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A middle-aged adult with major depressive disorder suffers from psychomotor retardation, hypersomnia, and amotivation. Which intervention is likely to be most effective in returning this client to a normal level of functioning?
- A. Encourage the client to exercise.
- B. Suggest that the client develop a list of pleasurable activities.
- C. Provide education on methods to enhance sleep.
- D. Teach the client to develop a plan for daily structured activities.
Correct Answer: D
Rationale: The correct answer is D: Teach the client to develop a plan for daily structured activities. This intervention is most effective because it addresses the symptoms presented by the client - psychomotor retardation, hypersomnia, and amotivation. Structured activities can help regulate the client's daily routine, combat inertia, and provide a sense of purpose and accomplishment. By setting specific tasks and goals, the client can gradually increase their level of activity and engagement, which can improve mood and motivation. Encouraging exercise (choice A) may be beneficial, but developing a structured plan encompasses a broader approach to address all symptoms. Creating a list of pleasurable activities (choice B) may not address the lack of motivation or structure. Providing education on sleep enhancement methods (choice C) may not directly address psychomotor retardation and amotivation.
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The nurse is preparing medications for a client with bipolar disorder and notices that the antipsychotic medication was discontinued several days ago. Which medication should also be discontinued?
- A. Alprazolam (Xanax)
- B. Benztropine (Cogentin)
- C. Magnesium (Milk of Magnesia)
- D. Lithium (Lithotabs)
Correct Answer: B
Rationale: The correct answer is B: Benztropine (Cogentin). Benztropine is a medication commonly used to treat extrapyramidal side effects caused by antipsychotic medications. If the antipsychotic medication is discontinued, there is no longer a need for Benztropine. Alprazolam (A) is used to treat anxiety and should not be automatically discontinued. Magnesium (C) is a laxative and unrelated to bipolar disorder treatment. Lithium (D) is a mood stabilizer commonly used in bipolar disorder treatment and should not be discontinued without a healthcare provider's guidance.
A client tells the RN that he has an IQ of 400+ and is a genius and an inventor. He also reports that he is married to a female movie star and thinks that his brother wants a sexual relationship with her. What is the priority nursing problem for admission to the psychiatric unit?
- A. Ineffective sexual patterns.
- B. Impaired environmental interpretation.
- C. Disturbed sensory perception.
- D. Compromised family coping.
Correct Answer: C
Rationale: The correct answer is C: Disturbed sensory perception. The client's delusions and false beliefs indicate a break from reality, which is a hallmark symptom of disturbed sensory perception. This poses a risk to the client's safety and well-being. Ineffective sexual patterns (choice A) and compromised family coping (choice D) may be secondary to the primary issue of distorted perceptions. Impaired environmental interpretation (choice B) is less relevant as the client's issues are more internal. Overall, addressing the disturbed sensory perception is the priority to ensure the client's safety and initiate appropriate treatment.
A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?
- A. Obsessive-compulsive disorder
- B. Generalized anxiety disorder
- C. Persistent depressive disorder
- D. Substance use disorder
Correct Answer: D
Rationale: The correct answer is D: Substance use disorder. Ramelteon is a melatonin receptor agonist used to treat insomnia by regulating the sleep-wake cycle without the risk of dependence or abuse, making it ideal for patients with substance use disorder. People with substance use disorder often have disrupted sleep patterns, and ramelteon can help improve their sleep without the risk of worsening their substance use disorder.
A: Obsessive-compulsive disorder - Ramelteon does not specifically target symptoms of OCD.
B: Generalized anxiety disorder - While insomnia can be a symptom of GAD, other medications may be more suitable for addressing anxiety symptoms.
C: Persistent depressive disorder - Ramelteon may not directly address depressive symptoms, and other medications may be more effective for PDD.
Overall, the unique pharmacological profile of ramelteon makes it an appropriate choice for patients with substance use disorder who also have insomnia.
To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.
- A. Alcohol use disorder
- B. Major depressive disorder
- C. Stomach cancer
- D. Polydipsia
Correct Answer: A
Rationale: The correct answer is A: Alcohol use disorder. Patients with schizophrenia are at higher risk for co-occurring substance use disorders, including alcohol use disorder. Assessing for alcohol use is crucial as it can worsen symptoms and interfere with treatment. Major depressive disorder (B) is a common comorbidity but is not specific to schizophrenia. Stomach cancer (C) is not directly associated with schizophrenia. Polydipsia (D), excessive thirst, can be seen in schizophrenia due to medication side effects but is not a primary associated condition.
A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?
- A. Place in a side-lying position with head of bed elevated.
- B. Administer disulfiram (Antabuse) immediately
- C. Give lorazepam (Ativan) PRN for signs of withdrawal.
- D. Provide thiamine and folate supplements as prescribed.
Correct Answer: A
Rationale: The correct answer is A: Place in a side-lying position with head of bed elevated. This is the priority intervention because the client is difficult to arouse, indicating potential risk for airway compromise and aspiration due to the head injury and elevated BAL. Placing the client in a side-lying position with the head of the bed elevated helps prevent aspiration and promotes optimal airway management. Administering disulfiram (choice B) is not indicated as the priority intervention in this acute situation. Giving lorazepam (choice C) for signs of withdrawal may further depress the client's level of consciousness and is not the priority at this time. Providing thiamine and folate supplements (choice D) is important for alcohol-related deficiencies but does not address the immediate risk of airway compromise.