NUR 422 Exam Testbank Guide
With Complete Solution
The nurse manager on the psychiatric unit was explaining to the new staff
the differences between typical and atypical antipsychotics. The nurse
correctly states that atypical antipsychotics:
a. Remain in the system longer
b. Act more quickly to reduce delusions
c. Produce fewer extrapyramidal effects
d. Are risk free for neuroleptic malignant syndrome - ANSWER ANS: C
Atypical antipsychotics produce less D2 blockade; thus movement disorders
are less of a
problem. No evidence suggests that the medication remains in the system
longer nor that it actsmore quickly to reduce delusions. The atypicals are not
risk free for NMS.
The nurse would assess for neuroleptic malignant syndrome (NMS) if a
patient on haloperidol(Haldol) develops a:
a. 30 mm Hg decrease in blood pressure reading
b. Respiratory rate of 24 respirations per minute
c. Temperature reading of 104 F
d. Pulse rate of 70 beats per minute - ANSWER ANS: C
,Increased temperature is the cardinal sign of NMS. This BP is not a significant
feature of NMS.
There are no significant findings to support the options related to
respirations or pulse rate.
Which behavior displayed by a patient receiving a typical antipsychotic
medication would beassessed as displaying behaviors characteristic of
tardive dyskinesia (TD)?
a. Grimacing and lip smacking
b. Falling asleep in the chair and refusing to eat lunch
c. Experiencing muscle rigidity and tremors
d. Having excessive salivation and drooling - ANSWER ANS: A
TD manifests as abnormal movements of voluntary muscle groups after a
prolonged period of
dopamine blockade. Movements may affect any muscle group, but muscles
of the face, mouth,tongue, and digits are commonly affected. Falling asleep
is reflective of the sedative effect of these medications. Muscle rigidity and
drooling reflect EPS caused from imbalance between dopamine and
acetylcholine.
When the nurse realizes that a patient diagnosed with schizophrenia is not
taking the prescribed oral haloperidol (Haldol), which intervention would
promote medication compliance?
a. Instructing the patient to have friends monitor his medications
b. Beginning administration of haloperidol (Haldol) decanoate
,c. Writing instructions in detail for the patient to follow
d. Changing haloperidol to an atypical antipsychotic - ANSWER ANS: B
Haloperidol decanoate is a depot medication, given intramuscularly every 2
to 4 weeks. It is unknown whether the patient has a support system. The
patient probably received education, including written instructions prior to
discharge. Changing to
another classification of medication would not necessarily improve
compliance.
When asked how tricyclic antidepressants affect neurotransmitter activity,
the nurse should respond that they:
a. Decrease available dopamine.
b. Increase availability of norepinephrine and serotonin.
c. Make available increased amounts of monoamine oxidase.
d. Increase the effects of the chemical gamma-aminobutyric acid. - ANSWER
ANS: B
Tricyclic antidepressants block neurotransmitter uptake, increasing the
amounts of norepinephrine and serotonin available. Decreasing dopamine is
the action of typical antipsychotic medication. Increasing monoamine
oxidase is not the action of tricyclics.Benzodiazepines, not tricyclics, increase
the effects of GABA.
Which of these statements made by a patient taking the MAOI phenelzine
(Nardil) would warrant further instruction?
a. I often forget to wear sunscreen when I go outside.
, b. I need to restrict the amount of sodium in my diet.
c. I should not use over-the-counter cold medications.
d. I usually order liver and onions when my wife and I eat out. - ANSWER
ANS: D
MAOIs require patients to observe a tyramine-free diet to prevent
hypertensive crisis. Liver is a food that contains large amounts of tyramine.
The remaining options have no relevance for MAOI therapy.
Which statement made by a patient who will be maintained on lithium
following discharge will require further instruction by the nurse?
a. I will have my blood work done regularly.
b. When I get home, I may go on a salt-free diet.
c. I have learned not to restrict my intake of water.
d. I understand some people gain weight on lithium. - ANSWER ANS: B
This statement shows that the patient does not understand the relationship
between lithium and sodium. The patient must be taught that changing
dietary salt intake will affect lithium levels. Adding salt can cause lower
levels; reducing salt can result in toxicity. The remaining options reflect
correct information regarding lithium therapy.
Which person with mania is the least likely candidate to receive lithium? The
patient who is:
a. Six weeks pregnant
b. Recovering from a hysterectomy
With Complete Solution
The nurse manager on the psychiatric unit was explaining to the new staff
the differences between typical and atypical antipsychotics. The nurse
correctly states that atypical antipsychotics:
a. Remain in the system longer
b. Act more quickly to reduce delusions
c. Produce fewer extrapyramidal effects
d. Are risk free for neuroleptic malignant syndrome - ANSWER ANS: C
Atypical antipsychotics produce less D2 blockade; thus movement disorders
are less of a
problem. No evidence suggests that the medication remains in the system
longer nor that it actsmore quickly to reduce delusions. The atypicals are not
risk free for NMS.
The nurse would assess for neuroleptic malignant syndrome (NMS) if a
patient on haloperidol(Haldol) develops a:
a. 30 mm Hg decrease in blood pressure reading
b. Respiratory rate of 24 respirations per minute
c. Temperature reading of 104 F
d. Pulse rate of 70 beats per minute - ANSWER ANS: C
,Increased temperature is the cardinal sign of NMS. This BP is not a significant
feature of NMS.
There are no significant findings to support the options related to
respirations or pulse rate.
Which behavior displayed by a patient receiving a typical antipsychotic
medication would beassessed as displaying behaviors characteristic of
tardive dyskinesia (TD)?
a. Grimacing and lip smacking
b. Falling asleep in the chair and refusing to eat lunch
c. Experiencing muscle rigidity and tremors
d. Having excessive salivation and drooling - ANSWER ANS: A
TD manifests as abnormal movements of voluntary muscle groups after a
prolonged period of
dopamine blockade. Movements may affect any muscle group, but muscles
of the face, mouth,tongue, and digits are commonly affected. Falling asleep
is reflective of the sedative effect of these medications. Muscle rigidity and
drooling reflect EPS caused from imbalance between dopamine and
acetylcholine.
When the nurse realizes that a patient diagnosed with schizophrenia is not
taking the prescribed oral haloperidol (Haldol), which intervention would
promote medication compliance?
a. Instructing the patient to have friends monitor his medications
b. Beginning administration of haloperidol (Haldol) decanoate
,c. Writing instructions in detail for the patient to follow
d. Changing haloperidol to an atypical antipsychotic - ANSWER ANS: B
Haloperidol decanoate is a depot medication, given intramuscularly every 2
to 4 weeks. It is unknown whether the patient has a support system. The
patient probably received education, including written instructions prior to
discharge. Changing to
another classification of medication would not necessarily improve
compliance.
When asked how tricyclic antidepressants affect neurotransmitter activity,
the nurse should respond that they:
a. Decrease available dopamine.
b. Increase availability of norepinephrine and serotonin.
c. Make available increased amounts of monoamine oxidase.
d. Increase the effects of the chemical gamma-aminobutyric acid. - ANSWER
ANS: B
Tricyclic antidepressants block neurotransmitter uptake, increasing the
amounts of norepinephrine and serotonin available. Decreasing dopamine is
the action of typical antipsychotic medication. Increasing monoamine
oxidase is not the action of tricyclics.Benzodiazepines, not tricyclics, increase
the effects of GABA.
Which of these statements made by a patient taking the MAOI phenelzine
(Nardil) would warrant further instruction?
a. I often forget to wear sunscreen when I go outside.
, b. I need to restrict the amount of sodium in my diet.
c. I should not use over-the-counter cold medications.
d. I usually order liver and onions when my wife and I eat out. - ANSWER
ANS: D
MAOIs require patients to observe a tyramine-free diet to prevent
hypertensive crisis. Liver is a food that contains large amounts of tyramine.
The remaining options have no relevance for MAOI therapy.
Which statement made by a patient who will be maintained on lithium
following discharge will require further instruction by the nurse?
a. I will have my blood work done regularly.
b. When I get home, I may go on a salt-free diet.
c. I have learned not to restrict my intake of water.
d. I understand some people gain weight on lithium. - ANSWER ANS: B
This statement shows that the patient does not understand the relationship
between lithium and sodium. The patient must be taught that changing
dietary salt intake will affect lithium levels. Adding salt can cause lower
levels; reducing salt can result in toxicity. The remaining options reflect
correct information regarding lithium therapy.
Which person with mania is the least likely candidate to receive lithium? The
patient who is:
a. Six weeks pregnant
b. Recovering from a hysterectomy
