326 EXAM 1 MEDS

A nurse is assessing for the presence of extrapyramidal side effects (EPS) in a client who is taking chlorpromazine. Which of the following findings should the nurse recognize as EPS? (Select all that apply) 1. Muscle spasms of the neck 2. Fidgeting behavior 3. Blurred vision 4. Tremors of the hands 5. Sexual dysfunction

1. Muscle spasms of the neck 2. Fidgeting behavior 4. Tremors of the hands

A nurse is teaching a female client who has anxiety disorder about alprazolam. Which of the following information should the nurse include in the teaching? A. "Use a reliable form of contraception while taking this medication." B. "If a dose is missed, double the next dose of medication." C. "This medication may increase your blood pressure." D. "Do not eat aged cheeses while taking this medication."

A. "Use a reliable form of contraception while taking this medication." - Alprazolam is a pregnancy category D medication, indicating it causes definitive adverse effects on a fetus.

A nurse is teaching a client who has depressive disorder about fluoxetine. Which of the following information should the nurse include in the teaching? A. "You may experience a decreased sex drive while taking this medication." B. "You will notice an improvement in your depressive symptoms in 2 to 3 days." C. "You may notice that you have less appetite while taking this medication." D. "You may experience drooling while taking this medication."

A. "You may experience a decreased sex drive while taking this medication." - Fluoxetine can cause decreased libido and impotence in men.

A nurse is reviewing abnormal laboratory values for four clients who have schizophrenia and take clozapine. For which of the following clients should the nurse withhold the medication and notify the provider immediately to have clozapine therapy discontinued? A. A client who has a WBC of 2,900 cells/mm3 B. A client who has a hematocrit of 55% C. A client who has a serum potassium of 3.3 mEq/L D. A client who has a BUN of 22 mg/dL

A. A client who has a WBC of 2,900 cells/mm3 - A white blood cell count of 2,900 cells/mm3 is below the normal reference range of 5000 to 10000 cells/mm3. The client who takes clozapine is at risk for agranulocytosis; therefore, a client who has a WBC of less than 3000 mm3 should have clozapine withheld and treatment stopped until the WBC returns to normal. Clozapine should be permanently stopped if a client's WBC falls below 2000 mm3.

A nurse is caring fro a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects? A. Dysrhythmias B. Cataracts C. Pancreatitis D. Bleeding

A. Dysrhythmias - Cardiac dysrhythmias are a risk for clients taking haloperidol and other conventional antipsychotic medications. The client should be monitored for changes in vital signs, tachycardia, and ECG changes, including prolonged QT interval, while taking haloperidol. There is a risk for cardiac arrest due to torsades de pointes.

A nurse is caring for a client who has been hospitalized for treatment of bipolar disorder and will be discharged with a prescription of lithium. The nurse's discharge teaching should include information cautioning against which of the following factors that may cause lithium toxicity? A. Experiencing diarrhea B. Exercising moderately C. Increasing sodium intake D. Drinking green tea

A. Experiencing diarrhea - Lithium is used to treat the manic stage of bipolar disorder. Toxicity occurs when the level of lithium in the blood becomes too high. A low sodium level, or factors which result in a low sodium level, (such as dehydration, diarrhea, sweating, excess exercise in hot weather, diuretic use, a low sodium diet) increases the lithium level because the kidney processes sodium and lithium in the same way. If sodium levels fall, the body conserves lithium, causing lithium levels to rise.

A nurse is caring for a client who has a serum lithium level of 2.0 mEq/L. Which of the following is the priority action for the nurse to take? A. Notify the primary provider the result indicates toxicity. B. Continue to monitor this expected maintenance level. C. Request the provider increase the client's medication dose. D. Check the client for manifestations of hypernatremia.

A. Notify the primary provider the result indicates toxicity. - The therapeutic reference range for lithium is 0.8-1.4 mEq/L. The nurse should recognize the client could require hospitalization and report the finding to the provider. The nurse should check the client for findings associated with advanced to severe lithium toxicity like vision changes, neurological impairment, and hypotension.

A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements? A. Sodium B. Potassium C. Vitamin K D. Vitamin C

A. Sodium - Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity.

A nurse is providing discharge teachings to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse should teach the client that which of the following factors puts her at risk for lithium toxicity? A. The client runs 4 miles outdoors every afternoon. B. The client drinks 2 liters of liquids daily. C. The client eats 2 to 3 gm of sodium-containing foods daily. D. The client eats foods high in tyramine.

A. The client runs 4 miles outdoors every afternoon. - Strenuous exercise in outdoor heat, which can lead to dehydration, puts the client at risk for lithium toxicity. Mild to moderate exercise will not lead to lithium toxicity, but if the client engages in strenuous exercise during hot weather, she should take care to replace any water and sodium that have been lost through profuse sweating. This also applies to other factors that can cause the client to become dehydrated, such as having diarrhea or taking diuretics.

A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed? A. Thyroid hormone assay B. Liver function tests C. Erythrocyte sedimentation rate D. Brain natriuretic peptide

A. Thyroid hormone assay - Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction

A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred vision and ataxia. Which of the following actions should the nurse take? A. withhold the medication B. Prepare to administer propranolol C. administer the next dose as prescribed D. Plan to administer levothyroxine

A. withhold the medication - The nurse should withhold the medication, because the client is displaying manifestations of toxicity, which includes ataxia, confusion, large output of dilute urine, blurred vision, clonic movements, seizures, stupor, severe hypotension, and coma. Pulmonary complications may lead to death.

A nurse is an acute care mental health facility is preparing to administer morning medications for a client who has been taking lithium for 2 weeks and has a current lithium level of 1.0 mEq/L. Which of the following actions should the nurse take? A. Prepare for gastric lavage due to an extremely elevated lithium level. B. Administer the morning dose of lithium. C. Check the client's medication record to assess whether the client has been refusing her lithium. D. Hold the medication and assess for early manifestations of toxicity.

B. Administer the morning dose of lithium. - The nurse should administer the lithium dose since a lithium level of 1.0 mEq/L is within the expected initial therapeutic range of 0.8 to 1.3 mEq/L. At a therapeutic level the client might demonstrate adverse effects of lithium, such as a fine hand tremor, thirst, and mild nausea, and the nurse should note if any of these manifestations are present. The nurse should continue to monitor for adverse effects and signs of toxicity, which usually occur at levels of 1.5 mEq/L or higher.

A nurse is modifying the diet of a client who has Parkinson's disease and is prescribed selegiline, an MAOI. Which of the following foods should the nurse eliminate? A. Fresh fish B. Cheddar cheese C. Cherries D. Chicken

B. Cheddar cheese - The nurse should eliminate aged cheeses from the diet of a client who is prescribed selegiline. Cheddar cheese contains tyramine, which can cause a hypertensive crisis.

A nurse reviews the laboratory report for a client who is receiving lithium three times daily PO. The clients current blood lithium level is 1.8 mEq/L. The nurse identifies that this lab value indicates which of the following? A. A blood lithium level of 1.8 mEq/L is not within the maintenance treatment level. B. The lithium level is at the toxic level. C. The lithium level is below the therapeutic treatment level. D. The lithium level is within the therapeutic level for initial treatment.

B. The lithium level is at the toxic level. - A blood lithium level greater than 1.5 mEq/L indicates toxicity. The nurse should monitor the client for GI manifestations, coarse hand tremor, confusion, drowsiness, and should withhold the lithium and notify the provider. A therapeutic initial blood level of lithium is 0.8 to 1.4 mEq/L. Blood levels for lithium maintenance should be between 0.4 and 1.3 mEq/L.

A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which the following statements by the client indicates an understanding of the teaching? A. "I will report any loss of appetite." B. "Increased flatulence is an indication of toxicity." C. "Vomiting is an indication of toxicity." D. "I will call my provider if I experience any headaches."

C. "Vomiting is an indication of toxicity." - Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider.

A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk B. Celery sticks C. Bologna sandwich D. Sliced apples

C. Bologna sandwich - Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided.

A nurse is evaluating teaching for a client who has newly diagnosed depression & a new prescription for bupropion. Which of the following statements by the client indicates understanding of the teaching? A. I may develop a slow heartbeat while taking bupropion. B. I can drink one glass of wine with dinner each day while taking bupropion. C. I may not notice a lifting of my mood for at least 2 weeks. D. I should watch for increased salivation and drooling while taking bupropion.

C. I may not notice a lifting of my mood for at least 2 weeks. - Bupropion is a atypical antidepressant. As with other antidepressants, it can take 2 to 4 weeks for therapeutic effects to occur when taking bupropion.

A nurse is teaching a client who has depression about a new prescription for fluoxetine 20 mg daily. Which of the following statements by the client indicates understanding of the teaching? A. I should expect relief from depression within 3 to 4 days. B. I will take my fluoxetine at bedtime so I can sleep better. C. I should notify my provider if I develop a skin rash. D. I will notice an improvement in my sex drive.

C. I should notify my provider if I develop a skin rash.

A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity? A. Constipation B. Urinary retention C. Muscle weakness D. Hyperactivity

C. Muscle weakness

A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? A. "I should expect to feel better after 24 hours of starting this medication." B. "I should not take this medicine with grapefruit juice." C. "I'll take this medicine with food." D. "I'll take this medicine first thing in the morning."

D. "I'll take this medicine first thing in the morning." - The client should take fluoxetine in the morning to reduce the risk for insomnia.

A nurse is assessing a client who is taking bupropion. The nurse recognizes which of the following findings as an indication that the medication is effective? A. Increased weight gain B. Increased urinary output C. Decreased sexual function D. Decreased urge to smoke

D. Decreased urge to smoke - Bupropion is an antidepressant, also used for smoking cessation

A nurse is planning to administer haloperidol to a client who has acute psychosis. The nurse should monitor the client for which of the following findings as an adverse effect of the medication? A. Excess salivation B. Increased agitation C. Diarrhea D. Dystonia

D. Dystonia - The nurse should monitor the client for dystonia after administering Haloperidol. Dystonia is a repetitive muscular contraction that may cause twisting of the body.

A nurse is caring for a client who has schizophrenia and generalized anxiety disorder. The client has a prescription for alprazolam 0.25 mg PO every 8 hr PRN anxiety. For which of the following client statements should the nurse consider administering alprazolam? A. The client states, "I see purple bugs crawling on the wall. B. The client tells the nurse that he is too tired to attend the group meeting. C. The client tells the nurse he is a government agent. D. The client states, "My heart is pounding out of my chest."

D. The client states, "My heart is pounding out of my chest." - Alprazolam is a benzodiazepine and is used to treat anxiety. The medication works in the central nervous system to decrease the severity of panic attacks, decrease anxiety and insomnia, and promote relaxation of muscles. Physiological symptoms of anxiety as it reaches the panic level often include tension, impatience, apprehension, increased heart and respiratory rates, confusion, feelings of impending doom, and extreme fright and horror. Expected adverse effects of alprazolam are dizziness, lightheadedness, and drowsiness. The nurse should closely monitor the client and assist the client with ambulation and self-care needs.

A nurse is assessing a client who has schizophrenia which has been treated with fluphenazine for several years. Which of the following findings should the nurse document as manifestations of tardive dyskinesia (TD)? A. Shuffling gait B. Constant tapping of feet when sitting C. Sudden onset of high fever D. Twisting tongue movements

D. Twisting tongue movements - Twisting tongue movement, tics, sudden involuntary jerking movements of the extremities, and other findings occur in TD. The nurse should notify the provider of these findings since treatment includes reducing dosage of antipsychotic medications or perhaps changing to a second-general antipsychotic medication.