Nokea
A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports
- A. Feeling sleepy and less energetic.
- B. Weight gain of 7 pounds in the last month.
- C. Minimum mood swings.
- D. Increased feelings of self-worth.
Correct Answer: C
Rationale: Mood-stabilizing drugs like lithium aim to minimize mood swings in bipolar disorder. Weight gain and lethargy may occur but are not indicators of appropriate dosing, and inflated self-worth is a symptom that should diminish with treatment.
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The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient.
- A. Have you ever had an allergic reaction to radioactive dye?
- B. Have you had anything to eat in the last 24 hours?
- C. Does your insurance cover the cost of this scan?
- D. Are you anxious about being in tight spaces?
Correct Answer: D
Rationale: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans, not MRIs, require radioactive substances. Fasting is not required for brain imaging studies, and verifying insurance is not a primary nursing role.
A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated?
- A. Call the physician for an increase in dosage.
- B. Do not give the next dose, and call the physician.
- C. Increase fluid intake for the next week.
- D. No intervention is necessary at this time.
Correct Answer: D
Rationale: A lithium level of 1.2 mEq/L is within the therapeutic range (0.5-1.5 mEq/L), so no intervention is necessary.
One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 39.5?°C, and altered mental status. The nurse should notify the physician because these symptoms are indicative of
- A. Acute dystonia
- B. Extrapyramidal side effects
- C. Neuroleptic malignant syndrome
- D. Tardive dyskinesia
Correct Answer: C
Rationale: These symptoms "muscle rigidity, high fever, and altered mental status "are classic signs of neuroleptic malignant syndrome, a potentially fatal reaction requiring immediate medical attention.
A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on?
- A. Aripiprazole (Abilify)
- B. Risperidone (Risperdal Consta)
- C. Fluphenazine (Prolixin)
- D. Fluoxetine (Prozac)
Correct Answer: A
Rationale: New-generation antipsychotics like aripiprazole are preferred for initial treatment of psychotic symptoms due to fewer side effects. Injectable antipsychotics like Risperdal Consta are used after stabilization, and fluoxetine is an antidepressant, not indicated for psychosis.
A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report?
- A. A headache after eating wine and cheese
- B. A decrease in sexual pleasure during intimacy
- C. An intense need to move about
- D. Persistent runny nose
Correct Answer: B
Rationale: Sexual dysfunction is a common side effect of SSRIs like paroxetine due to enhanced serotonin transmission. Headaches from tyramine interactions are associated with MAOIs, not SSRIs. An intense need to move about is an extrapyramidal side effect of antipsychotics, and runny nose is not typical.