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PN120 PrepU Chapter 2

Terms in this set (100)

One of the most common ways in which neurotransmitters are deactivated within the nervous system at the neuronal level is:
enzymatic degradation, primarily by monoamine oxidase (MAO).
Benzodiazepines work by the following mechanism of action:
They act directly on GABA receptors and are thought to increase the amount of GABA available.
When caring for an older adult taking a psychotropic medication, the psychiatric nurse must be aware that older adults:
usually require a lower dose of these medications than do younger counterparts.
Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug?
Its ability to block the reuptake of serotonin
The psychiatric-mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply.
Contraindications
Adverse reactions
Indications for use
Food and drug interactions
When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible?
Frontal lobes
Which client would not be able to undergo a magnetic resonance imaging scan (MRI)?
A client with a pacemaker
Which reason do clients cite most frequently as the cause for self-discontinuation of medication?
Intolerable side effects
A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?
"Make sure that you don't drink any alcohol when you're taking this medication."
Dietary modifications are most likely necessary when a client is being treated with which antidepressant?
Monoamine oxidase inhibitors(MAOIs)
A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?
Pseudoparkinsonism
A client is prescribed medication for a psychiatric disorder. After 3 days, the client reports being constipated. Which instruction would the nurse give the client?
"You need to eat more fruits and vegetables and drink more water."
After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states what?
"I need to be careful because the drug can make me sleepy."
When describing the various neurotransmitters, which would a nurse identify as the primary cholinergic neurotransmitter?
Acetylcholine
A client has been diagnosed with Parkinson's disease. His symptoms of spasticity are related to a decrease in which neurotransmitter?
Dopamine
A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter?
Cholinergic
A 46-year-old client sustained a closed-head injury 4 hours ago. The client now presents to the emergency department because the client is having difficulty breathing. This is a result of swelling surrounding which brain structure?
Medulla oblongata
Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells?
Chemically
A client with Parkinson's disease is hospitalized on a medical unit. The nurse would be correct in identifying which neurotransmitter decreased in this disease?
Dopamine
A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms?
Damage to the hippocampus
A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what?
Tardive dyskinesia
Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?
Sexual dysfunction
A client who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the client's physician because the nurse suspects what?
Agranulocytosis
A client in the operating room goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is what?
Hypothalamus
A client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence?
Changing the client's medication route to intramuscular depot
Benzodiazepines and buspirone are included in which therapeutic category?
Anxiolytics
Which is the most commonly seen adverse side effect of typical antipsychotics?
Extrapyramidal symptoms and tardive dyskinesia
Extrapyramidal side effects are characterized by a triad of symptoms, including what?
Dystonia, akathisia, and pseudoparkinsonism
Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)?
Atypical antipsychotics block both serotonin and dopaminergic receptors.
What is the function of the thalamus and the hypothalamus?
Coordinate internal and external responses
The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain?
Cerebellum
All but which are currently used neuroimaging techniques?
Electrocardiogram (ECG)
A client who has been taking paroxetine for 3 years for depression abruptly discontinues the drug. For which signs and symptoms should the nurse monitor the client?
Diarrhea and agitation
Which medication classification blocks serotonin reuptake?
Antidepressant
Which is considered the first-line treatment for bipolar disorder?
Lithium
Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?
Hypertensive crisis
The therapeutic level of lithium range includes what?
1 to 1.5 mEq/L
Which client is most likely to benefit from treatment with an antiparkinsonism agent?
A client who has a medication-induced movement disorder
Clients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in what?
Tyramine
A client receiving an antipsychotic agent develops acute extrapyramidal symptoms. Which response by the nurse would be most appropriate?
"These are the results of the drug and can be treated; your illness is not getting worse."
A client has been diagnosed with Parkinson's disease. His symptoms of spasticity are related to a decrease in which neurotransmitter?
Dopamine
A college student wakes up and notices a racing heart and dilated pupils. The student is scheduled to write an exam later that morning. Which system is responsible for this physiological response?
Sympathetic nervous system
Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure?
Behavior
A client is returning from military service and has been diagnosed with post-traumatic stress disorder (PTSD). Dysfunction in which brain structure contributes to the rage and fear experienced in PTSD?
Hypothalamus
A Cuban American client has been prescribed an antipsychotic medication. Which response is most important for the nurse to make to this client?
"Call the doctor immediately if you experience any of the side effects we talked about."
A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?
Call the client's psychiatrist because her symptoms are indicative of moderate toxicity
What is the difference between traditional and atypical antipsychotics?
Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade.
Abnormalities in which lobe is believed to be associated with schizophrenia?
Frontal
The brain stem consists of which structure?
Midbrain
Which antipsychotic drug can cause a lengthening of the QT interval?
Thioridazine
The structure of the brain associated with emotional control, memory, and learning is what?
Limbic system
A drug that is an antagonist functions to do what?
Prevent natural or other substances from activating cell function
In the discharge instructions for a client who is taking alprazolam, the nurse should include what?
Sudden cessation of alprazolam can cause rebound insomnia and nightmares.
A client has begun taking 1 mg of eszopiclone at bedtime, a dose which is considered to be equivalent to a 3.75-mg dose of her previous hypnotic, zopiclone. This comparison of the relative dosages of these two drugs is referred to as what?
Potency
Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply.
Dry mouth
Constipation
Urinary retention
A nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the client will have difficulty with what?
Concept formation
In which way do neurons communicate through the use of synapses?
Chemically
What part of the brain would be responsible for activities such as walking and dancing?
Cerebellum
An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply.
The client often smacks lips when at rest
The client makes repetitive movements with the fingers
What is the primary factor that contributes to the high cost of providing mental health care?
Most mental illnesses are chronic in nature
Several neuroimaging techniques are available for researchers and practitioners. What value does this technology have in diagnosing disorders of the brain?
It provides data about the structures of the brain correlated with their activity.
Which is the primary role of neurotransmitters?
Communicate information from one cell or cell group to another
What are neuroleptic medications used to treat?
Schizophrenia
A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs?
Hyperpyrexia, severe hypertension, and diaphoresis
A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?
Intramuscularly
During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate?
Assessing the client for target symptoms and side effects
A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family?
"You may experience noticeable weight gain while taking this medication."
A nurse observes an older adult client who has been taking antipsychotic medications for 8 months. The nurse sees the client's lips smacking and eyes blinking rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?
Document the client's symptoms of tardive dyskinesia.
A nurse is aware that the likelihood a client will be in adherence with psychotropic medications is affected by what?
Receiving education and information about the medication.
The client cannot remember anything before an accident yesterday. Which brain structure might be injured?
Hippocampus
Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of:
cardiac or seizure disorders.
When haloperidol is given as a depot injection, it has an effectiveness of which duration?
4 weeks
The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?
White blood cell count
Which structures are components of the brain stem? Select all that apply.
Midbrain
Pons
Medulla
A 36-year-old client has been receiving a selective serotonin reuptake inhibitor for treatment of depression. The client is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which symptom of this syndrome?
Hyperreflexia
An older adult reports anxiety and is prescribed diazepam by a family physician. The physician asks the office nurse to explain to the client the problematic side effects of this medication. Which instruction about this drug would be most important for the nurse to emphasize?
"You may feel dizzy and be prone to falls after taking this medication."
A hospitalized client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he "cannot sit still." The nurse documents this finding as what?
Akathisia
A nurse administers a prescribed dose of lithium at 8 p.m. The nurse would schedule a specimen to be obtained for a blood concentration at which time?
8 a.m.
A client is brought to the emergency department by her sibling, who reports that the client became very agitated and "started hallucinating." Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The sibling states that the client is taking paroxetine for depression. Which would the nurse most likely suspect?
Serotonin syndrome
A nurse is teaching family members about the brain's connection to behaviors commonly seen in mental illnesses. How can the nurse best explain the term "neurotransmitter" to the family?
A chemical released in the brain.
The nurse is administering a sedative drug to a client before the magnetic resonance imaging (MRI) procedure. What are the possible reasons for which the nurse had to sedate the client? Select all that apply.
The client may have claustrophobia.
The client may have severe anxiety.
An older adult client has been taking diazepam on a daily basis for several years. On the advice of the client's daughter, the client now wants to stop taking it. Due to the possible effects of discontinuation, the nurse should perform what intervention?
Teach the client nonpharmacologic strategies for promoting sleep
Clients diagnosed with myasthenia gravis have a decrease in which receptor?
Acetylcholine
A client receives the first dose of fluphenazine. The next day, during the follow-up appointment, the nurse finds the client is confused and the client's temperature is 103°F, pulse rate is 116 beats per minute, respirations are 34 breaths per minute, and blood pressure is 100/50 mmHg. The nurse should investigate further for which condition?
Neuroleptic malignant syndrome
After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid what?
Tap beers
While discussing the CNS, the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what?
GABA
The most important reason that psychiatric nurses need to know about the brain is that ...
it is the organ of the mind and governs all forms of human behavior.
Benzodiazepines increase which neurotransmitter function?
GABA
A client with diminished serotonin levels would likely experience which symptom?
Depression and impulsivity
The prescription of clozapine requires weekly blood samples for which time frame?
6 months
A nurse is developing a plan of care for a client diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved?
Dopamine
What part of the neuron carries information into the neuron from other neurons?
Dendrite
A nurse administers haloperidol to a client to promote deescalation. The nurse finds that after administering the drug, the client has started having jerky and involuntary movements of the head and arms. Which medication would be useful in treating this problem?
Benztropine
An adult client has just been prescribed paroxetine by his primary care provider. When assessing the client prior to the beginning of drug therapy, the nurse should include what assessment?
Sexual function
A client with bipolar disorder has responded well to lithium therapy in the inpatient setting and is now being prepared for discharge. What should the nurse teach the client about outpatient lithium therapy?
"Try to time your visit to the laboratory for the morning, around 12 hours after your most recent dose."
Antipsychotics function by blocking receptors of which neurotransmitter?
Dopamine
Typical antipsychotics work by blocking which receptor?
Dopamine
Several factors impact synaptic transmission. What increases synaptic transmission?
Neurotransmitter
The use of psychopharmacologic agents in the treatment of mental illness comes from which domain of the biopsychosocial model?
Biologic
A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The nurse is teaching about effective administration of methylphenidate to the parents. What education given by the nurse is appropriate?
"Administer the drug early in the morning."
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