Test Bank for Psychiatric-Mental Health Nursing, 8th Edition (Chapters 1-24)

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Page 11.The nurse is assessing the factors contributing to the well-being of a newlyadmittedclient. Which of the following would the nurse identify as having a positiveimpact onthe individual's mental health?A)Not needing others for companionshipB)The ability to effectively manage stressC)A family history of mental illnessD)Striving for total self-relianceAns: BFeedback:Individual factors influencing mental health include biologic makeup, autonomy,independence, self-esteem, capacity for growth, vitality, ability to find meaning in life,emotional resilience or hardiness, sense of belonging, reality orientation, and coping orstress management abilities. Interpersonal factors such as intimacy and a balance ofseparateness and connectedness are both needed for good mental health, and therefore ahealthy person would need others for companionship. A family history of mental illnesscould relate to the biologic makeup of an individual, which may have a negative impacton an individual's mental health, as well as a negative impact on an individual'sinterpersonal and socialñcultural factors of health. Total self-reliance is not possible,and a positive social/cultural factor is access to adequate resources.2.Which of the following statements about mental illness are true? Select all that apply.A)Mental illness can cause significant distress, impaired functioning, or both.B)Mental illness is only due to social/cultural factors.C)Social/cultural factors that relate to mental illness include excessive dependencyon or withdrawal from relationships.D)Individuals suffering from mental illness are usually able to cope effectively withdaily life.E)Individuals suffering from mental illness may experience dissatisfaction withrelationships and self.Ans:A, D, EFeedback:Mental illness can cause significant distress, impaired functioning, or both. Mentalillness may be related to individual, interpersonal, or social/cultural factors. Excessivedependency on or withdrawal from relationships are interpersonal factors that relate tomental illness. Individuals suffering from mental illness can feel overwhelmed withdaily life. Individuals suffering from mental illness may experience dissatisfaction withrelationships and self.Psychiatric-Mental Health Nursing 8th edition by Videbeck Test BankChapter 1

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Page 23.Which of the following are true regarding mental health and mental illness?A)Behavior that may be viewed as acceptable in one culture is always unacceptablein other cultures.B)It is easy to determine if a person is mentally healthy or mentally ill.C)In most cases, mental health is a state of emotional, psychological, and socialwellness evidenced by satisfying interpersonal relationships, effective behaviorand coping, positive self-concept, and emotional stability.D)Persons who engage in fantasies are mentally ill.Ans:CFeedback:What one society may view as acceptable and appropriate behavior, another society maysee that as maladaptive, and inappropriate. Mental health and mental illness are difficultto define precisely. In most cases, mental health is a state of emotional, psychological,and social wellness evidenced by satisfying interpersonal relationships, effectivebehavior and coping, positive self-concept, and emotional stability. Persons who engagein fantasies may be mentally healthy, but the inability to distinguish reality from fantasyis an individual factor that may contribute to mental illness.4.A client grieving the recent loss of her husband asks if she is becoming mentally illbecause she is so sad. The nurse's best response would be,A)ìYou may have a temporary mental illness because you are experiencing so muchpain.îB)ìYou are not mentally ill. This is an expected reaction to the loss you haveexperienced.îC)ìWere you generally dissatisfied with your relationship before your husband'sdeath?îD)ìTry not to worry about that right now. You never know what the future brings.îAns:BFeedback:Mental illness includes general dissatisfaction with self, ineffective relationships,ineffective coping, and lack of personal growth. Additionally the behavior must not beculturally expected. Acute grief reactions are expected and therefore not consideredmental illness. False reassurance or overanalysis does not accurately address the client'sconcerns.

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Page 35.The nurse consults the DSM for which of the following purposes?A)To devise a plan of care for a newly admitted clientB)To predict the client's prognosis of treatment outcomesC)To document the appropriate diagnostic code in the client's medical recordD)To serve as a guide for client assessmentAns:DFeedback:The DSM provides standard nomenclature, presents defining characteristics, andidentifies underlying causes of mental disorders. It does not provide care plans orprognostic outcomes of treatment. Diagnosis of mental illness is not within thegeneralist RN's scope of practice, so documenting the code in the medical record wouldbe inappropriate.6.Which would be a reason for a student nurse to use the DSM?A)Identifying the medical diagnosisB)Treat clientsC)Evaluate treatmentsD)Understand the reason for the admission and the nature of psychiatric illnesses.Ans:DFeedback:Although student nurses do not use the DSM to diagnose clients, they will find it ahelpful resource to understand the reason for the admission and to begin buildingknowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis,treating, and evaluating treatments are not a part of the nursing process.7.The legislation enacted in 1963 was largely responsible for which of the following shiftsin care for the mentally ill?A)The widespread use of community-based servicesB)The advancement in pharmacotherapiesC)Increased access to hospitalizationD)Improved rights for clients in long-term institutional careAns:AFeedback:The Community Mental Health Centers Construction Act of 1963 accomplished therelease of individuals from long-term stays in state institutions, the decrease inadmissions to hospitals, and the development of community-based services as analternative to hospital care.

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Page 48.Which one of the following is a result of federal legislation?A)Making it easier to commit people for mental health treatment against their will.B)Making it more difficult to commit people for mental health treatment againsttheir will.C)State mental institutions being the primary source of care for mentally ill persons.D)Improved care for mentally ill persons.Ans:BFeedback:Commitment laws changed in the early 1970s, making it more difficult to commitpeople for mental health treatment against their will. Deinstitutionalizationaccomplished the release of individuals from long-term stays in state institutions.Deinstitutionalization also had negative effects in that some mentally ill persons aresubjected to the revolving door effect, which may limit care for mentally ill persons.9.The goal of the 1963 Community Mental Health Centers Act was toA)ensure patients' rights for the mentally ill.B)deinstitutionalize state hospitals.C)provide funds to build hospitals with psychiatric units.D)treat people with mental illness in a humane fashion.Ans:BFeedback:The 1963 Community Mental Health Centers Act intimated the movement towardtreating those with mental illness in a less restrictive environment. This legislationresulted in the shift of clients with mental illness from large state institutions to carebased in the community. Answer choices A, C, and D were not purposes of the 1963Community Mental Health Centers Act.10.The creation of asylums during the 1800s was meant toA)improve treatment of mental disorders.B)provide food and shelter for the mentally ill.C)punish people with mental illness who were believed to be possessed.D)remove dangerous people with mental illness from the community.Ans:BFeedback:The asylum was meant to be a safe haven with food, shelter, and humane treatment forthe mentally ill. Asylums were not used to improve treatment of mental disorders or topunish mentally ill people who were believed to be possessed. The asylum was notcreated to remove the dangerously mentally ill from the community.

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Page 511.The major problems with large state institutions are: Select all that apply.A)attendants were accused of abusing the residents.B)stigma associated with residence in an insane asylum.C)clients were geographically isolated from family and community.D)increasing financial costs to individual residents.Ans:A, CFeedback:Clients were often far removed from the local community, family, and friends becausestate institutions were usually in rural or remote settings. Choices B and D were notmajor problems associated with large state instructions.12.A significant change in the treatment of people with mental illness occurred in the 1950swhenA)community support services were established.B)legislation dramatically changed civil commitment procedures.C)the Patient's Bill of Rights was enacted.D)psychotropic drugs became available for use.Ans:DFeedback:The development of psychotropic drugs, or drugs used to treat mental illness, began inthe 1950s. Answer choices A, B, and C did not occur in the 1950s.13.Before the period of the enlightenment, treatment of the mentally ill includedA)creating large institutions to provide custodial care.B)focusing on religious education to improve their souls.C)placing the mentally ill on display for the public's amusement.D)providing a safe refuge or haven offering protection.Ans:CFeedback:In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing andridiculing the mentally ill, who were seen as animals, less than human. Custodial carewas not often provided as persons who were considered harmless were allowed towander in the countryside or live in rural communities, and more dangerous lunaticswere imprisoned, chained, and starved. In early Christian times, primitive beliefs andsuperstitions were strong. The mentally ill were viewed as evil or possessed. Priestsperformed exorcisms to rid evil spirits, and in the colonies, witch hunts were conductedwith offenders burned at the stake. It was not until the period of enlightenment whenpersons who were mentally ill were offered asylum as a safe refuge or haven offeringprotection at institutions.

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Page 614.The first training of nurses to work with persons with mental illness was in 1882 inwhich state?A)CaliforniaB)IllinoisC)MassachusettsD)New YorkAns:CFeedback:The first training for nurses to work with persons with mental illness was in 1882 atMcLean Hospital in Belmont, Massachusetts.15.What is meant by the term ìrevolving door effectî in mental health care?A)An overall reduction in incidence of severe mental illnessB)Shorter and more frequent hospital stays for persons with severe and persistentmental illnessC)Flexible treatment settings for mentally illD)Most effective and least expensive treatment settingsAns:BFeedback:The revolving door effect refers to shorter, but more frequent, hospital stays. Clients arequickly discharged into the community where services are not adequate; withoutadequate community services, clients become acutely ill and require rehospitalization.The revolving door effect does not refer to flexible treatment settings for mentally ill.Even though hospitalization is more expensive than outpatient treatment, if utilizedappropriately could result in stabilization and less need for emergency department visitsand/or rehospitalization. The revolving door effect does not relate to the incidence ofsevere mental illness.

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Page 716.Which of the following statements is true of treatment of people with mental illness inthe United States today?A)Substance abuse is effectively treated with brief hospitalization.B)Financial resources are reallocated from state hospitals to community programsand support.C)Only 25% of people needing mental health services are receiving those services.D)Emergency department visits by persons who are acutely disturbed are declining.Ans:CFeedback:Only one in four (25%) adults needing mental health care receives the needed services.Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions inthe current managed care environment. Money saved by states when state hospitals wereclosed has not been transferred to community programs and support. Although peoplewith severe and persistent mental illness have shorter hospital stays, they are admitted tohospitals more frequently. In some cities, emergency department visits for acutelydisturbed persons have increased by 400% to 500%.17.Which of the following is the priority of the Healthy People 2020 objectives for mentalhealth?A)Improved inpatient careB)Primary prevention of emotional problemsC)Stress reduction and managementD)Treatment of mental illnessAns:DFeedback:The objectives are to increase the number of people who are identified, diagnosed,treated, and helped to live healthier lives. The objectives also strive to decrease rates ofsuicide and homelessness, to increase employment among those with serious mentalillness, and to provide more services both for juveniles and for adults who areincarcerated and have mental health problems. Answer choices A, B, and C are notpriorities of Healthy People 2020.

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Page 818.Which is a positive aspect of treating clients with mental illness in a community-basedcare?A)ìYou will not be allowed to go out with your friends while in the program.îB)ìYou will have to have supervision when you want to go anywhere else in thecommunity.îC)ìYou will be able to live in your own home while you still see a therapistregularly.îD)ìYou will have someone in your home at all times to ask questions if you have anyconcerns.îAns:CFeedback:Clients can remain in their communities, maintain contact with family and friends, andenjoy personal freedom that is not possible in an institution. Full-time home care is notincluded in community-based programs.19.One of the unforeseen effects of the movement toward community mental healthservices isA)fewer clients suffering from persistent mental illnesses.B)an increased number of hospital beds available for clients seeking treatment.C)an increased number of admissions to available hospital services.D)Longer hospital stays for people needing mental health services.Ans:CFeedback:Although people with severe and persistent mental illness have shorter hospital stays,they are admitted to hospitals more frequently. Although deinstitutionalization reducedthe number of public hospital beds by 80%, the number of admissions to those bedscorrespondingly increased by 90%. The number of individuals with mental illness didnot change.20.Which is included in Healthy People 2020 objectives?A)To decrease the incidence of mental illnessB)To increase the number of people who are identified, diagnosed, treated, andhelped to live healthier livesC)To provide mental health services only in the communityD)To decrease the numbers of people who are being treated for mental illnessAns:BFeedback:One of the Healthy People 2020 objectives is to increase the number of people who areidentified, diagnosed, treated, and helped to live healthier lives. It may not be possible todecrease the incidence of mental illness. At this time, the focus is on ensuring thatpersons with mental illness are receiving needed treatment. It may not be possible ordesirable to provide mental health services only in the community.

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Page 921.A client diagnosed with a mild anxiety disorder has been referred to treatment in acommunity mental health center. Treatment most likely provided at the center includesA)medical management of symptoms.B)daily psychotherapy.C)constant staff supervision.D)psychological stabilization.Ans:AFeedback:Community mental health centers focus on rehabilitation, vocational needs, education,and socialization, as well as on management of symptoms and medication. Dailytherapies, constant supervision, and stabilization require a more acute care inpatientsetting.22.Which of the following is defined as an advanced-level function in the practice area ofpsychiatric mental health nursing?A)Case managementB)CounselingC)EvaluationD)Health teachingAns:CFeedback:Advanced-level functions are psychotherapy, prescriptive authority, consultation andliaison, evaluation, and program development and management. Case management,counseling, and health teaching are basic-level functions in the practice area ofpsychiatric mental health nursing.23.Psychiatric nursing became a requirement in nursing education in which year?A)1930B)1940C)1950D)1960Ans:CFeedback:It was not until 1950 that the National League for Nursing, which accredits nursingprograms, required schools to include an experience in psychiatric nursing.

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Page 1024.A new graduate nurse has accepted a staff position at an inpatient mental health facility.The graduate nurse can expect to be responsible for basic-level functions, includingA)providing clinical supervision.B)using effective communication skills.C)adjusting client medications.D)directing program development.Ans:BFeedback:Basic-level functions include counseling, milieu therapy, self-care activities,psychobiologic interventions, health teaching, case management, and health promotionand maintenance. Advanced-level functions include psychotherapy, prescriptiveauthority for drugs, consultation and liaison, evaluation, program development andmanagement, and clinical supervision.25.Which one of the following is one of the American Nurses Association standards ofpractice for psychiatricñmental health nursing?A)Prescriptive authority is granted to psychiatricñmental health registered nurses.B)All aspects of Standard 5: Implementation may be carried out bypsychiatricñmental health registered nurses.C)Some aspects of Standard 5: Implementation may only be carried out bypsychiatricñmental health advanced practice nurses.D)Psychiatricñmental health advanced practice nurses are the only ones who mayprovide milieu therapy.Ans:CFeedback:Prescriptive authority is used by psychiatricñmental healthadvanced practiceregisterednurses in accordance with state and federal laws and regulations. Standards 5DñGareadvanced practice interventions and may be performed only by the psychiatricñmentalhealth advanced practice registered nurse. Psychiatricñmental health registered nursesmay provide milieu therapy according to Standard 5C. This is not restricted topsychiatricñmental health advanced practice nurses.

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Page 1126.Which of the following is a standard of professional performance?A)AssessmentB)EducationC)PlanningD)ImplementationAns:BFeedback:Education is a standard of professional performance. Other standards of professionalperformance include the quality of practice, professional practice evaluation,collegiality, collaboration, ethics, research, resource utilization, and leadership.Assessment, planning, and implementation are components of the nursing process, notstandards of professional performance.27.Which of the following is a standard of practice?A)Quality of careB)Outcome identificationC)CollegialityD)Performance appraisalAns:BFeedback:Standards of practice include assessment, diagnosis, outcomes identification, planning,implementation, coordination of care, health teaching and health promotion, and milieutherapy. The standards of professional performance include quality of practice,education, professional practice evaluation, collegiality, collaboration, ethics, research,resource utilization, and leadership.

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Page 1228.A student appears very nervous on the first day of clinical in a psychiatric setting. Thestudent reviews the instructor's guidelines and appropriately takes which of thefollowing actions? Select all that apply.A)Tells the client about personal events and interestsB)Discusses the anxious feelings with the instructorC)Assumes that the client's unwillingness to talk to a student nurse is a personalinsult or failureD)Builds rapport with the patient before asking personal questionsE)Consults the instructor if a shocking situation arisesF)Gravitates to clients that the student may know personallyAns:B, D, EFeedback:Listening carefully, showing genuine interest, and caring about the client are extremelyimportant rather than speaking about oneself. The student must deal with his or her ownanxiety about approaching a stranger to talk about very sensitive and personal issues.Student nurses should not see the client's unwillingness to talk to a student nurse as apersonal insult or behavior. Being available and willing to listen are often all it takes tobegin a significant interaction with someone. Questions involving personal mattersshould not be the first thing a student says to the client. These issues usually arise aftersome trust and rapport have been established. The nursing instructor and staff arealways available to assist if the client is shocking or distressing to the student. If thestudent recognizes someone he or she knows, it is usually best for the student to talkwith the client and reassure him or her about confidentiality. The client should bereassured that the student will not read the client's record and will not be assigned towork with the client.29.The appropriate action for a student nurse who says the wrong thing is toA)pretend that the student nurse did not say it.B)restate it by saying, ìThat didn't come out right. What I meant was...îC)state that it was a joke.D)ignore the error, since no one is perfect.Ans:BFeedback:No one magic phrase can solve a client's problems; likewise, no single statement cansignificantly worsen them. Listening carefully, showing genuine interest, and caringabout the client are extremely important. A nurse who possesses these elements but sayssomething that sounds out of place can simply restate it by saying, ìThat didn't come outright. What I meant wasÖî Pretending that the student nurse did not say it, stating that itwas a joke, and ignoring the error are not likely to help the student nurse build andmaintain credibility with the client.

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Page 11.Chapter 2.The nurse is assessing a patient suffering a head injury as a result of analtercation withtwo other individuals. The patient has difficulty accurately reporting theevents of thealtercation and appears very emotional during the assessment. The nursesuspects whichpart of the brain received the greatest amount of injury?A)CerebrumB)CerebellumC)MedullaD)AmygdalaAns: AFeedback:The frontal lobes of the cerebrum control the organization of thought, body movement,memories, emotions, and moral behavior. The cerebellum is located below the cerebrumand is the center for coordination of movements and postural adjustments. The medulla,located at the top of the spinal cord, contains vital centers for respiration andcardiovascular functions. The hippocampus and amygdala are involved in emotionalarousal and memory.2.An abnormality of which of the following structures of the cerebrum would beassociated with schizophrenia?A)Parietal lobesB)Frontal lobeC)Occipital lobeD)Temporal lobesAns: BFeedback:Abnormalities in the frontal lobes are associated with schizophrenia, attention deficithyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations oftaste and touch and assist in spatial orientation. The temporal lobes are centers for thesenses of smell and hearing and for memory and emotional expression. The occipitallobe assists in coordinating language generation and visual interpretation, such as depthperception.

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Page 23.A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't want tobe sick.î The nurse would best respond with,A)ìPeople who develop mental illnesses often had very traumatic childhoodexperiences.îB)ìThere is some evidence that contracting a virus during childhood can lead tomental disorders.îC)ìSometimes people with mental illness have an overactive immune system.îD)ìWe don't fully understand the cause, but mental illnesses do seem to run infamilies.îAns:DFeedback:Current theories and studies indicate that several mental disorders may be linked to aspecific gene or combination of genes, but that the source is not solely genetic;nongenetic factors also play important roles. A compromised immune system couldcontribute to the development of a variety of illnesses, particularly in populationsalready genetically at risk. Maternal exposure to a virus during critical fetaldevelopment of the nervous system may contribute to mental illness.4.Which of the following statements about the neurobiologic causes of mental illness ismost accurate?A)Genetics and heredity can explain all causes of mental illness.B)Viral infection has been proven to be the cause of schizophrenia.C)There is no evidence that the immune system is related to mental illness.D)Several mental disorders may be linked to genetic and nongenetic factors.Ans:DFeedback:Current theories and studies indicate that several mental disorders may be linked to aspecific gene or combination of genes, but that the source is not solely genetic;nongenetic factors also play important roles. Most studies involving viral theories havefocused on schizophrenia, but so far none has provided specific or conclusive evidence.A compromised immune system could contribute to the development of a variety ofillnesses, particularly in populations already genetically at risk. So far, efforts to link aspecific stressor with a specific disease have been unsuccessful. When the inflammatoryresponse is critically involved in illnesses such as multiple sclerosis or lupuserythematosus, mood dysregulation and even depression are common.

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Page 35.Which of the following is an inhibitory neurotransmitter?A)DopamineB)GABAC)NorepinephrineD)EpinephrineAns:BFeedback:GABA is the major inhibitory neurotransmitter in the brain and has been found tomodulate other neurotransmitter systems rather than to provide a direct stimulus.Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.6.Which of the following is a neuromodulator?A)NeuropeptidesB)GlutamateC)DopamineD)GABAAns:AFeedback:Neuropeptides are neuromodulators. Glutamate and dopamine are excitatoryneurotransmitters. GABA is an inhibitory neurotransmitter.7.A nurse is leading a medication education group for patients with depression. A patientstates he has read that herbal treatments are just as effective as prescription medications.The best response is,A)ìWhen studies are published they can be trusted to be accurate.îB)ìWe need to look at the research very closely to see how reliable the studies are.îC)ìYour prescribed medication is the best for your condition, so you should not readthose studies.îD)ìSwitching medications will alter the course of your illness. It is not advised.îAns:BFeedback:Often, reports in the media regarding new research and studies are confusing,contradictory, or difficult for clients and their families to understand. The nurse mustensure that clients and families are well informed about progress in these areas and mustalso help them to distinguish between facts and hypotheses. The nurse can explain if orhow new research may affect a client's treatment or prognosis. The nurse is a goodresource for providing information and answering questions.

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Page 48.The nurse is preparing a patient for an MRI scan of the head. The nurse should ask thepatient,A)ìHave you ever had an allergic reaction to radioactive dye?îB)ìHave you had anything to eat in the last 24 hours?îC)ìDoes your insurance cover the cost of this scan?îD)ìAre you anxious about being in tight spaces?îAns:DFeedback:The person undergoing an MRI must lie in a small, closed chamber and remainmotionless during the procedure, which takes about 45 minutes. Those who feelclaustrophobic or have increased anxiety may require sedation before the procedure.PET scans require radioactive substances to be injected into the bloodstream. A patientis not required to fast before brain imaging studies. Verifying insurance benefits is not aprimary role of the nurse.9.How should the nurse respond to a family member who asks how Alzheimer's disease isdiagnosed?A)It is impossible to know for certain that a person has Alzheimer's disease until theperson dies and his or her brain can be examined via autopsy.B)Positron emission tomography (PET) scans can identify the amyloid plaques andtangles of Alzheimer's disease in living clients.C)Alzheimer's disease can be diagnosed by using chemical markers that demonstratedecreased cerebral blood flow.D)It will be necessary for the patient to undergo positron emission tomography(PET) scans regularly for a long period of time to know if the patient hasAlzheimer's disease.Ans:BFeedback:Positron emission tomography (PET) scans can identify the amyloid plaques and tanglesof Alzheimer's disease in living clients. These conditions previously could be diagnosedonly through autopsy. Some persons with schizophrenia also demonstrate decreasedcerebral blood flow. A limitation of PET scans is that the use of radioactive substanceslimits the number of times a person can undergo these tests.

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Page 510.A patient is being seen in the crisis unit reporting that poison letters are coming in themail. The patient has no history of psychiatric illness. Which of the followingmedications would the patient most likely be started on?A)Aripiprazole (Abilify)B)Risperidone (Risperdal Consta)C)Fluphenazine (Prolixin)D)Fluoxetine (Prozac)Ans:AFeedback:New-generation antipsychotics are preferred over conventional antipsychotics becausethey control symptoms without some of the side effects. Injectable antipsychotics, suchas Risperdal Consta, are indicated after the client's condition is stabilized with oraldoses of these medications. Prozac is an antidepressant and is not indicated to relieve ofpsychotic symptoms.11.Which one of the following types of antipsychotic medications is most likely to produceextrapyramidal effects?A)Atypical antipsychotic drugsB)First-generation antipsychotic drugsC)Third-generation antipsychotic drugsD)Dopamine system stabilizersAns:BFeedback:The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2,D3, and D4. This makes them effective in treating target symptoms but also producesmany extrapyramidal side effects because of the blocking of the D2 receptors. Newer,atypical or second-generation antipsychotic drugs are relatively weak blockers of D2,which may account for the lower incidence of extrapyramidal side effects. The thirdgeneration of antipsychotics, called dopamine system stabilizers, is being developed.These drugs are thought to stabilize dopamine output that results in control of symptomswithout some of the side effects of other antipsychotic medications.

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Page 612.A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily.The patient asks the nurse how this medicine works. The nurse explains that themechanism by which the olanzapine controls the patient's psychotic symptoms isbelieved to beA)increasing the amount of serotonin and norepinephrine in the brain.B)decreasing the amount of an enzyme that breaks down neurotransmitters.C)normalizing the levels of serotonin, norepinephrine, and dopamine.D)blocking dopamine receptors in the brain.Ans:DFeedback:The major action of all antipsychotics in the nervous system is to block receptors for theneurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotoninand norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaksdown neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitterssuch as serotonin, norepinephrine, acetylcholine, and dopamine.13.A patient with depression has been taking paroxetine (Paxil) for the last 3 months andhas noticed improvement of symptoms. Which of the following side effects would thenurse expect the patient to report?A)A headache after eating wine and cheeseB)A decrease in sexual pleasure during intimacyC)An intense need to move aboutD)Persistent runny noseAns:BFeedback:Sexual dysfunction can result from enhanced serotonin transmission associated withSSRI use. Headache caused by hypertension can result when combining MAOIs withfoods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs causeless weight gain than other antidepressants. Dry mouth and nasal passages are commonanticholinergic side effects associated with all antidepressants. An intense need to moveabout (akathisia) is an extrapyramidal side effect that would be expected of anantipsychotic medication. Furthermore, sedation is a common side effect of Paxil.

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Page 714.Which one of the following drugs should the nurse expect the patient to require serumlevel monitoring?A)AnticonvulsantsB)WellbutrinC)LithiumD)ProzacAns:CFeedback:Toxicity is closely related to serum lithium levels and can occur at therapeutic doses.For clients taking lithium and the anticonvulsants, monitoring blood levels periodicallyis important.15.Which of the following disorders are extrapyramidal symptoms that may be caused byantipsychotic drugs? Select all that apply.A)AkathisiaB)PseudoparkinsonismC)Neuroleptic malignant syndromeD)DystoniaE)Anticholinergic effectsF)Breast tenderness in men and womenAns:A, B, DFeedback:Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia.Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is anidiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breasttenderness in men and women is also a potential side effect of antipsychotic drugs thatcause elevated prolactin levels, but it is not an extrapyramidal symptom.16.Which of the following antidepressant drugs is a preferred drug for clients at high riskof suicide?A)Tranylcypromine (Parnate)B)Sertraline (Zoloft)C)Imipramine (Tofranil)D)Phenelzine (Nardil)Ans:BFeedback:SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those whoare potentially suicidal or highly impulsive because they carry no risk of lethaloverdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil areMAOIs. Tofranil is a cyclic compound.

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Page 817.The nurse knows that the client understands the rationale for dietary restrictions whentaking MAOI when the client makes which of the following statements?A)ìI am now allergic to foods that are high in the amino acid tyramine such as agedcheese, organ meats, wine, and chocolate.îB)ìCertain foods will cause me to have sexual dysfunction when I take thismedication.îC)ìFoods that are high in tyramine will reduce the medication's effectiveness.îD)ìI should avoid foods that are high in the amino acid tyramine such as agedcheese, meats, and chocolate because this drug causes the level of tyramine to goup to dangerous levels.îAns:DFeedback:Because the enzyme MAO is necessary to break down the tyramine in certain foods, itsinhibition results in increased serum tyramine levels, causing severe, hypertension,hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias.Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a commonside effect of MAOIs. There is no evidence that foods high in tyramine will increasesexual dysfunction or reduce the medication's effectiveness.18.A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseatedsince beginning the medication. Which of the following actions is indicated initially?A)Instruct the client to stop the medication for a few days to see if the nausea goesaway.B)Reassure the client that this is an expected side effect that will improve with time.C)Suggest that the client take the medication with food.D)Tell the client to contact the physician for a change in medication.Ans:CFeedback:Taking selective serotonin reuptake inhibitors with food usually eliminates nausea.There is a delayed therapeutic response to antidepressants. The client should not stoptaking the drug. It would be appropriate to reassure the client that this is an expectedside effect that will improve with time, but that would not be done initially. A change inmedication may be indicated if the nausea is intolerable or persistent, but that would notbe done initially.

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Page 919.In planning for a client's discharge, the nurse must know that the most serious risk forthe client taking a tricyclic antidepressant is which of the following?A)HypotensionB)Narrow-angle glaucomaC)SeizuresD)Suicide by overdoseAns:DFeedback:Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if takenin an overdose. The cyclic antidepressants block cholinergic receptors, resulting inanticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention,dry nasal passages, and blurred near vision. More severe anticholinergic effects such asagitation, delirium, and ileus may occur, particularly in older adults. Other common sideeffects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clientsmay develop tolerance to anticholinergic effects (such as orthostatic hypotension andworsening of narrow-angle glaucoma, but these side effects are common reasons thatclients discontinue drug therapy. The risk of seizures is increased by bupropion, whichis a different type of antidepressant.20.A client with severe and persistent mental illness has been taking antipsychoticmedication for 20 years. The nurse observes that the client's behavior includes repetitivemovements of the mouth and tongue, facial grimacing, and rocking back and forth. Thenurse recognizes these behaviors as indicative ofA)extrapyramidal side effectsB)loss of voluntary muscle controlC)posturingD)tardive dyskinesiaAns:DFeedback:The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, asyndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversiblemovement disorders induced by antipsychotic or neuroleptic medication. The client'sbehavior is not a loss of voluntary control or posturing.

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Page 1021.A client is seen in the clinic with clinical manifestations of an inability to sit still and arigid posture. These side effects would be correctly identified as which of the following?A)Tardive dyskinesiaB)Neuroleptic malignant syndromeC)DystoniaD)AkathisiaAns:DFeedback:Akathisia is reported by the client as an intense need to move about. The client appearsrestless or anxious and agitated, often with a rigid posture or gain and a lack ofspontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntarymovements of the tongue, facial and neck muscles, upper and lower extremities, andtruncal musculature. Tongue thrusting and protruding, lip smacking, blinking,grimacing, and other excessive unnecessary facial movements are characteristic.Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity,high fever, and autonomic instability. Acute dystonia includes acute muscular rigidityand cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases,laryngospasm and respiratory difficulties.22.Which of the following is a term used to describe the occurrence of the eye rolling backin a locked position, which occurs with acute dystonia?A)OpisthotonusB)Oculogyric crisisC)TorticollisD)PseudoparkinsonismAns:BFeedback:Oculogyric crisis is the occurrence of the eye rolling back in a locked position, whichoccurs with acute dystonia. Opisthotonus is tightness in the entire body with the headback and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis,opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism isdrug-induced parkinsonism and is often referred to by the generic label ofextrapyramidal side effects.

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Page 1123.Which of the following medications rarely causes extrapyramidal side effects (EPS)?A)Ziprasidone (Geodon)B)Chlorpromazine (Thorazine)C)Haloperidol (Haldol)D)Fluphenazine (Prolixin)Ans:AFeedback:First-generation antipsychotic drugs cause a greater incidence of EPS than do atypicalantipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol,and Prolixin are all first-generation antipsychotic drugs.24.Which of the following increases the risk for neuroleptic malignant syndrome (NMS)?A)OverhydrationB)Intake of vitaminsC)DehydrationD)Vegetarian dietAns:CFeedback:Dehydration, poor nutrition, and concurrent medical illness all increase the risk forNMS. Overhydration is opposite of dehydration and would therefore not increase therisk of NMS. Intake of vitamins would likely reduce the risk of NMS as it wouldimprove nutritional status. Vegetarian diet would not relate to NMS.25.Which of the following was the first nonstimulant medication specifically designed andtested for ADHD?A)Methylphenidate (Ritalin)B)Amphetamine (Adderall)C)Atomoxetine (Strattera)D)Pemoline (Cylert)Ans:CFeedback:Strattera was the first nonstimulant medication specifically designed and tested forADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin),amphetamine (Adderall), and pemoline (Cylert).

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Page 1226.Which of the following is the primary consideration with clients taking antidepressants?A)Decreased mobilityB)Emotional changesC)SuicideD)Increased sleepAns:CFeedback:Suicide is always a primary consideration when treating clients with depression.27.Which of the following would not be included as a symptom of drug-inducedparkinsonism?A)Stooped postureB)Cogwheel rigidityC)DroolingD)TachycardiaAns:DFeedback:Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are allsymptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism includemask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarsepill-rolling movements of the thumb and fingers while at rest.28.Which drug classification is the primary medication treatment for schizophrenia?A)AnticoagulantsB)AntidepressantsC)AntimanicsD)AntipsychoticsAns:DFeedback:Antipsychotic drugs are the primary medical treatment for clients diagnosed withschizophrenia and are also used in psychotic episodes of acute mania, psychoticdepression, and drug-induced psychosis.

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Page 1329.A client on the unit suddenly cries out in fear. The nurse notices that the client's head istwisted to one side, his back is arched, and his eyes have rolled back in their sockets.The client has recently begun drug therapy with haloperidol (Haldol). Based on thisassessment, the first action of the nurse would be toA)get a stat. order for a serum drug level.B)hold the client's medication until the symptoms subside.C)place an urgent call to the client's physician.D)give a PRN dose of benztropine (Cogentin) IM.Ans:DFeedback:The client is having an acute dystonic reaction; the treatment is anticholinergicmedication. Dystonia is most likely to occur in the first week of treatment, in clientsyounger than 40 years, in males, and in those receiving high-potency drugs such asHaldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.30.One week after beginning therapy with thiothixene (Navane), the client demonstratesmuscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinaselevel, stupor, and incontinence. The nurse should notify the physician because thesesymptoms are indicative ofA)acute dystonic reaction.B)extrapyramidal side effects.C)neuroleptic malignant syndrome.D)tardive dyskinesia.Ans:CFeedback:The client demonstrates all the classic signs of neuroleptic malignant syndrome.Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue withdifficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.Extrapyramidal side effects are reversible movement disorders induced by antipsychoticor neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologicside effect of antipsychotic medications characterized by abnormal, involuntarymovements, such as blinking, chewing, and grimacing.

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Page 1431.A client with bipolar disorder has been taking lithium, and today his serum blood levelis 2.0 mEq/L. What effects would the nurse expect to see?A)Constipation and postural hypotensionB)Fever, muscle rigidity, and disorientationC)Nausea, diarrhea, and confusionD)None; the serum level is in therapeutic rangeAns:CFeedback:Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of morethan 1.5 mEq/L are usually considered toxic. The client would show signs of toxicitywith a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea,vomiting, drowsiness, muscle weakness, and lack of coordination.32.For a client taking clozapine (Clozaril), which of the following symptoms should thenurse report to the physician immediately as it may be indicative of a potentially fatalside effect?A)Inability to stand still for 1 minuteB)Mild rashC)Photosensitivity reactionD)Sore throat and malaiseAns:DFeedback:Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychoticdrugs, but it has the potentially fatal side effect of agranulocytosis. This developssuddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia.This side effect may not be manifested immediately and can occur up to 24 weeks afterthe initiation of therapy. Any symptoms of infection must be investigated immediately.Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, andleukopenia. Mild rash and photosensitivity reaction are not serious side effects.33.A patient with bipolar disorder takes lithium 300 mg three times daily. The nurseevaluates that the dose is appropriate when the patient reportsA)feeling sleepy and less energetic.B)weight gain of 7 pounds in the last 6 months.C)minimal mood swings.D)increased feelings of self-worth.Ans:CFeedback:Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client'smood, preventing or minimizing the highs and lows that characterize bipolar illness, andtreating acute episodes of mania. Weight gain is a common side effect, and fatigue andlethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolardisorder, which should diminish with effective treatment.

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Page 1534.When the client experiences facial flushing, a throbbing headache, nausea and vomitingafter consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that thisis due to which of the following?A)A mild side effect of the medication.B)The intended therapeutic result.C)An idiosyncratic reactionD)A severe allergy to the medication.Ans:BFeedback:Disulfiram is a sensitizing agent that causes an adverse reaction when mixed withalcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol,symptoms begin to appear: facial and body flushing from vasodilation, a throbbingheadache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. Thesesymptoms are not mild side effects because these are very uncomfortable symptoms.These symptoms would not be an idiosyncratic reaction because this is the expectedreaction. These symptoms are not indicative of a severe allergy to the medication.35.When the client asks the nurse how long it will take before the SSRI antidepressantmedication will be effective, which of the following replies is most accurate andtherapeutic?A)ìThis is a good medication! It will be effective within 20 minutes of the first dose.îB)ìYou will have gradual improvement in symptoms over the next few weeks, butthe changes may be so subtle that you may not notice them for a while. It isimportant for you to keep taking the medication.îC)ìIt will probably take months for the medication to work. In the meantime, youshould work on improving your attitude.îD)ìIf you believe it will work, then it will. You have to have faith!îAns:BFeedback:SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of thesedrugs are an ìinitiating eventî and that eventual therapeutic effectiveness results whenneurons respond more slowly, making serotonin available at the synapses. Themedication will not be effective within 20 minutes of the first dose, and it will not likelytake months for the medication. Attitude and faith will improve with the medication'seffectiveness.

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Page 1636.A client has a lithium level of 1.2 mEq/L. Which of the following interventions by thenurse is indicated?A)Call the physician for an increase in dosage.B)Do not give the next dose, and call the physician.C)Increase fluid intake for the next week.D)No intervention is necessary at this time.Ans:DFeedback:The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/Lare rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic.Answers A, B, and C are not appropriate interventions for the given lithium level.37.A patient is seen for frequent exacerbation of schizophrenia due to nonadherence tomedication regimen. The nurse should assess for which of the following commoncontributors to nonadherence?A)The patient is symptom-free and therefore does not need to adhere to themedication regimen.B)The patient cannot clearly see the instructions written on the prescription bottle.C)The patient dislikes the weight gain associated with antipsychotic therapy.D)The patient sells the antipsychotics to addicts in the neighborhood.Ans:CFeedback:Patients with schizophrenia are less likely to exercise or eat low-fat nutritionallybalanced diets; this pattern decreases the likelihood that they can minimize potentialweight gain or lose excess weight. Antipsychotics should be taken regularly and notomitted when free of symptoms. Antipsychotics do not adversely affect vision, nor dothey have addictive potential.38.Which of the following side effects of lithium are frequent causes of noncompliance?Select all that apply.A)Metallic taste in the mouthB)Weight gainC)AcneD)ThirstE)LethargyAns:B, EFeedback:Lethargy and weight gain are difficult to manage or minimize and frequently lead tononcompliance.

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Page 1739.The nurse is educating a patient and family about strategies to minimize the side effectsof antipsychotic drugs. Which of the following should be included in the plan? Select allthat apply.A)Drink plenty of fruit juice.B)Developing an exercise program is important.C)Increase foods high in fiber.D)Laxatives can be used as needed.E)Use sunscreen when outdoors.F)For missed doses, take double the dose at the next scheduled time.Ans:B, C, EFeedback:Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The clientshould avoid calorie-laden beverages and candy because they promote dental caries,contribute to weight gain, and do little to relieve dry mouth. Methods to prevent orrelieve constipation include exercising and increasing water and bulk-forming foods inthe diet. Stool softeners are permissible, but the client should avoid laxatives. The use ofsunscreen is recommended because photosensitivity can cause the client to sunburneasily. If the client forgets a dose of antipsychotic medication, he or she can take themissed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or thenext dose is due, the client can omit the forgotten dose.40.The nurse has completed health teaching about dietary restrictions for a client taking amonoamine oxidase inhibitor. The nurse will know that teaching has been effective bywhich of the following client statements?A)ìI'm glad I can eat pizza since it's my favorite food.îB)ìI must follow this diet or I will have severe vomiting.îC)ìIt will be difficult for me to avoid pepperoni.îD)ìNone of the foods that are restricted are part of a regular daily diet.îAns:CFeedback:Pepperoni is one of the foods containing tyramine, so it must be avoided. Particularconcern to this client is the potential life-threatening hypertensive crisis if the clientingests food that contains tyramine. Answer choices A, B, and D are inappropriatestatements toward effective teaching for the client receiving a monoamine oxidaseinhibitor.

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Page 1841.When teaching a client about restrictions for tranylcypromine (Parnate), the nurse willtell the client to avoid which of the following foods?A)Broad beansB)Citrus fruitC)Egg productsD)Fried foodsAns:AFeedback:Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beanscontain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine-containing foods.

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