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Videbeck PSYCH PrepU Chapter 2
Terms in this set (60)
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.
The client cannot remember anything before an accident yesterday. Which brain structure might be injured?
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.
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?
The brain stem consists of which structure?
The brain stem consists of the midbrain, pons, and medulla.
Benzodiazepines increase which neurotransmitter function?
A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what?
Positron emission tomography (PET) scan
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 nurse is attending a review class on the neurologic basis of psychiatric disorders. The class also includes a review of the anatomy and physiology of the neurological system. The nurse demonstrates understanding of the information by identifying which structures ascomponents of the brain stem? (Select all that apply.)
The prescription of clozapine requires weekly blood samples for which time frame?
Although agranulocytosis can occur with any antipsychotic, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment and then every 2 weeks after that for as long as the drug is taken.
A client who has been taking clozapine for 6 weeks visits the clinic reporting fever, sore throat, and mouth sores. The nurse notifies the client's physician because the nurse suspects:
A hospitalized male 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:
The client's inability to "sit still"; and the client's frequent pacing are termed akathisia, an extrapyramidal effect of the antipsychotic medication. Akinesia is slowed movements. Dystonia involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles. Pseudoparkinsonism includes rigidity, slowed movements, and tremor.
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?
Blood concentrations should be monitored 12 hours after the last dose of medication.
A female 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?
The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI]) suggest serotonin syndrome. Neuroleptic malignant syndrome and acute dystonic reaction would occur with antipsychotic uses. Hypothyroidism may result from lithium use.
A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter?
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?
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
Insomnia is a common side effect associated with methylphenidate. The drug should be administered early in the morning to combat insomnia. Unlike with atomoxetine, nausea and vomiting are not the side effects of methylphenidate. Unlike with clonidine, dizziness is not known to be a side effect associated with methylphenidate. Appetite suppression is another side effect associated with this drug. If the drug is administered before breakfast or lunch, it would limit dietary intake. Therefore the drug should be administered along with breakfast to maintain good dietary intake.
A client is experiencing hallucinations and delusions. The nurse would expect the physician to order which class of drug?
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 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.
When educating an African-American client regarding newly prescribed antipsychotic medication, it is vital that the nurse address which care issue? Choose the best answer.
Early recognition of extrapyramidal symptoms
Thirty-three percent of African Americans have been found to be slower than whites in metabolizing psychotropic medications. This decreased metabolism can lead to an increased incidence of adverse effects, especially extrapyramidal symptoms. Taking the medication exactly as prescribed, being aware of gastrointestinal side effects, and keeping scheduled appointments with the primary health care provider represent recommendations applicable to all clients prescribed a psychotropic medication.
Lithium was one of the first psychotropic drugs developed. Lithium is in which medication classification?
Which term is used to describe the amount of the drug needed to achieve the maximum effect?
Which is considered an atypical antipsychotic?
Olanzapine is considered an atypical antipsychotic. Haloperidol, thioridazine, and thiothixene are considered conventional antipsychotics.
When haloperidol is given as a depot injection, it has an effectiveness of which duration?
The structure of the brain associated with emotional control, memory, and learning is what?
The limbic system controls emotions, memory, and learning. The basal ganglia initiate and control voluntary motor activities and muscle tone. The brainstem controls respiration, gastrointestinal motility, circulation, and sleep and wakefulness, and directs visual and auditory reflexes. The cerebellum controls and guides movements and maintains muscle tone.
Benzodiazepines and buspirone are included in which therapeutic category?
The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?
The foods contain tyramine, which may provoke hypertensive crisis.
Monoamine oxidase inhibitors contain tyramine, which can trigger hypertensive crisis. The client must be instructed to avoid all aged foods. None of the other options provide accurate information about the association of the medication and the suggested foods.
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?
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?
Abnormally high activity of dopamine has been associated with schizophrenia. Loss of cholinergic neurons is associated with Alzheimer's disease. Decreased norepinephrine is associated with depression; excessive norepinephrine is associated with manic symptoms. Increased serotonin is associated with mania; decreased serotonin is associated with depression and insomnia.
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?
A nurse is reviewing the process of neuronal transmission. The nurse demonstrates understanding of this concept by identifying which part of the neuron as carring information into the neuron from other neurons?
A nurse is teaching a patient about how impulses are transmitted and describes the factors that can impact this transmission. Which factor would the nure most likely identify as increasing synaptic transmission?
The function of the thalamus and the hypothalamus is to coordinate:
internal and external responses
The use of psychopharmacologic agents in the treatment of mental illness comes from which domain of the biopsychosocial model?
A nurse is assessing a child with a diagnosis of autism spectrum disorder. The child has severe uncontrollable temper outbursts and repeatedly bangs the head on the wall or door. When considering medication for treatment, the nurse knows which will be the most effective?
Antipsychotic medication like haloperidol is used to treat specific symptoms such as temper tantrums and stereotypic behavior (repeatedly bangs head on the wall or door). Pemoline and methylphenidate are used to treat attention deficit hyperactivity disorder. Imipramine is used to treat enuresis.
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 depo
What is the primary factor that contributes to the high cost of providing mental health care?
most mental illnesses are chronic in nature
Which culture would the nurse expect to be disproportionately diagnosed as having schizophrenia when compared to other groups?
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 lobe damage shows symptoms that include loss of emotional control, rage, violent behavior as well as changes in mood and personality and uncharacteristic behavior. Thus, when a client who is generally pleasant and cooperative begins to show aggressive behavior toward most members of the milieu, the nurse suspects the client has experienced cerebral trauma to the frontal lobe. Temporal, occipital, and limbic lobe damage do not exhibit aggressive behavior or personality changes.
Clients diagnosed with myasthenia gravis have a decrease in which receptor?
Clients diagnosed with myasthenia gravis, a neuromuscular disorder, have a decreased amount of acetylcholine. Acetylacholine is a neurotransmitter found in the brain, spinal cord, and peripheral nervous system, particularly at the neuromuscular junction of the skeletal muscle. Dysfunction of dopamine is associated with with schizophrenia and other psychoses as well as Parkinson's disease. Serotonin plays an important role in anxiety, mood disorders, and schizophrenia. Norepinephrine dysfunction is implicated in several anxiety disorders, deficits may contribute to memory loss, social withdrawal, and depression.
A drug that is an antagonist functions to do what?
Prevent natural or other substances from activating cell function
Typical antipsychotics work by blocking which receptor?
Typical or traditional antipsychotic agents (neuroleptics) block dopamine receptors in the brain, thus altering the release and turnover of dopamine. Typical psychotropic agents do not play a role in the blockade of serotonin or norepinephrine.
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
The most serious and potentially fatal side effect of the typical antipsychotics is neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered consciousness, disorientation, dysphagia, elevated creatinine phosphokinase, stupor, catatonia, hyperpyrexia, and labile pulse and blood pressure. This life-threatening condition can occur after a single dose of a neuroleptic; however, it is more common in the first 2 weeks of administration or with an increase in dose. It can continue for up to 2 weeks after discontinuation of the medication.
Though the client does not exhibit any signs or symptoms of depression, a client's physician has prescribed a low dose of the antidepressant mirtazapine. What is the most likely rationale for the physician's action?
To make use of an off-label application of the medication
A client has developed deficits involving the senses of smell and hearing. The nurse would correlate this sensory dysfunction with which cerebral lobe?
The temporal lobes contain the primary auditory and olfactory areas. The parietal lobes contribute to the ability to recognize objects by touch, calculate, write, recognize fingers of the opposite hands, draw, and organize spatial directions, such as how to travel to familiar places. The frontal lobes are thought to contain the highest or most complex aspects of cortical functioning, which collectively make up a large part of personality. The occipital lobes are involved in many aspects of visual integration of information, including color vision, object and facial recognition, and the ability to
A decrease in which neurotransmitter has been implicated in seizure disorders?
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?
Symptoms of pseudoparkinsonism include the classic triad of Parkinson's disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. Dystonia is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating use of an antipsychotic. NMS is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever.
A client is in the acute phase of mania and is receiving lithium. Which blood concentration of lithium is within the therapeutic range for acute mania?
During the acute phase of mania, lithium blood concentrations of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control.
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."
Diazepam is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client.
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.
After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client states:
"I need to be careful because the drug can make me sleepy."
Imipramine is a tricyclic antidepressant and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high fiber intake would be appropriate to decrease possible constipation.
While discussing the CNS, the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what?
Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure?
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 molecular substance 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.
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?
Jerky and involuntary movements of the head and arms are the extrapyramidal side effects associated with haloperidol. Benztropine is known to be effective in rapid alleviation of these side effects. Extrapyramidal side effects are caused due to antipsychotic drugs. Clozapine, risperidone, and olanzapine are all the antipsychotic drugs. Administration of these drugs would further aggravate the extrapyramidal symptoms.
A group of nursing students are reviewing information related to drug therapy for mood disorders. The students demonstrate understanding of the information when they identify which agent as the gold standard for treating bipolar disorder?
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."
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