The nurse prepares to assess a patient diagnosed with major depressive disorder for disturbances in circadian rhythms. Which question should the nurse ask this patient?

Correct Answer: B

Rationale: The correct answer is B because asking about the patient's worst and best times of the day can provide insight into their circadian rhythms, which are often disrupted in major depressive disorder. By understanding when the patient feels most and least energized, the nurse can assess their sleep-wake cycle and potential issues with sleep patterns. A: Asking about hallucinations is not relevant to assessing circadian rhythms in major depressive disorder. C: Inquiring about thinking patterns may provide information on cognition but not specifically related to circadian rhythm disturbances. D: Asking about memory issues is important but not directly related to assessing circadian rhythms in major depressive disorder.

Correct Answer: D

Rationale: The correct answer is D: Benzodiazepines. Benzodiazepines are the first-line medication for acute anxiety due to their rapid onset of action and effectiveness in reducing anxiety symptoms. They work by enhancing the effects of the neurotransmitter GABA, which helps to calm the central nervous system. Tricyclic antidepressants (A) are not typically used for acute anxiety and have a slower onset of action. Antipsychotic drugs (B) are not indicated for anxiety and are more commonly used for psychotic disorders. Mood stabilizers (C) are used to manage mood disorders like bipolar disorder and are not typically used for acute anxiety. In summary, benzodiazepines are the most appropriate choice for managing acute anxiety in this scenario due to their rapid action and effectiveness in reducing anxiety symptoms.

Correct Answer: D

Rationale: Step 1: Phenothiazine medications have a strong dopaminergic effect, which can result in extrapyramidal side effects such as muscle movement changes. Step 2: Teaching the patient to report changes in muscle movement is crucial to monitor for potential side effects. Step 3: Chewing sugarless gum is not directly related to the dopaminergic effect of the drug. Step 4: Increasing dietary fiber is not specifically relevant to the dopaminergic effect of the drug. Step 5: Arising slowly from bed is more related to orthostatic hypotension, a common side effect of phenothiazines, rather than the dopaminergic effect.

Correct Answer: C

Rationale: The correct answer is C: phenelzine. Phenelzine is a monoamine oxidase inhibitor (MAOI) antidepressant that requires dietary restrictions to avoid tyramine-containing foods. Tyramine-rich foods can cause a hypertensive crisis when combined with MAOIs. The other medications listed do not have specific dietary restrictions related to their use. Haloperidol is an antipsychotic, carbamazepine is an anticonvulsant, and trazodone is an antidepressant, none of which necessitate a special diet. Therefore, the nurse should order a special diet for the patient taking phenelzine to prevent potential adverse reactions.

Correct Answer: A

Rationale: The correct answer is A. A white blood cell count of 3000 mm3 in a patient taking clozapine is concerning for agranulocytosis, a potentially life-threatening side effect. The nurse should report these results to the health care provider immediately for further evaluation and possible discontinuation of the medication. Administering the next dose (B) can worsen the condition. Giving aspirin and forcing fluids (C) is not indicated for this situation. Repeating the laboratory test (D) may delay necessary intervention.