Chapter 7 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 7

Question 1

Type: MCSA

A nurse planning a staff education session would correctly explain the role of psychopharmacologic treatment as which of the following?

1. Decrease clients worst symptoms so that they do not require long-term treatment.

2. Promote clients physiologic stability so that they can grow holistically.

3. Stabilize clients so that they can participate in psychoanalysis.

4. Manage clients so that they are happy and do not have to endure the stresses of everyday life.

Correct Answer: 2

Rationale 1: The goal of psychopharmacology is to stabilize brain function, thus allowing clients to grow emotionally, in their relationships, and at their jobs or school. The goal should be more than just decreasing the worst symptoms. Psychoanalysis is only one form of psychotherapy. All people need to learn how to cope with the stresses of everyday life, and a medication does not make a person happy. It can improve brain function and decrease or eliminate depressive symptoms.

Rationale 2: The goal of psychopharmacology is to stabilize brain function, thus allowing clients to grow emotionally, in their relationships, and at their jobs or school. The goal should be more than just decreasing the worst symptoms. Psychoanalysis is only one form of psychotherapy. All people need to learn how to cope with the stresses of everyday life, and a medication does not make a person happy. It can improve brain function and decrease or eliminate depressive symptoms.

Rationale 3: The goal of psychopharmacology is to stabilize brain function, thus allowing clients to grow emotionally, in their relationships, and at their jobs or school. The goal should be more than just decreasing the worst symptoms. Psychoanalysis is only one form of psychotherapy. All people need to learn how to cope with the stresses of everyday life, and a medication does not make a person happy. It can improve brain function and decrease or eliminate depressive symptoms.

Rationale 4: The goal of psychopharmacology is to stabilize brain function, thus allowing clients to grow emotionally, in their relationships, and at their jobs or school. The goal should be more than just decreasing the worst symptoms. Psychoanalysis is only one form of psychotherapy. All people need to learn how to cope with the stresses of everyday life, and a medication does not make a person happy. It can improve brain function and decrease or eliminate depressive symptoms.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explore how psychopharmacology has changed psychiatricmental health nursing since 1958.

Question 2

Type: MCMA

A nurse in the inpatient unit says to the client, I want to speak to you about the drugs you are taking, particularly the antipsychotic ones. After the client walks away without interacting, the nurse asks another nurse for suggestions. Which of the following would help the nurse improve this interaction?

Standard Text: Select all that apply.

1. Use the word medication instead of drugs.

2. Explain that you want to talk with the client not to the client.

3. Set up an appointment with the client at least a day in advance of the discussion.

4. State the name of the medication instead of the word antipsychotic.

5. Have the psychiatrist speak with the client about medications since this is not a nursing role.

Correct Answer: 1,2,4

Rationale 1: Use the word medication instead of drugs. The word drugs often connotes negative images of illegal drug use. The word medication is used in the treatment of people with physical illnesses as well as mental illnesses.

Rationale 2: Explain that you want to talk with the client not to the client. Education should be a dialog with the client, not a lecture to the client.

Rationale 3: Set up an appointment with the client at least a day in advance of the discussion. Making an appointment a day in advance to discuss medications is not necessary.

Rationale 4: State the name of the medication instead of the word antipsychotic. Antipsychotic medications may be used for mood stabilization that do not necessarily entail psychosis.

Rationale 5: Have the psychiatrist speak with the client about medications since this is not a nursing role. The role of the nurse does include medication education.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explore how psychopharmacology has changed psychiatricmental health nursing since 1958.

Question 3

Type: MCSA

A client with a long history of schizophrenia is being switched from a conventional antipsychotic medication to a newer antipsychotic. The client asks, I wonder why I am being switched since I have not had hallucinations for years. The psychiatrist said something about negative symptoms. Which response by the nurse is correct?

1. Negative symptoms are those that interrupt your life, such as hearing voices or thinking that people are out to get you.

2. The conventional antipsychotic medications do not work well with positive symptoms, such as hallucinations.

3. You must have heard wrong because medications would not be switched due to negative symptoms.

4. Newer antipsychotic medications work on hallucinations as well as negative symptoms, such as lack of motivation.

Correct Answer: 4

Rationale 1: The newer antipsychotic medications work on the negative as well as the positive symptoms of schizophrenia. The conventional antipsychotic medications worked well with the positive symptoms, such as hallucinations and delusions. The negative symptoms include flat affect and lack of motivation. Treating significant negative symptoms would be one reason for switching from a conventional to an atypical antipsychotic medication.

Rationale 2: The newer antipsychotic medications work on the negative as well as the positive symptoms of schizophrenia. The conventional antipsychotic medications worked well with the positive symptoms, such as hallucinations and delusions. The negative symptoms include flat affect and lack of motivation. Treating significant negative symptoms would be one reason for switching from a conventional to an atypical antipsychotic medication.

Rationale 3: The newer antipsychotic medications work on the negative as well as the positive symptoms of schizophrenia. The conventional antipsychotic medications worked well with the positive symptoms, such as hallucinations and delusions. The negative symptoms include flat affect and lack of motivation. Treating significant negative symptoms would be one reason for switching from a conventional to an atypical antipsychotic medication.

Rationale 4: The newer antipsychotic medications work on the negative as well as the positive symptoms of schizophrenia. The conventional antipsychotic medications worked well with the positive symptoms, such as hallucinations and delusions. The negative symptoms include flat affect and lack of motivation. Treating significant negative symptoms would be one reason for switching from a conventional to an atypical antipsychotic medication.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explore how psychopharmacology has changed psychiatricmental health nursing since 1958.

Question 4

Type: MCMA

A mental health nurse is reviewing the post-test responses for a staff educational session that the nurse provided on the chronological development of psychiatric medications. Which of the following responses would indicate the participants understood the information correctly?

Standard Text: Select all that apply.

1. The newer antidepressants, the SSRI group, have fewer side effects than the older antidepressants.

2. The effectiveness of antidepressants has led to research resulting in a better understanding of brain biochemistry.

3. The discovery of chlorpromazine (Thorazine) dramatically changed psychiatric treatment.

4. Few new psychiatric medications are needed due to the large number of safe and effective current medications.

5. Each new type of psychiatric medication was developed due to a focus on a specific psychiatric illness and not due to chance.

Correct Answer: 1,2,3,5

Rationale 1: The newer antidepressants, the SSRI group, have fewer side effects than the older antidepressants. The SSRI do not have the dietary restrictions with the risk of hypertension crisis as the MAOIs do. The tricyclic antidepressants have more side effects than do the SSRIs.

Rationale 2: The effectiveness of antidepressants has led to research resulting in a better understanding of brain biochemistry. The pharmacology of the antidepressants has led to the theory of serotonin and norepinephrine shortages in the brain as causes of depression.

Rationale 3: The discovery of chlorpromazine (Thorazine) dramatically changed psychiatric treatment. The discovery and use of chlorpromazine led to the discharge of psychiatric clients from mental institutions to the treatment of clients in the community.

Rationale 4: Few new psychiatric medications are needed due to the large number of safe and effective current medications. The continuing explosion of psychobiologic knowledge is paving the way for the release of newer medications with fewer side effects.

Rationale 5: Each new type of psychiatric medication was developed due to a focus on a specific psychiatric illness and not due to chance. The use of many new medications for psychiatric treatment was discovered accidentally. Chlorpromazine was originally studied for use in the operating room, while the first tricyclic antidepressant was found while researching for an antipsychotic medication.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explore how psychopharmacology has changed psychiatricmental health nursing since 1958.

Question 5

Type: MCSA

A client previously treated for insomnia with flurazepam (Dalmane) is being switched to eszopiclone (Lunesta). How would the nurse explain the benefits of the newer nonbenzodiazepines as compared to the benzodiazepines for the treatment of insomnia?

1. Benzodiazepines do not induce sleep.

2. Nonbenzodiazepines lead to more withdrawal.

3. Nonbenzodiazepines trigger a rebound effect.

4. Nonbenzodiazepines do not produce as much hangover effect.

Correct Answer: 4

Rationale 1: Nonbenzodiazepines are more rapidly eliminated and thus, produce minimal hangover effect. Benzodiazepines do induce sleep and can lead to tolerance and withdrawal symptoms. Rebound effect is more likely with the benzodiazepines than with the nonbenzodiazepines.

Rationale 2: Nonbenzodiazepines are more rapidly eliminated and thus, produce minimal hangover effect. Benzodiazepines do induce sleep and can lead to tolerance and withdrawal symptoms. Rebound effect is more likely with the benzodiazepines than with the nonbenzodiazepines.

Rationale 3: Nonbenzodiazepines are more rapidly eliminated and thus, produce minimal hangover effect. Benzodiazepines do induce sleep and can lead to tolerance and withdrawal symptoms. Rebound effect is more likely with the benzodiazepines than with the nonbenzodiazepines.

Rationale 4: Nonbenzodiazepines are more rapidly eliminated and thus, produce minimal hangover effect. Benzodiazepines do induce sleep and can lead to tolerance and withdrawal symptoms. Rebound effect is more likely with the benzodiazepines than with the nonbenzodiazepines.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate psychiatric medications into treatment for two diagnostic groups.

Question 6

Type: MCSA

The client of Asian extraction asks the nurse why the clients own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct?

1. People of Asian extraction have higher expressed emotionality leading to better prognosis and lower dosages.

2. Often people of Asian extraction have lower metabolic rates and need lower amounts of medication.

3. There is no correlation between ethnic background and the amount of medication someone receives.

4. People of European extraction have more side effects from medication than do those of Asian extraction.

Correct Answer: 2

Rationale 1: People of Asian extraction do have lower metabolic rates, show more side effects, and often have lower doses of medication than do people of European extraction. Research has shown that higher expressed emotionality leads to a poorer prognosis and is not characteristic of people from an Asian extraction.

Rationale 2: People of Asian extraction do have lower metabolic rates, show more side effects, and often have lower doses of medication than do people of European extraction. Research has shown that higher expressed emotionality leads to a poorer prognosis and is not characteristic of people from an Asian extraction.

Rationale 3: People of Asian extraction do have lower metabolic rates, show more side effects, and often have lower doses of medication than do people of European extraction. Research has shown that higher expressed emotionality leads to a poorer prognosis and is not characteristic of people from an Asian extraction.

Rationale 4: People of Asian extraction do have lower metabolic rates, show more side effects, and often have lower doses of medication than do people of European extraction. Research has shown that higher expressed emotionality leads to a poorer prognosis and is not characteristic of people from an Asian extraction.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Apply biologic impacts of medications to three ethnically distinct groups.

Question 7

Type: MCSA

When the nurse reviews the effectiveness of the clients lithium level, the nurse should take into account which of the following client factors?

1. Marital status

2. Gender

3. Ethnicity

4. Weight

Correct Answer: 3

Rationale 1: Because of differing metabolic rates, the therapeutic range of lithium differs among Asian, African-American, and Caucasian groups. Weight, gender, and marital status would not impact the effectiveness of the medication.

Rationale 2: Because of differing metabolic rates, the therapeutic range of lithium differs among Asian, African-American, and Caucasian groups. Weight, gender, and marital status would not impact the effectiveness of the medication.

Rationale 3: Because of differing metabolic rates, the therapeutic range of lithium differs among Asian, African-American, and Caucasian groups. Weight, gender, and marital status would not impact the effectiveness of the medication.

Rationale 4: Because of differing metabolic rates, the therapeutic range of lithium differs among Asian, African-American, and Caucasian groups. Weight, gender, and marital status would not impact the effectiveness of the medication.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Apply biologic impacts of medications to three ethnically distinct groups.

Question 8

Type: MCSA

A 15-year-old client was depressed due to the loss of the clients mother and was placed on venlafaxine (Effexor). Two weeks later the client returns to the clinic and says, I am feeling worse and have no hope. What nursing action is a priority?

1. Assess for suicidality.

2. Ask what the client enjoys.

3. Assess if the client is sleeping at night.

4. Evaluate how the clients other family members are coping.

Correct Answer: 1

Rationale 1: In the initial treatment period, children and adolescents may carry an increased risk of suicidal ideation and behavior. It would be a priority to assess the clients current risk. The other items may be part of the clients assessment but would not be a life or death priority at this time.

Rationale 2: In the initial treatment period, children and adolescents may carry an increased risk of suicidal ideation and behavior. It would be a priority to assess the clients current risk. The other items may be part of the clients assessment but would not be a life or death priority at this time.

Rationale 3: In the initial treatment period, children and adolescents may carry an increased risk of suicidal ideation and behavior. It would be a priority to assess the clients current risk. The other items may be part of the clients assessment but would not be a life or death priority at this time.

Rationale 4: In the initial treatment period, children and adolescents may carry an increased risk of suicidal ideation and behavior. It would be a priority to assess the clients current risk. The other items may be part of the clients assessment but would not be a life or death priority at this time.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify two manifestations that require you to differentiate psychiatric symptomatology from medication side effects.

Question 9

Type: MCSA

The client with schizophrenia was started on imipramine (Tofranil) for a depressed mood and subsequently started hearing voices again and refuses to take the Tofranil because the client thinks it is poison. The nursing response is based on what information?

1. Tricyclic antidepressants can trigger overt symptoms in someone with schizophrenia.

2. There is no evidence that tricyclic antidepressants trigger psychotic symptoms in susceptible clients.

3. Often new antipsychotic medications like imipramine have paradoxical effects.

4. MAOIs do not interact well with other antipsychotic medications and can cause worsening of symptoms.

Correct Answer: 1

Rationale 1: Tricyclic antidepressants (TCAs) can trigger overt symptoms in clients with schizophrenia. TCAs, such as imipramine, are not antipsychotic medications. Imipramine is not an MAOI.

Rationale 2: Tricyclic antidepressants (TCAs) can trigger overt symptoms in clients with schizophrenia. TCAs, such as imipramine, are not antipsychotic medications. Imipramine is not an MAOI.

Rationale 3: Tricyclic antidepressants (TCAs) can trigger overt symptoms in clients with schizophrenia. TCAs, such as imipramine, are not antipsychotic medications. Imipramine is not an MAOI.

Rationale 4: Tricyclic antidepressants (TCAs) can trigger overt symptoms in clients with schizophrenia. TCAs, such as imipramine, are not antipsychotic medications. Imipramine is not an MAOI.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify two manifestations that require you to differentiate psychiatric symptomatology from medication side effects.

Question 10

Type: MCSA

The client with schizophrenia is on olanzapine (Zyprexa) and has gained ten pounds in the four weeks after its initiation. The client asks the nurse if the weight gain is related to this medication. What nursing response is correct?

1. This medication is associated with weight gain in some clients.

2. The client is most likely gaining weight due to a hidden alcohol problem.

3. The client was evidently not weighed correctly initially.

4. The client is probably just feeling better and eating more.

Correct Answer: 1

Rationale 1: The CAITIE study demonstrated that antipsychotics, especially olanzapine, can trigger significant weight gain in some clients. Although plausible as reasons for the weight gain/difference, the other choices are not as probable and negate the importance of monitoring weight in a client on olanzapine.

Rationale 2: The CAITIE study demonstrated that antipsychotics, especially olanzapine, can trigger significant weight gain in some clients. Although plausible as reasons for the weight gain/difference, the other choices are not as probable and negate the importance of monitoring weight in a client on olanzapine.

Rationale 3: The CAITIE study demonstrated that antipsychotics, especially olanzapine, can trigger significant weight gain in some clients. Although plausible as reasons for the weight gain/difference, the other choices are not as probable and negate the importance of monitoring weight in a client on olanzapine.

Rationale 4: The CAITIE study demonstrated that antipsychotics, especially olanzapine, can trigger significant weight gain in some clients. Although plausible as reasons for the weight gain/difference, the other choices are not as probable and negate the importance of monitoring weight in a client on olanzapine.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify two manifestations that require you to differentiate psychiatric symptomatology from medication side effects.

Question 11

Type: MCMA

The client with depression was started on flurazepam (Dalmane) and looks very tired after breakfast. What factors should the nurse assess related to the clients tiredness?

Standard Text: Select all that apply.

1. If the client has felt hung-over from this medication in the past

2. If the clients blood pressure is elevated

3. If the clients TSH level is low

4. The level of the clients depression

5. The length and quality of the clients sleep

Correct Answer: 1,4,5

Rationale 1: If the client has felt hung-over from this medication in the past. This medication can cause a hung-over effect.

Rationale 2: If the clients blood pressure is elevated. An elevated blood pressure is often asymptomatic and does not typically cause fatigue.

Rationale 3: If the clients TSH level is low. A low TSH would indicate a hyperactive thyroid and not cause fatigue.

Rationale 4: The level of the clients depression. The client might have fatigue associated with depression.

Rationale 5: The length and quality of the clients sleep. The length and quality of the clients sleep should be assessed to determine the effectiveness of the medication flurazepam, used for the treatment of insomnia.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify two manifestations that require you to differentiate psychiatric symptomatology from medication side effects.

Question 12

Type: MCSA

The white blood cell count of the client on clozapine (Clozaril) is 2.8. What action should the nurse take?

1. Hold the medication and call the psychiatrist.

2. Administer the medication and monitor the next count.

3. Monitor the client for orthostatic hypotension.

4. Check to see if the thyroid levels are normal.

Correct Answer: 1

Rationale 1: Agranulocytosis, a marked decrease in white blood cell counts, is a serious side effect of this medication. It should be held and stopped by the prescriber before the client gets a serious infection. Thyroid levels are not related to agranulocytosis and neither is orthostatic hypotension.

Rationale 2: Agranulocytosis, a marked decrease in white blood cell counts, is a serious side effect of this medication. It should be held and stopped by the prescriber before the client gets a serious infection. Thyroid levels are not related to agranulocytosis and neither is orthostatic hypotension.

Rationale 3: Agranulocytosis, a marked decrease in white blood cell counts, is a serious side effect of this medication. It should be held and stopped by the prescriber before the client gets a serious infection. Thyroid levels are not related to agranulocytosis and neither is orthostatic hypotension.

Rationale 4: Agranulocytosis, a marked decrease in white blood cell counts, is a serious side effect of this medication. It should be held and stopped by the prescriber before the client gets a serious infection. Thyroid levels are not related to agranulocytosis and neither is orthostatic hypotension.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Describe how you would document the positive and negative impacts of psychiatric medications on behavior.

Question 13

Type: MCSA

The client says to the nurse, Im worried that this new antidepressant may not be working because I always feel tired after taking it in the morning. The nursing response should be based on what principle?

1. Antidepressants can have a sedating effect.

2. Antidepressants only have a stimulant effect.

3. Antidepressants that cause sedation usually cause tremors.

4. Antidepressants that cause sedation are not effective.

Correct Answer: 1

Rationale 1: Although sedation can be an adverse reaction from an antidepressant and appear similar to the fatigue of depression, it can usually be managed by taking the medication at bedtime. Antidepressants are not stimulants and there is no correlation between sedation and tremors.

Rationale 2: Although sedation can be an adverse reaction from an antidepressant and appear similar to the fatigue of depression, it can usually be managed by taking the medication at bedtime. Antidepressants are not stimulants and there is no correlation between sedation and tremors.

Rationale 3: Although sedation can be an adverse reaction from an antidepressant and appear similar to the fatigue of depression, it can usually be managed by taking the medication at bedtime. Antidepressants are not stimulants and there is no correlation between sedation and tremors.

Rationale 4: Although sedation can be an adverse reaction from an antidepressant and appear similar to the fatigue of depression, it can usually be managed by taking the medication at bedtime. Antidepressants are not stimulants and there is no correlation between sedation and tremors.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Document the positive and negative impacts of psychiatric medications on behavior.

Question 14

Type: MCSA

The client reports that the medication must be effective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medications?

1. Paroxetine (Paxil)

2. Methylphenidate (Ritalin)

3. Zolpidem (Ambien)

4. Olanzapine (Zyprexa)

Correct Answer: 4

Rationale 1: Olanzapine is an antipsychotic medication used to treat psychotic symptoms such as hallucinations. Methylphenidate is a stimulant used to treat attention deficit disorder. Paroxetine is an antidepressant, while zolpidem is for insomnia.

Rationale 2: Olanzapine is an antipsychotic medication used to treat psychotic symptoms such as hallucinations. Methylphenidate is a stimulant used to treat attention deficit disorder. Paroxetine is an antidepressant, while zolpidem is for insomnia.

Rationale 3: Olanzapine is an antipsychotic medication used to treat psychotic symptoms such as hallucinations. Methylphenidate is a stimulant used to treat attention deficit disorder. Paroxetine is an antidepressant, while zolpidem is for insomnia.

Rationale 4: Olanzapine is an antipsychotic medication used to treat psychotic symptoms such as hallucinations. Methylphenidate is a stimulant used to treat attention deficit disorder. Paroxetine is an antidepressant, while zolpidem is for insomnia.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Describe how you would document the positive and negative impacts of psychiatric medications on behavior.

Question 15

Type: MCSA

The client who was taking zaleplon (Sonata) took about an hour to fall asleep the first night after it was discontinued. The client asks the nurse if this means that the client is addicted to the medication. Which nursing response is correct?

1. There are no sedativehypnotics that can be addictive.

2. This medication is not associated with withdrawal symptoms.

3. Usually the medication is tapered off over six weeks to prevent withdrawal.

4. The client is addicted, but withdrawal is mild.

Correct Answer: 2

Rationale 1: Although this medication may cause some minor difficulty in falling asleep after it is discontinued, it is not associated with withdrawal symptoms. The medication does not need to be tapered off. The client is not addicted to the medication. The barbiturates and benzodiazepines can be addictive.

Rationale 2: Although this medication may cause some minor difficulty in falling asleep after it is discontinued, it is not associated with withdrawal symptoms. The medication does not need to be tapered off. The client is not addicted to the medication. The barbiturates and benzodiazepines can be addictive.

Rationale 3: Although this medication may cause some minor difficulty in falling asleep after it is discontinued, it is not associated with withdrawal symptoms. The medication does not need to be tapered off. The client is not addicted to the medication. The barbiturates and benzodiazepines can be addictive.

Rationale 4: Although this medication may cause some minor difficulty in falling asleep after it is discontinued, it is not associated with withdrawal symptoms. The medication does not need to be tapered off. The client is not addicted to the medication. The barbiturates and benzodiazepines can be addictive.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Describe how you would document the positive and negative impacts of psychiatric medications on behavior.

Question 16

Type: MCSA

The client with bipolar disorder has been on lamotrigine (Lamictal) for three years and has had a stable mood for one year and asks what the risks would be of just stopping all the lamotrigine at once. Which nursing response is the most important point?

1. Stopping this medication is usually not problematic.

2. Stopping this medication could trigger a panic attack.

3. Stopping this medication may trigger headaches.

4. Stopping this medication abruptly carries the risk of seizures.

Correct Answer: 4

Rationale 1: If the dose is not tapered slowly to discontinuation, the client may have a seizure. A headache would not be as risky as a seizure. A panic attack should not occur as lamotrigine is generally used as a mood stabilizer in psychiatry.

Rationale 2: If the dose is not tapered slowly to discontinuation, the client may have a seizure. A headache would not be as risky as a seizure. A panic attack should not occur as lamotrigine is generally used as a mood stabilizer in psychiatry.

Rationale 3: If the dose is not tapered slowly to discontinuation, the client may have a seizure. A headache would not be as risky as a seizure. A panic attack should not occur as lamotrigine is generally used as a mood stabilizer in psychiatry.

Rationale 4: If the dose is not tapered slowly to discontinuation, the client may have a seizure. A headache would not be as risky as a seizure. A panic attack should not occur as lamotrigine is generally used as a mood stabilizer in psychiatry.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe how you would document the positive and negative impacts of psychiatric medications on behavior.

Question 17

Type: MCSA

In preparing for the treatment of a client only on carbamazepine (Tegretol), the nurse plans for which of the following?

1. A client with auditory hallucinations

2. A client with mood instability or convulsions

3. A client with memory deficits

4. A client with alcohol withdrawal or delusions

Correct Answer: 2

Rationale 1: Some anticonvulsants are used in the treatment of mood instability. Antipsychotic medications treat hallucinations. Acetylcholinesterase inhibitors treat memory issues. Alcohol withdrawal symptoms are treated with benzodiazepines.

Rationale 2: Some anticonvulsants are used in the treatment of mood instability. Antipsychotic medications treat hallucinations. Acetylcholinesterase inhibitors treat memory issues. Alcohol withdrawal symptoms are treated with benzodiazepines.

Rationale 3: Some anticonvulsants are used in the treatment of mood instability. Antipsychotic medications treat hallucinations. Acetylcholinesterase inhibitors treat memory issues. Alcohol withdrawal symptoms are treated with benzodiazepines.

Rationale 4: Some anticonvulsants are used in the treatment of mood instability. Antipsychotic medications treat hallucinations. Acetylcholinesterase inhibitors treat memory issues. Alcohol withdrawal symptoms are treated with benzodiazepines.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare and contrast the general classifications of medications used for particular psychiatric symptoms.

Question 18

Type: MCMA

In reviewing the history of a client on risperidone (Risperdal), the nurse notes that no previous diagnosis is available. The nurse knows that the newer atypical antipsychotic medications are commonly given for which of the following syndromes?

Standard Text: Select all that apply.

1. Dementia with psychotic features

2. Schizophrenia

3. Antisocial personality disorder

4. Attention deficit disorder

5. Bipolar I disorder

Correct Answer: 1,2,5

Rationale 1: Dementia with psychotic features. Atypical antipsychotic medications are used to treat the behavioral and psychotic features of dementia.

Rationale 2: Schizophrenia. Atypical antipsychotic medications treat psychotic symptoms in disorders such as schizophrenia.

Rationale 3: Antisocial personality disorder. Antisocial personality disorders due not respond to antipsychotic medications.

Rationale 4: Attention deficit disorder. Atypical antipsychotic medications are not useful for attention deficit disorder, which is often treated with stimulants.

Rationale 5: Bipolar I disorder. Atypical antipsychotic medications are used to treat bipolar mania.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare and contrast the general classifications of medications used for particular psychiatric symptoms.

Question 19

Type: MCSA

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for which of the following?

1. Level of depression

2. Memory impairment

3. Blood pressure

4. Mania

Correct Answer: 2

Rationale 1: Acetylcholinesterase inhibitors are used to treat memory and other cognitive impairments in people with dementia. Depression is treated with antidepressants and not acetylcholinesterase inhibitors. Blood pressure changes are not common adverse reactions of these medications. Mania is not treated with this group of medications.

Rationale 2: Acetylcholinesterase inhibitors are used to treat memory and other cognitive impairments in people with dementia. Depression is treated with antidepressants and not acetylcholinesterase inhibitors. Blood pressure changes are not common adverse reactions of these medications. Mania is not treated with this group of medications.

Rationale 3: Acetylcholinesterase inhibitors are used to treat memory and other cognitive impairments in people with dementia. Depression is treated with antidepressants and not acetylcholinesterase inhibitors. Blood pressure changes are not common adverse reactions of these medications. Mania is not treated with this group of medications.

Rationale 4: Acetylcholinesterase inhibitors are used to treat memory and other cognitive impairments in people with dementia. Depression is treated with antidepressants and not acetylcholinesterase inhibitors. Blood pressure changes are not common adverse reactions of these medications. Mania is not treated with this group of medications.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare and contrast the general classifications of medications used for particular psychiatric symptoms.

Question 20

Type: MCSA

The client with bipolar disorder, who is on Divalproex, asks the nurse why the psychiatrist ordered an anticonvulsant when the client has no history of seizures.

1. Clients with bipolar disorder are at increased risk of having seizures and are treated to prevent them.

2. Divalproex is not an anticonvulsant; it is an antipsychotic medication.

3. The client must be on another medication that lowers the seizure threshold and the Divalproex is protective.

4. Several anticonvulsant medications, including Divalproex, are used as mood stabilizers.

Correct Answer: 4

Rationale 1: A number of anticonvulsant medications are mood stabilizers. Clients with bipolar disorder are not at increased risk of having seizures; however, abrupt withdrawal of anticonvulsant medications may trigger seizures. Divalproex is an anticonvulsant. There is no data to support that the client is on another medication; Divalproex is used as a mood stabilizer for this client, not as an anticonvulsant.

Rationale 2: A number of anticonvulsant medications are mood stabilizers. Clients with bipolar disorder are not at increased risk of having seizures; however, abrupt withdrawal of anticonvulsant medications may trigger seizures. Divalproex is an anticonvulsant. There is no data to support that the client is on another medication; Divalproex is used as a mood stabilizer for this client, not as an anticonvulsant.

Rationale 3: A number of anticonvulsant medications are mood stabilizers. Clients with bipolar disorder are not at increased risk of having seizures; however, abrupt withdrawal of anticonvulsant medications may trigger seizures. Divalproex is an anticonvulsant. There is no data to support that the client is on another medication; Divalproex is used as a mood stabilizer for this client, not as an anticonvulsant.

Rationale 4: A number of anticonvulsant medications are mood stabilizers. Clients with bipolar disorder are not at increased risk of having seizures; however, abrupt withdrawal of anticonvulsant medications may trigger seizures. Divalproex is an anticonvulsant. There is no data to support that the client is on another medication; Divalproex is used as a mood stabilizer for this client, not as an anticonvulsant.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Compare and contrast the general classifications of medications used for particular psychiatric symptoms.

Question 21

Type: MCSA

A nurse new to psychiatry asks her colleague why the newer antipsychotic medications do not cause as many EPSEs as do the conventional antipsychotic medications. Which response, if made by the nurse, is correct?

1. The newer antipsychotics also have a muscle relaxing effect that masks the EPSEs.

2. The newer antipsychotics do not impact dopamine.

3. The newer antipsychotics only act in the lower extrapyramidal dopamine pathways.

4. The newer antipsychotics have less affinity for dopamine receptors and also bind to serotonin receptors.

Correct Answer: 4

Rationale 1: The conventional antipsychotic medications have a greater affinity for the dopamine receptors, and occupancy of the dopamine receptors above 80% leads to EPSEs. The newer antipsychotic medications have less affinity for dopamine and some affinity for serotonin, both of which reduce the risk for EPSE. The newer antipsychotics do not have a muscle relaxing effect and must work in the higher dopamine pathways to be effective.

Rationale 2: The conventional antipsychotic medications have a greater affinity for the dopamine receptors, and occupancy of the dopamine receptors above 80% leads to EPSEs. The newer antipsychotic medications have less affinity for dopamine and some affinity for serotonin, both of which reduce the risk for EPSE. The newer antipsychotics do not have a muscle relaxing effect and must work in the higher dopamine pathways to be effective.

Rationale 3: The conventional antipsychotic medications have a greater affinity for the dopamine receptors, and occupancy of the dopamine receptors above 80% leads to EPSEs. The newer antipsychotic medications have less affinity for dopamine and some affinity for serotonin, both of which reduce the risk for EPSE. The newer antipsychotics do not have a muscle relaxing effect and must work in the higher dopamine pathways to be effective.

Rationale 4: The conventional antipsychotic medications have a greater affinity for the dopamine receptors, and occupancy of the dopamine receptors above 80% leads to EPSEs. The newer antipsychotic medications have less affinity for dopamine and some affinity for serotonin, both of which reduce the risk for EPSE. The newer antipsychotics do not have a muscle relaxing effect and must work in the higher dopamine pathways to be effective.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain one of the psychobiologic mechanisms important in psychopharmacology.

Question 22

Type: MCSA

Because venlafaxine (Effexor) increases norepinephrine, the nurse assesses for what symptom in the client, especially when the client is on the higher doses of this medication?

1. Sedation

2. Hypothermia

3. Bradycardia

4. Elevated blood pressure

Correct Answer: 4

Rationale 1: The impact of norepinephrine on the sympathetic nervous system increases the risk of hypertension. Bradycardia, hypothermia, and sedation would not occur when the sympathetic nervous system is activated.

Rationale 2: The impact of norepinephrine on the sympathetic nervous system increases the risk of hypertension. Bradycardia, hypothermia, and sedation would not occur when the sympathetic nervous system is activated.

Rationale 3: The impact of norepinephrine on the sympathetic nervous system increases the risk of hypertension. Bradycardia, hypothermia, and sedation would not occur when the sympathetic nervous system is activated.

Rationale 4: The impact of norepinephrine on the sympathetic nervous system increases the risk of hypertension. Bradycardia, hypothermia, and sedation would not occur when the sympathetic nervous system is activated.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Explain one of the psychobiologic mechanisms important in psychopharmacology.

Question 23

Type: MCSA

At a medication education meeting, a colleague asks the nurse how medications that increase acetylcholine are helpful to people with dementia. What nursing response is correct?

1. The cholinergic system is useful in helping to dull clients awareness of their progressive losses.

2. Acetylcholine is involved in restoring serotonin and other chemicals that decrease anxiety.

3. Acetylcholine is helpful in censoring feelings that arise in the midbrain and cause distress.

4. The cholinergic system is involved in memory, problem solving, and other cognitive skills.

Correct Answer: 4

Rationale 1: The acetylcholinesterase inhibitors work by decreasing acetylcholinesterase, which reduces the amount of acetylcholine. The end result is that with more acetylcholine the functions of memory and other cognitive skills are improved. Acetylcholine does not have the actions listed in the other three choices.

Rationale 2: The acetylcholinesterase inhibitors work by decreasing acetylcholinesterase, which reduces the amount of acetylcholine. The end result is that with more acetylcholine the functions of memory and other cognitive skills are improved. Acetylcholine does not have the actions listed in the other three choices.

Rationale 3: The acetylcholinesterase inhibitors work by decreasing acetylcholinesterase, which reduces the amount of acetylcholine. The end result is that with more acetylcholine the functions of memory and other cognitive skills are improved. Acetylcholine does not have the actions listed in the other three choices.

Rationale 4: The acetylcholinesterase inhibitors work by decreasing acetylcholinesterase, which reduces the amount of acetylcholine. The end result is that with more acetylcholine the functions of memory and other cognitive skills are improved. Acetylcholine does not have the actions listed in the other three choices.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explain one of the psychobiologic mechanisms important in psychopharmacology.

Question 24

Type: MCSA

A family member tells the nurse that much information is available on the internet about medications. This family member asks the nurse to explain what neurotransmitters are impacted by lithium. Which nursing response is correct?

1. Lithium interacts with GABA and opens the chloride channels.

2. Lithium lowers the amount of serotonin and norepinephrine available in the neural synapses.

3. Lithium increases the amount of dopamine available at the postsynaptic receptor.

4. Lithium raises the norepinephrine levels in the neural synapse.

Correct Answer: 2

Rationale 1: Lithium aids in the reduction of neurotransmitter release, this results in lower amounts of serotonin and norepinephrine in the neural synapses. Lithium does not interact with GABA and open chloride channels, does not increase the amount of dopamine available at the postsynaptic receptor, and does not raise the norepinephrine levels in the neural synapse.

Rationale 2: Lithium aids in the reduction of neurotransmitter release, this results in lower amounts of serotonin and norepinephrine in the neural synapses. Lithium does not interact with GABA and open chloride channels, does not increase the amount of dopamine available at the postsynaptic receptor, and does not raise the norepinephrine levels in the neural synapse.

Rationale 3: Lithium aids in the reduction of neurotransmitter release, this results in lower amounts of serotonin and norepinephrine in the neural synapses. Lithium does not interact with GABA and open chloride channels, does not increase the amount of dopamine available at the postsynaptic receptor, and does not raise the norepinephrine levels in the neural synapse.

Rationale 4: Lithium aids in the reduction of neurotransmitter release, this results in lower amounts of serotonin and norepinephrine in the neural synapses. Lithium does not interact with GABA and open chloride channels, does not increase the amount of dopamine available at the postsynaptic receptor, and does not raise the norepinephrine levels in the neural synapse.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain one of the psychobiologic mechanisms important in psychopharmacology.

Question 25

Type: MCSA

The client asks the nurse how the SSRI antidepressant that the client is prescribed works. What nursing response is correct?

1. SSRIs work on depression by sedating the centers of the brain responsible for worrying.

2. SSRIs allow more of a chemical neurotransmitter, serotonin, to be available to areas of the brain.

3. SSRIs are stimulants that enhance the activity of the brain and pleasure centers.

4. SSRIs decrease the amount of norepinephrine available in the lower cortical areas.

Correct Answer: 2

Rationale 1: Selective serotonin reuptake inhibitors decrease the reuptake of serotonin from the neural synapse, thus allowing more to be present at the postsynaptic receptor site. SSRIs are selective for serotonin and do not lower norepinephrine. They are neither stimulants nor sedatives.

Rationale 2: Selective serotonin reuptake inhibitors decrease the reuptake of serotonin from the neural synapse, thus allowing more to be present at the postsynaptic receptor site. SSRIs are selective for serotonin and do not lower norepinephrine. They are neither stimulants nor sedatives.

Rationale 3: Selective serotonin reuptake inhibitors decrease the reuptake of serotonin from the neural synapse, thus allowing more to be present at the postsynaptic receptor site. SSRIs are selective for serotonin and do not lower norepinephrine. They are neither stimulants nor sedatives.

Rationale 4: Selective serotonin reuptake inhibitors decrease the reuptake of serotonin from the neural synapse, thus allowing more to be present at the postsynaptic receptor site. SSRIs are selective for serotonin and do not lower norepinephrine. They are neither stimulants nor sedatives.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain one of the psychobiologic mechanisms important in psychopharmacology.

Question 26

Type: MCSA

The nurse evaluates which of the following client statements as validation that the teaching on lithium was effective?

1. I will restrict fluids to 100 ml per eight hours.

2. I will quit taking lithium if I get depressed.

3. I will have my blood levels checked every two to three months.

4. I will have liver function tests every six months.

Correct Answer: 3

Rationale 1: Lithium levels are drawn every two to three months and after increases. If fluid is restricted to the point of dehydration, toxicity can occur. Lithium is a mood stabilizer and treats mania and Bipolar symptoms and, therefore, would not be stopped during depression. Liver function tests are not needed for lithium since it is an ion and not metabolized by the liver.

Rationale 2: Lithium levels are drawn every two to three months and after increases. If fluid is restricted to the point of dehydration, toxicity can occur. Lithium is a mood stabilizer and treats mania and Bipolar symptoms and, therefore, would not be stopped during depression. Liver function tests are not needed for lithium since it is an ion and not metabolized by the liver.

Rationale 3: Lithium levels are drawn every two to three months and after increases. If fluid is restricted to the point of dehydration, toxicity can occur. Lithium is a mood stabilizer and treats mania and Bipolar symptoms and, therefore, would not be stopped during depression. Liver function tests are not needed for lithium since it is an ion and not metabolized by the liver.

Rationale 4: Lithium levels are drawn every two to three months and after increases. If fluid is restricted to the point of dehydration, toxicity can occur. Lithium is a mood stabilizer and treats mania and Bipolar symptoms and, therefore, would not be stopped during depression. Liver function tests are not needed for lithium since it is an ion and not metabolized by the liver.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Teach clients and their families about the effects and uses of psychotropic medications.

Question 27

Type: MCSA

The client tells the nurse that the medications are so expensive and says that there is a website that sells the medications at quite a reduction. What education is warranted by the nurse?

1. The client should try the medications for a while and note if they seem to have the same effect.

2. There are no legitimate sources for psychiatric medications on the internet.

3. Legitimate internet pharmacies carry accreditation that can be verified.

4. Less expensive medications will not work as well as those that cost more.

Correct Answer: 3

Rationale 1: The Verified Internet Pharmacy Practice Sites Accreditation Program can be used to see if a pharmacy is accredited and thus a reputable source. The cost of a medication does not verify its authenticity; a drug that costs more is not necessarily better than a drug that costs less and vice versa. It would be too risky for a person to try a medication to test whether or not it is counterfeit.

Rationale 2: The Verified Internet Pharmacy Practice Sites Accreditation Program can be used to see if a pharmacy is accredited and thus a reputable source. The cost of a medication does not verify its authenticity; a drug that costs more is not necessarily better than a drug that costs less and vice versa. It would be too risky for a person to try a medication to test whether or not it is counterfeit.

Rationale 3: The Verified Internet Pharmacy Practice Sites Accreditation Program can be used to see if a pharmacy is accredited and thus, a reputable source. The cost of a medication does not verify its authenticity; a drug that costs more is not necessarily better than a drug that costs less and vice versa. It would be too risky for a person to try a medication to test whether or not it is counterfeit.

Rationale 4: The Verified Internet Pharmacy Practice Sites Accreditation Program can be used to see if a pharmacy is accredited and thus a reputable source. The cost of a medication does not verify its authenticity; a drug that costs more is not necessarily better than a drug that costs less and vice versa. It would be too risky for a person to try a medication to test whether or not it is counterfeit.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Teach clients and their families about the effects and uses of psychotropic medications.

Question 28

Type: MCSA

An older client with mild dementia of the Alzheimers type is started on donepezil (Aricept). The clients daughter asks the nurse how long it will take for her mother to be cured. Which response by the nurse is correct?

1. Cure rates vary by individuals and will take about six weeks to determine.

2. It takes about two weeks for the neurochemical cure to occur.

3. As long as she continues to take the medication, she will be symptom-free but not cured.

4. The medication will improve her memory but not cure the dementia.

Correct Answer: 4

Rationale 1: Acetylcholinesterase inhibitors target the symptom of memory loss but do not cure the underlying disease process that is progressive. The medication will not ensure that the client will be symptom-free. There is currently no cure for Alzheimers dementia; therefore, the time frames given in the other answers do not apply.

Rationale 2: Acetylcholinesterase inhibitors target the symptom of memory loss but do not cure the underlying disease process that is progressive. The medication will not ensure that the client will be symptom-free. There is currently no cure for Alzheimers dementia; therefore, the time frames given in the other answers do not apply.

Rationale 3: Acetylcholinesterase inhibitors target the symptom of memory loss but do not cure the underlying disease process that is progressive. The medication will not ensure that the client will be symptom-free. There is currently no cure for Alzheimers dementia; therefore, the time frames given in the other answers do not apply.

Rationale 4: Acetylcholinesterase inhibitors target the symptom of memory loss but do not cure the underlying disease process that is progressive. The medication will not ensure that the client will be symptom-free. There is currently no cure for Alzheimers dementia; therefore, the time frames given in the other answers do not apply.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Teach clients and their families about the effects and uses of psychotropic medications.

Question 29

Type: MCSA

The client who is recovering from schizophrenia has just seen the psychiatrist and tells the nurse that the Olanzapine (Zyprexa) is being reduced from 20 mg to 15 mg. This client asks the nurse why the Olanzapine is just not discontinued since the client has not had a hallucination for two months. Which nursing response to the client is correct?

1. I will check your serum level to see if it was too high and the reason for the reduction.

2. This medication is gradually reduced and continued to prevent a relapse.

3. I think that you should call your psychiatrist and ask to discontinue the Olanzapine.

4. The 20 mg of Olanzapine is above the recommended dose and was reduced due to the risk of toxicity.

Correct Answer: 2

Rationale 1: Antipsychotic medications are gradually reduced after maximum clinical improvement has been obtained. The dosage range of Olanzapine is between 520 mg. Serum levels for antipsychotic medications are not routinely checked. It would be premature to discontinue the medication for at least three to six months following an acute episode.

Rationale 2: Antipsychotic medications are gradually reduced after maximum clinical improvement has been obtained. The dosage range of Olanzapine is between 520 mg. Serum levels for antipsychotic medications are not routinely checked. It would be premature to discontinue the medication for at least three to six months following an acute episode.

Rationale 3: Antipsychotic medications are gradually reduced after maximum clinical improvement has been obtained. The dosage range of Olanzapine is between 520 mg. Serum levels for antipsychotic medications are not routinely checked. It would be premature to discontinue the medication for at least three to six months following an acute episode.

Rationale 4: Antipsychotic medications are gradually reduced after maximum clinical improvement has been obtained. The dosage range of Olanzapine is between 520 mg. Serum levels for antipsychotic medications are not routinely checked. It would be premature to discontinue the medication for at least three to six months following an acute episode.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Teach clients and their families about the effects and uses of psychotropic medications.

Question 30

Type: MCSA

A woman calls the nurse at the mental health clinic about her husband who takes phenelzine (Nardil). She states that he took several over-the-counter decongestants and now has a stiff neck, headache, nausea, and vomiting. The nurse bases her response on what information?

1. Agranulocytosis is an adverse reaction that occurs due to the interaction of MAOIs and decongestants.

2. MAOIs can trigger a hypertensive crisis if taken with sympathomimetics.

3. Flu-like symptoms are common when clients begin taking MAOIs.

4. Neuroleptic malignant syndrome presents with muscular rigidity following the ingestion of MAOIs.

Correct Answer: 2

Rationale 1: When MAOIs are mixed with foods containing tyramine or sympathomimetics, a hypertensive crisis can occur that is heralded by the symptoms of headache, stiff neck, nausea, vomiting, and rising blood pressure. MAOIs, when not taken with foods containing tyramine or sympathomimetics, are not associated with flu-like symptoms. Agranulocytosis is demonstrated by a low white blood cell count and can occur following the initiation of antipsychotic medications. Neuroleptic malignant syndrome is an adverse reaction to antipsychotic medications.

Rationale 2: When MAOIs are mixed with foods containing tyramine or sympathomimetics, a hypertensive crisis can occur that is heralded by the symptoms of headache, stiff neck, nausea, vomiting, and rising blood pressure. MAOIs, when not taken with foods containing tyramine or sympathomimetics, are not associated with flu-like symptoms. Agranulocytosis is demonstrated by a low white blood cell count and can occur following the initiation of antipsychotic medications. Neuroleptic malignant syndrome is an adverse reaction to antipsychotic medications.

Rationale 3: When MAOIs are mixed with foods containing tyramine or sympathomimetics, a hypertensive crisis can occur that is heralded by the symptoms of headache, stiff neck, nausea, vomiting, and rising blood pressure. MAOIs, when not taken with foods containing tyramine or sympathomimetics, are not associated with flu-like symptoms. Agranulocytosis is demonstrated by a low white blood cell count and can occur following the initiation of antipsychotic medications. Neuroleptic malignant syndrome is an adverse reaction to antipsychotic medications.

Rationale 4: When MAOIs are mixed with foods containing tyramine or sympathomimetics, a hypertensive crisis can occur that is heralded by the symptoms of headache, stiff neck, nausea, vomiting, and rising blood pressure. MAOIs, when not taken with foods containing tyramine or sympathomimetics, are not associated with flu-like symptoms. Agranulocytosis is demonstrated by a low white blood cell count and can occur following the initiation of antipsychotic medications. Neuroleptic malignant syndrome is an adverse reaction to antipsychotic medications.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Teach clients and their families about the effects and uses of psychotropic medications.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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