Chapter 16 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 16

Question 1

Type: MCSA

The patient tells the nurse, I thought I was just depressed, but my doctor says I have bipolar disorder. What is that? What is the best response by the nurse?

1. Bipolar disorder is just another type of depression, except your depression occurs in cycles.

2. Bipolar disorder is a type of depression that includes attention deficit disorder symptoms.

3. Bipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter.

4. Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania.

Correct Answer: 4

Rationale 1: Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either mania or hypomania, not just depression. Bipolar disorder must include depression with either mania or hypomania, not attention-deficit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal affective disorder.

Rationale 2: Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either mania or hypomania, not just depression. Bipolar disorder must include depression with either mania or hypomania, not attention-deficit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal affective disorder.

Rationale 3: Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either mania or hypomania, not just depression. Bipolar disorder must include depression with either mania or hypomania, not attention-deficit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal affective disorder.

Rationale 4: Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions. Bipolar disorder must include either mania or hypomania, not just depression. Bipolar disorder must include depression with either mania or hypomania, not attention-deficit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal affective disorder.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-1

Question 2

Type: MCSA

The mother of a 7-year-old child says to the nurse, My child is distractible in school, cannot complete assignments on time, and interrupts other children while they are speaking. What do you think? What is the best response by the nurse?

1. This sounds like your child is depressed; depression looks different in children and is very serious.

2. This sounds like bipolar disorder; you might want to have your child tested by a child psychiatrist.

3. This could be attention-deficit hyperactivity disorder (ADHD); you might want to have your child tested.

4. This sounds like typical 7-year-old behaviors to me; if they do not resolve, have your child tested.

Correct Answer: 3

Rationale 1: Symptoms of attention-deficit hyperactivity disorder (ADHD) include difficulty in paying attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking excessively. Being distractible, unable to complete assignments, and interrupting other children are not typical 7-year-old behaviors. Depression does look different in children, but these symptoms are clearly symptoms of attention-deficit hyperactivity disorder (ADHD). Being distractible, unable to complete assignments, and interrupting other children are symptoms of attention-deficit hyperactivity disorder (ADHD), not bipolar disorder.

Rationale 2: Symptoms of attention-deficit hyperactivity disorder (ADHD) include difficulty in paying attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking excessively. Being distractible, unable to complete assignments, and interrupting other children are not typical 7-year-old behaviors. Depression does look different in children, but these symptoms are clearly symptoms of attention-deficit hyperactivity disorder (ADHD). Being distractible, unable to complete assignments, and interrupting other children are symptoms of attention-deficit hyperactivity disorder (ADHD), not bipolar disorder.

Rationale 3: Symptoms of attention-deficit hyperactivity disorder (ADHD) include difficulty in paying attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking excessively. Being distractible, unable to complete assignments, and interrupting other children are not typical 7-year-old behaviors. Depression does look different in children, but these symptoms are clearly symptoms of attention-deficit hyperactivity disorder (ADHD). Being distractible, unable to complete assignments, and interrupting other children are symptoms of attention-deficit hyperactivity disorder (ADHD), not bipolar disorder.

Rationale 4: Symptoms of attention-deficit hyperactivity disorder (ADHD) include difficulty in paying attention and focusing on tasks, hyperactivity, distractibility, impulsivity, and talking excessively. Being distractible, unable to complete assignments, and interrupting other children are not typical 7-year-old behaviors. Depression does look different in children, but these symptoms are clearly symptoms of attention-deficit hyperactivity disorder (ADHD). Being distractible, unable to complete assignments, and interrupting other children are symptoms of attention-deficit hyperactivity disorder (ADHD), not bipolar disorder.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-2

Question 3

Type: MCMA

The nurse is conducting a group education session for patients who have been diagnosed with depression. The nurse evaluates the education as effective when a patient makes which comment(s) about the cause of depression?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Depression has many causes; they could include environmental as well as brain-based disorders.

2. Depression includes impaired relationships, and is also an inherited illness.

3. We really dont know what causes depression; it has not been studied very much.

4. Depression results from unresolved conflicts in your childhood.

5. Depression results from parents who are cold and distant and dont really care about their children.

Correct Answer: 1,2

Rationale 1: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link, and will include impaired relationships. Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression. Depression could result from cold and distant parents, but this answer does not include the biological basis for depression. Depression has been studied extensively.

Rationale 2: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link, and will include impaired relationships. Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression. Depression could result from cold and distant parents, but this answer does not include the biological basis for depression. Depression has been studied extensively.

Rationale 3: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link, and will include impaired relationships. Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression. Depression could result from cold and distant parents, but this answer does not include the biological basis for depression. Depression has been studied extensively.

Rationale 4: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link, and will include impaired relationships. Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression. Depression could result from cold and distant parents, but this answer does not include the biological basis for depression. Depression has been studied extensively.

Rationale 5: Depression has many causes; it is a brain-based disorder that is exacerbated by environmental influences. Depression runs in families, supporting a genetic link, and will include impaired relationships. Environmental influences are only one of the causes of depression; this answer does not include the biological basis for depression. Depression could result from cold and distant parents, but this answer does not include the biological basis for depression. Depression has been studied extensively.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-3

Question 4

Type: MCSA

The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the best assessment by the nurse include?

1. The patients cardiac status

2. The patients liver function

3. The patients renal status

4. The patients neurological function

Correct Answer: 1

Rationale 1: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment, not the patients renal status. Cardiac status is the primary assessment, not the patients liver function. Cardiac status is the primary assessment, not the patients neurological function.

Rationale 2: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment, not the patients renal status. Cardiac status is the primary assessment, not the patients liver function. Cardiac status is the primary assessment, not the patients neurological function.

Rationale 3: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment, not the patients renal status. Cardiac status is the primary assessment, not the patients liver function. Cardiac status is the primary assessment, not the patients neurological function.

Rationale 4: Tricyclic antidepressants are cardiotoxic. An overdose could result in a fatal dysrhythmia. Cardiac status is the primary assessment, not the patients renal status. Cardiac status is the primary assessment, not the patients liver function. Cardiac status is the primary assessment, not the patients neurological function.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-5

Question 5

Type: MCSA

The patient has been receiving amitriptyline (Elavil) for 2 weeks. He tells the nurse he doesnt think this medicine is working, as he is still depressed. What is the best response by the nurse?

1. It is working, but it can take several weeks to have an effect.

2. You might still feel depressed, but you are looking much better.

3. This may not be the best medicine for you; Ill call your doctor.

4. It is working, but it can take several months to have an effect.

Correct Answer: 1

Rationale 1: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur. It is inappropriate for the nurse to call the physician; tricyclic antidepressants need time to work. Telling a depressed patient he looks better negates the patients feelings and is inappropriate. The time frame for efficacy is several weeks, not several months.

Rationale 2: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur. It is inappropriate for the nurse to call the physician; tricyclic antidepressants need time to work. Telling a depressed patient he looks better negates the patients feelings and is inappropriate. The time frame for efficacy is several weeks, not several months.

Rationale 3: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur. It is inappropriate for the nurse to call the physician; tricyclic antidepressants need time to work. Telling a depressed patient he looks better negates the patients feelings and is inappropriate. The time frame for efficacy is several weeks, not several months.

Rationale 4: The therapeutic effects of tricyclic antidepressants may take 2 to 6 weeks to occur. It is inappropriate for the nurse to call the physician; tricyclic antidepressants need time to work. Telling a depressed patient he looks better negates the patients feelings and is inappropriate. The time frame for efficacy is several weeks, not several months.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

Question 6

Type: MCSA

The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse?

1. I will let your doctor know, and he will most likely change your medication.

2. This does happen, but treating your depression is a bigger priority.

3. I am concerned that you will become suicidal if you stop the medication.

4. Keep taking the medicine, as this usually goes away after a few months.

Correct Answer: 1

Rationale 1: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, sexual functioning is important to patients. It is inappropriate to tell a patient that the sexual function usually subsides because it does not usually subside. The patient could become suicidal if he stops the medication, but this response does not address the patients concern, and he will most likely stop the medicine anyway.

Rationale 2: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, sexual functioning is important to patients. It is inappropriate to tell a patient that the sexual function usually subsides because it does not usually subside. The patient could become suicidal if he stops the medication, but this response does not address the patients concern, and he will most likely stop the medicine anyway.

Rationale 3: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, sexual functioning is important to patients. It is inappropriate to tell a patient that the sexual function usually subsides because it does not usually subside. The patient could become suicidal if he stops the medication, but this response does not address the patients concern, and he will most likely stop the medicine anyway.

Rationale 4: One of the most common side effects of the selective serotonin reuptake inhibitors (SSRIs) relates to sexual dysfunction; up to 70% or men and women can experience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, sexual functioning is important to patients. It is inappropriate to tell a patient that the sexual function usually subsides because it does not usually subside. The patient could become suicidal if he stops the medication, but this response does not address the patients concern, and he will most likely stop the medicine anyway.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

Question 7

Type: MCSA

The patient has been depressed and the physician plans to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask?

1. How much alcohol do you consume during the week?

2. Are you allergic to any medications?

3. How long have you been depressed?

4. Have you had any thoughts about killing yourself?

Correct Answer: 4

Rationale 1: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. The length of the patients depression is important, but is not a safety issue. Assessing for alcohol intake is important, but is not a safety issue. Asking about allergies is a good safety question, but is not the priority with a depressed patient, and there are very few allergies to antidepressant medication. This question can be asked later.

Rationale 2: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. The length of the patients depression is important, but is not a safety issue. Assessing for alcohol intake is important, but is not a safety issue. Asking about allergies is a good safety question, but is not the priority with a depressed patient, and there are very few allergies to antidepressant medication. This question can be asked later.

Rationale 3: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. The length of the patients depression is important, but is not a safety issue. Assessing for alcohol intake is important, but is not a safety issue. Asking about allergies is a good safety question, but is not the priority with a depressed patient, and there are very few allergies to antidepressant medication. This question can be asked later.

Rationale 4: The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue. The length of the patients depression is important, but is not a safety issue. Assessing for alcohol intake is important, but is not a safety issue. Asking about allergies is a good safety question, but is not the priority with a depressed patient, and there are very few allergies to antidepressant medication. This question can be asked later.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-4

Question 8

Type: MCMA

The nurse has completed medication education for a patient prior to the patient receiving phenelzine (Nardil). The nurse evaluates the education as effective when the patient makes which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected

.

Standard Text: Select all that apply.

1. I am really going to miss my morning coffee and sweet roll.

2. Ill have to give up my beer at the football games.

3. I cant eat fried chicken and gravy.

4. I am not supposed to have processed meats or cheese.

5. I really shouldnt eat at a restaurant; too many foods are on my restricted list.

Correct Answer: 2,4

Rationale 1: Beer and processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis. Fried chicken and gravy are not high in tyramine and are considered safe. There are many foods that are safe to eat; the patient can safely eat at a restaurant. Coffee and a sweet roll are not high in tyramine and are considered safe.

Rationale 2: Beer and processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis. Fried chicken and gravy are not high in tyramine and are considered safe. There are many foods that are safe to eat; the patient can safely eat at a restaurant. Coffee and a sweet roll are not high in tyramine and are considered safe.

Rationale 3: Beer and processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis. Fried chicken and gravy are not high in tyramine and are considered safe. There are many foods that are safe to eat; the patient can safely eat at a restaurant. Coffee and a sweet roll are not high in tyramine and are considered safe.

Rationale 4: Beer and processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis. Fried chicken and gravy are not high in tyramine and are considered safe. There are many foods that are safe to eat; the patient can safely eat at a restaurant. Coffee and a sweet roll are not high in tyramine and are considered safe.

Rationale 5: Beer and processed meats and cheese are high in tyramine. Combining tyramine-rich foods with a monoamine oxidase inhibitor can result in a hypertensive crisis. Fried chicken and gravy are not high in tyramine and are considered safe. There are many foods that are safe to eat; the patient can safely eat at a restaurant. Coffee and a sweet roll are not high in tyramine and are considered safe.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-5

Question 9

Type: MCSA

The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium (Eskalith). The patients current lithium level is 0.4. What will the nurse expect to assess in this patient?

1. A return to baseline behavior, calm and rational

2. Hyperactivity and pressured speech

3. Signs and symptoms of depression

4. A decrease in manic behavior

Correct Answer: 2

Rationale 1: A therapeutic lithium level is 0.6 to 1.5. Since this patients level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not exhibit signs and symptoms of depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range.

Rationale 2: A therapeutic lithium level is 0.6 to 1.5. Since this patients level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not exhibit signs and symptoms of depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range.

Rationale 3: A therapeutic lithium level is 0.6 to 1.5. Since this patients level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not exhibit signs and symptoms of depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range.

Rationale 4: A therapeutic lithium level is 0.6 to 1.5. Since this patients level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not exhibit signs and symptoms of depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-5

Question 10

Type: MCSA

The nurse has completed medication education with the patient who is receiving lithium (Eskalith). What is the best patient outcome?

1. The patient will be able to work a normal work schedule and will receive adequate sleep.

2. The patient will identify signs of lithium (Eskalith) toxicity and verbalize measures to avoid it.

3. The patient will engage in activities of daily living and report enjoyment with them.

4. The patient will report stabilization of mood, including absence of mania or depression.

Correct Answer: 2

Rationale 1: Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, patients must understand the signs of toxicity and measures to avoid it. Stabilization of mood is important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Working as normal work schedule and receiving adequate sleep are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Engaging in activities of life and enjoying them are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity.

Rationale 2: Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, patients must understand the signs of toxicity and measures to avoid it. Stabilization of mood is important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Working as normal work schedule and receiving adequate sleep are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Engaging in activities of life and enjoying them are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity.

Rationale 3: Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, patients must understand the signs of toxicity and measures to avoid it. Stabilization of mood is important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Working as normal work schedule and receiving adequate sleep are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Engaging in activities of life and enjoying them are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity.

Rationale 4: Lithium (Eskalith) has a narrow therapeutic range. In order to avoid toxicity, patients must understand the signs of toxicity and measures to avoid it. Stabilization of mood is important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Working as normal work schedule and receiving adequate sleep are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity. Engaging in activities of life and enjoying them are important, but with medication education about lithium (Eskalith), the focus must be on identifying and avoiding signs of toxicity.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-7

Question 11

Type: MCSA

The patient asks the nurse why she needs to continue using table salt because her prescribed lithium (Eskalith) is a salt. What is the best response by the nurse?

1. You must continue to use salt to avoid lithium (Eskalith) toxicity. If you use sea salt, you dont need as much.

2. You must use table salt or your kidneys will retain lithium (Eskalith), and you will become toxic.

3. The amount is not important; just increase your table salt if you notice signs of lithium (Eskalith) toxicity.

4. Salt is very important to avoid lithium (Eskalith) toxicity, but not as important as drinking 1 to 1.5 L of water per day.

Correct Answer: 2

Rationale 1: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Instructing a patient to increase salt if toxicity occurs is inappropriate because the patient must try to avoid toxicity, not treat it after it occurs. There is no evidence to support the claim that sea salt is more effective than any other kind of salt. Drinking 1 to 1.5 L of water per day of water is important, but does not substitute for adequate sodium chloride.

Rationale 2: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Instructing a patient to increase salt if toxicity occurs is inappropriate because the patient must try to avoid toxicity, not treat it after it occurs. There is no evidence to support the claim that sea salt is more effective than any other kind of salt. Drinking 1 to 1.5 L of water per day of water is important, but does not substitute for adequate sodium chloride.

Rationale 3: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Instructing a patient to increase salt if toxicity occurs is inappropriate because the patient must try to avoid toxicity, not treat it after it occurs. There is no evidence to support the claim that sea salt is more effective than any other kind of salt. Drinking 1 to 1.5 L of water per day of water is important, but does not substitute for adequate sodium chloride.

Rationale 4: The kidneys are responsible for maintaining normal sodium levels. If there is sodium depletion, the kidneys will conserve any salt, in this case lithium (Eskalith). This will lead to lithium (Eskalith) toxicity. Instructing a patient to increase salt if toxicity occurs is inappropriate because the patient must try to avoid toxicity, not treat it after it occurs. There is no evidence to support the claim that sea salt is more effective than any other kind of salt. Drinking 1 to 1.5 L of water per day of water is important, but does not substitute for adequate sodium chloride.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-6

Question 12

Type: MCSA

What is the priority outcome for a 6-year-old patient who had been started on methylphenidate (Ritalin)?

1. The patient will avoid altercations with peers.

2. The patient will be able to complete age-appropriate chores at home.

3. The patient will use age-appropriate play with peers.

4. The patient will maintain weight within norms for this age group.

Correct Answer: 3

Rationale 1: Children with attention-deficit hyperactivity disorder have difficulty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate (Ritalin) increases their focus and decreases their distractibility, impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to healthy development with school-age children. Avoiding altercations with peers does not address a decrease in ADHD-related behaviors. Completing age-appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage.

Rationale 2: Children with attention-deficit hyperactivity disorder have difficulty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate (Ritalin) increases their focus and decreases their distractibility, impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to healthy development with school-age children. Avoiding altercations with peers does not address a decrease in ADHD-related behaviors. Completing age-appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage.

Rationale 3: Children with attention-deficit hyperactivity disorder have difficulty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate (Ritalin) increases their focus and decreases their distractibility, impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to healthy development with school-age children. Avoiding altercations with peers does not address a decrease in ADHD-related behaviors. Completing age-appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage.

Rationale 4: Children with attention-deficit hyperactivity disorder have difficulty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate (Ritalin) increases their focus and decreases their distractibility, impulsiveness, and hyperactivity. Age-appropriate play with peers is fundamental to healthy development with school-age children. Avoiding altercations with peers does not address a decrease in ADHD-related behaviors. Completing age-appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-5

Question 13

Type: MCSA

The 8-year-old patient is receiving methylphenidate (Ritalin). The patients mother tells the nurse that he wont eat while on his medication. What is the best response by the nurse?

1. It sounds like he is becoming depressed. I will speak to the doctor about starting an antidepressant medication.

2. Give the medication after meals and encourage him to have supplements between meals.

3. You are right to be concerned. I will speak to the doctor about starting an appetite stimulant medication.

4. This is a very serious concern; it would be best for him to see a nutritionist for counseling.

Correct Answer: 2

Rationale 1: Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the patient take the medication after meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isnt any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies first.

Rationale 2: Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the patient take the medication after meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isnt any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies first.

Rationale 3: Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the patient take the medication after meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isnt any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies first.

Rationale 4: Methylphenidate (Ritalin) is an appetite suppressant. The best approach is to have the patient take the medication after meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isnt any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies first.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

Question 14

Type: MCSA

The 10-year-old patient is receiving methylphenidate (Ritalin). The patients mother tells the nurse he just wont sleep while on his medication. What is the best response by the nurse?

1. You can give him a 25 mg diphenhydramine (Benadryl) tablet at bedtime.

2. Do not give the medication after 4:00 p.m.

3. Do not give the medication after 6:00 p.m.

4. This is serious; you should ask the doctor about atomoxetine (Strattera).

Correct Answer: 2

Rationale 1: Stimulant medications like methylphenidate (Ritalin) will interfere with sleep. To avoid insomnia, it is best to give the last dose prior to 4:00 p.m. Diphenhydramine (Benadryl) is not necessary. The effects of methylphenidate (Ritalin) will wear off by bedtime if it is given prior to 4:00 p.m. 6:00 p.m. is too late for the last dose of methylphenidate (Ritalin). A medication change is premature without first trying to give the medication earlier in the day.

Rationale 2: Stimulant medications like methylphenidate (Ritalin) will interfere with sleep. To avoid insomnia, it is best to give the last dose prior to 4:00 p.m. Diphenhydramine (Benadryl) is not necessary. The effects of methylphenidate (Ritalin) will wear off by bedtime if it is given prior to 4:00 p.m. 6:00 p.m. is too late for the last dose of methylphenidate (Ritalin). A medication change is premature without first trying to give the medication earlier in the day.

Rationale 3: Stimulant medications like methylphenidate (Ritalin) will interfere with sleep. To avoid insomnia, it is best to give the last dose prior to 4:00 p.m. Diphenhydramine (Benadryl) is not necessary. The effects of methylphenidate (Ritalin) will wear off by bedtime if it is given prior to 4:00 p.m. 6:00 p.m. is too late for the last dose of methylphenidate (Ritalin). A medication change is premature without first trying to give the medication earlier in the day.

Rationale 4: Stimulant medications like methylphenidate (Ritalin) will interfere with sleep. To avoid insomnia, it is best to give the last dose prior to 4:00 p.m. Diphenhydramine (Benadryl) is not necessary. The effects of methylphenidate (Ritalin) will wear off by bedtime if it is given prior to 4:00 p.m. 6:00 p.m. is too late for the last dose of methylphenidate (Ritalin). A medication change is premature without first trying to give the medication earlier in the day.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

Question 15

Type: MCSA

Which of the following symptoms experienced over 1 month would be most helpful to diagnose bipolar disorder?

1. Difficulty sleeping, obsession with death, hallucinations

2. Delusions, unkempt appearance, fatigue

3. Abnormal eating patterns, feelings of despair, flight of ideas

4. Increased goal-directed behavior and talkativeness, distractibility

Correct Answer: 3

Rationale 1: Bipolar disorder involves periods of mania and depression. Abnormal eating patterns and feelings of despair are symptoms of depression, whereas flight of ideas is a symptom of mania. Increased goal-directed behavior, talkativeness, and distractibility are symptoms of mania. Difficulty sleeping, obsession with death, hallucinations, delusions, unkempt appearance, and fatigue are symptoms of depression.

Rationale 2: Bipolar disorder involves periods of mania and depression. Abnormal eating patterns and feelings of despair are symptoms of depression, whereas flight of ideas is a symptom of mania. Increased goal-directed behavior, talkativeness, and distractibility are symptoms of mania. Difficulty sleeping, obsession with death, hallucinations, delusions, unkempt appearance, and fatigue are symptoms of depression

Rationale 3: Bipolar disorder involves periods of mania and depression. Abnormal eating patterns and feelings of despair are symptoms of depression, whereas flight of ideas is a symptom of mania. Increased goal-directed behavior, talkativeness, and distractibility are symptoms of mania. Difficulty sleeping, obsession with death, hallucinations, delusions, unkempt appearance, and fatigue are symptoms of depression.

Rationale 4: Bipolar disorder involves periods of mania and depression. Abnormal eating patterns and feelings of despair are symptoms of depression, whereas flight of ideas is a symptom of mania. Increased goal-directed behavior, talkativeness, and distractibility are symptoms of mania. Difficulty sleeping, obsession with death, hallucinations, delusions, unkempt appearance, and fatigue are symptoms of depression.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 16-1

Question 16

Type: MCSA

Which statement is accurate regarding attention-deficit hyperactivity disorder (ADHD)?

1. ADHD is characterized by periods of mania and periods of depression.

2. Anxiety and social withdrawal are more frequently seen in girls than in boys.

3. Diagnosis is higher in girls than in boys.

4. ADHD is generally diagnosed later in life.

Correct Answer: 2

Rationale 1: ADHD is generally diagnosed in childhood and in boys more frequently than in girls. Boys have more overt activity levels, where girls show less aggression but more social withdrawal. Periods of mania and periods of depression are more characteristic with bipolar disorder, not ADHD.

Rationale 2: ADHD is generally diagnosed in childhood and in boys more frequently than in girls. Boys have more overt activity levels, where girls show less aggression but more social withdrawal. Periods of mania and periods of depression are more characteristic with bipolar disorder, not ADHD.

Rationale 3: ADHD is generally diagnosed in childhood and in boys more frequently than in girls. Boys have more overt activity levels, where girls show less aggression but more social withdrawal. Periods of mania and periods of depression are more characteristic with bipolar disorder, not ADHD.

Rationale 4: ADHD is generally diagnosed in childhood and in boys more frequently than in girls. Boys have more overt activity levels, where girls show less aggression but more social withdrawal. Periods of mania and periods of depression are more characteristic with bipolar disorder, not ADHD.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 16-2

Question 17

Type: MCSA

Depression that occurs during cold winter months would be classified as

1. baby blues.

2. bipolar disorder.

3. seasonal affective disorder.

4. obsessive-compulsive disorder.

Correct Answer: 3

Rationale 1: Seasonal affective disorder is frequently experienced during the winter months. Obsessive-compulsive disorder involves doing certain tasks repetitively. Baby blues are associated with mothers who have recently had a baby. Bipolar disorder involves periods of mania and periods of depression.

Rationale 2: Seasonal affective disorder is frequently experienced during the winter months. Obsessive-compulsive disorder involves doing certain tasks repetitively. Baby blues are associated with mothers who have recently had a baby. Bipolar disorder involves periods of mania and periods of depression.

Rationale 3: Seasonal affective disorder is frequently experienced during the winter months. Obsessive-compulsive disorder involves doing certain tasks repetitively. Baby blues are associated with mothers who have recently had a baby. Bipolar disorder involves periods of mania and periods of depression.

Rationale 4: Seasonal affective disorder is frequently experienced during the winter months. Obsessive-compulsive disorder involves doing certain tasks repetitively. Baby blues are associated with mothers who have recently had a baby. Bipolar disorder involves periods of mania and periods of depression.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-3

Question 18

Type: MCSA

Which of the following drug types used to treat depression works by preventing enzymatic destruction of the neurotransmitter norepinephrine?

1. Beta-adrenergic blockers

2. Selective serotonin reuptake inhibitors (SSRIs)

3. Tricyclic antidepressants (TCAs)

4. Monoamine oxidase inhibitors (MAOIs)

Correct Answer: 4

Rationale 1: MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine oxidase. TCAs inhibit neurotransmitter reuptake, while SSRIs slow the reuptake of serotonin. Beta blockers block beta receptors within the sympathetic nervous system.

Rationale 2: MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine oxidase. TCAs inhibit neurotransmitter reuptake, while SSRIs slow the reuptake of serotonin. Beta blockers block beta receptors within the sympathetic nervous system.

Rationale 3: MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine oxidase. TCAs inhibit neurotransmitter reuptake, while SSRIs slow the reuptake of serotonin. Beta blockers block beta receptors within the sympathetic nervous system.

Rationale 4: MAOIs limit the breakdown of norepinephrine by inhibiting the enzyme monoamine oxidase. TCAs inhibit neurotransmitter reuptake, while SSRIs slow the reuptake of serotonin. Beta blockers block beta receptors within the sympathetic nervous system.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-5

Question 19

Type: MCSA

Which of the following drug types are often used as a first-line treatment for depression due to their side effect profile?

1. Monoamine oxidase inhibitors (MAOIs)

2. Beta-adrenergic blockers

3. Tricyclic antidepressants (TCAs)

4. Selective serotonin reuptake inhibitors (SSRIs)

Correct Answer: 4

Rationale 1: Of the drugs available for depression, the SSRIs have the most favorable side effect profile.

Rationale 2: Of the drugs available for depression, the SSRIs have the most favorable side effect profile.

Rationale 3: Of the drugs available for depression, the SSRIs have the most favorable side effect profile.

Rationale 4: Of the drugs available for depression, the SSRIs have the most favorable side effect profile.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-5

Question 20

Type: MCSA

Which of the following food items should the nurse advise a patient taking a monoamine oxidase inhibitor (MAOI) to avoid?

1. Orange juice, cottage cheese, and turkey

2. Spring water, ice cream, and salmon

3. Chocolate, wine, and fava beans

4. Spinach, rice, and venison

Correct Answer: 3

Rationale 1: Chocolate, wine, and fava beans are high in tyramine, which can cause severe hypertension in patients taking MAOIs.

Rationale 2: Chocolate, wine, and fava beans are high in tyramine, which can cause severe hypertension in patients taking MAOIs.

Rationale 3: Chocolate, wine, and fava beans are high in tyramine, which can cause severe hypertension in patients taking MAOIs.

Rationale 4: Chocolate, wine, and fava beans are high in tyramine, which can cause severe hypertension in patients taking MAOIs.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-4

Question 21

Type: MCSA

The traditionally prescribed drug types used to treat attention-deficit hyperactivity disorder (ADHD) include

1. CNS depressants.

2. parasympathomimetics.

3. CNS stimulants.

4. sympathomimetics.

Correct Answer: 3

Rationale 1: CNS stimulants have traditionally been the drug of choice for treating ADHD.

Rationale 2: CNS stimulants have traditionally been the drug of choice for treating ADHD.

Rationale 3: CNS stimulants have traditionally been the drug of choice for treating ADHD.

Rationale 4: CNS stimulants have traditionally been the drug of choice for treating ADHD.

Global Rationale:

Cognitive Level: Remembering

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6

Question 22

Type: MCSA

Which statement best explains why a CNS stimulant helps a patient with attention-deficit hyperactivity disorder (ADHD)?

1. Neurotransmitters are blocked, limiting the effects they can produce within the PNS.

2. Activation of certain areas of the brain causes increased attention and ability to focus.

3. Neurotransmitter levels are reduced, which produces a calming effect within the CNS.

4. Certain areas of the brain are deactivated, resulting in a calming effect.

Correct Answer: 2

Rationale 1: At first, it might seem confusing to use a CNS stimulant to treat a hyperactivity disorder. However, CNS stimulants activate the reticular activating system, causing higher levels of attention and ability to focus. Neurotransmitters such as epinephrine and serotonin are released, not blocked or reduced

Rationale 2: At first, it might seem confusing to use a CNS stimulant to treat a hyperactivity disorder. However, CNS stimulants activate the reticular activating system, causing higher levels of attention and ability to focus. Neurotransmitters such as epinephrine and serotonin are released, not blocked or reduced.

Rationale 3: At first, it might seem confusing to use a CNS stimulant to treat a hyperactivity disorder. However, CNS stimulants activate the reticular activating system, causing higher levels of attention and ability to focus. Neurotransmitters such as epinephrine and serotonin are released, not blocked or reduced.

Rationale 4: At first, it might seem confusing to use a CNS stimulant to treat a hyperactivity disorder. However, CNS stimulants activate the reticular activating system, causing higher levels of attention and ability to focus. Neurotransmitters such as epinephrine and serotonin are released, not blocked or reduced.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-6

Question 23

Type: MCSA

A 40-year-old patient experiencing periods of mania and periods of depression would most likely benefit from which of the following?

1. Atomoxetine (Strattera)

2. Amitriptyline (Elavil)

3. Methylphenidate (Ritalin)

4. Lithium (Eskalith)

Correct Answer: 4

Rationale 1: Lithium is the primary drug for treating bipolar disorder. Methylphenidate and atomoxetine are indicated for ADHD. Amitriptyline is indicated for depression.

Rationale 2: Lithium is the primary drug for treating bipolar disorder. Methylphenidate and atomoxetine are indicated for ADHD. Amitriptyline is indicated for depression.

Rationale 3: Lithium is the primary drug for treating bipolar disorder. Methylphenidate and atomoxetine are indicated for ADHD. Amitriptyline is indicated for depression.

Rationale 4: Lithium is the primary drug for treating bipolar disorder. Methylphenidate and atomoxetine are indicated for ADHD. Amitriptyline is indicated for depression.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 16-6

Question 24

Type: MCMA

The nurse is concerned that a patient is moving into the manic phase of bipolar disorder when what is assessed?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Not sleeping

2. Losing weight

3. Sluggish activity

4. Complaints of muscle pain

5. Constant talking

Correct Answer: 1,2,5

Rationale 1: Decreased need for sleep is a symptom of the manic phase of bipolar disorder.

Rationale 2: Decreased need for food is a symptom of the manic phase of bipolar disorder.

Rationale 3: Sluggish activity is not a symptom of the manic phase of bipolar disorder.

Rationale 4: Complaints of muscle pain are not a symptom of the manic phase of bipolar disorder.

Rationale 5: Increased talkativeness is a symptom of the manic phase of bipolar disorder.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-1

Question 25

Type: MCMA

The nurse is instructing a patient on the cause of bipolar disorder. What neurotransmitters will the nurse describe as contributing to the manic phase of this disorder?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Excessive glutamate

2. Excessive norepinephrine

3. Deficiency of gamma-aminobutyric acid

4. Deficiency of dopamine

5. Excessive serotonin

Correct Answer: 1,2,3

Rationale 1: Mania may involve an excess of excitatory neurotransmitters such as glutamate.

Rationale 2: Mania may involve an excess of excitatory neurotransmitters such as norepinephrine.

Rationale 3: Mania may involve a deficiency of inhibitory neurotransmitters such as gamma-aminobutyric acid (GABA).

Rationale 4: Dopamine is not associated with the manic phase of bipolar disorder.

Rationale 5: Serotonin is not associated with the manic phase of bipolar disorder.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-2

Question 26

Type: MCMA

During a health history, the nurse wants to include an assessment of depression with an older patient. What statements will the nurse use to make this assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. How often do you go out to socialize with friends?

2. Explain your self-care activities.

3. How much alcohol do you consume every day?

4. How is living with your oldest daughter and her family working out for you?

5. Are you feeling depressed?

Correct Answer: 1,2,3,4

Rationale 1: This question would assess if the patient is reluctant to leave the home, which can indicate depression in the older adult.

Rationale 2: Older patients are reluctant to admit depression because it is seen as an inability to continue to care for themselves.

Rationale 3: In some cases, the older patient may overuse alcohol or combine it with other medications that are depressants, which can further impact depression.

Rationale 4: Factors that contribute to depression in the older patient include the need to move in with other family members because of health status or finances.

Rationale 5: Depression is greatly underdiagnosed among older patients. One reason is the reluctance to admit depression because it can be seen as a sign of weakness or an inability to care for oneself. Asking patients directly if they feel depressed is not likely to elicit the desired information.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 16-3

Question 27

Type: MCMA

During a health history, the nurse is concerned that a patient with depression is at risk for suicide when the patient

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. states that suicide is always an option.

2. describes a previous unsuccessful attempt at suicide by aspirin overdose.

3. states that the prescribed medication is not working and that feelings of depression are worse.

4. requests prescriptions for pain medication and a sleeping aid.

5. expresses interest in meeting with friends more often.

Correct Answer: 1,2,3,4

Rationale 1: If a person verbalizes about committing suicide, the talk must be taken seriously.

Rationale 2: A patient who has had a previous suicide attempt is at higher risk for suicide and must be monitored carefully.

Rationale 3: Worsening symptoms of depression must be reported immediately because these may indicate that the drug is not working or that the patient is not compliant with pharmacotherapy.

Rationale 4: All prescription drugs must be monitored because suicidal patients often take overdoses. Therapy with multiple central nervous system depressants is discouraged because these agents produce additive sedation.

Rationale 5: This information would not indicate a worsening of depression or the risk for suicide.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 16-4

Question 28

Type: MCMA

A patient who has been taking antidepressant medication for several months and is demonstrating an improvement in symptoms tells the nurse that counseling sessions might be helpful. Which types of therapies will the nurse review with the patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Behavioral therapy

2. Interpersonal therapy

3. Cognitive-behavioral therapy

4. Psychodynamic therapy

5. Crisis therapy

Correct Answer: 1,2,3,4

Rationale 1: Behavioral therapies help patients unlearn the behavioral patterns that contribute to or result from their depression.

Rationale 2: Interpersonal therapy focuses on a patients disturbed personal relationships that both cause and exacerbate depression.

Rationale 3: Cognitive-behavioral therapies help patients change negative styles of thought and behavior that are often associated with depression.

Rationale 4: Psychodynamic therapies focus on resolving the patients internal conflicts by looking at the influence of past experiences on current behavior and how behavior is influenced by emotional factors.

Rationale 5: Crisis therapy is not a type of therapy for depression.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-5

Question 29

Type: MCMA

A patient with depression does not want to take prescribed medication because of the side effects. What can the nurse suggest to help with medication adherence?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Use ice chips to help alleviate dry mouth.

2. Chew gum or use hard candy to help alleviate dry mouth.

3. Avoid alcohol-based mouthwash to help alleviate dry mouth.

4. Use dry eye drops to help with eye dryness.

5. Take alcoholic beverages several times a week to help with unpleasant side effects.

Correct Answer: 1,2,3,4

Rationale 1: Using ice chips helps to alleviate dry mouth associated with these medications.

Rationale 2: Chewing gum or sucking on hard candy helps to alleviate dry mouth associated with these medications.

Rationale 3: Alcohol-based mouthwash can increase the feeling of dry mouth associated with these medications.

Rationale 4: Dry eye drops help alleviate eye dryness associated with these medications.

Rationale 5: The nurse should not instruct the patient to take any antidepressant medications with alcohol because of the potential for adverse effects.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 16-7

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

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