A client with schizophrenia has had 2 hospitalizations within the past 9 months due to non-adherence to medications and their counseling plan. What measures should the nurse and the mental health treatment team recommend for tertiary prevention? (Select All That Apply)

Recommend the client distance themselves from people who knew them before their diagnosis.

Provide the client with a multi-step written plan to follow if auditory hallucinations occur.

Risperidone as a depot formulation every 2 weeks.

Increase white bread and bananas to help with anticholinergic symptoms.

Assist the client to enroll in a program of assertive community treatment.

Answer and Explanation

Correct Answer : B,C,E

Choice A Reason:

Recommending the client distance themselves from people who knew them before their diagnosis is not a suitable measure for tertiary prevention. Tertiary prevention aims to reduce the impact of an ongoing illness by helping patients manage long-term, complex health problems and injuries. It focuses on improving quality of life and reducing symptoms. Distancing from familiar people could lead to social isolation, which might worsen the client’s condition.

Choice B Reason:

Providing the client with a multi-step written plan to follow if auditory hallucinations occur is a practical measure for tertiary prevention. This plan can help the client manage symptoms effectively and reduce the likelihood of hospitalization. It empowers the client to take control of their symptoms and provides clear steps to follow during a crisis, which can be crucial for maintaining stability.

Choice C Reason:

Risperidone as a depot formulation every 2 weeks is an effective measure for ensuring medication adherence in clients with schizophrenia. Depot formulations are long-acting injections that help maintain consistent medication levels in the body, reducing the risk of relapse due to missed doses. This approach is particularly beneficial for clients who have difficulty adhering to daily oral medication regimens.

Choice D Reason:

Increasing white bread and bananas to help with anticholinergic symptoms is not a recommended measure for managing schizophrenia. While diet can play a role in overall health, there is no evidence to suggest that these specific foods help with anticholinergic symptoms. Anticholinergic symptoms are typically managed with medications and other medical interventions.

Choice E Reason:

Assisting the client to enroll in a program of assertive community treatment (ACT) is a highly effective measure for tertiary prevention. ACT provides comprehensive, community-based psychiatric treatment, rehabilitation, and support to individuals with serious and persistent mental illnesses. This approach helps clients manage their symptoms, adhere to treatment plans, and reduce the risk of hospitalization by providing continuous, personalized care.

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Correct Answer is A

Explanation

Choice A Reason:

Lorazepam is a benzodiazepine commonly used to manage acute agitation and anxiety. It works by enhancing the effect of the neurotransmitter GABA, which has a calming effect on the brain. Lorazepam is often administered in emergency situations to quickly reduce agitation and prevent escalation to violence. Its rapid onset of action makes it an ideal choice for managing acute episodes of agitation and potential assault.

Choice B Reason:

Valproic acid is an anticonvulsant and mood stabilizer used primarily for the treatment of epilepsy and bipolar disorder. While it can help manage mood swings and prevent manic episodes, it is not typically used for the immediate management of acute agitation or aggression. Its effects are not rapid enough to address an escalating situation effectively.

Choice C Reason:

Bupropion is an atypical antidepressant used to treat major depressive disorder and to support smoking cessation. It works by inhibiting the reuptake of norepinephrine and dopamine, but it does not have the sedative properties needed to manage acute agitation or aggression. Therefore, it is not suitable for immediate intervention in a potentially violent situation.

Choice D Reason:

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety disorders, and other mood disorders. While it is effective for long-term management of anxiety and depression, it does not have the rapid calming effects required for managing acute agitation or potential assault. SSRIs generally take several weeks to achieve their full therapeutic effect.

A. Prevents the breakdown of acetylcholine. B. Decreases amyloid plaques in the brain. C. Increases acetylcholine levels in the brain. D. Limits neurotransmitter engagement of NMDA receptors

Correct Answer is A

Explanation

Choice A Reason:

Prevents the breakdown of acetylcholine.

Galantamine is an acetylcholinesterase inhibitor, which means it works by preventing the breakdown of acetylcholine in the brain. Acetylcholine is a neurotransmitter that is important for memory and learning. By inhibiting the enzyme that breaks down acetylcholine, galantamine increases the levels of acetylcholine available in the brain, which can help improve cognitive function in patients with Alzheimer’s disease1. This mechanism of action is crucial because it directly addresses the cholinergic deficit observed in Alzheimer’s disease.

Choice B Reason:

Decreases amyloid plaques in the brain.

This statement is incorrect. Galantamine does not work by decreasing amyloid plaques in the brain. Amyloid plaques are one of the pathological hallmarks of Alzheimer’s disease, but galantamine’s primary mechanism of action is related to acetylcholine metabolism. Other treatments and research efforts focus on targeting amyloid plaques, but this is not the function of galantamine.

Choice C Reason:

Increases acetylcholine levels in the brain.

While this statement is partially correct, it is not as precise as the correct answer. Galantamine increases acetylcholine levels indirectly by preventing its breakdown rather than directly increasing its production. The distinction is important because the therapeutic approach involves inhibiting the enzyme acetylcholinesterase, which breaks down acetylcholine, thereby increasing its availability.

Choice D Reason:

Limits neurotransmitter engagement of NMDA receptors.

This statement is incorrect. Limiting neurotransmitter engagement of NMDA receptors is the mechanism of action for a different class of Alzheimer’s medications, such as memantine. Galantamine does not affect NMDA receptors; instead, it enhances cholinergic function by inhibiting acetylcholinesterase and potentiating nicotinic receptors.

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A client with schizophrenia has had 2 hospitalizations within the past 9 months due to non-adherence to medications and their counseling plan. What measures should the nurse and the mental health treatment team recommend for tertiary prevention? (Select All That Apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse would expect to administer which of the following medications to a client who is escalating to the point of a possible assault?

Correct Answer is A

Explanation

A patient with mild Alzheimer’s disease is prescribed to take galantamine. Which statement best describes how this medication works to treat this disease?

Correct Answer is A

Explanation

The nurse notices a client wandering in the hospital hall giggling, with bizarre behavior that is annoying and frightening other clients. A priority in caring for her is to:

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The nurse is attempting to de-escalate a client who is becoming increasingly agitated on the unit. Which of the following interventions would be appropriate for this type of client? (SELECT ALL THAT APPLY)