ATI TEST - mental health nursing PDF

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Neuro CH 11,13,14,15,16,17,19,20,21 Pharm for Nurses Book and ATI CH 7-16 CH 11 Pharm for Nurses Book 1. Following a surgical procedure, the client states that he does not want to take narcotic analgesics for pain because he is afraid he will become addicted to the drug. What is the best response by the nurse to the client’s concerns? a. 1. Dependence on narcotics is common among postoperative clients but can be managed successfully. b. 2. Addiction to prescription drugs is rare when used as prescribed and according to medical protocol such as for pain control. c. 3. Female patients are more likely to become addicted. d. 4. Addiction is rare if the patient has a high pain threshold. Rationale: Prescription drugs rarely cause addiction when used according to accepted medical protocols. Options 1, 3, and 4 are incorrect. Postoperative clients or females are not more likely to become addicted than other clients. A client’s pain threshold does not determine the potential for addiction. The risk of addiction for prescription medications is primarily a function of the dose and the length of therapy.. 2. The client states that she has been increasing the amount and frequency of the antianxiety drug she is using because “it just isn’t working like it did before.” What effect does this indicate? a. 1. Immunity b. 2. Resistance c. 3. Tolerance d. 4. Addiction Rationale: Tolerance is a biologic condition that occurs when the body adapts to a substance after repeated administration. Over time, higher doses of the drug are required to produce the same initial effect. Options 1, 2, and 4 are incorrect. Immunity is related to the response of the body’s immune system and not to drug response. Resistance is a concept most often applied to antibiotic drugs, and the term addiction is used to describe an overwhelming compulsion that drives someone to take drugs repetitively, despite serious health and social consequences. 3. A 17-year-old confides to the nurse that he smokes marijuana but that “it isn’t as bad as tobacco cigarettes; it’s not addicting like nicotine!” Which statement would be an appropriate response by the nurse? a. 1. While marijuana may not be addicting in the same way that nicotine is, it damages lung tissue and may cause breathing problems and cancer. b. 2. Marijuana is not approved for any use except under highly regulated conditions. c. 3. Marijuana is four times as addicting as nicotine. d. 4. The effects of marijuana are much more prolonged than nicotine because it stays in the body longer.

Rationale: Marijuana does not appear to cause physical dependence or tolerance but because it is inhaled deeper and held in the lungs for a longer length of time, it may damage lung tissue and promote cancer. Options 2, 3, and 4 are incorrect. Marijuana is a controlled substance; however, because this teen is using the drug, stating this fact may have little influence on his use. Marijuana has not been shown to be more addicting than nicotine. And while metabolites of marijuana remain in the body for prolonged periods, the effects may not remain. This statement may be considered a desirable reason to continue using the drug. 4. The client with a history of alcohol abuse is admitted to the hospital. The nursing care plan includes assessment for symptoms of alcohol withdrawal. What symptoms will the nurse observe for? (Select all that apply.) a. 1. Confusion b. 2. Violent yawning c. 3. Tremors d. 4. Constricted pupils e. Hallucinations Rationale: Clients who are experiencing alcohol withdrawal typically experience tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, and delirium. Options 2 and 4 are incorrect. Violent yawning is a symptom of heroin withdrawal and constricted pupils is a sign of opioid toxicity 5. The client states that she is going to quit smoking “cold turkey.” The nurse teaches the client to expect which of the following symptoms during withdrawal from nicotine? (Select all that apply.) a. 1. Headaches and insomnia b. 2. Increased appetite c. 3. Tremors d. 4. Insomnia e. 5. Increased heart rate and blood pressure Rationale: Symptoms of nicotine withdrawal include irritability, anxiety, restlessness, headaches, increased appetite, insomnia, inability to concentrate, and a decrease in heart rate and blood pressure. Options 3 and 5 are incorrect. Nicotine withdrawal is not known to cause tremors or an increase in heart rate or blood pressure. If these occur, the nurse should evaluate for another possible causative factor. 6. What is the difference between physical and psychological dependence? a. 1. Physical dependence is the adaptation of the body to a substance over time such that when the substance is withdrawn, withdrawal symptoms will result. Psychological dependence is the overwhelming desire to continue using a substance after it is stopped or withdrawn but without physical withdrawal symptoms occurring. b. 2. Physical and psychological dependence are terms that are used interchangeably. In both cases, physical withdrawal symptoms will result if the substance is withdrawn from use.

c. 3. They occur together: psychological dependence is the first type of dependence to occur with a substance, followed by physical dependence. d. 4. Psychological dependence develops when the brain adapts over time to the use of the substance. Physical dependence is the active seeking of a substance associated with a desire to continue using the substance. Rationale: Physical dependence and psychological dependence may occur together and result in drug-seeking behavior. But physical dependence occurs as the body adapts to the substance such that withdrawal symptoms will occur if the substance is stopped. Physical withdrawal symptoms do not occur with psychological dependence although an intense craving for the substance may be felt. Options 2, 3, and 4 are incorrect. Physical and psychological dependence are not interchangeable terms and one does not always lead to the other. Psychological dependence is a term associated with the desire to continue using the drug, not the term physical dependence.

CH 13 Pharm for Nurses Book 1. Following administration of phenylephrine (NeoSynephrine), the nurse would assess for which of the following adverse drug effects? a. 1. Insomnia, nervousness, and hypertension b. 2. Nausea, vomiting, and hypotension c. 3. Dry mouth, drowsiness, and dyspnea d. 4. Increased bronchial secretions, hypotension, and bradycardia Rationale: Adrenergic agonists such as phenylephrine (NeoSynephrine) stimulate the sympathetic nervous system and produce symptoms including insomnia, nervousness, and hypertension. Options 2, 3, and 4 are incorrect. Nausea, vomiting, and drowsiness are common adverse effects to many drugs and are not adverse effects known to occur with adrenergic agonists. Hypotension and bradycardia are potential adverse reactions related to the use of adrenergic antagonists. Dry mouth may occur from anticholinergics and increased bronchial secretions are an effect of cholinergic agents. Dyspnea is not an adverse reaction related to adrenergic agonists and adrenergics may be ordered for bronchodilation properties. 2.

2. Anticholinergics may be ordered for which of the following conditions? (Select all that apply.) a. 1. Peptic ulcer disease b. 2. Bradycardia c. 3. Decreased sexual function d. 4. Irritable bowel syndrome e. 5. Urine retention Rationale: Anticholinergics are used in the treatment of peptic ulcer disease, irritable bowel syndrome, and bradycardia because they suppress the effects of acetylcholine and stimulate the sympathetic nervous system. Options 3 and 5 are incorrect.

Anticholinergics may cause decreased sexual function because the parasympathetic impulses are blocked. Urine retention is a potential adverse effect of anticholinergics. 3. 3. Propranolol (Inderal) has been ordered for a client with hypertension. Because of adverse effects related to this drug, the nurse would carefully monitor for which adverse effect? a. 1. Bronchodilation b. 2. Tachycardia c. 3. Edema d. 4. Bradycardia Rationale: Because beta-adrenergic blockers such as propranolol (Inderal) slow electrical conduction through the cardiac conduction system, they may cause bradycardia. Options 1, 2, and 3 are incorrect. Bronchodilation, tachycardia, and edema are not adverse effects associated with betaadrenergic blockers. 4. 4. Older adult clients taking bethanechol (Urecholine) need to be assessed more frequently because of which of the following adverse effects? a. 1. Tachycardia b. 2. Hypertension c. 3. Dizziness d. 4. Urinary retention Rationale: The nurse should monitor older adult clients for episodes of dizziness caused by CNS stimulation from the parasympathomimetic system. Options 1, 2, and 4 are incorrect. Bethanechol does not cause tachycardia or hypertension and is used to treat nonobstructive urinary retention. 5. 5. The client taking benztropine (Cogentin) should be provided education on methods to manage which common adverse effect? a. 1. Heartburn b. 2. Constipation c. 3. Hypothermia d. 4. Increased gastric motility Rationale: Anticholinergic medications such as benztropine (Cogentin) slow intestinal motility; therefore, constipation is a potential side effect. Clients should be taught methods to manage constipation such as increasing fluids and fiber in the diet. Options 1, 3, and 4 are incorrect. Heartburn and hypothermia are not associated with the use of benztropine. 6. 6. The client or family of a client taking tacrine (Cognex) should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred? a. 1. Excessive sweating, salivation, and drooling b. 2. Extreme constipation

c. 3. Hypertension and tachycardia d. 4. Excessively dry eyes and reddened sclera Rationale: Overdosage of parasympathomimetics (cholinesterase-inhibitors) such as tacrine (Cognex) may produce excessive sweating, drooling, dyspnea, or excessive fatigue. These symptoms should be promptly reported. Options 2, 3, and 4 are incorrect. Diarrhea is an adverse effect associated with parasympathomimetics (cholinesteraseinhibitors), not constipation. Hypertension, tachycardia, dry eyes, or reddened sclera are not associated with these drugs.

CH 14 Pharm for Nurses Book 1. 1. The nurse should assess a client who is taking lorazepam (Ativan) for the development of which of these adverse effects? a. 1. Tachypnea b. 2. Astigmatism c. 3. Ataxia d. 4. Euphoria Rationale: Adverse CNS effects for lorazepam (Ativan) include ataxia, amnesia, weakness, disorientation, blurred vision, diplopia, nausea, and vomiting. Options 1, 2, and 4 are incorrect. Lorazepam is not known to cause tachycardia, astigmatism, or euphoria. If these symptoms occur, the client should be assessed for other causative factors. 2. A client is receiving temazepam (Restoril). Which of these responses should a nurse expect the client to have if the medication is achieving the desired effect? a. 1. The client sleeps in 3-hour intervals, awakens for a short time, and then falls back to sleep. b. 2. The client reports feeling less anxiety during activities of daily living. c. 3. The client reports having fewer episodes of panic attacks when stressed. d. 4. The client reports sleeping 7 hours without awakening. Rationale: Temazepam (Restoril) is a benzodiazepine ordered for insomnia. Therefore, the client should be experiencing relief from insomnia and reporting feeling rested when awakening. Options 1, 2, and 3 are incorrect. Sleeping 3 hours or less would indicate less than therapeutic effects. Whereas some benzodiazepines are used in the treatment of anxiety or panic disorders, temazepam’s primary use is in the treatment of insomnia 3. A 32-year-old female client has been taking lorazepam (Ativan) for her anxiety and is brought into the emergency department after taking 30 days’ worth at one time. What antagonist for benzodiazepines may be used in this case? a. 1. Epinephrine b. 2. Atropine c. 3. Flumazenil d. 4. Naloxone

Rationale: The competitive antagonist drug used in cases of benzodiazepine overdosage is flumazenil (Romazicon). Options 1, 2, and 4 are incorrect. Epinephrine, an adrenergic agonist is not an antagonist to the benzodiazepines. Atropine is an anticholinergic and naloxone is a competitive antagonist to opioid (narcotic) drugs. 4. A 17-year-old client has been prescribed escitalopram (Lexapro) for increasing anxiety uncontrolled by other treatment measures. Because of this client’s age, the nurse will ensure that the client and parents are taught what important information? a. 1. Cigarette smoking will counteract the effects of the drug. b. 2. Signs of increasing depression or thoughts of suicide should be reported immediately. c. 3. The drug causes dizziness and alternative schooling arrangements may be needed for the first two months of use. d. 4. Anxiety and excitability may increase during the first two weeks of use but then will have significant improvement. Rationale: Escitalopram (Lexapro) is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. The drug carries a black box warning of increased risk of suicidal thinking and behavior in children, adolescents, and young adults. Signs of increasing depression or suicidal thoughts should be reported immediately. Options 1, 3, and 4 are incorrect. Smoking has no direct effects on escitalopram. Although dizziness may occur, it should not be significant enough to warrant a change in schooling needs. Escitalopram should not cause increased anxiety or excitability in the first few weeks of use and other causes should be investigated should these occur. 5. 5. Zolpidem (Ambien) has been ordered for a client for the treatment of insomnia. What information will the nurse provide for this client? (Select all that apply.) a. 1. Be cautious when performing morning activities because it may cause a significant “hangover” effect with drowsiness and dizziness. b. 2. Take the drug with food; this enhances the absorption for quicker effects. c. 3. Take the drug immediately before going to bed; it has a quick onset of action. d. 4. If the insomnia is long-lasting, this drug may safely be used for up to one year. e. 5. Alcohol and other drugs that cause CNS depression (e.g., antihistamines) should be avoided while taking this drug. Rationale: Zolpidem (Ambien) has a rapid onset, approximately 7 to 27 minutes, and should be taken immediately before going to bed. It should not be taken with alcohol or other drugs that cause CNS depression because of increased sedation and CNS depression. Options 1, 2, and 4 are incorrect. Taking the drug with food will significantly impair its absorption and the onset of action may be delayed. Zolpidem has a duration of action of approximately 6 to 8 hours. Depending on when the drug is taken the night before, significant “hangover” effects such as sedation are not as likely to occur as with other drugs in the category. The drug is approved for short-term treatment of insomnia only

6. Education given to clients about the use of all drugs to treat insomnia should include an emphasis on what important issue? a. 1. They will be required long-term to achieve lasting effects. b. 2. They require frequent blood counts to avoid adverse effects. c. 3. They are among the safest drugs available and have few adverse effects. d. 4. Long-term use may increase the risk of adverse effects, create a “sleep debt,” and cause rebound insomnia when stopped. Rationale: Long-term use of drugs to treat insomnia is not recommended. They have significant adverse effects, may cause a “sleep debt” due to effects on the sleep cycle, and may cause rebound insomnia when discontinued. Options 1, 2, and 3 are incorrect. Many of the drugs used for insomnia have significant adverse effects and are not used long term. Whereas some drugs in the category may require concurrent blood counts, this is not required for all drugs in the category

CH 15 Pharm for Nurses Book 1. An 8-year-old boy is evaluated and diagnosed with absence seizures. He is started on ethosuximide (Zarontin). Which information should the nurse provide the parents? a. 1. After-school sports activities will need to be stopped because they will increase the risk of seizures. b. 2. Monitor height and weight to assess that growth is progressing normally. c. 3. Fractures may occur, so increase the amount of vitamin D and calcium-rich foods in the diet. d. 4. Avoid dehydration with activities and increase fluid intake. Rationale: Because adverse drug effects such as nausea, anorexia, or abdominal pain may occur with ethosuximide (Zarontin), the parents should monitor the child’s height and weight to assess whether nutritional intake is sufficient for normal growth and development. Options 1, 3, and 4 are incorrect. Physical activity does not increase the risk of seizure activity or need to be curtailed, and the drug does not affect bone growth or require extra vitamin D or calcium in the diet. Dehydration is a condition to be avoided in all clients, although increasing fluid intake is not necessary related to the use of ethosuximide. 2.

2. The nurse is providing education for a 12-year-old client with partial seizures currently prescribed valproic acid (Depakene). The nurse will teach the client and the parents to immediately report which symptom? a. 1. Increasing or severe abdominal pain b. 2. Decreased or foul taste in the mouth c. 3. Pruritus and dry skin d. 4. Bone and joint pain Rationale: Valproic acid may cause a life-threatening pancreatitis and any severe or increasing abdominal pain should be reported immediately. Options 2, 3, and 4 are

incorrect. The drug is not known to cause dysgeusia (altered sense of taste) or effects on bones or joints. Although pruritus is an adverse effect associated with valproic acid, it may be managed with simple therapies, and unless it progresses to a more serious rash, it does not need to be reported immediately. 3. 3. The nurse is caring for a 72-year-old client taking gabapentin (Neurontin) for a seizure disorder. Because of this client’s age, the nurse would establish which nursing diagnosis related to the drug’s common adverse effects? a. 1. Risk for Deficient Fluid Volume b. 2. Risk for Impaired Verbal Communication c. 3. Risk for Constipation d. 4. Risk for Falls Rationale: Common adverse effects to gabapentin (Neurontin) include CNS depression including dizziness and drowsiness. Because of this client’s age, these effects may increase the risk of falls. Options 1, 2, and 3 are incorrect. The drug is not known to cause dehydration (fluid volume deficit) or constipation or impair the ability to communicate. 4. 4. A client has been taking phenytoin (Dilantin) for control of generalized seizures, tonic–clonic type. The client is admitted to the medical unit with symptoms of nystagmus, confusion, and ataxia. What change in the phenytoin dosage does the nurse anticipate will be made based on these symptoms? a. 1. The dosage will be increased. b. 2. The dosage will be decreased. c. 3. The dosage will remain unchanged; these are symptoms unrelated to the phenytoin. d. 4. The dosage will remain unchanged but an additional antiseizure medication may be added. Rationale: Nystagmus, confusion, and ataxia may occur with phenytoin, particularly with higher dosages. The dosage is likely to be decreased. Options 1, 3, and 4 are incorrect. The dosage would not remain the same or be increased because these are adverse effects of phenytoin that are related to overdosage. 5. 5. Teaching for a client receiving carbamazepine (Tegretol) should include instructions that the client should immediately report which symptom? a. 1. Leg cramping b. 2. Blurred vision c. 3. Lethargy d. 4. Blister-like rash Rationale: Carbamazepine (Tegretol) is associated with Stevens–Johnson Syndrome (SJS) and exfoliative dermatitis. A blister-like skin rash may indicate that these conditions are developing. Options 1, 2, and 3 are incorrect. Blurred vision, leg cramping, and

drowsiness or lethargy are adverse effects of carbamazepine but do not require immediate reporting and may diminish over time 6. 6. Which of the following medications may be us...