Question 1

A patient with depression is prescribed duloxetine (Cymbalta).What should the nurse instruct the patient about this medication?

Accepted Answer

Many people take St.John's wort,an OTC herbal supplement,for depression.Although it may be effective for some people with mild depression,it can interact with many prescribed medications that influence serotonin levels.If combined with prescription serotonin-type antidepressants,it can cause serotonin syndrome,an excess of serotonin resulting in agitation,confusion,diarrhea,muscle spasms,and even death.A.This medication does not need to be taken with fruit juice.C.This medication should not be abruptly stopped.D.This medication can cause systolic hypertension.

Question 2

A patient comes into the emergency department experiencing chest pain and feelings of impending doom.Which assessment findings should the nurse use to determine if this patient is experiencing a panic attack? (Select all that apply.)

Accepted Answer

Panic is a state of extreme fear that cannot be controlled; it may be referred to as a panic attack.Panic episodes are recurrent and occur unpredictably.Patients may present themselves at the emergency room because they believe they are having a heart attack or other significant physical illness.Patients must exhibit several episodes within a specified time frame to be given the diagnosis of panic disorder.Additional symptoms associated with panic disorder include dissociation and shaking.B.D.Neck pain and vomiting brown emesis are not manifestations of a panic disorder.

Question 3

The nurse is reviewing the causes of anxiety with a patient diagnosed with an anxiety disorder.Which neurotransmitter abnormalities should the nurse include as causing symptoms of anxiety? (Select all that apply.)

Accepted Answer

Anxiety,as explained by biological theory,is associated with increased epinephrine and norepinephrine,and decreased GABA.A.C.Increased substance P is associated with depression,and increased somatostatin is associated with Huntington's disease.D.Anxiety is associated with increased and not decreased norepinephrine.

Question 4

A patient has been prescribed fluoxetine (Prozac)to treat depression.What should be included in the nurse's teaching about the drug? (Select all that apply.)

Accepted Answer

Teach patient who is taking a selective serotonin reuptake inhibitor (SSRI)that it will take 6 to 8 weeks for therapeutic effects to occur,and possibly longer with Prozac.Possible side effects include excitation,nausea and vomiting,decreased libido,anorexia,and weight loss.B.SSRIs should be administered before 3 p.m.to prevent excitation from affecting sleep.A.They are taken daily.D.Aged foods are avoided with monoamine oxidase inhibitors (MAOIs),not SSRIs.

Question 5

The nurse is assisting with teaching a patient who is to begin taking a monoamine oxidase inhibitor (MAOI).Which foods should the nurse teach the patient to avoid? (Select all that apply.)

Accepted Answer

When a patient taking a monoamine oxidase inhibitor (MAOI)consumes foods high in tyramine,the drug prevents the normal breakdown of tyramine,leading to excessive epinephrine levels.Hypertension can occur which can be severe enough to cause intracranial hemorrhage.Foods to be avoided include wine and aged cheese.A.C.D.Breads,pastas,and fish do not need to be restricted because of tyramine content.

Question 6

A patient with extreme anxiety is arriving for out-patient chemotherapy.What should the nurse do to help reduce the patient's anxiety during this current treatment?

Accepted Answer

A study was done that looked at the effect of nature based sounds to reduce agitation,anxiety level and physiological signs of stress in patients.The experimental group had significantly lower systolic blood pressure,diastolic blood pressure,anxiety and agitation levels than the control group.The use of music or nature based sounds incorporated into nursing care may help reduce anxiety.B.Selecting a program televising a sporting event might be too stressful for the patient.C.Closing the door to the treatment room might cause the patient to feel abandoned.D.Reminding the patient that anxiety is not going to make the treatment effective is threatening and is a negative statement.The patient should be counseled in positive self-talk.

Question 7

The nurse is assisting in planning care for a patient with extreme anxiety.Which interventions should the nurse include in this patient's plan of care? (Select all that apply.)

Accepted Answer

Nursing care for the patient with extreme anxiety includes maintaining a calm environment,encouraging verbalization of feelings,and encouraging positive self-talk.D.Activities should be encouraged however the patient should not be placed in a competitive situation since it can produce anxiety.E.The nurse should stay with the patient during an acute anxiety event because feeling abandoned can increase anxiety.

Question 8

The nurse is assisting in the preparation of an educational seminar on anxiety disorders.Which anxiety disorders should the nurse make sure are included in this presentation? (Select all that apply.)

Accepted Answer

Phobias are the most common of the anxiety disorders.Additional disorders are panic disorder,generalized anxiety disorder,obsessive-compulsive disorder,and post-traumatic stress disorder.D.Depression is a mood disorder.C.Schizophrenia is a brain disorder that is a group of illnesses,not one of the anxiety disorders.

Question 9

A patient with schizophrenia is returning from a CT scan of the brain followed by an electroencephalogram.Which diagnostic test findings should the nurse identify as supporting this patient's diagnosis? (Select all that apply.)

Accepted Answer

The brains of patients with a diagnosis of schizophrenia show a significant loss of gray matter,enlarged ventricles,and diminished prefrontal cortex functioning.C.Nerve de-myelinization would not be visible through a CT scan or electroencephalogram.D.Aneurysms are not a normal finding in the patient with schizophrenia and would be considered an emergency.

Question 10

The nurse is reviewing potential patient teaching needs.For which prescribed medications should the nurse plan to instruct patients to follow a tyramine-free diet? (Select all that apply.)

Accepted Answer

Tyramine-free diet is required for patients taking monoamine oxidase inhibitor (MAOI)antidepressants including phenelzine (Nardil),tranylcypromine (Parnate),and isocarboxazid (Marplan).B.D.E.A tyramine-free diet is not required for patients taking buspirone (Buspar),valproic acid (Depakote),or lithium carbonate (Eskalith).

Question 11

The nurse is assisting with data collection on a patient newly diagnosed with schizophrenia.Which observations should the nurse consider as being positive symptoms of schizophrenia? (Select all that apply.)

Accepted Answer

Positive symptoms of schizophrenia can be thought of as those symptoms that reflect an "excess" or distortion of normal functioning.Positive symptoms include hallucinations,delusions,disorganized thinking,and disorganized behavior.A.B.E.Negative symptoms include affective blunting or flattening,alogia,avolition,apathy,anhedonia,and social isolation.

Quiz 57: Nursing Care of Patients With Mental Health Disorders

A patient with depression is prescribed duloxetine (Cymbalta) .What should the nurse instruct the patient about this medication?