Psychiatric Nursing 8th Edition Keltner Test Bank
Chapter 19: Over-the-Counter Drugs
Keltner: Psychiatric Nursing, 8th Edition
MULTIPLE CHOICE
1. Alternative therapy is associated with what characteristic?
a. Any natural therapy without a research basis
b. Evidence-based pharmacologic use of plant products
c. Therapies used in conjunction with Western medicine
d. Therapies not generally accepted by Western medicine
ANS: D
Alternative therapies are therapies that are not generally accepted by mainstream Western
medicine—for example, herbaceuticals. Some alternative therapies have been researched.
Focusing on herbs is too narrow. Therapies used in conjunction with Western medicine are
called complementary therapies.
DIF: Cognitive level: Understanding
TOP: Nursing process: Planning
MSC: Client Needs: Health Promotion and Maintenance
2. For which patient comorbid diagnosis would it be most important for the nurse to urge the
patient to immediately discontinue using kava-kava?
a. Cirrhosis
b. Osteoarthritis
c. Multiple sclerosis
d. Chronic back pain
ANS: A
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Kava-kava should be used with caution in patients with liver disease because of its potentially
hepatotoxic effects. The other health problems do not pose immediate dangers.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
3. Select the example of complementary therapy.
a. St. John wort used with olanzapine.
b. Valerian used with disulfiram (A).
c. Fluoxetine used with lorazepam.
d. Propranolol used with systematic desensitization.
ANS: A
Complementary therapy is an alternative therapy used in conjunction with conventional
Western medicine. St John wort is an alternative therapy, and olanzapine is a Western medical
therapy for some mental health disorders. None of the other options demonstrate components
of both alternative and Western medicine.
DIF: Cognitive level: Understanding
TOP: Nursing process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
4. A patient reports taking melatonin daily. Which aspect of the patient’s health and function
would be most important for the nurse to assess?
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Psychiatric Nursing 8th Edition Keltner Test Bank
a.
b.
c.
d.
Urinary and bowel elimination
Energy and activity tolerance
Sleep hygiene and patterns
Memory and cognition
ANS: C
Melatonin is used to reduce sleep-onset latency and decrease the number of nocturnal
awakenings. The nurse should assess the patient’s sleep patterns and hygiene. It does not
directly relate to the aspects of function identified in the distracters.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Assessment
MSC: Client Needs: Physiologic Integrity
5. Which statement causes the nurse to suspect the patient may be self-medicating with an
alternative therapy?
a. “I frequently have skin rashes that itch.”
b. “Constipation is an everyday problem for me.”
c. “My computed tomography scan shows that I have uterine fibroid tumors.”
d. “I’ve been very depressed and anxious since I lost my job.”
ANS: D
Herbals are among the most frequently used alternative therapies for depression. Four of the
12 most common herbs are used to treat or prevent psychiatric symptoms. None of the other
options reflects such a common problem that is treated with an alternative therapy.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Evaluation
MSC: Client Needs: Physiologic Integrity
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U S inNwhich
T areaOwhen taking valerian?
6. The patient will report improvement
a. A lower stress level
b. Undisturbed sleep throughout the night
c. An increased interest in recreational activities
d. Awakening without an alarm clock in the morning
ANS: B
Valerian decreases sleep latency and nocturnal awakening, and it leads to a subjective sense of
good sleep. Sleeping through the night is the best indicator that the herb was effective. The
herb is not associated with the conditions identified by the other options.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Evaluation
MSC: Client Needs: Physiologic Integrity
7. An anxious patient diagnosed with diabetes says, “I’m considering taking angelica to help me
relax.” What is the best outcome for this patient’s plan of care?
a. The patient will report subjective feelings of improved sleep.
b. The patient will identify other options to manage anxiety.
c. The patient will monitor fingerstick blood glucose daily.
d. The patient will rate anxiety as 5 or less on a scale of 10.
ANS: B
Angelica is contraindicated in diabetes. The patient should identify other strategies to manage
anxiety. The other options imply that this herb is safe to use in this situation.
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Psychiatric Nursing 8th Edition Keltner Test Bank
DIF: Cognitive level: Analyzing
TOP: Nursing process: Planning
MSC: Client Needs: Physiologic Integrity
8. Which patient who takes both phenytoin and valerian regularly is a risk for developing serious
side effects?
a. A pregnant woman
b. An adult with a history of alcohol abuse
c. An adult with an acute peptic ulcer
d. A teen with an allergy to ragweed
ANS: A
Valerian is thought to negate the effects of several drugs, including phenytoin, and should be
avoided during pregnancy. Valerian is not contraindicated for the other diagnoses.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
9. A patient with which disorder would most likely benefit from taking St. John wort?
a. Suicidal depression
b. Hypomanic symptoms
c. Mild depressive symptoms
d. Panic disorder with agoraphobia
ANS: C
Research has found St. John wort to be effective in treating mild-to-moderate depression. St.
John wort has not been found to be effective in treatment of severe depression, bipolar
disorder, or anxiety disorders.
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DIF: Cognitive level: Applying
TOP: Nursing process: Planning
MSC: Client Needs: Psychosocial Integrity
10. During an admission interview, a patient who reports high levels of anxiety says, “I’ve been
using kava-kava for about a week to relieve anxiety.” When the nurse assesses mental status,
what is the expected finding?
a. Reduced coordination and slurred speech
b. Intact cognitive functioning
c. Slow response times
d. Paranoid thinking
ANS: B
Kava-kava relieves anxiety without producing cognitive impairment, reducing mental acuity,
or affecting coordination. Kava-kava is known to have an affinity for benzodiazepine
receptors. It does not usually produce any of the effects cited in the other options.
DIF: Cognitive level: Applying
TOP: Nursing process: Assessment
MSC: Client Needs: Psychosocial Integrity
11. A patient tells the nurse, “I’ve been having problems with my memory. I read some
information on the Internet and started taking gingko.” Select the nurse’s best response.
a. “The Internet does not have reliable health information.”
b. “The most recent studies indicate that gingko started early may slow cognitive
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Psychiatric Nursing 8th Edition Keltner Test Bank
decline.”
c. “SAM-e has been shown to have better effects for treating memory problems.”
d. “Your memory problems are related to your mental illness. Herbs will not help.”
ANS: B
Evidence gathered indicates that a daily regimen of 240 mg of EGb-761 may be efficacious in
stabilizing or slowing cognitive decline in persons with dementia. SAM-e is useful for treating
mild depression. The other distracters are misleading.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
12. A patient diagnosed with a history of depression disorder tells the nurse, “My primary-care
provider told me to start taking fish oil capsules to prevent heart disease. Will it cause
problems with my mental illness?” What is the nurse’s best response?
a. “It will not cause problems. It may actually help with your depressed feelings.”
b. “I cannot discuss recommendations you received from another health care
provider.”
c. “It would be better for you to take vitamins C and E. I will notify your
primary-care provider.”
d. “Please have your primary-care provider call me so we can discuss issues related
to this preparation.”
ANS: A
Fish oil capsules supplement omega-3 and omega-6 fatty acids. These substances not only
provide cardiovascular benefits; studies have demonstrated positive results in ameliorating
depression after 2 or more weeks of omega-3. The other options fail to support the patient
with appropriate information.NURSINGTB.COM
DIF: Cognitive level: Analyzing
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
13. A patient asks, “I want to consult an herbalist. What should I do to make sure I don’t get some
impostor?” What should the nurse advise the patient to first ask their primary provider?
a. “How much will treatments cost?”
b. “Have you treated this condition before?”
c. “Do the treatments pose any dangers to me?”
d. “What group has certified you in this practice?”
ANS: D
The priority question is whether the individual is credentialed to practice via license or
certification. Either credential suggests, but does not guarantee, some degree of knowledge
and competence. The other questions are reasonable to ask but are not as fundamental.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
14. A neighbor asks a nurse, “Are there any resources that would help me get reliable information
about alternative and complementary therapies?” Which resource should the nurse
recommend?
a. National Center for Complementary and Alternative Medicine
b. American Psychiatric Association
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Psychiatric Nursing 8th Edition Keltner Test Bank
c. American Medical Association
d. Centers for Disease Control and Prevention
ANS: A
The National Center for Complementary and Alternative Medicine, a part of the National
Institutes of Health, has responsibility for providing information to the public regarding the
safety and efficacy of alternative therapies and for funding research for these therapies. The
other options would be inappropriate to recommend.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
15. A patient diagnosed with depression tells the nurse, “I’ve been supplementing my paroxetine
with St. John wort, and it has helped a great deal.” What is the nurse’s priority action?
a. Assess changes in the patient’s level of depression.
b. Remind the patient to use a secondary form of birth control.
c. Educate the patient about the risks of serotonin syndrome.
d. Suggest adding valerian to the treatment regimen to further improve results.
ANS: C
Research has suggested that St. John wort inhibits serotonin reuptake by elevating
extracellular sodium; thus it may interact with medication, particularly selective serotonin
reuptake inhibitors, to produce serotonin syndrome. Discussing the patient’s birth control
method is a secondary priority.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
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MULTIPLE RESPONSE
1. A client reports having symptoms suggesting a fight or flight response. The nurse suggests
limiting consumption of which beverages? (Select all that apply.)
a. Coffee
b. Tea
c. Grapefruit juice
d. Sodas
e. Chocolate milk
ANS: A, B, D, E
Caffeine triggering a sympathomimetic reaction akin to a “fight-and-flight” response that
includes elevated blood pressure and heart rate (hence the colloquialism “coffee nerves”
experienced with high doses of caffeine). Natural sources of caffeine include coffee, tea, and
chocolate; also, mild amounts of caffeine have been added to soda-type beverages for nearly a
century. Grapefruit juice is not known to contain caffeine.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Health Promotion and Maintenance
2. A patient takes the herb Angelica. Which assessment question should the nurse ask? (Select
all that apply.)
a. “Are you currently pregnant?”
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Psychiatric Nursing 8th Edition Keltner Test Bank
b.
c.
d.
e.
“Have you been diagnosed with diabetes?”
Do you have any history of liver problems?”
“Do you have a history of peptic ulcers?”
“Are you currently prescribed an anticoagulant medication?”
ANS: A, B, E
Angelica is contraindicated for individuals with a history of or currently experiencing
diabetes, peptic ulcer disease, bleeding disorders being managed with an anticoagulant, or
pregnancy. Liver disorders are not specifically associated with a contraindication for angelica.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
3. Which important points should the nurse teach a patient about using herbal preparations?
(Select all that apply.)
a. Check active and inactive ingredients.
b. Discontinue use if side effects or adverse effects occur.
c. Buying from online sources is preferable and cheaper.
d. Avoid herbals during pregnancy and breastfeeding.
e. Inform your health care provider about the use of herbals.
ANS: A, B, D, E
All of the instructions are correct except the one regarding purchase of herbals. Internet
purchasing of herbals might not be the best plan unless the reputation of the firm can be
confirmed.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic
Integrity
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4. A patient reports frequent sleep disturbances. Which preparations could be considered to help
improve the patient’s sleep pattern? (Select all that apply.)
a. Yohimbine
b. Vitamin C
c. Melatonin
d. Valerian
e. SAM-e
ANS: C, D
Melatonin and valerian have relaxant effects that help sleep. Yohimbine can actually cause
insomnia. SAM-e may help with mild depression. Vitamin C has no effect on sleep.
DIF: Cognitive level: Understanding
TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
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