TEST BANK FOR STAHL PSYCHOPHARMACOLOGY (Neuro-scientific Basis and Practical Applications) | Complete Guide | 2023/2024

Which of the following processes is most likely to occur as a result of a spinal reflex? A) Peristalsis of the small and large bowel B) Control of oculomotor function in changing light levels C) Pain sensation from a potentially damaging knee movement D) Withdrawal of a hand from a hot stove element ANS.D 17. A patient has required mechanical ventilation following a traumatic head injury sustained in a motorcycle crash, during which he sustained damage to his respiratory center. Which of the patients brain structures has been injured? A) Brain stem B) Midbrain C) Diencephalon D) Frontal lobe 18. ANS.A A patient with a diagnosis of epilepsy has required surgical removal of part of her prefrontal cortex. Which of the following effects should her family and care team anticipate? A) Lapses in balance and coordination B) Deficits in regulation of the endocrine system C) Sensory losses D) Changes in behavior and judgment 19. ANS.D A patients primary care provider has prescribed a b-adrenergic receptor blocker. Which of the following therapeutic effects do the patient and care provider likely seek? A) Reduction in heart rate and blood pressure B) Slowing of gastrointestinal motility C) Increase in mental acuity D) Decreased production of gastric acid 20. ANS.A Neurotrophic factors contribute to the maintenance of homeostasis in which of the following ways? A) By catalyzing the effects of neurotransmitters B) By increasing the sensitivity of receptors on postsynaptic cells C) By promoting the growth and survival of neurons D) By selectively increasing or decreasing the release of neurotransmitters ANS. C Chapter 3 Ion channels as targets of psychopharmacological drug action 1. A nurse is teaching a medication class to a group of psychiatric patients. One of them asks the nurse why he has so much more trouble learning now when hes in his 60s than he did when he was younger. Which of the following concepts would the nurse integrate into the response? A) The extrapyramidal motor system B) The amygdala C) Neuroplasticity D) Psychoneuroimmunology 2. ANS.C Which of the following would a nursing instructor identify when describing the area of the brain involved with verbal language function, including areas for both receptive and expressive speech? A) Right hemisphere B) Parietal lobe C) Occipital lobe D) Left hemisphere 3. ANS.D A nurse is developing a plan of care for a patient experiencing expressive aphasia. The nurse incorporates knowledge that the patient most likely has sustained damage to which of the following? A) The postcentral gyrus B) Brocas area C) Basal ganglia D) The hippocampus 4. ANS.B The nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the patient will have difficulty with which of the following? A) Smell B) Concept formation C) Receptive speech D) Hearing 5. ANS.B The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the following? A) Perceiving sensory input B) Calculating a math problem C) Seeing objects in front of him D) Speaking fluently 6. ANS.B A patient has been diagnosed with memory dysfunction associated with Alzheimers disease. The nurse determines that damage to the patients brain includes deterioration of temporal lobe structures and the nerves of which of the following? A) Basal ganglia B) Limbic system C) Frontal lobe D) Hippocampus 7. ANS.D The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patients plan of care, in which of the following areas would the nurse anticipate a problem? A) Sleep B) Constipation C) Speech D) Motor activity 8. ANS.A A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG) in the morning is experiencing moderate anxiety about the procedure. Based on an understanding of this test, which of the following would the nurse avoid? A) Explaining in depth what to expect during the upcoming procedure B) Administering a benzodiazepine medication prescribed for anxiety C) Taking a thorough history of her use of prescribed and illicit drugs D) Giving her a noncaffeinated beverage of her choice 9. ANS.B A nursing instructor asks a student to explain the influence of chronobiology on depression. Which of the following would the student include when responding? A) The exact location of genes leads to identifying the gene responsible for causing depression. B) A break in the corpus coliseum blocks information exchange between the right and left hemispheres. C) Damage to the posterior areas of the parietal lobe leads to altered discriminative sensory function. D) Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression. 10. ANS.D When describing the various neurotransmitters, which of the following would the nurse identify as the primary cholinergic neurotransmitter? A) Dopamine B) Acetylcholine C) Norepinephrine D) Serotonin 11. ANS.B A group of nursing students are reviewing the various neurotransmitters. The students demonstrate understanding when they identify which of the following as a neuropeptide? A) Melatonin B) Serotonin C) Glutamate D) Gamma-aminobutyric acid 12. ANS.A The nurse is assessing a patient experiencing anxiety and observes increased sweating and gooseflesh. The nurse understands that these are the result of which substance? A) Acetylcholine B) Norepinephrine C) Serotonin D) Histamine 13. ANS.B A nurse is developing a plan of care for a patient diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved? A) Acetylcholine B) Dopamine C) Norepinephrine D) Serotonin ANS.B 14.A group of students are reviewing information about neurotransmitter subtypes. The group demonstrates understanding of the information when they identify which neurotransmitter as having muscarinic and nicotinic receptors? A) Serotonin B) Gamma-aminobutyric acid (GABA) C) Dopamine D) Acetylcholine 15. ANS.D A nurse is involved in gathering information about the inheritance of mental disorders using population genetics. Which of the following would the nurse be least likely to be evaluating? A) Concordance rates B) Occurrence in first-degree relatives C) Risk factor analysis D) Adoptions studies 16. ANS.C A nurse is reading a journal article about psychoneuroimmunology. Which information would the nurse most likely find? Select all that apply. A) Neurotoxins role in receptor site damage B) Hypothalamicpituitarythyroid axis disruption C) Static activity of natural killer cells in response to stress D) Hypothalamic damage leading to immune dysfunction E) Interruption in the typical circadian rhythm cycle 17. ANS.A,B,D A patient is scheduled for a challenge test. Which of the following would the nurse include when explaining this test to the patient? A) Intravenous administration of a substance to induce symptoms B) Application of electrodes to the scalp for monitoring C) Evaluation electrical impulses recorded on graph paper D) Exposure to a flashing strobe light to elicit abnormal activity 18. ANS.A A patient with depression tells the nurse that he is to have a test that involves the recording of an electroencephalogram (EEG) throughout the night. The nurse most likely identifies this testing as which of the following? A) Sleep deprivation EEG B) Polysomnography C) Evoked potentials D) Functional magnetic resonance imaging 19. ANS.B A group of nursing students are reviewing the role of serotonin in psychiatric disorders. The students demonstrate a need for additional study when they identify which disorder as being associated with its dysfunction? A) Depression B) Obsessive-compulsive disorder C) Panic disorder D) Schizophrenia 20. ANS.D When describing neuronal transmission, an instructor describes the area where the electrical intracellular signal becomes a chemical one. The instructor is describing which of the following? A) Soma B) Synaptic cleft C) Terminal D) Receptor site ANS.B Chapter 4 Psychosis and schizophrenia MULTIPLE CHOICE 1. A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis? a. Uses a rhyming form of speech b. Refuses to eat any unwrapped foods c. Laughs when watching a sad movie d. Maintains an immobilized state for hours ANS: D Catatonic schizophrenia is characterized by extremes of psychomotor activity ranging from frenzied behavior to immobilization and may include echopraxia and posturing. Paranoid thinking is characteristic of paranoid schizophrenia. Inappropriate affect and clanging are seen in disorganized schizophrenia. 2. What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence? a. Decide their own daily schedule. b. Decide which unit groups they will attend. c. Choose which clinic staff member to work with. d. Choose between two outfits to wear each morning. ANS: D An early step would be to make choices about nonthreatening matters when presented with limited alternatives. The remaining options represent decisions that are too complicated for the patient to make initially. 3. What is the priority nursing diagnosis for a catatonic patient? a. Ineffective coping b. Impaired physical mobility c. Impaired social interaction d. Risk for deficient fluid volume ANS: D The highest priority for the patient is maintenance of basic physiologic needs, such as hydration. Mobility is of lesser physiological importance than fluid volume. The remaining options do not have priority over a physiological need. 4. Which nursing diagnosis is appropriate for a patient who insists being called Your Highness and demonstrates loosely associated thoughts? a. Risk for violence b. Defensive coping c. Impaired memory d. Disturbed thought processes ANS: D Delusions and loose associations suggest disturbed thought processes. The other options are not supported by data in the scenario. 5. Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts? a. Accept that delusion is illogical. b. Distinguish external boundaries. c. Explain the basis for the delusions. d. Engage in reality-oriented conversation. ANS: D Delusions are not reality oriented; thus an appropriate outcome would be that patient will engage in reality-oriented conversation rather than discussing delusional beliefs. Delusions are fixed, false beliefs. Patients rarely accept anyone using logic to dispute them. Data are not present to suggest boundary disturbance. Explaining the delusion is not progress; it suggests the patient still holds to the belief. 6. Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking? a. Confronting the delusion b. Refuting the delusion with logic c. Exploring reasons the patient has the delusion d. Focusing on feelings suggested by the delusion ANS: D Focusing on feelings suggested by the delusion will help meet patient needs and help the patient stay based in reality. This technique fosters rapport and trust while discouraging the belief without challenging or refuting it. 7. Which assessment observation supports a patients diagnosis of disorganized schizophrenia? a. Reports suicidal ideations b. Last relapse was 6 years ago c. Consistent inappropriate laughing d. Believes that the government is out to get me ANS: C The presence of disorganization and inappropriate affect identifies this disorder as disorganized schizophrenia. The symptoms of residual schizophrenia have long periods of remission. Schizoaffective disorder presents with severe mood disorders along with symptoms of schizophrenia. Paranoid schizophrenia is characterized by persecutory or grandiose delusions. 8. A patient tried to gouge out his eye in response to auditory hallucinations commanding, If thine eye offends thee, pluck it out. The nurse would analyze this behavior as indicating: a. Derealization b. Inappropriate affect c. Impaired impulse control d. Inability to manage anger ANS: C Command hallucinations may be so intense that the patient cannot control the impulse to do what the hallucination tells him to do; thus the patient has impaired impulse control. This is not an anger management problem. Derealization is a feeling that the environment is distorted or unreal and not suggested in the scenario. No evidence of inappropriate affect is given. 9. An appropriate intervention for a patient with an identified nursing diagnosis of situational low self-esteem would be: a. Providing large muscle activities to relieve stress b. Attempting to determine triggers to hallucinations c. Engaging patient in activities designed to permit success d. Encouraging verbalization of feelings in a safe environment ANS: C All are useful interventions for a patient with schizophrenia; however, engaging the patient in specifically designed activities is the only option that addresses improving self-esteem. 10. A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia. The patient sits alone rubbing her arms and smiling. She tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the primary deficit associated with the patients condition as: a. Social isolation b. Disturbed thinking c. Altered mood states d. Poor impulse control ANS: B The nurse interprets the patients statements that were not reality-based as indicating disturbed thought processes. Social isolation is not the primary patient problem. No data exist to support the other options. 11. A patient has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. He occasionally curses or calls another patient a jerk without provocation. The nurse asks the patient how he is feeling, and he responds, Everybody picks on me. They frobitz me. The patients communication exhibits: a. A neologism b. Loose associations c. Delusional thinking d. Circumstantial speech ANS: A A newly coined word having meaning only for the patient is called a neologism (meaning, new word). It is associated with autistic thinking. The patients speech does not show associative looseness or circumstantiality. The use of a neologism is not delusional in and of itself, but it suggests delusional thinking may be present. 12. A patient has been admitted with disorganized type schizophrenia. The nurse asks the patient how he is feeling, and he responds, Everybody picks on me. They frobitz me. The best response for the nurse to make would be: a. Thats really too bad that you are being treated that way. b. Who do you mean when you say everybody? c. What difference does frobitzing make? d. Why do they frobitz? ANS: B This response will help clarify the patients thinking and change the focus from global to specific. In this situation, sympathizing with the patient is a nonproductive response. The remaining options appear to accept the neologism thus supporting the patients delusional thinking. 13. Which patient behavior would support the diagnosis of residual schizophrenia with negative symptoms? a. Communicating using only rhyming phases b. Claims that worms are crawling in my brain c. Maintaining both arms suspended awkwardly overhead d. Shows no emotion when telling the story of a sisters recent death ANS: D Blunted affect is considered a negative symptom. The other symptoms would be classified as positive symptoms. 14. By discharge, which outcome is appropriate for a patient who hears voices telling him he is evil? a. Respond verbally to the voices. b. Verbalize the reason the voices say he is evil. c. Identify events that increase anxiety and promote hallucinations. d. Integrate the voices into his personality structure in a positive manner. ANS: C An appropriate outcome for a patient with hallucinations is recognition of events that precede the onset of hallucinations. Trigger events or situations usually cause increased feelings of anxiety. The remaining options are neither desirable nor appropriate. 15. Which response by the nurse would best assist a patient in de-escalating aggressive behavior? a. Tell me whats going on. b. Why are you getting so upset? c. If you throw something, you will be restrained. d. Its time for group therapy. You can talk there. ANS: A Using how, what, and when to gather information is a nonthreatening approach. It will promote patient verbalization and explanation of events without causing the patient to become defensive. Mentioning restraints sounds threatening even though it may be meant to remind the patient of limits.Why questions are demanding and threatening to patients. Sending the patient into group therapy sidesteps the problem. 16. A 34-year-old male admitted with catatonic schizophrenia has been mute and motionless for several days while at home prior to admission. He still appears stuporous in the hospital. Which nursing intervention would be an initial priority? a. Orienting the patient to the unit b. Reinforcing reality with the patient c. Establishing a nonthreatening relationship d. Assessing the patient for physical problems ANS: D Patients who are mute and motionless and inattentive to environmental stimuli are at risk for a number of physical problems. Further, they are unable to communicate existing problems. The nurse must make thorough and astute assessments before creating plans to meet the patients needs. A patient who is stuporous may not be able to attend to information given about unit rules and protocols. While establishing a therapeutic nurse-patient relationship is an important intervention, it does not have priority according to Maslows hierarchy. Because the patient is mute, one can only suspect lack of reality orientation. While an appropriate intervention, it is not the priority according to Maslows hierarchy. 17. Which response is appropriate when a patients mother expresses guilt over causing my child to be schizophrenic? a. I can see how you would be upset over this turn of events. b. New findings suggest this disorder is biological in nature. c. Dont be so hard on yourself; your daughter needs you to be strong. d. Its difficult to see what produces stress for the child at the time its occurring. ANS: B Many individuals in the mental health field attribute the development of schizophrenia to multiple causes centering on biological theories. The remaining options do little to provide the mother with new information. 18. Which response demonstrates both empathy and understanding of the relationship genetics has to the development of schizophrenia in twins? a. In fraternal twins, the chance of the other twin developing the disorder is quite small. b. Studies show that 50% of twins develop schizophrenia when it is present in the other twin. c. No one can say what will happen, so we will hope for the best for you and both of your sons. d. You poor woman! I wish I could tell you that your other son he will be free of the disorder. ANS: A Current research supports the correct option, whereas the remaining options are not factual and show expressed sympathy rather than empathy. 19. The wife of a patient diagnosed with paranoid schizophrenia asks, Ive been told that my husbands illness is probably related to imbalanced brain chemicals. Can you be more specific? The response based on the dopamine hypothesis is: a. Breakdown of dopamine produces LSD, which in large amounts produces psychosis. b. An increase in the brain chemical dopamine explains the presence of delusions and hallucinations. c. Decreased amounts of the brain chemical dopamine explain the presence of delusions and hallucinations. d. An increase in the brain chemical dopamine explains the presence of lack of motivation and disordered affect. ANS: B The statement is correctly based on the dopamine hypotheses while the remaining options are neither known to be true nor based on that theory 20. What is the basis for the reduction in disturbed thought processes when a patient is administered haloperidol (Haldol)? a. Reduction in the number of brain cells that crave dopamine b. Dopamine receptors are blocked, making dopamine less available c. Dopamine receptors are enhanced, making more dopamine available d. Medication causes an increased cellular production of dopamine ANS: B Excess dopamine is responsible for symptoms of psychosis such as delusions and hallucinations. Blocking dopamine receptors will result in reduction of primary symptoms. The other options do not reflect the action of typical antipsychotic medications. 21. During a treatment team meeting, the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (5HT2) excess will suggest that the patient receive: a. Haloperidol (Haldol) b. Chlorpromazine (Thorazine) c. Olanzapine (Zyprexa) d. Phenelzine (Nardil) ANS: C Olanzapine is an atypical antipsychotic. Atypical antipsychotic medications are more effective than typical antipsychotics in blocking serotonin receptors and reducing the negative symptoms of schizophrenia. Haloperidol (Haldol) and chlorpromazine (Thorazine) are typical antipsychotic medications while phenelzine (Nardil) is an MAOI antidepressant. 22. What response would be anticipated when a patient who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia is switched to Seroquel (quetiapine)? a. Development of pseudoparkinsonism b. Development of dystonic reactions c. Improvement in tardive dyskinesia d. Worsening of anticholinergic symptoms ANS: C Atypical antipsychotics have been noted to block oral dyskinesia and improve tardive dyskinesia as well as improve both positive and negative symptoms of schizophrenia. Pseudoparkinsonism and dystonic reactions are associated with typical antipsychotic medication. Anticholinergic symptoms are not intense with the use of atypical antipsychotic medication. 23. A patient admitted with the diagnosis of schizophreniform disorder R/O organic pathology. Based on this information, the nurse can expect that the patient will: a. Be scheduled for a magnetic resonance imaging (MRI) test b. See a mental health specialist for extensive psychological testing c. Have an immunologic assay performed within 2 days of the admission d. Participate in a dexamethasone suppression test (DST) administered by the staff ANS: A The MRI will reveal structural changes in the brain that might be responsible for symptoms of psychosis (e.g., abscess, tumor). Psychologic testing may be performed but will be less definitive in ruling out organic pathology. Immunologic studies are not indicated. The DST is related to depression. 24. In planning aftercare for a patient with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the patient to have stimulation, structure, socialization, and support. Which option would best incorporate these factors? a. Day hospitalization b. Attending a psychosocial club c. Living with his elderly mother d. Spending free time in the mall ANS: B A psychosocial club is organized to provide the 4 Ss and is not costly to patients. Day hospitalization would not be possible because of the lack of insurance benefits. Living with his mother might fall short of stimulation and support. Spending time in the mall lacks structure, socialization, and support. 25. A patient with catatonic schizophrenia has been standing with his left arm upraised and his right foot off the floor for the majority of the last 20 hours, eating only when allowed to eat standing up. Which nursing intervention has priority for this patient? a. Providing high-calorie drinks hourly b. Assessing for lower extremity edema bid c. Taking the patient to activities therapy once daily d. Encouraging the patient to sit or lie down for 30 minutes hourly ANS: B Patients who maintain one position for long periods of time should be assessed for dependent edema. In this case, the nurse would look for edema of the lower extremities and would be concerned about the pressure exerted by standing on one foot for long periods of time. Such encouragement would probably be met with resistance by the patient. High-calorie drinks would be necessary if the patient failed to eat at meals. The patient probably would not be able to cognitively process what is required to participate in activities. 26. Which nursing action best addresses the needs of a paranoid patient who believes the food is poisoned? a. Explaining that others eat the food and are not harmed b. Allowing the patient to select food from vending machines c. Encouraging the patient to discuss why someone would poison the food d. Taking steps to prevent the patient from verbalizing the delusional thoughts ANS: B Patients who think hospital food is being poisoned will sometimes eat wrapped foods that have not been opened, and occasionally, they may eat food brought from the outside by a trusted person. Delusions are fixed, false beliefs that cannot be refuted by logic. The patient will probably state that the others have been given the antidote to the poison. Encouraging discussion about the delusion is not therapeutic. Although it is wise to minimize the amount of discussion about delusions, refusing to allow the patient to speak about the delusions will not foster a therapeutic alliance. 27. Prior to discharge, the nurse plans to teach the patient and family about relapse. Which items will the nurse include in the teaching? a. Recognizing warning signs of relapse b. Using street drugs judiciously and only in small amounts c. Lowering medication dosage to manage emerging side effects d. Notifying the nurse of warning signs present for more than one month ANS: A The patient and family must be aware of signs of impending relapse. These signs are usually similar to those that the patient experienced prior to hospitalization and will be patient-specific. The nurse should be notified ASAP, rather than waiting two weeks. Patients should never adjust medication dosage. Street drug use often precipitates relapse since many street drugs are dopaminergic. 28. Because of the cognitive disturbances associated with schizophrenia, which technique will be useful as the nurse teaches a patient about self-management? a. Use only verbal instruction. b. Teach material in small segments. c. Offer opportunities for making numerous choices. d. Plan the teaching for a time when the patient has been recently medicated. ANS: B Patients with cognitive disturbances should be taught small blocks of information at a time and given frequent reinforcement. Both verbal and visual materials should be used since processing of verbal stimuli may be more impaired. Teaching should be scheduled when the patient is most alert. A large number of choices may be confusing for the person, but a few simple choices may be included. 29. The wife of a patient newly diagnosed with paranoid schizophrenia is concerned that her husband will be this sick for the rest of his life. What information can the nurse provide to the wife? a. This disorder generally responds well with treatment and follow-up. b. All types of schizophrenia by their nature are chronic relapsing disorders. c. Outcomes are related to the patients pre-hospital symptoms of disorganization. d. The typical outcome for this diagnosis is that total remission is not achievable. ANS: A The prognosis for paranoid schizophrenia is good with appropriate treatment and effective follow-up. The remaining options are not correct when considering this type of schizophrenia 30. A patient is exhibiting auditory hallucinations in addition to being forgetful and easily confused. Which diagnosis does the nurse base this patients interventions on? a. Social isolation b. Deficient knowledge c. Situational low self-esteem d. Impaired cognitive functioning ANS: D Schizophrenia may alter cognitive functioning, including memory, retention, attention, and the processing of incoming information. Altered cognition accounts for many of the symptoms mentioned in the scenario. Knowing that cognition is altered, the nurse can adjust plans to take the deficits into account. The patient is not exhibiting symptoms that would warrant any of the other options. 31. A patient experiences intrusive, insulting auditory hallucinations. Which independent behavioral technique can the nurse teach the patient to employ when the voices are troublesome? a. Introduce a distraction like reading. b. Use positive talk to offset the insults. c. Sing or whistle to compete with the voices. d. Increase the daily dose of an antipsychotic medication. ANS: C This action provides an alternative to listening to the voices and gives the patient a sense of control. The patient should not adjust medication independently. Reading will not be particularly effective, because the voices are uncontested in a quiet atmosphere. Positive talk is generally used to positively affect self-esteem. 32. A patient with schizophrenia tells the nurse as they sit in the day room, I hear voices telling me bad things. The most therapeutic response the nurse can make is: a. Tell me what the voices are saying. b. I believe you hear voices, but I dont hear them myself. c. The voices are not real. Theyre a product of your imagination. d. Do you think the voices would go away if we went into your room to talk? ANS: B By voicing his or her own reality related to the voices, the nurse does not deny the patients experiences but helps the patient distinguish actual voices from those resulting from internal stimulation. Discussing what the voices are saying serves only to validate the reality of the voices. Challenging the voices will cause the patient to defend his perceptions and thereby reinforce the importance of the hallucination. Asking to move validates the reality of the voices and is not a helpful action since the voices go where the patient goes. 33. A patient tells the nurse, When Im in the day room, I hear people whispering about me, and that makes me want to punch them. What direction will the nurse provide the staff regarding interacting with this patient? a. To minimize the need to whisper, utilize nonverbal techniques when possible. b. Stay physically close to this patient and use touch as a tool to interact with him. c. Treat this patient matter-of-factly. Be direct; dont talk about him or others in his presence. d. Interact with this patient only when necessary. The fewer interactions, the fewer misinterpretations there will be. ANS: C This approach is important when providing care for a patient who is misinterpreting reality and is suspicious of the motives of others. Ostracizing the patient is nontherapeutic. Patients often misinterpret touch as threatening. This might promote loss of control. Using nonverbal communication techniques would be nontherapeutic as it would increase patient anxiety and promote loss of control. 34. A patient with schizophrenia is medication compliant and has well-controlled symptoms. He has, however, never been successful in holding a job because of poor social skills and lack of understanding of basic job skills. The nurse case manager should consider referring the patient: a. For cognitive therapy b. To assertiveness training c. To a day hospital program d. For psychosocial rehabilitation ANS: D Psychosocial rehabilitation helps patients readjust to community living by promoting development of necessary skills. Social skills training and job skills training programs are usually available. The patient does not need the more intensive services found in a day hospital. Cognitive therapy will not offer the needed community living skills training. Assertiveness training is only a small portion of the community living skills the patient needs. 35. A patient prescribed an antipsychotic medication develops a high fever, unstable blood pressure, and muscle rigidity. Her next dose of medication is due. The nurse should: a. Administer the medication and monitor the vital signs every 4 hours. b. Give a lower dose of the medication for 24 hours and monitor the blood pressure. c. Prepare to administer a prn dose of the anticholinergic drug benztropine (Cogentin). d. Hold the medication and immediately describe the patients symptoms to the doctor. ANS: D These symptoms could be related to a possibly fatal disorder called neuroleptic malignant syndrome (NMS), and the nurse should hold the medication and contact the doctor immediately. The other options are inappropriate in light of the seriousness of the situation. MULTIPLE RESPONSE 1. Which interventions will the nurse implement to preserve milieu safety when a patient becomes agitated? Select all that apply. a. Project confidence and control. b. Provide a show of force when appropriate. c. Ask the agitated patient why they are feeling so aggressive. d. Move to within 5 feet of the patient to help contain their movement. e. Provide the patient with several options as means of de-escalating the crisis. ANS: A, B, E The correct options demonstrate that the staff is in control without unnecessarily challenging the patient. Asking why is often interpreted as being challenging and often serves to future agitate the patient. Eight feet is considered to be the therapeutic distance between patient and staff in this type of situation. 2. Which interventions will the nurse implement to assure effective staff crises management skills? Select all that apply. a. Schedule regular staff crises simulations. b. Encourage the staff to discuss the details of unit crises. c. Attempt to identify staff who are ineffective during crises. d. Review documentation that describe the details of unit crises. e. Review unit crises management policies for needed updates. ANS: A, B, D, E The correct options empower the staff while improving/maintaining their crises management skills. The failures of the process should be identified without blaming staff for ineffective crises management. Chapter 5 Antipsychotic agents MULTIPLE CHOICE 1. The nurse is assessing a patient who is complaining of hearing voices. What is this patient experiencing? a. Delusions b. Flight of ideas c. Disorganized thinking d. Hallucinations ANS: D Hallucinations are false sensory perceptions that are experienced without an external stimulus but seem real to the patient. Auditory hallucinations are prominent in a schizophrenic patient. Additional sensory hallucinations include those of touch, sight, smell, and body sensation. Delusions are false beliefs that persist despite evidence to the contrary. Flight of ideas is characterized by rapid changes in thought from one topic to another. Disorganized thinking is commonly associated with psychoses and consists of a flight of ideas during which the individual jumps from one idea or topic to another one. 2. A patient with schizophrenia has been nonadherent with his home medication regimen. He requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic episodes. Which medication regimen would be appropriate for this patient? a. Daily home nursing visits to administer the prescribed oral medication b. Continuous inpatient hospitalization for medication therapy c. Administration of depot antipsychotic medication d. Subcutaneous medication administration ANS: C Depot antipsychotic medications are long acting injections that may be used with noncompliant patients and may assist in avoiding repeated hospital admissions. Daily home nursing visits are not an efficient way to ensure medication compliance. Continuous inpatient hospitalization is not an efficient way to ensure medication compliance. Subcutaneous medication administration is not an option for this patient. 3. What is the most common cause of nonadherence to antipsychotic pharmacologic treatment? a. Expense b. Increased symptoms of chemical dependency c. Extrapyramidal effects d. Inability of the patient to understand the need to take medications ANS: C Extrapyramidal effects are the most common reason for nonadherence to antipsychotic therapy. The four categories of extrapyramidal effects are dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. Although expense may be a concern, it is not the most common reason for noncompliance. Chemical dependency is not a feature of therapy with antipsychotic drugs. Although knowledge deficit is a concern, it is not the most common reason for noncompliance. 4. Which type of adverse effects is present when a patient displays prolonged tonic contractions of the tongue, oculogyric crisis, and torticollis? a. Dystonic reactions b. Pseudoparkinsonism c. Akathisia d. Tardive dyskinesia ANS: A Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is taking antipsychotic agents. Dystonias are spasmodic movements of muscle groups such as tongue protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms (trismus), or neck torsion (torticollis). Pseudoparkinsonism is characterized by tremor and rigidity. Akathisia is characterized by subjective feelings of anxiety and restlessness, accompanied by pacing and the inability to remain in one place for extended periods. Tardive dyskinesia is characterized by persistent involuntary hyperkinetic movements. 5. The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests for the first 6 months of treatment to monitor for which potential complication? a. Agranulocytosis b. Vitamin deficiencies c. Clotting abnormalities d. Polycythemia ANS: A The use of clozapine requires a baseline and weekly white blood cell (WBC) counts because of the high incidence of agranulocytosis. Clozapine does not cause vitamin deficiencies. Clozapine does not interfere with clotting abilities. Clozapine does not affect red blood cell volume. 6. A male patient becomes verbally aggressive and insists the nurse is poisoning him as she attempts to administer haloperidol (Haldol). Which action will the nurse take? a. Support the patients decision to refuse the medication. b. Discreetly ask an assistant to put the medication in the patients food. c. Firmly redirect the patient to take the medication. d. Speak privately with the patient and reinforce medication action. ANS: C During episodes of acute psychosis, the patient is out of touch with reality and often does not understand the need for medication in stabilizing his or her condition. Target symptoms such as agitation, suspicion, and paranoia are common. Health care providers must be supportive yet firm in their expectations. An open and direct manner in handling patients who are highly suspicious is critical. Delusions should not be supported. The patient is not competent to determine his need for medication. It is dishonest to hide medication in a patients food and destroys a trusting relationship. Reasoning with the patient is unlikely to change his mind; he needs external structure for making decisions when he is aggressive and paranoid. 7. Which statement is true regarding the adverse effects associated with antipsychotic medications? a. Tardive dyskinesia is a common, reversible condition. b. Painful dystonic reactions can occur in the first 72 hours of initiation of therapy. c. Neuroleptic malignant syndrome (NMS) is a common adverse effect. d. Pseudoparkinsonian symptoms can cause Parkinsons disease. ANS: B Approximately 90% of all dystonic reactions occur in the first 72 hours of antipsychotic therapy. These symptoms are often frightening and painful. Tardive dyskinesia is present in 20% to 25% of patients and may become irreversible. NMS is not a common adverse effect. Pseudoparkinsonism is not related to Parkinsons disease. 8. To what does potency of an antipsychotic medication refer? a. Severity of adverse effects associated with the drug b. Length of time that it takes to reach a therapeutic blood level of the drug c. Milligram doses used for the medication d. Effectiveness of the drug in alleviating psychotic behavior ANS: C Low and high potency refers only to the milligram doses used for the medications and does not suggest any difference in effectiveness. Potency is not related to severity of adverse effects or onset of action. Potency does not refer to effectiveness. 9. Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect? a. Extrapyramidal symptoms b. Allergic reactions c. Idiosyncratic reactions d. Therapeutic responses ANS: A There are four categories of extrapyramidal symptoms: dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. These are not allergic reactions, idiosyncratic reactions, or therapeutic responses. 10. Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)? a. Assess for signs and symptoms of hypoglycemia. b. Encourage a low fiber diet. c. Measure the patients waist circumference. d. Monitor for insomnia. ANS: C Waist circumference baseline measurement is appropriate because of the weight gain and onset of diabetes with use of these medications. Hypoglycemia and insomnia do not occur with this medication. A low fiber diet is not appropriate. 11. A young male patient taking an antipsychotic is experiencing an oculogyric crisis. The nurse prepares to administer: a. diphenhydramine. b. haloperidol. c. aripiprazole. d. risperidone. ANS: A Acute dystonic reactions may be controlled by intramuscular injections of diphenhydramine. Haloperidol, aripiprazole, and risperidone are not used for dystonic reactions. MULTIPLE RESPONSE 12. A patient admitted to the hospital is exhibiting psychotic behavior. Which sign(s) and/or symptom(s) would support the diagnosis of psychosis? (Select all that apply.) a. Constant eye contact during the admission history b. Deterioration of social functioning c. Reporting that the FBI has solicited important secret information from his phone conversations d. Confirmation of hearing voices in his head e. Changing the topic of conversation inappropriately ANS: B, C, D, E Social deterioration, disordered thinking (including delusions), disordered perception, (including hallucinations), and flight of ideas are symptoms of psychotic behavior. It is uncommon for a psychotic patient to maintain eye contact. 13. Why is a combination of antipsychotic agents with benzodiazepines useful in initial treatment of the agitated patient? (Select all that apply.) a. Antipsychotics are not effective for 2 days. b. Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high dose therapy. c. It assists in calming the psychotic patient. d. It allows for rapid increase in dosing of the antipsychotic agents to expedite treatment of hallucinations. e. It effectively treats extrapyramidal adverse effects associated with antipsychotic agents. ANS: B, C The use of benzodiazepines allows lower dosages of antipsychotic agents to be used. Benzodiazepines assist in calming the agitated psychotic patient. Antipsychotic medications can be effective in a matter of minutes when injected. Benzodiazepines do not facilitate the increase of antipsychotic medications or treat extrapyramidal adverse effects associated with antipsychotic agents. 14. Which is/are extrapyramidal adverse effect(s) of antipsychotic agents? (Select all that apply.) a. Spasmodic movements of muscle groups b. Masklike expression c. Lip smacking d. Inability to sit in one place for an extended period e. Weight gain ANS: A, B, C, D Dystonic reactions, pseudoparkinsonism, tardive dyskinesia, and akathisia are extrapyramidal symptoms of antipsychotic agents. Antipsychotic drug therapy often causes substantial weight gain, but this is not classified as a extrapyramidal adverse effect. 15. Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.) a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness e. Bradycardia ANS: A, B, C, D Fever, severe extrapyramidal symptoms, hypertension, and alterations in consciousness (such as stupor, mutism, and coma) are characteristic of neuroleptic malignant syndrome. Bradycardia is not a sign of neuroleptic malignant syndrome. 16. Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.) a. Acute dystonia b. Akathisia c. Weight loss d. Neuroleptic malignant syndrome e. Hypoglycemia f. Tardive dyskinesia ANS: A, B, D, F Antipsychotic drugs can cause neuroleptic malignant syndrome and motor dysfunctions such as dystonia, akathisia, and tardive dyskinesia. Antipsychotic drugs may cause weight gain and hyperglycemia. 17. A patient admitted to a psychiatric facility is hallucinating, pacing, and acting highly suspicious. Based on this information, the nurse will take which action(s)? (Select all that apply.) a. Use the most restrictive restraints available to subdue the patient. b. Be open and direct when handling the patient. c. Encourage a variety of interactions with others. d. Provide high-protein, high-calorie foods. e. Reinforce hallucinations. ANS: B, D Nursing interventions for patients with psychosis must be individualized and based on patient assessment data. The nurse should be open and direct when handling patients who are highly suspicious. High-protein, high-calorie foods are appropriate for the individual to eat while pacing or highly active. If physical restraints are necessary, they should be the least restrictive possible for the circumstances. Interactions should be minimized when perceptions are altered. Hallucinations should not be reinforced. 18. The psychiatric nurse is educating an elderly patient and family about antipsychotic drug therapy. When providing this education, the nurse will include which statement(s)? (Select all that apply.) a. Hallucinations may be reduced within 1 week of starting. b. Rapid increase in dosages will increase frequency of adverse effects. c. Older patients should be observed for hypertension. d. Tardive dyskinesia may be reversible in early stages e. Full therapeutic response may require 6 to 8 weeks to be achieved. ANS: B, D, E Rapid increases in dosages of antipsychotic medication will not reduce the antipsychotic response time but will increase the frequency of adverse effects. Tardive dyskinesia may be reversible in early stages, but it becomes irreversible with continued use of the antipsychotic medication. Reduction in hallucinations, delusions, and thought disorders often requires 6 to 8 weeks for a full therapeutic response to be achieved. Older patients should be observed for hypotension. Chapter 6 Mood disorders MULTIPLE CHOICE 1. What occurs with mania associated with bipolar disorder? a. Varying degrees of sadness b. Distinct episodes of elation c. Suicide d. Psychomotor retardation ANS: B Mania is characterized by distinct episodes of euphoria and elation. Sadness is characteristic of depression. Suicide is not generally associated with mania; it is more commonly associated with depression. Psychomotor retardation is not associated with mania. 2. Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin? a. Meperidine (Demerol) b. Morphine c. Ibuprofen (Advil) d. Acetaminophen (Tylenol) ANS: B Morphine is the narcotic analgesic of choice because it will not interact with the patients MAOI. Meperidine will interact with the patients medication. Ibuprofen and acetaminophen are not narcotic analgesics. 3. What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy? a. They are less expensive than the other classes of antidepressants. b. They cure major depressive illnesses. c. They do not cause the anticholinergic and cardiovascular adverse effects. d. Therapeutic relief is immediate. ANS: C SSRIs are the most widely used class of antidepressants. Although they are as effective in treating depression as the tricyclic antidepressants, they do not cause the anticholinergic and cardiovascular adverse effects that often limit the use of tricyclic antidepressants. SSRIs tend to be more expensive than other available antidepressants. SSRIs do not cure major depressive illnesses. As with other antidepressants, it takes 2 to 4 weeks to obtain the full therapeutic benefit when taking SSRIs. 4. Lithium (Eskalith) is the drug of choice for which of the following disorders? a. Psychotic episodes b. Obsessive compulsive disorders (OCDs) c. Bipolar disorders d. Depressive disorders ANS: C Lithium is used to treat acute mania and for prophylactic treatment of recurrent manic and depressive episodes in bipolar disorders. Psychotic episodes are treated with major tranquilizers that have an antipsychotic effect. The drugs of choice for treating OCD are SSRIs. Depressive disorders are not primarily treated with lithium. 5. Which psychological manifestation of depression will improve in response to antidepressant therapy? a. Loss of energy b. Palpitations c. Sleep disturbances d. Social withdrawal ANS: D Social withdrawal and lack of interest in surroundings are psychological responses that will improve within 2 to 4 weeks of the patient receiving an effective dosage of antidepressant therapy. An increase in energy, decreased palpitations, and improvement in sleep patterns are physiological responses. 6. On what is the choice of tricyclic antidepressants based? a. The need to decrease the action of norepinephrine, dopamine, or serotonin b. Patient age and gender c. An absence of adverse effects, such as orthostatic hypotension d. The need for stimulation and increased mental alertness ANS: B The choice of tricyclic antidepressants is based on their individual therapeutic characteristics. Tricyclics prolong the action of norepinephrine, dopamine, and serotonin. All tricyclics produce orthostatic hypotension to some degree. All tricyclics produce sedation, not stimulation. 7. The nurse is teaching a patient about medication treatment for depression. The patient asks how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate? a. 3 days b. 1 week c. 4 weeks d. 2 months ANS: B The physiological manifestations of depression (sleep disturbance, change in appetite, loss of energy, fatigue, palpitations) begin to be alleviated within the first week of therapy. It takes longer than 3 days for the symptoms to improve. Four weeks and 2 months are longer than it takes for the symptoms to improve. 8. What is the action of MAOIs on neurotransmitters? a. Blocking their reuptake b. Increasing their production c. Blocking their destruction d. Increasing their reuptake ANS: C MAOIs act by blocking the metabolic destruction of epinephrine, norepinephrine, dopamine, and serotonin neurotransmitters by the enzyme monoamine oxidase in the presynaptic neurons of the brain. They prevent the degradation of these central nervous system (CNS) neurotransmitters so that their concentration is increased. MAOIs do not block or increase the reuptake of neurotransmitters. MAOIs do not increase production of neurotransmitters. 9. A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication? a. Constipation b. Hypotension c. Neck stiffness d. Urinary retention ANS: C Hypertensive crisis is a major potential complication. Common prodromal symptoms of hypertensive crisis include severe occipital headache, stiff neck, sweating, nausea, vomiting, and sharply elevated blood pressure. Constipation, hypotension, and urinary retention are not indicative of a major potential complication when patients consume foods high in tyramine. 10. Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety? a. Excessive thirst b. Hand tremor c. Drowsiness d. Diarrhea ANS: C Drowsiness is a common adverse effect, and people who work with machinery, drive a car, administer medicines, or perform other duties in which they must remain mentally alert should not take trazodone while working. Excessive thirst, hand tremors, and diarrhea are not an adverse effect associated with trazodone. 11. The nurse is caring for a patient who is taking a newly prescribed drug, nefazodone, for treatment of depression. Which physical assessment finding is most important for the nurse to report to the health care provider immediately? a. Bradycardia b. Dizziness c. Drowsiness d. Urinary retention ANS: A Bradycardia with a drop in 15 beats/min is to be reported to the health care provider immediately; withholding the dose is warranted until approved. Dizziness, drowsiness, and urinary retention are common adverse effects that would not need to be reported to the health care provider. 12. The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation. Which statement by the patient would indicate the need for further teaching? a. My dose will increase after 3 days. b. I should swallow this medication whole. c. If I have the urge to smoke, I will take more medication. d. I do not need to taper my dose when the drug is discontinued. ANS: C Dosage will begin at 150 mg/day for the first 3 days and then, for most patients, be increased to 300 mg/day. The patient is maintained on doses of 300 mg/day for 7 to 12 weeks and dosage is not based on a desire to smoke. Bupropion should be swallowed whole, not crushed, divided, or chewed. Dose tapering is not required when discontinuing bupropion. 13. Which nursing action is most important when providing care to a patient diagnosed with a mood disorder? a. Assess the patient for thoughts of suicide. b. Provide supplemental feedings as needed. c. Assist with activities of daily living. d. Offer opportunities for interaction with other patients. ANS: A Determining if there is a risk for suicide, monitoring at specified intervals, and providing patient safety and supervision are the highest priorities with severe mood disorders. Providing supplemental feedings, assisting with activities of daily living, and offering opportunities for interaction with other patients are not priorities of care. 14. A patient is admitted to a long term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug. a. immediately following the last dose of b. in 1 week following the last dose of c. in 14 days following the last dose of d. before discontinuing ANS: C MAOIs and TCAs, especially imipramine and desipramine, should not be administered concurrently. It is recommended that at least 14 days lapse between discontinuing an MAOI and starting SSRI/SNRI therapy. 15. A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is: a. nausea. b. imbalanced nutrition (less than body requirements). c. fluid volume deficit. d. altered peripheral tissue perfusion. ANS: C Nausea and vomiting are common adverse effects of vilazodone. Persistent vomiting should be evaluated for other causes, as well as for the development of electrolyte imbalance. Fluid volume deficit can lead to life threatening cardiac arrhythmias and therefore is the priority nursing diagnosis. The nursing diagnosis nausea is appropriate, but is not the priority. Imbalanced nutrition is an appropriate nursing diagnosis but is not the priority at this time. Altered peripheral tissue perfusion does MULTIPLE RESPONSE 16. Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted with depression? (Select all that apply.) a. Current medications and medical history b. Recent stressors and support system c. Family history of mood disorder d. Dietary patterns e. Insurance coverage ANS: A, B, C, D It is important to obtain a thorough history when assessing the patient with depression, including current medical status and medications, recent stressors, support system, family history of mood disorders, and nutritional patterns. Financial matters should not be part of the nursing assessment. 17. Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith) who is being discharged? (Select all that apply.) a. Persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the health care provider immediately. b. It is important to comply with schedules for blood tests to assess therapeutic levels. c. You should avoid foods such as Chianti wine and aged cheeses. d. The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve. e. You will be gradually weaned off this medication. f. Take the medication with food or milk. ANS: A, B, D, F Patients should be informed of the importance of toxic symptoms to report and monitoring therapeutic lithium levels. Nausea, vomiting, and abdominal cramps are common adverse effects and tend to resolve. Lithium should be administered with food or milk. Chianti wine and aged cheeses are to be avoided during MAOI therapy. The bipolar patient may be on lithium treatment for the rest of his or her life and will not be weaned from the medication. 18. What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil)? (Select all that apply.) a. Dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem. b. Rise slowly from a supine or sitting position to avoid dizziness and orthostatic hypotension. c. Avoid alcohol and barbiturates. d. If adverse effects occur, discontinue the medication. e. An immediate elevation in mood will be noted. ANS: A, B, C Common adverse effects associated with tricyclic antidepressants are dry mouth and orthostatic hypotension. Alcohol and barbiturates should be avoided while taking tricyclic antidepressants because they enhance sedation.Adverse effects are likely to occur, and the medication should not be discontinued without the direction of the health care provider. Tricyclic antidepressants typically take several weeks to produce a therapeutic effect. 19. Which food(s) containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy? (Select all that apply.) a. Beer b. Red meat c. Aged cheeses d. Green vegetables e. Bananas ANS: A, C, E Beer, red wines, well ripened cheeses (such as camembert, edam, roquefort, parmesan, mozzarella, and cheddar), and overripe bananas contain tyramine. Red meat and green vegetables do not contain tyramine. 20. Which nursing assessment(s) is/are important before the initiation of antidepressant therapy?(Select all that apply.) a. Compliance with medication therapy within the last 2 months b. Nonverbal interactions among patient and significant others present c. Evaluation of the coherency, relevancy, and organization of thoughts in responses d. Appearance and posture e. Elimination pattern ANS: A, B, C, D Compliancy with prescribed medications over the last 2 months provides the health care provider with information regarding the patients state of mind and ability to follow through with medication administration independently. Patients with altered thought processes often display inconsistencies between statements of feelings and behavior norms in social settings. Coherency, relevancy, and organization of thoughts are often affected by thought disorders. This assessment also provides information regarding the accuracy of other information that the patient has offered. Note general appearance and appropriateness of attire and posture because these are often affected by mood disorders. Elimination pattern is not a priority premedication assessment. 21. Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant drugs? (Select all that apply.) a. MAOIs block the effects of dopamine in the CNS. b. SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft. c. Tricyclic antidepressants block the action of norepinephrine and epinephrine in the SNS. d. Monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action. e. SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine. ANS: B, D, E SSRIs block the destruction and storage of serotonin at the synaptic cleft, therefore increasing the amount of serotonin available. Monocyclic antidepressants have an unknown mechanism of action. They are weaker inhibitors of the reuptake and inactivation of the neurotransmitters serotonin norepinephrine and dopamine. SNRIs act by inhibiting the reuptake and destruction of serotonin and norepinephrine and, to a lesser extent, dopamine, from the synaptic cleft, thereby prolonging the action of the neurotransmitters. MAOIs act by blocking the metabolic destruction of dopamine, so concentration is increased. Tricyclics block the reuptake of neurotransmitters, not their effects. 22. Which drug(s) interact(s) with SSRI agents? (Select all that apply.) a. Tranylcypromine (Parnate) b. Lithium (Eskalith) c. Warfarin (Coumadin) d. Furosemide (Lasix) e. Propranolol (Inderal) ANS: A, B, C, E A 14-day lapse is recommended between MAOIs, such as Parnate, and SSRI agents. The incidence of lithium toxicity is increased with SSRI agents. The anticoagulant effects of warfarin may be enhanced with SSRIs. The SSRIs fluvoxamine and citalopram inhibit the metabolism of beta adrenergic blocking agents such as propranolol. Lasix does not interact with SSRI agents. 23. The nurse must be sure to instruct the patient about which potential adverse effect(s) of tricyclic antidepressants? (Select all that apply.) a. Diarrhea b. Dryness of mouth, nose, and throat c. Constipation d. Nocturia e. Urinary retention f. Blurred vision ANS: B, C, E, F The patient may experience difficulty with dryness of the mouth, nose, and throat as well as smooth muscle contraction (resulting in constipation, urinary retention, and blurred vision). Diarrhea and nocturia are not adverse effects of tricyclic antidepressants. 24. The nurse is preparing 0800 medications for a patient with the medical diagnosis of end stage renal disease. When reviewing the medication administration record (MAR), the nurse notices the patient is scheduled to receive an MAOI drug. Which intervention(s) will the nurse perform before administering the drug? (Select all that apply.) a. Assess temperature. b. Provide an alternative drug. c. Hold the MAOI drug. d. Consult with the prescribing health care provider. e. Assess urine output prior to administration. ANS: C, D If the patient prescribed an MAOI drug has a history of severe renal disease, the medication must not be given and the prescribing health care provider consulted. It is not necessary to assess temperature at this time. An alternative medication needs to be ordered by a health care provider licensed to prescribe. Assessing urine output does not apply to this situation. Chapter 7 Antidepressants Identify the choice that best completes the statement or answers the question. ____ 1. You are admitting a new patient who is depressed. Your initial contact should do what? A. Address why he is depressed B. Keep communication open C. Lift his spirits D. Establish trust ____ 2.