ATI RN Mental Health

The Correct Answer is:

C. A client who has schizophrenia and is taking antipsychotic medication.

Explanation:

Extrapyramidal symptoms (EPS) are a group of movement disorders that are commonly caused by antipsychotic medications, particularly the first-generation (typical) antipsychotics. EPS include symptoms such as tremors, rigidity, bradykinesia, tardive dyskinesia, and akathisia. Since the client with schizophrenia is taking antipsychotic medication, they are at risk for developing these symptoms.

Why the other options are incorrect:

A. An adult client who has type 2 diabetes mellitus and is taking insulin.

Insulin therapy does not cause extrapyramidal symptoms. The primary concern in this case is managing blood sugar levels and preventing complications related to diabetes.

B. A client who is in the third trimester of pregnancy and taking iron supplements.

Iron supplements are typically used to treat anemia during pregnancy, and they do not cause extrapyramidal symptoms. The focus during pregnancy is on ensuring adequate iron intake and monitoring for any pregnancy-related complications.

D. An older adult client who has pancreatitis and is taking enzymes.

Enzyme replacement therapy for pancreatitis does not cause extrapyramidal symptoms. The primary goal is to manage pancreatic enzyme deficiency and alleviate digestive symptoms.

The Correct Answer is:

D. Diazepam

Explanation:

Diazepam, a benzodiazepine, is commonly used to manage acute alcohol withdrawal symptoms. It helps reduce anxiety, agitation, and the risk of seizures associated with alcohol withdrawal. Benzodiazepines like diazepam are considered first-line treatment during the acute withdrawal phase because they can help stabilize the client and prevent serious complications such as delirium tremens and seizures.

Why the other options are incorrect:

A. Naltrexone

Naltrexone is used to help reduce cravings and prevent relapse in people who are in recovery from alcohol use disorder, but it is not used during the acute withdrawal phase. It works by blocking the effects of alcohol and reducing the desire to drink.

B. Acamprosate

Acamprosate is used to help maintain alcohol abstinence after the detoxification and withdrawal phase. It works by reducing the physical and emotional distress that can occur during abstinence but is not used during acute withdrawal.

C. Disulfiram

Disulfiram is used as part of alcohol use disorder treatment to create an unpleasant reaction when alcohol is consumed. It is not used during the withdrawal phase because it is intended for long-term maintenance, not for managing acute withdrawal symptoms.

The Correct Answer is:

B. Forgetfulness gradually progressing to disorientation

Explanation:

In primary dementia, such as Alzheimer's disease, a common early manifestation is forgetfulness, which gradually progresses to more severe cognitive impairments like disorientation. Initially, the client may forget recent events or conversations, but over time, this can evolve into disorientation to time, place, and even identity. This progression typically becomes more noticeable as the disease advances. It is a hallmark feature of dementia and helps in distinguishing it from other conditions.

Why the other options are incorrect:

A. Decreased auditory and visual acuity

While decreased sensory acuity (auditory and visual) can occur in aging individuals, it is not a primary symptom of dementia. Dementia primarily affects cognitive functions such as memory, thinking, and reasoning, rather than sensory perception.

C. Personality traits that are opposite of original traits

In dementia, particularly in its early stages, personality changes may occur, but these changes are more likely to be subtle or manifest as irritability, withdrawal, or emotional instability. The personality traits that develop are generally more consistent with the individual’s pre-dementia behavior, rather than being opposites of their original traits.

D. Decreased display of emotions

While some individuals with dementia may exhibit changes in emotional expression, a decreased display of emotions is not a defining feature of the disease. Emotional changes are more likely to manifest as increased anxiety, agitation, or mood swings rather than a reduction in emotional expression.

The Correct Answer is:

D. Agoraphobia

Explanation:

Agoraphobia is characterized by the fear of being in situations where escape might be difficult or help unavailable, leading to avoidance of places such as open spaces, public places, or being outdoors alone. The client’s fear of leaving her home and being outdoors alone fits the definition of agoraphobia.

Why the other options are incorrect:

A. Mysophobia

Mysophobia is the fear of germs or dirt. It does not match the client's fear of being outdoors alone.

B. Xenophobia

Xenophobia refers to the fear of strangers or foreigners. This does not align with the fear described in the scenario, which is about leaving the home and being outdoors alone.

C. Acrophobia

Acrophobia is the fear of heights. While it involves a specific fear, it does not describe the generalized fear of being outside or away from home, as seen in agoraphobia.

The Correct Answer is:

A. "You should avoid driving when taking St. John's wort because it can cause drowsiness."

Explanation:

St. John's wort is a common herbal supplement used for depression. It can cause drowsiness or fatigue in some people, so it's important for clients to be cautious when engaging in activities like driving or operating heavy machinery. The sedative effect might be subtle, but it's essential to be aware of how the supplement affects them personally.

Why the other options are incorrect:

B. "St. John's wort may cause gastrointestinal irritation."

While gastrointestinal upset is a possible side effect, it is not the most notable or common issue associated with St. John's wort. The primary concern with St. John's wort is its interactions with other medications and potential for causing side effects like dizziness, dry mouth, or photosensitivity.

C. "You may experience vivid dreams while taking St. John's wort."

Vivid dreams are not a common side effect of St. John's wort. While some individuals report sleep disturbances, this is not a typical reaction to the herb.

D. "St. John's wort may increase your risk of developing oxalate kidney stones."

There is no established evidence to suggest that St. John's wort increases the risk of developing oxalate kidney stones. This side effect is not associated with St. John's wort.

The Correct Answer is:

D. A client who has chronic alcohol use disorder.

Explanation:

Chronic alcohol use disorder significantly increases the risk of vitamin B6 deficiency. Alcohol interferes with the absorption and metabolism of vitamin B6, making it more difficult for the body to maintain adequate levels of this essential nutrient. Vitamin B6 plays a key role in enzyme function, neurotransmitter production, and the formation of red blood cells. Deficiency can lead to symptoms like irritability, depression, confusion, and peripheral neuropathy.

Why the other options are incorrect:

A. A client who has asthma.

Asthma itself does not directly impact vitamin B6 levels. While medications used to treat asthma (such as corticosteroids) can affect nutritional status, asthma alone does not predispose individuals to vitamin B6 deficiency.

B. A client who takes heparin to prevent deep vein thrombosis.

Heparin, an anticoagulant used to prevent deep vein thrombosis, does not directly cause a vitamin B6 deficiency. Although certain anticoagulants may have an effect on other nutrients, heparin is not known to impact vitamin B6 metabolism.

C. A client who takes gabapentin as part of treatment for phenytoin for a seizure disorder.

While both gabapentin and phenytoin are associated with other potential nutritional deficiencies (such as vitamin D and folate), they do not directly cause vitamin B6 deficiency. This makes the client taking these medications less likely to be at risk for vitamin B6 deficiency than those with chronic alcohol use.

The Correct Answer is:

D. Skipping doses can lead to relapse of symptoms

Explanation:

The most important point to convey is that adherence to antipsychotic medication is crucial for managing symptoms and preventing relapse. Skipping doses can lead to a recurrence of the client’s psychiatric symptoms and may increase the risk of hospitalization or further complications. Consistent medication adherence helps maintain stability and prevent the worsening of the condition.

Why the other options are incorrect:

A. Increased physical activity negates the need for medication

Physical activity is beneficial for overall mental and physical health, but it does not replace the need for antipsychotic medications. Antipsychotics are essential for managing conditions like schizophrenia and bipolar disorder.

B. Antipsychotics cure mental illness

Antipsychotics do not cure mental illness, but they are effective in managing symptoms. They help control hallucinations, delusions, and other symptoms of psychotic disorders, but they do not eliminate the underlying illness.

C. Taking medication at bedtime always prevents side effects

Taking medication at bedtime may help reduce some side effects like drowsiness, but it does not guarantee that side effects will be prevented. Each patient’s experience with antipsychotics can differ, and side effects may still occur regardless of the timing of the medication.

The Correct Answer is:

B. Conduct a thorough assessment to evaluate John's safety and risk of harm to himself or others.

Explanation:

The priority nursing action is to assess John’s safety, including the risk of self-harm or harm to others, given his current symptoms of extreme mood swings, risky behaviors during manic episodes, and feelings of hopelessness during depressive episodes. This assessment helps determine the urgency of intervention and ensures that immediate safety concerns, such as suicidal ideation or impulsive actions, are addressed.

Why the other options are incorrect:

A. Administer a mood stabilizer immediately.

While administering a mood stabilizer is an important part of managing bipolar disorder, the priority action is to first assess the client’s safety. Immediate intervention with medication can follow after safety concerns are addressed.

C. Schedule John for regular therapy sessions to manage his mood swings.

Therapy sessions are important for long-term management of bipolar disorder, but the immediate priority is ensuring John’s safety before focusing on therapy scheduling.

D. Educate John and his wife about the signs and symptoms of Bipolar Spectrum Disorder.

Education is an essential component of treatment, but it is not the immediate priority. The nurse must first ensure the client’s safety before providing education.

The Correct Answer is:

A. The client responds to questions with disorganized speech.

Explanation:

Disorganized speech is a hallmark sign of acute mania in bipolar disorder. During manic episodes, individuals may exhibit pressured speech, flight of ideas, and difficulty maintaining a coherent conversation. This is indicative of the racing thoughts and impulsivity that are characteristic of mania.

Why the other options are incorrect:

B. The client's spouse reports that client has recently gained weight.

Weight gain is not typically associated with acute mania. In fact, during manic episodes, individuals may engage in excessive activities, such as spending sprees, which may result in weight loss or erratic eating habits. Weight gain may occur during depressive episodes or due to medication.

C. The client reports that voices are telling him to write a novel.

Although auditory hallucinations (hearing voices) can occur in severe manic or psychotic episodes, the specific belief that voices are instructing the person to act (e.g., write a novel) suggests a more delusional thought pattern. This would indicate psychosis but does not directly align with acute mania itself, which is more often characterized by extreme mood swings, irritability, and impulsive behavior rather than delusions.

D. The client is dressed in all black.

Dressing in all black is not a specific sign of mania. It may indicate mood disturbance or personal style, but it does not support the diagnosis of acute mania. Manic clients may demonstrate impulsivity in behavior (e.g., dressing inappropriately for the weather or occasion), but this is not as specific as disorganized speech or other behavioral signs of mania.