-Mental Health Practice Exam HESI med

1. A male client with schizophrenia who is taking fluphenazine decanoate (Prolixin decanoate) is being discharged in the morning. A repeat dose of medication is scheduled for 20 days after discharge. The client tells the nurse that he is going on vacation in the Bahamas and will return in 18 days. Which statement by the client indicates a need for health teaching? A) When I return from my tropical island vacation, I will go to the clinic to get my Prolixin injection. B) While I am on vacation and when I return, I will not eat or drink anything that contains alcohol. C) I will notify the healthcare provider if I have a sore throat or flu-like symptoms. D) I will continue to take my benztropine mesylate (Cogentin) every day. Photosensitivity is a side effect of Prolixin and a vacation in the Bahamas (with its tropical island climate) increases the client's chance of experiencing this side effect. He should be instructed to avoid direct sun (A) and wear sunscreen. (B, C, and D) indicate accurate knowledge. Alcohol acts synergistically with Prolixin (B). (C) lists signs of agranulocytosis, which is also a side effect of Prolixin. In order to avoid extrapyramidal symptoms (EPS), anticholinergic drugs, such as Cogentin, are often prescribed prophylactically with Prolixin. 2. A male client is admitted to the mental health unit because he was feeling depressed about the loss of his wife and job. The client has a history of alcohol dependency and admits that he was drinking alcohol 12 hours ago. Vital signs are: temperature, 100° F, pulse 100, and BP 142/100. The nurse plans to give the client lorazepam (Ativan) based on which priority nursing diagnosis? A) Risk for injury related to suicidal ideation. B) Risk for injury related to alcohol detoxification. C) Knowledge deficit related to ineffective coping. D) Health seeking behaviors related to personal crisis. The most important nursing diagnosis is related to alcohol detoxification (B) because the client has elevated vital signs, a sign of alcohol detoxification. Maintaining client safety related to (A) should be addressed after giving the client Ativan for elevated vital signs secondary to alcohol withdrawal. (C and D) can be addressed when immediate needs for safety are met. 5. A client who is being treated with lithium carbonate for bipolar disorder develops diarrhea, vomiting, and drowsiness. What action should the nurse take? A) Notify the healthcare provider immediately and prepare for administration of an antidote. B) Notify the healthcare provider of the symptoms prior to the next administration of the drug. C) Record the symptoms as normal side effects and continue administration of the prescribed dosage. D) Hold the medication and refuse to administer additional amounts of the drug. Early side effects of lithium carbonate (occurring with serum lithium levels below 2.0 mEq per liter) generally follow a progressive pattern beginning with diarrhea, vomiting, drowsiness, and muscular weakness. At higher levels, ataxia, tinnitus, blurred vision, and large dilute urine output may occur. (B) is the best choice. Although these are expected symptoms, the healthcare provider should be notified prior to the next administration of the drug. (A, C, and D) would not reflect good nursing judgment.13. Which diet selection by a client who is depressed and taking the MAO inhibitor tranylcypromine sulfate (Parnate) indicates to the nurse that the client understands the dietary restrictions imposed by this medication regimen? A) Hamburger, French fries, and chocolate milkshake. B) Liver and onions, broccoli, and decaffeinated coffee. C) Pepperoni and cheese pizza, tossed salad, and a soft drink. D) Roast beef, baked potato with butter, and iced tea. Only (D) contains no tyramine. Tyramine in foods interacts with MAOI in the body causing a hypertensive crisis which is life-threatening, and Parnate is classified as an MAOI antidepressant. Some items in (A, B, and C) contain tyramine and would not be permitted for a client taking Parnate. 18. Based on non-compliance with the medication regimen, an adult client with a medical diagnosis of substance abuse and schizophrenia was recently switched from oral fluphenazine HCl (Prolixin) to IM fluphenazine decanoate (Prolixin Decanoate). What is most important to teach the client and family about this change in medication regimen? A) Signs and symptoms of extrapyramidal effects (EPS). B) Information about substance abuse and schizophrenia. C) The effects of alcohol and drug interaction. D) The availability of support groups for those with dual diagnoses. Alcohol enhances the EPS side effects of Prolixin. The half-life of Prolixin PO is 8 hours, whereas the half-life of the Prolixin Decanoate IM is 2 to 4 weeks. That means the side effects of drinking alcohol are far more severe when the client drinks alcohol after taking the long-acting Prolixin Decanoate IM. (A, B, and D) provide valuable information and should be included in the client/family teaching, but they do not have the priority of (C). 50. A client who is known to abuse drugs is admitted to the psychiatric unit. Which medication should the nurse anticipate administering to a client who is exhibiting benzodiazepine withdrawal symptoms? A) Perphenazine (Trilafon). B) Diphenhydramine (Benadryl). C) Chlordiazepoxide (Librium). D) Isocarboxazid (Marplan). Librium (C), an antianxiety drug, as well as other benzodiazepines, are used in titrated doses to reduce the severity of abrupt benzodiazepine withdrawal. (A) is an antipsychotic agent. (B) is an antihistamine and antianxiety drug. (D) is an MAO inhibitor. Correct Answer(s): C 56. When preparing a teaching plan for a client who is to be discharged with a prescription for lithium carbonate (Lithonate), it is most important for the nurse to include which instruction? A) It may take 3 to 4 weeks to achieve therapeutic effects. B) Keep your dietary salt intake consistent. C) Avoid eating aged cheese and chicken liver. D) Eat foods high in fiber such as whole grain breads. Lithium's effectiveness is influenced by salt intake (B). Too much salt causes more lithium to be excreted, thereby decreasing the effectiveness of the drug. Too little salt causes less lithium to be excreted, potentially resulting in toxicity. (A, C, and D) are not specific instructions pertinent to teaching about lithium carbonate (Lithonate).59. The nurse is preparing to administer phenelzine sulfate (Nardil) to a client on the psychiatric unit. Which complaint related to administration of this drug should the nurse expect this client to make? A) My mouth feels like cotton. B) That stuff gives me indigestion. C) This pill gives me diarrhea. D) My urine looks pink. A dry mouth (A) is an anticholinergic effect that is an expected side effect of MAO inhibitors such as phenelzine sulfate (Nardil). (B, C, and D) are not expected side effects of this medication. Correct Answer(s): A 61. A 46-year-old female client has been on antipsychotic neuroleptics for the past three days. She has had a decrease in psychotic behavior and appears to be responding well to the medication. On the fourth day, the client's blood pressure increases, she becomes pale and febrile, and demonstrates muscular rigidity. Which action should the nurse initiate? A) Place the client on seizure precautions and monitor carefully. B) Immediately transfer the client to ICU. C) Describe the symptoms to the charge nurse and record on the client's chart. D) No action is required at this time as these are known side effects of such drugs. These symptoms are descriptive of neuroleptic malignant syndrome (NMS) which is an extremely serious/life threatening reaction to neuroleptic drugs (B). The major symptoms of this syndrome are fever, rigidity, autonomic instability, and encephalopathy. Respiratory failure, cardiovascular collapse, arrhythmias, and/or renal failure can result in death. This is an EMERGENCY situation, and the client requires immediate critical care. Seizure precautions (A) are not indicated in this situation. (C and D) do not consider the seriousness of the situation. 63. The nurse should hold the next scheduled dose of a client's haloperidol (Haldol) based on which assessment finding(s)? A) Dizziness when standing. B) Shuffling gait and hand tremors. C) Urinary retention. D) Fever of 102° F. A fever (D) may indicate neuroleptic malignant syndrome (NMS), a potentially fatal complication of antipsychotics. The healthcare provider should be contacted before administering the next dose of Haldol. (A, B, and C) are all adverse effects of Haldol which can be managed. *A client who has been taking the prescribed dose of zolpidem (Ambien) for 5 days returns to the clinic for a follow-up visit. When interviewing the client, the nurse identifies that the medication has been effective when the client says: 1) "I have less pain." 2) "I have been sleeping better." 3) "My blood glucose is under control." 4) "My blood pressure is coming down." Zolpidem (Ambien) is a sedative-hypnotic that produces central nervous system depression in the limbic, thalamic, and hypothalamic areas of the brain. Zolpidem is not an analgesic, antidiabetic, or antihypertensive medication.*What should the nurse do when determining whether a client is experiencing adverse effects of risperidone (Risperdal)? 1Monitor for episodes of diarrhea. 2Test sensation of lower extremities. 3Question if dizziness is experienced. 4Auscultate breath sounds to detect wheezing. Hypotension and dizziness are adverse effects of risperidone (Risperdal). Risperidone may cause constipation, not diarrhea. It does not affect the neuromuscular or cardiovascular function of the legs; numbness and coldness of the feet do not occur. Risperidone does not cause wheezing or shortness of breath. *Donepezil (Aricept) is prescribed for a senior client who has mild dementia of the Alzheimer type. What information does the nurse include when discussing this medication with the client and family? 1Fluids should be limited to four large glasses per day. 2Constipation should be reported to the practitioner immediately. 3Blood tests that reflect liver function will be performed routinely. 4The client's medication dosage may be self-adjusted according to the client's response. Donepezil may affect the liver because alanine aminotransferase (ALT) is found predominantly in the liver; most ALT increases indicate hepatocellular disease. Clients taking this medication should have regular liver function tests and report light stools and jaundice to the practitioner. Fluids should not be limited, because one of the side effects of donepezil (Aricept) is constipation. A side effect of constipation is expected; therefore fluids, high-fiber foods, and exercise should be recommended to help keep the stools soft . The client should not abruptly increase or decrease the dosage; donepezil should be taken exactly as prescribed. *A client has been taking amoxapine (Asendin) for the past 3 months with no improvement. The practitioner prescribes phenelzine (Nardil) to be given as well. The nurse should: 1Question the prescription and withhold the medication. 2Ask the client about allergies to feathers before giving the first dose. 3Withhold the medication until a specimen for liver enzymes is drawn. 4Remind the client that this medication should be taken with meals and that milk products must be avoided. Amoxapine (Asendin) is a tricyclic antidepressant (TCA), and phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI); TCAs are contraindicated in concomitant use with MAOIs. Although checking for allergies is important, an allergy to feathers is not specific to MAOIs. Blood tests are not done specifically before the administration of MAOIs. Phenelzine does not have to be taken with food. Milk products, with the exception of aged cheeses and yogurt, may be eaten; products containing tyramine must be avoided. *Considering the anticholinergic-like side effects of many of the psychotropic drugs, the nurse should encourage clients taking these drugs to: 1Restrict their fluid intake. 2Eat a diet high in carbohydrates. 3Suck on sugar-free hard candies. 4Avoid products that contain aspirin.Hard candy may produce salivation, which helps alleviate the anticholinergic-like side effect of dry mouth that is experienced with some psychotropics. Dry mouth increases the risk for cavities; candy with sugar adds to this risk. Fluids should be encouraged, not discouraged; fluids may alleviate the dry mouth. The other options are unnecessary. *An 18-year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam (Rohypnol). The nurse knows that flunitrazepam is often used: 1As a date rape drug 2To control symptoms of psychosis 3To control symptoms of bipolar mania 4To treat hangover symptoms after excessive alcohol consumption Rohypnol (flunitrazepam), illegal in the United States, has been used in date rapes; the victim is attacked after consuming a drink spiked with the drug. Flunitrazepam is not used to treat psychosis, mania, or hangover symptoms *What medication should the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? 1Lithium 2Flumazenil 3Methadone 4Chlorpromazine Flumazenil (Romazicon) is the drug of choice in the management of overdose when a benzodiazepine is the only agent ingested by a client not at risk for seizure activity. Flumazenil medication competitively inhibits activity at benzodiazepine recognition sites on γ-aminobutyric acid-benzodiazepine receptor complexes. Lithium is used in the treatment of mood disorders. Methadone is used for narcotic addiction withdrawal. Chlorpromazine is contraindicated in the presence of central nervous system depressants. *A client has been taking prescribed risperidone (Risperdal) 3 mg twice a day for the past 8 days. A friend brings the client to the outpatient clinic. The client reports tremors, shortness of breath, a fever, and sweating. What should the nurse do? 1Call 911 and have the client transported to the nearest psychiatric unit. 2Take the client's vital signs and arrange for immediate transfer to a hospital. 3Check the number of risperidone tablets left in the prescription bottle to see whether there was an overdose. 4Request a prescription for intramuscular benztropine (Cogentin) 2 mg stat and assess the client in 10 to 15 minutes for symptom relief. These clinical manifestations signal the presence of neuroleptic malignant syndrome; the cardinal sign of this condition is a high body temperature. Therefore the nurse first should document the hyperthermia and then arrange for immediate hospitalization. Unless the client is experiencing impaired ventilation, it is important to complete a focused assessment before transfer. The care needed can be provided in an emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant syndrome may occur without an overdose; this syndrome can occur when a high-potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after initiation of the medication. Benztropine (Cogentin) will have little or no effect on neuroleptic malignant syndrome.*The psychiatrist is concerned that one of the clients receiving haloperidol (Haldol) may be developing neuroleptic malignant syndrome. When assessing the client for this syndrome, for which clinical manifestations should the nurse monitor the client? 1Jaundice and malaise 2Tremors and seizures 3Diaphoresis and hyperpyrexia 4Dry skin and hyperbilirubinemia Diaphoresis and hyperpyrexia are the classic signs of neuroleptic malignant syndrome, which is caused by neuroleptic-induced blockage of dopamine receptors. Jaundice and malaise are side effects of haloperidol (Haldol), not neuroleptic malignant syndrome. Tremors and seizures and dry skin and hyperbilirubinemia are side effects of haloperidol, not neuroleptic malignant syndrome. *A client receiving fluphenazine decanoate (Prolixin Decanoate) develops dystonia early during therapy. What medication does the nurse expect to be prescribed to reverse this side effect? 1Nafarelin (Synarel) 2Fluoxetine (Prozac) 3Trandolapril (Mavik) 4Benztropine (Cogentin) Dystonia is an extrapyramidal side effect (EPS) of fluphenazine decanoate (Prolixin Decanoate). The anticholinergic benztropine (Cogentin) is used to reverse the signs and symptoms (e.g., oculogyric crisis, torticollis, retrocollis) of dystonia. Nafarelin (Synarel) is a gonadotropin that stimulates the release of luteinizing hormone and folliclestimulating hormone. Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor antidepressant. Trandolapril (Mavik) is an angiotensin-converting enzyme inhibitor antihypertensive. Mental Health practice (MEDS) *A nurse in a mental health clinic is planning care for a client who has a new prescription for olanzapine. Which of the following interventions should the nurse identify as the priority? 1. Advise the client to take frequent sips of water. 2. Instruct the client to avoid driving during initial therapy 3. Consult a dietitian for a calorie-controlled diet plan 4. Recommend that the client exercise regularly Rationale: The greatest risk to this client is injury resulting from drowsiness or dizziness. Therefore, the nurse's priority intervention is to instruct the client to avoid activities that require mental alertness during initial medication therapy. *A nurse is admitting a client who has anorexia nervosa and is at 60% of ideal body weight. Which of the following interventions should the nurse include in the plan of care? 1. Encourage the client to drink 125 mL of fluid each hour while awake 2. All the client to eat independently in his room 3. Weigh the client twice weekly 4. Measure the client's vital signs once each day Rationale: The nurse should encourage the client to drink 125 mL of fluid each waking hour to maintain hydration*A nurse is admitting a client who has major depressive disorder and a new prescription for tranylcypromine. Which of the following over-the-counter medications that the client reports taking should alert the nurse to a potential adverse reaction? 1. Lansoprazole 2. Naproxen 3. Magnesium hydroxide 4. Phenylephrine Rationale: Clients who are taking tranylcypromine, an MAOI antidepressant, should not take phenylephrine and other over-the-counter medications for sinus congestion, colds, or allergies due to their actions on the sympathetic nervous system, which can result in severe hypertension. *A nurse is preparing to administer chlorpromazine 0.55 mg/kg PO to an adolescent who weighs 110 lb. Available is chlorpromazine syrup 10 mg/5 mL. How many mL should the nurse administer? (Round to the nearest whole number) 14 *A nurse is planning care for a client who is to undergo electroconvulsive therapy (ECT). Which of the following actions should the nurse include in the plan? 1. Administer phenytoin 30 min prior to the procedure 2. Instruct the client to expect a headache following the procedure 3. Place the client in four point restraints prior to the procedure 4. Monitor the client's cardiac rhythm during the procedure Rationale: The seizure induced during ECT can stress that client's heart. Therefore, the nurse should plan to monitor the client's cardiac rhythm during ECT via an electrocardiogram *A nurse is caring for a client who has schizophrenia and was prescribed a conventional antipsychotic medication yesterday. Which of the following findings indicates the nurse should administer benztropine 2 mg IM? 1. Shuffling gait 2. Hypotension 3. Decreased WBC count 4. Blurred vision Rationale: Benztropine is used to treat parkinsonism manifestations, such as shuffling gait *A nurse is reviewing laboratory results for a client who has schizophrenia and is taking clozapine. Which of the following values should the nurse identify as a contraindication for receiving clozapine? 1. WBC 2500/mm3 2. Hgb 11.5 mg/dL 3. Platelets 150,000/mm3 4. RBC 3.5 million/mm3 1. WBC 2500/mm3 Rationale: Clozapine can cause agranulocytosis, which can be fatal due to overwhelming infection. The nurse should identify a WBC count below 3000/mm3 as a possible manifestation of agranulocytosis and should withhold the medication and notify the provider*A nurse is teaching a family member and a client who has a new diagnosis of Alzheimer's disease and is to start taking donepezil. Which of the statements should the nurse include in the teaching? 1. "Take this medication in the evening at bedtime." 2. "Expect this medication to reverse the effects of Alzheimer's disease." 3. "If you miss a dose, double the next dose." 4. "You can crush this medication in applesauce." 1. "Take this medication in the evening at bedtime." Rationale: The client should take this medication in the evening at bedtime for optimal effectiveness. *A nurse on a medical-surgical unit is assessing a client who sustained injuries 12 hr ago following a motor-vehicle crash. The client's admission blood alcohol level was 325 mg/dL. Which of the following findings should indicate to the nurse that the client is experiencing alcohol withdrawal? 1. Somnolence 2. Blood pressure 154/96 mm Hg 3. Pinpoint pupils 4. Blood glucose 210 mg/dL Rationale: Physical manifestations of alcohol withdrawal occur in addition to psychological effects. A client who is experiencing alcohol withdrawal is expected to have hypertension, tachycardia, and fever greater than 38.3 C (101 F). It will be important for the nurse to rule out infection in the client who has a fever. *A nurse is reviewing routine laboratory values for several clients who are taking lithium carbonate. Which of the following clients should the nurse assess further for findings indicating lithium toxicity? 1. A client who has a fasting blood glucose of 80 mg/dL 2. A client who has a sodium level of 128 mEq/L 3. A client who has a BUN of 18 mg/dL 4. A client who has a potassium level of 3.6 mEq/L 2. A client who has a sodium level of 128 mEq/L Rationale: A sodium level of 128 mEq/L should alert the nurse that the client is at risk for lithium toxicity because renal excretion of lithium is decreased in the presence of a low sodium level *A nurse in a mental health clinic is caring for a client who has bipolar disorder and reports that she stopped taking lithium 2 weeks ago. The nurse should recognize which of the following as an expected adverse effect that might have caused the client to stop taking the medication? 1. Sore throat 2. Photophobia 3. Hand tremors 4. Constipation 3. Hand tremors Rationale: Fine hand tremors are an expected adverse effect of lithium and can interfere with the client's ADLs, causing the client to stop taking the medication.*A nurse is creating a plan of care for a client who has been placed in seclusion after threatening to harm others on the unit. Which of the following interventions should the nurse include in the plan? 1. Document the client's behavior every 8 hr 2. Limit the client's fluid intake to 50 mL/hr 3. Renew the prescription for the client every 4 hr 4. Toilet the client every 4 hr Rationale: The nurse should assess the client's behavior frequently during seclusion and should renew the prescription for seclusion for an adult client every 4 hr, for a maximum of 24 hr. *A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? 1. Orient the client to person, place, and time 2. Assist the client with deep-breathing exercises 3. Calm the client by using therapeutic touch 4. Have the client sit alone in a quiet room Rationale: Relaxation techniques, such as deep, abdominal breathing exercises, help defuse manifestations of anxiety. *A nurse is assessing a client who has major depressive disorder and has been receiving amitriptyline for 1 week. Which of the following outcomes should the nurse expect? 1. Rapid improvement in affect within 30 to 60 min after taking the medication 2. Greater risk of attempting suicide as affect and energy improve 3. Onset of frequent loose stools 4. Development of physiologic dependence on the medication Rationale: An initial response to amitriptyline can develop in 1 week. For a client who has been severely depressed with suicidal ideation, the energy to carry out a plan is more possible after 1 week of treatment *A client who has bipolar disorder is to be discharged home with a prescription for lithium. Which of the following statements indicates that client teaching regarding the medication has been effective? 1. "I should eat a regular diet with normal amounts of salt and fluids." 2. "I should discontinue the lithium when I begin to feel better." 3. "I need to be careful to avoid becoming addicted to the lithium." 4. "I can skip a dose of medication if my stomach is upset." Rationale: This statement indicates that the client understands the teaching because normal levels of sodium and fluid need to be maintained to ensure adequate excretion of lithium. If sodium levels are low, the body compensates by decreasing lithium excretion, which can lead to toxicity. *A nurse is caring for a child who is taking methylphenidate. The nurse should monitor the child for which of the following findings as an adverse effect of methylphenidate? 1. Weight gain 2. Tinnitus 3. Tachycardia 4. Increased salivationRationale: The nurse should monitor the child for tachycardia, which is an adverse effect of methylphenidate *A nurse in an outpatient mental health setting is collecting a health history from a client who is taking paroxetine for depression. The client reports to the nurse that he also takes herbal supplements. The nurse should advise the client that which of the following supplements interacts adversely with paroxetine? 1. St. John's wort 2. Saw palmetto 3. Echinacea 4. Ginkgo Rationale: St. John's wort is an herbal preparation that decreases the reuptake of serotonin. The nurse should advise the client that taking St. John's wort with another medication that also inhibits the reuptake of serotonin, such as paroxetine, places the client at risk for serotonin syndrome. *A nurse is caring for a client who was admitted following an overdose of amitriptyline. The nurse should monitor the client for which of the following adverse effects associated with this medication? 1. Loose stools 2. Urinary retention 3. Fever 4. Dyspnea Rationale: Urinary retention is an anticholinergic effect of amitriptyline. Therefore, the nurse should monitor for this as an adverse effect. *A nurse who is working on a mental health unit should recognize that which of the following are indications for the use of electroconvulsive therapy (ECT)? 1. A client who is suicidal and in need of rapid treatment 2. A client who has recently been diagnosed with severe depression 3. A client who has bipolar disorder with rapid cycling 4. A client who has mania and has not responded to medication therapy 5. A client whose depression is secondary to situational difficulties Rationale: ECT can be used when there is a need for a rapid, definitive response for a client who is suicidal. ECT works best for a client who has bipolar disorder with rapid cycling. ECT is indicated for clients who have mania and have not responded to medication therapy *A nurse is teaching a client who has a depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching? 1. "You may notice an increase in saliva while taking this medication." 2. "You may experience difficulties with sexual functioning while taking this medication." 3. "You should expect an improvement in symptoms of depression in 3 to 4 days." 4. "You may notice a temporary ringing in the ears when starting this medication." Rationale: Fluoxetine is a selective serotonin reuptake inhibitor that can cause sexual dysfunction such as anorgasmia and impotence. The nurse should instruct the client to notify the provider if sexual dysfunction occurs.*A nurse is teaching the parent of a 10-year-old child who has ADHD and a new prescription for dextroamphetamine. Which of the following instructions should the nurse include in the teaching? 1. "You should expect you child to gain weight while taking medication." 2. "Administer the first dose of medication to your child 30 minutes before breakfast." 3. "You should expect your child to have diarrhea while taking this medication." 4. "Administer the last dose of medication to your child 6 hours before bedtime." Rationale: An adverse effect of dextroamphetamine is insomnia. Therefore, the nurse should instruct the parent to administer the last dose of medication to the child 6 hr before bedtime. *A nurse is assessing a client who recently used cocaine. Which of the following findings should the nurse expect? 1. Polyphagia 2. Hypertension 3. Decreased temperature 4. Depressed mood Rationale: Cocaine is a stimulant that increases blood pressure. It also increases heart rate, body temperature, energy levels, and metabolism. *A nurse is caring for a client who is undergoing electroconvulsive therapy (ECT) and will receive succinylcholine. The client asks the nurse about this medication. What is an appropriate response by the nurse? 1. "Succinylcholine will enhance the therapeutic effects of this treatment." 2. "Succinylcholine is given to reduce muscle movements during therapy." 3. "Succinylcholine will decrease the anxiety level that you might experience with this treatment." 4. "Succinylcholine is used as a general anesthetic to make sure you are sleeping during the procedure." Rationale: Succinylcholine is a muscle-paralyzing agent that will decrease muscle movement during the procedure so that injury is less likely to occur. *A nurse in the emergency department is admitting a client who reports a headache along with heart palpitations after having a glass of wine with dinner a few hours ago. The client has a history of depression and has a blood pressure of 210/105 mm Hg. Which of the following questions should the nurse ask first? 1. "Do you have a family history of hypertension?" 2. "When did you last see your primary provider?" 3. "What medications are you currently taking?" 4. "Do you currently use relaxation techniques for increased stress?" Rationale: The nurse should verify what medication the client is currently taking, including MAOI medication to treat depression. The client's history of depression indicates that this client is at the greatest risk for hypertensive crisis from MAOI medications used to treat depression. These medications can precipitate a hypertensive crisis if consumed with tyramine-containing foods, including wine.*A nurse is caring for a client who has a history of substance use disorder and was involuntarily admitted to a mental health facility. When the nurse attempts to administer oral lorazepam, the client refuses to take the medication and becomes physically aggressive. Which of the following actions should the nurse take? 1. Do not administer the lorazepam 2. Request a prescription for IV lorazepam 3. Request that another nurse attempt to administer the lorazepam 4. Place the lorazepam in the client's food Rationale: Clients who are in a facility due to an involuntary admission retain the right to refuse treatment. Therefore, the nurse should hold the medication and document the client's wishes. *A nurse is reviewing the medication administration record for a client who is experiencing the adverse effects of chlorpromazine. The nurse should administer benztropine to relieve which of the following adverse effects? 1. Blurred vision 2. Orthostatic hypotension 3. Dry mouth 4. Acute dystonia Rationale: The nurse should administer benztropine, an anticholinergic agent, to relieve acute dystonia, which is an extrapyramidal adverse effect of chlorpromazine. *A nurse is assessing a client who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect? 1. Sedation 2. Rhinorrhea 3. Bradycardia 4. Hypothermia Rationale: The nurse should expect the client who is experiencing opioid withdrawal to have rhinorrhea and flu-like manifestations such as yawning, sneezing, and abdominal pain. *A nurse is preparing to administer diazepam 7.5 mg IV bolus to a client for alcohol withdrawal. Available is diazepam injection 5 mg/mL. How many mL should the nurse administer? (Round to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) 1.5 mL *A nurse in a provider's office is collecting a health history from the parent is the priority for the nurse to report to the provider? 1. Reduced appetite 2. Fatigue 3. Dark urine 4. Sweating Rationale: The greatest risk for the child is liver damage from atomoxetine, which can progress to liver failure and death. Therefore, this is the nurse's priority finding.*A nurse is caring for a client who is taking clozapine. For which of the following findings should the nurse withhold the medication? 1. The client reports a sore throat 2. The client reports being constipated for 2 days 3. The client reports feeling dizzy when getting out of bed 4. The client has gained 1.4 kg (3 lb) in the past month 1. The client reports a sore throat Rationale: Clozapine can lead to a potentially fatal blood disorder known as agranulocytosis. Agranulocytosis is a severe drop in a client's WBCs, which leaves the client highly susceptible to infection. The nurse should withhold the medication for any indications of infection and notify the provider. *A nurse in the emergency department is caring for a client who has alcohol toxicity and is unresponsive. Which of the following interventions should the nurse take? 1. Gather supplies for endotracheal intubation 2. Administer a beta blocker intravenously 3. Position the client in a low-fowler's position 4. Place a cooling blanket over the client Rationale: The nurse should gather supplies for endotracheal intubation since an expected finding of an unresponsive client who has alcohol toxicity is respiratory depression. *A nurse is caring for a client who has alcoholic cardiomyopathy. Which of the following laboratory findings should the nurse expect? 1. Increased creatine phosphokinase (CPK) 2. Increased low-density lipoproteins (LDL) 3. Decreased fasting blood glucose (FBG) 4. Decreased aspartate aminotransferase (AST) Rationale: An increase in CPK, a muscle enzyme released when muscle tissue is damaged, occurs with cardiomyopathy. *A nurse is teaching a client who has bipolar disorder and a prescription for lithium. Which of the following instructions should the nurse include in the teaching? 1. "Take this medication with food." 2. "Reduce sodium intake to 1,000 milligrams each day." 3. "Limit fluid intake to 1,200 milliliters each day." 4. "Be aware that this medication can be addictive." *A nurse is planning discharge teaching for a client who has undergone alcohol detoxification. The nurse should plan to teach the client about which of the following medications? 1. Buprenorphine 2. Methadone 3. Varenicline 4. Acamprosate Rationale: The nurse should teach the client about how acamprosate can assist with an alcohol abstinence management program. Acamprosate decreases the unpleasant manifestations of abstinence, such as anxiety, tension, and dysphoria, and can help to prevent relapse.*A nurse is caring for a client who is experiencing withdrawal from prescription oxycodone use. Which of the following medications should the nurse expect the provider to prescribe? 1. Varenicline 2. Lorazepam 3. Buprenorphine 4. Hydromorphone Rationale: The nurse should expect the provider to prescribe buprenorphine, which is a partial opioid agonist that is prescribed for up to 1 year to assist clients who are withdrawing from opioids, such as oxycodone. *A nurse is obtaining a history from a client who has major depressive disorder and a new prescription for paroxetine. Which of the following statements by the client indicates a contraindication to this medication? 1. "I take phenelzine tablets every day." 2. "I was just diagnosed with type 2 diabetes mellitus." 3. "I take glucosamine sulfate." 4. "I have had osteoarthritis for several years." Rationale: The nurse should recognize the concurrent use of paroxetine with phenelzine and other MAOIs is contraindicated due to an increased risk for serotonin syndrome. *A nurse is providing teaching to a client who has schizophrenia and a new prescription for olanzapine. Which of the following adverse effects of the medication should the nurse instruct the client to report to the provider? 1. Hypertension 2. Blurred vision 3. Urinary frequency 4. Drooling Rationale: Diabetes can be an adverse effect of olanzapine. The nurse should instruct the client to report any clinical manifestations of diabetes, such as polyuria, polydipsia, and polyphagia, to the provider. *A nurse is assessing a client who has been taking clozapine for 3 months. The nurse should document which of the following findings as the priority? 1. Photophobia 2. Urinary hesitancy 3. Orthostatic hypotension 4. Hyperprexia Rationale: The greatest risk to the client who is taking clozapine is agranulocytosis. Therefore, the priority finding the nurse should document is hyperprexia , or elevated temperature, because it can indicate infection. *A nurse is assessing a client who is taking chlorpromazine. Which of the following findings should the nurse identify as an indication that the medication is effective? 1. Decreased seizures 2. Decreased agitation 3. Decreased manifestations of depression 4. Decreased blood pressureRationale: Chlorpromazine is an antipsychotic medication that improves psychotic symptoms for clients who have schizophrenia. The client should experience decreased hallucinations, delusions, and agitation. The client should also show improved judgment, social skills, and self-care abilities. *A nurse is teaching about dietary restrictions for a client who has a new prescription for isocarboxazid. Which of the following foods should the nurse instruct the client to limit? 1. Smoked salmon 2. Chicken 3. Cottage cheese 4. Yogurt Rationale: A client who is taking isocarboxazid, an MAOI, should restrict foods that contain dietary tyramine, such as smoked salmon, due to the risk of hypertensive crisis. MAOI's allow tyramine to enter the general circulation, enhance norepinephrine release, and cause extensive vasoconstriction and cardiac stimulation. *A nurse is assessing a client who has an opioid use disorder. Which of the following medications should the nurse plan to administer? 1. Varenicline 2. Methadone 3. Phenobarbital 4. Disulfiram Rationale: The nurse should plan to administer methadone to ease the client's withdrawal from opioid use. Along with use during the initial withdrawal period, methadone can be administered for maintenance and suppressive therapy *A nurse on an inpatient eating-disorder unit is reviewing the recent laboratory reports for a client who has bulimia nervosa. Which of the following laboratory values indicates a therapeutic response to the treatment plan? 1. BUN 25 mg/dL 2. Sodium 128 mEq/L 3. Potassium 3.9 mEq/L 4. Hematocrit 53% Rationale: Clients who have bulimia nervosa often have decreased potassium levels due to excessive vomiting or diuretic use. This level is within the expected reference range indicating a therapeutic response to the treatment plan *A nurse is caring for a client who is experiencing acute alcohol withdrawal. Which of the following medications should the nurse expect to administer to the client to prevent complications? 1. Carbamazepine 2. Clonidine 3. Buproprion 4. Naltrexone Rationale: The nurse should expect to administer carbamazepine to a client who is experiencing acute alcohol withdrawal to prevent seizures*A nurse is caring for a client who has a depressive disorder and a new prescription for an antidepressant. The client tells the nurse that he does not want to take any kind of medication. Which of the following responses should the nurse make? 1. "Why don't you want to take an antidepressant?" 2. "You are not going to get better unless you follow your doctor's recommendations." 3. "What are your concerns about taking the medication?" 4. "I agree with you about the use of medication." Rationale: The nurse is encouraging the client to describe his feelings about the use of antidepressants, which allows the nurse to better understand him and offer support *A home health nurse is assessing a client who has serious mental illness (SMI). Which of the following factors should the nurse identify as a risk factor for relapse? 1. The client attends a day program twice weekly 2. The client's medical record indicates she has anosognosia 3. The client tells the nurse that her brother has become her guardian 4. The client's case manager is a paraprofessional who visits her weekly Rationale: A client who has anosognosia is unable to recognize that she has a mental illness. This manifestation might cause nonadherence to treatment increasing the risk for relapse *A nurse is caring for a client who has schizophrenia and is taking loxapine. Which of the following findings should the nurse identify as the priority? 1. Spasms of the tongue and face 2. Orthostatic hypotension 3. Photosensitivity 4. Dry mouth Rationale: Spasms of the muscles of the tongue, face, neck and back are an indication that the client is experiencing acute dystonia, and extrapyramidal manifestations. These findings place the client at greatest risk for injury; therefore, the nurse should identify this as the priority finding *A nurse is taking a medication history from a client who has a new prescription for fluphenazine. Which of the following medications should the nurse report to the provider as placing the client at risk for an adverse interaction? 1. Docusate sodium 2. Acetaminophen 3. Calcium gluconate 4. Diphenhydramine Rationale: Both fluphenazine and diphenhydramine have CNS depressant and anticholinergic effects. Taking both of these medications at the same time places the client at risk for cumulative adverse effects such as respiratory depression, tachycardia, and blurred vision *A nurse is taking a medication history from a client who has a new prescription for phenelzine. Which of the following supplements should the nurse report to the provider as placing the client at risk for an adverse interaction? 1. Soy protein 2. St. John's wort 3. Echinacea 4. FlaxseedRationale: Both phenelzine and St. John's wort are serotonin enhancing agents, and using them together places the client at risk for serotonin syndrome, a potentially fatal adverse effect. Clinical manifestations include confusion, decreased attention span, ataxia, hyperactive reflexes, tremor, and fever *A nurse is providing medication teaching with a client who has a depressive disorder and a new prescription for transdermal therapy with selegiline. Which of the following instructions should the nurse include? 1. "Replace the patch every 3 days." 2. "Discontinue the patch if you develop a rash." 3. "Cover the patch with an adhesive dressing." 4. "Apply the patch to dry, intact skin." Rationale: The client should apply the patchy to dry, intact skin and use the palm to press down firmly for approximately 10 seconds to promote medication absorption *A nurse is reviewing the medical record of a client who takes lithium carbonate to treat bipolar disorder. The nurse should identify which of the following laboratory values as the priority? 1. Lithium level 0.8 mEq/L 2. Sodium 142 mEq/L 3. Creatinine 2.3 mg/dL 4. TSH 4.5 milliunits/L Rationale: A serum creatinine level of 2.3 mg/dL is an indication that the client is at greatest risk for renal dysfunction, an adverse effect of long term use of lithium; therefore, the nurse should identify this as the priority laboratory value