Mental Health Nursing 6th Edition

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CHAPTER 10
1.1 During a staff meeting on antipsychotic
medications, a staff member asks the nurse to
explain the difference between the
physiological actions of the first- and second-
generation antipsychotic medications. Which
of the following is the correct nursing
response?
a. Both block norepinephrine, while the first-
generation antipsychotic medications
enhance the available dopamine.
b. Both decrease dopamine or block the
overactive receptors, while only the second-
generation antipsychotic medications block
the serotonin receptors.
c. Both enhance the available acetylcholine,
while the first-generation antipsychotic
medications increase the GABA.
d. Both enhance the serotonin and
norepinephrine available in the neural
synapses.
1.2 The family member of a client with
paranoid schizophrenia asks the nurse about
risperidone (Risperdal) and wants to know
what symptoms should decrease as a result of
this medication. Which symptoms should the
nurse say will decrease as a result of
Risperdal?
a. Dyslexia and difficulty reading.
b. Dreams of early childhood experiences.
c. Feelings of urinary frequency.
d. Delusions that the client is being followed
by the FBI.
1.3 Which of the following client statements
indicates to the nurse that the client with
depression has a correct understanding of the
goal for antidepressant therapy?
a. “I should remain on antidepressants all my
Answer: b
Rationale: The positive symptoms of
schizophrenia are thought to be due to the
excess of dopamine or from hypersensitive
dopamine receptors. Both generations of
antipsychotic medications decrease dopamine
or block the hypersensitive receptors. The
second-generation medications also block
serotonin receptors. The other responses are
not the actions of antipsychotic medications.
Application
Implementation
Safe, Effective Care Environment
Learning Objective 1.1
Answer: d
Rationale: The therapeutic effect of
antipsychotic medications is to decrease
psychotic symptoms. A client with
paranoid schizophrenia would experience a
decrease in persecutory delusions. Dreams
of childhood experiences, urinary
frequency, and dyslexia are not symptoms
of schizophrenia.
Application
Planning
Physiological Integrity
Learning Objective 1.2
Answer: c
Rationale: The therapeutic purpose of
antidepressants is to decrease as many
depressive symptoms as possible and to enable
the client to participate in other treatments. It
 life after one episode of depression.”
b. “Within 24 hours, I should have a dramatic
change in my mood.”
c. “I should expect a decrease in many if not
all depressive symptoms.”
d. “I should expect to be more depressed for
the first 2 weeks of treatment.”
1.4 A staff member asks the nurse how lithium
works biologically as a mood stabilizer. Which
of the following mechanisms correctly explains
the action of lithium?
a. Lithium is a central nervous system
stimulant that blocks irrelevant thoughts
and impulses.
b. Lithium reverses the deficiencies of the
neurotransmitters dopamine, serotonin,
norepinephrine, and acetylcholine.
c. Lithium potentiates the effects of GABA, an
inhibitory neurotransmitter.
d. Lithium inhibits a second messenger system Implementation
whose overactivity may be responsible for
mania and depression.
1.5 The nurse reviews the chart of a child and
notes that the child is prescribed
methylphenidate (Ritalin). The nurse expects to
see which of the following if the Ritalin is
effective?
a. Ability to focus
b. Hallucinations
c. Insomnia
d. Anxiety
takes an average of 10-14 days for the
beginning effect of most antidepressants. After
4 months-1 year of being symptom-free,
following an initial depressive episode, a client
may be taken off antidepressants. Even though
the full effect of an antidepressant may take 2-
4 weeks, the client should not feel more
depressed during that time period.
Analysis
Evaluation
Physiological Integrity
Learning Objective 1.3
Answer: d
Rationale: Lithium affects the phosphatidyl
inositol cycle, a second messenger system
inside many cells. It does interact with
dopamine, norepinephrine, and serotonin but
does not increase their amounts.
Benzodiazepines potentiate the effects of
GABA, not lithium. Some of the
anticonvulsants used as mood stabilizers also
increase GABA activity. Lithium is not a CNS
stimulant.
Application
Physiological Integrity
Learning Objective 1.4
Answer: a
Rationale: Ritalin is prescribed to treat the
symptoms of attention deficit/hyperactivity
disorder (ADHD). Hallucinations occur in
psychotic disorders, such as schizophrenia.
Insomnia could be a side effect of Ritalin but is
not a sign of efficacy. Anxiety is not a
symptom of ADHD.
Application
Assessment
Physiological Integrity
Learning Objective 1.5
1.6 The client with a history of alcohol abuse is Answer: b
prescribed buspirone (BuSpar) for anxiety and Rationale: Buspirone (BuSpar) is
asks the nurse why alprazolam (Xanax) was recommended for the treatment of anxiety in
not ordered. Which nursing response is clients with a history of substance abuse
correct? because buspirone is not addictive. Relief of
a. Buspirone has a shorter onset of action for anxiety may take 1-2 weeks for buspirone
relieving anxiety. while alprazolam works quickly. Both
b. Buspirone does not potentiate alcohol and is buspirone and alprazolam are used to treat
anxiety symptoms.
not addictive.
Analysis
c. Buspirone will help the client withdraw
safely from alcohol. Implementation
d. Buspirone is given for anxiety and Physiological Integrity
alprazolam is not. Learning Objective 1.6
2.1 For which of the following medications Answer: a
would the nurse plan to teach clients to wear Rationale: Risperidone is an antipsychotic
protective clothing or sunscreen when outdoors medication that as a group can cause
to protect the skin from rashes or sunburns? photosensitivity to sunlight. Duloxetine and
a. Risperidone (Risperdal) fluoxetine are antidepressants that generally do
not cause photosensitivity. Lorazepam is a
b. Duloxetine (Cymbalta)
benzodiazepine that does not cause
c. Lorazepam (Ativan) photosensitivity.
d. Fluoxetine (Prozac) Analysis
Planning
Physiological Integrity
Learning Objective 2.1
2.2 When should the nurse be most alert to Answer: d
assess for signs of dystonia in clients taking Rationale: Dystonia is an often frightening
antipsychotic medications?
muscle spasm that usually occurs within the
a. When the client has a pill rolling movement first 5 days of treatment or when the dosage of
of the hand at rest antipsychotic medications is increased. Tardive
dyskinesia is a side effect that is often
b. After long-term use of first-generation
irreversible and occurs generally after 2 or
antipsychotic medications
more years of treatment. Photosensitivity
c. When the client is exposed to direct sunlight occurs with exposure to direct sunlight. Pill
between 10 a.m. and 2 p.m. rolling is a symptom of parkinsonism.
d. Within the first 5 days of treatment or when Application
the dose is increased.
Assessment
Physiological Integrity

2.3 The nurse monitors body mass index and
weight in clients taking second-generation
antipsychotic medications because of the risk
of which of the following side effects?
a. Neuroleptic malignant syndrome
b. Parkinsonism
c. Metabolic syndrome
d. QT prolongation
2.4 The client asks the nurse which
antidepressants are associated with sexual
dysfunction. Which of the following
antidepressants does the nurse correctly say are
associated with this side effect?
Select all that apply.
a. Citalopram (Celexa)
b. Clomipramine (Anafranil)
c. Fluoxetine (Prozac)
d. Sertraline (Zoloft)
e. Bupropion (Wellbutrin)
2.5 The client with bipolar disorder is started
on lamotrigine (Lamictal) and develops a rash.
What is the correct nursing response?
a. Tell the client the rash will fade after a day
Learning Objective 2.2
Answer: c
Rationale: Obesity is a risk factor for metabolic
syndrome associated with the second-
generation antipsychotic medications. The
nurse, therefore, monitors for weight gain and
body mass index. The other choices are side
effects that are not particularly affected by
weight gain.
Analysis
Implementation
Physiological Integrity
Learning Objective 2.3
Answers: a, b, c, d
Rationale:
• Citalopram (Celexa). Sexual dysfunction
can present in people taking SSRIs.
Citalopram is an SSRI.
• Clomipramine (Anafranil). Clomipramine
is a tricyclic antidepressant with high
affinity for serotonin and can cause sexual
dysfunction.
• Fluoxetine (Prozac). Sexual dysfunction can
present in people taking SSRIs. Fluoxetine is
an SSRI.
• Sertraline (Zoloft). Sexual dysfunction can
present in people taking SSRIs. Sertraline is
an SSRI.
• Bupropion (Wellbutrin). Bupropion causes
virtually no sexual side effects.
Application
Implementation
Physiological Integrity
Learning Objective 2.4
Answer: b
Rationale: A rash during the first 8 weeks of
lamotrigine treatment may be an indication of a
life-threatening syndrome, Stevens-Johnson
 or two.
b. Notify the prescriber immediately.
c. Ask for a dermatologist consult when the
admitting doctor comes in.
d. Ask the client about anxiety symptoms.
2.6 Which of the following is a priority for the
nurse to include in the teaching of a client who
was recently prescribed alprazolam (Xanax) as
an oral medication?
a. Monitor temperature daily.
b. Avoid unprotected exposure to sunlight.
c. Monitor heart rate before taking the
medication.
d. Avoid alcohol.
3.1 Which of the following situations in clients
on lithium therapy should alert the nurse to an
increased risk of lithium toxicity?
Select all that apply.
a. Weight gain
b. Diarrhea
c. Excessive sweating
d. Elimination of dietary salt
e. Vomiting
syndrome. The rash should be reported
immediately to the prescriber. Waiting a day or
two to see if the rash goes away or asking for a
consult at a later time may put the client’s life
at risk if the rash is the precursor to Stevens-
Johnson syndrome. Asking about anxiety is not
a priority at this time.
Analysis
Implementation
Physiological Integrity
Learning Objective 2.5
Answer: d
Rationale: Alprazolam is a benzodiazepine and
can potentiate the central nervous system
depression of alcohol. Exposure to sunlight
should not be an issue. The client does not
need to monitor heart rate or temperature prior
to taking alprazolam.
Analysis
Implementation
Physiological Integrity
Learning Objective 2.6
Answers: b, c, d, e
Rationale:
• Vomiting. Loss of fluids and sodium can
lead to toxicity. Vomiting leads to fluid loss.
• Diarrhea. Loss of fluids can lead to lithium
toxicity. Diarrhea causes fluid loss.
• Excessive sweating. Loss of fluids can lead
to lithium toxicity. Excessive sweating can
lead to fluid loss.
• Elimination of dietary salt. A normal
sodium balance is needed to ensure a
therapeutic lithium level.
• Weight gain. Weight gain is not related to
lithium toxicity.
Application
Implementation

3.2 Which of the following would be a priority
nursing intervention in caring for a client
following an overdose of an antipsychotic
medication?
a. Administering haloperidol (Haldol) for
sedation
b. Controlling hypertension
c. Administering IV fluids with NaCl for
hyponatremia
d. Maintaining a patent airway
3.3 The client arrives at the hospital with
slurred speech, disorientation, and impaired
judgment and is ordered flumazenil
(Romazicon). The nurse prepares to administer
this medication as treatment for which of the
following?
a. An overdose of lithium
b. Withdrawal from alcohol
c. Dementia of the Alzheimer’s type
d. An overdose of a benzodiazepine
3.4 A family member asks the nurse what the
worst consequences of overdosing on valproate
(Depakote) would be. The family member
worries that the client has overdosed on
medications in the past. What is the correct
nursing response?
a. Headache for several hours
b. Severe coma and death
c. Stevens-Johnson syndrome
d. Insomnia
Physiological Integrity
Learning Objective 3.1
Answer: d
Rationale: The primary symptom of overdose
is central nervous system depression, which
makes it necessary to monitor vital signs and
maintain a patent airway. Hypotension would
be a more likely symptom than hypertension.
The client should not be hyponatremic. Since
Haldol is an antipsychotic, taking Haldol
would lead to a worsening of the overdose.
Analysis
Implementation
Physiological Integrity
Learning Objective 3.2
Answer: d
Rationale: Flumazenil is the antidote for
overdose of a benzodiazepine and can reverse
sedation, respiratory depression, and coma.
Withdrawal from alcohol is treated with
benzodiazepines. Dementia is treated with
acetylcholinesterase inhibitors. Lithium
overdose is not treated with flumazenil.
Application
Implementation
Physiological Integrity
Learning Objective 3.3
Answer: b
Rationale: The worst consequences of
overdosing on valproate would be severe coma
and death. A headache is not a severe
consequence. Stevens-Johnson syndrome can
occur when a client is on lamotrigine
(Lamictal) or when lamotrigine is combined
with valproate. The client would be more likely
to be sedated and go into a coma than to have
insomnia.
Application

3.5 The client has been on lithium maintenance
for 2 years and calls the clinic because of
tinnitus, blurred vision, and a new irregular
tremor. The nurse suspects which of the
following?
a. Lithium toxicity
b. Discontinuation of lithium
c. Alcohol abuse
d. Worsening of mania
3.6 The client overdosed on amitriptyline
(Elavil). The nurse would expect to see which
of the following symptoms?
Select all that apply.
a. Agitation
b. Increased coronary blood flow
c. Seizures
d. Arrhythmia
e. Hallucinations
4.1 A client of Asian ethnicity asks the nurse
why the client’s dose of antipsychotic
medication is effective at a lower dose than for
other clients who are mostly from European
backgrounds. Which nursing response is
Implementation
Physiological Integrity
Learning Objective 3.4
Answer: a
Rationale: If symptoms occur during the
maintenance period, they are usually
indications of lithium toxicity. A sudden
discontinuation of lithium would not produce
tinnitus and neither would alcohol abuse or
mania.
Analysis
Assessment
Physiological Integrity
Learning Objective 3.5
Answers: a, c, d, e
Rationale:
• Agitation. Agitation is a symptom of
overdose on a tricyclic antidepressant.
• Hallucinations. Hallucinations are
symptoms of overdose on a tricyclic
antidepressant.
• Seizures. Seizures are symptoms of
overdose on a tricyclic antidepressant.
• Arrhythmia. Arrhythmia is a symptom of
overdose on a tricyclic antidepressant.
• Increased coronary blood flow. The
coronary blood flow would be decreased,
not increased.
Application
Assessment
Physiological Integrity
Learning Objective 3.6
Answer: a
Rationale: People of Asian ethnicity have
lower metabolic rates, show more side effects,
and often require lower doses of medication
correct?
a. Often people of Asian ethnicity have lower
metabolic rates and need lower amounts of
medication.
b. There is no correlation between ethnic
background and the amount of medication
someone receives.
c. People of European ethnicity have more
side effects from medication than do those
of Asian ethnicity.
d. Asians are rapid metabolizers of
medications and have fewer side effects.
4.2 A staff member asks the nurse if the older
adult client can be on a long-acting medication
since his son is. Which of the following
nursing responses is correct?
a. It is not the place of staff members to
questions clients’ medications.
b. There is no reason that age should make a
difference in long- versus short-acting
medications.
c. It would be a good idea since long-acting
medications usually require fewer doses per
day.
d. Long-acting medications are stored much
longer in older adults and are not
recommended.
4.3 A pregnant client asks the nurse why
fluoxetine (Prozac) was decreased in her last
weeks of pregnancy. Which of the following
nursing responses is correct?
a. Decreasing it reduces the risk of withdrawal
in the infant after birth.
b. Decreasing it reduces the risk of the woman
being too relaxed during childbirth.
c. Decreasing it reduces the chance of
stillbirth.
d. Decreasing it is done because women are
less depressed as delivery approaches.
than do people of European ethnicities.
Application
Implementation
Physiological Integrity
Learning Objective 4.1
Answer: d
Rationale: Many long-acting medications are
stored in adipose tissue that increases by 10%-
50% in those over 65. The medications stored
in adipose tissues are available for a longer
period of time if given in a long-acting
formulation. If it were not for the physiological
changes due to aging, long-acting medications
would be a good idea. All staff members
should question treatment options.
Analysis
Implementation
Safe, Effective Care Environment
Learning Objective 4.2
Answer: a
Rationale: The rationale for decreasing
fluoxetine prior to delivery is to reduce the risk
of withdrawal in the infant as the medication is
available to the infant’s circulation during
pregnancy. Fluoxetine would not make the
mother too relaxed nor does it cause stillbirth.
A depressed woman would not be less
depressed as delivery approaches.
Analysis
Implementation
Physiological Integrity
Learning Objective 4.3
4.4 A nurse new to child psychiatry asks a
more experienced nurse why children have
both smaller and multiple doses of
medications, unlike adults who have larger
doses once or twice a day. Which of the
following is the correct nursing response?
a. Children are more compliant if they are
accustomed to taking medications
frequently.
b. Children absorb and metabolize
medications faster than adults do.
c. Children store medications longer and
require smaller doses.
d. Children experience a better understanding
that they are ill if reminded more
frequently.
4.5 Which of the following is a priority nursing Answer: d
intervention for a child or adolescent newly
started on an SSRI antidepressant?
a. Teaching dietary restrictions
b. Teaching the child relaxation exercises
c. Keeping the child on one-to-one observation are given antidepressants in the community
d. Close monitoring for suicidal thoughts or
actions
4.6 The client with cardiac problems and
depression asks the nurse which group of
antidepressants would be recommended.
Which of the following groups of
antidepressants is generally recommended in
this situation?
a. SSRIs
b. Tricyclic antidepressants
c. MAOIs
Answer: b
Rationale: The increased efficiency in
absorption and metabolism of medications
indicates that it is more appropriate to
administer smaller, more frequent doses
throughout the day rather than one larger dose.
This will help the child maintain a steady
therapeutic level of the medication throughout
the day. Compliance is often better with fewer
administrations of medication, and children
should not be reminded that they are not
healthy.
Application
Implementation
Physiological Integrity
Learning Objective 4.4
Rationale: The risk of suicidal thoughts and
behaviors in a child or adolescent is higher in
the first month of treatment with an
antidepressant. Relaxation would not be a life-
or-death priority at this time. Many children
and are closely monitored but not put on one-
to-one observation. There are no dietary
restrictions for SSRIs.
Analysis
Implementation
Psychosocial Integrity
Learning Objective 4.5
Answer: a
Rationale: The SSRIs are less likely to produce
cardiac side effects than are the tricyclic
antidepressants and the MAOIs.
Benzodiazepines are not antidepressants.
Applications
Implementation
Physiological Integrity
d. Benzodiazepines
5.1 A client complains to the nurse of
experiencing constipation after starting on a
new medication. What nursing response is
most helpful?
a. Have the client discuss changing
medications with the prescriber.
b. Teach the client to increase fluids, fiber, and laxatives. Since this is a common side effect, it
exercise.
c. Ask if the client really wants to take the
medication.
d. Teach the client to use enemas.
5.2 A woman calls the nurse at the mental
health clinic. The woman’s husband takes
phenelzine (Nardil), and the woman states that
he took several over-the-counter decongestants
as well, and now he has a stiff neck, headache,
nausea, and vomiting. The nurse bases her
response on what information?
a. Agranulocytosis is an adverse reaction that
occurs due to the interaction of MAOIs and
decongestants.
b. Flulike symptoms are common when
patients begin taking MAOIs.
c. MAOIs can trigger a hypertension crisis if
taken with sympathomimetics.
d. Neuroleptic malignant syndrome presents
with muscular rigidity following the
ingestion of MAOIs.
5.3 The nurse evaluates which of the following
client statements as validation that the teaching
on lithium was effective?
a. “I will quit taking lithium if I get
depressed.”
b. “I will restrict fluids to 100 mL per 8
Learning Objective 4.6
Answer: b
Rationale: Many psychotropic medications
have anticholinergic side effects, including
constipation. Teaching the client about fluids,
diet, and exercise would be the beginning point
and could be followed by teaching about bulk
would not be appropriate to change
medications at this point. The nurse should not
challenge the client’s desire to be compliant
when a legitimate question was asked. Enemas
would not be appropriate at this time.
Application
Implementation
Physiological Integrity
Learning Objective 5.1
Answer: c
Rationale: When MAOIs are mixed with foods
containing tyramine or sympathomimetics, a
hypertensive crisis can occur that is heralded
by the symptoms of headache, stiff neck,
nausea, vomiting, and rising blood pressure.
Agranulocytosis is demonstrated by low white
blood cell count and can occur following the
initiation of antipsychotic medications.
Neuroleptic malignant syndrome is an adverse
reaction to antipsychotic medications.
Analysis
Assessment
Physiological Integrity
Learning Objective 5.2
Answer: c
Rationale: Lithium levels are drawn every 2-3
months and after dosage increases. If fluid is
restricted to the point of dehydration, toxicity
can occur. As a mood stabilizer, lithium treats
both depression and mania and therefore would
 hours.”
c. “I will have my blood levels checked every
2-3 months.”
d. “I will have liver function tests every 6
months.”
5.4 Which of the following client statements
would indicate that the client needs further
teaching related to benzodiazepine therapy?
a. “I sometimes share my medications with a
friend.”
b. “I will not quit taking this medication
abruptly.”
c. “I will not drive until I see how this affects
me.”
d. “I will limit alcohol to two beers per night.”
5.5 The nurse is developing a group teaching
plan for clients taking antipsychotic
medications. Which of the following are
correct points to include in the teaching?
Select all that apply.
a. Call your primary health care provider
immediately if you get a sore throat, high
fever, or rash.
b. Double the dose if it becomes too difficult
to cope with the hallucinations.
c. Rise slowly from a sitting or lying position.
d. Quit taking the medications when the
hallucinations are gone for 1 month.
e. Limit your exposure to direct sunlight and
wear sunscreen and protective clothing
outdoors.
not be stopped during depression. Liver
function tests are not needed for lithium since
lithium is an ion and is not metabolized by the
liver.
Application
Evaluation
Physiological Integrity
Learning Objective 5.3
Answer: d
Rationale: Alcohol in combination with drugs
that suppress the CNS could be fatal. Because
of withdrawal symptoms, benzodiazepines
should not be abruptly stopped. This
medication can cause drowsiness, and the
client should not drive or operate heavy
machinery until the effects of the medication
are known. Prescriptions should not be shared
with others.
Analysis
Evaluation
Physiological Integrity
Learning Objective 5.4
Answers: a, c, e
Rationale:
• Call your primary health care provider
immediately if you get a sore throat, high
fever, or rash. Antipsychotic medications
can cause agranulocytosis, and the client can
be overwhelmed by infection if
agranulocytosis is not detected early.
• Limit your exposure to direct sunlight and
wear sunscreen and protective clothing
outdoors. Photosensitivity can be a
medication side effect and can be prevented
by protecting the skin from sun exposure.
• Rise slowly from a sitting or lying
position. Orthostatic hypotension is a side
effect that can lead to falls if the client rises
too fast from a sitting or lying position to a
standing posture.

5.6 The client with chronic schizophrenia asks
if the client’s spouse could be included in the
medication teaching. Which of the following
nursing responses is therapeutic for the client?
a. “I’m wondering why you think that you
cannot handle this medication by yourself.”
b. “You are the client; it would be better for
you to learn about your medications by
yourself.”
c. “Perhaps if you were not so dependent on
your spouse, you would not have had this
relapse.”
d. “Yes, it is often helpful for family members
to be knowledgeable about medications.”
• Quit taking the medications when the
hallucinations are gone for 1 month. The
client should not stop taking the medications
as medications are often continued to
prevent relapse.
• Double the dose if it becomes too difficult
to cope with the hallucinations. Never take
more of a medication without first
consulting the prescriber.
Analysis
Implementation
Physiological Integrity
Learning Objective 5.5
Answer: d
Rationale: Family members can be supportive
allies in the long-term treatment of family
members. It is important for the nurse to
include family members in the medication
education. The other choices put unrealistic
expectations on the client and are judgmental
of the client’s desire to include the spouse.
Application
Implementation
Psychosocial Integrity
Learning Objective 5.6
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