For a client with a sleep disorder, which CAM therapy could be used safely without interference with any allopathic methods of treatment?
a. Progressive relaxation
b. Dietary supplements
c. Herbal supplements
d. Aromatherapy
ANS: A
Progressive relaxation is noninvasive in that it uses deep breathing and conscious muscle relaxation and therefore would not interfere with allopathic methods of treatment. Dietary and herbal supplements can interfere with other medications (allopathic therapy) that may be taken by this client. Aromatherapy could interfere with this client’s allopathic treatment if he is being treated for allergies.
DIF: Cognitive Level: Application REF: p. 63 OBJ: 8
TOP: CAM Approaches to Mental Health Care
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
A female client would like to use biofield therapy for her addiction to nicotine. Which form of therapy would she most likely choose?
a. Aromatherapy
b. Acupuncture
c. Nicotine patches
d. Group therapy
ANS: B
Acupuncture is a form of biofield therapy, which is a form of energy medicine. Aromatherapy is a CAM that is a biologically based practice. Nicotine patches would be considered allopathic, and group therapy is socioculturally based therapy.
DIF: Cognitive Level: Application REF: p. 62 OBJ: 7
TOP: Energy Medicine KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Physiological Integrity
A male client experiences a phobia of enclosed spaces (claustrophobia) and is seeking an energy-based therapy that he can practice and initiate on his own when he experiences symptoms. Which therapy will the nurse recommend?
a. Music and sound therapy
b. Relaxation and visualization
c. Hypnosis therapy
d. Spiritual healing
ANS: B
Although all of these therapies are considered energy-based, the one that would be best suited for these circumstances is relaxation and visualization. The other choices would be difficult to initiate in a claustrophobic situation.
DIF: Cognitive Level: Application REF: p. 61 OBJ: 6
TOP: Mind-Body Medicine KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity
Which theory best describes energy medicine?
a. There is a harmony within the body, nature, and the world.
b. The body has a natural ability to heal itself.
c. There is a vital, life-force energy that flows through an individual’s body.
d. The mind and spirit affect body functions and influence illness.
ANS: C
Energy medicine is best described as the belief that there is a vital energy that flows through an individual’s body. The theory that there is harmony within the body, nature, and the world describes holistic care. The theory that the body has a natural ability to heal itself describes body-based CAM therapies, and mind-body medicine followers believe that the mind and spirit affect body functions and influence illness.
DIF: Cognitive Level: Comprehension REF: p. 62 OBJ: 7
TOP: Energy Medicine KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
A female client is receiving therapy for severe depression that consists of repetitive transcranial magnetic stimulation. This form of therapy is considered to be:
a. Energy medicine
b. Illegal according to FDA regulations
c. A form of expressive therapy
d. A biofield therapy
ANS: A
Repetitive transcranial magnetic stimulation is a form of energy medicine in the category of electromagnetic field therapies. This therapy is not considered to be illegal. Expressive therapy is the use of creative activities such as dance and music to express emotions, and biofield therapy is another form of energy medicine.
DIF: Cognitive Level: Comprehension REF: p. 63 OBJ: 7
TOP: Energy Medicine KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
A 70-year-old male client tells the nurse that he is using chelation therapy to prevent Alzheimer’s disease. Which adverse effect is the client most likely to experience?
a. Allergic reactions
b. Low potassium levels
c. Elevated blood glucose levels
d. Interactions with other medications
ANS: B
Although adverse effects of CAM therapy cannot be predicted in any individual, the most likely adverse effect of chelation therapy is a low potassium level because EDTA binds with heavy metals, causing potassium depletion. This therapy is controversial, and its effectiveness has not been proved scientifically.
DIF: Cognitive Level: Comprehension REF: p. 64 OBJ: 10
TOP: Adverse Effects KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Physiological Integrity
A male client of Indian origin practices meditation and yoga, uses herbs and follows specific diet practices, and practices controlled breathing and exposure to sunlight. Which type of CAM therapy is this individual practicing?
a. Traditional Chinese medicine
b. Homeopathy
c. Ayurveda
d. Reiki
ANS: C
Ayurveda is a body-based CAM therapy that often is practiced by Indian cultures with a central focus on being knowledgeable of how to live. Homeopathy uses natural substances to heal, and traditional Chinese medicine deals with a balance between yin and yang, that is, “laying on of hands” to promote relaxation and healing.
DIF: Cognitive Level: Application REF: p. 58 OBJ: 4
TOP: Whole Medical Systems KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
What is the main function of the National Center for Complementary and Alternative Medicine (NCCAM)?
a. To seek scientific validation of CAM and also be a resource for the public for CAM therapies
b. To investigate and develop new CAM therapies
c. To produce a monthly newsletter on new CAM therapies
d. To monitor the production of dietary and herbal supplements used in CAM therapies
ANS: A
The function of the NCCAM is to seek scientific validation of CAM and also be a resource for the public for CAM therapies. The other options are not representative of the functions of NCCAM.
DIF: Cognitive Level: Knowledge REF: p. 57 OBJ: 3
TOP: National Center for Complementary and Alternative Medicine
KEY: Nursing Process Step: Assessment MSC: Client Needs: Health Maintenance and Promotion
The Food and Drug Administration (FDA) does not impose the same guidelines on __________ as it does on prescription drugs.
a. Chiropractic treatment
b. Dietary supplements
c. Homeopathic treatments
d. Hypnotic therapy
ANS: B
The Dietary Supplement Health and Education Act of 1994 (DSHEA) addresses dietary supplements but does not include the same guidelines that govern prescription drugs. Guidelines are less stringent for dietary supplements; therefore, the safety of use of these products with prescription drugs is one of the concerns associated with such supplements. Dietary supplements include, but are not limited to, vitamins, minerals, and herbs. The FDA does not govern chiropractic treatment, homeopathic treatment, or hypnotic therapy.
DIF: Cognitive Level: Knowledge REF: p. 59 OBJ: 5
TOP: Biologically Based Practices KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity
A 45-year-old male client uses a treatment method that focuses on the relationship between an individual’s body structure and its function. This mode of treatment is:
a. Naturopathic
b. Homeopathic
c. Chiropractic
d. Acupuncture
ANS: C
Chiropractors use manipulation therapy of the spine to improve the relationship of the body structure (spine) to its function, which is thought to aid the body in healing various conditions, such as migraine headache. Naturopathic therapy, homeopathic therapy, and acupuncture do not have this focus.
DIF: Cognitive Level: Comprehension REF: p. 60 OBJ: N/A
TOP: Body-Based Practices KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
Massage therapy manipulates muscles and connective tissue and has been found to be very successful as a CAM method in the treatment of which disorder(s)?
a. Schizophrenia
b. Bipolar disorder
c. PTSD and OCD
d. Depression and anxiety
ANS: D
Massage therapy has been frequently reported to assist in the relaxation of clients with a diagnosis of depression and anxiety disorder. No documentation of massage therapy for schizophrenia, bipolar disorder, or PTSD and OCD is available.
DIF: Cognitive Level: Knowledge REF: p. 60 OBJ: N/A
TOP: Body-Based Practices KEY: Nursing Process Step: Implementation
MSC: Client Needs: Psychosocial Integrity
Which type of therapy has yielded positive results for psychological functioning and is considered one of the safest treatment modalities?
a. Mind-body medicine
b. Chiropractic treatment
c. Dietary supplements
d. Herbal therapy
ANS: A
Mind-body medicine (music and dance therapy, expressive therapy, meditation) has been found effective in improving psychological functioning. They are considered safe because they are noninvasive. Chiropractic treatment and herbal and dietary supplements are more invasive and can interfere with medicines and cause alterations in body systems.
DIF: Cognitive Level: Knowledge REF: p. 61 OBJ: 6
TOP: Mind-Body Medicine KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
A therapy that once was denounced by the scientific community but now is being used to treat successfully victims of the events of 9/11, Hurricane Katrina, and the South Asian tsunami of 2004 and that helps the rational left side of the brain bond with a traumatic memory from the emotional right side of the brain is known as:
a. Hypnosis therapy
b. Eye Movement Desensitization and Reprocessing (EMDR)
c. Shiatsu
d. Doshas
ANS: B
EMDR is thought to help clients who have experienced a horrific trauma to process the event so they can deal with their emotions. The other therapies are not being used widely for treatment following these events.
DIF: Cognitive Level: Knowledge REF: p. 60 OBJ: N/A
TOP: Body-Based Practices KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
__________ is a form of therapy that has been used for over 2000 years to successfully treat clients with drug addiction; it is believed to restore the energy balance in the body and to stimulate the release of certain neurotransmitters and hormones.
a. Yoga
b. Meditation
c. Therapeutic touch
d. Acupuncture
ANS: D
Acupuncture is of Asian origin and has been used for over 2000 years. It has been found to be successful as adjunctive therapy for drug addiction. Yoga, meditation, and therapeutic touch are also forms of energy medicine, but they are more focused on relaxation and on understanding of the inner self.
DIF: Cognitive Level: Knowledge REF: p. 62 OBJ: 7
TOP: Energy Medicine KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
Color therapy has been found to be especially effective in the treatment of:
a. Seasonal affective disorder
b. Bipolar disorder
c. Drug addiction
d. Generalized anxiety disorder
ANS: A
Color therapy involves the use of high-intensity light therapy and is highly effective in improving the symptoms of seasonal affective disorder. Color therapy is not an effective therapy for bipolar disorder, drug addiction, or generalized anxiety disorder.
DIF: Cognitive Level: Knowledge REF: p. 63 OBJ: 7
TOP: Energy Medicine KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
A client experiencing symptoms of anxiety would benefit from which therapy?
a. Chelation
b. Phototherapy
c. Therapeutic touch
d. Magnetic therapy
ANS: C
Therapeutic touch is effective in stress-related conditions such as migraine headaches and anxiety. Chelation is effective against atherosclerosis, phototherapy is used to treat depression, and magnetic therapy is used for primarily for alleviation of pain.
DIF: Cognitive Level: Knowledge REF: p. 60 OBJ: 8
TOP: Energy Medicine: Stress Reduction and Relaxation
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
A child who is the victim of domestic violence refuses to talk about the experience. He is doing poorly in school and having trouble sleeping. Which therapy would he benefit from?
a. Massage
b. Biofeedback
c. Aromatherapy
d. Art therapy
ANS: D
Art, or expressive, therapy is indicated to release inner conflicts and repressed emotions. Massage uses manipulation to relax muscles, biofeedback monitors physical responses during relaxation and aromatherapy uses scents to promote well-being. None of these provides for the expression of repressed emotions.
DIF: Cognitive Level: Knowledge REF: p. 61 OBJ: 6
TOP: Mind Body Medicine: Expression Therapy
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
Which CAM therapy would a nurse be most concerned about if used by a client being treated with antipsychotic medications?
a. Biologically based practices
b. Body-based practices
c. Mind body practices
d. Technology-based practices
ANS: A
Biologically based practices include dietary supplements and herbal therapies that may have adverse or unwanted effects in combination with pharmacotherapy. None of the other practices has the potential to interact with pharmacological agents.
DIF: Cognitive Level: Comprehension REF: p. 64 OBJ: 10
TOP: Biologically Based Practices KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
An allopathic mental health practitioner would most likely recommend which treatment for a client suffering from anxiety?
a. Expressive therapy
b. Acupuncture
c. Antianxiety agents
d. Dietary supplements
ANS: C
Allopathic practitioners use medical and surgical methods to treat disease and injury. The other therapies are CAM agents.
DIF: Cognitive Level: Knowledge REF: p. 56 OBJ: 10
TOP: Biologically Based Practices KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
Which treatments are used in biologically based practice? (Select all that apply.)
a. Dietary supplements
b. Aromatherapy
c. Herbal supplements
d. EDTA
ANS: A, B, C
Dietary supplements, aromatherapy, and herbal supplements fit the category of biologically based practice. EDTA is a body-based practice that involves moving the body into an improved state of function.
DIF: Cognitive Level: Knowledge REF: p. 59 OBJ: 5
TOP: Biologically Based Practices KEY: Nursing Process Step: Implementation
MSC: Client Needs: Physiological Integrity
Which of the following principles best describes the beliefs of naturopathic practitioners? (Select all that apply.)
a. Treatment of the whole person should occur.
b. Prevention of diseases/disorders is a key concept.
c. The doctor is the teacher.
d. Use of wavelengths is beneficial for client treatment.
ANS: A, B, C
In naturopathy, treatment of the whole person should occur, prevention of disease is a key concept, and the doctor is the teacher. Some of the treatments used in naturopathic medicine include acupuncture, colonic irrigation, hydrotherapy, and counseling. Use of wavelengths is part of energy-based therapy.
DIF: Cognitive Level: Comprehension REF: p. 59 OBJ: 4
TOP: Whole Medical Systems KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
Self-help groups provide support to individuals who are dealing with or who have had similar experiences. Which of the following are characteristics of self-help groups? (Select all that apply.)
a. Groups are informal, nonprofit, and free of charge.
b. Membership requires referral from a physician or counselor.
c. Meetings are facilitated by trained counselors.
d. Groups provide support, education, and encouragement to members.
e. Groups benefit individuals who are dealing with life-altering events such as addiction.
ANS: A, D, E
Self-help groups are informal, nonprofit, and free of charge; provide support, education, and encouragement to members; and benefit individuals who are dealing with life-altering events. Membership is voluntary, and meetings usually are facilitated by a survivor or someone with experiences similar to those of the group.
DIF: Cognitive Level: Comprehension REF: p. 64 OBJ: 9
TOP: CAM Mental Health Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
Which of the following CAM mental health therapies are indicated for a client with PTSD? (Select all that apply.)
a. Diet
b. Aromatherapy
c. Eye movement desensitization
d. Yoga
e. Biofeedback
ANS: C, D, E
Treatments indicated for posttraumatic stress disorder (PTSD) include eye movement sensitization, yoga, and biofeedback. Aromatherapy and diet are indicated for stress and sleep disorders.
DIF: Cognitive Level: Comprehension REF: p. 63 OBJ: 8
TOP: CAM Mental Health Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
COMPLETION
CAM therapy is an acronym for __________.
ANS:
complementary and alternative medicine
This therapy comprises two basic groups: body-based CAM and energy-based CAM. It is important for health care providers to be familiar with CAM therapies so they can incorporate these into the plan of care when appropriate or necessary.
DIF: Cognitive Level: Knowledge REF: p. 57 OBJ: 1
TOP: Complementary and Alternative Therapies
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
New approaches to mental health care that include telemedicine, telephone counseling, and radio psychiatry are known as _______________ approaches.
ANS:
technology-based
Technology-based approaches are increasing because of factors such as ease of accessibility for a wide range of people, a greater number of people seeking CAM approaches to mental health care, and increased use of the Internet.
DIF: Cognitive Level: Knowledge REF: p. 63 OBJ: N/A
TOP: Technology-Based CAM Applications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
Chapter 7: Psychotherapeutic Drug Therapy
Test Bank
MULTIPLE CHOICE
During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant (TCA) to not expect to see a difference in mood or anxiety level for up to:
a. 5 days
b. 2 to 3 weeks
c. 4 to 5 weeks
d. 6 weeks
ANS: B
It is important that the client understand that TCAs typically take 2 to 3 weeks to take effect so he will not become discouraged when he does not see immediate results.
DIF: Cognitive Level: Comprehension REF: p. 69 OBJ: 4
TOP: Antidepressant Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor (MAOI). Which is the most important teaching point the nurse must include in his care plan?
a. Avoid foods high in sodium content.
b. Avoid alcoholic beverages.
c. Ensure that protein intake is 60 grams per day.
d. Take a potassium supplement.
ANS: B
This client should be given a list of foods and beverages that are restricted when taking MAOIs, such as some alcoholic beverages, sausage and bologna, and some cheeses. Sodium, protein, and potassium are not factors when MAOIs are taken.
DIF: Cognitive Level: Application REF: p. 71 OBJ: 4
TOP: Antidepressant Medications KEY: Nursing Process Step: Planning
MSC: Client Needs: Physiological Integrity
A female client is 3 days postoperative and has been receiving meperidine (Demerol) for pain control. The family mentions to the nurse that the client has been taking phenelzine (Nardil) for years for her depression. The client did not list this medication on admission. What signs and symptoms should the nurse look for in case of reaction between these two medications?
a. Increased pulse and respirations
b. Hyperactivity and difficulty concentrating
c. Increased tearing and increased urinary output
d. Sedation, disorientation, and hallucinations
ANS: D
Nardil is a monoamine oxidase inhibitor; therefore, symptoms of CNS depression such as sedation, disorientation, and hallucinations, rather than increased vital signs, hyperactivity and difficulty concentrating, and increased tearing and urination, most likely would occur as a reaction between these two medications.
DIF: Cognitive Level: Application REF: p. 70 OBJ: 4
TOP: Antidepressant Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
The nurse is aware that he or she may be administering the new antianxiety medication pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating:
a. Depression
b. Psychotic episodes
c. Neuropathic pain
d. Bipolar disorder
ANS: C
Pregabalin (Lyrica) has been found to be effective for the treatment of neuropathic pain, as well as seizure disorders. This medication is not used for any of the other options listed.
DIF: Cognitive Level: Knowledge REF: p. 70 OBJ: 3
TOP: Antianxiety Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
Selective serotonin reuptake inhibitors (SSRIs) are most health care providers’ drug of choice for the treatment of depression because:
a. Side effects are more manageable than with most antidepressants.
b. They are the only class safe for long-term therapy.
c. This is the oldest class of antidepressants.
d. They are fast-acting medications.
ANS: A
The side effect most commonly reported, gastrointestinal (GI) upset, usually can be avoided if the client takes the medication with food. SSRIs can be used for both short- and long-term therapy; they are not the oldest class of antidepressants; and they usually take a few weeks before onset of effect.
DIF: Cognitive Level: Comprehension REF: p. 71 OBJ: 4
TOP: Antidepressant Medications KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity
In preparing discharge planning for a client who has been prescribed lithium for the treatment of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the need to monitor his or her diet for intake of:
a. Potassium
b. Carbohydrates
c. Protein
d. Sodium
ANS: D
Lithium is a salt that is absorbed into the bloodstream and is excreted by the kidneys at a faster rate than sodium. Therefore, clients must monitor their sodium and fluid intake, as well as their activity level. The other options are not a concern when lithium is taken.
DIF: Cognitive Level: Comprehension REF: p. 71 OBJ: 5
TOP: Antimanic Medications KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Physiological Integrity
A female client calls the clinic for advice after forgetting to take her morning dose of twice-daily lithium 5 hours ago. Which instructions should the nurse give the client?
a. Take the dose immediately, and then take the second dose 3 hours late.
b. Take half of a dose now, and then take the second dose at the normal time.
c. Eliminate the dose missed, and take the second dose at the normal time.
d. Immediately take the missed dose, and take the second dose at the normal time.
ANS: C
Because lithium should be taken at the same time each day and the therapeutic range is narrow, 5 hours after the first dose was missed would be too close to take the second dose. The client should not to try to make up the first missed dose. Altering the schedule for one missed dose could cause more problems with future doses.
DIF: Cognitive Level: Analysis REF: p. 72 OBJ: 5
TOP: Antimanic Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
A female client who has had bipolar disorder for several years decides to stop all of her medications because she is tired of the side effects. She also cancels all appointments with her therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client is considered:
a. Depressed
b. Noncompliant
c. Suffering from an anxiety disorder
d. Possessing obsessive-compulsive tendencies
ANS: B
Noncompliance occurs with many individuals with mental health disorders because of the ways the side effects of the medication affect an individual as well as other factors. It is important to work with clients to prevent noncompliance. Depression, anxiety disorder, and obsessive-compulsive tendencies are not indicated in the situation described.
DIF: Cognitive Level: Application REF: p. 76 OBJ: 9
TOP: Noncompliance KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity
A male client with schizophrenia lives in an assisted-living complex for individuals with mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his antipsychotic medication and therefore stops taking his medication after much discussion with his treatment team. He is progressively withdrawing from reality but is not a safety risk at this point to himself or others. What is the best response of the nurse and treatment team?
a. Try to coerce him into taking his medication.
b. Ensure that the client and those around him are safe, and monitor for additional symptoms of his schizophrenia while maintaining trust with the client.
c. Crush his antipsychotic medications and put them in his food to stop the process of his withdrawal from reality.
d. Speak to his family about seeking an involuntary emergency hold in a mental health facility to get him back on his medications.
ANS: B
The Patient Self-Determination Act states that individuals who are not in an emergency or safety-threatening situation cannot be coerced, forced, or talked into following a suggested course, such as taking medication against their will. All three remaining options go against the Act. In addition, an involuntary emergency hold in a mental facility is not reasonable because the client is not a threat to himself or others.
DIF: Cognitive Level: Analysis REF: p. 76 OBJ: 9
TOP: Informed Consent KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
An adult female client has been diagnosed recently with mild depression but opts not to take the medication prescribed by her physician after talking with the physician about the benefits, risks, possible outcomes, and side effects. She decides to investigate alternative treatments. This client is making this decision based on the premise of:
a. Informed consent
b. Noncompliance
c. Client education
d. Right to privacy
ANS: A
Informed consent most accurately describes the situation because all aspects of taking the medication were discussed with the client before she made the decision to not take the medication. If she had already been in agreement with the regimen rather than seeking other alternatives, she would have been considered noncompliant. Client teaching, such as how and when to take the medication would occur if she decided to take the medication. The client’s right to privacy is not addressed in this scenario.
DIF: Cognitive Level: Application REF: p. 76 OBJ: 9
TOP: Informed Consent KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Safe and Effective Care Environment
The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia. The nurse would expect to see which medication ordered for this client?
a. Lithium
b. Depakene
c. Neurontin
d. Risperdal
ANS: D
Risperdal is an antipsychotic medication that is used for schizophrenia. The other options are all antimanic medications.
DIF: Cognitive Level: Comprehension REF: p. 72 OBJ: 2
TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system. Which of the following is considered a sympathetic response?
a. Pupil dilation
b. Increased saliva production
c. Decreased heart rate
d. Constricted airway
ANS: A
Pupil dilation is a sympathetic response. All the other options are examples of a parasympathetic response.
DIF: Cognitive Level: Comprehension REF: p. 68 OBJ: 1
TOP: How Psychotherapeutic Drug Therapy Works
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands, then sits back down. The nurse knows that this client most likely is experiencing the side effect of:
a. Drug-induced parkinsonism
b. Dystonia
c. Akathisia
d. Akinesia
ANS: C
Akathisia is an extrapyramidal side effect (EPSE) of antipsychotic drugs that causes an individual to be unable to sit still. The other options are also EPSEs but are not evident in the scenario.
DIF: Cognitive Level: Knowledge REF: p. 73 OBJ: 6
TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
__________ is a side effect that can occur while a client is taking an antipsychotic medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation.
a. Drug-induced parkinsonism
b. Neuroleptic malignant syndrome (NMS)
c. Tardive dyskinesia
d. Dystonia
ANS: B
NMS is a very serious side effect of antipsychotic drugs that can lead to coma and death. Muscle rigidity is usually the first symptom, with symptoms progressing rapidly after the onset and reaching peak intensity in 3 days. The other options are also side effects of antipsychotics but do not describe NMS.
DIF: Cognitive Level: Knowledge REF: p. 73 OBJ: 6
TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
The __________ constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias.
a. Benzodiazepines
b. Tricyclics
c. Azaspirones
d. Beta-blockers
ANS: D
In the past, beta-blockers were strictly cardiac drugs, but new research has found this class of drugs to be successful as adjunctive treatment for social phobias. The other options are antianxiety and antidepressant medications; they are not used for cardiac arrhythmias.
DIF: Cognitive Level: Knowledge REF: p. 69 OBJ: 3
TOP: Antianxiety Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
Valium is administered to a client anxious about impending surgery. Which of the following side effects is the client at risk for?
a. Seizures
b. Falls
c. Hypertensive crisis
d. Tachycardia
ANS: B
Orthostatic hypotension from use of a benzodiazepine places the client at risk for falls. MAOIs may cause hypertensive crisis, seizures, and tachycardia.
DIF: Cognitive Level: Knowledge REF: p. 70 OBJ: 3
TOP: Antianxiety Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
When educating the client being treated with lithium, which item in their diet should be monitored or avoided?
a. Fresh fruit
b. Whole milk
c. Hot dogs and ham
d. Fresh vegetables
ANS: C
Lithium and sodium compete for elimination from the body through the kidneys. An increase or decrease in salt affects proper elimination of lithium from the body. Processed foods like hot dogs and ham contain larger amounts of sodium.
DIF: Cognitive Level: Knowledge REF: p. 71 OBJ: 5
TOP: Guidelines for Clients Taking Lithium
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
The CMA is administering an antianxiety medication to a client. Monitoring side effects is the responsibility of which member of the health care team?
a. Nurse
b. CMA
c. Physician
d. Therapist
ANS: A
While all care providers should be aware of the actions and side effects of the client’s medication, the nurse remains responsible to for monitoring drug effectiveness and adverse reactions.
DIF: Cognitive Level: Knowledge REF: p. 74 OBJ: 7
TOP: Drug Administration KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
Careful assessment for changes in attitude and suicidal gestures should be monitored in a client taking which medication?
a. Lithium
b. Ativan (lorazepam)
c. Librium (chlordiazepoxide)
d. Paxil (paroxetine)
ANS: D
Clients taking Paxil (an antidepressant) should be assessed for changes in attitudes and suicidal gestures. All other medications are antianxiety agents.
DIF: Cognitive Level: Knowledge REF: p. 70 OBJ: 4
TOP: Antidepressant Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
MULTIPLE RESPONSE
Which of the following are basic responsibilities of nurses who administer psychotherapeutic drugs? (Select all that apply.)
a. Monitoring and evaluating the client’s response to the medication
b. Continually assessing the client’s condition
c. Adjusting medication dosages according to therapeutic levels
d. Assisting in the coordination of the client’s care
e. Teaching clients about their medications
f. Administering prescribed medications
ANS: A, B, D, E, F
These responsibilities require nurses to be cognizant of all aspects of medication administration. Adjusting medication dosages is not within the nurse’s scope of practice.
DIF: Cognitive Level: Comprehension REF: p. 73 OBJ: 7
TOP: Client Care Guidelines KEY: Nursing Process Step: Implementation
MSC: Client Needs: Physiological Integrity
The nurse is developing a teaching plan for a client who has been diagnosed recently with a mental health disorder and has been prescribed a psychotropic medication. Which interventions regarding the medication should the nurse include in the teaching plan? (Select all that apply.)
a. Teach signs and symptoms of side effects and what to do if these occur.
b. Provide written information regarding the purpose, dosage, route, and dosing schedule.
c. Ask the client and significant other to verbally explain when it is necessary to contact the physician should side effects occur.
d. Provide written information regarding how the client should decrease dosages in response to side effects or improvement in symptoms.
ANS: A, B, C
The nurse should teach signs and symptoms of side effects, provide information about the drug, and have the client and significant other verbally explain when it is necessary to call the physician. The nurse should never provide written information about decreasing dosages without contacting the physician. The physician will determine whether side effects can be controlled, or if dosage adjustments are necessary. In addition, improvement in symptoms is most likely the desired effect of the medication and ensures that the dosage and medications are correct.
DIF: Cognitive Level: Application REF: p. 75 OBJ: 8
TOP: Client Teaching
KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation MSC: Client Needs: Physiological Integrity
Clients diagnosed with Type I–positive schizophrenic symptoms respond better to antipsychotic medications. Manifestations of Type I schizophrenia include which of the following? (Select all that apply.)
a. Delusions
b. Hallucinations
c. Apathy
d. Anhedonia
e. Illusions
ANS: A, B, E
Type I: Positive symptoms include delusions, illusions, and hallucinations, and patients have a good response to medications. Type II: Negative symptoms include anhedonia, apathy, and flat affect, and patients usually do not respond well to antipsychotic medications.
DIF: Cognitive Level: Application REF: p. 73 OBJ: 6
TOP: Positive and Negative Symptoms of Schizophrenia
KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity
COMPLETION
__________ side effects can occur when antipsychotic medications are taken that manifest as abnormal movements such as akathisia and pseudo-Parkinson symptoms.
ANS:
Extrapyramidal
These side effects occur as a result of an imbalance of neurotransmitters in the brain. Additional extrapyramidal side effects (EPSEs) include dyskinesia, akinesia, and dystonia.
DIF: Cognitive Level: Knowledge REF: p. 73 OBJ: 6
TOP: Antipsychotic (Neuroleptic) Medications
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
The four classes of psychotherapeutic medications include antianxiety agents, antidepressants, antimanics, and __________.
ANS:
antipsychotics
Antipsychotics treat individuals with psychotic disorders by helping to control symptoms associated with loss of reality, such as hallucinations.
DIF: Cognitive Level: Knowledge REF: p. 68 OBJ: 2
TOP: Classifications of Psychotherapeutic Drugs
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity
Lithium levels are considered toxic when they become higher than __________ mEq/L.
ANS:
1.5
Lithium therapy must be closely monitored because the therapeutic range is narrow and toxicity can be life threatening. Anything higher than 1.5 mEq/L is considered toxic.
DIF: Cognitive Level: Knowledge REF: p. 71 OBJ: 5
TOP: Antimanic Medications KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity
