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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?
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Chapter 3 Ion channels as targets of psychopharmacological drug action
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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.
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ANS: B 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? |
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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?
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ANS: B 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? |
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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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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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9. Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect?
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15. Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.)
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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?
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ANS: B 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? |
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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.
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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. |
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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.) |
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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
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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?
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____ 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: |
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____ 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?
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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.
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10. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients:
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ANS: C 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? |
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ANS: A 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: |
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ANS: D 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?
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ANS: B 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:: |
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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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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?
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ANS: C 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? |
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ANS: A 37. Which of the following statements would correctly serve as a basis for teaching a family the usual outcome of an adjustment disorder? |
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ANS: A Medications are not used routinely to treat adjustment disorders. Relaxation techniques are interventions rather than outcomes. |
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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?
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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? |
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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.
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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?
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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: |
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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.) |
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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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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.)
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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.
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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? |
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ANS: C |
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10. Which intervention will best help a teenager manage aggressive behavior? |
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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:
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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?
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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: |
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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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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?
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ANS: C The remaining options identify interventions that are not generally a result of this diagnosis. |
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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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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. |
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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: |
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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:
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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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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. |
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25. Which intervention will the nurse plan for when managing the detoxification of a patient diagnosed with chronic alcoholism?
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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. |