MENTAL HEALTH DISORDERS COMPREHENSIVE
EXAMINATION ANSWERS AND RATIONALES
1. 1. Antipsychotic drugs produce varying
degrees of muscarinic cholinergic block-
ade, including dry mouth, blurred vision,
and photophobia. Chewing sugarless
gum may help dry mouth.
2. Antipsychotic medications promote
orthostatic hypotension by blocking
alpha-adrenergic receptors on blood
vessels; therefore, the nurse should teach
the client about orthostatic hypotension.
3. The sedative effects of the antipsychotic
medications should have subsided by the
time the client is discharged; therefore, this
is not an appropriate teaching for discharge.
Sedation is common during the early days of
treatment, but it subsides within a week or so.
4. Antipsychotics can cause sexual dysfunc-
tion in women and men, so this should
be discussed by the nurse.
5. Flu-like symptoms are a sign of agran-
ulocytosis, which is a rare but serious
reaction to antipsychotic medications. In
agranulocytosis, the body loses its ability
to fight infection.
2. 1. The client eating 90% of the meal does not
indicate the client has gained weight.
2. The amitriptyline (Elavil), an antidepres-
sant, and cyproheptadine (Periactin), an
antihistamine, is effective if the client
gains weight, and 2.2 pounds is an excel-
lent weight gain for a client diagnosed
with anorexia.
3. The antihistamine would be effective if the
client had no signs of hay fever, but this is not
why this medication is being administered.
4. The client can say anything, but weight gain
indicates the medication is effective.
MEDICATION MEMORY JOGGER: The nurse
determines the effectiveness of a medi-
cation by assessing for the symptoms, or
lack thereof, for which the medication was
prescribed.
3. 1. Sleeping most of the day does not indicate
sertraline (Zoloft), an SSRI, is effective. This
may indicate the client is very depressed or
is taking too much medication.
2. Weight loss or gain may indicate the client
is depressed.
3. Verbalizing remorse does not indicate the
medication is effective.
4. Setting new goals and priorities, such
as getting a job, indicates the client may
362
6924_Ch13_333-366.indd 362
no longer be depressed and sertraline
(Zoloft), an SSRI, is effective.
4. 1. Clients taking phenelzine (Nardil), an
MAOI, must not eat foods high in tyramine
because this causes a life-threatening com-
plication. This statement does not warrant
intervention.
2. Dextromethorphan (Robitussin) inter-
acts with MAOIs to produce hyperten-
sion, fever, and coma. This statement
warrants intervention.
3. Acetaminophen (Tylenol) does not interact
with MAOIs; therefore, this statement does
not warrant intervention.
4. Caffeine should be limited when taking
MAOIs, but it may be consumed in mod-
eration. This statement does not warrant
intervention.
MEDICATION MEMORY JOGGER: Some
classes of medications are notorious for
adverse reactions and MAO inhibitors,
which are prescribed rarely for depression,
are among the worst.
5. 1. This client is stable and has a diagnosis
of panic attack. Administering alprazolam
(Xanax), a benzodiazepine, would be an
appropriate task to assign to an LPN.
2. Tardive dyskinesia is a life-threatening
complication of antipsychotic medications
such as haloperidol (Haldol), and the nurse
should not delegate care of a client who is
unstable.
3. This lithium level is toxic, and the client
should not receive any lithium (Lithobid).
4. The client should receive IV, not oral,
thiamine (B1), a vitamin. The client is not
stable and the nurse should not delegate this
medication administration.
6. 1. This is the scientific rationale for admin-
istering donepezil (Aricept) to a client
diagnosed with Alzheimer’s disease.
2. This is the scientific rationale for admin-
istering lithium to a client diagnosed with
bipolar disorder.
3. Atomoxetine (Strattera), a norepineph-
rine reuptake inhibitor, is prescribed for
ADHD because it is not a CNS stimu-
lant or controlled substance. It acts to
increase norepinephrine and regulate
impulse control, organizes thoughts, and
focuses attention. It does not decrease
7/11/18 4:39 PM

appetite, and the child does not need to
take drug holidays.
4. This is the scientific rationale for adminis-
tering methylphenidate (Ritalin) to children
diagnosed with ADHD.
7. 1. The glucose level is not monitored when
taking pemoline (Cylert).
2. The child should test positive for amphet-
amine because amphetamines are the pro-
totype for pemoline (Cylert), but this test is
not monitored because the drug’s effective-
ness is determined by the client’s behavior.
3. Melatonin is a hormone produced by the
body that regulates sleep patterns. Cylert
can cause insomnia, but it does not interfere
with melatonin levels.
4. Pemoline (Cylert), as with most medica-
tions, is metabolized by the liver and can
cause liver dysfunction or liver failure if
taken over a long period; therefore, liver
function tests should be monitored.
MEDICATION MEMORY JOGGER: The
kidneys and the liver are responsible for
metabolizing and excreting all medications.
8. 1. Some OTC medications are as effective as
prescription medications; therefore, this is a
false statement.
2. Tylenol PM is a combination of acetamino-
phen and diphenhydramine (Benadryl), and
it is not addictive.
3. The client did not verbalize this concern.
The client needs factual information, not a
therapeutic response.
4. Zolpidem (Ambien CR) allows the client
to fall asleep and stay asleep, which is
why it is prescribed for clients diagnosed
with insomnia. Short-term use does not
result in an addiction to this medication.
9. 1. Chlordiazepoxide (Librium), a benzodiaz-
epine, is used to prevent delirium tremens;
therefore, the nurse would not question this
medication.
2. Haloperidol (Haldol), an antipsychotic,
is prescribed for psychosis; therefore, the
nurse would not question this medication.
3. Clonidine (Catapres), an alpha-
adrenergic agonist, is administered
primarily to treat hypertension, but it
is also used to reduce the symptoms
of withdrawal from opioids, nicotine,
and alcohol. The nurse would question
administering this medication because of
the client’s low blood pressure no matter
why it is being prescribed.
6924_Ch13_333-366.indd 363
CHAPTER 13 MENTAL HEALTH DISORDERS 363
4. Thiamine (B1), a vitamin, is used to dimin-
ish Wernicke-Korsakoff encephalopathy,
which is characterized by confusion, mem-
ory loss, and loss of cranial nerve function
resulting from chronic alcohol abuse.
10. 1. Cannabis is marijuana and results in a lack
of sense of time, apathy, and increased
appetite, not the signs and symptoms the
client is experiencing.
2. Heroin abuse results in slurred speech,
sedated appearance, apathy, and decreased
emotional pain, not hypervigilance and
insomnia.
3. Hypervigilance, insomnia, dilated
pupils, and a runny nose are the signs
or symptoms of cocaine abuse.
4. Alcohol abuse results in lack of control,
hostility, rationalization, grandiosity,
confusion, and blackouts, not the signs and
symptoms this client has.
MEDICATION MEMORY JOGGER: Many of
the illegal substances that are abused by
clients may produce the same symptoms,
so the test taker must focus on symptoms
that are different, such as “runny nose” for
cocaine.
11. 1. The nurse cannot delegate evaluation of
assessment data. The UAP can obtain the
intake and output, but not evaluate it.
2. The UAP can obtain the client’s weight.
This does not require judgment.
3. The UAP should not be manipulating the
IV, the IV pump, or the IV tubing. TPN
is a medication, and the nurse cannot
delegate the administration of medications.
4. The client is anorexic, and any food intake
should be evaluated by the nurse. Having
the UAP go to the cafeteria removes the
employee from the unit for an extended
period; therefore, this is not an appropriate
task to delegate.
5. The TPN is high in glucose and the cli-
ent’s glucose level should be monitored
every 6 hours. The UAP can perform
this skill.
12. 1. Substance abuse, whether involving legal
or illegal substances, is still abuse, and the
client needs psychological intervention to
help with the abuse. The pharmacologic
intervention helps with the physiologic
withdrawal, with the scientific rationale
being to help the client not take any type
of medication, legal or illegal.
2. The two main purposes for prescrib-
ing medication for clients who are
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 364 PHARMACOLOGY SUCCESS
addicted to alcohol, sedative/hypnotics,
and benzodiazepines are to permit safe
withdrawal from the substance and to
prevent relapse into addiction again.
3. No medications used in substance abuse
detoxification can prevent all side effects.
4. This statement is not true.
13. 1. This is within the therapeutic range
of 0.6 to 1.2 mEq/L; therefore, the
nurse should take no action, except to
make sure the client has a follow-up
appointment.
2. This would be appropriate if the client’s
lithium level was elevated, which it is not.
3. This would be appropriate if the client’s
lithium level was elevated, which it is not.
4. The lithium level is therapeutic; therefore,
the client does not need to adjust his or
her salt intake.
MEDICATION MEMORY JOGGER: The
nurse must be knowledgeable about
accepted standards of practice for med-
ication administration, including which
client assessment data and laboratory data
should be monitored prior to administer-
ing the medication.
14. 1. The nicotine patch and nicotine gum are
both nicotine replacement products, and
if one doesn’t work, neither will the other
one.
2. The nicotine patch is an OTC medication,
so this recommendation is not helpful to
the client.
3. Nicotine lowers vitamin C levels in the
body, so it will not help the client with
withdrawal symptoms from nicotine.
4. Bupropion (Wellbutrin) is an antide-
pressant that has been proved to be an
adjunct to smoking cessation.
15. 1. This is the correct amount of chlor-
promazine (Thorazine) to administer to
the client. 100 divided by 50 is 0.5 mL.
2. This would be a medication error and
would be administering 100 mg of medica-
tion, or twice the dose prescribed.
3. This would be a medication error and
would be administering 150 mg of medica-
tion, or three times the dose prescribed.
4. This would be a medication error and
would be administering 200 mg of medica-
tion, or four times the dose prescribed.
MEDICATION MEMORY JOGGER: Most
pharmaceutical companies package the
medication in amounts that are usually
prescribed by the HCP. If the nurse uses
6924_Ch13_333-366.indd 364
more than one vial to administer a medi-
cation, then the nurse should seek clarifi-
cation of the prescription.
16. 1. The multivitamins in the IV solution cause
the IV solution to be yellow; therefore,
there is not a reason to notify the HCP.
2. This IV does not need to be protected
from light. The yellow color is normal for
this IV therapy.
3. This IV therapy is commonly known as a
“banana bag” because of the yellow color
of the IV solution. The nurse should
administer the medication as prescribed.
4. This is not cost effective because the yel-
low color is normal for this medication.
17. 1. Involuntary movements of the tongue
and lips are signs and symptoms of
tardive dyskinesia, which is an adverse
reaction to first-generation antipsy-
chotic medications such as chlorproma-
zine (Thorazine).
2. Antianxiety medications, such as lora-
zepam (Ativan), do not cause tardive
dyskinesia.
3. Antibiotics, such as cefuroxime (Zinacef),
do not cause tardive dyskinesia.
4. The client has signs and symptoms of
tardive dyskinesia, which is an adverse
reaction to a first-generation antipsy-
chotic medication such as chlorpromazine
(Thorazine). The nurse must intervene
when assessing these signs and symptoms.
18. 1. Risperidone (Risperdal), an antipsychotic,
is the drug of choice for an adolescent
diagnosed with bipolar disorder.
2. Cimetidine (Tagamet), a histamine
blocker, may reduce the effects of anti-
psychotic medications and lead to med-
ication failure. The client diagnosed
with schizophrenia would be taking an
antipsychotic medication, so the nurse
should discuss an alternate medication
to decrease the client’s gastric acidity.
3. The client receiving rifampin (Rifadin), an
antituberculin, must receive it to prevent
resistant strains of TB and protect the
community.
4. Amitriptyline (Elavil), a tricyclic antide-
pressant, has shown efficacy in promoting
weight gain in clients diagnosed with
anorexia nervosa; therefore, the nurse
would not need to discuss this medication
with the HCP.
19. 1. Desipramine (Norpramin), a tricyclic anti-
depressant, is administered to improve the
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 CHAPTER 13
mood; therefore, this indicates the medica-
tion is effective.
2. Arguing with the parents will not deter-
mine the effectiveness of the medication.
3. Verbalizing future goals will not determine
the effectiveness of the medication.
4. Being preoccupied with shape and
weight is a symptom of anorexia and
6924_Ch13_333-366.indd 365
MENTAL HEALTH DISORDERS 365
indicates the desipramine (Norpramin),
a tricyclic antidepressant, is not
effective.
MEDICATION MEMORY JOGGER: The
nurse determines the effectiveness of a
medication by assessing for the symptoms,
or lack thereof, for which the medication
was prescribed.
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