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A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to ?±??-receptors because the patient may experience what effect?
- A. Increased psychotic symptoms
- B. Severe appetite disturbance
- C. Orthostatic hypotension
- D. Hypertensive crisis
Correct Answer: C
Rationale: Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the uplink position. Blockage of ?±??-receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Patients should be taught ways of minimizing this phenomenon.
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The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment?
- A. Do you ever see or hear things that others do not?
- B. Do you have problems with short-term memory?
- C. How would you describe your sleep pattern?
- D. How would you describe your thinking?
Correct Answer: C
Rationale: Mood changes throughout the day are related to circadian rhythms. Questions about sleep pattern would also be relevant to circadian rhythms. The question about seeing or hearing things is relevant to the assessment for illusions and hallucinations. The question about thinking is relevant to the assessment of thought processes. The other question is relevant to assessment of memory.
A patient taking an antipsychotic medication develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action?
- A. Anticholinergic effects
- B. Dopamine-blocking effects
- C. Endocrine-stimulating effects
- D. Ability to stimulate spinal nerves
Correct Answer: B
Rationale: Medications that block dopamine often produce disturbances of movement (extrapyramidal side effects) such as akathisia because dopamine affects neurons involved in both the thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.
The spouse of a patient diagnosed with schizophrenia asks, 'Which neurotransmitters are more active when a person has schizophrenia?' The nurse's response will focus on which neurotransmitters? (Select all that apply.)
- A. GABA
- B. Substance P
- C. Histamine
- D. Dopamine
- E. Norepinephrine
Correct Answer: D,E
Rationale: Dopamine plays a role in the integration of thoughts and emotions, and excess dopamine is implicated in the thought disturbances of schizophrenia. Increased activity of norepinephrine also occurs. Substance P is most related to the pain experience. Histamine decrease is associated with depression. Increased GABA is associated with anxiety reduction.
A patient hospitalized with a mood disorder has demonstrated aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the health care provider is most likely to prescribe a medication from what classification?
- A. Anticholinergic
- B. Mood stabilizer
- C. Psychostimulant
- D. Tricyclic antidepressant
Correct Answer: B
Rationale: The symptoms describe a manic episode. Mania is effectively treated by the mood stabilizing medication, lithium and selected anticonvulsants such as carbamazepine, valproic acid, and lamotrigine. No drugs from the other classifications listed are effective in the treatment of mania.
A patient presents with anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter?
- A. GABA
- B. Histamine
- C. Acetylcholine
- D. Norepinephrine
Correct Answer: D
Rationale: Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for the 'fight-or-flight' response. GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation.