The nurse observes blunted affect and social isolation

a.		Necessary but generally for psychiatric nurses who focus primarily on behavioral interventions
b.		A complex undertaking that advance practice psychiatric nurses frequently use in their practice
c.
d.

a.	Too much stress has been proven to cause all kinds of cancer.
b.		There have been no research studies done on stress and disease yet.
c.
d.
ANS: C Research indicates that stress causes a release of corticotropin-releasing factors that suppress the immune system. Studies indicate that psychiatric disorders such as mood disorders are sometimes associated with decreased functioning of the immune system. Research does not support a connection between many cancers and stress. There is a significant amount of research about stress and the body. Research has shown that there are some connections between stress and physical disease.

a.
b.		The patient reports that, I dont feel as anxious as I did a couple of days ago.
c.	The patient reports that both auditory and visual hallucinations have decreased.
d.

a.
b.		Does your father seem to experience mood swings?
c.	Have you noticed your father talking about seeing things you cant see?
d.

a.
b.		Excess dopamine will be prevented from attaching to receptor sites.
c.	Serotonin deficiency will be managed through a prolonged reuptake period.
d.
ANS: D

12. There remains a stigma attached to psychiatric illnesses. The psychiatric nurse makes the greatest impact on this sociological problem when:

To insinuate that the children are at such risk would not be supported by research.

14. A patient whose symptoms of mild depression have been managed with
antidepressants is concerned about the affect of accepting a promotion that will require working the night shift. What will be the basis of the response the nurse gives to address the patients concern?

a.
b.
c.

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c.
d.
e.
3. The nurse is preparing a patient for a positron emission tomography (PET) scan. Which instructions will the nurse include? Select all that apply.
a.	There will likely be a 30 to 45 minute wait between the injection and the beginning of the scan.
b.
c.
d.
e.
ANS: A, B, C, E Appropriate patient preparation for a PET scan would include information regarding the time interval between injection of the isotope and the actual scan, the fact that steps will be taken to minimize the effects of sights and sounds during the scan, lying still is critical to achieving a quality image, and that being asleep during the scan will alter the results. It is not necessary to fast before or during the scan. 4. A patient with schizophrenia is described as having difficulty with executive functions. What patient dysfunction can the nurse expect to assess behaviorally? Select all that apply.
a.
b.
c.
d.
e.	Frequently speaks of hurting himself or of hurting other patients
ANS: A, B, D Executive functions include reasoning, planning, prioritizing, sequencing behavior, insight, flexibility, judgment, focusing on tasks, responding to social cues, and attending in appropriate ways to incoming stimuli. Memory is not considered an

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1.
A)	peripheral nerves.
B)	abdominal viscera.
C)
D)

3.
A)	local protection.
B)	control functions.
C)
D)

5. Chemical synapses rely on ____ in order to provide communication between neurons.

A)	diffusion
B)
C)
D)
6.
A)	oxygen.
B)	protein.
C)
D)

8.
A)	spinal fluid.
B)	fibrocartilage.
C)
D)

9. Which of the following is the neurotransmitter for most postganglion sympathetic neurons?

10.	In contrast to the sympathetic nervous system, the functions of the parasympathetic nervous system include:
A)	sweating.
B)
C)
D)

12.	A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in which the oligodendrocytes of the patients central nervous system (CNS) are progressively destroyed. Which physiologic process within the neurologic system is most likely be affected by this disease process?
A)	Oxygen metabolism
B)
C)
D)

ANS.C
13.A neuron has been hyperpolarized. How will this affect the excitability of the neuron?

14.
A)	malformation of the mesoderm.
B)	abnormal closure of the neural tube.
C)
D)

16.
A)	Peristalsis of the small and large bowel
B)	Control of oculomotor function in changing light levels
C)
D)

17. A patient has required mechanical ventilation following a traumatic head injury sustained in a motorcycle crash, during which he sustained damage to his respiratory center. Which of the patients brain structures has been injured?

	A patients primary care provider has prescribed a b-adrenergic receptor blocker. Which of the following therapeutic effects do the patient and care provider likely seek?
A)

	Increase in mental acuity
D)

	By catalyzing the effects of neurotransmitters
B)

D) ANS. C

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Chapter 3 Ion channels as targets of psychopharmacological drug action

ANS.C

2.
A)
B)
C)
D)	Left hemisphere

ANS.D

ANS.B

4.
A)

5.	The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the following?
A)	Perceiving sensory input
B)
C)
D)

7.	The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patients plan of care, in which of the following areas would the nurse anticipate a problem?
A)	Sleep
B)
C)

ANS.A

8.
A)
B)
C)
D)	Giving her a noncaffeinated beverage of her choice

ANS.B

ANS.D

10.
A)
B)
C)

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11.
A)
B)	Serotonin
C)	Glutamate
D)

13.
A)
B)	Dopamine
C)	Norepinephrine
D)

15.
A)	Concordance rates
B)	Occurrence in first-degree relatives
C)
D)

17.	A patient is scheduled for a challenge test. Which of the following would the nurse include when explaining this test to the patient?
A)	Intravenous administration of a substance to induce symptoms
B)

18.
A)
B)
C)	Evoked potentials
D)	Functional magnetic resonance imaging


A)
B)		Synaptic cleft
C)		Terminal
D)

d.
5. Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts?
a.	Accept that delusion is illogical.
b.
c.
d.
6. Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking?
a.	Confronting the delusion
b.
c.
d.
7. Which assessment observation supports a patients diagnosis of disorganized schizophrenia?
a.	Reports suicidal ideations
b.
c.
d.
ANS: C The presence of disorganization and inappropriate affect identifies this disorder as disorganized schizophrenia. The symptoms of residual schizophrenia have long periods of remission. Schizoaffective disorder presents with severe mood disorders

along with symptoms of schizophrenia. Paranoid schizophrenia is characterized by persecutory or grandiose delusions.

8. A patient tried to gouge out his eye in response to auditory hallucinations commanding, If thine eye offends thee, pluck it out. The nurse would analyze this behavior as indicating:

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The nurse interprets the patients statements that were not reality-based as indicating disturbed thought processes. Social isolation is not the primary patient problem. No data exist to support the other options.

a.
b.
c.
d.		Circumstantial speech
ANS: A A newly coined word having meaning only for the patient is called a neologism (meaning, new word). It is associated with autistic thinking. The patients speech does not show associative looseness or circumstantiality. The use of a neologism is not delusional in and of itself, but it suggests delusional thinking may be present.
a.
b.
c.
d.		Why do they frobitz?
ANS: B This response will help clarify the patients thinking and change the focus from global to specific. In this situation, sympathizing with the patient is a nonproductive response. The remaining options appear to accept the neologism thus supporting the patients delusional thinking.
a.
b.
c.
d.		Shows no emotion when telling the story of a sisters recent death
ANS: D

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a.
b.		New findings suggest this disorder is biological in nature.
c.	Dont be so hard on yourself; your daughter needs you to be strong.
d.

a.
b.		Studies show that 50% of twins develop schizophrenia when it is present in the other twin.
c.	No one can say what will happen, so we will hope for the best for you and both of your sons.
d.

a.
b.		An increase in the brain chemical dopamine explains the presence of delusions and hallucinations.
c.	Decreased amounts of the brain chemical dopamine explain the presence of delusions and hallucinations.

a.
b.		See a mental health specialist for extensive psychological testing
c.	Have an immunologic assay performed within 2 days of the admission
d.

a.
b.		Attending a psychosocial club
c.	Living with his elderly mother
d.

a.
b.		Assessing for lower extremity edema bid
c.	Taking the patient to activities therapy once daily

b.
c.
d.
ANS: B Patients with cognitive disturbances should be taught small blocks of information at a time and given frequent reinforcement. Both verbal and visual materials should be used since processing of verbal stimuli may be more impaired. Teaching should be scheduled when the patient is most alert. A large number of choices may be confusing for the person, but a few simple choices may be included. 29. The wife of a patient newly diagnosed with paranoid schizophrenia is concerned that her husband will be this sick for the rest of his life. What information can the nurse provide to the wife?
a.
b.
c.
d.

ANS: A
The prognosis for paranoid schizophrenia is good with appropriate treatment and effective follow-up. The remaining options are not correct when considering this type of schizophrenia
30. A patient is exhibiting auditory hallucinations in addition to being forgetful and easily confused. Which diagnosis does the nurse base this patients interventions on?

c.
d.
ANS: C This action provides an alternative to listening to the voices and gives the patient a sense of control. The patient should not adjust medication independently. Reading will not be particularly effective, because the voices are uncontested in a quiet atmosphere. Positive talk is generally used to positively affect self-esteem. 32. A patient with schizophrenia tells the nurse as they sit in the day room, I hear voices telling me bad things. The most therapeutic response the nurse can make is:
a.
b.
c.
d.
ANS: B By voicing his or her own reality related to the voices, the nurse does not deny the patients experiences but helps the patient distinguish actual voices from those resulting from internal stimulation. Discussing what the voices are saying serves only to validate the reality of the voices. Challenging the voices will cause the patient to defend his perceptions and thereby reinforce the importance of the hallucination. Asking to move validates the reality of the voices and is not a helpful action since the voices go where the patient goes. 33. A patient tells the nurse, When Im in the day room, I hear people whispering about me, and that makes me want to punch them. What direction will the nurse provide the staff regarding interacting with this patient?
a.
b.
c.
d.
ANS: C This approach is important when providing care for a patient who is misinterpreting reality and is suspicious of the motives of others. Ostracizing the patient is non-therapeutic. Patients often misinterpret touch as threatening. This might promote loss of control. Using nonverbal communication techniques would be nontherapeutic as it would increase patient anxiety and promote loss of control.

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34. A patient with schizophrenia is medication compliant and has well-controlled symptoms. He has, however, never been successful in holding a job because of poor social skills and lack of understanding of basic job skills. The nurse case manager should consider referring the patient:

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e.		Provide the patient with several options as means of de-escalating the crisis.

a.
b.
c.	Attempt to identify staff who are ineffective during crises.
d.		Review documentation that describe the details of unit crises.
e.
ANS: A, B, D, E The correct options empower the staff while improving/maintaining their crises management skills. The failures of the process should be identified without blaming staff for ineffective crises management.

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c.
d.

a.	Dystonic reactions
b.		Pseudoparkinsonism
c.
d.

a.	Agranulocytosis
b.		Vitamin deficiencies
c.
d.

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9. Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect?

a.		Extrapyramidal symptoms
b.
c.
d.
10. Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)?
a.	Assess for signs and symptoms of hypoglycemia.
b.
c.
d.
11. A young male patient taking an antipsychotic is experiencing an oculogyric crisis. The nurse prepares to administer:
a.
b.
c.
d.
ANS: A Acute dystonic reactions may be controlled by intramuscular injections of diphenhydramine. Haloperidol, aripiprazole, and risperidone are not used for dystonic reactions. MULTIPLE RESPONSE 12. A patient admitted to the hospital is exhibiting psychotic behavior. Which sign(s) and/or symptom(s) would support the diagnosis of psychosis? (Select all that apply.)
a.
b.

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15. Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.)

a.
b.
c.
d.
e.	Bradycardia
ANS: A, B, C, D Fever, severe extrapyramidal symptoms, hypertension, and alterations in consciousness (such as stupor, mutism, and coma) are characteristic of neuroleptic malignant syndrome. Bradycardia is not a sign of neuroleptic malignant syndrome.
a.
b.
c.
d.		Neuroleptic malignant syndrome
e.	Hypoglycemia
f.

a.
b.		Be open and direct when handling the patient.
c.	Encourage a variety of interactions with others.
d.
e.
ANS: B, D Nursing interventions for patients with psychosis must be individualized and based on patient assessment data. The nurse should be open and direct when handling patients who are highly suspicious. High-protein, high-calorie foods are appropriate for the individual to eat while pacing or highly active. If physical restraints are necessary,

18. The psychiatric nurse is educating an elderly patient and family about antipsychotic drug therapy. When providing this education, the nurse will include which statement(s)? (Select all that apply.)

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Chapter 6 Mood disorders
MULTIPLE CHOICE
1. What occurs with mania associated with bipolar disorder?

a.
b.
c.
d.
ANS: B Mania is characterized by distinct episodes of euphoria and elation. Sadness is characteristic of depression. Suicide is not generally associated with mania; it is more commonly associated with depression. Psychomotor retardation is not associated with mania. 2. Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin?
a.
b.
c.
d.
ANS: B Morphine is the narcotic analgesic of choice because it will not interact with the patients MAOI. Meperidine will interact with the patients medication. Ibuprofen and acetaminophen are not narcotic analgesics. 3. What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy?
a.
b.
c.
d.
ANS: C SSRIs are the most widely used class of antidepressants. Although they are as effective in treating depression as the tricyclic antidepressants, they do not cause the anticholinergic and cardiovascular adverse effects that often limit the use of tricyclic antidepressants. SSRIs tend to be more expensive than other available antidepressants.

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SSRIs do not cure major depressive illnesses. As with other antidepressants, it takes 2 to 4 weeks to obtain the full therapeutic benefit when taking SSRIs.

b.
c.	4 weeks
d.		2 months

a.
b.
c.	Blocking their destruction
d.		Increasing their reuptake

a.
b.		Hypotension
c.	Neck stiffness
d.

a.
b.		Hand tremor

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d.
14. A patient is admitted to a long term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug.
a.	immediately following the last dose of
b.
c.
d.
15. A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is:
a.	nausea.
b.
c.
d.
ANS: C Nausea and vomiting are common adverse effects of vilazodone. Persistent vomiting should be evaluated for other causes, as well as for the development of electrolyte imbalance. Fluid volume deficit can lead to life threatening cardiac arrhythmias and therefore is the priority nursing diagnosis. The nursing diagnosis nausea is appropriate, but is not the priority. Imbalanced nutrition is an appropriate nursing diagnosis but is not the priority at this time. Altered peripheral tissue perfusion does MULTIPLE RESPONSE 16. Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted with depression? (Select all that apply.)
a.
b.		Recent stressors and support system
c.	Family history of mood disorder

a.
b.		Red meat
c.	Aged cheeses
d.
e.

a.	Compliance with medication therapy within the last 2 months
b.		Nonverbal interactions among patient and significant others present
c.
d.
e.
21. Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant drugs? (Select all that apply.)
a.	MAOIs block the effects of dopamine in the CNS.
b.

24. The nurse is preparing 0800 medications for a patient with the medical diagnosis of end stage renal disease. When reviewing the medication administration record (MAR), the nurse notices the patient is scheduled to receive an MAOI drug. Which intervention(s) will the nurse perform before administering the drug? (Select all that

apply.)

a.
b.
c.
d.
e.	Assess urine output prior to administration.
ANS: C, D If the patient prescribed an MAOI drug has a history of severe renal disease, the medication must not be given and the prescribing health care provider consulted. It is not necessary to assess temperature at this time. An alternative medication needs to be ordered by a health care provider licensed to prescribe. Assessing urine output does not apply to this situation.

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____ 6. Your depressed patient who is taking a tricyclic antidepressant is advised of possible anticholinergic side effects. Which of the following is NOT an
anticholinergic side effect?

A.
B.
C.
D.
____ 7. Helen, a 47-year-old client with a long history of severe depression, has not responded to antidepressant medications or psychotherapy. The nurse caring for the patient knows that the treatment of choice for depression unresponsive to conventional treatment would be:
A.	Lithium.
B.	Electroconvulsive therapy (ECT).
C.
D.

____ 11. You are doing patient teaching for Margaret, who has been prescribed amitriptyline (Elavil) for treatment of depression. Which of the following statements suggests that Margaret needs further instruction?

A.	I know I might not start feeling better for a few weeks, but Ill keep taking the medication just as the doctor prescribed.
B.
C.
D.
____ 12. What is the main difference between major depression and dysthymic depression?
A.
B.	Dysthymia is a chronic, low-level depression that lasts for years, while major depression is more severe.
C.	Dysthymia is more likely to be caused by psychological factors and major depression is caused by neurological dysfunction.
D.
____ 13. Your depressed patient is starting a new medication called phenelzine (Nardil). Which teaching would be most important to emphasize?
A.
B.
C.
D.		Inform the patient that this medication takes 4 to 6 weeks to take full effect.
____ 14. Which of the following antidepressants is a tricyclic?
A.	Bupropion (Wellbutrin)
B.
C.
D.
____ 15. Which statement is most true about depression?
A.
B.	It is rare to have more than one episode of major depression in ones lifetime.

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A.	Pepperoni pizza and beer
B.	Roast chicken, baked potato, and beer
C.
D.
____ 22. Your patient with major depression sits in her room for hours staring out the window. Which of the following would be the most appropriate intervention?
A.
B.
C.	Offer the class once and then let the patient decide.
D.		Sit with the patient and ask her to list reasons for her depression.
____ 23. Which of the following drugs is a tricyclic antidepressant?
A.
B.
C.
D.
____ 24. Some medications such as tricyclics cause blurred vision. What is the cause of this effect?
A.	Hyperglycemia
B.	Anticholinergic effect
C.
D.
____ 25. Your patient has been taking a SSRI antidepressant for 6 weeks. On arrival at the clinic, which observation would indicate a positive outcome from the medication?
A.
B.
C.	Patient reports a weight loss of 10 pounds.
D.		Patient arrives neatly dressed.
____ 26. Which response best describes how dysthymic disorder is different from major depression?
A.
B.
C.

C.
D.
E.	Provide meaningful activities
F.	Include alternative therapies in the treatment plan

5. ANS: A
This medication is a MAOI (monoamine oxidase inhibitor). Eating foods with this enzyme can trigger a hypertensive crisis.

6. ANS: D
Muscle rigidity is not an anticholinergic side effect.

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Exposure to light has been shown to lift mood in this disorder.

14. ANS: C
The other medications are examples of SSRIs and SSNIs.

15. ANS: A
Nearly twice as many women as men are affected by depression. Men are more likely to mask depression in other ways, such as substance abuse. The elderly and children are also at risk for depression.

20. ANS: B
This response has no right or wrong answer and doesnt tax memory or concentration, which would occur in responses A and C. Television is passive and the patient can withdraw into his or her own world.

21. ANS: C
The other responses contain dangerous foods, including pepperoni, beer, and pickled herring.

24. ANS: B
Anticholinergic effect can create blurred vision, urinary retention, and dry mouth caused by the blockage of acetylcholine.

25. ANS: D
Attention to personal appearance is an important indicator of improved mood. The other responses are not indicative of improvements in depression. Abnormal sleep patterns indicate continued depression. Weight loss can occur with some
antidepressants but would not be used as a measure of positive outcome for depression.

MULTIPLE RESPONSE
30. ANS: A, B, D, F
Dysthymic disorder includes symptoms of low level depression over a long period of time. It does not include hallucinations or periods of euphoria.

31. ANS: A, D, E
Basic supportive interventions focus on communication and promoting self-esteem. All depressed patients do not need to be monitored for suicidal ideation. Lithium is usually not a medication for depression. Alternate therapies may not be appropriate for some patients.

a.
b.		Leaden paralysis
c.	Psychomotor agitation
d.

a.
b.		Setting strict limits on dress and behavior
c.	Conducting an in-depth suicide assessment
d.

a.
b.		I will take my medications with food.
c.	I will have my blood drawn on schedule.
d.

a.

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10. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients:

a.
b.
c.
d.
ANS: C Phenelzine (Nardil) administration requires strict adherence to a restricted diet. The patient must have the cognitive ability to understand the food and medication interactions that may cause a serious reaction. 11. A patient who has a history of bipolar disorder recently underwent orthopedic surgery and was discharged to return home. When visited by the home care nurse, the nurse documented the following: slow and soft speech; sad facial expression; and patient crying when describing extreme fatigue, low mood, and the feeling that he will never get well. He has refused to bathe and perform ADLs for several days. Which nursing diagnosis would be appropriate?
a.
b.
c.
d.
ANS: A Refusal to perform tasks of bathing, grooming, and other ADLs provides evidence of a self-care deficit. The other symptoms documented by the nurse are characteristic of depression. No data are present to suggest the diagnoses given in the other options. 12. The nurse caring for an extremely withdrawn patient with depression wants to assist her to become more interactive. The best approach would be to say:
a.
b.
c.
d.
ANS: D This direct approach invites the patient to participate in a kind, but firm manner. The patient is not given an option to simply say yes or no. It is not therapeutic to give false reassurance. The remaining options focus too intensively on negative thoughts and feelings. 13. Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid?

15. Which principle should the nurse apply when planning nursing care for a patient who was voluntarily admitted after a suicide attempt?

a.
b.
c.
d.
ANS: B Patients whose suicidal ideation includes a vague, diffuse plan or no plan at all are not at as high a risk for attempting suicide as an individual who has a well-developed plan and the means to carry it out. The nurse will need to continually reassess the patient. None of the remaining options are true statements concerning suicide attempts. 16. An appropriate nursing strategy to assist a patient who was involuntarily admitted after a suicide attempt is::
a.

c.		Mood disorders generally see a decrease in cyclic affecting within 5 years of onset.
d.		Persons with higher cognitive abilities will generally exhibit fewer cyclic episodes.

a.
b.
c.	46 years of age and complains of dysphoric mood for 3 years, poor concentration, loss of interest in social activities, indecision, low energy, and low self-esteem
d.		38 years of age and complains of sadness, loss of ability to react to positive stimuli, weight gain, hypersomnia, leaden paralysis of limbs, and sensitivity to interpersonal rejection

a.
b.
c.	People who have seasonal mood changes often feel better when spring comes.
d.		Usually patients with this disorder see improvement during the fall and winter.
ANS: C Seasonal affective disorder is a condition in which the patient experiences depression beginning in the fall, lasting throughout the winter, and remitting in spring in the northern hemisphere. Fall and winter is not reflective of any diagnostic category of mood disorder. Spontaneous improvement occurs only with the change of seasons and available sunlight. Questioning is a response that does not address the point of understanding SAD.

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a.
b.
c.	Identify negative evaluations and challenge pessimistic beliefs.
d.		Seek to uncover unconscious conflicts about significant relationships.

a.
b.
c.	Schemata
d.		Anhedonia

a.
b.
c.	Implements a laissez-faire approach to the patients symptoms

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a.
b.	Educate the patient to the risk to the fetus as a result of exposure to the lithium in her blood.
c.	Suggest to the physician that the lithium dose should be increased for better symptom control.

The first need is to learn whether the patient is pregnant. Lithium ingestion by the mother can cause fetal damage. Lithium should be discontinued, not increased, if pregnancy is confirmed. It is premature to discuss fetal malformations before the pregnancy is confirmed. Options b and c are inappropriate and harmful. Birth control information has no value unless the pregnancy test is negative.

30. Which nursing measure would be relevant to protecting the physiologic integrity of a patient during a manic episode when marked hyperactivity is present?

a.
b.	Including family members in the interdisciplinary treatment plan
c.	Identifying the precipitating stressful event and current problems
d.

33. When a father states, I dont understand what the doctor means by saying my daughter has an adjustment disorder. The nurse explains that this disorder often results from:

d.
ANS: C Finding no pleasure in living should suggest the need for further assessment of suicide potential. Safety needs take priority over problems suggested by other data collected. 36. The nurse has been working with a patient who has adjustment disorder with depressed mood. Which finding would permit the nurse to accurately evaluate that the crisis has been resolved?
a.
b.
c.
d.
ANS: A When the presenting symptoms are absent, the nurse can evaluate the problems as resolved. Most patients with adjustment disorders do not require medication, so this is not a good indicator. Data do not substantiate that the patient is experiencing problem socializing. This could indicate the patient is overeating as a means of dealing with stress. 37. Which of the following statements would correctly serve as a basis for teaching a family the usual outcome of an adjustment disorder?
a.
b.
c.
d.
ANS: A The prognosis for most patients with adjustment disorders is good. In the majority of cases, identification of the stressor and use of effective coping strategies result in resolution. Continued self-harm is not a usual outcome for an adjustment disorder. Medications are not used routinely to treat adjustment disorders. Relaxation techniques are interventions rather than outcomes.
a.
b.
c.
d.		Engaging in regular, age-appropriate physical exercise
ANS: D

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ANS: A, B, D
Manic and hypomanic episodes share symptom criteria, and they differ primarily with regard to their severity and duration but not the nature of the activity. Hypomanic episodes are not severe enough to cause significant impairment in social and
occupational functioning or to require hospitalization. However, for diagnosis, it must be evident that the mood and behavioral disturbances of hypomaniarepresent a definite change in the persons usual functioning that lasts for at least 4 days. As judgment declines, patients sometimes fail to recognize the consequences of their actions and the presence of possible danger.

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Chapter 9 Anxiety disorders and anxiolytics
MULTIPLE CHOICE
1. What is the recommended time over which antianxiety medications must be gradually tapered before discontinuation?

4. The outcome statement for a patient suffering from anxiety disorder reads, After 1 week on alprazolam (Xanax) therapy, patient will exhibit a manageable level of anxiety. Which assessment finding validates that this outcome is met?

a.		Patient is unable to participate in group therapy conversations.
b.
c.
d.
5. Which is true regarding psychological drug dependence?
a.	It is easier to treat than physiological dependence.
b.
c.
d.
Psychological addictions are often more difficult to overcome than physiological addictions. Psychological drug dependence can be very difficult to treat. 6. The nurse is preparing to educate a patient and significant other about antianxiety medications before the patients discharge. What is pertinent information to be included in the teaching plan?
a.
b.
c.

ANS: CThe most common adverse effects of azaspirone therapy include dizziness, nervousness, drowsiness, and lightheadedness. Azaspirones do not have a risk for abuse or addiction.

a.
b.		Patient with recent anxiety reactions
c.	Patient with severe depression in addition to being anxious
d.

a.

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a.	She is able to sleep 5 hours during the night.
b.		The tremor and pacing she exhibited on admission are reduced.
c.
d.
e.
14. Which substance(s) may increase the toxic effects of benzodiazepines? (Select all that apply.)
a.
b.
c.
d.
e.	Vitamins
f.	Hypnotics

a.
b.
c.	Control of itching in allergic reactions

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a.		TPPPS
b.		FLACC
c.
d.

a.	Elevate the patients head of bed to facilitate lung expansion.
b.		Increase the patients primary intravenous (IV) flow rate.
c.
d.
ANS: D The patient is exhibiting signs of respiratory depression. Administration of the antidote naloxone would be the most appropriate nursing intervention. Lung expansion or increasing the primary IV infusion rate would not relieve respiratory depression. Assessing the patients pain at this point is a lesser priority than treating the respiratory depression.

4. What is the advantage of taking a nonsteroidal anti inflammatory drug (NSAID) that is a COX 2 inhibitor?

a.		The medication is cheaper than aspirin.
b.
c.
d.
] 5. An 86 year old patient who was admitted with GI bleeding as a result of salicylate therapy is being discharged. As the nurse reviews the discharge medication list, the patient states that she doesnt understand why Tylenol doesnt work as well as the aspirin she had been taking. What would be the nurses best response?
a.	Tylenol and aspirin are chemically the same drug.
b.
c.
d.
Tylenol can be useful in the relief of moderate pain. Tylenol can be effective in a single dose, without needing treatment over a period of time. 6. What term is used to define an awareness of pain?
a.
b.
c.

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a.
b.
c.	Propoxyphene (Darvon)
d.		Morphine (Roxanol)

a.
b.
c.	Reduction of respiratory rate from 24 to 18 breaths/min
d.		Verbal report of 2 on a 1 to 10 scale

a.
b.
c.	Oxycodone (OxyContin)
d.		Oxycodone and aspirin (Percodan)

a.		immediately contact the physician.
b.		reassess pain level in 30 to 45 minutes.
c.
d.
17. A patient is taking meperidine (Demerol) as needed for moderate to severe pain following an open appendectomy. The nurse assesses the following: current pain level 2, temperature 99 F, BP 130/76, respirations 10, lung sounds clear, abdomen soft and tender, bowel sounds present. Based on this assessment information, the priority nursing diagnosis is:
a.	altered breathing pattern.
b.
c.
d.
Respirations less than 12/min indicates altered breathing pattern and requires immediate intervention. Temperature of 99 F is not the priority concern. The abdomen is soft, so there is no indication of constipation. Pain level of 2 is considered mild; therefore, this is not the top priority. MULTIPLE RESPONSE 18. Which additional nursing intervention(s) would be effective with pain management in the pediatric population? (Select all that apply.)
a.
b.
c.
d.

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a.		Migraine headache
b.		Swollen joints
c.
d.
e.
21. When teaching a patient who is starting therapy with NSAIDs, the nurse must be sure to mention drug interactions with which drug(s)? (Select all that apply.)
a.	Warfarin (Coumadin)

a.		Administer zolpidem after taking the patients vital signs.
b.		Close the patients door for privacy after administering Tylenol.
c.
d.

a.	Allergic
b.		Hypersensitivity
c.
d.

a.	Chronic amnesia
b.		Chronic insomnia
c.
d.
ANS: C The sedative hypnotic effect of benzodiazepines facilitates surgical sedation. Short acting benzodiazepines are administered intramuscularly for preoperative sedation. They are also given intravenously for conscious sedation before short diagnostic procedures or for the induction of general anesthesia. Benzodiazepines are not recommended for long term use and do not affect amnesia. Benzodiazepines are a

4. A patient receiving diazepam (Valium) is complaining of nausea and vomiting and is becoming jaundiced. Which type of blood work will be performed?

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a.
b.
c.
d.		Stage IV
ANS: D As we age, stage IV sleep diminishes. Many people older than 75 years do not demonstrate any stage IV sleep patterns. Between 2% and 5% of sleep is stage I. Stage II comprises about 50% of normal sleep time. Stage III is a transition between lighter sleep and deeper sleep.
a.
b.
c.
d.		Instruct the patient to lie down before taking the medication.
ANS: B Measuring blood pressure in sitting and lying positions is important to assess for transient hypotension. Ativan does not have to be taken with food. Rapid discontinuance of the medication after long term use may result in symptoms similar to those of alcohol withdrawal. Gradual withdrawal of benzodiazepines is over 2 to 4 weeks. Medications should be taken sitting up.
a.
b.
c.
d.		Renal failure
ANS: C Individuals who sleep less than 5 hours a night have a threefold increased risk of heart attacks. Cancer, glaucoma, and renal failure are not associated with lack of sleep.
a.

a.
b.
c.
d.		This is an herbal medication that has been used for hundreds of years.
ANS: A Antihistamines (particularly diphenhydramine and doxylamine) have sedative properties that may be used for short term treatment of mild insomnia. They are common ingredients in over the counter (OTC) sleep aids. Tolerance develops after only a few nights of use; increasing the dose actually causes a more restless and irregular sleep pattern. Diphenhydramine does not cause nausea. There is no restriction on taking diphenhydramine after a high fat meal. Diphenhydramine is not an herbal medication.

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16. Barbiturates have which common adverse effect(s)? (Select all that apply.)

a.	Residual daytime sedation
b.
c.
d.
e.

ANS: A, B, D, EThe long half life of a barbiturate medication often causes residual daytime sedation.Headache is a general adverse effect of barbiturates. Blurred vision is an adverse effect associated with the hypnotic dosages of long acting barbiturates.

Impaired coordination is an adverse effect of barbiturates. Hyperactivity is not generally an adverse effect of barbiturates unless the patient is experiencing a paradoxical response.

a.
b.		I get a stomach ache when its my weekend at my dads house.
c.	I cant sleep when I stay at Grandmas because I worry about my mom.
d.

a.
b.		Advanced as far as the sixth grade and works at a warehouse every day and supports himself
c.	Advanced as far as the second grade and provides her own personal care with supervision
d.
ANS: C Individuals diagnosed as having moderate mental retardation acquire some communication skills, but rarely advance academically beyond the second grade. With supervision they can provide for their own personal care. Persons requiring constant supervision and total physical care would be considered profoundly retarded. Persons achieving elementary or above learning skills would be considered mildly retarded. 3. The nurse is assessing a child with autism. Which of the following behaviors would the nurse expect to observe?
a.
b.
c.
d.		Is insistent that a dim light be left on in the bedroom at night
ANS: C

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a.		Repetitive patterns of behavior
b.
c.
d.
8. Which behaviors would support a diagnosis of oppositional-defiant disorder?
a.	Exhibits involuntary facial twitching and blinking and makes barking sounds
b.		Negative, hostile, and spiteful toward parents and blames others for misbehavior
c.
d.
9. Which childs history is a risk for developing a reactive attachment disorder?
a.	Father is a chronic alcoholic
b.
c.
d.
10. Which intervention will best help a teenager manage aggressive behavior?
a.	Administering prescribed medication as ordered
b.
c.
d.
ANS: C

Role-play situations that trigger aggressiveness explore and reinforce alternative methods of coping. The other options although appropriate lack the opportunity to reflect on the triggers and practice the coping skills.

11. Which intervention will best help a child manage hyperactive behavior?

12. The nursing diagnosis that would be universally applicable for children with autistic disorder would be:

a.		Risk for constipation related to odd eating habits
b.
c.
d.
13. A childs diagnosis of conduct disorder is supported by the fact that:
a.	The childs mother is a chronic alcoholic.
b.
c.
d.
14. Which intervention will best help minimize parental guilt in the family of a child diagnosed with a psychiatric disorder?
a.	Helping them to develop realistic expectations for their child
b.

16. A 15-year-old has been diagnosed with major depression and admitted to the adolescent unit. Which behavior would the nurse expect to observe in this patient?

a.		Discussing repeated run-ins with the law
b.
c.
d.
17. When discussing depression and suicide with parents of teenagers, the nurse is accurate in reporting that the most common method used in late adolescent suicide is:
a.	Hanging
b.
c.
d.

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Statistics show the use of firearms is the most commonly used method of committing suicide among adolescents. With this in mind, the nurse could counsel parents about the importance of keeping firearms locked away from teens. The other options are less-often used methods for attempting suicide.

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a.
b.
c.	I think with the use of some behavior modification techniques, he can learn to control the facial tics.
d.		Your sons behavior is likely due to a neurological dysfunction that causes those involuntary facial tics.

a.
b.
c.	Running out into the street regardless of frequent instruction to look both ways first
d.		Having a difficult time concentrating on reading since his attention is easily diverted

a.
b.
c.	Seeking counseling for a child who has been experimenting with drugs
d.		Showing a unified approach to parenting when dealing with a violent child
ANS: B

a.		Methylphenidate (Concerta)
b.		Zolpidem (Ambien)
c.
d.
e.
ANS: A, C, D Ambien is a sleeping medication and not typically used to treat ADHD. Haldol is an antipsychotic that is not specified for use for ADHD. The other medications are sometimes used for ADHD.

Chapter 13 Dementia and its treatment
MULTIPLE CHOICE
1. A patient diagnosed with moderate dementia consistently appears to be distorting the truth resulting in his wife asking, What should I do when he lies to me about unimportant things? Upon what rationale should the nurses response be based?

c.
d.
ANS: C Because of inactivity, hypoactive delirium patients are more likely to develop further complications, including decubiti that could be minimized by frequent repositioning. The remaining options identify interventions that are not generally a result of this diagnosis.
a.
b.
c.
d.		It is a primary dementia characterized by stepwise decreases in cognitive abilities. It is irreversible but treatable with antihypertensive medications.
ANS: B This option provides accurate information about Alzheimers disease. Alzheimers disease is not a secondary dementia nor is it treated with antihypertensive medications.
a.
b.
c.
d.		The patient will retain full physical functioning through cognitive and occupational therapies.
ANS: B This outcome addresses health maintenance (i.e., maintaining an optimal functional level as determined by present capacity). Although long-term placement may be an option, it is not necessarily appropriate during this stage. Patients in stage 1 are often able to make simple decisions. Continuing to make decisions gives the patient a sense of control. Although a patient in stage 1 does not appear markedly deteriorated, some diminution of function may be present.

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a.
b.
c.	Isolate the patient until she is calm, and then direct her back to the activity.
d.		Give the patient prn antianxiety medication and restrict her activity participation.

a.

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c.
d.

a.	Powerlessness
b.		Defensive coping
c.
d.

a.	1
b.		2
c.
d.
ANS: B In stage 2, memory and cognitive deficits are worsening. The patient is less able to make sense of a confusing world and makes faulty interpretations resulting in paranoid delusional thinking. The patient in stage 1 does not usually have delusions. The patient in stage 3 often is unable to communicate meaningfully. There is no stage 4 of Alzheimers disease.

a.		Perseveration
b.		Recent memory loss
c.
d.

a.	Bathe daily with reminders.

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c.
d.
ANS: D Donepezil is a cholinesterase inhibitor that increases the concentration of acetylcholine. Acetylcholine is needed for intact memory and for learning. This medication is not prescribed for the conditions identified in the remaining options. 21. A patient with dementia is unable to name ordinary objects. Instead, he describes the function of each item (e.g., the thing you cut meat with). The nurse assesses this as:
a.	Apraxia
b.		Agnosia
c.
d.
22. Which intervention has highest priority for a patient with stage 3 Alzheimers disease?
a.	Cutting the patients food into bite size pieces
b.
c.
d.
23. A patient was admitted to a dementia unit after persistently wandering away from home. Which intervention will best address this patients risk for injury?
a.	Place the patient in a geriatric chair with a tray across the lap.
b.
c.

Stress reduction allowing for better rest is an appropriate outcome. The other options are not necessarily appropriate nor will they result in improvement for the caregiver. 26. A teenager is admitted to the ED after being alternately hyperalert and difficult to arouse. The symptoms started within the last few hours, during which time he became disoriented, confused, and delusional. These symptoms support the diagnosis of:

a.		Amnesia
b.
c.
d.
MULTIPLE RESPONSE 1. Which interventions provided by the caregiver will help ensure effective care for the patient diagnosed with dementia? (Select all that apply)
a.	Taking the patients blood pressure regularly
b.
c.
d.
e.
ANS: B, C, E These interventions take responsibility for areas in which the patient is incapable of providing self-care and addressing the special needs this patient has. Taking the blood pressure is not necessary unless there is a medical condition that requires doing so. Although the patients ability to provide self-care will deteriorate, independence should be encouraged as appropriate.
a.
b.
c.
d.		Rivastigmine (Exelon)
e.	Galantamine (Razadyne)
ANS: A, B, D, E The only drug that is not generally prescribed for Alzheimers disease is Haldol.

a.
b.
c.
d.		The new mother exhibiting symptoms of postpartum depression
ANS: A Posttraumatic stress disorder creates a risk for substance use or relapse. A total of 30% to 60% of persons with SUDs meet the criteria for comorbid posttraumatic stress disorder. The remaining options have not shown such a prevalence of comorbid relationship with SUDs.

a.
b.
c.
d.		Womens substance abuse only recently acknowledge by society
ANS: D The existence of an alcohol abuse problem among women has only been recently recognized and this has dramatically affected treatments and services being provided.
a.
b.
c.	Has been taking a tricyclic antidepressant for more than 2 years
d.		Took a narcotic for 1 week to manage postdental surgery pain
ANS: C Tricyclic antidepressants are strictly contraindicated with alcohol consumption because of their potential effect on cardiac function. Although aspirin increases bleeding times and antihistamines and narcotics increase sedation, the outcome of combining alcohol and these drugs is not as dangerous as that of the correct option.

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d.		Auditory hallucinations

a.
b.
c.	Protection from both physical and emotional abuse
d.		Access to reasonable housing and employment opportunities

a.
b.
c.	Determining if the patient has ever been tested for human immunodeficiency virus (HIV)
d.		Evaluating the patients understanding of the increased risk for developing sexually transmitted diseases

a.
b.		Adjust the staff members assignment to minimize patient contact
c.	Providing the staff member with material regarding alcohol abuse and treatment
d.

a.
b.		Having the patient, describe your relationship with you adult children, co-workers, and friends.
c.	Asking, Please identify for me all the medications both prescribed and over the counter you regularly take.
d.

d.

a.	Medication interventions are based on the presence of withdrawal symptoms.
b.		Medications are prescribed at appropriate intervals for at least one full week.
c.	Symptoms are managed with medications for only the initial 24 hours of hospitalization.
d.

a.
b.		Has alcohol intoxication
c.	Is reacting to disulfiram (Antabuse)
d.

a.
b.		Have you been told that you drink too much alcohol?
c.	Have you been diagnosed with an acute bacterial infection before?

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b.
c.
d.		Promising to, stop the drinking so I can be a good parent and raise a good child
ANS: B One of the most prominent factors that leads an individual to recovery is the patients recognition that substance use has caused or influenced his or her lifes problems and interrupted his or her functioning. The remaining options lack that element of self-reflection.

a.
b.		States differs greatly in their definitions of legal intoxication
c.	Legal issues with securing consent for the test from an impaired patient
d.

a.
b.		Focusing attention on providing patient safety
c.	Implementing suicide precautions immediately
d.

a.
b.		Re-connection with family and support system
c.	Identification of triggers that cause alcohol abuse
d.

25. Which intervention will the nurse plan for when managing the detoxification of a patient diagnosed with chronic alcoholism?

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a.
b.
c.
d.		A flattened bridge of the nose
e.	Symptoms of a septal heart defect

a.
b.
c.	Long-term use can result in poor short- and long-term memory.
d.		Irreversible kidney damage is often observed with even casual use.
e.
ANS: A, C, E Research as shown that even teens who engage in sniffing high concentrations on inhalants often experience hearing loss, CNS and bone marrow damage, and impaired cognitive function. Kidney impairment is often seen as reversible.