Nokea
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.
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A nurse caring for a patient prescribed a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to what outcome?
- A. Mood improvement
- B. Logical thought processes
- C. Reduced levels of motor activity
- D. Decreased extrapyramidal symptoms
Correct Answer: A
Rationale: SSRIs affect mood, relieving depression in many patients. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.
Priority teaching for a patient taking clozapine should include which instruction?
- A. Report sore throat and fever immediately.
- B. Avoid foods high in polyunsaturated fat.
- C. Use water-based lotions for rashes.
- D. Avoid unprotected sex.
Correct Answer: A
Rationale: Clozapine therapy may produce agranulocytosis a rare but serious decrease in granulated white blood cells (WBCs); therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly. The other options are not relevant to clozapine administration.
A patient asks a nurse, 'What are neurotransmitters? My doctor says mine are out of balance.' What is the nurse's best response?
- A. You must feel relieved to know that your problem has a physical basis.
- B. Neurotransmitters are chemicals that pass messages between brain cells.
- C. It is a high-level concept to explain. You should ask the doctor to tell you more.
- D. Neurotransmitters are substances we eat daily that influence memory and mood.
Correct Answer: B
Rationale: Stating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurate information. Neurotransmitters are messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The incorrect responses do not answer the patient's question, are demeaning, and provide untrue and misleading information.
The laboratory report for a patient taking clozapine indicates the patient is experiencing agranulocytosis. The nurse should implement which intervention first?
- A. Report the laboratory results to the health care provider.
- B. Give the next dose of the medication as prescribed.
- C. Administer aspirin and force fluids.
- D. Repeat the laboratory tests.
Correct Answer: A
Rationale: These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider. The drug should be withheld because the health care provider will discontinue it. The health care provider may repeat the laboratory test, but, in the meantime, the drug should be withheld. Giving aspirin and forcing fluids are measures that are less important than stopping the administration of the drug.
A nurse prepares to administer an antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring of the medication's effects and side effects will be most important if the patient is also diagnosed with which health problem? (Select all that apply.)
- A. Parkinson disease
- B. Graves' disease
- C. Osteoarthritis
- D. Epilepsy
- E. Diabetes
Correct Answer: A,D,E
Rationale: Antipsychotic medications may produce weight gain, which complicates the care of a patient with diabetes, or lowers the seizure threshold (or both), which complicates the care of a patient with epilepsy. Parkinson disease involves changes in transmission of dopamine and acetylcholine; therefore, these drugs also complicate the care of a patient with the disorder. Osteoarthritis and Graves' disease should have no synergistic effect with this medication.