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ATI RN MENTAL HEALTH AND PSYCHIATRIC NURSING TEST BANK WITH ANSWERS & RATIONALE / ATI RN MENTAL HEALTH AND PSYCHIATRIC NURSING
COMPREHENSIVE MENTAL HEALTH AND PSYCHIATRIC NURSING 2023/2024 NEW UPDATE GRADED A+ATI RN MENTAL HEALTH AND PSYCHIATRIC NURSING TEST BANK WITH ANSWERS & RATIONALE / ATI RN ...
ATI RN MENTAL HEALTH AND PSYCHIATRIC
NURSING TEST BANK WITH ANSWERS &
RATIONALE / ATI RN MENTAL HEALTH AND
PSYCHIATRIC NURSING
COMPREHENSIVE MENTAL HEALTH AND
PSYCHIATRIC NURSING 2023/2024 NEW UPDATE
GRADED A+
1. Tristan is on Lithium and has suffered from diarrhea and vomiting. What should the nurse
in- charge do first:
A. Recognize this as a drug interaction.
B. Give the client Cogentin.
C. Reassure the client that these are common side effects of lithium therapy.
D. Hold the next dose and obtain an order for a stat serum lithium level.
Correct Answer: D. Hold the next dose and obtain an order for a stat serum lithium level
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should
be withheld and a test is done to validate the observation. Monitoring of therapeutic levels
includes trough plasma levels drawn 8 to 12 hours after the last dose. The therapeutic range is
1.0 to 1.5 mEq/L for acute treatment and 0.6 to 1.2 mEq/L for chronic therapy. Monitoring
should be done every 1 to 2 weeks until reaching the desired therapeutic levels. Then, check
lithium levels every 2 to 3 months for six months. It is also important to monitor patients for
dehydration and lower the dose when there are signs of infection, excessive sweating, or
diarrhea. Toxic levels are when the drug level is more than 2
mEq/L.
Option A: The manifestations are not due to drug interaction. Lithium has a very narrow
therapeutic index, and toxic levels are when the drug is above 2 mEq/L, which is very close to
its therapeutic range. Lithium toxicity can cause interstitial nephritis, arrhythmia, sick sinus
,syndrome, hypotension, T wave abnormalities, and bradycardia. Rarely, toxicity can cause
pseudotumor cerebri and seizures. Lithium toxicity has no antidote.
Option B: Cogentin is used to manage the extrapyramidal symptom side effects of
antipsychotics. Benztropine is used to treat symptoms of Parkinson’s disease or involuntary
movements due to the side effects of certain psychiatric drugs (antipsychotics such as
chlorpromazine/haloperidol). Benztropine belongs to a class of medication called
anticholinergics that work by blocking a certain natural substance (acetylcholine). This helps
decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking
ability in people with Parkinson’s disease.
Option C: The common side effects of Lithium are fine hand tremors, nausea, polyuria, and
polydipsia. Lithium can cause several adverse effects. Typically the side effects are dose-
related. Treatment for lithium toxicity is primarily hydration and to stop the drug. Give
hydration with normal saline, which will also enhance lithium excretion. Avoid all diuretics.
If the patient has severe renal dysfunction or failure, or severely altered mental status, then
start with hemodialysis. 20 to 30 mg of propranolol given 2 to 3 times per day may help
reduce tremors.
2. What herbal medication for depression, widely used in Europe, is now being prescribed in
the United States?
A. Ginkgo biloba
B. Echinacea
C. St. John's wort
D. Ephedra
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to prescription
antidepressants. St. John’s Wort (Hypericum perforatum) is commonly used to treat mild-to-
moderate depression. Several bioactive compounds have been identified in St. John’s Wort
that work synergistically to provide its antidepressant and anti-inflammatory attributes. St.
,John’s Wort was more efficacious than standard antidepressant therapy in patients with mild-
to-moderate depression.
Option A: Ginkgo biloba is prescribed to enhance mental acuity. Ginkgo biloba is commonly
used to improve memory and cognition in the elderly suffering from impaired cerebral
circulation.
Mitochondrial dysfunction is one theory proposed as the leading cause of cognitive decline.
The two main components in Gingko biloba leaves are flavonoids and terpenes tri lactones.
Together, these compounds enhance and protect mitochondrial function and scavenge reactive
molecules like hydroxyl and peroxyl radicals, nitric oxide, and superoxide ions.
Option B: Echinacea has immune-stimulating properties. Echinacea is known as an
immunostimulant, boosting both innate and specific immunity. It has also demonstrated anti-
viral, anti-inflammatory, and antimicrobial effects. Intracellular bactericidal activity and
enhanced phagocytosis were also observed. A randomized, double-blind study of 473 patients
virologically confirmed with influenza infection, showed Echinacea was as effective as
oseltamivir with fewer adverse events and reduced risk.
Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine. Ephedra is a
medicinal preparation from the plant Ephedra sinica. Several additional species belonging to
the genus Ephedra have traditionally been used for a variety of medicinal purposes, and are a
possible candidate for the Soma plant of Indo-Iranian religion.
3. A male client recently admitted to the hospital with sharp, substernal chest pain suddenly
complains of palpitations. Nurse Ryan notes a rise in the client’s arterial blood pressure and a
heart rate of 144 beats/minute. On further questioning, the client admits to having used
cocaine recently after previously denying use of the drug. The nurse concludes that the client
is at high risk for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder
Correct Answer: A. Coronary artery spasm
, Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial
infarction, dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death.
Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an excess of
these neurotransmitters at postsynaptic receptor sites. Cocaine and its metabolites may cause
arterial vasoconstriction hours after use. Epicardial coronary arteries are especially vulnerable
to these effects, leading to a decreased myocardial oxygen supply.
Option B: Consequently, the drug is more likely to cause tachyarrhythmias than
bradyarrhythmias. Cocaine-induced central sympathetic stimulation and direct cardiac effects
may lead to tachycardia, hypertension, and coronary or cerebral artery vasoconstriction
leading to myocardial infarction and stroke.
Option C: Although neurobehavioral deficits are common in neonates born to cocaine users,
they are rare in adults. CNS reactions may be more excitatory than depressant. In its mild
form, the patient may display anxiety, restlessness, and excitement. Full-body tonic-clonic
seizures may result from moderate to severe CNS stimulation. These seizures are often
followed by CNS depression, with death resulting from respiratory failure and/or
asphyxiation if concomitant emesis is present.
Option D: As craving for the drug increases, a person who’s addicted to cocaine typically
experiences euphoria followed by depression, not panic disorder. Cardiovascular toxicity and
agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic
outflow. However, there is a risk of over-sedation and respiratory depression with escalating
and numerous doses of benzodiazepines, which is often necessary. Non-dihydropyridine
calcium channel blockers such as diltiazem and verapamil have shown the ability to reduce
hypertension reliably, but not tachycardia.
4. A male client is hospitalized with fractures of the right femur and right humerus sustained
in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident.
Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to
drinking heavily for years. During hospitalization, the client periodically complains of
tingling and numbness in the hands and feet. Nurse Gian realizes that these symptoms
probably result from:
A. Acetate accumulation
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