TEST BANK FOR Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter Chapter 1-36

Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or á1 norepinephrine blockade. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 3-24, 25 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 69 Test Bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter |Test Bank|Chapter 1-36 UPDATED 2022 25. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3 . Select the nurse‘s best action. 70 Test Bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter |Test Bank|Chapter 1-36 UPDATED 2022 a. Report the results to the health care provider immediately. b. Administer the next dose as prescribed. c. Give aspirin and force fluids. d. Repeat the laboratory test. ANS: A These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld. (Note: This question requires students to apply previous learning regarding normal and abnormal values of white blood cell counts.) PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 3-38, 39 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 26. A drug blocks the attachment of norepinephrine to α1 receptors. The patient may experience a. hypertensive crisis. b. orthostatic hypotension. c. severe appetite disturbance. d. an increase in psychotic symptoms. ANS: B Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of α1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Teach patients ways of minimizing this phenomenon. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 3-28, 41, 42 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 27. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. With which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance? The patient receiving a. lithium. b. clozapine. c. fluoxetine. d. venlafaxine. ANS: A Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, 71 Test Bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter |Test Bank|Chapter 1-36 UPDATED 2022 edema, and other symptoms of imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine 72 Test Bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter |Test Bank|Chapter 1-36 UPDATED 2022 block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 3-33, 62 (Table 3-3) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 28. An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain? a. H1 b. 5 HT2 c. Acetylcholine d. GABA ANS: A H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patient‘s weight. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 3-37, 38, 40 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 29. An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individual‘s vital signs is most likely? a. Pulse rate changes from 90 to 72. b. Respiratory rate changes from 22 to 18. c. Complaints of intestinal cramping begin. d. Blood pressure changes from 114/62 to 136/78. ANS: D This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 3-5, 50 (Figure 3-1) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 30. Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group? a. Galantamine b. Valproate c. Buspirone d. Tacrine 73 Test Bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter |Test Bank|Chapter 1-36 UPDATED 2022 ANS: B 74 Test Bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing A Clinical 9th Edition by Margaret Jordan Halter |Test Bank|Chapter 1-36 UPDATED 2022 The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimer‘s disease and anxiety. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 3-33, 34 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 31. A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient remembers the appointment? a. Write the appointment day, time, and location on a piece of paper and give it to the player. b. Log the appointment day, time, and location into the player‘s cell phone calendar feature. c. Ask the health care provider to admit the patient to the hospital overnight. d. Verbally inform the patient of the appointment day, time, and location. ANS: B This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has significant role in maintaining memory. Logging the appointment into the player‘s cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the patient is unlikely to remember verbal instruction. Hospitalization is unnecessary. See relationship to audience response question. Caution: This question requires students to apply previous learning regarding central nervous system anatomy and physiology. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 3-12 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment MULTIPLE RESPONSE 1. A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? (Select all that apply.) a. Parkinson‘s disease b. Grave‘s disease c. Hyperlipidemia d. Osteoarthritis e. Diabetes