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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.
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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.
A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient?
- A. Cerebral arteriogram
- B. Functional magnetic resonance imaging (fMRI)
- C. Computed tomography (CT) scan or magnetic resonance imaging (MRI)
- D. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)
Correct Answer: C
Rationale: A CT scan and an MRI visualize neoplasms and other structural abnormalities. A PET scan, SPECT scan, and fMRI, which give information about brain function, are not indicated. An arteriogram would not be appropriate.
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.
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.
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.