APEA Psychiatric-Mental Health Organized Columbia Nursing Psychiatric Exam Questions and Verified Answers| graded A+|Brand New!

The nurse understands that which medications are considered typical antipsychotics? Select all that apply. One, some, or all responses may be correct. - Answer Thioridazine, Chlorpromazine Rationale: First-generation antipsychotic medications also are known as typical/conventional antipsychotics. Thioridazine and chlorpromazine are typical antipsychotics. Asenapine, lurasidone, and aripiprazole are atypical antipsychotics, also known as second-generation antipsychotics. Which medication acts as an antidote to benzodiazepine? - Answer Flumazenil Rationale: Flumazenil is a benzodiazepine receptor antagonist and is used to reverse conscious sedation induced by benzodiazepines. Temazepam, suvorexant, and flumazenil are benzodiazepines. Which medication is contraindicated in a pregnant client? - Answer Paroxetine Rationale: Paroxetine is a selective serotonin reuptake inhibitor that should be avoided in a pregnant client because it may cause birth defects. Sertraline, venlafaxine, and desipramine can be safely prescribed to a pregnant client. The nurse would identify which medication as a high-potency medication used to treat schizophrenia? - Answer Fluphenazine Rationale: Fluphenazine is a high-potency medication used for schizophrenia. Loxapine and perphenazine are medium-potency medications used to treat schizophrenia. Thioridazine is a low-potency medication used to treat schizophrenia. An older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. Which intervention is appropriate? - Answer Withholding the next dose of lithium and drawing blood for a lithium level Rationale: The client is displaying signs and symptoms of early lithium toxicity; older clients should be monitored carefully and given smaller doses of lithium because its excretion from the kidneys is slower than that in younger adults. There is no antidote to lithium. Coarse hand tremor is an indication of advanced lithium toxicity; the lithium should be withheld. Although antiepileptics are effective in 25% to 50% of clients with treatment-resistant bipolar disorder, this is not the appropriate treatment for lithium toxicity. A client with a diagnosis of schizophrenia is prescribed an antipsychotic medication. The nurse understands which side effect of antipsychotic medications may be irreversible? - Answer Tardive Dyskinesia Rationale: Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia (motor restlessness), parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson's disease such as resting tremors, muscle weakness, reduced movement, and festinating gait), and dystonia (impairment of muscle tonus) usually can be treated with antiparkinsonian or anticholinergic medications while the antipsychotic medication is continued. The nurse is preparing to administer methylphenidate to an older adult with apathy and depression. Which would the nurse include in the assessment to monitor for complications? Select all that apply. One, some, or all responses may be correct. - Answer Vision, Weight, Heart Rate Rationale: When methylphenidate is administered to older adults, the nurse will monitor the client's vision for signs of glaucoma, as well as their weight, heart rate, and blood pressure. Skin turgor and bowel sounds are not affected by methylphenidate. A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The primary health care provider prescribes the anticholinergic medication benztropine, 2 mg daily. The nurse should inquire about which symptom when assessing the client? - Answer Constipation Rationale: The anticholinergic activity of each medication is magnified, and adverse effects such as paralytic ileus may occur. Hypotension, not hypertension, occurs with anticholinergic medications. Dryness of the mouth, not increased salivation, occurs with anticholinergic medications. Decreased, not increased, perspiration occurs with anticholinergic medications. In which situation would the nurse anticipate naltrexone to be administered? - Answer To decrease the recovering alcoholic's desire to drink Rationale: Naltrexone is effective in reducing the risk of relapse among recovering alcoholics in conjunction with other types of therapy. Naloxone, not naltrexone, is used for opioid overdose. Naltrexone is not used to treat the effects of cocaine. It is an opioid antagonist. It is not used for antianxiety agent withdrawal. When the client taking haloperidol has a sudden change in health status, the nurse reviews the client's medical record and performs a physical assessment. Which medical emergency would the nurse conclude that the client is experiencing? - Answer Neuroleptic malignant syndrome Rationale: The data presented are indicative of neuroleptic malignant syndrome, a rare and life threatening complication of antipsychotic medications such as haloperidol. The medication should be discontinued and supportive care provided. An oculogyric crisis is an extrapyramidal side effect of neuroleptic (not antipsychotic) medications in which there is uncontrolled rolling back of the eyes. This should be treated quickly with an antiparkinsonian agent. Although many of the adaptations presented are associated with serotonin syndrome, the client is not taking a selective serotonin reuptake inhibitor antidepressant or other medications that increase the serotonin level. Haloperidol toxicity is manifested as an increase in the intensity of medication side effects; hyperpyrexia and diaphoresis are not associated with toxicity. The laboratory calls to report that a hospitalized client's lithium level is 1.9 mEq/L (1.9 mmol/L) after 10 days of lithium therapy. How will the nurse respond to this information? - Answer The nurse will notify the health care provider of the findings because the level is dangerously high. Rationale: Any result above 1.5 mEq/L (1.5 mmol/L) is approaching or in the toxic range. The therapeutic range for lithium is 0.6 to 1.2 mEq/L (0.6-1.2 mmol/L). Immediate action must be taken. The level is dangerously high, and continued administration of the medication and simply monitoring are unsafe. The health care provider instructs a client who has been taking clozapine for 2 months to discontinue the medication for a few weeks. Which laboratory parameter would the nurse recognize as supporting the intervention? - Answer White blood cell count of 2,500/mm3 Rationale: Because clozapine may cause agranulocytosis, the client's white blood cell (WBC) count should be monitored weekly. The medication should be discontinued if the count falls below 3,000/mm3. Thus the medication should be discontinued when the WBC count is 2,500/mm3. A platelet count of 30,000/mm3may indicate thrombocytopenia. Clozapine may not cause thrombocytopenia. A hemoglobin of 12 g/dL is within normal range. A red blood cell count of 4.2 million/mm3 is a normal value. Donepezil is prescribed for a client who has mild dementia of the Alzheimer type. Which information would the nurse include when discussing this medication with the client and family? - Answer Blood tests that reflect liver function will be performed routinely. Rationale: Donepezil may affect the liver because alanine aminotransferase (ALT) is found predominantly in the liver; most ALT increases indicate hepatocellular disease. Clients taking this medication should have regular liver function tests and report light stools and jaundice to the primary health care provider. Fluids should not be limited, because a side effect of donepezil is constipation. A side effect of constipation is expected; therefore, fluids, high-fiber foods, and exercise should be recommended to help keep the stools soft. The client should not increase or decrease the dosage abruptly; donepezil should be taken exactly as prescribed. A health care provider prescribes disulfiram for a client who abuses alcohol. The nurse teaches the client that disulfiram will have which action? - Answer It causes a severe adverse reaction if alcohol is consumed. Rationale: Disulfiram is used for aversion therapy; a person who consumes alcohol while taking disulfiram will experience a severe reaction consisting of nausea, vomiting, hypotension, headache, tachycardia, tachypnea, and flushing. The medication does not decrease alcohol cravings, and it does not decrease inebriant effects. When taking disulfiram, the client cannot tolerate any alcohol. A client on a psychiatric unit who has auditory hallucinations is receiving a neuroleptic medication for the first time. The client takes the cup of water and the pill and stares at them. Which statement by the nurse is therapeutic? - Answer "This will help you not to hear the voices. It will only work if you take it." Rationale: Explaining what the medication will do for the client is an appropriate nursing intervention. Telling the client that the provider wants him or her to take the medication and instructing him or her to do so presents reality and simply states the expected behavior. Telling the client that he or she has to take the medication is an authoritarian, not a therapeutic, statement. The client has the right to refuse medication. Telling the client that the medication has been prescribed for him or her does not tell the client what behavior is expected. Noting that there must be a reason that the client doesn't want to take the medication assumes that the client does not want to take medication, even though the client may simply not understand what to do. While caring for a client on phenelzine, the nurse notes an excess elevation of the person's temperature. Which medication being taken concurrently by the client may be responsible for this condition? - Answer Meperidine Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. Meperidine is a strong analgesic that when taken concurrently with MAOIs may result in excessive temperature elevation. Desipramine and amitriptyline are tricyclic antidepressants that may cause hypertensive episodes or hypertensive crisis when taken concurrently with MAOIs. Amphetamine is an indirectly acting sympathomimetic that causes a hypertensive crisis when taken concurrently with MAOIs. A client with chronic, undifferentiated schizophrenia is receiving an antipsychotic medication. For which potentially irreversible extrapyramidal side effect would the nurse monitor the client? - Answer Tardive dyskinesia Rationale: Tardive dyskinesia occurs as a late and persistent extrapyramidal complication of long-term antipsychotic therapy. It most often manifests in abnormal movements of the lips, tongue, and mouth. Torticollis, oculogyric crisis, and pseudoparkinsonism are reversible with administration of an anticholinergic (e.g., benztropine) or an antihistamine (e.g., diphenhydramine) or cessation of the medication. A client comes to the mental health clinic for a monthly injection of 37.5 mg of fluphenazine decanoate. It is available as 25 mg/mL. How many milliliters of solution would the nurse administer? Record your answer to one decimal place. ____ mL - Answer 1.5 A client with a history of alcoholism develops Wernicke encephalopathy associated with Korsakoff syndrome. Which medication therapy is indicated for management of this condition? - Answer Intramuscular injections of thiamine Rationale: Thiamine is a coenzyme necessary for the production of energy from glucose. If thiamine is not present in adequate amounts, nerve activity is diminished and damage or degeneration of myelin sheaths occurs. A traditional phenothiazine is a neuroleptic antipsychotic that should not be prescribed because it is hepatotoxic. Antipsychotics must be avoided; their use has a higher risk of toxic side effects in older or debilitated persons. Chlorpromazine, a neuroleptic, cannot be used because it is severely toxic to the liver. A client has been receiving phenytoin for epilepsy and is newly prescribed haloperidol. The nurse would include which information when teaching the client about the interaction of these medications? - Answer Potentiation of haloperidol's central nervous system depressant effect Rationale: Antiseizure medications and haloperidol exert a synergistic central nervous system depressant effect. The effect is potentiated, not masked. Anticonvulsants do not affect the absorption or metabolism of haloperidol. Which adverse effect would the nurse continually assess for in a client receiving valproic acid? - Answer Yellow sclerae Rationale: Yellow sclerae are a sign of jaundice; pancreatitis and hepatic failure are life threatening adverse effects of valproic acid. The client must have frequent liver function tests. Motor restlessness (akathisia) is associated with antipsychotic medications. Ringing or buzzing in the ears (tinnitus) is associated with aspirin. Torsion of the neck (torticollis) because of contracted cervical muscles is associated with antipsychotic medications. Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. Which signs and symptoms of this syndrome will the nurse identify? Select all that apply. One, some, or all responses may be correct. - Answer Diaphoresis, Hyperrigidity, Hyperthermia Rationale: Diaphoresis, hyperrigidity, and hyperthermia occur with neuroleptic malignant syndrome as a result of dopamine blockade in the hypothalamus. Jaundice and photosensitivity are not associated with neuroleptic malignant syndrome. A client, who is currently taking digoxin 0.125 mg in the morning and alprazolam 0.5 mg twice a day, is prescribed donepezil 5 mg daily for early dementia of the Alzheimer type. Which instruction would the nurse include when teaching the client's spouse about medication administration? - Answer "Prefill a weekly medication box with the medications for the client to...