You are the nurse responsible for assessing for extrapyramidal side effects in a patient who has been taking chlorpromazine. Which of the following may be side effects for this medication? (Select all that apply.) - ANSWER-Akathisia
Acute dystonia
Tardive Dyskinesia
An adult with depression ha...
Rasmussen mental health exam 2 test (Answered)
You are the nurse responsible for assessing for extrapyramidal side effects in a patient who has been taking chlorpromazine. Which of the following may be side effects for this
medication? (Select all that apply.) - ANSWER-Akathisia
Acute dystonia
Tardive Dyskinesia
An adult with depression has been treated with medication and cognitive behavioral therapy. The patient now verbalizes that being passive and letting others make decisions for her contributed to the depression. What referrals could the nurse make to help this patient prevent recurrence of depression? - ANSWER-Social skills training
A patient with suicidal impulses is placed on the highest level of suicide precautions. Which measures should be incorporated into the plan of care by the nurse caring for the
patient? (Select all that apply.) - ANSWER-Maintain arm's-length distance, institute one-
on-one nursing observation around the clock
Allow no glass or metal on meal trays
Remove all potentially harmful objects from the patient's possession
Which statement indicates a patient with major depression's most likely outlook on life during the acute phase of the illness? - ANSWER-"I deserve to be this way."
The nurse knows that sedation is a side effect of many antipsychotics. Which of the following medications should the nurse question if ordered for a patient taking antipsychotics? - ANSWER-diphenhydramine
The nurse is caring for a patient who experiences orthostatic hypotension related to taking chlorpromazine. The nurse should suggest which of the following interventions for managing this side effect? - ANSWER-Sit on the side of the bed before standing up.
The nurse is evaluating the effectiveness of an antipsychotic on negative symptoms of psychosis. Which of the following symptoms would be classified as negative symptoms of psychosis? - ANSWER-flat affect
During the maintenance phase of treatment a patient with bipolar disorder asks the nurse, "Do I have to keep taking this lithium even though my mood is stable now?" Which is the most appropriate response? - ANSWER-"Taking the medication every day helps prevent relapses and recurrences."
A patient with bipolar disorder commands another patient to "Get me that book. Take this other stuff out of here," and makes other similar demands. Which of the following actions could the nurse use to interrupt this behavior without entering into a power struggle with the patient? Select all that Apply - ANSWER-Providing a distraction
Setting clear limits
A patient with depression is evaluated at the clinic and started on citalopram. The patient tells the nurse, "I have some pills I previously took for depression. They're called
MAOIs. I think I should take them along with this new medication." What information is essential for the nurse to communicate regarding her statements? - ANSWER-The risk of a serious reaction if SSRIs and MAOIs are combined.
A patient with schizophrenia begins to talks about "volmers" hiding in the warehouse at work. which of the following should the term "volmers" be assessed as? - ANSWER-a neologism
The nurse is caring for a female patient diagnosed with schizophrenia who believes that
her thoughts are broadcast to others. What is the most appropriate nursing diagnosis for
this patient? - ANSWER-Disturbed Thought Processes
A nurse receives this laboratory result: lithium level 1.7 mEq/L. How should the nurse interpret this lab value? - ANSWER-Above therapeutic limits
Which of the following interventions should the nurse prioritize for a patient with severe depression? - ANSWER-Careful unobtrusive observation around the clock
Which comment by a patient experiencing severe anxiety would indicate the possibility of obsessive-compulsive disorder? - ANSWER-"I have to keep checking to see where my car keys are."
When educating a client and their family about taking a serotonin reuptake inhibitor (SSRI), which should the nurse prioritize for teaching purposes? - ANSWER-Report increased suicidal thoughts
Which of the following are potential complications that the patient receiving lithium should be assessed for? - ANSWER-Diaphoresis, weakness, and nausea
Which statement by a patient in the continuation phase of treatment for bipolar disorder indicates that a referral may still be needed? - ANSWER-"It is difficult to live down all the crazy stuff I did during my last manic episode."`
Which nursing diagnosis is likely to apply to an individual with a severe and persistent mental illness who is homeless? - ANSWER-Chronic low self-esteem
A patient is undergoing a series of diagnostic tests. The patient says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes and coughs a lot, has lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? - ANSWER-Denial
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