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MH CH 13 part 2

rename
wipimebe's version from 2015-10-06 21:49

Section

21. Neuroleptic medication accomplishes which of the following?

 

a. cures schizophrenia
b. controls positive symptoms of schizophrenia
c. totally eliminates negative symptoms of schizophrenia
d. returns the client to the workplace

 

22. A client newly diagnosed with schizophrenia has been receiving a neuroleptic medication since yesterday. This client comes to the nurse with her head down and turned to one side. This clientÕs tongue is fixed and protruding, and she is very upset. The nurse knows that this clientÕs dystonia is:

 

a. rarely dangerous and can be ignored until the client is choking
b. a side effect of medication that will likely respond to other drugs
c. not a side effect of neuroleptics
d. likely to bring a risk of airway obstruction

 

ANS: B
The most readily treated side effect of antipsychotic medications is dystonia. Clients may present with the head drawn forcefully to one side, with spasms of the mouth muscles, or with fixed tongue protrusion. Dystonic reactions typically occur within a few hours or days of starting an antipsychotic medications. It is generally treated with diphenhydramine (Benadryl) or other anticholinergic medications.

 

23. Clozapine, an atypical neuroleptic, differs from the traditionally used neuroleptics because it is:

 

a. more effective with some populations than are older classic neuroleptic drugs
b. free of nearly every side effect and needs less daily monitoring
c. associated with fewer movement disorders
d. used with relative safety

 

ANS: A
Clozapine differs from the traditional neuroleptics because it is more effective with some populations than are the older classic neuroleptic drugs. Clozapine is a second-generation antipsychotic medication and addresses both the negative and positive symptoms of schizophrenia. However, clozapine occasionally and unpredictably causes severe agranulocytosis (reduction in the number of white blood cells).

 

24. Which of the following problems is MOST often associated with taking clozapine?

 

a. constipation
b. retrolental fibroplasia
c. agranulocytosis
d. proliferation of macrophages

 

ANS: C
Agranulocytosis is a problem associated with taking clozapine. Some clients experience a reduction in their white blood cell count requiring that the medication be discontinued.

 

25. You are working with a client who is taking a neuroleptic medication that has recently been changed and increased. You notice that the client has a high fever (104 degrees Fahrenheit), is confused, and has extreme muscle rigidity. You would do which of the following?

 

a. Suspect that the client has an infectious process, and call the health care provider, expecting an order for an antibiotic.
b. Call an ambulance immediately, notify the health care provider, and prepare for seizure control and cardiopulmonary resuscitation (CPR).
c. Suspect neuroleptic malignant syndrome, hold the neuroleptic medication, and call the health care provider.
d. Give the neuroleptic on time as ordered, call the health care provider to report the symptoms, and see if additional medication is needed.

 

ANS: C
The high fever, confusion, and muscle rigiditt is an indication that the client is experiencing neuroleptic malignant syndrome. The nurse should hold the medication and call the health care provider immediately. Neuroleptic malignant syndrome is the rarest side effect. If left untreated, it may rapidly lead to death.

 

26. A nurse is working with a client who is prescribed a second-generation neuroleptic medication and gains 40 pounds. The nurse knows that this weight gain may be a factor in the:

 

a. exacerbation of sleep apnea commonly observed with long-term use of these drugs
b. occurrence of obsessive-compulsive symptoms with long-term use of these drugs
c. lack of improvement in ÒnegativeÓ symptoms, even after long-term use of these drugs
d. development of diabetes that sometimes accompanies long-term use of these drugs

 

ANS: D
Weight gain is common with second-generation drugs, and gains of 40 pounds are not unusual. It is perhaps because of this weight gain that diabetes sometimes accompanies long-term use of the second-generation medications, and diabetic ketoacidosis has been reported in some patients.

 

27. Studies are currently underway to determine mortality risk of ziprasidone. Findings indicate that ziprasidone has additional mortality risk related to which of the following?

 

a. slightly prolonging the cardiac QT interval, increasing susceptibility to arrhythmias
b. exacerbation of the sleep apnea commonly observed with long-term use of these drugs
c. lack of improvement in ÒnegativeÓ symptoms, even after long-term use of these drugs
d. development of diabetes that sometimes accompanies long-term use of these drugs

 

ANS: A
Studies are currently underway to determine if ziprasidone may have additional mortality risk because of its tendency to slightly prolong the cardiac QT interval. This could possibly increase the clientÕs susceptibility to dangerous arrhythmias. The other options are not specific to the studies regarding ziprasidone.

 

28. Which of the following is a major impediment to successfully treating schizophrenia?

 

a. The difficulty of diagnosing schizophrenia in the earliest stages delays the onset of treatment.
b. The currently available antipsychotic medications are not particularly effective.
c. For treatment to be effective, it requires lengthy hospitalizations.
d. Most families resist having a family member diagnosed with schizophrenia.

 

ANS: A
The difficulty of diagnosing schizophrenia in the earliest stages delays the onset of treatment. Client symptoms may be ignored and labeled as eccentric behavior. In addition, there are numerous myths regarding schizophrenia that must be addressed through educational programs.

 

29. Among clients with schizophrenia, suicide:

 

a. is a minor risk
b. indicates that the client was incorrectly diagnosed
c. is more likely to occur when positive symptoms are improving
d. never takes place unless the client is also depressed

 

ANS: C
Suicide is a major risk among clients with schizophrenia. While depression not infrequently accompanies schizophrenia, suicide may take place in the absence of recognized depression. Suicide is more likely to occur when positive symptoms are improving.

 

30. A recent research study by Beebe (2002) evaluated the effectiveness of a nurse-initiated telephone intervention for persons with schizophrenia newly discharged from a hospital stay. The researchers found that this type of follow-up care:

 

a. interfered with the personÕs adjustment to outpatient follow-up treatment
b. exacerbated symptoms of schizophrenia by allowing the person to describe recent events
c. promoted passive dependence on the professional to initiate and maintain treatment
d. had the potential to reduce stressors and to identify helpful community resources

 

ANS: D
The nurse researchers concluded that telephone intervention has potential to reduce stressors, as it gave the clients a chance to describe recent life events. Telephone interventions also allowed the nurse to identify helpful community resources for the client.

 

31. Which of the following subtypes of schizophrenia may be treated with electroconvulsive shock therapy?

 

a. undifferentiated type
b. catatonic type
c. paranoid type
d. residual type

 

ANS: B
Evidence suggests electroconvulsive therapy to be of value to selective clients in catatonic states, when used in association with antipsychotic medication. However, the benefits are sometimes only short term.

 

32. Based on the nursing theory of modeling and role modeling, the first of five aims of nursing intervention when working with the client with schizophrenia is to promote:

 

a. strengths
b. positive orientation
c. trust
d. perceived control

 

ANS: C
The first of the five aims of intervention that can become the foundation for all work with the client with schizophrenia is to promote trust. The nurse can begin with building trust and work from an established nurse-client relationship to design care aimed at realistic and appropriate goals.

 

33. Which of the following behaviors would MOST likely be a reason for hospitalization for a client living in a group home in the community?

 

a. auditory hallucinations
b. short attention span in group meetings
c. inability to maintain a job
d. verbal threats toward the neighbors

 

ANS: D
The most likely reason for hospitalization for a client living in a group home in the community is if the client made verbal threats toward the neighbors. Involuntary admission to the hospital occurs when the client is harmful to him- or herself (suicidal), harmful to others (homicidal), or unable to care for him- or herself. Auditory hallucinations, short attention span, and the inability to maintain a job are not reasons for hospitalization.

 

34. The nurse listens to a client who spends time describing her delusion about being a great religious leader, because the nurse is assessing for which of the following?

 

a. a clue for what rationale to use in challenging the delusion
b. the effect of the delusion on the clientÕs judgment and responses
c. contents of the delusion that are real and need to be accepted
d. the clientÕs beliefs about God

 

ANS: B
When the nurse listens to a client describing delusions of being a great religious leader, the nurse is assessing the effect of the delusion on the clientÕs judgment and responses. The clientÕs statement is an example of a delusion of grandeur. The nurse recognizes that delusions are false fixed ideas and therefore the contents are untrue and should not be accepted. The nurse would not challenge the delusion and recognize that it includes excess religiosity, which is characteristic of schizophrenia.