Nokea
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.
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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.
The parent of an adolescent diagnosed with schizophrenia asks a nurse, 'My child's doctor ordered a positron-emission tomography (PET) scan. What is that?' What is the nurse's best response?
- A. PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does your teenager have any metal implants?
- B. It's a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred.
- C. PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures.
- D. PET is a special scan that shows blood flow and activity in the brain.
Correct Answer: D
Rationale: The parent is seeking information about PET scans. It is important to use terms the parent can understand. The correct option is the only reply that provides factual information relevant to PET scans. The incorrect responses describe magnetic resonance imaging (MRI), computed tomographic (CT) scans, and electroencephalography (EEG).
A nurse can anticipate anticholinergic side effects are likely to occur when a patient is prescribed what medication?
- A. Lithium
- B. Buspirone
- C. Risperidone
- D. Fluphenazine
Correct Answer: D
Rationale: Fluphenazine, a first-generation antipsychotic medication, exerts muscarinic blockade, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.
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 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.