Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E Chapter 16

Question 1 Type: MCSA The patient tells the nurse, "I thought I was just depressed, but my doctor says I have bipolar disorder. that!" hat is the best response by the nurse! 1. ""ipolar disorder is just another type o# depression, e$cept your depression occurs in cycles." 2. ""ipolar disorder is a type o# depression that includes attention de#icit disorder symptoms." 3. ""ipolar disorder just means that your mood alternates with the seasons, and it becomes worse in the winter." 4. ""ipolar disorder means you have cycles o# depression as well as hyperactivity, or mania." Correct Answer: % ationa!e 1& 'atients with bipolar disorder may shi#t #rom emotions o# e$treme depression to e$treme rage and agitation. Mania may include grandiosity, decreased need #or sleep, pressured speech, racing thoughts, buying sprees, and se$ual indiscretions. "ipolar disorder must include either mania or hypomania, not just depression. "ipolar disorder must include depression with either mania or hypomania, not attention(de#icit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal a##ective disorder. ationa!e 2& 'atients with bipolar disorder may shi#t #rom emotions o# e$treme depression to e$treme rage and agitation. Mania may include grandiosity, decreased need #or sleep, pressured speech, racing thoughts, buying sprees, and se$ual indiscretions. "ipolar disorder must include either mania or hypomania, not just depression. "ipolar disorder must include depression with either mania or hypomania, not attention(de#icit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal a##ective disorder. ationa!e 3& 'atients with bipolar disorder may shi#t #rom emotions o# e$treme depression to e$treme rage and agitation. Mania may include grandiosity, decreased need #or sleep, pressured speech, racing thoughts, buying sprees, and se$ual indiscretions. "ipolar disorder must include either mania or hypomania, not just depression. "ipolar disorder must include depression with either mania or hypomania, not attention(de#icit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal a##ective disorder. ationa!e 4& 'atients with bipolar disorder may shi#t #rom emotions o# e$treme depression to e$treme rage and agitation. Mania may include grandiosity, decreased need #or sleep, pressured speech, racing thoughts, buying sprees, and se$ual indiscretions. "ipolar disorder must include either mania or hypomania, not just depression. "ipolar disorder must include depression with either mania or hypomania, not attention(de#icit hyperactivity disorder. A mood change that becomes worse in the winter is called seasonal a##ective disorder. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity
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hat is

C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(Question 2 Type: MCSA The mother o# a 0(year(old child says to the nurse, "My child is distractible in school, cannot complete assignments on time, and interrupts other children while they are spea1ing. hat do you thin1!" hat is the best response by the nurse! 1. "This sounds li1e your child is depressed2 depression loo1s di##erent in children and is very serious." 2. "This sounds li1e bipolar disorder2 you might want to have your child tested by a child psychiatrist." 3. "This could be attention(de#icit hyperactivity disorder 3A45462 you might want to have your child tested." 4. "This sounds li1e typical 0(year(old behaviors to me2 i# they do not resolve, have your child tested." Correct Answer: 7 ationa!e 1& Symptoms o# attention(de#icit hyperactivity disorder 3A4546 include di##iculty in paying attention and #ocusing on tas1s, hyperactivity, distractibility, impulsivity, and tal1ing e$cessively. "eing distractible, unable to complete assignments, and interrupting other children are not typical 0(year(old behaviors. 4epression does loo1 di##erent in children, but these symptoms are clearly symptoms o# attention(de#icit hyperactivity disorder 3A4546. "eing distractible, unable to complete assignments, and interrupting other children are symptoms o# attention(de#icit hyperactivity disorder 3A4546, not bipolar disorder. ationa!e 2& Symptoms o# attention(de#icit hyperactivity disorder 3A4546 include di##iculty in paying attention and #ocusing on tas1s, hyperactivity, distractibility, impulsivity, and tal1ing e$cessively. "eing distractible, unable to complete assignments, and interrupting other children are not typical 0(year(old behaviors. 4epression does loo1 di##erent in children, but these symptoms are clearly symptoms o# attention(de#icit hyperactivity disorder 3A4546. "eing distractible, unable to complete assignments, and interrupting other children are symptoms o# attention(de#icit hyperactivity disorder 3A4546, not bipolar disorder. ationa!e 3& Symptoms o# attention(de#icit hyperactivity disorder 3A4546 include di##iculty in paying attention and #ocusing on tas1s, hyperactivity, distractibility, impulsivity, and tal1ing e$cessively. "eing distractible, unable to complete assignments, and interrupting other children are not typical 0(year(old behaviors. 4epression does loo1 di##erent in children, but these symptoms are clearly symptoms o# attention(de#icit hyperactivity disorder 3A4546. "eing distractible, unable to complete assignments, and interrupting other children are symptoms o# attention(de#icit hyperactivity disorder 3A4546, not bipolar disorder. ationa!e 4& Symptoms o# attention(de#icit hyperactivity disorder 3A4546 include di##iculty in paying attention and #ocusing on tas1s, hyperactivity, distractibility, impulsivity, and tal1ing e$cessively. "eing distractible, unable to complete assignments, and interrupting other children are not typical 0(year(old behaviors. 4epression does loo1 di##erent in children, but these symptoms are clearly symptoms o# attention(de#icit hyperactivity disorder 3A4546. "eing distractible, unable to complete assignments, and interrupting other children are symptoms o# attention(de#icit hyperactivity disorder 3A4546, not bipolar disorder.
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"!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(+ Question 3 Type: MCMA The nurse is conducting a group education session #or patients who have been diagnosed with depression. The nurse evaluates the education as e##ective when a patient ma1es which comment3s6 about the cause o# depression! .ote& Credit will be given only i# all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "4epression has many causes2 they could include environmental as well as brain(based disorders." 2. "4epression includes impaired relationships, and is also an inherited illness." 3. " e really don8t 1now what causes depression2 it has not been studied very much." 4. "4epression results #rom unresolved con#licts in your childhood." ,. "4epression results #rom parents who are cold and distant and don8t really care about their children." Correct Answer: -,+ ationa!e 1& 4epression has many causes2 it is a brain(based disorder that is e$acerbated by environmental in#luences. 4epression runs in #amilies, supporting a genetic lin1, and will include impaired relationships. *nvironmental in#luences are only one o# the causes o# depression2 this answer does not include the biological basis #or depression. 4epression could result #rom cold and distant parents, but this answer does not include the biological basis #or depression. 4epression has been studied e$tensively. ationa!e 2& 4epression has many causes2 it is a brain(based disorder that is e$acerbated by environmental in#luences. 4epression runs in #amilies, supporting a genetic lin1, and will include impaired relationships. *nvironmental in#luences are only one o# the causes o# depression2 this answer does not include the biological basis #or depression. 4epression could result #rom cold and distant parents, but this answer does not include the biological basis #or depression. 4epression has been studied e$tensively. ationa!e 3& 4epression has many causes2 it is a brain(based disorder that is e$acerbated by environmental in#luences. 4epression runs in #amilies, supporting a genetic lin1, and will include impaired relationships. *nvironmental in#luences are only one o# the causes o# depression2 this answer does not include the biological basis #or depression. 4epression could result #rom cold and distant parents, but this answer does not include the biological basis #or depression. 4epression has been studied e$tensively.
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ationa!e 4& 4epression has many causes2 it is a brain(based disorder that is e$acerbated by environmental in#luences. 4epression runs in #amilies, supporting a genetic lin1, and will include impaired relationships. *nvironmental in#luences are only one o# the causes o# depression2 this answer does not include the biological basis #or depression. 4epression could result #rom cold and distant parents, but this answer does not include the biological basis #or depression. 4epression has been studied e$tensively. ationa!e ,& 4epression has many causes2 it is a brain(based disorder that is e$acerbated by environmental in#luences. 4epression runs in #amilies, supporting a genetic lin1, and will include impaired relationships. *nvironmental in#luences are only one o# the causes o# depression2 this answer does not include the biological basis #or depression. 4epression could result #rom cold and distant parents, but this answer does not include the biological basis #or depression. 4epression has been studied e$tensively. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& *valuation &earnin$ *utcome: -/(7 Question 4 Type: MCSA The patient receives imipramine 3To#ranil6 as treatment #or depression. 5e is admitted to the emergency department #ollowing an intentional overdose o# this medication. hat will the best assessment by the nurse include! 1. The patient8s cardiac status 2. The patient8s liver #unction 3. The patient8s renal status 4. The patient8s neurological #unction Correct Answer: ationa!e 1& Tricyclic antidepressants are cardioto$ic. An overdose could result in a #atal dysrhythmia. Cardiac status is the primary assessment, not the patient8s renal status. Cardiac status is the primary assessment, not the patient8s liver #unction. Cardiac status is the primary assessment, not the patient8s neurological #unction. ationa!e 2& Tricyclic antidepressants are cardioto$ic. An overdose could result in a #atal dysrhythmia. Cardiac status is the primary assessment, not the patient8s renal status. Cardiac status is the primary assessment, not the patient8s liver #unction. Cardiac status is the primary assessment, not the patient8s neurological #unction.

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ationa!e 3& Tricyclic antidepressants are cardioto$ic. An overdose could result in a #atal dysrhythmia. Cardiac status is the primary assessment, not the patient8s renal status. Cardiac status is the primary assessment, not the patient8s liver #unction. Cardiac status is the primary assessment, not the patient8s neurological #unction. ationa!e 4& Tricyclic antidepressants are cardioto$ic. An overdose could result in a #atal dysrhythmia. Cardiac status is the primary assessment, not the patient8s renal status. Cardiac status is the primary assessment, not the patient8s liver #unction. Cardiac status is the primary assessment, not the patient8s neurological #unction. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(9 Question , Type: MCSA The patient has been receiving amitriptyline 3*lavil6 #or + wee1s. 5e tells the nurse he doesn8t thin1 this medicine is wor1ing, as he is still depressed. hat is the best response by the nurse! 1. "It is wor1ing, but it can ta1e several wee1s to have an e##ect." 2. ":ou might still #eel depressed, but you are loo1ing much better." 3. "This may not be the best medicine #or you2 I8ll call your doctor." 4. "It is wor1ing, but it can ta1e several months to have an e##ect." Correct Answer: ationa!e 1& The therapeutic e##ects o# tricyclic antidepressants may ta1e + to / wee1s to occur. It is inappropriate #or the nurse to call the physician2 tricyclic antidepressants need time to wor1. Telling a depressed patient he loo1s better negates the patient8s #eelings and is inappropriate. The time #rame #or e##icacy is several wee1s, not several months. ationa!e 2& The therapeutic e##ects o# tricyclic antidepressants may ta1e + to / wee1s to occur. It is inappropriate #or the nurse to call the physician2 tricyclic antidepressants need time to wor1. Telling a depressed patient he loo1s better negates the patient8s #eelings and is inappropriate. The time #rame #or e##icacy is several wee1s, not several months. ationa!e 3& The therapeutic e##ects o# tricyclic antidepressants may ta1e + to / wee1s to occur. It is inappropriate #or the nurse to call the physician2 tricyclic antidepressants need time to wor1. Telling a depressed patient he loo1s better negates the patient8s #eelings and is inappropriate. The time #rame #or e##icacy is several wee1s, not several months.
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ationa!e 4& The therapeutic e##ects o# tricyclic antidepressants may ta1e + to / wee1s to occur. It is inappropriate #or the nurse to call the physician2 tricyclic antidepressants need time to wor1. Telling a depressed patient he loo1s better negates the patient8s #eelings and is inappropriate. The time #rame #or e##icacy is several wee1s, not several months. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(9 Question 6 Type: MCSA The physician has prescribed sertraline 3;olo#t6 #or the patient who is an$ious and depressed. The patient calls the nurse to report that he has e$perienced delayed ejaculation since being on this medication. hat is the best response by the nurse! 1. "I will let your doctor 1now, and he will most li1ely change your medication." 2. "This does happen, but treating your depression is a bigger priority." 3. "I am concerned that you will become suicidal i# you stop the medication." 4. "<eep ta1ing the medicine, as this usually goes away a#ter a #ew months." Correct Answer: ationa!e 1& =ne o# the most common side e##ects o# the selective serotonin reupta1e inhibitors 3SS>Is6 relates to se$ual dys#unction2 up to 0,? or men and women can e$perience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, se$ual #unctioning is important to patients. It is inappropriate to tell a patient that the se$ual #unction usually subsides because it does not usually subside. The patient could become suicidal i# he stops the medication, but this response does not address the patient8s concern, and he will most li1ely stop the medicine anyway. ationa!e 2& =ne o# the most common side e##ects o# the selective serotonin reupta1e inhibitors 3SS>Is6 relates to se$ual dys#unction2 up to 0,? or men and women can e$perience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, se$ual #unctioning is important to patients. It is inappropriate to tell a patient that the se$ual #unction usually subsides because it does not usually subside. The patient could become suicidal i# he stops the medication, but this response does not address the patient8s concern, and he will most li1ely stop the medicine anyway. ationa!e 3& =ne o# the most common side e##ects o# the selective serotonin reupta1e inhibitors 3SS>Is6 relates to se$ual dys#unction2 up to 0,? or men and women can e$perience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, se$ual #unctioning is
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important to patients. It is inappropriate to tell a patient that the se$ual #unction usually subsides because it does not usually subside. The patient could become suicidal i# he stops the medication, but this response does not address the patient8s concern, and he will most li1ely stop the medicine anyway. ationa!e 4& =ne o# the most common side e##ects o# the selective serotonin reupta1e inhibitors 3SS>Is6 relates to se$ual dys#unction2 up to 0,? or men and women can e$perience this. In men, delayed ejaculation and impotence may occur. It is inappropriate to tell a patient that his depression is a higher priority, se$ual #unctioning is important to patients. It is inappropriate to tell a patient that the se$ual #unction usually subsides because it does not usually subside. The patient could become suicidal i# he stops the medication, but this response does not address the patient8s concern, and he will most li1ely stop the medicine anyway. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(9 Question Type: MCSA The patient has been depressed and the physician plans to begin treatment with an antidepressant medication. In per#orming the initial assessment, what is the most important @uestion #or the nurse to as1! 1. "5ow much alcohol do you consume during the wee1!" 2. "Are you allergic to any medications!" 3. "5ow long have you been depressed!" 4. "5ave you had any thoughts about 1illing yoursel#!" Correct Answer: % ationa!e 1& The nurse should always assess #or suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication ta1es several wee1s be#ore the #ull bene#it is obtained. This is a sa#ety issue. The length o# the patient8s depression is important, but is not a sa#ety issue. Assessing #or alcohol inta1e is important, but is not a sa#ety issue. As1ing about allergies is a good sa#ety @uestion, but is not the priority with a depressed patient, and there are very #ew allergies to antidepressant medication. This @uestion can be as1ed later. ationa!e 2& The nurse should always assess #or suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication ta1es several wee1s be#ore the #ull bene#it is obtained. This is a sa#ety issue. The length o# the patient8s depression is important, but is not a sa#ety issue. Assessing #or alcohol inta1e is important, but is not a sa#ety issue. As1ing about allergies is a good sa#ety @uestion, but is not the priority with a depressed patient, and there are very #ew allergies to antidepressant medication. This @uestion can be as1ed later.
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ationa!e 3& The nurse should always assess #or suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication ta1es several wee1s be#ore the #ull bene#it is obtained. This is a sa#ety issue. The length o# the patient8s depression is important, but is not a sa#ety issue. Assessing #or alcohol inta1e is important, but is not a sa#ety issue. As1ing about allergies is a good sa#ety @uestion, but is not the priority with a depressed patient, and there are very #ew allergies to antidepressant medication. This @uestion can be as1ed later. ationa!e 4& The nurse should always assess #or suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication ta1es several wee1s be#ore the #ull bene#it is obtained. This is a sa#ety issue. The length o# the patient8s depression is important, but is not a sa#ety issue. Assessing #or alcohol inta1e is important, but is not a sa#ety issue. As1ing about allergies is a good sa#ety @uestion, but is not the priority with a depressed patient, and there are very #ew allergies to antidepressant medication. This @uestion can be as1ed later. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(% Question . Type: MCMA The nurse has completed medication education #or a patient prior to the patient receiving phenelAine 3.ardil6. The nurse evaluates the education as e##ective when the patient ma1es which statement3s6! Note: Credit will be given only if all correct choices and no incorrect choices are selected . (tandard Te+t: Select all that apply. 1. "I am really going to miss my morning co##ee and sweet roll." 2. "I8ll have to give up my beer at the #ootball games." 3. "I can8t eat #ried chic1en and gravy." 4. "I am not supposed to have processed meats or cheese." ,. "I really shouldn8t eat at a restaurant2 too many #oods are on my restricted list." Correct Answer: +,% ationa!e 1& "eer and processed meats and cheese are high in tyramine. Combining tyramine(rich #oods with a monoamine o$idase inhibitor can result in a hypertensive crisis. Bried chic1en and gravy are not high in tyramine
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and are considered sa#e. There are many #oods that are sa#e to eat2 the patient can sa#ely eat at a restaurant. Co##ee and a sweet roll are not high in tyramine and are considered sa#e. ationa!e 2& "eer and processed meats and cheese are high in tyramine. Combining tyramine(rich #oods with a monoamine o$idase inhibitor can result in a hypertensive crisis. Bried chic1en and gravy are not high in tyramine and are considered sa#e. There are many #oods that are sa#e to eat2 the patient can sa#ely eat at a restaurant. Co##ee and a sweet roll are not high in tyramine and are considered sa#e. ationa!e 3& "eer and processed meats and cheese are high in tyramine. Combining tyramine(rich #oods with a monoamine o$idase inhibitor can result in a hypertensive crisis. Bried chic1en and gravy are not high in tyramine and are considered sa#e. There are many #oods that are sa#e to eat2 the patient can sa#ely eat at a restaurant. Co##ee and a sweet roll are not high in tyramine and are considered sa#e. ationa!e 4& "eer and processed meats and cheese are high in tyramine. Combining tyramine(rich #oods with a monoamine o$idase inhibitor can result in a hypertensive crisis. Bried chic1en and gravy are not high in tyramine and are considered sa#e. There are many #oods that are sa#e to eat2 the patient can sa#ely eat at a restaurant. Co##ee and a sweet roll are not high in tyramine and are considered sa#e. ationa!e ,& "eer and processed meats and cheese are high in tyramine. Combining tyramine(rich #oods with a monoamine o$idase inhibitor can result in a hypertensive crisis. Bried chic1en and gravy are not high in tyramine and are considered sa#e. There are many #oods that are sa#e to eat2 the patient can sa#ely eat at a restaurant. Co##ee and a sweet roll are not high in tyramine and are considered sa#e. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& *valuation &earnin$ *utcome: -/(9 Question / Type: MCSA The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium 3*s1alith6. The patient8s current lithium level is ,.%. hat will the nurse e$pect to assess in this patient! 1. A return to baseline behavior, calm and rational 2. 5yperactivity and pressured speech 3. Signs and symptoms o# depression 4. A decrease in manic behavior Correct Answer: +

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ationa!e 1& A therapeutic lithium level is ,./ to -.9. Since this patient8s level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not e$hibit signs and symptoms o# depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range. ationa!e 2& A therapeutic lithium level is ,./ to -.9. Since this patient8s level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not e$hibit signs and symptoms o# depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range. ationa!e 3& A therapeutic lithium level is ,./ to -.9. Since this patient8s level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not e$hibit signs and symptoms o# depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range. ationa!e 4& A therapeutic lithium level is ,./ to -.9. Since this patient8s level is low, behaviors will indicate mania, i.e., hyperactivity and pressured speech. There will be no decrease in manic behavior because the lithium level is too low. The patient will not e$hibit signs and symptoms o# depression, but will continue in the manic phase until the lithium level is within a therapeutic range. The patient will not return to baseline behavior, but will continue in the manic phase until the lithium level is within a therapeutic range. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(9 Question 10 Type: MCSA The nurse has completed medication education with the patient who is receiving lithium 3*s1alith6. best patient outcome! 1. The patient will be able to wor1 a normal wor1 schedule and will receive ade@uate sleep. 2. The patient will identi#y signs o# lithium 3*s1alith6 to$icity and verbaliAe measures to avoid it. 3. The patient will engage in activities o# daily living and report enjoyment with them. 4. The patient will report stabiliAation o# mood, including absence o# mania or depression. Correct Answer: +
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hat is the

ationa!e 1& Cithium 3*s1alith6 has a narrow therapeutic range. In order to avoid to$icity, patients must understand the signs o# to$icity and measures to avoid it. StabiliAation o# mood is important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. or1ing as normal wor1 schedule and receiving ade@uate sleep are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. *ngaging in activities o# li#e and enjoying them are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. ationa!e 2& Cithium 3*s1alith6 has a narrow therapeutic range. In order to avoid to$icity, patients must understand the signs o# to$icity and measures to avoid it. StabiliAation o# mood is important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. or1ing as normal wor1 schedule and receiving ade@uate sleep are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. *ngaging in activities o# li#e and enjoying them are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. ationa!e 3& Cithium 3*s1alith6 has a narrow therapeutic range. In order to avoid to$icity, patients must understand the signs o# to$icity and measures to avoid it. StabiliAation o# mood is important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. or1ing as normal wor1 schedule and receiving ade@uate sleep are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. *ngaging in activities o# li#e and enjoying them are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. ationa!e 4& Cithium 3*s1alith6 has a narrow therapeutic range. In order to avoid to$icity, patients must understand the signs o# to$icity and measures to avoid it. StabiliAation o# mood is important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. or1ing as normal wor1 schedule and receiving ade@uate sleep are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. *ngaging in activities o# li#e and enjoying them are important, but with medication education about lithium 3*s1alith6, the #ocus must be on identi#ying and avoiding signs o# to$icity. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& 'lanning &earnin$ *utcome: -/(0 Question 11 Type: MCSA The patient as1s the nurse why she needs to continue using table salt because her prescribed lithium 3*s1alith6 is a salt. hat is the best response by the nurse! 1. ":ou must continue to use salt to avoid lithium 3*s1alith6 to$icity. I# you use sea salt, you don8t need as much."
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2. ":ou must use table salt or your 1idneys will retain lithium 3*s1alith6, and you will become to$ic." 3. "The amount is not important2 just increase your table salt i# you notice signs o# lithium 3*s1alith6 to$icity." 4. "Salt is very important to avoid lithium 3*s1alith6 to$icity, but not as important as drin1ing - to -.9 C o# water per day." Correct Answer: + ationa!e 1& The 1idneys are responsible #or maintaining normal sodium levels. I# there is sodium depletion, the 1idneys will conserve any salt, in this case lithium 3*s1alith6. This will lead to lithium 3*s1alith6 to$icity. Instructing a patient to increase salt i# to$icity occurs is inappropriate because the patient must try to avoid to$icity, not treat it a#ter it occurs. There is no evidence to support the claim that sea salt is more e##ective than any other 1ind o# salt. 4rin1ing - to -.9 C o# water per day o# water is important, but does not substitute #or ade@uate sodium chloride. ationa!e 2& The 1idneys are responsible #or maintaining normal sodium levels. I# there is sodium depletion, the 1idneys will conserve any salt, in this case lithium 3*s1alith6. This will lead to lithium 3*s1alith6 to$icity. Instructing a patient to increase salt i# to$icity occurs is inappropriate because the patient must try to avoid to$icity, not treat it a#ter it occurs. There is no evidence to support the claim that sea salt is more e##ective than any other 1ind o# salt. 4rin1ing - to -.9 C o# water per day o# water is important, but does not substitute #or ade@uate sodium chloride. ationa!e 3& The 1idneys are responsible #or maintaining normal sodium levels. I# there is sodium depletion, the 1idneys will conserve any salt, in this case lithium 3*s1alith6. This will lead to lithium 3*s1alith6 to$icity. Instructing a patient to increase salt i# to$icity occurs is inappropriate because the patient must try to avoid to$icity, not treat it a#ter it occurs. There is no evidence to support the claim that sea salt is more e##ective than any other 1ind o# salt. 4rin1ing - to -.9 C o# water per day o# water is important, but does not substitute #or ade@uate sodium chloride. ationa!e 4& The 1idneys are responsible #or maintaining normal sodium levels. I# there is sodium depletion, the 1idneys will conserve any salt, in this case lithium 3*s1alith6. This will lead to lithium 3*s1alith6 to$icity. Instructing a patient to increase salt i# to$icity occurs is inappropriate because the patient must try to avoid to$icity, not treat it a#ter it occurs. There is no evidence to support the claim that sea salt is more e##ective than any other 1ind o# salt. 4rin1ing - to -.9 C o# water per day o# water is important, but does not substitute #or ade@uate sodium chloride. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(/ Question 12 Type: MCSA
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hat is the priority outcome #or a /(year(old patient who had been started on methylphenidate 3>italin6! 1. The patient will avoid altercations with peers. 2. The patient will be able to complete age(appropriate chores at home. 3. The patient will use age(appropriate play with peers. 4. The patient will maintain weight within norms #or this age group. Correct Answer: 7 ationa!e 1& Children with attention(de#icit hyperactivity disorder have di##iculty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate 3>italin6 increases their #ocus and decreases their distractibility, impulsiveness, and hyperactivity. Age(appropriate play with peers is #undamental to healthy development with school(age children. Avoiding altercations with peers does not address a decrease in A454(related behaviors. Completing age(appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage. ationa!e 2& Children with attention(de#icit hyperactivity disorder have di##iculty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate 3>italin6 increases their #ocus and decreases their distractibility, impulsiveness, and hyperactivity. Age(appropriate play with peers is #undamental to healthy development with school(age children. Avoiding altercations with peers does not address a decrease in A454(related behaviors. Completing age(appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage. ationa!e 3& Children with attention(de#icit hyperactivity disorder have di##iculty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate 3>italin6 increases their #ocus and decreases their distractibility, impulsiveness, and hyperactivity. Age(appropriate play with peers is #undamental to healthy development with school(age children. Avoiding altercations with peers does not address a decrease in A454(related behaviors. Completing age(appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage. ationa!e 4& Children with attention(de#icit hyperactivity disorder have di##iculty engaging in play with peers due to their distractibility, impulsiveness, and hyperactivity. Methylphenidate 3>italin6 increases their #ocus and decreases their distractibility, impulsiveness, and hyperactivity. Age(appropriate play with peers is #undamental to healthy development with school(age children. Avoiding altercations with peers does not address a decrease in A454(related behaviors. Completing age(appropriate chores at home does not address the interaction and play with peers, which is crucial during this developmental stage. Maintaining weight does not address the interaction and play with peers, which is crucial during this developmental stage. "!o#a! ationa!e: Co$niti%e &e%e!: AnalyAing C!ient 'eed: 'hysiological Integrity
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C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& 'lanning &earnin$ *utcome: -/(9 Question 13 Type: MCSA The D(year(old patient is receiving methylphenidate 3>italin6. The patient8s mother tells the nurse that he won8t eat while on his medication. hat is the best response by the nurse! 1. "It sounds li1e he is becoming depressed. I will spea1 to the doctor about starting an antidepressant medication." 2. "Eive the medication a#ter meals and encourage him to have supplements between meals." 3. ":ou are right to be concerned. I will spea1 to the doctor about starting an appetite stimulant medication." 4. "This is a very serious concern2 it would be best #or him to see a nutritionist #or counseling." Correct Answer: + ationa!e 1& Methylphenidate 3>italin6 is an appetite suppressant. The best approach is to have the patient ta1e the medication a#ter meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isn8t any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies #irst. ationa!e 2& Methylphenidate 3>italin6 is an appetite suppressant. The best approach is to have the patient ta1e the medication a#ter meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isn8t any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies #irst. ationa!e 3& Methylphenidate 3>italin6 is an appetite suppressant. The best approach is to have the patient ta1e the medication a#ter meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isn8t any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies #irst. ationa!e 4& Methylphenidate 3>italin6 is an appetite suppressant. The best approach is to have the patient ta1e the medication a#ter meals and consume nutritious supplements between meals. Seeing a nutritionist is premature at this time. There isn8t any evidence to support that the patient is becoming depressed. It is premature to start an appetite stimulant medication without trying other strategies #irst. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation
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&earnin$ *utcome: -/(9 Question 14 Type: MCSA The -,(year(old patient is receiving methylphenidate 3>italin6. The patient8s mother tells the nurse he just won8t sleep while on his medication. hat is the best response by the nurse! 1. ":ou can give him a +9 mg diphenhydramine 3"enadryl6 tablet at bedtime." 2. "4o not give the medication a#ter %&,, p.m." 3. "4o not give the medication a#ter /&,, p.m." 4. "This is serious2 you should as1 the doctor about atomo$etine 3Strattera6." Correct Answer: + ationa!e 1& Stimulant medications li1e methylphenidate 3>italin6 will inter#ere with sleep. To avoid insomnia, it is best to give the last dose prior to %&,, p.m. 4iphenhydramine 3"enadryl6 is not necessary. The e##ects o# methylphenidate 3>italin6 will wear o## by bedtime i# it is given prior to %&,, p.m. /&,, p.m. is too late #or the last dose o# methylphenidate 3>italin6. A medication change is premature without #irst trying to give the medication earlier in the day. ationa!e 2& Stimulant medications li1e methylphenidate 3>italin6 will inter#ere with sleep. To avoid insomnia, it is best to give the last dose prior to %&,, p.m. 4iphenhydramine 3"enadryl6 is not necessary. The e##ects o# methylphenidate 3>italin6 will wear o## by bedtime i# it is given prior to %&,, p.m. /&,, p.m. is too late #or the last dose o# methylphenidate 3>italin6. A medication change is premature without #irst trying to give the medication earlier in the day. ationa!e 3& Stimulant medications li1e methylphenidate 3>italin6 will inter#ere with sleep. To avoid insomnia, it is best to give the last dose prior to %&,, p.m. 4iphenhydramine 3"enadryl6 is not necessary. The e##ects o# methylphenidate 3>italin6 will wear o## by bedtime i# it is given prior to %&,, p.m. /&,, p.m. is too late #or the last dose o# methylphenidate 3>italin6. A medication change is premature without #irst trying to give the medication earlier in the day. ationa!e 4& Stimulant medications li1e methylphenidate 3>italin6 will inter#ere with sleep. To avoid insomnia, it is best to give the last dose prior to %&,, p.m. 4iphenhydramine 3"enadryl6 is not necessary. The e##ects o# methylphenidate 3>italin6 will wear o## by bedtime i# it is given prior to %&,, p.m. /&,, p.m. is too late #or the last dose o# methylphenidate 3>italin6. A medication change is premature without #irst trying to give the medication earlier in the day. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation
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&earnin$ *utcome: -/(9 Question 1, Type: MCSA hich o# the #ollowing symptoms e$perienced over - month would be most help#ul to diagnose bipolar disorder! 1. 4i##iculty sleeping, obsession with death, hallucinations 2. 4elusions, un1empt appearance, #atigue 3. Abnormal eating patterns, #eelings o# despair, #light o# ideas 4. Increased goal(directed behavior and tal1ativeness, distractibility Correct Answer: 7 ationa!e 1& "ipolar disorder involves periods o# mania and depression. Abnormal eating patterns and #eelings o# despair are symptoms o# depression, whereas #light o# ideas is a symptom o# mania. Increased goal(directed behavior, tal1ativeness, and distractibility are symptoms o# mania. 4i##iculty sleeping, obsession with death, hallucinations, delusions, un1empt appearance, and #atigue are symptoms o# depression. ationa!e 2& "ipolar disorder involves periods o# mania and depression. Abnormal eating patterns and #eelings o# despair are symptoms o# depression, whereas #light o# ideas is a symptom o# mania. Increased goal(directed behavior, tal1ativeness, and distractibility are symptoms o# mania. 4i##iculty sleeping, obsession with death, hallucinations, delusions, un1empt appearance, and #atigue are symptoms o# depression ationa!e 3& "ipolar disorder involves periods o# mania and depression. Abnormal eating patterns and #eelings o# despair are symptoms o# depression, whereas #light o# ideas is a symptom o# mania. Increased goal(directed behavior, tal1ativeness, and distractibility are symptoms o# mania. 4i##iculty sleeping, obsession with death, hallucinations, delusions, un1empt appearance, and #atigue are symptoms o# depression. ationa!e 4& "ipolar disorder involves periods o# mania and depression. Abnormal eating patterns and #eelings o# despair are symptoms o# depression, whereas #light o# ideas is a symptom o# mania. Increased goal(directed behavior, tal1ativeness, and distractibility are symptoms o# mania. 4i##iculty sleeping, obsession with death, hallucinations, delusions, un1empt appearance, and #atigue are symptoms o# depression. "!o#a! ationa!e: Co$niti%e &e%e!: >emembering C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& 4iagnosis &earnin$ *utcome: -/(Question 16 Type: MCSA
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hich statement is accurate regarding attention(de#icit hyperactivity disorder 3A4546! 1. A454 is characteriAed by periods o# mania and periods o# depression. 2. An$iety and social withdrawal are more #re@uently seen in girls than in boys. 3. 4iagnosis is higher in girls than in boys. 4. A454 is generally diagnosed later in li#e. Correct Answer: + ationa!e 1& A454 is generally diagnosed in childhood and in boys more #re@uently than in girls. "oys have more overt activity levels, where girls show less aggression but more social withdrawal. 'eriods o# mania and periods o# depression are more characteristic with bipolar disorder, not A454. ationa!e 2& A454 is generally diagnosed in childhood and in boys more #re@uently than in girls. "oys have more overt activity levels, where girls show less aggression but more social withdrawal. 'eriods o# mania and periods o# depression are more characteristic with bipolar disorder, not A454. ationa!e 3& A454 is generally diagnosed in childhood and in boys more #re@uently than in girls. "oys have more overt activity levels, where girls show less aggression but more social withdrawal. 'eriods o# mania and periods o# depression are more characteristic with bipolar disorder, not A454. ationa!e 4& A454 is generally diagnosed in childhood and in boys more #re@uently than in girls. "oys have more overt activity levels, where girls show less aggression but more social withdrawal. 'eriods o# mania and periods o# depression are more characteristic with bipolar disorder, not A454. "!o#a! ationa!e: Co$niti%e &e%e!: >emembering C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& *valuation &earnin$ *utcome: -/(+ Question 1Type: MCSA 4epression that occurs during cold winter months would be classi#ied as 1. baby blues. 2. bipolar disorder. 3. seasonal a##ective disorder. 4. obsessive(compulsive disorder.
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Correct Answer: 7 ationa!e 1& Seasonal a##ective disorder is #re@uently e$perienced during the winter months. =bsessive( compulsive disorder involves doing certain tas1s repetitively. "aby blues are associated with mothers who have recently had a baby. "ipolar disorder involves periods o# mania and periods o# depression. ationa!e 2& Seasonal a##ective disorder is #re@uently e$perienced during the winter months. =bsessive( compulsive disorder involves doing certain tas1s repetitively. "aby blues are associated with mothers who have recently had a baby. "ipolar disorder involves periods o# mania and periods o# depression. ationa!e 3& Seasonal a##ective disorder is #re@uently e$perienced during the winter months. =bsessive( compulsive disorder involves doing certain tas1s repetitively. "aby blues are associated with mothers who have recently had a baby. "ipolar disorder involves periods o# mania and periods o# depression. ationa!e 4& Seasonal a##ective disorder is #re@uently e$perienced during the winter months. =bsessive( compulsive disorder involves doing certain tas1s repetitively. "aby blues are associated with mothers who have recently had a baby. "ipolar disorder involves periods o# mania and periods o# depression. "!o#a! ationa!e: Co$niti%e &e%e!: >emembering C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(7 Question 1. Type: MCSA hich o# the #ollowing drug types used to treat depression wor1s by preventing enAymatic destruction o# the neurotransmitter norepinephrine! 1. "eta(adrenergic bloc1ers 2. Selective serotonin reupta1e inhibitors 3SS>Is6 3. Tricyclic antidepressants 3TCAs6 4. Monoamine o$idase inhibitors 3MA=Is6 Correct Answer: % ationa!e 1& MA=Is limit the brea1down o# norepinephrine by inhibiting the enAyme monoamine o$idase. TCAs inhibit neurotransmitter reupta1e, while SS>Is slow the reupta1e o# serotonin. "eta bloc1ers bloc1 beta receptors within the sympathetic nervous system.

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ationa!e 2& MA=Is limit the brea1down o# norepinephrine by inhibiting the enAyme monoamine o$idase. TCAs inhibit neurotransmitter reupta1e, while SS>Is slow the reupta1e o# serotonin. "eta bloc1ers bloc1 beta receptors within the sympathetic nervous system. ationa!e 3& MA=Is limit the brea1down o# norepinephrine by inhibiting the enAyme monoamine o$idase. TCAs inhibit neurotransmitter reupta1e, while SS>Is slow the reupta1e o# serotonin. "eta bloc1ers bloc1 beta receptors within the sympathetic nervous system. ationa!e 4& MA=Is limit the brea1down o# norepinephrine by inhibiting the enAyme monoamine o$idase. TCAs inhibit neurotransmitter reupta1e, while SS>Is slow the reupta1e o# serotonin. "eta bloc1ers bloc1 beta receptors within the sympathetic nervous system. "!o#a! ationa!e: Co$niti%e &e%e!: >emembering C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(9 Question 1/ Type: MCSA hich o# the #ollowing drug types are o#ten used as a #irst(line treatment #or depression due to their side e##ect pro#ile! 1. Monoamine o$idase inhibitors 3MA=Is6 2. "eta(adrenergic bloc1ers 3. Tricyclic antidepressants 3TCAs6 4. Selective serotonin reupta1e inhibitors 3SS>Is6 Correct Answer: % ationa!e 1& =# the drugs available #or depression, the SS>Is have the most #avorable side e##ect pro#ile. ationa!e 2& =# the drugs available #or depression, the SS>Is have the most #avorable side e##ect pro#ile. ationa!e 3& =# the drugs available #or depression, the SS>Is have the most #avorable side e##ect pro#ile. ationa!e 4& =# the drugs available #or depression, the SS>Is have the most #avorable side e##ect pro#ile. "!o#a! ationa!e: Co$niti%e &e%e!: >emembering
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C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(9 Question 20 Type: MCSA hich o# the #ollowing #ood items should the nurse advise a patient ta1ing a monoamine o$idase inhibitor 3MA=I6 to avoid! 1. =range juice, cottage cheese, and tur1ey 2. Spring water, ice cream, and salmon 3. Chocolate, wine, and #ava beans 4. Spinach, rice, and venison Correct Answer: 7 ationa!e 1& Chocolate, wine, and #ava beans are high in tyramine, which can cause severe hypertension in patients ta1ing MA=Is. ationa!e 2& Chocolate, wine, and #ava beans are high in tyramine, which can cause severe hypertension in patients ta1ing MA=Is. ationa!e 3& Chocolate, wine, and #ava beans are high in tyramine, which can cause severe hypertension in patients ta1ing MA=Is. ationa!e 4& Chocolate, wine, and #ava beans are high in tyramine, which can cause severe hypertension in patients ta1ing MA=Is. "!o#a! ationa!e: Co$niti%e &e%e!: Fnderstanding C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(% Question 21 Type: MCSA The traditionally prescribed drug types used to treat attention(de#icit hyperactivity disorder 3A4546 include 1. C.S depressants.
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2. parasympathomimetics. 3. C.S stimulants. 4. sympathomimetics. Correct Answer: 7 ationa!e 1& C.S stimulants have traditionally been the drug o# choice #or treating A454. ationa!e 2& C.S stimulants have traditionally been the drug o# choice #or treating A454. ationa!e 3& C.S stimulants have traditionally been the drug o# choice #or treating A454. ationa!e 4& C.S stimulants have traditionally been the drug o# choice #or treating A454. "!o#a! ationa!e: Co$niti%e &e%e!: >emembering C!ient 'eed: 'sychosocial Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(/ Question 22 Type: MCSA hich statement best e$plains why a C.S stimulant helps a patient with attention(de#icit hyperactivity disorder 3A4546! 1. .eurotransmitters are bloc1ed, limiting the e##ects they can produce within the '.S. 2. Activation o# certain areas o# the brain causes increased attention and ability to #ocus. 3. .eurotransmitter levels are reduced, which produces a calming e##ect within the C.S. 4. Certain areas o# the brain are deactivated, resulting in a calming e##ect. Correct Answer: + ationa!e 1& At #irst, it might seem con#using to use a C.S stimulant to treat a hyperactivity disorder. 5owever, C.S stimulants activate the reticular activating system, causing higher levels o# attention and ability to #ocus. .eurotransmitters such as epinephrine and serotonin are released, not bloc1ed or reduced ationa!e 2& At #irst, it might seem con#using to use a C.S stimulant to treat a hyperactivity disorder. 5owever, C.S stimulants activate the reticular activating system, causing higher levels o# attention and ability to #ocus. .eurotransmitters such as epinephrine and serotonin are released, not bloc1ed or reduced.
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ationa!e 3& At #irst, it might seem con#using to use a C.S stimulant to treat a hyperactivity disorder. 5owever, C.S stimulants activate the reticular activating system, causing higher levels o# attention and ability to #ocus. .eurotransmitters such as epinephrine and serotonin are released, not bloc1ed or reduced. ationa!e 4& At #irst, it might seem con#using to use a C.S stimulant to treat a hyperactivity disorder. 5owever, C.S stimulants activate the reticular activating system, causing higher levels o# attention and ability to #ocus. .eurotransmitters such as epinephrine and serotonin are released, not bloc1ed or reduced. "!o#a! ationa!e: Co$niti%e &e%e!: Fnderstanding C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(/ Question 23 Type: MCSA A %,(year(old patient e$periencing periods o# mania and periods o# depression would most li1ely bene#it #rom which o# the #ollowing! 1. Atomo$etine 3Strattera6 2. Amitriptyline 3*lavil6 3. Methylphenidate 3>italin6 4. Cithium 3*s1alith6 Correct Answer: % ationa!e 1& Cithium is the primary drug #or treating bipolar disorder. Methylphenidate and atomo$etine are indicated #or A454. Amitriptyline is indicated #or depression. ationa!e 2& Cithium is the primary drug #or treating bipolar disorder. Methylphenidate and atomo$etine are indicated #or A454. Amitriptyline is indicated #or depression. ationa!e 3& Cithium is the primary drug #or treating bipolar disorder. Methylphenidate and atomo$etine are indicated #or A454. Amitriptyline is indicated #or depression. ationa!e 4& Cithium is the primary drug #or treating bipolar disorder. Methylphenidate and atomo$etine are indicated #or A454. Amitriptyline is indicated #or depression. "!o#a! ationa!e: Co$niti%e &e%e!: Fnderstanding
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C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& 'lanning &earnin$ *utcome: -/(/ Question 24 Type: MCMA The nurse is concerned that a patient is moving into the manic phase o# bipolar disorder when what is assessed! Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. .ot sleeping 2. Cosing weight 3. Sluggish activity 4. Complaints o# muscle pain ,. Constant tal1ing Correct Answer: -,+,9 ationa!e 1& 4ecreased need #or sleep is a symptom o# the manic phase o# bipolar disorder. ationa!e 2& 4ecreased need #or #ood is a symptom o# the manic phase o# bipolar disorder. ationa!e 3& Sluggish activity is not a symptom o# the manic phase o# bipolar disorder. ationa!e 4& Complaints o# muscle pain are not a symptom o# the manic phase o# bipolar disorder. ationa!e ,& Increased tal1ativeness is a symptom o# the manic phase o# bipolar disorder. "!o#a! ationa!e: Co$niti%e &e%e!: AnalyAing C!ient 'eed: 'sychosocial Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(Question 2, Type: MCMA
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The nurse is instructing a patient on the cause o# bipolar disorder. as contributing to the manic phase o# this disorder!

hat neurotransmitters will the nurse describe

Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. *$cessive glutamate 2. *$cessive norepinephrine 3. 4e#iciency o# gamma(aminobutyric acid 4. 4e#iciency o# dopamine ,. *$cessive serotonin Correct Answer: -,+,7 ationa!e 1& Mania may involve an e$cess o# e$citatory neurotransmitters such as glutamate. ationa!e 2& Mania may involve an e$cess o# e$citatory neurotransmitters such as norepinephrine. ationa!e 3& Mania may involve a de#iciency o# inhibitory neurotransmitters such as gamma(aminobutyric acid 3EA"A6. ationa!e 4& 4opamine is not associated with the manic phase o# bipolar disorder. ationa!e ,& Serotonin is not associated with the manic phase o# bipolar disorder. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'hysiological Adaptation 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(+ Question 26 Type: MCMA 4uring a health history, the nurse wants to include an assessment o# depression with an older patient. statements will the nurse use to ma1e this assessment! Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply.
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hat

1. "5ow o#ten do you go out to socialiAe with #riends!" 2. "*$plain your sel#(care activities." 3. "5ow much alcohol do you consume every day!" 4. "5ow is living with your oldest daughter and her #amily wor1ing out #or you!" ,. "Are you #eeling depressed!" Correct Answer: -,+,7,% ationa!e 1& This @uestion would assess i# the patient is reluctant to leave the home, which can indicate depression in the older adult. ationa!e 2& =lder patients are reluctant to admit depression because it is seen as an inability to continue to care #or themselves. ationa!e 3& In some cases, the older patient may overuse alcohol or combine it with other medications that are depressants, which can #urther impact depression. ationa!e 4& Bactors that contribute to depression in the older patient include the need to move in with other #amily members because o# health status or #inances. ationa!e ,& 4epression is greatly underdiagnosed among older patients. =ne reason is the reluctance to admit depression because it can be seen as a sign o# wea1ness or an inability to care #or onesel#. As1ing patients directly i# they #eel depressed is not li1ely to elicit the desired in#ormation. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'sychosocial Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Assessment &earnin$ *utcome: -/(7 Question 2Type: MCMA 4uring a health history, the nurse is concerned that a patient with depression is at ris1 #or suicide when the patient Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. states that "suicide is always an option." 2. describes a previous unsuccess#ul attempt at suicide by aspirin overdose.
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3. states that the prescribed medication is not wor1ing and that #eelings o# depression are worse. 4. re@uests prescriptions #or pain medication and a sleeping aid. ,. e$presses interest in meeting with #riends more o#ten. Correct Answer: -,+,7,% ationa!e 1& I# a person verbaliAes about committing suicide, the tal1 must be ta1en seriously. ationa!e 2& A patient who has had a previous suicide attempt is at higher ris1 #or suicide and must be monitored care#ully. ationa!e 3& orsening symptoms o# depression must be reported immediately because these may indicate that the drug is not wor1ing or that the patient is not compliant with pharmacotherapy. ationa!e 4& All prescription drugs must be monitored because suicidal patients o#ten ta1e overdoses. Therapy with multiple central nervous system depressants is discouraged because these agents produce additive sedation. ationa!e ,& This in#ormation would not indicate a worsening o# depression or the ris1 #or suicide. "!o#a! ationa!e: Co$niti%e &e%e!: AnalyAing C!ient 'eed: 'sychosocial Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& 4iagnosis &earnin$ *utcome: -/(% Question 2. Type: MCMA A patient who has been ta1ing antidepressant medication #or several months and is demonstrating an improvement in symptoms tells the nurse that counseling sessions might be help#ul. hich types o# therapies will the nurse review with the patient! Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. "ehavioral therapy 2. Interpersonal therapy 3. Cognitive(behavioral therapy 4. 'sychodynamic therapy
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,. Crisis therapy Correct Answer: -,+,7,% ationa!e 1& "ehavioral therapies help patients unlearn the behavioral patterns that contribute to or result #rom their depression. ationa!e 2& Interpersonal therapy #ocuses on a patient8s disturbed personal relationships that both cause and e$acerbate depression. ationa!e 3& Cognitive(behavioral therapies help patients change negative styles o# thought and behavior that are o#ten associated with depression. ationa!e 4& 'sychodynamic therapies #ocus on resolving the patient8s internal con#licts by loo1ing at the in#luence o# past e$periences on current behavior and how behavior is in#luenced by emotional #actors. ationa!e ,& Crisis therapy is not a type o# therapy #or depression. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'sychosocial Integrity C!ient 'eed (u#: 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(9 Question 2/ Type: MCMA A patient with depression does not want to ta1e prescribed medication because o# the side e##ects. nurse suggest to help with medication adherence! Note: Credit will be given only if all correct choices and no incorrect choices are selected. (tandard Te+t: Select all that apply. 1. Fse ice chips to help alleviate dry mouth. 2. Chew gum or use hard candy to help alleviate dry mouth. 3. Avoid alcohol(based mouthwash to help alleviate dry mouth. 4. Fse "dry eye" drops to help with eye dryness. ,. Ta1e alcoholic beverages several times a wee1 to help with unpleasant side e##ects. Correct Answer: -,+,7,%
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hat can the

ationa!e 1& Fsing ice chips helps to alleviate dry mouth associated with these medications. ationa!e 2& Chewing gum or suc1ing on hard candy helps to alleviate dry mouth associated with these medications. ationa!e 3& Alcohol(based mouthwash can increase the #eeling o# dry mouth associated with these medications. ationa!e 4& "4ry eye" drops help alleviate eye dryness associated with these medications. ationa!e ,& The nurse should not instruct the patient to ta1e any antidepressant medications with alcohol because o# the potential #or adverse e##ects. "!o#a! ationa!e: Co$niti%e &e%e!: Applying C!ient 'eed: 'hysiological Integrity C!ient 'eed (u#: 'harmacological and 'arenteral Therapies 'ursin$/)nte$rated Concepts: .ursing 'rocess& Implementation &earnin$ *utcome: -/(0

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