Good Luck, Charlie!
A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has been proven to be effective for hallucinating clients is to:
a. practice saying "go away" or "stop" when they hear voices
b. encourage them to go into their room until the voices go away
c. take a PRN dose of psychotropic medication whenever they hear voices
d. play loud music on the unit to drown out the voices
a. practice saying "go away" or "stop" when they hear voices
What are manifestations of opioid withdrawal? Select all that apply.
a. runny nose
b. teary eyes
c. fever
d. hot and cold sweats
e. low energy
runny nose, teary eyes, hot and cold sweats, low energy
The client with schizophrenia who receives fluphenazine develops pseudoparkinsonism and akathisia. What drug should the nurse administer to minimize EPS?
a. benztropine
b. dantrolene
c. clonazepam
d. diazepam
a. benztropine
read p. 279, table 17.9
For Pseudopark - give trihexyphenidyl or benztropine
For acute Dystonia - give dephenhyrdramine or benztropine IM
For Tardive Dyskinesia - STOP the drug and go to a new antipsychotic such as second-gens
What atypical antipsychotic medication has the highest potential for a client to experience serious side effects?
a. haloperidol
b. chlorpromazine
c. risperidone
d. clozapine
Side Note:
p. 47, Paliperidone is a metabolite of risperdone, used for schizophrenia and schizoaffective, 24 hour release through kidneys, (OROS) system, give in the AM, Invega Sustenna - q month deltoid or gluteal injection!
Which neurochemical influence is a probable cause of substance misuse?
a. imbalances of serotonin and norepinephrine
b. inhibition of GABA
c. excessive serotonin activity in the central nervous system
d. overstimulation of dopamine pathways in the brain
d. overstimulation of dopamine pathways in the brain; flood the circuit with dopamine!
page 314
Remember!!! Dopamine is the pleasure/reward "drug"!
A client receiving haloperidol complains of a stiff jaw and difficulty swallowing. The nurse's first action is to administer a dose of:
a. benztropine IM
b. risperidone PO
c. lorazepam IM
d. desvenlafaxine IM
a. benztropine IM
The nurse is assessing the client who has a diagnosis of schizophrenia. The client states, "we wanted to take the bus, but the airport took up all the traffic." Which charting entry accurately documents this assessment?
a. the client is experiencing associative looseness
b. the client is utilizing clang association
c. the client is communicating with neologisms
d. the client is experiencing an illusion involving airplanes
a. associative looseness
A client diagnosed with bipolar disorder has also been diagnosed with rapid cycling. The health care provider prescribes an anticonvulsant medication. Which drug would this most likely be?
a. clonidine
b. carbamazepine
c. phenytoin
d. chlorpromazine
b. carbamazepine
page 249, this works with rapid cycling. , mixed states. and acute mania
A client is prescribed quetiapine 50mg bid has a nursing dx of risk for injury related to sedation. Which nursing intervention is appropriate?
a. assess for homicidal/suicidal ideation
b. remove clutter from the room to prevent injury
c. monitor orthostatic changes in bp and pulse
d. evaluate for auditory and visual hallucinations
b. remove clutter
a. tolerance for two drugs in the same class
b. tolerance for more than two drugs
c. inability to tolerate all medications
d. tolerance to citalopram and sertraline
tolerance for two drugs in the same class and tolerance to citalopram and sertraline - both are SSRIs
To evaluate outcomes for a client with schizophrenia receiving typical antipsychotic drug therapy, the nurse should look for improvement in:
a. affective mobility
b. positive symptoms
c. self-care activities
d. cognitive functioning
b. positive symptoms
The client on the inpatient psych unit refuses to take medications because "the pill has a special code written on it that will make it poisonous." What kind of delusion is the client reporting?
a. an erotomanic delusion
b. a grandiose delusion
c. a persecutory delusion
d. a somatic delusion
c. a persecutory delusion
A nurse on an inpatient psych unit is caring for a client during an acute manic episode. Which meal would be best suited for this client?
a. spaghetti and meatballs with a cup of soup and pudding
b. hamburger with string beans and an apple
c. meatloaf with a salad and ice cream cup
d. grilled chicken caesar salad, corn, and pudding
b. hamburger with string beans and an apple
p. 246 - frequent, high-caloric protein such as milkshakes, finger foods, fruit, or sandwich.
Although anxiety is the usual response to stress, when people perceive that nothing can be done to change their situation, they are prone to depression. What theory does this thinking support?
a. learned helplessness theory
b. stress-diathesis theory
c. social isolation theory
d. interpersonal theory of depression
a. learned helplessness theory
page 211
An individual purposely produces symptoms, such as reporting neck pain after a car accident, even though they are not experiencing these symptoms, in order to claim insurance money. This is known as what?
a. factitous disorder
b. malingering
c. dissociative amnesia
d. dissociative fugue
b. malingering
When assessing a child with Autism, level 2, what behaviors should the nurse expect to observe?
a. child initiates social interactions
b. a noticeable deficit in both verbal and non-verbal social and communication skills
c. changing focus, action, or routine causes great distress
d. language and speech are normal
b. a noticeable deficit in both verbal and non-verbal social and communication skills
The nurse is conducting an educational session on major depression. Which factor will the nurse explain has a strong association with major depression?
a. being male
b. 50 years of age or older
c. first-degree relatives
d. environmental influences
c. first-degree relatives
If tardive dyskinesia starts being evident the nurse should do what? Select all that apply.
a. STOP the medication
b. give the valbenazine (Ingrezza) that MD ordered
c. watch for prolonged QT waves with valbenazine
d. do nothing as this is a normal reaction to antipsychotics
a, b, c
Chapter 17
A suicidal Jewish-American client is admitted to the inpatient unit two days after the death of a parent. Which intervention must the nurse include in the client's plan of care?
a. allow the client to mourn the loss during the time of Shiva
b. provide distractions and encourage activity in the milieu
c. teach the client coping skills for grief
d. discuss positive aspects of the clients life and focus on the future
a. allow the client to mourn the loss during the time of Shiva
Assessment data for a child shows blurting out answers to questions before the question is complete, and persistently interrupting and intruding on conversations of others. What type of behavior is this?
a. hyperactivity
b. impulsivity
c. inattention
d. defiance
b. impulsivity
Which type of history in the overall nursing assessment should be prioritized when caring for a client with a substance abuse concern?
a. psychosocial history
b. medical history
c. history of substance use
d. psychiatric history
c. history of substance use
A client who has admitted to an alcoholism rehab program says, "I'm just a social drinker. I usually have a drink or two at brunch, a few in the afternoon, wine at dinner, and several drinks in the evening." Which defense mechanism is the client using?
a. rationalization
b. introjection
c. projection
d. denial
d. denial
A client has been prescribed a tricyclic (take in the pm) antidepressant to treat major depressive disorder. What is a complication of TCAs?
a. urinary frequency
b. cardiotoxicity
c. excessive thirst
d. impaired hearing
b. cardiotoxicity
page 275, table 15.6
The nurse is monitoring a client for manifestations of ETOH withdrawal. Manifestations peak within which time period following alcohol cessation?
a. within 1 - 2 hours
b. 12 hours
c. within 24 - 48 hours
d. 5 - 7 days
c. within 24 - 48 hours
Know the chart in table 19.4
1-2 hours, VS go up
24 - 48 hours (early/minor), increased vitals and hand tremors
A child with ADHD will begin medication therapy. The nurse should prepare a plan to teach the family about with class of medications?
a. central nervous system stimulants
b. MAOIs
c. antipsychotics
d. anxiolytics
a. CNS stimulants