FULL CHAPTER 61

100問 • 1年前

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A patient is given anxiolytic medications for a mental disorder. What type of approach is this considered?

Biologic

A patient states that he feels angry at work for no reason and often yells at his co-workers. The ther- apist asks the patient to describe events and then tells the patient to try different strategies to cope with these angry outbursts. What type of approach is this considered?

Interpersonal

What is the best action for the nurse to implement to effectively listen therapeutically to a patient?

Concentrate on the patient and not think of re- sponses to the patient while he or she is speaking.

A nurse speaking to a patient who is depressed says, "So what you are saying is that you are feeling very sad today." What is this considered?

Clarifying

When performing a mental status examination, a nurse notes that the patient keeps repeating, "I didn't do it. I didn't do it. I didn't do it." This response would be an example of which one of the components of the mental status examination?

Thought content

A patient says, "I just don't think I can keep going on. ANS: A I just want it all to end." The nurse assesses that this patient has suicidal ideation. What is the nurse's best response?

"Do you have any thoughts of harming yourself?"

What should a nurse suspect a patient diagnosis might be when the patient states, "I often feel restless, have a tight sensation in my chest, and have an increased heart rate at times"?

Anxiety disorder

A group of nursing students are taking their first ma- ANS: C jor examination. What should the nursing instructor expect the students might experience?

Mild anxiety

A patient who is admitted with posttraumatic stress disorder (PTSD) says he had a very stressful experience when in high school and has never really recovered. What is the most appropriate nursing action?

Guide the patient in relaxation techniques to dis- tract him when flashbacks occur.

A patient admitted with a conversion disorder after an automobile accident insists he is paralyzed, although no physical cause for his paraplegia can be found. What is the best nursing response when the patient asks the nurse to push him to his room?

"OK. I am going that way myself."

Which combination of medications could be used to treat an anxiety disorder?

Effexor and Ativan

A patient who went away to college in September returns in October, thinking that he is a drummer in a popular rock band. What is this most likely a manifestation of?

Schizophrenia

A patient is receiving large doses of chlorpromazine (Thorazine) and begins to exhibit extrapyramidal signs of involuntary muscle movement. Which classification of drugs should the nurse anticipate will be added to the patient's protocol?

Antiparkinsonian

A long-time patient with schizophrenia in the inpatient unit has developed involuntary movements of his tongue. What has this patient developed?

Tardive dyskinesia

Which is not considered as a probable cause of mood disorders?

Traumatic event in childhood

A patient with bipolar disorder is being treated with tricyclic medications. What should the nurse inform the patient to expect when teaching information concerning side effects?

Orthostatic hypotension

A patient is hyperactive with mania and has poor nutritional intake due to hyperactivity. What implementation is most appropriate when considering this diagnosis?

Offer nutritious finger foods and high-protein milk shakes to eat on the go.

A patient is brought in from the emergency department after telling the physician that he is a relative of the president of the United States. He says that he should not be detained because he has important business to attend to that involves national security. He is dressed in a bright coat with plaid pants and gets very angry when you try to question him. What is this patient is experiencing?

Manic episode

While in the dayroom, one of the patients becomes very agitated and begins to threaten to harm the other patients and is directing violence at the other patients and staff. What is the most appropriate nursing implementation?

Decrease the stimuli and use restraints if all other measures fail.

Since the summer weather began, a patient taking lithium for manic episodes has been walking daily. What important instruction should the nurse provide to this patient?

Maintain hydration.

A patient who has a history of episodes of road rage thinks that she is a very good driver and does not understand why she keeps being told she is a poor driver. She is losing her license now, and she tells the nurse that she is feeling very unhappy and abandoned. She feels like she might hurt herself. The nurse realizes that the patient is exhibiting which personality disorder?

Borderline

A co-worker is noted to be very organized. However, you see that he is always making lists and citing the rules of the organization. He wants all his projects to be perfect and gets very upset when things happen that make him miss his deadlines. The co-worker is exhibiting signs of which personality disorder?

Obsessive-compulsive

What is a common cause of delirium?

Neoplasms

A nurse is assessing a patient with an acute stress disorder. What characteristics of this disorder should the nurse assess? (Select all that apply.)

Diminished awareness of surroundings, Derealization, Depersonalization, Amnesia

A nursing instructor is explaining the difference be- tween illusion and hallucination. Which examples provided by students in the class indicate an illusion? (Select all that apply.)

A car backfiring being perceived as gunfire, The television news being perceived as someone talking to you, A spot on the wall being perceived as a spider

When a nurse asks questions like, "What day is to- day?" or "What time is it now?" the nurse is testing the patient's ______.

sensorium

What is the recommended time over which antianxiety medications must be gradually tapered before discontinuation?

1 month

Which is a benzodiazepine of choice when treating anxiety associated with alcohol withdrawal?

Oxazepam (Serax)

Which is the drug of choice to treat a patient with obsessive-compulsive disorder (OCD)?

Fluvoxamine (Luvox)

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

Patient reports sleeping better and increased in- terest in activities.

Which is true regarding psychological drug dependence?

It requires medical intervention to treat.

The nurse is preparing to educate a patient and signif- icant other about antianxiety medications before the patient's discharge. What is pertinent information to be included in the teaching plan?

Discuss, review, and validate the behavior moni- toring system and intervention flow sheet the patient and significant other will continue to use following

What will the nurse caution a patient about when providing information about the prescribed azapirone antidepressant?

Risk of injury when using machinery

Which patient is most likely to respond quickly to antianxiety therapy with benzodiazepines?

Patient with recent anxiety reactions

What instruction is most important for the nurse to teach the patient who has recently been prescribed alprazolam (Xanax)?

"You may feel dizzy or unsteady when rising to a standing position."

The nurse is developing a teaching plan for patients prescribed buspirone (BuSpar). Which information about this medication should be included?

There is minimal potential for abuse.

A newly admitted psychiatric patient repetitively states, "I wish I were dead. I just want to kill myself." The priority nursing at this time is to:

provide for patient safety.

The nurse transcribes an order for lorazepam for a patient experiencing nausea and vomiting as a result of alcohol withdrawal. The most appropriate route of administration for lorazepam with this patient would be:

intramuscularly.

A female patient is admitted to the adult psychiatric floor with a diagnosis of generalized anxiety disorder. Anxiolytic medications and group therapy have been prescribed. Evaluation of therapeutic outcomes related to her acute stay can be measured by which assessment(s)? (Select all that apply.)

She is able to sleep 5 hours during the night., The tremor and pacing she exhibited on admission are reduced., She is able to attend and actively participate in group sessions.

Which substance(s) may increase the toxic effects of benzodiazepines? (Select all that apply.)

Alcohol, Antihistamines, Analgesics, Sedatives, Hypnotics

In addition to the relief of mild to moderate anxiety, hydroxyzine (Vistaril) has which additional therapeutic outcome(s)? (Select all that apply.)

Reduced need for sedation and analgesia before and after surgery, Control of itching in allergic reactions, Control of vomiting

Which assessment(s) would be included in the eval- ANS: A, B, C, D, E uation of a patient with anxiety? (Select all that apply.) a. b. c. d. e. f.

Physical examination, Psychological evaluation, History of precipitation stressors, Medication history, Substance abuse history

The prenatal nurse is educating a woman regarding preconception care. The patient informs the nurse that she is currently taking a benzodiazepine drug for management of anxiety. Appropriate teaching for this patient will include that benzodiazepines: (Select all that apply.)

readily cross into breast milk, enter fetal circulation

What occurs with mania associated with bipolar disorder?

Distinct episodes of elation

Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin?

Morphine

What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of anti- depressant therapy?

They do not cause the anticholinergic and cardio- vascular adverse effects.

4. Lithium (Eskalith) is the drug of choice for which of the following disorders?

Bipolar disorders

Which psychological manifestation of depression will improve in response to antidepressant therapy?

Social withdrawal

On what is the choice of tricyclic antidepressants based?

Patient age and gender

The nurse is teaching a patient about medication treatment for depression. The patient asks how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate?

1 week

What is the action of MAOIs on neurotransmitters?

Blocking their destruction

A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication?

Neck stiffness

Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety?

Drowsiness

The nurse is caring for a patient who is taking a new- ANS: A ly prescribed drug, nefazodone, for treatment of de- pression. Which physical assessment finding is most important for the nurse to report to the healthcare provider immediately?

Bradycardia

The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation. Which statement by the patient would indicate the need for further teaching?

"If I have the urge to smoke, I will take more med- ication."

Which nursing action is most important when providing care to a patient diagnosed with a mood disorder?

Assess the patient for thoughts of suicide.

A patient is admitted to a long-term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug.

in 14 days following the last dose of

A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is:

fluid volume deficit.

Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted with depression? (Select all that apply.)

Current medications and medical history, Recent stressors and support system, Family history of mood disorder, Dietary patterns

Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith) who is being discharged? (Select all that apply.)

"Persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the healthcare provider immediately.", "It is important to comply with schedules for blood tests to assess therapeutic levels.", The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve.", "Take the medication with food or milk."

What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil)? (Select all that apply.)

Dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem., Rise slowly from a supine or sitting posi- tion to avoid dizziness and orthostatic hypotension., Avoid alcohol and barbiturates.

Which food(s) containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy? (Select all that apply.)

Beer, Aged cheeses, Bananas

Which nursing assessment(s) is/are important before the initiation of antidepressant therapy? (Select all that apply.)

Compliance with medication therapy within the last 2 months, Nonverbal interactions among patient and significant others present, Evaluation of the coherency, relevancy, and organization of thoughts in responses, Appearance and posture

Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant drugs? (Select all that apply.)

SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft., Monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action., SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine.

Which drug(s) interact(s) with SSRI agents? (Select all that apply.)

Tranylcypromine (Parnate) Willihnganz, Lithium (Eskalith), Warfarin (Coumadin), Propranolol (Inderal)

The nurse must be sure to instruct the patient about which potential adverse effect(s) of tricyclic antide- pressants? (Select all that apply.)

Dryness of mouth, nose, and throat, Constipation, Urinary retention, Blurred vision

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

Hold the MAOI drug., Consult with the prescribing healthcare provider.

The nurse is assessing a patient who is complaining of hearing voices. What is this patient experiencing?

Hallucinations

A patient with schizophrenia has been nonadherent with his home medication regimen. He requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic episodes. Which med- ication regimen would be appropriate for this patient?

Administration of depot antipsychotic medication

What is the most common cause of nonadherence to antipsychotic pharmacologic treatment?

Extrapyramidal effects

Which type of adverse effects is present when a patient displays prolonged tonic contractions of the tongue, oculogyric crisis, and torticollis?

Dystonic reactions

The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests for the first 6 months of treatment to monitor for which potential complication?

Agranulocytosis

A male patient becomes verbally aggressive and insists the nurse is poisoning him as she attempts to administer haloperidol (Haldol). Which action will the nurse take?

Firmly redirect the patient to take the medication.

Which statement is true regarding the adverse effects associated with antipsychotic medications?

Painful dystonic reactions can occur in the first 72 hours of initiation of therapy.

To what does potency of an antipsychotic medication refer?

Milligram doses used for the medication

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

Extrapyramidal symptoms

Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)?

Measure the patient's waist circumference.

A young male patient taking an antipsychotic is expe- riencing an oculogyric crisis. The nurse prepares to administer:

diphenhydramine

A patient admitted to the hospital is exhibiting psy- chotic behavior. Which sign(s) and/or symptom(s) would support the diagnosis of psychosis? (Select all that apply.)

Deterioration of social functioning, Reporting that the FBI has solicited important secret information from his phone conversations, Confirmation of hearing voices in his head, Changing the topic of conversation inappropriately

Why is a combination of antipsychotic agents with benzodiazepines useful in initial treatment of the agi- tated patient? (Select all that apply.)

Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high-dose therapy., It assists in calming the psy- chotic patient.

Which is/are extrapyramidal adverse effect(s) of an- tipsychotic agents? (Select all that apply.)

Spasmodic movements of muscle groups, Mask-like expression

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

Fever, Hypertension, Severe extrapyramidal symptoms, Alterations in consciousness

A patient admitted to a psychiatric facility is halluci- nating, pacing, and acting highly suspicious. Based on this information, the nurse will take which action(s)? (Select all that apply.)

Be open and direct when handling the patient., Provide high-protein, high-calorie foods

Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.)

Tardive dyskinesia, Neuroleptic malignant syndrome, Akathisia, Acute dystonia

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

Rapid increase in dosages will increase the frequency of adverse effects., Tardive dyskinesia may be re- versible in early stages, Full therapeutic response may require 6 to 8 weeks to be achieved.

Which condition is associated with hydantoin therapy?

Gingival hyperplasia

The nurse is preparing discharge instructions for a patient with a history of diabetes who has just been diagnosed with seizure disorder. The patient has been prescribed hydantoin therapy. What will the patient most likely experiencing?

Hyperglycemia

What is a guideline for the nurse when administering ANS: D phenytoin (Dilantin) intravenously?

Administer without mixing with other medications.

For which condition may carbamazepine (Tegretol) be used?

Trigeminal neuralgia pain

What is the drug of choice when treating a generalized tonic-clonic seizure?

Valproic acid (Depakene)

Which response by the nurse is accurate when a patient who has been on lamotrigine (Lamictal) for seizure control reports a skin rash and urticaria?

Advise the patient that this adverse effect usually resolves but should be reported to the healthcare provider.

Which medication is used to control seizures or pre- vent migraine headaches?

Topiramate (Topamax)

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity?

Nystagmus

Which condition would indicate to the nurse that a patient has phenytoin (Dilantin) toxicity?

Nystagmus

What information would be most important for the nurse to provide to a patient when teaching about the adverse effects of succinimide therapy?

Nausea, vomiting, and indigestion are common during the initiation of therapy.

What dose is within the acceptable range for administering IV phenytoin (Dilantin) to a patient with a seizure disorder?

30 mg/min

The nurse is providing discharge teaching to a patient prescribed phenytoin (Dilantin) for management of a seizure disorder. Which patient statement indicates a need for further teaching?

"If I develop enlarged gums, I will stop taking the medication."

Which premedication assessment by the nurse is most important prior to the initiation of carbamazepine (Tegretol) therapy?

Determine patient's ancestry.

The pediatric nurse is caring for a patient diagnosed with refractory seizures.The physician orders a ketogenic diet. When the child receives his food tray, the nurse should remove any food containing high levels of:

carbohydrates.

100

What is included in the nursing management of the patient with generalized tonic-clonic seizure activity? (Select all that apply.)

Placing padding around or under the patient's head, Positioning the patient on the side once the relaxation stage is entered to allow oral secretions to drain, Requesting additional assistance and/or necessary equipment in case the patient does not begin breathing spontaneously when the seizure is over

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