Meds
A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, "This medication isn't working. I don't feel any different." What is the best response by the nurse?
a. "I will call your care provider. Perhaps you need a different medication."
b. "Don't worry. You can try taking it at a different time of day to help it work better."
c. "It usually takes a few weeks for you to notice improvement from this medication."
d. "Your life is much better now. You will feel better soon."
a. "I will call your care provider. Perhaps you need a different medication."
A client with major depression is admitted to the psychiatric unit. What is the most important when assessing this client?
a. Amount of withdrawal
b. Self-destructive thoughts
c. Variations in mood
d. Type of sleep disturbance
b. Self-destructive thoughts
The nurse evaluates that a suspicious client is ready for discharge when the client:
a. Relates to others when rewarded
b. Communicates in a clear manner when relating to others
c. Speaks to others when they speak
d. Does not report any paranoid ideation
b. Communicates in a clear manner when relating to others
Asking for discharge criteria for a paranoid client. Communicating clearly is correct because disruptions in relationships is a major problem with the paranoid client. Relating to others when rewarded is manipulation of the relationship and is an unrealistic goal. Often the problem is not refusing to speak to others, but clarity of the message. Just because someone doesn't report paranoid ideation doesn't mean they are delusion free.
A woman is brought to the hospital by her husband. He found her roaming the neighborhood at 4 am asking people to sample her recipes. He tells the nurse that his wife has become increasingly agitated and energetic over the past two weeks. After admission to the psychiatric unit, the client shouts, "I am the greatest chef in the world. If you peasants are lucky, I may cook for you." The most appropriate room assignment the nurse could make for this client is a:
a. Room with soothing colors and no windows
b. Room near the nurses station for easy supervision by the staff
c. Semi-private room with a client with similar symptoms
d. Room with a television and radio for therapeutic distraction
b. Room near the nurses station for easy supervision by the staff
The physician prescribes morphine sulfate 2mg IV. The vial available contains 10 mg in 2 mL. How many mL should the nurse administer?
0.4 mL
Which diet choice would contraindicated for a client taking lithium carbonate?
a. Low salt ham, boiled potato and biscuit
b. Kielbasa, baked potato, Jell-o
c. Liver, mixed vegetables, ice cream
d. Broiled flounder, lima beans, sherbet
d. Broiled flounder, lima beans, sherbet
All other options are processed foods and are high in salt
A patient who has been diagnosed with depression is scheduled for cognitive therapy in addition to receiving prescribed antidepressant medication. The nurse understands that the goal of cognitive therapy will be met when what is reported by the patient?
a. "I will tell myself that I am a good person when things don't go well at work."
b. "My medications will make my problems go away."
c. "My family will help take care of my children while I am in the hospital."
d. "This therapy will improve my response to neurotransmitter impulses."
a. "I will tell myself that I am a good person when things don't go well at work."
Cognitive therapy helps patients restructure their patterns of thinking to various events or thoughts in a more healthy way. Medication alters neurotransmitters but does not make problems go away. Family support is important but is not the goal of cognitive therapy. Neurotransmitters are affected by medication and brain stimulation therapy, not by cognitive therapy.
A client, who recently returned from the warzone, tells the nurse, "You cannot possibly understand what I've been through. How can you help?" What would be the most therapeutic response by the nurse?
a. You sound angry. Can you tell me more about this?
b. The more you tell me about your experiences, the more I can understand them.
c. It must have been just horrible for you. You are right, I don't know what it was like.
d. I have had many clients experience traumatic events.
b. The more you tell me about your experiences, the more I can understand them.
She encourages the client to share his feelings about his experiences. This can help her to better understand him and build a rapport.
Option A is too vague. C increases the isolation feeling. D is defensive
A client who is experiencing mania refuses to sit and eat with clients at meal time. She states she "has places to go and people to see." What finger foods would be most appropriate for this client?
a. Carrot sticks, muffin, banana
b. Chicken strips, carton of milk, graham crackers
c. Bottle of cola, crackers and cheese cubes
d. Grapes, pretzel sticks, and a granola bar
b. Chicken strips, carton of milk, graham crackers
Although all the other options are finger foods and can be eaten on the run, none of the other options are high in protein. Option C also contains caffeine and should be avoided with mania.
A client with severe rheumatoid arthritis is prescribed 90mg of methylprednisolone acetate IM once a week. It is available in 125 mg/mL. How many mL should be given per dose. Round to the nearest tenth.
0.7 mL
A client who started lithium carbonate asks why they have to have their blood drawn all the time. What would the nurse include in teaching to the client? Select all that apply:
a. Lithium can adversely affect thyroid function
b. There is a narrow range between therapeutic and toxic levels of the drug in the blood
c. High doses of the drug can cause hypersexual behaviors
d. Blood lithium levels assure that the client is not taking any other drugs
e. Lithium levels can prove that the client has been compliant with dietary restrictions
a. Lithium can adversely affect thyroid function
b. There is a narrow range between therapeutic and toxic levels of the drug in the blood
Lithium is excreted by the kidneys and can have an adverse affect on the thyroid gland
A patient with a diagnosis of depression and suicidal ideation was started on an antidepressant 1 month ago. When the patient comes to the community health clinic for a follow-up appointment he is cheerful and talkative. What priority assessment must the nurse consider for this patient?
a. The medication dose needs to be decreased.
b. Treatment is successful, and medication can be stopped.
c. The patient is ready to return to work.
d. Specific assessment for suicide plan must be evaluated.
d. Specific assessment for suicide plan must be evaluated.
Energy levels increase as depression lifts; this may increase the risk of completing a suicide plan. An increase in mood would not indicate a decrease or discontinuation of prescribed medication. The patient may be ready to return to work, but assessment for suicide risk in a patient who has had suicidal ideation is the priority assessment.
In a client with expressive aphasia, the nurse should communicate by:
a. Speaking loudly and distinctly
b. Avoiding use of gestures
c. Presenting one idea at a time
d. Encouraging group participation
c. Presenting one idea at a time
They can be overwhelmed by more than one thought at a time
The nurse is caring for a client in the manic phase of bipolar disorder. What nursing actions are appropriate? Select all that apply: The nurse:
a. Encourages rest periods throughout the day
b. Teaches the client progressive relaxation exercises
c. Provides low protein finger foods throughout the day
d. Set limits on unsafe behavior
e. Suggest the client play chess with another client
a. Encourages rest periods throughout the day
b. Teaches the client progressive relaxation exercises
d. Set limits on unsafe behavior
Diet should be high protein; Patient will be unable to sit still and concentrate during the game and is also competitive and will bring out hostility and aggression.
The physician prescribes 2,700 mL of D5 0.25 NSS to infuse over 24 hours. How many mL will be given during an 8 hour shift?
900 mL
A patient who is taking prescribed lithium carbonate is exhibiting signs of diarrhea, blurred vision, frequent urination, and an unsteady gait. Which serum lithium level would the nurse expect for this patient?
a. 0 to 0.5 mEq/L
b. 0.6 to 0.9 mEq/L
c. 1.0 to 1.4 mEq/L
d. 1.5 or higher mEq/L
d. 1.5 or higher mEq/L
A nurse is caring for a depressed client. Which client behavior would warrant further investigation by the nurse? The client:
a. Starts to tell you he can see that his thinking is disturbed
b. Begins to verbalize his feelings of sadness and loneliness
c. Starts to plan a vacation for himself
d. Gives his baseball season tickets to his brother-in-law
d. Gives his baseball season tickets to his brother-in-law
Giving away prized items is a behavioral clue that the person doesn't intend to be around in the future. It is a sign of suicidal intent which should be addressed immediately by the nurse.
A patient newly diagnosed with depression states, "I have had other people in my family say that they have depression. Is this an inherited problem?" What is the nurse's best response?
a. "There are a lot of mood disorders that are caused by many different causes. Inheriting these disorders is not likely."
b. "Current research is focusing on fluid and electrolyte disorders as a cause for mood disorders."
c. "All of your family members raised in the same area have probably learned to respond to problems in the same way."
d. "Members of the same family may have the same biological predisposition to experiencing mood disorders."
d. "Members of the same family may have the same biological predisposition to experiencing mood disorders."
Research is showing a genetic or hereditary role in the predisposition of experiencing mood disorders. These tendencies can be inherited by family members. Fluid and electrolyte imbalances cause many problems, but neurotransmitters in the brain are more directly linked to mood disorders. Mood disorders are not a learned behavior, but are linked to neurotransmitters in the brain.
A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? SATA
a. Risk for caregiver strain
b. Impaired verbal communication
c. Risk for injury
d. Imbalanced nutrition, less than body requirements
e. Ineffective coping
f. Sleep deprivation
c. Risk for injury
d. Imbalanced nutrition, less than body requirements
f. Sleep deprivation
Risk for injury, poor nutrition, and impaired sleep are priority needs of the patient experiencing mania related to their impulsivity, inability to attend to activities of daily living such as diet and hygiene, and disruption of sleep. Caregiver strain is important to be addressed but is not a priority need on admission for the patient. Verbal communication improves when the mania is managed, and racing thoughts return to normal patterns. Ineffective coping will require stabilization of the acute phase along with cognitive therapy over time.
A client is prescribed 1000 mL D5W with 10 mEq of KCl over 8 hours. With a drop factor of 15, what is the current number of drops per minute?
31 drops per minute
hourly rate x drop factor / 60 min
(125 x 15) / 60 = 31
A nurse is conducting a teaching with a client being discharged on tranylcypromine (MAOI) for depression. What topics should the nurse include? Select all that apply:
a. risk of blood dyscrasias
b. low tyramine diet
c. importance of regular blood pressure monitoring
d. potential for addiction
e. potential medication interaction
f. adherence to low sodium diet
b. low tyramine diet (must be on tyramine restricted diet)
c. importance of regular blood pressure monitoring (at risk for htn crisis)
e. potential medication interaction (do not take other antidepressants)
As a nurse in the emergency department, you are caring for a patient who is exhibiting signs of depression. What is a priority nursing intervention you should perform for this patient?
a. Assess for depression and ask directly about suicide thoughts.
b. Ask the care provider to prescribe blood lab work to assess for depression.
c. Focus on the presenting problems and refer the patient for a mental health evaluation.
d. Interview the patient's family to identify their concerns about the patient's behavio
a. Assess for depression and ask directly about suicide thoughts.
Assessing directly for thoughts of harm to self or others is a priority intervention for any patient exhibiting signs of a mental health disorder. It is estimated that 50% of individuals who succeed in suicide had visited a health care provider within the previous 24 hours. Currently there is no serum lab that identifies depression. The risk of self-harm is a priority safety issue that is monitored in all health care within the scope of the nurse. It is important to obtain information directly from the patient when possible, and then validate the information from family or other secondary sources.
A client is being treated with systematic desensitization for his fear of riding buses. What helpful thoughts would the nurse share with the client? Select all that apply:
a. Tell the client that anxiety can be dangerous if left uncontrolled
b. Tell the client that all anxiety does eventually decrease
c. Ask the client why he believes he is afraid of riding a bus
d. Assure the client that repeated practice will make the exercise easier
e. Help the client understand that relaxation is incompatible with anxiety
b. Tell the client that all anxiety does eventually decrease
d. Assure the client that repeated practice will make the exercise easier
e. Help the client understand that relaxation is incompatible with anxiety
A- anxiety is uncomfortable but not life threatening; C- usually the client doesn't understand why he is experiencing the anxious feelings
A man is admitted to the psychiatric unit. He believes that his coworkers are plotting to remove him from his job and that they may be poisoning his food. He agreed to the admission because he would be safe from those people who are trying to hurt him. When interacting with the client, the nurse should:
a. Reassure him of his safety on the unit
b. Plan to meet several times for assessment
c. Assist him to become involved in a group activity
d. orient him to the unit and introduce him to other clients
b. Plan to meet several times for assessment
A-false assurance; C&D- overwhelming
A nurse is documenting I&O for her post operative client during the 3pm-11pm shift. The client consumed 2 cups of broth, 1/2 cup of gelatin, 8 oz glass of juice for dinner. He received a maintenance IV infusion of D5 0.5 NSS at a rate of 100 mL/hr. At 2pm his JP drained 130 mL of serosanguinous fluid that was described to be replaced 1/2 mL per mL of loss over four hours from 3pm-7pm with maintenance IV fluid. At 10pm, the nurse emptied the urinary catheter bag of 925 mL dark yellow urine. The JP was emptied of 90 mL serous fluid. How many mL did the client take in during the nurse's shift?
1,705 mL
They took in 840 mL orally. 865 mL parenterally (800 mL IV maintenance and 65 mL of replacement fluid - 130 mL x 1/2 mL = 65 mL) for a total input of 1705.