Question

Lexi, a 62-year-old woman, has struggled with depression since adolescence and has a strong family history of mental illness on both sides of her family. She previously tried SSRIs but did not respond. For the past 10 years, she has been taking phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI), and her symptoms have been well managed with this medication .During a clinic visit, Lexi shares several updates about her life. Based on her medication regimen, the nurse should be most concerned by which client’s statement?

Answer 1

Correct Answers:

“I am so excited for my Italian vacation next month for 3 weeks!”

Rationale :

💠 MAOIs such as phenelzine require strict dietary restrictions, and travel—especially international travel—significantly increases the risk of accidental ingestion of tyramine-rich foods.

💠 Italian cuisine commonly includes aged cheeses, cured meats, fermented foods, and wine, all of which are high in tyramine and can interact dangerously with MAOIs.

💠 Ingesting tyramine while taking an MAOI can precipitate a hypertensive crisis, a life-threatening condition characterized by severe headache, hypertension, and potential stroke.

💠 Eating habits while traveling are harder to control, especially when dining out frequently or encountering unfamiliar food preparation methods.

💠 Patient safety is the nurse’s priority, and this statement signals a high risk for a preventable but serious medication–food interaction.

Moving into a senior living facility

💠 This represents a social and environmental change but has no direct interaction with MAOI therapy.

💠 It may even provide increased support and monitoring, which can be beneficial for long-term mental health.

Son moving away

💠 This reflects a potential psychosocial stressor, not a pharmacologic risk.

💠 Emotional stress alone does not pose an immediate safety concern related to MAOI use.

Rescuing a kitten

💠 Pet adoption is often associated with improved mood and emotional support.

💠 There is no medication-related risk tied to this activity.

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Answer 2

Correct Answers:

Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
Macaroni and cheese, hot dogs, banana bread, caffeinated coffee

Rationale :

Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

💠 Aged cheese (cheddar) contains high tyramine levels, which can trigger hypertensive crisis when combined with MAOIs.

💠 Smoked sausage is a processed and fermented meat, making it unsafe due to tyramine accumulation during curing.

💠 Yeast rolls may contain active or concentrated yeast, which contributes to tyramine intake.

💠 Combining multiple tyramine-containing foods in one meal significantly increases the risk of a dangerous blood pressure spike.

💠 This meal reflects a high-risk dietary pattern that nurses must explicitly caution against during MAOI teaching.

Avocado salad, ham, creamed potatoes, asparagus, chocolate cake

💠 Avocados, especially when overripe, are a known moderate-to-high tyramine food.

💠 Ham is a cured meat, and curing processes increase tyramine content.

💠 Tyramine reactions are dose-dependent, and consuming more than one risky item compounds danger.

💠 MAOI-related hypertensive crises can occur suddenly and unpredictably after such meals.

💠 This meal demonstrates how seemingly healthy foods can still be unsafe with MAOI therapy.

Macaroni and cheese, hot dogs, banana bread, caffeinated coffee

💠 Macaroni and cheese often contains aged or processed cheese, which is high in tyramine.

💠 Hot dogs are processed meats, making them inappropriate for a tyramine-restricted diet.

💠 Banana bread may contain overripe bananas, another hidden tyramine source.

💠 Caffeinated coffee can raise blood pressure and potentiate sympathomimetic effects in MAOI users.

💠 This meal includes multiple interacting triggers, increasing the likelihood of a hypertensive emergency.

Mashed potatoes, ground beef patty, corn, green beans, apple pie

💠 Fresh, unprocessed meats and vegetables are low in tyramine and safe for MAOI therapy.

💠 This meal avoids aged, fermented, cured, or overripe foods, making it appropriate for a tyramine-restricted diet.

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Answer 3

Correct Answers:

The client has congestive heart failure (CHF) and is taking furosemide (Lasix).

Rationale :

💠 Lithium is excreted almost entirely by the kidneys, so any condition or medication that alters renal function directly affects serum lithium levels.

💠 Loop diuretics such as furosemide increase sodium loss, and because lithium follows sodium, the kidneys reabsorb more lithium, raising blood levels.

💠 Congestive heart failure reduces renal perfusion, making lithium clearance less predictable and increasing accumulation risk.

💠 Fluid shifts and dehydration, which are common in CHF management, further destabilize lithium concentrations.

💠 This combination makes frequent serum monitoring essential, as lithium toxicity can develop rapidly even at previously therapeutic doses.

Arthritis treated with acetaminophen

Acetaminophen does not significantly affect lithium levels

💠 Acetaminophen does not alter renal sodium handling, unlike NSAIDs or diuretics.

💠 It is generally considered safe for pain control in clients receiving lithium.

Epilepsy treated with diazepam

Diazepam has no direct effect on lithium clearance

💠 Benzodiazepines do not impact renal function or sodium balance.

💠 While CNS effects should be monitored, lithium serum levels are not directly affected.

Psoriasis treated with topical triamcinolone

Topical corticosteroids have minimal systemic absorption

💠 Topical use does not significantly influence fluid or electrolyte balance.

💠 This therapy does not interfere with lithium pharmacokinetics.

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Answer 4

Correct Answers:

“SSRIs increase serotonin concentration by making more serotonin available in the synaptic cleft.”

Rationale :

💠 SSRIs block the serotonin reuptake transporter (SERT) on the presynaptic neuron, preventing serotonin from being taken back up.

💠 This action increases serotonin concentration in the synaptic cleft, allowing prolonged interaction with postsynaptic receptors.

💠 Enhanced serotonergic signaling improves mood regulation, sleep, appetite, and emotional processing over time.

💠 The therapeutic effect is functional availability, not immediate neurotransmitter production or receptor creation.

💠 Clinical improvement typically occurs after adaptive receptor and signaling changes with continued use.

“SSRIs increase the production of serotonin within the presynaptic neuron.”

Production is not the primary target

💠 SSRIs do not stimulate synthesis of serotonin from tryptophan.

💠 Their effect is post-release, focused on reuptake inhibition.

“SSRIs cause an increase in the number of serotonin receptors at the postsynaptic terminal.”

Receptor number changes are indirect and delayed

💠 SSRIs do not directly increase receptor density.

💠 Any receptor adaptations occur secondarily over weeks, not as the core mechanism.

“SSRIs block muscarinic and alpha-1 norepinephrine receptors to improve mood.”

This describes older antidepressants

💠 Muscarinic and alpha-1 blockade is characteristic of tricyclic antidepressants, not SSRIs.

💠 SSRIs are highly selective for serotonin reuptake, minimizing these effects.

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Answer 5

Correct Answers:

Psychoanalysis

Rationale :

💠 Free association is a hallmark technique used to allow unconscious thoughts and feelings to surface without censorship.

💠 Dream analysis is central to exploring unconscious desires, fears, and internal conflicts influencing behavior.

💠 Transference is intentionally facilitated so clients project unconscious feelings onto the therapist for insight and resolution.

💠 Therapy is long-term and intensive, often lasting years, with frequent sessions aimed at deep psychological restructuring.

💠 The goal is insight into unconscious processes, leading to enduring changes in personality and emotional functioning.

Behavioral therapy

💠 Emphasizes conditioning and reinforcement, not insight or dream interpretation.

💠 Therapy is usually short-term and goal-focused, unlike the prolonged process described.

Cognitive therapy

💠 Focuses on identifying and restructuring distorted thinking, not unconscious conflict.

💠 Does not use free association or transference as core techniques.

Interpersonal Therapy (IPT)

💠 Focuses on present interpersonal issues, not childhood or unconscious dynamics.

💠 Typically time-limited and structured, unlike psychoanalysis.

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Answer 6

Correct Answers:

GABA inhibitory effects

Rationale :

💠 GABA is the primary inhibitory neurotransmitter, and enhancing its action suppresses neuronal excitability, explaining the client’s persistent drowsiness and CNS slowing.

💠 Increased GABA activity leads to sedation and anxiolysis, which commonly present with headaches and fatigue during early therapy.

💠 Peripheral vasodilation and reduced sympathetic tone can occur, accounting for the transient drop in blood pressure after dosing.

💠 GI discomfort and constipation may result from central inhibition of autonomic output, slowing gastrointestinal motility.

💠 Paresthesias (tingling) can reflect central sensory dampening associated with enhanced inhibitory signaling.

Dopamine-blocking effects

💠 Dopamine blockade more commonly causes extrapyramidal symptoms rather than generalized sedation with hypotension.

💠 It does not explain enhanced inhibitory neurotransmission as described.

Serotonin stimulating effects

💠 Serotonergic agents often cause GI upset or agitation, not the pronounced sedation and hypotension seen here.

💠 They do not directly enhance inhibitory CNS tone.

Anticholinergic effects

💠 Anticholinergic actions cause dry mouth, urinary retention, blurred vision, not tingling with CNS inhibition.

💠 These effects do not match a GABA-enhancing mechanism.

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Answer 7

Correct Answers:

Based on Maslow’s hierarchy of needs theory, client safety is in jeopardy, endotracheal tube removal by client might lead to trauma and possible death. Sedation is indicated to promote security and safety.

Rationale :

💠 Airway protection and oxygenation are at the top of Maslow’s hierarchy, and the client is already in acute respiratory failure requiring mechanical ventilation.

💠 Combative behavior with attempts to remove the endotracheal tube places the client at immediate risk of hypoxia, airway trauma, and cardiopulmonary arrest.

💠 Propofol (Diprivan) provides rapid-onset sedation, reducing agitation and preventing self-extubation, which could be fatal in this unstable patient.

💠 Sedation helps ensure synchrony with the ventilator, improving oxygen delivery and reducing the work of breathing.

💠 Promoting security and safety aligns directly with Maslow’s physiological and safety needs, which must be met before any higher-level needs.

Unit functionality and nurse dynamics

Focuses on staff convenience rather than patient survival

💠 Maslow prioritizes patient physiologic needs, not workflow efficiency.

💠 Sedation is never justified to improve unit dynamics.

Sedation will not do much harm

Minimizes respiratory risk and misapplies Maslow’s theory

💠 Sedation is used to prevent harm, not because harm is inevitable.

💠 This rationale ignores the life-threatening risk of self-extubation.

Interpersonal relationships and communication

Misrepresents Maslow’s hierarchy

💠 Interpersonal needs are lower priority than airway and safety.

💠 Removing the endotracheal tube would endanger life, not improve communication.

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Answer 8

Correct Answers:

Pseudo parkinsonism... MD will lower the antipsychotic dose and add an anticholinergic agent.

Rationale :

💠 Fluphenazine strongly blocks dopamine (D2) receptors, particularly in the nigrostriatal pathway, leading to extrapyramidal symptoms.

💠 Shuffling, propulsive gait reflects impaired motor initiation and rigidity similar to Parkinson disease.

💠 Masklike facial expression results from reduced facial muscle movement caused by dopamine inhibition.

💠 Drooling occurs due to impaired oral motor control and decreased swallowing coordination.

💠 The expected intervention is to reduce the antipsychotic dose and add an anticholinergic agent (e.g., benztropine) to rebalance dopamine–acetylcholine activity.

Serotonin syndrome

💠 This condition is caused by excess serotonin, not dopamine blockade.

💠 It presents with hyperthermia, clonus, diaphoresis, and autonomic instability, which are absent in this client.

Neuroleptic malignant syndrome (NMS)

💠 NMS is a medical emergency marked by high fever, lead-pipe rigidity, altered mental status, and elevated CK.

💠 The client shows localized motor slowing without systemic instability, making NMS unlikely.

Akathisia

💠 Akathisia is defined by subjective inner restlessness and inability to remain still, not rigidity or bradykinesia.

💠 This client demonstrates slowed, stiff movement, which is inconsistent with akathisia.

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Answer 9

Correct Answers:

Oral

Rationale :

💠 Freud’s oral stage (birth–18 months) focuses on gratification through oral activities such as sucking and feeding.

💠 Fixation at the oral stage can occur when needs are overgratified or undergratified, disrupting normal development.

💠 Adults with oral fixation may develop manipulative behaviors as a way to ensure their needs are met by others.

💠 Suspiciousness and dependency are common traits, reflecting insecurity and fear of abandonment rooted in early infancy.

💠 Using others to satisfy personal desires aligns with oral-dependent or oral-aggressive personality characteristics.

Genital stage

💠 This stage centers on mature sexual intimacy and balanced relationships, not manipulation.

💠 Fixation here does not produce dependency or exploitative behaviors.

Anal stage

💠 Anal fixation is associated with control, rigidity, stubbornness, or excessive orderliness.

💠 Manipulation to meet emotional needs is not a defining feature of this stage.

Phallic stage

💠 This stage involves identity formation and Oedipal conflict resolution.

💠 Fixation may cause vanity or recklessness, not dependency-driven manipulation.

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Answer 10

Correct Answers:

Limbic System

Rationale :

💠 The limbic system is the primary center for emotional regulation, and dysfunction leads to sudden anger, excessive crying, and inappropriate laughter, as described.

💠 Structures within the limbic system, especially the amygdala and hippocampus, are essential for emotional processing and memory formation, explaining both mood instability and memory gaps.

💠 Impairments in short-term and long-term memory, including difficulty forming new memories and retrieving old ones, are classic findings with hippocampal involvement.

💠 Apathy, loss of motivation, and decreased interest in pleasurable activities reflect disruption of limbic connections involved in reward and drive.

💠 The absence of motor, balance, or coordination deficits supports involvement of a behavioral–emotional network, rather than motor-control brain regions.

Prefrontal Cortex

💠 This region is responsible for executive function, decision-making, and impulse control, not primary emotional expression.

💠 Isolated prefrontal dysfunction would not explain significant memory formation and retrieval deficits.

Cerebellum

💠 The cerebellum primarily regulates coordination, balance, and fine motor control.

💠 Normal gait and intact coordination make cerebellar involvement unlikely.

Temporal Lobe

💠 While the temporal lobe contributes to memory and auditory processing, it does not independently regulate emotional intensity and motivation.

💠 The emotional symptoms described require involvement of integrated limbic structures, not cortical temporal areas alone.

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QLexNursing

9 :
A nurse assesses that a client is suspicious and frequently manipulates others to satisfy his own desires. Using the Freudian theory, these traits are related to which psychosexual stage?

QLexNursing

9 : A nurse assesses that a client is suspicious and frequently manipulates others to satisfy his own desires. Using the Freudian theory, these traits are related to which psychosexual stage?

9 :
A nurse assesses that a client is suspicious and frequently manipulates others to satisfy his own desires. Using the Freudian theory, these traits are related to which psychosexual stage?