A 62-years-old client comes to the neighborhood health center for his annual physical examination.
1. While interacting with the nurse,the client states that he feels tired all of the time, has trouble sleeping and has problem in thinking. The best nursing action is to;
a.Inform the client about the normal aging process.
b.Further assess the client's mental status and mental history.
c.Refer the client to a senior citizen'support group.
d.Advice the client to discontinue day time napping.
(The correct answer is b, The client is exhibiting signs of possible depression. The nurse should explore his medical history and conduct a mental status examination to further assess and explore his possibility. He is not exhibiting sign and symptoms of the normal aging process. Referral to a senior citizen'support group may be will appropriate later,depending on the client's need and interest. Day time napping should be discouraged if it interrupt night time sleeping).
2. During the nurse's conversation with the client, the client sates,'I have no reason to be sad. I have a great Job and a wonderful wife and family', which of the following comments would be best for the nurse to make at this time?
a.'why do you think you are depressed?'
b.'Think about how fortunate you are'
c.'You have many positive qualifies'
d.'Depression can be caused by chemical imbalance in the brain'
(The correct answer is d, The biological theory of depression indicates a neurotransmitter imbalance involving serotonin, norepinephrine and possibly dopamine. Endogenous depression (depression coming from within the person) is biochemical in nature. Asking the client why he is depressed is non therapeutic because there is no external cause or reason for the client's depression and it will only increase the client's feelings or guilt for not being able to answer the nurse. Telling the client that he is fortunate and has positive qualities is not helpful and will not decrease his sadness or feeling depression because it is biologically based).
3. The client is taking Sertraline (Zoloft) 50 mg q am, The nurse includes which of the following in the teaching plan about Zoloft ?
a..Zolof may cause erectile and ejaculatory dysfunction in some men.
b.It may be 3 to 4 weeks after starting Zoloft before the client feel better.
c.Zoloft cause lightheadedness or dizziness when rising.
d.Zoloft increase the appetite and cause weight gain.
(The correct answer is a,To promote medication compliance and treatment of depression, its important for the male to client to know that zoloft may cause loss of libido, erectile dysfunction and ejaculatory dysfunction. A decrease in dosage can decrease these symptoms. Zoloft typically take 1 to 2 weeks to work before benefits are noted).
4. The nurse meet with the client and his wife to discuss depression and client's medication. Which the following comment by his wife would indicate a correct understanding of her husband's illness and medication?
a.'His depression is almost cured'
b.'he's intelligent and won't need to depend on a pill much longer'.
c.'It's important for him to take his medication so that the depression will not return or get worse.'
d.'It's important to watch for physical dependency of zolof'
(The correct answer is c, Medication compliance is essential to prevent a return of worsening of the symptoms of endogenous depression. Maintaining biochemical balance can occur with medication. Depression is not cured and is not dependent on the client's intelligent to will the illness away. Zolof is not physically
addicting).
The client was admitted to the psychiatric unit yesterday. The nurse observes that his head is bowed in a dejected manner, his facial expression is sad and he is isolates him self in his room.
5. After a few minutes of conversation the client wearily asks the nurse,'why pick me to talk to when there are so many other people here?' which reply the nurse will be best;
a.' I am assign to care for you to day, if you will let me'.
b.'You have a lot of potential and I'd like to help you'.
c.'Why shouldn't I want to talk to you as well as the others'.
d.'You are wondering why I am interested in you and not the others?'.
(The correct answer is d, The nurse is using therapeutic technique of restatement when reiterating the client's comment in the form a question. This technique best help the client to continue conversation with expression of his feeling. Telling the client that the nurse is assigned to care fro him and why is impersonal and implies that the client is being uncooperative. Telling the client that the nurse is there because the client has potential for improvement implies that others client perhaps do not have this potential.
Asking the client a question with the word 'why' challenges approaches is effective as using the technique of restatement).
6. The nurse meets with the client daily. The client stays mostly in his room and speak only when addressed,answering briefly and abruptly while keeping his eyes on the floor. In this tage in their relationship, the nurse focuses on the client's ability to;
a. make decision.
b. relate to other clients.
c. function independently.
d. express him self verbally.
(The correct answer is d, when working with a client who speaks little,answer briefly and look at the floor, the nurse should focus on the simplest type of behavior (ie;behavior requiring the least effort for the client). The relationship described in this item is the orientation phase. When self expression and verbalization are more appropriate goals then decision making,relating to others and functioning independently may be pursued).
7. Which of the following clients behavior would best indicate to the nurse that the relationship with the client is in the working phase;
a. The client attempts to familiarize him self with the nurse.
b. The client makes an effort to describe his problems in detail.
c. The client tries to summarize his progress in the relationship.
d. The client start to challenge the boundaries or outer limits of the relationship.
(The correct answer is b, This nurse-client relationship is most probably in the working phase. The client's effort to describe his problem to the nurse illustrates that the client has gone beyond testing and acquainting himself with a new relationship and is now working on his problems. The relationship is in an orientation phase when the client attempt to familiarize himself with the nurse and challenge boundaries of the relationship. The relationship is in a termination phase when the client summarizes and evaluate his progress).
8. The client is concerned that the information he gives to the nurse remain confidential. which of the following comments would be best for the nurse to make in this situation;
a.'If the information you share with me is important in relation to your care, I'll need to share it with staff'.
b.'We can keep the information just between the two of us if you prefer'
c.'I'll share the information with staff members only with your approval'.
d.'You can decide whether your physician needs this information for your care'
(The correct answer is a, The nurse should make sure that the client understands that the nurse's need to discus information given by the client when, in the nurse's judgement, the information is necessary in relation to his therapy. This is a judgment the client is unable to make with safety. Promising the a client to keep information confidential places the nurse in difficult position. If the client tells the nurse something that the nurse considers vitals information for others in the health team, the nurse would need to break a promise to the client to share the information).
A Client is admitted to the psychiatric unit with complains of sleep disturbance, fatigue and feeling of uselessness also inability to concentrate. The client was let go from her place of employment last month owing to her inability to keep up with the demands of her person.
9. On the day after an interview during which which the client talked at length and tearfully about feeling useless and old, she failed to keep an appointment with the nurse. Which action woluld be best for the nurse to take?
a.Assume that the client had good a reason for not coming nad let her make the next move.
b.Confront the client with her behavior and ask her to explain the reason fro her absence.
c.Seek out the client at the end of of the scheduled interview time and tell her she was missed to day.
d.Arrange for another seasons with the client lather the same day and say nothing about her absence.
The correct answer is c, The responsibility for maintaining a relationship with a client rest with the nurse. If the client missed s scheduled interview, the nurse is assuming responsibility for the relationship by seeking her out at the end of the scheduled interview time and telling her she was missed. To confront the client with her absence and ask her to explain it is non therapeutic and threatening. To arrange another session with the client and to say nothing about the missed appointment does not keep to the terms of the nurse-client contract and offers little help to the client. The nurse makes an assumption with out knowing the facts by thinking that the patient has good reason not for keeping her appointment. The nurse is not assuming responsibility by waiting fro the client to make the next move in this situation).
10. The client speaks in a seemingly sincere manner about her former employer who replaced her with a younger person. 'He was a wonderful boss, He was a most understanding boss I've ever had. It was a privilege to work fro him'. Which of the following defense mechanisms is the client most likely using?
a. Sublimation.
b. Suppression.
c. Repression.
d. Reaction Formation.
(The correct answer is d, Reaction formation is a defense
mechanisms that occurs when a person expresses an attitude or feeling opposite from his unconscious feeling or attitudes. The client compliments her employer when,unconsciously,she most likely does not like him,because he fired her. Sublimation involves directing unacceptable impulses into constructive channels. Suppression is a conscious effort to overcome unacceptable thoughts or desires. Repression is defense mechanisms that occurs when a person excludes or bars painful experiences and thoughts from his or her state of consciousness).
11. The client begins to attend group sessions daily. She explains to the group how she lost her job. Which of the following statements by a group member would be most therapeutic fro the client?.
a. 'Tell us what you did in your job'.
b. 'It must have been very upsetting for you'.
c. 'With you skill, finding another job should be easy'.
d. 'The company must have had some reason for letting you go'.
(The correct answer is b, It is most therapeutic when client in group session help each other explore feelings furthers and when they demonstrate understanding of each others. In this situation, asking the client to describe her work and indicating that the company must have had a reason fro firing her avoid discussing the client's feelings. Suggesting to the client that she will not have trouble finding another job offers false hope without full knowledge of the situation).
12. During an interaction with the nurse, the client states. ' I have nothing to be depressed about.my husband was supported me throughout each of many hospitalizations. He'll probably leave me this time. I'am an awful person and wife. I'm no good. I can't do anything right'. Based on this information the nurse should consider which of the following as an appropriate nursing diagnosis?;
a. Ineffective Individual Coping related to depression, as evidenced by withdrawal.
b. Self Esteem Disturbance related to numerous hospitalization, as evidenced by negative self statement.
c. Dysfunctional Grieving related to imagined loss of husband, as evidenced by negativity.
d. Potential for self-directed violence related to numerous failures, as evidenced by worthlessness.
(The correct answer is b, Negative self statements are directly related to how the client views and feels about her self. The comments reflex a feeling of low self-esteem because of the psychopathology of the illness necessitating or related to her many hospitalizations. Information concerning whether the client is withdrawn or is going to hurt her self is absent. The client only imagines that her husband will leave her because of her view of her self).
13. The client has tearfully described her negative feeling about herself to the nurse during their last three interactions. Which of the following goals would be appropriate for the nurse to include in the care plan at this time? The client will;
a.increase herself-esteem.
b.write her negative feelings in daily journal.
c.verbalize her work related,accomplishments.
d.verbalize three things she like about herself.
(The correct answer is d, Describing and verbalizing feelings are necessary and normal because the client has usually repressed or blocked feelings,which is partly responsible for the client pain. Expressing feelings are a prerequisite before the nurse can intervene in how the client thiks and behaves. Stating a goals like increasing self esteem is too global and non specific . Writing feeling in a journal will not benefit the client since she verbalize them to the nurse).
The Client with depression has been hospitalized for three days on the psychiatric unit. This is second hospitalization during the past year.
14. The physician orders a different drug,tranylcypromine sulfat (parnate), when the client does not respond positively to a tricyclic anti depressant. Which of the following reaction should be cautioned about if her diet includes food containing tyramine?;
a. Hearth block.
b. Grand mal seizure.
c. Respiratory arrest.
d. Hypertensive crisis.
(The correct answer is d, Tranylcypromine sulfate (parnate) is a mono amin oxidase (MAO) inhibitor. A client taking this drug in combination with foods or beverages rich in tyramine is likely to have a hypertensive crisis. The medication should be discontinued and the physician notified if the exhibits symptoms related to an impending hypertensive crisis,such as headaches,diaphoresis,palpitations,pallors,nausea and vomiting and chest pain).
15. While the client is taking tranylcypromine sulfate (Parnate) the nurse would teach her to avoid which food in particular because of its high tyramine content?
a. Nuts.
b. Ages cheeses.
c. Grain cereals.
d. Reconstituted milk.
(The correct answer is b, Ages and strong cheeses are tyramine-rich foods and when ingested in combination with MAO inhibitors can cause a severe hypertensive crisis. Other foods and beverages rich in tyramine include aged meat and other non fresh meat,liver,dried fish, any fermented high protein food, Italian broad beans(pods), green bean pods,wine,bear and ale. In many instances,the following caffeine-containing foods and beverages are also restricted; coffee,tea cocoa,chocolate and caffeine-containing soft drinks).
16. The client obtains permission for a 24 hours pass to go home
. Which of the following suggestions to the family in preparing for the visit indicates the best understanding of the client's needs?;
a. Plan to encourage the client to seek employment outside the home.
b. Limit friend's visits so the client can rest during the day.
c. Schedule a day of interesting activities for the client outside home.
d. Plan to involve the client in usual at home pursuits of the immediate family.
(The correct answer is d, Planning to involve the client in usual at home pursuits of the immediate family is best when the client is to go home for a pass. There are no indications that this client requires extra rest or unusual activities. It is too early and possibly inappropriate for the client to start looking for employment).
17. After a two month hospitalization, the client is preparing for discharge. Which of the following subjects would be most helpful to discuss when preparing to terminate the nurse-client relationship?;
a. The gains that the client has made during therapy.
b. The plans that the client should find the job.
c. The knowledge that the client's daughter is divorcing her husband.
d. The conflicts the client has had with another staff member.
(The correct answer is a, terminating a nurse-client relationship is a weaning process. Subjects such a plans for finding employment,divorce plans of a family member and conflicts during hospitalization do not aid this weaning. Discussing the gains that the client has made during hospitalization does. The content focuses ob gains made in treatment, feelings about termination and saying goodbye. Introducing new material at termination may impede therapeutic termination).;
18. Which client reaction in termination in relationship with the nurse should be considered the most healthy?;
a. A lack of response.
b. A display of anger.
c. An attempt at humor.
d. An expression of grief.
(The correct answer d, Grief is a direct and appropriate response to termination of a positive relationship and indicates acceptance of termination. Anger is healthy when openly expressed but is a less healthy reaction than grief. A lack of
response may be interpreted as indifference, but it represents a profound emotional reaction that the patient is unable to express. Humor may be a defense against feeling of loss).
A Client is admitted involuntary by court order to a psychiatric hospital for 90 days. Document sent with her cite, among other things,that she will not eat because she feels her stomach is missing and her bowel have turned to jelly and that she views this as 'just punishment for my past wickedness and for the evil I've brought on my family'.
19. To be evaluate as being legally commit table, which of the following criteria did the client most likely have to meet?;
a. Presence of psychosis.
b. Tried to harm herself or others.
c. Unable to afford private treatment.
d. Made threatening remarks to friends or relatives.
(The correct answer is b, A client is legally commit table when she tries to harm herself or others).
20. Which of the following right did the client lose by being admitted involuntarily to a psychiatric hospital? The right to;
a. Send and receive mail.
b. vote in national election.
c. make a will or legally binding contract.
d. sign out of the hospital against medical advice.
(The correct answer is d, A person who has been involuntarily committed to a hospital for mentally ill loses the right to leave the hospital of his own accord. He does not necessarily lose right to vote, make a will or contract or send and receive email).
21. Through which of the following legal methods could the client seek release from the psychiatric hospital if she believe she was being improperly detained?;
a. Malpractice suit.
b. Guardianship hearing.
c. Writ of habeas corpus.
d. Lien of property petition.
(The correct answer is c, A writ of habeas corpus is defined as an order requiring that a prisoner (in this case,the client) be brought before a judge or into court to decide whether he is being held lawfully. Its purpose is to obtain liberation of a person held without just cause).
22. When the client expresses feelings of unworthiness, how would the nurse best respond?;
a.'you family loves you even if you feel unworthy'
b.'your feelings of being unworthy are just your imagination'
c.'It would be best to try to forget the idea that you are unworthy'
d.'as you begin to feel better, your feelings of unworthiness will begin to disappear'
(The correct answer is d, When the client feels unworthiness, she reflect low self-esteem. Presenting another set of facts in manner that is accepting of the client but avoids a power struggles is necessary. Telling the client that her feeling are imaginary, that her
family still loves her,and that she should try to forget ideas of unworthiness disregard her feelings and may be perceived as rejection).
23. The client has not been eating. After serving the client her tray,which of the following actions by the nurse would be most likely encourage her to eat;
a. Leave the client room with out comment.
b. Sit beside the client and place the fork in her hand.
c. Tell the client that she will not recover unless she eat./
d. Comment on how good the food looks.
(The correct answer is b, Sitting beside the client and placing the fork in her hand are likely to stimulate the depressed client to eat. Sitting with her client also conveys a message of having time for her and of caring. Leaving the client alone, telling to her that she must eat to recover and trying to encourage her by saying the food looks are techniques that are less likely to interest the client in eating).
24. The nurse note that the client becomes restless and incoherent in night. Beside administering a prescribed medication, which of the following actions by the nurse would be most helpful for the client at this time?;
a. Encourage the client to talk about her family.
b. Read the client with the lights turned dawn low.
c. Help the client take a cool shower before retiring.
d. Sit quietly with the client until the medication take effect.
(The correct answer is d, Doing something with or to this client is unlikely to help restlessness and incoherence . It is best to sit quietly with the client until medication take effects. A warm bath may take helpful,but not a cool shower).
25. The client demands to be left alone to die. She states 'If you try to cheat the avenger,you will suffer'. Which of the following possible replies by the nurse would be best;
a. 'I won't let anything harm you'
b. 'It sound like you are trying to frighten me'
c. ' I am not try to cheat any one. What do you mean by that?'
d. 'I'll leave you alone for 15 minutes. Then will be back to see how you're doing'.
(The correct answer is d, When this client want to left alone to die, it is best to leave the client for a few minutes , then return to see how the client is getting along. This response acknowledges the client's request and also let the client know that the nurse will be back shortly. It respond to reality . Telling the client that the nurse will not allow anything to hurt the client and then the may be trying to frighten the nurse all are responding to delusional material).
A. Client is being admitted to the psychiatric unit. She responds to some nurse's question with one word answers. Her eyes are downcast and her movements are very slow.
26. Later that morning, the nurse approaches the client and asks how she feels about being in the hospital. The client does not respond verbally and continues to gaze at the floor. Which of the following action should take by the nurse first?;
a. Spent time sitting and silence with the client.
b. Leave the client alone and tell her that you will be back later to talk .
c. Introduce another client to her and ask him to join to you.
d. Ask another staff member to include the client in an informal group discussion.
(The correct answer is a, Sitting in silence with the client shows that the nurse accepts the client and cares about her. It also will help the client to get to know the nurse, initiate a feeling of comfort with the nurse and lead to development of trust. The nurse would not persist in asking the client's questions or attempt to engage her in conversation because these measures would only overwhelm the client at this time. Leaving the client alone does not promote comfort or trust with the nurse. Telling the client that the nurse will be back to talk later will only burden the client with the nurse's expectation to talk,which the client may not be likely to meet. Including the client in the group discussion will increase her discomfort and anxiety and will not be therapeutic at this time).
27. Which short-term goal should the nurse include in the client's care plan?, the nurse will;
a. Approach the nurse or engage in one to one interaction by the end of the week.
b. Verbally interact with the nurse for 5 minute in week.
c. Problem solve with the nurse in one week.
d. Participate in milieu activities by the end of the week.
(The correct answer is b, The goal of the nurse-client interaction for 5 minutes is realistic one to work toward based on the severity of the client's illness. This implies that the client will have gained some measures of trust in the nurse. Expecting the client to take the initiative to approach the nurse to interact in one week is probably unrealistic. Participating in milieu activities and problem solving are unrealistic goals at this time. The client must be first start talking with the nurse before she tolerate the groups or participate in group activities. The client will feel too anxious and overwhelmed if urged too soon to participate in groups).
28. The nurse observes that the client has bathed, is wearing a clean blouse and slacks and has combed her hair. Which statement by the nurse would be most helpful for the client?;
a. 'You look good to day'.
b. 'I'm glad you're feeling better today'.
c. 'I'm glad you combed your hair to day'.
d. 'I like your blouse and slacks'.
(The correct answer is c, Relating to the client that she combed her hair points out a visible accomplishment to the client and reinforces positive self-care behavior. Telling to the client that she looks good to day implies that the client did not look yesterday. Expressing gladness that the client is feeling better to day may be an erroneous interpretation. The client may feel just as depressed as before. If the nurse compliments the client's blouse and slacks,the client may infer that the nurse did not like the client's clothing before this time).
A Client with recurrent, endogenous depression has been hospitalized on the psychiatric unit for 3 days. He exhibits psychomotor retardation,anhedonia and indecision.
29. Which goal of nursing care should have highest priority if the client demonstrates suicidal tendencies?;
a. Provide for contact between the client and his wife.
b. Use measures to protect the client from harming himself.
c. Reassure the client of his worthiness in gentle manner.
d. Maintain a calm environment in which the client can express his feelings and thoughts.
(The correct answer is b, Whenever the client suicidal, steps must be taken to prevent the client from harming herself. Others goals of care are less important tha being sure the client does not carry out the treat of suicide. All treats of suicide should be taken seriously and proper precautions should be taken to protect the client from self-harm).
30. The nursing assistant approaches the nurse and states,"The client does not know what caused him to be so depressed. He must not want to tell me because he doesn't trust me yets'. In responding to this staff member, which of the following statements by the nurse would most accurately describe the client's illness?;
a. 'Endogenous depression is biochemical in nature and isn't caused by an outside stressor or problem.Therefore, the client can't tell you why he's depressed because he really doesn't know'.
b. 'Endogenous depression can be caused by various stressors. Perhaps the client is not willing to tell you at this time'.
c. 'Endogenous depression comes from with the person. it's a reaction to loss. You need to give the client more time to identify the cause or loss'.
d. 'Endogenous depression usually derives from past childhood conflicts. It really is not important for the client to remember what happened years ago'.
(The correct answer is a, The cause of endogenous depression is believed to biochemical and not a reaction to a loss. it's cause by an imbalance or decreased of availability of nor epinephrine,serotonin and possibly dopamine, so the client can't identify a specific outside cause or a loss. Reactive depression is reaction to a loss or a stressor. It is wrong to consider that luck of trust or slow thinking are reason why the client will not identify the cause of his depression. Problems and stressor in the client's life are usually present,however and he can discuss the with the staff when he is willing or able).
31. The client's condition improves, but he still remains alone in his room most of the time. Which of the following statements by the nurse would most likely help the client become involved in a unit activity?;
a. "Would you like to go to the movie to day with me?".
b. "I be back at 4 o'clock to take you to the movie?".
c. "I hope you go to the movie this afternoon. It will cheer you up".
d. "You might want to go to the movie in the day room in this afternoon".
(The correct answer is b, A depressed client is often ambivalent; that is, he both want to and does not want to carry out an activity. This client should not be given choice to allow him to say no. His disinterest may not really indicate a wish to be left alone. making an appointment to take a client to a unit acitvity is more helpful than allowing the client to say he does not wish to go or leaving it up to the client to decide on his own).
32. The physician orders imipramine (Tofranil) for the client. The nurse explains purpose the medication for the client. The client asks the nurse, "If I start taking the pills,I'll have to take them rest of my life.won't it?". Which would be the nurse's most accurate and therapeutic reply?".
a. 'Your condition determines the need for continued medication'.
b. 'The medication prescribed is safe and routine'.
c. 'After your symptoms decrease,the need for the medication will be reevaluated'.
d. 'Are you concerned about taking medication?'.
(The correct Answer is c, This response provides the most complete information about both the current and future treatment plans and answer the question asked by the client).
33. Which of the following health status assessments must be completed before the client starts taking imipramine (tofranil)?.
a. Electrocardiogram (ECG).
b. Urine sample for protein.
c. Thyroid scan.
d. Creatinine clearance test.
(The correct answer is a, Because tricyclic anti depressants such as imipramine(Tofranil) cause tachycardia and ECG changes, an ECG should be done before the clients taking the medication. Others side effects include urinary retention,constipation and drowsiness. Imipramine is administered cautiously to clients receiving thyroid medication).
34. One nurse strongly believes that all psychiatric medications is form of chemical mind control. When the client's wife ask about the efficacy of anti depressant medications, which of the following courses of action would be best for this nurse to take?;
a. Give an honest opinion of the treatment.
b. Refer the client's wife to another knowledgeable person for information about the treatment.
c. Explain that there are not enough current statistic about the efficacy of the treatment.
d. Provide a package insert for the wife to read.
(The correct answer is b, When strongly opposed to a type of therapy,the nurse should refer people who's asks about the therapy to another knowledgeable perosn for information. If the nurse gives the client and family and honest opinion,it may cause the client and family to lose confidence in prescribed therapy. It would be dishonest to tell the client and family that the nurse does not know enough about the treatment to be of help. Just providing copy of the package insert is impersonal and likely to be of little help).
35. The nurse develops a medication teaching plan for the client. Which of the following plan components would be least important?;
a. A description of possible side effect
b. An opportunity for the client to express her fears and concerns about the therapy.
c. A description of current research into anti depressant therapy.
d. An explanation of why the first dose of medication is less then a full dose.
(The correct answer is c, A medication teaching plan includes information relevant to the client's care. A description of current research about anti depressant therapy is not essential unless the client is participating in a research protocol).
36. The client has been taking imipramine (Tofranil) is helping her feel less depressed but that she is still experiencing dry mouth. Which statement by the patient would indicate the need for further teaching;
a. ask for a snack of cookies.
b. sleep 12 to 14 hours a night.
c. states that she can feel her stomach getting better.
d. asks to take the medication in the morning.
(The correct answer is a, Improved appetite and improved sleep patterns indicate that the medication is having a therapeutic effect. Over sleeping could indicate over sedation).
37. The client states that Imipramine (Tofranil) is helping her feel less depressed but that she is still experiencing dry mouth. Which statement by the client would indicate the need for further teaching?;
a. 'I have been chewing sugarless gum'.
b. 'I'm sucking on ice chips'.
c. 'I'm drinking a lot of water'.
d. 'I'm sipping water often'.
(The correct answer is c, Dry mouth is common side effect of tricyclic antidepressants. Drinking copious amounts of water does not eliminate this side effect and can be physiologically detrimental,possibly leading to electrolyte imbalance).
A Client with depression has been taking Fluoxetine (Prozac), 20 mg qd at 9 am for 7 days.
38. Wich of the following will be most important to refort to the evening nursing staff?;
a. The client received Tylenol at 2 pm for a headache. He spent most of the day in his room.
b. The client is till depressed. He refused to participate in group to day.
c. The client was weighted this morning;he has lost 4 pounds since admission last week.
d. The client seemed much less depressed to day and participated in a card game for the fisrt time since admission.
(The correct answer is d, The client's lessening depression could indicate that the client has decided to commit suicide. Headache and loss appetite are side effects of medication and are not life-threatening. A full therapeutic effect could take up to 4 week, so a continuance of the depressive sate would be a cause for concern at this time).
39. The nurse visit the client in a group home one week after discharge. He is prescribed Fluoxetine 40 mg qd at 9 am. The client states he is having problems concentrating,feels nervous and has diarrhea. The nurse appraises the client's symptoms to be
a. Important, probably suggesting a decrease in dosage or change to another medication.
b. of no consequence because the client symptoms are side effects of the Prozac.
c. indicative of an exacerbation of the client's depression.
d. unimportant and a method to elicit the nurse's empathy and attention.
(The correct answer is a, Anxiety and diarrhea are side effects of Prozac and may be relieved by a decrease in dosage or may be necessary to change to another SSRI (selective serotonin reuptake inhibitor) or to a different class of antidepressants. The discomfort experience by the client could lead to medication non compliance and dehydration. The client's symptoms alone do not indicate a worsening of depression. Concluding that the client's symptoms are a means to seek attention is a grave error of judgment. Other behaviors or evidence would need to be present for the nurse to reach that conclusion).
Next for The client with bipolar disorder, Manic phase
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