the negative symptom.

Answer 79

3. Risperidone to address the positive symptom. - antipsychotic - positive symptoms: symptoms pt has that they should't have (hallucinations) - negative symptoms: pt not having things that they should have (flat affect)

Question 80

A client is diagnosed with schizophrenia. A physician orders haloperidol 50 mg BID, benztropine 1 mg PRN, and zolpidem 10 mg HS. Which client behaviour would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Restlessness and muscle rigidity 4. Reports of hearing disturbing voices

Answer 80

3. Restlessness and muscle rigidity - anticholinergic and helps with EPS

Question 81

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? 1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. 2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. 3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. 4. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

Answer 81

2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. - all symptoms that patient has and they shouldn't

Question 82

A 60-year-old client diagnosed with schizophrenia presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? 1. NMS treated by discontinuing antipsychotic medications. 2. Agranulocytosis treated by administration of clozapine. 3. EPS treated by administration of benztropine. 4. Tardive dyskinesia treated by discontinuing antipsychotic medications.

Answer 82

4. Tardive dyskinesia treated by discontinuing antipsychotic medications. - happens after pt has been taking antipsychotics chronically - irreversible, that's why you stop med - chronic schizophrenia: pt has been on antipsychotics for a long time - NMS: increased T, increased HR, muscle rigidity - EPS: restlessness, muscle rigidity

Question 83

After taking chlorpromazine for 1 month, a client presents to an emergency department with severe muscle rigidity, tachycardia, and a temperature of 40.5 C. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? 1. NMS treated by discontinuing chlorpromazine and administering dantrolene. 2. NMS treated by increasing chlorpromazine and administering an anti-anxiety medication. 3. Dystonia treated by administering trihexyphenidyl. 4. Dystonia treated by administering bromocriptine.

Answer 83

1. NMS treated by discontinuing chlorpromazine and administering dantrolene. - dantrolene is a muscle relaxant - med has caused the NMS

Question 84

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse address first? 1. Respirations of 22 breaths/minute 2. Weight gain of 8 pounds in 2 months 3. Temperature of 40 C 4. Excessive salivation

Answer 84

3. Temperature of 40 C - high-grade temperature: can cause seizure

Question 85

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent for HTN. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

Answer 85

3. "Rise slowly when you change position from lying or sitting to standing." - risk of orthostatic hypotensionI

Question 86

If clozapine therapy is being considered, which laboratory test should a nurse review to establish a baseline for comparison to evaluate a potentially life-threatening side effect? 1. WBC count 2. Liver function studies 3. Creatinine clearance 4. BUN

Answer 86

1. WBC count - risk of agranulocytosis

Question 87

Which components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (SATA) 1. Group therapy 2. Medication management 3. Deterrent therapy 4. Supportive family therapy 5. Social skills training

Answer 87

1. Group therapy 2. Medication management 4. Supportive family therapy 5. Social skills training - group therapy: work out issues with other peers in a safe place - deterrent therapy: something that discourages client from doing something

Question 88

A nurse is administering risperidone to a client diagnosed with schizophrenia. Which symptoms should a nurse expect the therapeutic effect of this medication to address? (SATA) 1. Somatic delusions 2. Social isolation 3. Gustatory hallucinations 4. Flat affect 5. Clang associations

Answer 88

1. Somatic delusions 3. Gustatory hallucinations 5. Clang associations - antipsychotic med that treats positive symptoms of schizophrenia