Question 1

A client who presents in the psychiatric unit tells the admitting nurse that he or she is very depressed and is having a hard time staying clean and sober. Which of the following describes the psychobiology of his or her illness?

Accepted Answer

Research has shown that alcohol dependence and depression have a genetic component, as well as being influenced by environmental factors. In addition, substance abuse can directly affect the brain and lead to mental health issues, but it can also be a way of self-medicating existing mental health problems. Therefore, both conditions should be treated together, with a focus on addressing underlying causes and providing comprehensive care.

Question 2

The nurse expresses ambivalence about the use of electroconvulsive therapy (ECT). How can this attitude influence client care?

Accepted Answer

The nurse's ambivalence about ECT may be communicated to the client and their family, which may cause them to feel less confident in the treatment that the nurse is providing. This can hinder the nursing care and the client's progress. It is important for the nurse to remain unbiased towards different treatments and present all options to the client in a fair and neutral manner.

Question 3

A client hospitalized for psychotic symptoms including auditory hallucinations and delusions of reference is prescribed a medication with a strong dopamine blocking action. The nurse teaches the client to recognize which symptom as a possible side effect of the medication?

Accepted Answer

Muscle stiffness is a possible side effect of medication with a strong dopamine blocking action. This is known as extrapyramidal symptoms (EPS) and includes muscle stiffness, tremors, and restlessness. The other side effects listed are less commonly associated with this type of medication.

Question 4

The family of a client with a diagnosis of dementia of the Alzheimer's type (DAT) has expressed concern that they may inherit the disorder. The nurse tells the family which of the following?

Accepted Answer

While there is no definitive answer to the cause of DAT, there appears to be a genetic link in the development of early onset DAT (before age 60). However, for the more common late onset form of the disorder, environmental factors and aging are thought to be more influential.

Question 5

The client says to the nurse, "I'm worried that this new antidepressant may not be working because I always feel tired after taking it in the morning." The nursing response should be based on what principle?

Accepted Answer

Antidepressants can have either a stimulant or sedating effect, depending on the type of medication and individual response. Feeling tired after taking an antidepressant in the morning may indicate a sedating effect, but it does not necessarily mean the medication is ineffective. The nurse should assess for other signs and symptoms of depression and potential side effects of the medication before determining if a change in medication is necessary.

Question 6

A fifteen-year-old client was depressed due to the loss of the client's mother and was placed on venlaxafine (Effexor). Two weeks later the client returns to the clinic and says, "I am feeling worse and have no hope." What nursing action is a priority?

Accepted Answer

Assessing for suicidality is the priority in this situation as the client is expressing feelings of hopelessness and the medication change may not be effective. It is important to determine if the client is at immediate risk for self-harm or suicide and take appropriate actions to ensure their safety. The other options can also be addressed, but assessing for suicidality is the priority.

Question 7

A nurse planning a staff education session would correctly explain the role of psychopharmacologic treatment as which of the following?

Accepted Answer

Psychopharmacologic treatment is used to stabilize clients' physiologic stability so that they can grow holistically. It helps to manage symptoms of mental illness so that clients can participate in other forms of therapy and achieve overall wellness. However, it is not intended to eliminate the need for long-term treatment or simply make clients happy.

Question 8

In preparing for the treatment of a client only on the SSRI fluoxetine (Prozac), the nurse plans for which of the following?

Accepted Answer

Fluoxetine (Prozac) is primarily used in the treatment of depression and obsessive-compulsive disorder. It is not typically used to treat memory deficits, auditory hallucinations, alcohol withdrawal, or delusions.

Question 9

A client with a long history of schizophrenia is being switched from a conventional antipsychotic medication to a newer, atypical antipsychotic. The client asks, "I wonder why I am being switched since I have not had hallucinations for years. The psychiatrist said something about negative symptoms." Which response by the nurse is correct?

Accepted Answer

Atypical antipsychotics work on both positive symptoms, such as hallucinations, as well as negative symptoms, such as lack of motivation. The client's psychiatrist may have wanted to switch to improve overall functioning and quality of life. Option A is incorrect as medications can be switched to target negative symptoms. Option B is incorrect as conventional antipsychotics are effective for positive symptoms but may not address negative symptoms. Option C is incorrect as negative symptoms refer to a lack of behaviors or experiences, not those that interrupt one's life.

Question 10

A nurse new to psychiatry asks her colleague why the newer atypical antipsychotic medications do not cause as many EPSEs as do the conventional antipsychotic medications. Which response, if made by the nurse, is correct?

Accepted Answer

The newer atypical antipsychotic medications have less affinity for dopamine receptors and also bind to serotonin receptors, which reduces the likelihood of EPSEs. Unlike conventional antipsychotic medications, which primarily act on dopamine receptors in the brain, atypical antipsychotics target both dopamine and serotonin receptors. This reduces the risk of EPSEs because serotonin has an inhibitory effect on the dopamine system. Therefore, option C is the correct response. Option A is incorrect because atypical antipsychotics do not mask EPSEs; they simply have a lower risk of causing them. Option B is incorrect because atypical antipsychotics act on multiple dopamine pathways, not just the lower extrapyramidal pathway. Option D is incorrect because the newer antipsychotics do impact dopamine, but they also have an effect on serotonin receptors.

Question 11

A nurse in the inpatient unit says to the client, "I want to speak to you about the drugs you are taking, particularly the antipsychotic ones." After the client walks away without interacting, the nurse asks another nurse for suggestions. Which of the following would help the nurse improve this interaction?
Select all that apply.

Accepted Answer

The nurse should use language that is respectful and non-stigmatizing, such as avoiding the use of the word "drugs" and using the specific name of the medication. The nurse should also approach the conversation as a collaborative effort to discuss the client's medication, rather than talking "to" or lecturing the client. Setting up an appointment in advance may also be helpful for ensuring the client is prepared and willing to participate in the conversation, but this may not always be feasible or necessary. It is still within the scope of nursing practice to educate and discuss medications with clients, so there is no need to involve the psychiatrist unless there are specific concerns or questions beyond the nurse's knowledge and expertise.

Question 12

The client with depression was started on flurazepam (Dalmane) and looks very tired after breakfast. What factors should the nurse assess related to the client's tiredness?
Select all that apply.

Accepted Answer

The answer of The client with depression was started on...

Question 13

The client who was taking zaleplon (Sonata) took about an hour to fall asleep the first night after it was discontinued. The client asks the nurse if this means that the client is addicted to the medication. Which nursing response is correct?

Accepted Answer

Zaleplon (Sonata) is a sedative-hypnotic used for the short-term treatment of insomnia. It is not typically associated with withdrawal symptoms, and the experience of taking an hour to fall asleep after discontinuation does not indicate addiction.

Question 14

What are the benefits of the newer nonbenzodiazepines as compared to the benzodiazepines for the treatment of insomnia?

Accepted Answer

Nonbenzodiazepines do not produce as much hangover effect, which means patients are less likely to feel groggy or foggy the next day. This can lead to better overall functioning and improved quality of life.

Question 15

The client with schizophrenia was started on imipramine (Tofranil) for a depressed mood and subsequently started hearing voices again and refuses to take the Tofranil because the client thinks it is poison. The nursing response is based on what information?

Accepted Answer

Tricyclic antidepressants like imipramine can trigger overt psychotic symptoms in someone with schizophrenia, and this may be the reason for the client's worsening symptoms after starting the medication. The nursing response should involve assessing the client's current symptoms and working with the treatment team to adjust the medication regimen as needed. It may be necessary to discontinue the imipramine and consider a different medication that is better tolerated by the client.

Question 16

The client who is recovering from schizophrenia has just seen the psychiatrist and tells the nurse that the Olanzapine (Zyprexa) is being reduced from 20 mg to 15 mg. This client asks the nurse why the Olanzapine is just not discontinued since the client has not had a hallucination for two months. Which nursing response to the client is correct?

Accepted Answer

Gradual reduction of antipsychotic medication is recommended to prevent relapse and to avoid withdrawal symptoms. The nurse should explain to the client the importance of continuing medication as prescribed and the risks of suddenly discontinuing the medication. Checking serum levels and monitoring for signs of toxicity is important, but it is not the reason for reducing the medication dosage in this case. Choice A is incorrect because it is not appropriate for the nurse to recommend discontinuing medication without consulting the psychiatrist. Similarly, choice D is incorrect because the reason for reducing the medication dosage is not related to toxicity, but rather to prevent relapse and to adjust the medication to the client's current clinical status.

Question 17

A mental health nurse is reviewing the post-test responses for a staff educational session that the nurse provided on the chronological development of psychiatric medications. Which of the following responses would indicate the participants understood the information correctly?
Select all that apply.

Accepted Answer

These responses indicate an understanding of the chronological development of psychiatric medications. The SSRI group of antidepressants has fewer side effects than older antidepressants (A). The discovery of chlorpromazine (Thorazine) dramatically changed psychiatric treatment (C). The effectiveness of antidepressants has led to research resulting in a better understanding of brain biochemistry (E).

Question 18

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for which of the following?

Accepted Answer

Acetylcholinesterase inhibitors are frequently prescribed for memory loss associated with Alzheimer's disease. Therefore, memory impairment would be the most important thing to assess for. Assessing for depression, mania, and blood pressure may also be relevant but are not directly related to the medication.

Question 19

The white blood cell count of the client on clozapine (Clozaril) is 2.8. What action should the nurse take?

Accepted Answer

A white blood cell count of 2.8 while on clozapine (Clozaril) is significantly low and may indicate the development of agranulocytosis, a potentially life-threatening side effect of the medication. The nurse should hold the medication and notify the prescribing psychiatrist immediately to determine the appropriate course of action. Monitoring the client for orthostatic hypotension, administering the medication, or checking thyroid levels are not appropriate actions in this situation.

Question 20

A nurse manager is mentoring a junior nurse. The junior nurse models everything after the manager, and even dresses like the manager. How would the manager address the junior nurse's identification?

Accepted Answer

The answer of A nurse manager is mentoring a junior...

Quiz 1: The Strength and Structure of Psychiatric Mental Health Nursing; Theoretical Basis for Psychiatric-Mental Health Nursing Practice and Process