Exam 2: Chapters 12, 13, and 15

Question 1

lithium range

Answer 1

0.6-1.2 mEq/L

Question 2

T/F

A benzodiazepine antianxiety agent can help reduce agitation or anxiety.

Answer 2

true

Question 3

What is lithium used to treat?

A. depression
B. mania
C. schizophrenia
D. seizures

Answer 3

B. mania

Question 4

Which of the following are the correct dermatologic adverse effects of lithium?

A. acne, pruritus, eczema
B. pruritus, acne, alopecia
C. psoriasis, ringworm, acne
D. acne, alopecia, psoriasis

Answer 4

D. acne, alopecia, psoriasis

Question 5

Which of the following are the correct digestive adverse effects of lithium?

A. diarrhea, nausea, vomiting
B. abdominal cramping, constipation, nausea
C. bloating, nausea, vomiting
D. abdominal cramping, diarrhea, vomiting

Answer 5

A. diarrhea, nausea, vomiting

Question 6

Which of the following are the correct endocrine adverse effects of lithium?

A. hypothyroidism, weight loss
B. hypothyroidism, weight gain
C. hyperthyroidism, weight gain
D. hyperthyroidism, weight loss

Answer 6

B. hypothyroidism, weight gain

Question 7

Which of the following are the correct fluid and electrolyte adverse effects of lithium?

A. edema, polydipsia, polyuria
B. dehydration, metabolic acidosis, polyuria
C. edema, metabolic alkalosis
D. dehydration, anuria, edema

Answer 7

A. edema, polydipsia, polyuria

Question 8

Which of the following are the correct CNS and musculoskeletal adverse effects of lithium?

A. shuffling gait, tremors, agitation
B. fine tremors, fever
C. ataxia, sedation, fine tremor
D. ataxia, shuffling gait, fever

Answer 8

C. ataxia, sedation, fine tremor

Question 9

Lithium must reach therapeutic __________ levels to be effective.

A. blood
B. tissue
C. trough
D. physical activity

Answer 9

A. blood

Question 10

__________ is generally contraindicated in patients with CV disease, brain damage, renal disease, thyroid disease, or myasthenia gravis.

A. valproic acid
B. lamotrigine
C. carbamzepine
D. lithium

Answer 10

D. lithium

Question 11

Why should you monitor liver enzymes for your patient who is taking carbamazepine?

A. because the drug can decrease levels of liver enzymes that can speed its metabolism
B. because the drug can decrease levels of liver enzymes that can slow its metabolism
C. because the drug can increase levels of liver enzymes that can slow its metabolism
D. because the drug can increase levels of liver enzymes that can speed its metabolism

Answer 11

D. because the drug can increase levels of liver enzymes that can speed its metabolism

Question 12

T/F

Complete blood counts should be drawn prior to beginning carbamazepine and periodically after since it’s known to cause leukopenia and aplastic anemia.

Answer 12

true

Question 13

__________ carries a black box warning for serious dermatologic reactions.

A. valproate
B. carbamazepine
C. lithium
D. lamotrigine

Answer 13

B. carbamazepine

Question 14

Which degree of lithium toxicity do these side effects belong to?

Coarse hand tremor, worsening GI symptoms, confusion, slurred speech, marked lethargy, nausea, vomiting, diarrhea

A. early toxicity
B. severe toxicity
C. past severe toxicity

Answer 14

A. early toxicity

Question 15

Which degree of lithium toxicity do these side effects belong to?

ataxia, confusion, polyuria with dilute urine, blurred vision, clonic movement (twitching), hypotension, seizures, stupor, coma

A. early toxicity
B. severe toxicity
C. past severe toxicity

Answer 15

B. severe toxicity

Question 16

Which degree of lithium toxicity do these side effects belong to?

cardiac dysrhythmias

A. early toxicity
B. severe toxicity
C. past severe toxicity

Answer 16

C. past severe toxicity

Question 17

A sudden __________ in sodium intake may result in __________ lithium levels.

A. increase; increased
B. decrease; increased
C. increase; decreased
D. decrease; decreased

Answer 17

B. decrease; increased

Question 18

Name this drug based on the MOA.

may alter sodium, potassium ion transport across cell membranes in nerve, and muscle cells; may balance biogenic amines of norepinephrine, and serotonin in CNS areas involved in emotional responses

Answer 18

lithium

Question 19

Name this drug based on the MOA.

increases levels of GABA in the brain, which decreases seizure activity

Answer 19

valproic acid

Question 20

Name this drug based on the MOA.

decreases polysynaptic responses and block post-tetanic potentiation

Answer 20

carbamazepine

Question 21

Name this drug based on the MOA.

may inhibit voltage-sensitive sodium channels, decreasing seizures

Answer 21

lamotrigine

Question 22

How long is the onset of lithium?

Answer 22

10-21 days

Question 23

T/F

Lithium is safe to take while pregnant.

Answer 23

false

Question 24

_________ is helpful in preventing future manic episodes.

Answer 24

valproic acid

Question 25

What is carbamazepine used for?

Answer 25

acute mania and mixed states

Question 26

What labs must be completed for you patient who is taking carbamezepine?

Answer 26

liver blood

Question 27

In about 10% of people taking _________, a rash appears within 8 weeks of starting treatment. a. lithium b. lamotrigine c. valproic acid d. carbamazepine

Answer 27

b. lamotrigine

Question 28

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen? It will: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. be used for long-term control of hyperactivity.

Answer 28

b. bring hyperactivity under rapid control.

Question 29

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin b. clonidine c. risperidone d. carbamazepine

Answer 29

d. carbamazepine

Question 30

The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient‘s last dose of lithium was 8 hours ago. This result is a. within therapeutic limits. b. below therapeutic limits. c. above therapeutic limits. d. invalid because of the time lapse since the last dose.

Answer 30

a. within therapeutic limits.

Question 31

Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin.Which medication also belongs to this classification? a. clonazepam b. risperidone c. lamotrigine d. aripiprazole

Answer 31

c. lamotrigine

Question 32

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with a. meals. b. an antacid. c. an antiemetic. d. a large glass of juice.

Answer 32

a. meals.

Question 33

A health teaching plan for a patient taking lithium should include instructions to a. maintain normal salt and fluids in the diet. b. drink twice the usual daily amount of fluid. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats, and red wine.

Answer 33

a. maintain normal salt and fluids in the diet.

Question 34

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient‘s behavior? a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. b. Continue to monitor and document the patient‘s speech patterns and motor activity. c. Ask the health care provider to prescribe an increased dose and frequency of lithium. d. Consider the need to check the lithium level. The patient may not be swallowing medications.

Answer 34

d. Consider the need to check the lithium level. The patient may not be swallowing medications.

Question 35

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient‘s family during this phase of treatment? a. Attending psychoeducation sessions b. Decreasing physical activity c. Increasing food and fluids d. Meeting self-care needs

Answer 35

a. Attending psychoeducation sessions

Question 36

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse‘s appropriate response. a. "You will be able to stop the medication in about 1 month." b. "Taking the medication every day helps reduce the risk of a relapse." c. "Most patients take medication for approximately 6 months after discharge." d. "It‘s unusual that the health care provider hasn‘t already stopped your medication."

Answer 36

b. "Taking the medication every day helps reduce the risk of a relapse."

Question 37

An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, "I‘ve had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse will advise the patient to a. restrict food and fluids for 24 hours and stay in bed. b. have someone bring the patient to the clinic immediately. c. drink a large glass of water with 1 teaspoon of salt added. d. take one dose of an over-the-counter antidiarrheal medication now.

Answer 37

b. have someone bring the patient to the clinic immediately.

Question 38

A newly diagnosed patient is prescribed lithium. Which information from the patient‘s history indicates that monitoring of serum concentrations of the drug will be challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Heart failure

Answer 38

d. Heart failure

Question 39

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? (SATA) A. “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.” B. “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.” C. “Lithium may help me lose the few extra pounds I tend to carry around.” D. “I take my lithium on an empty stomach to help with absorption.” E. “I’ve already made arrangements for outpatient lithium level monitoring.”

Answer 39

A. “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.” B. “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.” E. “I’ve already made arrangements for outpatient lithium level monitoring.”

Question 40

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? (SATA) A. getting up at night to urinate B. increased attentiveness C. improved vision D. an upset stomach for no apparent reason E. shaky hands that make holding a cup difficult

Answer 40

D. an upset stomach for no apparent reason E. shaky hands that make holding a cup difficult

Question 41

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? A. reinforce that the level is considered therapeutic B. instruct the patient to hold the next dose of medication and contact the prescriber C. have the patient go to the hospital emergency department immediately D. alert the patient to the possibility of seizures and appropriate precautions

Answer 41

B. instruct the patient to hold the next dose of medication and contact the prescriber

Question 42

Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? (SATA) a. monitor the patient's vital signs frequently b. keep the patient distracted with group-orientated activities c. provide the patient with frequent milkshakes and protein drinks d. reduce the volumes on the television and dim bright lights in the environment e. use a firm but calm voice to give specific concise directions to the patient

Answer 42

a. monitor the patient's vital signs frequently c. provide the patient with frequent milkshakes and protein drinks d. reduce the volumes on the television and dim bright lights in the environment e. use a firm but calm voice to give specific concise directions to the patient

Question 43

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I disorder 8 years ago. Ted has a history of IV drug use, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends: A. Clonazepam (Klonopin) B. Fluoxetine (Prozac) C. Electroconvulsive therapy (ETC) D. Lurasidone (Latuda)

Answer 43

C. Electroconvulsive therapy (ETC)

Question 44

A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psych NP states, "You are read to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing __________." a. a higher dosage b. once a week dosing c. a lower dosage d. a different drug

Answer 44

c. a lower dosage

Question 45

A nurse is preparing a teaching plan for a client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching? (SATA) a. "This medication can safely be taken during pregnancy." b. "Eliminate grapefruit juice from your diet." c. "You will need to have a complete blood count and carbamazepine levels drawn periodically." d. "Notify your provider if you develop a rash." e. "Avoid driving for the first few days after starting this medication."

Answer 45

b. "Eliminate grapefruit juice from your diet." c. "You will need to have a complete blood count and carbamazepine levels drawn periodically." d. "Notify your provider if you develop a rash." e. "Avoid driving for the first few days after starting this medication."

Question 46

A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about way to prevent lithium toxicity, the nurse should advise the client to do which of the following? a. avoid the use of acetaminophen for headaches b. restrict intake of foods rich in sodium c. decreases fluid intake to less than 1,500 mL daily d. limit aerobic activity in hot weather

Answer 46

d. limit aerobic activity in hot weather

Question 47

A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client to have which of the following blood laboratory tests completed periodically? (SATA) a. thrombocytopenia count b. glucose c. sodium d. liver function tests e. potassium

Answer 47

a. thrombocytopenia count d. liver function tests

Question 48

A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? a. "Stop that! No one did anything to provoke an attack by you." b. "If you do that one more time, you will be secluded immediately." c. "Do not hit anyone. If you are unable to control yourself, we will help you." d. "You know we will not let you hit anyone. Why do you continue this behavior?"

Answer 48

c. "Do not hit anyone. If you are unable to control yourself, we will help you."

Question 49

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide? a. "A high proportion of patients with bipolar disorders are found among creative writers." b. "A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder." c. "Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress." d. "More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

Answer 49

b. "A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder."

Question 50

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Which initial approach should the nurse select? a. Distraction: "Let's go to the dining room for a snack." b. Humor: "How much are you paying servants these days?" c. Limit setting: "You must stop ordering other patients around." d. Honest feedback: "Your controlling behavior is annoying others."

Answer 50

a. Distraction: "Let's go to the dining room for a snack."

Question 51

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? a. Allow the patient to act out feelings. b. Set limits on patient behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity and aggression.

Answer 51

b. Set limits on patient behavior as necessary.

Question 52

At a unit meeting, the staff discusses decor for a special room for patients with acute mania. Which suggestion is appropriate? a. An extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery

Answer 52

b. Neutral walls with pale, simple accessories

Question 53

A patient demonstrating behaviors associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially? a. Confer with the health care provider to consider use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Conduct a meeting with all staff and patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.

Answer 53

b. Hold a staff meeting to discuss consistency and limit-setting approaches.

Question 54

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by a. quietly asking the patient, "Why don't you put your clothes on?" b. firmly telling the patient, "Stop dancing and put on your clothing." c. putting a blanket around the patient and walking with the patient to a quiet room. d. letting the patient stay in the group room and moving the other patients to a area.

Answer 54

c. putting a blanket around the patient and walking with the patient to a quiet room.

Question 55

A patient waves a newspaper and says, "I must have my credit card and use the computer right now. A store is having a big sale, and I need to order 10 dresses and four pairs of shoes." Select the nurse‘s appropriate intervention. The nurse a. suggests the patient have a friend do the shopping and bring purchases to the unit. b. invites the patient to sit together and look at new fashion magazines. c. tells the patient computer use is not allowed until self-control improves. d. asks whether the patient has enough money to pay for the purchases.

Answer 55

b. invites the patient to sit together and look at new fashion magazines.

Question 56

Which dinner menu is best suited for a patient with acute mania? a. Spaghetti and meatballs, salad, and a banana b. Beef and vegetable stew, a roll, and chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, and an apple d. Chicken casserole, green beans, and flavored gelatin with whipped cream

Answer 56

c. Broiled chicken breast on a roll, an ear of corn, and an apple

Question 57

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on a. developing an optimistic outlook. b. distorted thought self-control. c. interest in the environment. d. sleep pattern stabilization.

Answer 57

b. distorted thought self-control.

Question 58

Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective? a. "Converses with few interruptions; clothing matches; participates in activities." b. "Irritable, suggestible, distractible; napped for 10 minutes in afternoon." c. "Attention span short; writing copious notes; intrudes in conversations." d. "Heavy makeup; seductive toward staff; pressured speech."

Answer 58

a. "Converses with few interruptions; clothing matches; participates in activities."

Question 59

A patient experiencing acute mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation? a. Monitor physiological functioning. b. Provide a subdued environment. c. Supervise personal hygiene. d. Observe for mood changes.

Answer 59

b. Provide a subdued environment.

Question 60

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should a. direct the patient to wear clothes at all times. b. ask if the patient finds clothes bothersome. c. tell the patient that others feel embarrassed. d. arrange for one-on-one supervision.

Answer 60

d. arrange for one-on-one supervision.

Question 61

A patient experiencing acute mania is dancing atop a pool table in the recreation room. The patient waves a cue in one hand and says, "I‘ll throw the pool balls if anyone comes near me." To best assure safety, the nurse‘s first intervention is to a. tell the patient, "You need to be secluded." b. clear the room of all other patients. c. help the patient down from the table. d. assemble a show of force.

Answer 61

b. clear the room of all other patients.

Question 62

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient‘s family during this phase of treatment? a. Attending psychoeducation sessions b. Decreasing physical activity c. Increasing food and fluids d. Meeting self-care needs

Answer 62

a. Attending psychoeducation sessions

Question 63

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse‘s appropriate response. a. "You will be able to stop the medication in about 1 month." b. "Taking the medication every day helps reduce the risk of a relapse." c. "Most patients take medication for approximately 6 months after discharge." d. "It‘s unusual that the health care provider hasn‘t already stopped your medication."

Answer 63

b. "Taking the medication every day helps reduce the risk of a relapse."

Question 64

Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with a. bipolar I disorder. b. bipolar II disorder. c. dysthymic disorder. d. cyclothymic disorder.

Answer 64

a. bipolar I disorder.

Question 65

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? (Select all that apply.) a. Limit credit card access. b. Provide a structured environment. c. Encourage group social interaction. d. Supervise medication administration. e. Monitor the patient‘s sleep patterns.

Answer 65

a. Limit credit card access. b. Provide a structured environment. d. Supervise medication administration. e. Monitor the patient‘s sleep patterns.

Question 66

The plan of care for a patient in the manic state of bipolar disorder should include which interventions? (Select all that apply.) a. Touch the patient to provide reassurance. b. Invite the patient to lead a community meeting. c. Provide a structured environment for the patient. d. Ensure that the patient‘s nutritional needs are met. e. Design activities that require the patient‘s concentration.

Answer 66

c. Provide a structured environment for the patient. d. Ensure that the patient‘s nutritional needs are met.

Question 67

T/F Genetics are not involved in OCD.

Answer 67

false

Question 68

Name the correct obsession based on the example. A middle-age woman worries, "If I go to church, what will stop me from blurting out obscenities?" Despite his desire to attend services, has not gone to church in 2 years a. losing control and religious concerns b. harm c. unwanted sexual thoughts d. perfectionism

Answer 68

a. losing control and religious concerns

Question 69

Name the correct obsession based on the example. "If I don't turn the light switch off, the room will catch on fire, and my mom will die while I am at school," worries a 9-year-old girl. Returns to her room four times before school, checks that the light is turned off, and taps the four sides of the light switch a. losing control and religious concerns b. harm c. unwanted sexual thoughts d. perfectionism

Answer 69

b. harm

Question 70

Name the correct obsession based on the example. A young man has a recurrent thought: "What if I get a STD from a prostitute during sleepwalking?" Ritualistically locks the doors of the house with a key each night and hides his wallet. a. losing control and religious concerns b. harm c. unwanted sexual thoughts d. perfectionism

Answer 70

c. unwanted sexual thoughts

Question 71

Name the correct obsession based on the example. "My work is never second best," proclaims an administrative assistant." Gets to work early, leaves work late, never has a messy desk, always completes tasks. a. losing control and religious concerns b. harm c. unwanted sexual thoughts d. perfectionism

Answer 71

d. perfectionism

Question 72

Name the correct obsession based on the example. A man repeatedly has the thought "I should kill her" when he sees a blonde woman. Abruptly turns his head away from women and squints eyes to try to avoid seeing blondes. a. violence b. contamination c. superstitions d. losing control and religious concerns

Answer 72

a. violence

Question 73

Name the correct obsession based on the example. "All lists need to end in an even number," thinks a college professor. Adds or deletes items from tests, agendas, and other numbered items. a. violence b. contamination c. superstitions d. losing control and religious concerns

Answer 73

c. superstitions

Question 74

pulling hair our disorder

Answer 74

trichotillomania

Question 75

secretly swallowing pulled hair

Answer 75

trichophagia

Question 76

skin picking disorder

Answer 76

excoriation disorder

Question 77

A homebound patient diagnosed with agoraphobia has been reviewing therapy at home. The nurse recognizes effective teaching when the patient states the following: A. “I may never leave the house again.” B. “Having groceries delivered is very convenient.” C. “My risk for agoraphobia is increased by my family history.” D. “I will go out again someday, just not today.”

Answer 77

C. “My risk for agoraphobia is increased by my family history.”

Question 78

A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, "My feet are huge. I‘ve asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Social anxiety disorder b. Body dysmorphic disorder c. Separation anxiety disorder d. Obsessive-compulsive disorder due to a medical condition

Answer 78

b. Body dysmorphic disorder

Question 79

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of a. flooding. b. desensitization. c. relaxation technique. d. cognitive restructuring.

Answer 79

d. cognitive restructuring.

Question 80

A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient? a. An interview room furnished with a desk and two chairs b. A small, empty storage room with no windows or furniture c. A room with an examining table, instrument cabinets, desk, and chair d. The nurse‘s office, furnished with chairs, files, magazines, and bookcases

Answer 80

a. An interview room furnished with a desk and two chairs

Question 81

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can‘t bring myself to leave my apartment alone." Which nursing intervention is appropriate? a. Help the person use online video calls to provide interaction with others. b. Advise the person to accept the situation and use a companion. c. Ask the person to explain why the fear is so disabling. d. Teach the person to use positive self-talk techniques.

Answer 81

d. Teach the person to use positive self-talk techniques.

Question 82

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a. "I check where my car keys are eight times." b. "My legs often feel weak and spastic." c. "I‘m embarrassed to go out in public." d. "I keep reliving a car accident."

Answer 82

b. "My legs often feel weak and spastic."

Question 83

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis? a. feelings of responsibility for the health of family members b. approval-seeking behavior from friends and family c. persistent thoughts about bacteria, germs, and dirt d. needs to avoid interactions with others

Answer 83

c. persistent thoughts about bacteria, germs, and dirt

Question 84

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping? a. Allow the patient to set a hand-washing schedule. b. Encourage the patient to participate in social activities. c. Encourage the patient to discuss hand-washing routines. d. Focus on the patient‘s symptoms rather than on the patient.

Answer 84

b. Encourage the patient to participate in social activities.

Question 85

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? (Select all that apply.) a. "Are there certain social situations that cause you to feel especially uncomfortable?" b. "Are there others in your family who must do things in a certain way to feel comfortable?" c. "Have you been a victim of a crime or seen someone badly injured or killed?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

Answer 85

b. "Are there others in your family who must do things in a certain way to feel comfortable?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

Question 86

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual? (Select all that apply.) a. Ineffective home maintenance b. Situational low self-esteem c. Chronic low self-esteem d. Disturbed body image e. Risk for injury

Answer 86

a. Ineffective home maintenance c. Chronic low self-esteem e. Risk for injury

Question 87

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? a. Verify the patient‘s learning style. b. Lower the patient‘s current anxiety. c. Create outcomes and a teaching plan. d. Assess how the patient uses defense mechanisms.

Answer 87

b. Lower the patient‘s current anxiety.

Question 88

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a. "What would you like me to do to help you?" b. "Why do you suppose you are feeling anxious?" c. "I‘m not sure I understand. Give me an example." d. "You must get your feelings under control before we can continue."

Answer 88

c. "I‘m not sure I understand. Give me an example."

Question 89

A patient fearfully runs from chair to chair crying, "They‘re coming! They‘re coming!" The patient does not follow the staff‘s directions or respond to verbal interventions. The initial nursing intervention of highest priority is to a. provide for the patient‘s safety. b. encourage clarification of feelings. c. respect the patient‘s personal space. d. offer an outlet for the patient‘s energy.

Answer 89

a. provide for the patient‘s safety.

Question 90

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Present the information again in a calm manner using simple language. c. Tell the patient that staff is prepared to promote recovery. d. Encourage the patient to express feelings to family.

Answer 90

b. Present the information again in a calm manner using simple language.

Question 91

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention? a. Offering hope allays and defuses the patient‘s anxiety. b. Concerns stated aloud become less overwhelming and help problem solving begin. c. Anxiety is reduced by focusing on and validating what is occurring in the environment. d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety

Answer 91

b. Concerns stated aloud become less overwhelming and help problem solving begin.

Question 92

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. b. Advise the student to discuss this experience with a health care provider. c. Encourage the student to begin antioxidant vitamin supplements. d. Listen attentively, using silence in a therapeutic way.

Answer 92

a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects.

Question 93

A patient experiencing panic suddenly began running and shouting, "I‘m going to explode!" Select the nurse‘s best action. a. Ask, "I‘m not sure what you mean. Give me an example." b. Capture the patient in a basket-hold to increase feelings of control. c. Tell the patient, "Stop running and take a deep breath. I will help you." d. Assemble several staff members and say, "We will take you to seclusion to help you regain control."

Answer 93

c. Tell the patient, "Stop running and take a deep breath. I will help you."

Question 94

For a patient experiencing panic, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Prepare to implement physical controls. d. Provide calm, brief, directive communication.

Answer 94

d. Provide calm, brief, directive communication.

Question 95

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest? (Select all that apply.) a. Use a calm manner and low voice. b. Maintain simplicity in the environment. c. Avoid repetition in what is said to the child. d. Minimize opportunities for exercise and play. e. Explain and reinforce reality to avoid distortions.

Answer 95

a. Use a calm manner and low voice. b. Maintain simplicity in the environment. e. Explain and reinforce reality to avoid distortions.

Question 96

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially in attempting to help the patient de-escelate the anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began? d. "Are you feeling anxious right now?"

Answer 96

c. "Can you identify what was happening when your anxiety began?

Question 97

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse‘s comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

Answer 97

b. Moderate

Question 98

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person‘s level of anxiety? a. Mild b. Moderate c. Severe d. Panic

Answer 98

c. Severe

Question 99

A person experiencing a __________ level of anxiety sees, hears, and grasps more information, and problem solving becomes more effective. a. mild b. moderate c. severe. d. panic

Answer 99

a. mild

Question 100

Mild, moderate, severe, or panic anxiety? physical symptoms include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors

Answer 100

mild

Question 101

T/F As anxiety increases, the perceptual field narrows, and some details are excluded form observation.

Answer 101

true

Question 102

The person experiencing __________ anxiety sees, hears, and grasps less information and may demonstrate selective inattention, where only certain things in the environment are seen or heard unless they are pointed out. a. mild b. moderate c. severe d. panic

Answer 102

b. moderate

Question 103

Mild, moderate, severe, or panic anxiety? perceptual field - heightened perceptual field - focus is flexible and is aware of the anxiety a. mild b. moderate c. severe d. panic

Answer 103

a. mild

Question 104

Mild, moderate, severe, or panic anxiety? perceptual field - narrowed perceptual field - grasps less of what is going on a. mild b. moderate c. severe d. panic

Answer 104

b. moderate

Question 105

Mild, moderate, severe, or panic anxiety? perceptual field - focuses on the source of anxiety - less able to pay attention a. mild b. moderate c. severe d. panic

Answer 105

b. moderate

Question 106

Mild, moderate, severe, or panic anxiety? perceptual field - greatly reduced and distorted perceptual field - focuses on details or one specific detail - attention is scattered a. mild b. moderate c. severe d. panic

Answer 106

c. severe

Question 107

Mild, moderate, severe, or panic anxiety? perceptual field - unable to attend to the environment - focus is lost; may feel unreal or that the world is unreal a. mild b. moderate c. severe d. panic

Answer 107

d. panic

Question 108

Mild, moderate, severe, or panic anxiety? ability to solve problems - able to work effectively towards a goal or examine alternatives a. mild b. moderate c. severe d. panic

Answer 108

a. mild

Question 109

Mild, moderate, severe, or panic anxiety? ability to solve problems - able to solve problems but not at optimal levels a. mild b. moderate c. severe d. panic

Answer 109

b. moderate

Question 110

Mild, moderate, severe, or panic anxiety? ability to solve problems - problem solving feels impossible - unable to see connections between events or details a. mild b. moderate c. severe d. panic

Answer 110

c. severe

Question 111

Mild, moderate, severe, or panic anxiety? ability to solve problems - completely unable to process what is happening - disorganized or irrational reasoning a. mild b. moderate c. severe d. panic

Answer 111

d. panic

Question 112

Which patient is at increased risk for the development of anxiety and will require frequent assessment by the nurse? (SATA) a. exacerbation of asthma signs and symptoms b. history of peanut butter and strawberry allergies c. history of COPD d. current treatment for unstable angina pectoris e. history of a TBI

Answer 112

a. exacerbation of asthma signs and symptoms c. history of COPD d. current treatment for unstable angina pectoris e. history of a TBI

Question 113

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states the following: A.”I would like to try a benzodiazepine for my anxiety.” B. “If I study harder, my anxiety level will go down.” C. “Mild anxiety is okay because it helps me to focus.” D. “I have fear that I will fail at college.”

Answer 113

C. “Mild anxiety is okay because it helps me to focus.”

Question 114

intense excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or where help might not be available

Answer 114

agoraphobia

Question 115

a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat

Answer 115

anxiety

Question 116

ritualistic behaviors individuals feel driven to perform in an attempt to reduce anxiety or prevent an imagined calamity

Answer 116

compulsions

Question 117

automatic coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories

Answer 117

defense mechanisms

Question 118

The person with __________ anxiety may focus on one particular detail or on many scattered details and have difficulty noticing what is going on in the environment, even when another person points it out. a. mild b. moderate c. severe d. panic

Answer 118

c. severe

Question 119

the most extreme level of anxiety and results in markedly dysregulated behavior a. mild b. moderate c. severe d. panic

Answer 119

d. panic

Question 120

thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind even thought the individual attempts to do so

Answer 120

obsessions

Question 121

a sudden, sustained contraction of one or several muscle groups, usually of the head and neck

Answer 121

acute dystonia

Question 122

symptoms involving emotions and their expressions

Answer 122

affective symptoms

Question 123

a motor restlessness that causes pacing and/or an inability to stay still or remain in one plane

Answer 123

akathisia

Question 124

the inability to realize one is ill

Answer 124

anosognosia

Question 125

results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected

Answer 125

associative looseness

Question 126

choosing words based on their sound rather than their meaning and often involves words that rhyme or have a similar beginning sound

Answer 126

clang association

Question 127

the person is directed to take an action

Answer 127

command hallucination

Question 128

an impaired ability to think abstractly, resulting in interpreting or perviging things in a literal manner

Answer 128

concrete thinking

Question 129

false beliefs that are help despite a lack of evidence to support them

Answer 129

delusions

Question 130

the mimicking of movements of another

Answer 130

echopraxia

Question 131

occur when a person perceives a sensory experience for which no external source exists

Answer 131

hallucination

Question 132

misinterpretations of a real experience

Answer 132

illusion

Question 133

the absence of qualities that should be present examples: the inability to enjoy activities, social discomfort, or lack of goal-directed behavior

Answer 133

negative symptoms

Question 134

words that have meaning for the patient but a different or nonexistent meaning for others

Answer 134

neologisms

Question 135

an irrational fear, ranging from mild to profound

Answer 135

paranoia

Question 136

the presence of symptoms that should not be present examples: hallucinations, delusions, paranoia, or disorganized or bizzare thoughts, behavior, or speech

Answer 136

positive symptoms

Question 137

altered cognition, altered perception, and/or an impaired ability to determine what is or is not real

Answer 137

psychosis

Question 138

the automatic and unconscious process by which we determine what is and is not real

Answer 138

reality testing

Question 139

a persistent EPS involving involuntary rhythmic movements

Answer 139

tardive dyskinesia

Question 140

Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? (SATA) a. always afraid that others will steal his belongings b. displays unusual interest in numbers and specific topics c. has increasingly unusual thoughts and uses words oddly d. demonstrates increasing difficulty with concentration

Answer 140

all of the choices are correct

Question 141

Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? (SATA) a. screening 15-to-25 year-olds for early symptoms b. forming a support group for females aged 25 to 35 who are diagnosed with substance use disorders c. teaching ways to cope and build resiliency d. educating about the risk of psychosis with marijuana use

Answer 141

a. screening 15-to-25 year-olds for early symptoms c. teaching ways to cope and build resiliency d. educating about the risk of psychosis with marijuana use

Question 142

To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for a. alcohol use disorder b. major depressive disorder c. stomach cancer d. polydipsia e. metabolic syndrome

Answer 142

e. metabolic syndrome

Question 143

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. her memory problems will likely decrease b. depressive episodes would be less severe c. she will probably enjoy social interactions more d. she should experience a reduction in hallucinations

Answer 143

d. she should experience a reduction in hallucinations

Question 144

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. depersonalization b. pressured speech c. negative symptoms d. paranoia

Answer 144

d. paranoia

Question 145

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is hallucinations? (SATA) a. "I know you say you hear voices, but I cannot hear them." b. "Stop listening to the vices, they are NOT real." c. "Tell me more about what you hear." d. "Please tell the voices to leave you alone for now."

Answer 145

a. "I know you say you hear voices, but I cannot hear them." c. "Tell me more about what you hear."

Question 146

When patients are diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that a. the medication provided are ineffective b. nurses are trying to control their minds c. the medications ill make them sick d. they are not actually ill

Answer 146

d. they are not actually ill

Question 147

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) a week ago. You find him sitting stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2F. What is the priority nursing intervention? (SATA) a. hold his medication and contact his prescriber stat b. wipe him with a washcloth that has been wetted with cold water or alcohol c. administer an "as needed" medication such as benztropine IM to correct his dystonic reaction d. treasure him that no treatment is needed and that this reaction will pass e. hold his medication for now and consult his prescriber when he comes to the unit later today

Answer 147

a. hold his medication and contact his prescriber stat b. wipe him with a washcloth that has been wetted with cold water or alcohol

Question 148

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disorder and can be an effort to: (SATA). a. self-medicate for social discomfort b. cope with anxiety c. enhance mood d. enable Tomas to better express himself

Answer 148

a. self-medicate for social discomfort b. cope with anxiety c. enhance mood

Question 149

A patient reports that "the voices are really bad today." Helpful nursing responses would include a. giving an additional "as needed" dosage of his antipsychotic medication b. telling him that the voices are not real and that he should ignore them c. directing him to return to his room and try not to think about the voices d. encouraging the patient to use competing auditory stimuli

Answer 149

d. encouraging the patient to use competing auditory stimuli

Question 150

Which medication should the nurse be prepared to educate patients on when they are prescribed an SSRI for panic attacks? a. alprazolam (Xanax) b. fluoxetine (Prozac) c. clonazepam (Klonpin) d. venlafaxine (Effexor)

Answer 150

b. fluoxetine (Prozac)

Question 151

The activity of GABA contributes to a slowing neural activity. Which of the following drugs facilitate the action of GABA? a. benzodiazepines b. antihistamines c. anticonvulsants d. noradrenergics

Answer 151

a. benzodiazepines

Question 152

A patient has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this patient shouts, "They‘re all plotting to destroy me. Isn‘t that true?" Select the nurse‘s most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you."

Answer 152

b. "Feeling that people want to destroy you must be very frightening."

Question 153

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.

Answer 153

b. an idea of reference.

Question 154

A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a. Disorganized b. Dangerous c. Supportive d. Bizarre

Answer 154

b. Dangerous

Question 155

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose

Answer 155

a. Sedation and muscle stiffness

Question 156

Which hallucination necessitates the nurse to implement safety measures? The patient says, a. "I hear angels playing harps." b. "The voices say everyone is trying to kill me." c. "My dead father tells me I am a good person." d. "The voices talk only at night when I‘m trying to sleep."

Answer 156

b. "The voices say everyone is trying to kill me."

Question 157

A patient‘s care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase

Answer 157

b. Darting eyes, tilted head, mumbling to self

Question 158

A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole

Answer 158

d. Aripiprazole

Question 159

A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse‘s most therapeutic response. a. "Nothing you are saying is clear." b. "Your thoughts are very disconnected." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."

Answer 159

d. "I am having difficulty understanding what you are saying."

Question 160

A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a. Self-esteem b. Psychosocial c. Physiological d. Self-actualization

Answer 160

c. Physiological

Question 161

A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient‘s activities of daily living are severely compromised. An appropriate outcome would be that the patient will a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of day 3. c. gradually take the initiative for self-care by the end of week 2. d. accept tube feeding without objection by day 2.

Answer 161

b. perform self-care activities with coaching by the end of day 3.

Question 162

A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a. Echolalia b. Waxy flexibility c. Depersonalization d. Thought withdrawal

Answer 162

b. Waxy flexibility

Question 163

A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications? a. Constipation b. Gynecomastia c. Visual changes d. Photosensitivity

Answer 163

b. Gynecomastia

Question 164

A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective? a. Suggest analogies that might apply to a common daily problem. b. Assign each participant a problem to solve independently and present to the group. c. Ask each patient to read aloud a short segment from a book about problem solving. d. Invite participants to come up with solution to getting incorrect change for a purchase.

Answer 164

d. Invite participants to come up with solution to getting incorrect change for a purchase.

Question 165

A nurse educates a patient about the antipsychotic medication regime. Afterward, which comment by the patient indicates the teaching was effective? a. "I will need higher and higher doses of my medication as time goes on." b. "I need to store my medication in a cool dark place, such as the refrigerator." c. "Taking this medication regularly will reduce the severity of my symptoms." d. "If I run out or stop taking my medication, I will experience withdrawal symptoms."

Answer 165

c. "Taking this medication regularly will reduce the severity of my symptoms."

Question 166

A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse‘s most helpful reply. a. "Do you hear the voices often?" b. "Do you have a plan for getting away from the voices?" c. "I‘ll stay with you. Focus on what we are talking about, not the voices." d. "Forget the voices and ask some other patients to play cards with you."

Answer 166

c. "I‘ll stay with you. Focus on what we are talking about, not the voices."

Question 167

A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisia

Answer 167

c. Pseudoparkinsonism

Question 168

A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the patient is calm. Two hours later the nurse sees the patient‘s head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. An acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia

Answer 168

a. An acute dystonic reaction

Question 169

An acutely violent patient diagnosed with schizophrenia received several doses of haloperidol. Two hours later the nurse notices the patient‘s head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine 50 mg IM from the prn medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the prn medication administration record.

Answer 169

a. Administer diphenhydramine 50 mg IM from the prn medication administration record.

Question 170

A patient diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient‘s neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourette‘s syndrome d. Anticholinergic effects

Answer 170

b. Tardive dyskinesia

Question 171

A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse‘s most therapeutic response. a. "Why are you laughing?" b. "Please share the joke with me." c. "I don‘t think I said anything funny." d. "You‘re laughing. Tell me what‘s happening."

Answer 171

d. "You‘re laughing. Tell me what‘s happening."

Question 172

The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a. Auditory hallucinations b. Delusions of grandeur c. Poor personal hygiene d. Psychomotor agitation

Answer 172

c. Poor personal hygiene

Question 173

What assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d. Loose associations, concrete thinking, and echolalia neologisms

Answer 173

a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion

Question 174

A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident? a. Poverty of content b. Concrete thinking c. Neologisms d. Paranoia

Answer 174

d. Paranoia

Question 175

A patient diagnosed with schizophrenia begins a new prescription for ziprasidone. The patient is 5'6'' and currently weighs 204 lbs. The patient has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the patient‘s plan of care? a. Skin care techniques b. Scheduling a colonoscopy c. Weight management strategies d. Teaching to limit caffeine intake

Answer 175

c. Weight management strategies

Question 176

A patient diagnosed with schizophrenia says, "It‘s beat. Time to eat. No room for the cat." What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness

Answer 176

d. Associative looseness

Question 177

A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol b. Olanzapine c. Chlorpromazine d. Diphenhydramine

Answer 177

b. Olanzapine

Question 178

The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family‘s role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Family

Answer 178

a. Psychoeducational

Question 179

A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of a. the need for psychoeducation. b. medication nonadherence. c. chronic deterioration. d. relapse.

Answer 179

d. relapse.

Question 180

A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as a. a neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.

Answer 180

a neologism.

Question 181

A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should a. sit close to the patient. b. place an arm protectively around the patient‘s shoulders. c. place a hand on the patient‘s arm and exert light pressure. d. maintain a normal social interaction distance from the patient.

Answer 181

d. maintain a normal social interaction distance from the patient.

Question 182

A patient diagnosed with schizophrenia anxiously tells the nurse, "The voice is telling me to do things." Select the nurse‘s priority assessment question. a. "How long has the voice been directing your behavior?" b. "Does what the voice tell you to do frighten you?" c. "Do you recognize the voice speaking to you?" d. "What is the voice telling you to do?"

Answer 182

d. "What is the voice telling you to do?"

Question 183

A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse‘s best analysis and action. a. Agranulocytosis; institute reverse isolation. b. Tardive dyskinesia; withhold the next dose of medication. c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome; notify health care provider stat.

Answer 183

d. Neuroleptic malignant syndrome; notify health care provider stat.

Question 184

A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can‘t judge a book by looking at the cover.‘?" Which response by the patient indicates concrete thinking? a. "The table of contents tells what a book is about." b. "You can‘t judge a book by looking at the cover." c. "Things are not always as they first appear." d. "Why are you asking me about books?"

Answer 184

a. "The table of contents tells what a book is about."

Question 185

The nurse is developing a plan for psychoeducational sessions for a small group of adults diagnosed with schizophrenia. Which goal is best for this group? Members will a. gain insight into unconscious factors that contribute to their illness. b. explore situations that trigger hostility and anger. c. learn to manage delusional thinking. d. demonstrate improved social skills.

Answer 185

d. demonstrate improved social skills.

Question 186

A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse‘s best initial action. a. Tell the client, "Facebook is a safe website. You don‘t need to worry about Homeland Security." b. Tell the client, "You are in a safe place where you will be helped." c. Administer a prn dose of an antipsychotic medication. d. Tell the client, "You don‘t need to worry about that."

Answer 186

b. Tell the client, "You are in a safe place where you will be helped."

Question 187

Which finding constitutes a negative symptom associated with schizophrenia? a. Hostility b. Bizarre behavior c. Poverty of thought d. Auditory hallucinations

Answer 187

c. Poverty of thought

Question 188

A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident? a. Visual hallucinations b. Magical thinking c. Idea of reference d. Thought insertion

Answer 188

b. Magical thinking

Question 189

A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding? a. Word salad b. Neologism c. Anhedonia d. Echolalia

Answer 189

a. Word salad

Question 190

A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority? (Select all that apply.) a. "The importance of taking your medication correctly" b. "How to complete an application for employment" c. "How to dress when attending community events" d. "How to give and receive compliments" e. "Ways to quit smoking"

Answer 190

a. "The importance of taking your medication correctly" e. "Ways to quit smoking"

Question 191

A patient diagnosed with schizophrenia was hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof, suspicious, and says, "Two staff members I saw talking were plotting to kill me." Based on data gathered at this point, which nursing diagnoses relate? (Select all that apply.) a. Risk for other-directed violence b. Disturbed thought processes c. Risk for loneliness d. Spiritual distress e. Social isolation

Answer 191

a. Risk for other-directed violence b. Disturbed thought processes

Question 192

This nursing diagnosis applies to a patient experiencing acute mania: Imbalanced nutrition: less than body requirements related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select an appropriate outcome. The patient will a. ask staff for assistance with feeding within 4 days. b. drink six servings of a high-calorie, high-protein drink each day. c. consistently sit with others for at least 30 minutes at meal time within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

Answer 192

b. drink six servings of a high-calorie, high-protein drink each day.

Question 193

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen? It will a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. be used for long-term control of hyperactivity.

Answer 193

b. bring hyperactivity under rapid control.

Question 194

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin b. clonidine c. risperidone d. carbamazepine

Answer 194

d. carbamazepine

Question 195

Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin. Which medication also belongs to this classification? a. clonazepam b. risperidone c. lamotrigine d. aripiprazole

Answer 195

c. lamotrigine

Question 196

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications? a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edema

Answer 196

c. Diaphoresis, weakness, and nausea

Question 197

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse‘s appropriate response. a. "You will be able to stop the medication in about 1 month." b. "Taking the medication every day helps reduce the risk of a relapse." c. "Most patients take medication for approximately 6 months after discharge." d. "It‘s unusual that the health care provider hasn‘t already stopped your medication."

Answer 197

b. "Taking the medication every day helps reduce the risk of a relapse."

Question 198

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient‘s medical record, which is most appropriate to give as a prn anxiolytic? a. buspirone b. lorazepam c. amitriptyline d. desipramine

Answer 198

b. lorazepam

Question 199

When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.

Answer 199

c. avoid alcoholic beverages.

Question 200

A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? (Select all that apply.) a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach

Answer 200

a. Caution in use of machinery d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach

Question 201

Valproate is a(n) __________ drug.

Answer 201

anticonvulsant

Question 202

T/F Lamotrigine is a mood stabilizer.

Answer 202

false; anticonvulsant

Question 203

T/F Second-generation antipsychotics can lead to weight gain which can lead to further complications.

Answer 203

true

Question 204

T/F NSAIDS can influence lithium levels.

Answer 204

true

Question 205

T/F Take lithium with meals to avoid stomach irritation.

Answer 205

true

Question 206

What is the neurotransmitter for lithium?

Answer 206

GABA

Question 207

What is the neurotransmitter for carbamazepine?

Answer 207

GABA

Question 208

What is the neurotransmitter for lamotrigine?

Answer 208

GABA

Question 209

Many of the __________-generation antipsychotics are approved for acute mania. A. first B. second C. third D. fourth

Answer 209

B. second

Question 210

__________ is contraindicated in mothers who are breastfeeding and children under 12 years of age. A. valproic acid B. carbamazepine C. lithium D. risperidone

Answer 210

C. lithium

Question 211

The FDA has a black box warning against __________ use in pregnancy due to teratogenicity. A. valproic acid B. carbamazepine C. lithium D. risperidone

Answer 211

A. valproic acid

Question 212

When a child grows and their parent took valproic acid while pregnant, a condition sometimes known as __________ may become evident. A. ADHD B. congenital myotonia C. fetal anticonvulsant syndrome D. paraplegia

Answer 212

C. fetal anticonvulsant syndrome

Question 213

Which of the following are the first line of treatment drugs for depression? A. MAOIs B. SSRIs C. tricyclics D. SARIs

Answer 213

B. SSRIs

Question 214

What time of day should you administer tricyclics to your patient? A. morning B. afternoon C. evening D. night

Answer 214

D. night

Question 215

T/F SSRIs have an anticholinergic effect.

Answer 215

false

Question 216

What type of foods should someone taking an MAOI avoid? A. protein B. tyramine C. iron D. fish, omega-3 fatty

Answer 216

B. tyramine

Question 217

contains phenylethylamine, a pressor agent; large amounts can cause a reaction A. chocolate B. fava beans C. ginseng D. caffeinated beverages

Answer 217

A. chocolate

Question 218

__________ is a weak pressor agent; large amounts may cause a reaction. A. chocolate B. fava beans C. ginseng D. caffeinate

Answer 218

D. caffeinate

Question 219

headache, tremulousness, and mania-like reactions have occurred A. chocolate B. fava beans C. ginseng D. caffeinated beverages

Answer 219

C. ginseng

Question 220

contain dopamine, a pressor agent; reactions are most likely with overripe beans A. chocolate B. fava beans C. ginseng D. caffeinated beverages

Answer 220

B. fava beans

Question 221

Which of the following is the second line of treatment drugs for depression? A. MAOIs B. SSRIs C. tricyclics D. SARIs

Answer 221

C. tricyclics

Question 222

T/F TCAs have an anticholinergic effect.

Answer 222

true

Question 223

Why are MAOIs 3rd in line for the treatment of depression?

Answer 223

too many significant drug and food interactions

Question 224

_________ selectively stop serotonin reuptake, allowing more serotonin to stay at the junction of the neurons. A. SSRIs B. MAOIs C. TCAs D. SARIs

Answer 224

A. SSRIs

Question 225

T/F SSRIs do not block the uptake of dopamine or norepinephrine.

Answer 225

true

Question 226

T/F SSRIs have a short half-life.

Answer 226

false; long half-life

Question 227

T/F SSRIs are compatible with MAOIs and TCAs.

Answer 227

false

Question 228

Cabot has multiple symptoms of depression, including mood reactivity, social phobia, anxiety, and operating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? A. tricyclic antidepressants B. selective serotonin reuptake inhibitors C. serotonin and norepinephrine reuptake inhibitors D. monoamine oxidase inhibitor

Answer 228

D. monoamine oxidase inhibitor

Question 229

What is the most commonly used antidepressant?

Answer 229

benzodiazepine

Question 230

T/F Benzodiazepines are used for long-term drug therapy.

Answer 230

false; short-term

Question 231

__________ used shortly before delivery can result in a dystonia and muscle weakness in the newborn baby known as floppy infant syndrome. A. SSRIs B. benzodiazepines C. antihistamines D. antipsychotics

Answer 231

B. benzodiazepines

Question 232

__________ enhance the inhibitory effects of gamma-aminobutyric acid in the CNS; relief from anxiety occurs rapidly following administration. A. SSRIs B. MAOIs C. barbiturates D. benzodiazepines

Answer 232

D. benzodiazepines