YOU'RE CRAZY
During a mental status examination, a client describes a feeling of 'being detached from my body as if I'm watching myself from the ceiling.' The nurse should identify this as:
A.Derealization
B.Dissociative Amnesia
C.Depersonalization
D.An illusion
C.
Depersonalization
That's right!
Depersonalization is a dissociative symptom where a person feels like an outside observer of their own body or mental processes.
A nurse is caring for a client with delirium. Which characteristic best distinguishes delirium from dementia?
A. Sudden onset and potentially reversible.
B. Intact level of consciousness until the end stages.
C. Permanent and irreversible brain damage.
D. Slow, gradual decline in cognitive function.
A.Sudden onset and potentially reversible.
That's right!
Delirium is typically acute, has a fluctuating course, and can be cured if the underlying cause is addressed, whereas dementia is chronic and progressive.
A nurse is teaching a client with depression about the herbal supplement St. John's Wort. Which statement is most important for the nurse to include?
A.
This supplement has no known side effects or drug interactions.
B.
You must take this supplement on an empty stomach for it to work.
C.
This herb is a safe and effective replacement for your prescribed medication.
D.
Combining this with your SSRI can lead to a life-threatening serotonin syndrome.
D.
Combining this with your SSRI can lead to a life-threatening serotonin syndrome.
Right answer
St. John's Wort has antidepressant properties that increase serotonin; using it with SSRIs can cause dangerous serotonin toxicity.
Which of the following is considered a 'negative' symptom of schizophrenia?
A.
Disorganized speech
B.
Bizarre delusions
C.
Auditory hallucinations
D.
Avolition (lack of motivation)
D.
Avolition (lack of motivation)
Right answer
Negative symptoms represent a loss or deficit in normal functioning, such as a lack of motivation, flattened affect, or poverty of speech.
What is the primary difference between a therapeutic relationship and a social relationship in a nursing context?
A therapeutic relationship is focused solely on the patient's needs and goals, whereas a social relationship is mutual.
In a Mental Status Examination (MSE), the component 'Affect' refers to _____.
the patient's e______ p________ of a f______ state or e_______ responsiveness.
In a Mental Status Examination (MSE), the component 'Affect' refers to _____.
the patient's external presentation of a feeling state or emotional responsiveness
What dietary restriction is mandatory for patients taking monoamine oxidase inhibitors (MAOIs) to prevent a hypertensive crisis?
Avoidance of foods containing t____, such as aged c___, s____, and fava beans.
Avoidance of foods containing tyramine, such as aged cheeses, salami, and fava beans.
The Interaction: Tyramine and MAOIs
MAOIs, such as phenelzine (Nardil) and tranylcypromine (Parnate), work by inhibiting the enzyme monoamine oxidase, which normally breaks down neurotransmitters and substances like tyramine. When this enzyme is blocked, tyramine levels can rise significantly, leading to a sudden and dangerous increase in blood pressure. Because of these strict dietary requirements and the risk of severe drug interactions, MAOIs are generally not considered a first-choice drug for depression.
2. Mandatory Dietary Restrictions
Patients must avoid a long list of foods and beverages that are high in tyramine. According to the sources, these include:
Tricyclic antidepressants (TCAs) are known to cause significant cardiac side effects and are potentially fatal in the event of a(n) _____.
overdose
What early signs of lithium toxicity should a nurse monitor for in a patient?
T____, n____, vomiting, d_____, and changes in level of c_________.
Tremor, nausea, vomiting, diarrhea, and changes in level of consciousness.
1. The Therapeutic Window
Target Levels: The therapeutic blood level for treating acute mania is typically between 0.5 and 1.5 mEq/L
.
Toxicity Threshold: Toxicity generally occurs when serum levels exceed 1.5 mEq/L
. However, older adults or medically compromised patients may experience toxic symptoms at even lower levels
.
2. Breakdown of Early Signs and Symptoms
The symptoms listed on your flashcard are the primary red flags that the lithium level in the blood has become too high:
Gastrointestinal Distress: Nausea, vomiting, and diarrhea are common early indicators
.
Neurological/Motor Changes: A visible tremor or "tremulousness" is a hallmark sign of rising levels
.
Mental Status: Changes in the level of consciousness—such as increased confusion or lethargy—indicate that the toxicity is affecting the central nervous system
.
3. Critical Risk Factors: Hydration and Sodium
The sources emphasize that lithium is a salt excreted by the kidneys, which makes its concentration in the blood highly dependent on the patient's fluid and salt balance
.
Dehydration: If a patient becomes dehydrated (due to fever, heavy sweating, or poor fluid intake), their kidneys may retain lithium, leading to toxicity
.
Sodium Intake: Patients must be instructed not to alter their salt intake while taking lithium
. A sudden decrease in sodium can cause the kidneys to hold onto lithium instead, while a sudden increase might cause lithium levels to drop too low
.
4. Nursing Management and Patient Teaching
To prevent toxicity, nurses and patients must follow specific protocols:
Frequent Lab Work: Serum lithium levels must be monitored regularly to ensure they stay within the narrow therapeutic range
.
Renal Monitoring: Because lithium is excreted by the kidneys, nurses must monitor renal function tests, specifically serum creatinine and BUN
.
Hydration Instructions: Patients should maintain adequate fluid intake, especially in hot weather or during exercise
.
Avoid Caffeine: Patients are advised to avoid excessive use of caffeinated beverages, which can affect lithium levels
.
Reporting: Patients must be taught to report signs of toxicity immediately to their healthcare provider
.
Which pharmacological class of antidepressants is usually the first choice for treating major depression due to its safety profile and lower overdose risk?
Selective serotonin reuptake inhibitors (SSRIs)
The sources identify several common medications within this class:
Patients taking lamotrigine (Lamictal) must be monitored closely for a life-threatening skin reaction known as _____.
Stevens-Johnson syndrome
A client diagnosed with Major Depressive Disorder (MDD) has not showered for three days and refuses to leave their room. Which nursing diagnosis is the priority?
A.Self-care deficit: bathing/hygiene
B.Spiritual distress
C.Chronic low self-esteem
D.Impaired social interaction
A.
Self-care deficit: bathing/hygiene
That's right!
Addressing immediate functional impairments and activities of daily living is a primary focus when a client is unable to maintain basic hygiene.
A nurse is caring for a client who experienced a traumatic event 2 weeks ago. The client reports nightmares, avoids the location of the event, and feels emotionally numb. How should these findings be categorized?
A.Acute Stress Disorder
B.Adjustment Disorder
C.Generalized Anxiety Disorder
D.Posttraumatic Stress Disorder (PTSD)
A.
Acute Stress Disorder
Right answer
Acute Stress Disorder is diagnosed when PTSD-like symptoms occur within one month of a traumatic event.
A nurse is teaching a client who has a new prescription for alprazolam. Which of the following instructions should the nurse include?
A.This medication is safe to take during pregnancy.
B.Avoid consuming alcohol while taking this medication.
C.You can stop taking this medication as soon as your anxiety feels better.
D.Expect the medication to take 2-4 weeks to start working.
B.
Avoid consuming alcohol while taking this medication.
That's right!
Benzodiazepines and alcohol are both CNS depressants; taking them together significantly increases the risk of respiratory depression and over-sedation.
16 / 26
A client with Body Dysmorphic Disorder (BDD) is most likely to exhibit which of the following behaviors?
A.Excessive grooming or checking one's appearance in mirrors
.B.The intentional creation of physical symptoms to gain attention.
C.A fear of being in open spaces where escape might be difficult.
D.Accumulating large amounts of worthless items in the home.
A.
Excessive grooming or checking one's appearance in mirrors.
Right answer
BDD involves a preoccupation with perceived flaws in physical appearance, leading to repetitive behaviors like mirror checking.
List 4 mood stabilizer drugs
**HINT
c______
l_______
li____
va_____ a____
PG-1250
CARBAMAZEPINE( TEGRETOL)
LAMOTRIGINE (LAMICTAL)
LITHIUM (LITHIUM CARBONATE, LITHOBID, LITHIUM SR)
VALPORID ACID / DIVALPROEX SODIUM (DEPAKOTE, DEPAKENE)
A client with bipolar disorder has a lithium level of 1.8 . Which of the following actions should the nurse take first?
A.
Encourage the client to limit fluid intake for the next 4 hours.
B.
Document the finding as within the expected therapeutic range.
C.
Withhold the next dose and notify the provider immediately.
D.
Administer the next scheduled dose as prescribed.
C.
Withhold the next dose and notify the provider immediately.
That's right!
Lithium toxicity typically occurs at levels above 1.5 , requiring immediate cessation of the drug and medical intervention.
In Somatic Symptom Disorder, are the patient's physical symptoms real or manufactured?
The symptoms are ____ and not i________ produced.
The symptoms are real and not intentionally produced.
A nurse is assessing a client for possible neuroleptic malignant syndrome (NMS). Which of the following findings should the nurse recognize as a hallmark sign?
A.Restlessness and an urgent need to stay in motion.
B.Severe muscle rigidity and high fever.
C.Acute spasms of the neck and back muscles.
D.Involuntary tongue protrusion and lip smacking.
B.
Severe muscle rigidity and high fever.
Right answer
NMS is a medical emergency characterized by hyperpyrexia, lead-pipe muscle rigidity, and autonomic instability.
A nurse is caring for a client with borderline personality disorder who tells the nurse, 'You are the only person who actually cares about me. The night shift nurse is mean and incompetent.' The nurse should recognize this as which defense mechanism?
A.
Dissociation
B.
Reaction Formation
C.
Splitting
D.
Projection
C.
Splitting
Right answer
Splitting involves an inability to integrate positive and negative qualities of others, resulting in viewing people as either all good or all bad.
A nurse is assessing a client with schizophrenia who reports hearing voices telling him that the 'government is monitoring his thoughts.' How should the nurse document these findings?
A.
Negative symptoms and tactile hallucinations.
B.
Visual hallucinations and ideas of reference.
C.
Looseness of association and word salad.
D.
Auditory hallucinations and persecutory delusions.
D.
Auditory hallucinations and persecutory delusions.
Hearing non-existent voices is a sensory perception (hallucination), and believing one is being targeted or monitored is a false fixed belief (delusion).
A nurse is caring for a client who is observed repeatedly checking the locks on the doors and the knobs on the stove. The client states, 'If I don't do this, something terrible will happen to my family.' This behavior is characteristic of which condition?
A.
Panic Disorder
B.
Generalized Anxiety Disorder
C.
Obsessive-Compulsive Disorder
D.
Specific Phobia
C.
Obsessive-Compulsive Disorder
That's right!
Compulsions are repetitive behaviors performed to reduce anxiety associated with intrusive, distressing thoughts (obsessions).
How does Bipolar I Disorder differ from Bipolar II Disorder?
Bipolar I involves __ least ___ ____ episode, while Bipolar II involves m__ d______ alternating with h________.
Bipolar I involves at least one manic episode, while Bipolar II involves major depression alternating with hypomania.
Which laboratory value is most critical for the nurse to monitor in a client taking clozapine?
A. Serum amylase
B. White blood cell (WBC) count
C. Blood urea nitrogen (BUN)
D. Serum potassium level
B.
White blood cell (WBC) count
That's right!
Clozapine carries a risk of agranulocytosis, a dangerous drop in WBCs that makes the client highly susceptible to infection.
A client is admitted with symptoms of paralysis in both legs. Extensive medical testing reveals no neurological or physical cause. The client appears calm and unconcerned about the paralysis. Which condition is most likely?
hint**Note the presence of a specific functional deficit paired with an unusual lack of emotional distress.
A.Somatic Symptom Disorder
B.Conversion Disorder
C.Illness Anxiety Disorder
D.Factitious DisorderHint
B.
Conversion Disorder
Right answer
Conversion disorder involves neurological symptoms without a physical cause, often accompanied by 'la belle indifférence' (lack of concern about the symptom).