Final Mental Health Exam Questions

Lithium carbonate is a medication used to treat bipolar disorder. However, it has a narrow therapeutic range, meaning that the difference between a therapeutic dose and a toxic dose is small. If the serum levels of lithium carbonate exceed 1.5 mEq, symptoms of toxicity are likely to appear. This suggests that levels above this threshold can lead to harmful effects and should be closely monitored to avoid potential complications.

The correct answer is "Sit on the side of the bed before getting up; then stand up very slowly." This teaching plan is important because tricyclic antidepressants (TCA) can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions. Sitting on the side of the bed before standing up allows the client to adjust to the change in position slowly, reducing the risk of dizziness or fainting.

The client's symptoms of lip smacking, tongue protrusion, and facial grimaces are consistent with tardive dyskinesia, a side effect of long-term use of antipsychotic medication. Tardive dyskinesia is characterized by involuntary movements of the face and tongue and is more commonly seen in older adults who have been on antipsychotics for an extended period. Parkinsonism, antidrenergic effects, and anticholinergic effects do not match the client's symptoms and are not associated with tardive dyskinesia.

Alcohol withdrawal refers to the physical and psychological symptoms that occur when a person abruptly stops or reduces their alcohol intake after prolonged and heavy use. Diaphoresis, which is excessive sweating, nausea and vomiting, and tremors are common symptoms of alcohol withdrawal. These symptoms are caused by the body's reaction to the sudden absence of alcohol, as it tries to readjust and regain balance. They can range in severity and may be accompanied by other symptoms such as anxiety, irritability, and increased heart rate. It is important to seek medical attention if experiencing alcohol withdrawal symptoms, as they can be potentially dangerous and require proper management.

The client statement "My symptoms can come back if I don't take the medication exactly as ordered" indicates understanding of the nurse's teaching regarding antipsychotic medications because it demonstrates awareness that adherence to the prescribed medication regimen is important for preventing symptom recurrence. This statement reflects knowledge of the potential consequences of not taking the medication as directed, suggesting that the client understands the importance of following the prescribed treatment plan for managing their condition effectively.

The nurse's best response is "There is an increased risk of birth defects if you become pregnant while taking this medication." This is the correct answer because valproic acid (Depakote) is known to be associated with an increased risk of birth defects, particularly neural tube defects, when taken during pregnancy. It is important for the client to be aware of this risk and to discuss alternative treatment options with her healthcare provider if she is planning to become pregnant.

When starting a client on the MAOI phenelzine (Nardil), it is important to monitor their blood pressure frequently. MAOIs can cause a potentially dangerous increase in blood pressure, known as a hypertensive crisis. This can lead to symptoms such as severe headache, chest pain, palpitations, and even stroke. Therefore, monitoring blood pressure regularly is essential to ensure the client's safety and to detect any potential hypertensive crisis early on.

The client's symptoms of nausea, vomiting, loss of appetite, and abdominal pain may indicate a serious side effect of Valproic acid. These symptoms could be signs of hepatotoxicity, which is a potential complication of taking this medication. It is important for the client to contact their primary care provider immediately to discuss these symptoms and determine the appropriate course of action.

The most appropriate intervention is to ask the client directly about his hallucinations, but avoid treating hallucinaions or delusions as if they were real. Stopping the interview until a later time may not be feasible since th client may experience hallucinations much of the time. Distraction can be helpful for working with a client with hallucinations; however, continusing the interview without commenting on this clien't hallucinations will not be an effective distraction

Flumazenil (Romazicon) is the correct answer because it is an antidote specifically used for benzodiazepine overdose or toxicity. It works by blocking the effects of benzodiazepines on the central nervous system, reversing their sedative and respiratory depressant effects. Busiprone (BuSpar), Hydroxyzine (Vistaril), and Naloxone (Narcan) are not antidotes for benzodiazepine overdose or toxicity.

A serum lithium level above 1.5 is considered in the toxic range

Extrapyramidal symptoms are side effects that can occur with antipsychotic medications. These symptoms affect the muscles and can include muscular weakness, rigidity, tremors, and facial spasms. These symptoms are important to watch for because they can be uncomfortable for the client and may indicate a need for a change in medication or dosage. Monitoring for these symptoms allows the nurse to provide appropriate care and support to the client.

The correct answer is "I will not stop taking the drug abruptly". This statement indicates that the client understands the importance of gradually tapering off benzodiazepine instead of stopping it suddenly, which can lead to withdrawal symptoms and potential harm. It shows that the teaching has been effective in educating the client about the proper way to discontinue the medication.

True: Alcohol and benzodiazepines are cross-tolerant. Therefore, tolerance to one would mean that the client also has tolerance to the other.

The client's symptoms of confusion, excessive sweating, and hallucinations indicate a serious reaction to fluoxetine. These symptoms may be indicative of serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin levels. Therefore, it is important to stop the drug immediately and seek medical attention.

The correct answer is to educate the client about a tyramine-restricted diet and the prohibition of concurrent use of over-the-counter medications without physician notification. This is because MAOIs (Monoamine Oxidase Inhibitors) can interact with certain foods and medications, leading to potentially dangerous hypertensive crises. A tyramine-restricted diet is necessary to avoid consuming foods high in tyramine, such as aged cheeses, cured meats, and fermented foods, as they can cause a sudden increase in blood pressure. Concurrent use of over-the-counter medications without physician notification should be avoided as they may contain substances that can interact with MAOIs and cause adverse effects.

In depersonalization, the individual describes himself as seeming unreal. Derealization includes describing a familiar situation or event as unreal or strange. Rationalization is a defense whereby the individual justifes his behavior using faulty logic. In regression, the indivdual keeps threatening thoughts or feelings from coming to consciousness

The highest priority nursing diagnosis in this scenario is "Potential for injury related to seizure activity." This is because bupropion (Wellbutrin) is known to lower the seizure threshold, and overdose can significantly increase the risk of seizures. Seizures can cause harm to the client and require immediate medical intervention. Therefore, ensuring the client's safety and preventing injury from seizure activity is of utmost importance.

Buspirone has a delayed onset of action and cannot be used on a PRN (as needed) basis. This means that it takes time for the medication to start working, so it is not effective for immediate relief of anxiety symptoms. Alprazolam, on the other hand, is a fast-acting medication that can be taken as needed when feeling anxious. Therefore, it is more suitable for managing panic disorder symptoms in the moment.

Alcohol withdrawal symptoms typically begin within 12 hours after the last drink. This is because alcohol is a depressant that affects the central nervous system. When a person abruptly stops consuming alcohol, their body goes into withdrawal as it tries to readjust to functioning without the depressant. Symptoms such as tremors, anxiety, sweating, and irritability can start to appear within the first 12 hours. It is important to seek medical assistance during alcohol withdrawal to manage symptoms and prevent complications.

Dissociative disorders are caused by exposure t extreme stress. Witnessing extreme violence is an event that can bring about the stress. While abusing drugs and alcohol can cause memory lapses, these lapses are not considered disssociative disorders according to the DSM-IV. Epileptic seizures can cause periods of amnesia concurrent with the seizure, but this type of amnesia is not considered dissociative. Insomnia usually does not cause amnesia, although it can cause memory impairment

Catatonic schizophrenia is a subtype of schizophrenia characterized by abnormal motor behaviors and movements. Purposeless motor agitations, such as repetitive or stereotyped movements without any apparent reason or goal, are commonly associated with catatonic schizophrenia. This can include excessive motor activity, such as pacing, rocking, or grimacing. Other symptoms of catatonic schizophrenia may include immobility, mutism, echolalia (repeating others' words), and negativism (resistance or opposition to instructions or movements). Tactile hallucinations, word salad and flight of ideas, and eccentric behaviors or odd beliefs are not specifically associated with catatonic schizophrenia.

Buspirone is different from other antianxiety medications because it does not cause physical or psychological dependence. This means that individuals who take buspirone do not develop a tolerance to the medication, nor do they experience withdrawal symptoms when they stop taking it. This is in contrast to other antianxiety medications, such as benzodiazepines, which can lead to dependence and withdrawal symptoms. The lack of dependence potential makes buspirone a safer option for long-term use in the treatment of anxiety disorders.

The nurse might identify a chronic cocaine user based on the symptom of red, irritated nostrils. This is because cocaine can be snorted through the nose, which can cause damage to the nasal passages and result in inflammation and irritation. Chronic cocaine use can lead to persistent redness and irritation of the nostrils as a characteristic sign of drug abuse. The other symptoms listed, such as clear, constricted pupils, muscle aches, and conjunctival redness, may be associated with other conditions or drug use, but they are not specific to chronic cocaine use.

False: Flumazenil (romazicon) is a specific antidote for benzodiazepine toxicity. An antidote for opioid toxicity is intravenous naloxone (Narcan)

False: The statement is an example of denial. Projection would occur if the client blamed someone else for her own unacceptable mistakes or shortcomings

Antianxiety medications such as benzodiazepines produce a calming effect by depressing the CNS. This means that they slow down the activity of the central nervous system, which includes the brain and spinal cord. By doing so, they can reduce feelings of anxiety and promote relaxation.

Potential for violence is not a factor for the client with somatization disorder; a potential for self-directed violence might be relevant for this client, however. All other options are important for the nurse who is planning care

The client is the acute stages of paranoid schizophrenia would have disturbed thought processes with active hallucinations and or delusions. A risk for violence is not universally present, although the nurse should assess for it. Noncompliance and disabled family coping are not necessarily present in clients with schizophrenia

Fine hand tremors are an expected side efffect of lithium. This side effect may either subside or continue during lithium therapy. However, if the tremors begin to increase and become coarse, early lithium toxicity is a possibility

The physician is most likely to order Chlordiazepoxide (Librium) for Mr. White during his withdrawal syndrome because it is a benzodiazepine medication commonly used to manage alcohol withdrawal symptoms. It helps to reduce anxiety, agitation, and seizures that can occur during withdrawal. Haloperidol is an antipsychotic medication used for psychosis and not specifically for withdrawal. Propoxyphene is a pain medication and Phenytoin is an anticonvulsant, neither of which are typically used for withdrawal symptoms.

The nurse's best response is that regular aspirin would be a better choice because Advil can raise the client's lithium level too high. This is the correct answer because NSAIDs like Advil can interfere with the excretion of lithium, leading to increased levels of lithium in the blood. This can be dangerous and potentially toxic for the client. Regular aspirin is a safer alternative for pain relief in this case.

Antipsychotic medications are believed to reduce psychotic symptoms by blocking the action of dopamine in the brain. Dopamine is a neurotransmitter that plays a role in regulating mood, behavior, and cognition. Excessive dopamine activity has been linked to the development of psychotic symptoms such as hallucinations and delusions. By blocking dopamine receptors, antipsychotic medications help to normalize dopamine levels and alleviate these symptoms.

Furosemide (Lasix) is a loop diuretic that can cause dehydration and electrolyte imbalances, such as low sodium levels, when taken concurrently with lithium. Lithium is also known to cause dehydration and electrolyte imbalances, so combining it with furosemide can increase the risk of toxicity. This is why furosemide can produce a toxic effect when given concurrently with lithium. Insulin, prednisone, and digoxin do not have the same potential for interaction and toxicity with lithium.

The initial symptoms of lithium toxicity include ataxia, tinnitus, blurred vision, and diarrhea. These symptoms may occur as a result of the toxic effects of lithium on the central nervous system and gastrointestinal tract. Ataxia refers to a lack of coordination and muscle control, tinnitus is the perception of ringing or buzzing sounds in the ears, blurred vision is the loss of sharpness and clarity in vision, and diarrhea is the frequent passage of loose or watery stools. These symptoms may indicate an overdose or accumulation of lithium in the body, which requires medical attention.

Valproic acid (Depakote) is known to have hepatotoxic effects, meaning it can cause damage to the liver. AST/ALT (aspartate aminotransferase/alanine aminotransferase) and LDH (lactate dehydrogenase) are liver function tests that can help monitor liver health and detect any potential liver damage caused by valproic acid. Regular monitoring of these laboratory studies is important to ensure the medication is not causing harm to the client's liver.

When an individual is addicted to heroin and stops using it, they are likely to experience symptoms of withdrawal. These symptoms include nausea and vomiting, diarrhea, and diaphoresis (excessive sweating). These physical symptoms occur as the body tries to adjust to the absence of heroin and can be extremely uncomfortable for the individual going through withdrawal. The other options listed in the question, such as increased heart rate and blood pressure, tremors, insomnia, and seizures, and incoordination and unsteady gait, may also be present during heroin withdrawal, but the most common symptoms are nausea, vomiting, diarrhea, and diaphoresis.

Conversion disorder symptoms are frequently accompanied by la belle indifference, a lack of concern about the symptoms. Level of education and income are not factors in conversion syndrome. The fact that there is no history of neurologic problems is not relevant. The client's report that one leg is deformed could be a sign of body dysmorphic disoder, but it does not relate to conversion disorder

Schizophrenia is a psychiatric disorder characterized by hallucinations, delusions, and disorganized thinking. Antipsychotic medications are commonly used to treat schizophrenia, and these medications can cause various side effects. Blurred vision is one such side effect that can occur due to the blockade of muscarinic receptors. Muscarinic receptors are found in various parts of the body, including the eyes. Blockade of these receptors can lead to a decrease in the activity of the parasympathetic nervous system, resulting in blurred vision. Therefore, the correct answer is Muscarinic Receptors.

Based on the statement, "The green and whites do me good after speed," the nurse can interpret that the client is referring to amphetamines as "speed" and the combination of green and white pills as anxiolytics. This suggests that the client is abusing both amphetamines and anxiolytics.

The reason why doses of bupropion should be administered at least 4 to 6 hours apart and never doubled when a dose is missed is to prevent seizures. Bupropion is an antidepressant medication that can lower the seizure threshold, increasing the risk of seizures. By spacing out the doses and not doubling them when missed, the medication is more likely to maintain a consistent level in the body, reducing the likelihood of seizures.

Depersonaliztion (a feeling of being seperated from one's body) and derealization (a sensation of being in a strange environment) are examples of problems with personal boundaries. Delusions and hallucinations are positive symptoms of schizophrenia, but they are not personl boundary issues.

Administering PRN trihexyphenidyl (Artane) would be a priority nursing intervention if extrapyramidal symptoms occur. Trihexyphenidyl is an anticholinergic medication that helps to reduce the symptoms of these side effects caused by antipsychotic medications. By administering this medication, the nurse can alleviate the symptoms and provide relief to the client. Notifying the physician may be necessary, but immediate intervention to relieve the symptoms should be the priority. Withholding the next dose of the antipsychotic medication or explaining that the symptoms are temporary may not address the immediate need for symptom relief.

The statement "I will control my caloric intake and get lots of exercise" indicates an understanding of the adverse effects of fluoxetine (Prozac). One of the common adverse effects of this medication is weight gain, so controlling caloric intake and exercising can help minimize this side effect. This statement shows that the client is aware of the potential impact on their weight and is taking proactive measures to mitigate it.