Me, Meds, Milieu
When considering environmental aspects of milieu management, which intervention has the highest priority for a client admitted after a failed suicide attempt?
A) Sending the client’s new medication prescriptions to the pharmacy
B) Assigning a staff member to one-on-one observation of the client
C) Orienting the client to the milieu’s public and private spaces
D) Having all potentially dangerous items removed from the client’s belongings
B) Assigning a staff member to one-on-one observation of the client
**Hidden Gem worth 300 if correct**
A nurse, preparing a community presentation, should include what information concerning the most accurate characterization of treatment of the mentally ill prior to the Period of Pre/Enlightenment?
A) Large public asylums provided custodial care.
B) Care for the mentally ill was more compassionate.
C) Care focused on reducing stress and meeting basic human needs.
D) Patients were often displayed for public amusement.
D) Patients were often displayed for public amusement.
Which patient would be most at risk for adverse reactions when administered a highly protein bound medication?
A) A 15-year-old adolescent athlete
B) A 76-year-old patient that is malnourished
C) A woman in the second trimester of pregnancy
D) An adult with a fractured femur from a sporting accident
B) A 76-year-old patient that is malnourished
A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The nurse should use which term to document these findings?
A) Dystonia
B) Akathisia
C) Dyskinesia
D) Bradykinesia
B) Akathisia
Considering potency, what should the nurse closely monitor a patient receiving a traditional high-potency antipsychotic medication for?
A) adrenergic effects.
B) extrapyramidal side effects.
C) anticholinergic side effects.
D) changes in pain perception.
B) extrapyramidal side effects.
When teaching about the monoamine oxidase inhibitor (MAOI) tranylcypromine, the nurse should consider it a priority to provide what information?
A) A list of tyramine-rich foods
B) A warning to avoid direct sunlight
C) Instructions to manage fever with acetaminophen
D) Directions to report dry mouth and blurred vision
A) A list of tyramine-rich foods
Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of which electrolyte?
A) Potassium
B) Chloride
C) Sodium
D) Magnesium
C) Sodium
A patient started diazepam 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. What phenomenon is responsible for this situation?
A) Addiction
B) Tolerance
C) Dependence
D) Disinhibition
B) Tolerance
The patient will report improvement in which area when taking valerian?
A) A lower stress level
B) Undisturbed sleep throughout the night
C) An increased interest in recreational activities
D) Awakening without an alarm clock in the morning
B) Undisturbed sleep throughout the night
Which statement forms the foundation upon which a nurse should base the implementation of psychotherapeutic management to the care of a patient with mental illness?
A) The nurse’s role in client care is supported by the multidisciplinary team.
B) Omitting any one component will compromise the effectiveness of the treatment.
C) The most important element of psychotherapeutic management is drug therapy.
D) A therapeutic nurse-patient relationship is the most important aspect of treatment.
B) Omitting any one component will compromise the effectiveness of the treatment.
A person says, “What mental health issues are a major concern for the general population.” The nurse’s reply should be based on what confirmed fact concerning mental health issues?
A) Bipolar disorder is a rare diagnosis among the general population.
B) A diagnosis of schizophrenia is rarely confirmed during the teenage years.
C) Major depression is very prevalent among the adult population.
D) Alcohol-related issues are minimal considering the entire adult population.
C) Major depression is very prevalent among the adult population.
A nurse assesses a newly hospitalized patient with a long history of serious and persistent mental illness. What is the priority assessment information should the nurse obtain to minimize any risk associated with medication safety?
A) Adverse reactions to drugs taken previously
B) History of drug compliance and noncompliance
C) Level of support available from significant others
D) Length of time on various psychotropic medications
A) Adverse reactions to drugs taken previously
A patient has taken perphenazine for a year. The nurse observes lip smacking and grinding teeth. Which tool should the nurse use to complete the client’s assessment?
A) AIMS
B) EPSE
C) SAD PERSONS
D) CAGE
A) AIMS
When assessing for a positive outcome to drug therapy with fluphenazine, the nurse would look primarily for improvement in which focus area?
A) Range of affect
B) Personal hygiene
C) Social interactions
D) Hallucinations
D) Hallucinations
A patient diagnosed with depression has taken a selective serotonin reuptake inhibitor (SSRI) for 1 month. The nurse should use direct questions to evaluate which potential side effect?
A) Aggressive impulses
B) Sexual dysfunction
C) Paranoid delusions
D) Weight gain
B) Sexual dysfunction
A patient has taken lithium 600 mg three times daily for 1 week. A laboratory result in which range shows that the desired serum lithium level was achieved?
A) 0.4 mEq/L
B) 0.8 mEq/L
C) 1.4 mEq/L
D) 2 mEq/L
B) 0.8 mEq/L
By what mechanism does lorazepam reduce anxiety?
A) Increasing serotonin levels
B) Blocking dopamine receptors
C) Depressing norepinephrine levels
D) Potentiating gamma-aminobutyric acid (GABA)
D) Potentiating gamma-aminobutyric acid (GABA)
A patient with which disorder would most likely benefit from taking St. John wort?
A) Suicidal depression
B) Hypomanic symptoms
C) Mild depressive symptoms
D) Panic disorder with agoraphobia
C) Mild depressive symptoms
Which statement most accurately describes a nurse’s role regarding psychopharmacology?
A) “You will need to frequently make decisions regarding the administration of PRN medications to help the client manage anger.”
B) “It’s a nursing responsibility to adjust a medication dose to assure effective patient responses.”
C) “Nurses administer medications while evaluating drug effectiveness is a medical responsibility.”
D) “To best assure appropriate response, a patient’s questions about drug therapy should be referred to the psychiatrist.”
A) “You will need to frequently make decisions regarding the administration of PRN medications to help the client manage anger.”
**Hidden Gem worth 600 if correct**
When a nurse working in a well-child clinic asks a parent’s address, the parent responds, “My children and I are homeless.” What assumption should the nurse make of this response?
A) It is a common occurrence, because 1 out of 50 children are homeless.
B) It signals a need to investigate the possibility that the parent has severe mental illness.
C) Confirms that evidence of child abuse or neglect that should be reported to social service agencies.
D) Suggests that the parent may have substance abuse problem.
A) It is a common occurrence, because 1 out of 50 children are homeless.
What is a realistic patient-focused outcome of patient teaching regarding psychotropic medications?
A) Understanding physiologic responses to drug therapy
B) Assessing effectiveness of prescribed drugs in controlling symptoms
C) Describing onset, peak, and duration of action of each drug prescribed.
D) Stating the purpose, dose, and significant side effects of each drug prescribed.
D) Stating the purpose, dose, and significant side effects of each drug prescribed.
A patient who has taken three doses of haloperidol suddenly cries out for help. The nurse observes that the patient’s eyes are rolled upward in a fixed gaze. The nurse should administer which drug from the patient’s PRN list?
A) Vitamin E
B) Carbidopa
C) Benztropine
D) Amantadine
C) Benztropine
A patient who takes a traditional antipsychotic medication says, “I feel shaky and very warm.” The patient is diaphoretic. What is the nurse’s best first action when suspecting that a patient is experiencing neuroleptic malignant syndrome (NMS)?
A) Take the patient’s vital signs.
B) Position the patient in the semi-Fowler position.
C) Begin oxygen by nasal cannula at 2 L/min.
D) Place the patient on one-to-one supervision.
A) Take the patient’s vital signs.
A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will significantly increase the availability of which neurotransmitter?
A) GABA
B) Glutamate
C) Serotonin
D) Norepinephrine
D) Norepinephrine
A patient’s serum lithium level is 1.8 mEq/L. What is the nurse’s priority action related to this evidence?
A) Restrict fluid intake.
B) Assess for signs of toxicity.
C) Encourage intake of high-potassium foods.
D) Ensure that the patient is swallowing the capsules.
B) Assess for signs of toxicity.
Which patient behavior should the nurse identify as the greatest risk for overdose with a benzodiazepine?
A) Taking the drug with antacids
B) Taking the drug before meals
C) Combining the drug with alcohol
D) Experiencing depression as well as anxiety
C) Combining the drug with alcohol
**Hidden Gem worth 600 if correct
A patient is prescribed donepezil for Alzheimer disease (AD). Vital signs for this patient are: temperature 98.2°F; blood pressure 135/82 mm Hg; pulse 54 beats/min; respirations 18 breaths/min. Which variance should the nurse consider most likely attributable to donepezil therapy?
A) Temperature
B) Blood pressure
C) Pulse rate
D) Respiratory rate
C) Pulse rate
A patient’s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessment question demonstrates the nurse’s understanding of the resulting needs of the client?
A) “Will you have any difficulty getting your prescription refilled?”
B) “Have you begun experiencing any forms of hallucinations?”
C) “What do you expect will occur since the dosage has been reduced?”
D) “What can I do to help you manage this reduction in haloperidol therapy?”
B) “Have you begun experiencing any forms of hallucinations?”
Which individual should the nurse assess as having the highest risk for homelessness?
A) An older adult woman with mild dementia who lives alone in an apartment
B) An adult with serious mental illness and no family
C) An adolescent with an eating disorder
D) A married person with alcoholism
B) An adult with serious mental illness and no family
A patient taking a psychotropic medication reports, “This medicine isn’t working right for me. It’s causing side effects.” Select the nurse’s best comment to further assess the scenario.
A) “Has the drug caused diaphoresis?”
B) “Have you experienced urinary retention?”
C) “Are you experiencing episodes of tachycardia?”
D) “Tell me more about how the medication is affecting you.”
D) “Tell me more about how the medication is affecting you.”
Which patient receiving fluphenazine should be monitored most closely for extrapyramidal side effects (EPSEs)?
A) 35-year-old man
B) 45-year-old woman
C) 74-year-old woman
D) Patient diagnosed with chronic schizophrenia
C) 74-year-old woman
During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, which aspect of physical assessment is most important?
A) Blood pressure, pulse, and respirations
B) Urinary output
C) Abnormal involuntary movements (AIMS scale)
D) Temperature
A) Blood pressure, pulse, and respirations
A 75-year-old patient with a long history of depression begins amitriptyline 100 mg/day. The patient also takes a diuretic daily for hypertension. What is the highest priority nursing diagnosis this patient is at risk for?
A) Falls related to dizziness and orthostatic hypotension.
B) Ineffective thermoregulation related to anhidrosis.
C)Infection related to suppressed white blood cell count.
D) Constipation related to slowed gastrointestinal peristalsis.
A) Falls related to dizziness and orthostatic hypotension.
A patient has taken lithium 300 mg three times daily for 1 week. The patient reports the presence of fine hand tremors and thirst. What is the nurse’s priority action to these assessment finding?
A) Increase sodium in the patient’s diet.
B) Immediately obtain a serum lithium level determination.
C) Comfort the patient that these effects will probably decrease over time.
D) Withhold the lithium until the patient no longer exhibits these side effects.
C) Comfort the patient that these effects will probably decrease over time.
A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse’s priority action?
A) Begin seizure precautions.
B) Refer the patient for addiction counseling.
C) Institute a behavior modification program.
D) Prepare to administer flumazenil.
A) Begin seizure precautions.
The family of a patient diagnosed with Alzheimer disease (AD) asks the nurse, “How can drugs help our parent?” Which reply provides the most realistic expectations for medication therapy?
A) “Unfortunately, drugs are not helpful.”
B) “Drugs are available to stop the disease process.”
C) “Drugs can help preserve mental abilities for a time.”
D) “We will teach you ways of helping your parent adjust.”
C) “Drugs can help preserve mental abilities for a time.”
What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder to community-based care? (Select all that apply.)
A) Need for PRN medication
B) Severity of the patient’s illness
C) Need for structured formal therapy
D) Presence of suicidal or homicidal ideation
E) Amount of supervision required by the patient
B) Severity of the patient’s illness
D) Presence of suicidal or homicidal ideation
E) Amount of supervision required by the patient
Which changes in psychiatric nursing practice are directly attributable to events occurring during the Decade of the Brain? (Select all that apply.)
A) Homeless shelters became practice sites.
B) Nurses upgraded knowledge of psychopharmacology.
C) Nurses provided psychoeducation to patients and families.
D) Nurses viewed psychiatric symptoms as resulting from brain irregularities.
E) Nurses were more likely to advocate for patients’ rights related to involuntary commitment.
B) Nurses upgraded knowledge of psychopharmacology.
C) Nurses provided psychoeducation to patients and families.
D) Nurses viewed psychiatric symptoms as resulting from brain irregularities.
**Hidden Gem worth 1000 if correct
An outpatient diagnosed with schizophrenia has been omitting doses of medication. Which questions should the clinic nurse ask to determine the reasons for the problem? (Select all that apply.)
A) “Are you experiencing any troublesome side effects?”
B) “Is the medicine affecting your sexual performance?”
C) “Does the medicine make you think slower?”
D) “Do you believe your dose is too low?”
E) “Do you believe you have an illness?”
All of the choices are correct
Which medication from a patient’s pharmacologic profile is most likely to precipitate neuroleptic malignant syndrome (NMS)?
A) Diphenhydramine
B) Risperidone
C) Haloperidol
D) Clozapine
C) Haloperidol
An adult diagnosed with schizophrenia was started on clozapine 4 days ago. At 2100 today, the patient’s vital signs are temperature 101°F; pulse 143 beats/min; respirations 20 breaths/min; blood pressure 100/60 mm Hg. What is the nurse’s best action regarding the 2100 dose of clozapine?
A) Recognize the alterations in vital signs as typical for early therapy and administer the medication.
B) Hold the medication and notify the health care provider.
C) Give the drug and continue to monitor vital signs every 4 hours.
D) Postpone the dose until vital signs are normal.
B) Hold the medication and notify the health care provider.
A patient diagnosed with depression is prescribed the tricyclic antidepressant (TCA) bupropion. What is the benefit of this medication for non-hospitalized patients?
A) It has antianxiety properties as well as antidepressant effects.
B) It lowers the seizure threshold to a lesser extent than TCAs.
C) There is reduced potential for lethal overdose.
D) It stimulates appetite and weight gain.
C) There is reduced potential for lethal overdose.
A patient diagnosed with mild lithium toxicity with a serum level of 1.6 mEq/L. Which assessment findings are most likely and will require nursing attention? (Select all that apply.)
A) Coarse hand tremor
B) Elevated white blood cell count
C) Dizziness
D) Facial tics
E) Coordination problems
A) Coarse hand tremor
C) Dizziness
E) Coordination problems
The teaching plan for a patient beginning Xanax (alprazolam) should include what instructions? (Select all that apply.)
A) Take the drug on an empty stomach.
B) Avoid discontinuing the drug abruptly.
C) Stop taking the drug if side effects occur.
D) Drink only moderate amounts of alcohol.
E) Avoid herbal preparations.
B) Avoid discontinuing the drug abruptly.
E) Avoid herbal preparations.
A patient reports frequent sleep disturbances. Which preparations could be considered to help improve the patient’s sleep pattern? (Select all that apply.)
A) Yohimbine
B) Vitamin C
C) Melatonin
D) Valerian
E) SAM-e
C) Melatonin
D) Valerian