Nokea
A patient is demonstrating signs of dementia. The health care provider wants to make a differential diagnosis between Alzheimer's disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first?
- A. Computed tomography (CT) scan
- B. Positron emission tomography (PET) scan
- C. Functional magnetic resonance imaging (fMRI)
- D. Single-photon emission computed tomography (SPECT) scan
Correct Answer: A
Rationale: A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarction-information that will be helpful to the health care provider. The other tests focus on brain activity and are more expensive; they may be ordered later.
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A patient demonstrates disorganized thinking associated related to a diagnosis of schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
- A. Brainstem
- B. Cerebellum
- C. Temporal lobe
- D. Prefrontal cortex
Correct Answer: D
Rationale: The prefrontal cortex is responsible for intellectual functioning. The temporal lobe is responsible for the sensation of hearing. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.
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 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.
A patient's partner, who is a chemist, asks a nurse how serotonin reuptake inhibitors (SSRIs) lift depression. What response will the nurse provide?
- A. Destroys increased amounts of neurotransmitters.
- B. Makes more serotonin available at the synaptic gap.
- C. Increases production of acetylcholine and dopamine.
- D. Blocks muscarinic and ?±??-norepinephrine receptors.
Correct Answer: B
Rationale: Depression is thought to be related to the lowered availability of the neurotransmitter serotonin. SSRIs act by blocking the reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. They actually prevent the destruction of serotonin, have no effect on acetylcholine and dopamine production, and do not block muscarinic or ?±??-norepinephrine receptors.
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.