The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent?
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Solution
Emotional lability, euphoria, and impaired memory
Option C: Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory.
Option A: Phencyclidine overdose can cause combativeness, sweating, and confusion.
Option B: Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation.
Option D: Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure.
A 65 years old client is in the first stage of Alzheimer’s disease. Nurse Patricia should plan to focus this client’s care on:
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Solution
Providing emotional support and individual counseling.
Option B: Clients in the first stage of Alzheimer’s disease are aware that something is happening to them and may become overwhelmed and frightened. Therefore, nursing care typically focuses on providing emotional support and individual counseling.
Options A, C, and D: The other options are appropriate during the second stage of Alzheimer’s disease when the client needs continuous monitoring to prevent minor illnesses from progressing into major problems and when maintaining adequate nutrition may become a challenge. During this stage, offering nourishing finger foods helps clients to feed themselves and maintain adequate nutrition.
A client seeks care because she feels depressed and has gained weight. To treat her atypical depression, the physician prescribes tranylcypromine sulfate (Parnate), 10 mg by mouth twice per day. When this drug is used to treat atypical depression, what is its onset of action?
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Solution
3 to 5 days
Option B: Monoamine oxidase inhibitors, such as tranylcypromine, have an onset of action of approximately 3 to 5 days. A full clinical response may be delayed for 3 to 4 weeks. The therapeutic effects may continue for 1 to 2 weeks after discontinuation.
Which medications have been found to help reduce or eliminate panic attacks?
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Solution
Antidepressants
Option A: Tricyclic and monoamine oxidase (MAO) inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn’t clearly understood.
Option B: Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don’t relieve the anxiety itself.
Option C: Antipsychotic drugs are inappropriate because clients who experience panic attacks aren’t psychotic.
Option D: Mood stabilizers aren’t indicated because panic attacks are rarely associated with mood changes.
Richard with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:
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Solution
Severe anxiety and fear.
Option B: Phobias cause severe anxiety (such as a panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia, and elevated blood pressure.
Options A and C: Insomnia, an inability to concentrate, and weight loss are common in depression.
Option D: Withdrawal and failure to distinguish reality from fantasy occur in schizophrenia.
Alfred was newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following?
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Solution
A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days.
Option A: The client should be informed that the drug’s therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed.
Option B: NMS hasn’t been reported with this drug, but tachycardia is frequently reported.
Option C: Blood level checks aren’t necessary.
Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD):
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Solution
fluvoxamine (Luvox) and clomipramine (Anafranil)
Option C: The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
Option B: Librium and Valium may be helpful in treating anxiety related to OCD but aren’t drugs of choice to treat the illness.
Options A and D: The other medications mentioned aren’t effective in the treatment of OCD.
Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, “Why has this happened to me?” What is the nurse’s best response?
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Solution
“Your problem is real but there is no physical basis for it. We’ll work on what is going on in your life to find out why it’s happened.”
Option C: The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear.
Option A: Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn’t help her understand and resolve the underlying conflict.
Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer the client’s question; knowing that the cause is psychological wouldn’t necessarily make her feel better.
After seeking help at an outpatient mental health clinic, Ruby who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby?
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Solution
Exploring the meaning of the traumatic event with the client.
Option D: The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse.
Option A: A special diet isn’t indicated unless the client also has an eating disorder or a nutritional problem.
Option B: The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate.
Option C: The client must explore the meaning of the event and won’t heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client’s anxiety and induce sleep.
Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior?
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Solution
By designating times during which the client can focus on the behavior.
Option A: The nurse should designate times during which the client can focus on the compulsive behavior or obsessive thoughts.
Option B: The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly.
Option C: She shouldn’t call attention to or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror to the client.
Option D: The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.