A client on an inpatient psychiatric unit yells "My roommate is Satan's crafty minion" and attempts to strangle him. The patient is refusing redirection. What medication should the nurse expect the on-call provider to order?

Haloperidol (Haldol).

Hydroxyzine (Vistaril).

Valproate (Depakote).

Lithium carbonate (Lithobid).

Answer and Explanation

The Correct Answer is A

Choice A reason: Haloperidol, a typical antipsychotic, blocks dopamine D2 receptors in the mesolimbic pathway, rapidly reducing agitation and psychosis-driven aggression in schizophrenia. This addresses the acute delusional behavior and amygdala hyperactivity, making it the preferred choice for immediate control.

Choice B reason: Hydroxyzine, an antihistamine, reduces anxiety via histamine and mild anticholinergic effects but lacks antipsychotic properties. It cannot address dopamine-driven delusions or aggression in schizophrenia, making it ineffective for controlling acute psychotic agitation.

Choice C reason: Valproate stabilizes mood in bipolar disorder via GABA enhancement but is not indicated for acute psychotic aggression. Schizophrenia’s dopamine excess requires rapid receptor blockade, which valproate cannot provide, making it unsuitable for this scenario.

Choice D reason: Lithium stabilizes mood in bipolar disorder by modulating sodium channels and inositol, not acute psychosis. Schizophrenia’s mesolimbic dopamine hyperactivity requires antipsychotic intervention, making lithium ineffective for controlling delusional aggression in this acute situation.

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Correct Answer is A

Explanation

Choice A reason: Suicide in depression is linked to low serotonin, impairing prefrontal cortex regulation and increasing impulsivity. SSRIs increase serotonin, stabilizing amygdala-prefrontal circuits, reducing suicidal ideation by enhancing mood regulation and impulse control, making them the first-line treatment.

Choice B reason: Atypical antipsychotics target dopamine and serotonin receptors for psychosis or mania, not primary suicide risk. Depression-related suicide stems from serotonin deficits, and antipsychotics are less effective for this neurochemical profile, making them inappropriate as first-line treatment.

Choice C reason: Mood stabilizers like lithium address bipolar mood swings, not primary depression-related suicide. Serotonin dysregulation drives suicidal behavior in depression, and stabilizers lack direct serotonin enhancement, making them less effective than SSRIs for this indication.

Choice D reason: Tricyclic antidepressants increase serotonin and norepinephrine but have higher side effect risks, like cardiotoxicity, compared to SSRIs. Serotonin deficits drive suicide risk, and SSRIs are safer and more effective for targeting this neurochemical imbalance in depression.

A. I really doubt that one person can be blamed for all the bad things that happen. B. Let's look at one bad thing that happened to see if another explanation exists. C. How does your belief in fate relate to your cultural heritage? D. You are being exceptionally hard on yourself when you say those things.

Correct Answer is B

Explanation

Choice A reason: This response dismisses the patient’s cognitive distortion without engaging in therapeutic exploration. Major depressive disorder involves negative cognitive biases due to altered serotonin and dopamine signaling in the prefrontal cortex, impairing rational attribution of causality. This choice fails to facilitate cognitive restructuring, missing the opportunity to address neurocognitive mechanisms underlying overgeneralization.

Choice B reason: This response uses cognitive-behavioral techniques to challenge overgeneralization, a distortion linked to dysfunctional prefrontal cortex activity and low serotonin levels in depression. Examining a specific event encourages re-evaluation of faulty attributions, promoting neuroplasticity through cognitive restructuring, which can enhance rational thinking and reduce depressive symptoms by altering maladaptive neural pathways.

Choice C reason: This response shifts focus to cultural beliefs, irrelevant to the patient’s cognitive distortion. Depression involves altered amygdala-prefrontal cortex interactions, leading to negative self-attribution. Exploring cultural heritage does not address serotonin deficiency or facilitate cognitive reframing, making it ineffective for correcting overgeneralized thinking driven by neurochemical imbalances.

Choice D reason: This response acknowledges self-criticism but fails to engage in active cognitive restructuring. Depression involves hyperactive amygdala responses and reduced prefrontal inhibition, perpetuating negative self-perceptions. Without guiding the patient to explore alternative explanations, this choice misses the chance to alter maladaptive neural pathways, limiting its therapeutic impact on distorted thinking.

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A client on an inpatient psychiatric unit yells "My roommate is Satan's crafty minion" and attempts to strangle him. The patient is refusing redirection. What medication should the nurse expect the on-call provider to order?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who has attempted suicide has an underlying diagnosis of depression. Based on the biochemical function that is most associated with suicidal behavior, the nurse anticipates which medication classification will be ordered for the client?

Correct Answer is A

Explanation

A patient diagnosed with major depressive disorder tells the nurse, "Bad things that happen are always my fault." To support the patient to reframe this overgeneralization, the nurse's best response is:

Correct Answer is B

Explanation

A nurse is working with a client who has frequent angry outbursts when he becomes frustrated. Which statement by the nurse is a true statement about anger?

Which client best exhibits the characteristics that are typical of the prodromal period of schizophrenia?

The nurse preparing to teach a patient diagnosed with post-traumatic stress disorder (PTSD) about recommended psychotherapy and psychopharmacology will discuss:

A troubled adolescent pulled out a gun in a school cafeteria, fatally shot three people, and injured many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next?

A client with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg daily. The client asks the nurse how this medicine minimizes hallucinations. The nurse explains that the mechanism by which olanzapine controls the client's psychotic symptoms is believed to be what?

A nurse is preparing to administer lactated Ringer's 100 mL IV over 15 minutes. The nurse should set the IV infusion pump to deliver how many mL/hr? (Round to the nearest whole number.)

Which central nervous system structure is associated with anger and aggression?

The experience of trauma causes neurochemical changes in the brain that play a role in encoding fear memories that are implicated in Post Traumatic Stress Disorder. The nurse identifies the involvement of which neurotransmitters?