Psychiatric & mental health nursing for canadian p
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1. 1. Question
Flumazenil (Romazicon) has been ordered for a male client who has
overdosed on oxazepam (Serax). Before administering the medication,
nurse Gina should be prepared for which common adverse effect?
o A. Seizures
o B. Shivering
o C. Anxiety
o D. Chest pain
Incorrect
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using
flumazenil to reverse benzodiazepine overdose. The effect is magnified
if the client has a combined tricyclic antidepressant and
benzodiazepine overdose. Benzodiazepine reversal has correlations
with seizures. Seizures may happen more frequently in patients who
have been on benzodiazepines for long-term sedation or in patients
who are showing signs of severe tricyclic antidepressant overdose. The
required dosage of Flumazenil should be measured and prepared by
the practitioners to manage seizures. Flumazenil use requires caution
in patients relying on a benzodiazepine for seizure control.
Option B: Shivering is not an adverse effect of flumazenil.
Monitor the patient for the possible return of sedation, mostly in
those who are tolerant of benzodiazepines. Patients should have
monitoring for respiratory depression, benzodiazepine
withdrawal, and other residual effects of benzodiazepines for at
least 2 hours.
Option C: Anxiety is a rare adverse effect for people using
flumazenil. Flumazenil has some associations with precipitation of
seizures in patients with benzodiazepine dependence with a
history of seizures. Flumazenil overdose is extremely rare. There
is no precise antidote for flumazenil toxicity. In mild to severe
toxicity, symptomatic and supportive treatment should be a
consideration.
Option D: An overdose of flumazenil in a patient who is not a
chronic benzodiazepine user would not be expected. Chronic
benzodiazepines users may experience withdrawal with abrupt
, discontinuation of the drug. Administration of benzodiazepines or
barbiturates may be necessary for seizure control.
2. 2. Question
Nurse Tamara is caring for a client diagnosed with bulimia. The most
appropriate initial goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Incorrect
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to stress
and underlying issues. The client must identify anxiety-causing
situations that stimulate the bulimic behavior and then learn new ways
of coping with the anxiety. Bulimia nervosa is a condition that occurs
most commonly in adolescent females, characterized by indulgence in
binge-eating, and inappropriate compensatory behaviors to prevent
weight gain.
Option A: Controlling shopping for large amounts of food isn’t a
goal early in treatment. It is important to educate patients who
abuse laxatives that these medications work in the
gastrointestinal tract after the areas where caloric absorption has
occurred primarily. It is crucial to inform patients that a period of
edema and weight gain may follow up to several weeks after
discontinuation of purging behavior.
Option B: Managing eating impulses and replacing them with
adaptive coping mechanisms can be integrated into the plan of
care after initially addressing stress and underlying issues. The
primary objective of treatment is a cessation of the binging and
purging behavior. Selective serotonin reuptake inhibitors such as
fluoxetine, citalopram, and sertraline have shown to reduce
symptoms of bulimia nervosa. Fluoxetine is the only FDA
approved medication for bulimia nervosa. It appears that a higher
dose (60 mg) is significantly better than a placebo in decreasing
the frequency of binge and vomiting episodes.
, Option D: Eating three meals per day isn’t a realistic goal early
in treatment. Patients with bulimia nervosa who purge by
vomiting often brush their teeth immediately after purging, which
can accelerate dental erosion. The clinician should instruct the
patients who persist in vomiting to rinse their mouths with water
or fluoride rather than brushing their teeth within 30 minutes of
each episode. Consider consulting a dentist to address dental
issues associated with vomiting.
3. 3. Question
A female client who’s at high risk for suicide needs close supervision.
To best ensure the client’s safety, Nurse Mary should:
A. Check the client frequently at irregular intervals
throughout the night.
B. Assure the client that the nurse will hold in confidence anything
the client says.
C. Repeatedly discuss previous suicide attempts with the client.
D. Disregard decreased communication by the client because this
is common with suicidal clients.
Incorrect
Correct Answer: A. Check the client frequently at irregular
intervals throughout the night
Checking the client frequently but at irregular intervals prevents the
client from predicting when observation will take place and altering
behavior in a misleading way at these times. Once the patient is
deemed to be at risk for suicide, then intervention steps must be
initiated right away. The individual must not be left alone. Enlist the
help of a support person while at home. The suicidal individual must be
treated in a safe and secure place. In addition, the place has to be
monitored.
Option B: This may encourage the client to try to manipulate the
nurse or seek attention for having a secret suicide plan.
Assessing the individual’s judgment is critical. One should try and
determine how the individual can handle stress. Does he or she
have an impairment in decision making? Does the individual
know that jumping in front of a train is dangerous? Reflect
, empathy and concern. Offer a hand to help. Provide the patient
with confidence that he or she can overcome the issues.
Option C: This may reinforce suicidal ideas. Help develop
internal coping strategies (e.g., exercise, journaling, reading,
developing a hobby). Utilize the help of healthcare professionals
to follow up on therapy. Once the individual is safe as an
inpatient or outpatient, a formal treatment plan should be
established. The next step is to refer all patients deemed to be at
higher risk for suicide to a mental health counselor as soon as
possible. Every state has laws and procedures regarding this
process which must be incorporated into the clinical practice
when addressing individuals at high suicide risk.
Option D: Decreased communication is a sign of withdrawal that
may indicate the client has decided to commit suicide; the nurse
shouldn’t disregard it. In some cases, assessment of the mental
status may provide a clue to the individual’s potential for self-
harm. Depressed patients will often tend to appear unclean and
unkempt. The clothing may not be ironed or dirty. The risk of
suicide is often high in people who appear very anxious or
depressed. The patient may exhibit a flat affect or no emotions at
all. Some depressed patients may develop hallucinations that
may be telling him or her to kill themselves. The majority of these
hallucinations are auditory.
4. 4. Question
Which of the following drugs should Nurse Mary prepare to administer
to a client with a toxic acetaminophen (Tylenol) level?
A. Deferoxamine mesylate (Desferal)
B. Succimer (Chemet)
C. Flumazenil (Romazicon)
D. Acetylcysteine (Mucomyst)
Incorrect
Correct Answer: D. Acetylcysteine (Mucomyst)
The antidote for acetaminophen toxicity is acetylcysteine. It enhances
conversion of toxic metabolites to nontoxic metabolites.
Acetaminophen (N-acetyl-para-aminophenol, paracetamol, APAP)
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