Exam 4: Psych Medications

*Question:*The nurse identifies which most common serious adverse effect of TCA therapy? A. Excitation B. Orthostatic hypotension C. Skin rash D. Sexual dysfunction

Correct answer: *B* Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

*Question:*The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

Correct answer: *A* Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

*Question:*A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? A. Aged cheese and sherry B. Grapefruit and other citrus juices C. Coffee, colas, and tea D. Potato and corn chips

Correct answer: *A* Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

*Question:*Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders? (Select all that apply.) A. Alcoholism B. Bulimia C. Schizophrenia D. Hypertension E. Glucocorticoid-induced psychosis

Correct answer: *A B C E* Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).

*Question:*The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? A. Lithium B. Risperidone C. Venlafaxine [Effexor]

Correct answer: *A* Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

*Question:*The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? (Select all that apply.) A. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." B. "When you stop taking this medication, you should not withdraw it abruptly." C. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." D. "This medication often causes drowsiness. You should take it at bedtime." E. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

Correct answer: *A B E* Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

*Question:*The nurse knows that which statements about postpartum depression are true? (Select all that apply.) A. About 80% of women experience depressive symptoms after giving birth. B. Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. C. Monoamine oxidase inhibitors are the first-line agents of choice for the treatment of postpartum depression. D. Once a woman has had postpartum depression, it will not recur with future deliveries. E. Sertraline [Zoloft] is the drug of choice for treating postpartum depression in breast-feeding mothers.

Correct answer: *A B E* The drug of choice for postpartum depression is an SSRI, such as sertraline [Zoloft], because these drugs are effective, well tolerated, and present little risk of toxicity if taken in overdose. If a woman has responded to another antidepressant in the past, that drug should be used first. The risk of relapse is high, as is the risk of postpartum depression with subsequent pregnancies. The statements in options C and D are false.

*Question:*Which of the following statements about bupropion are true? (Select all that apply.) A. Bupropion can reduce behavioral symptoms of ADHD. B. Bupropion is more effective than stimulants. C. Bupropion lacks the adverse effects associated with tricyclic antidepressants. D. Bupropion poses a risk for seizures. E. Bupropion is considered a second-line drug for ADHD.

Correct answer: *A C D E* Bupropion [Wellbutrin] can reduce behavioral symptoms of ADHD but is less effective than stimulants. The drug lacks the adverse effects associated with tricyclic antidepressants (eg, cardiotoxicity, anticholinergic effects) but does pose a risk of seizures.

*Question:*When teaching the patient and family about clozapine therapy, which statements should the nurse include? (Select all that apply.) A. "It is important for you to obtain ordered blood tests when taking this medication." B. "Most patients who take this medication lose weight, so you should increase the number of calories you consume each day." C. "If you experience increased urination, increased thirst, or increased appetite, contact your healthcare provider." D. "Inform your healthcare provider if you are taking any medications to control seizures." E. "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations."

Correct answer: *A C D E* Clozapine can cause agranulocytosis. Patients should be taught that clozapine will not be dispensed without repeated proof of blood counts. Patients taking clozapine are at increased risk of weight gain and dyslipidemia; they should be taught about the risk of weight gain and encouraged to control caloric intake and get regular exercise. Patients should be informed about early signs of infection (fever, sore throat, fatigue, mucous membrane ulceration) and instructed to notify their healthcare provider immediately if these should develop. Patients taking clozapine are at increased risk for the development of diabetes mellitus; they should be taught about the symptoms of diabetes (eg, hyperglycemia, polyuria, polydipsia, polyphagia, dehydration) and instructed to contact the prescriber if these occur. Clozapine should be used with caution in patients with seizure disorders. In rare cases, clozapine causes myocarditis; patients should be informed about the signs and symptoms (eg, unexplained fatigue, dyspnea, tachypnea, chest pain, palpitations) and advised to seek immediate medical attention if these develop. Clozapine should be withheld until myocarditis has been ruled out. If myocarditis is diagnosed, the drug should never be used again.

*Question:*The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? A. "When it is time to discontinue this drug, you will need to taper it off slowly." B. "Protect your skin from the sun to prevent rash and exaggerated sunburn." C. "Increase your intake of fluid and high-fiber foods to prevent constipation." D. "Take this medication on an empty stomach at least 2 hours after meals."

Correct answer: *A* Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

*Question:*A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used in the treatment of severe manic episodes to do what? A. Help control symptoms during the severe manic episode B. Elevate mood during the severe manic episode C. Produce sedating effects during the severe manic episode D. Reduce the amount of physical pain the patient experiences during the severe manic episode

Correct answer: *A* Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

*Question:*Which statement about aripiprazole would the nurse identify as true? A. It is the first representative of a unique class of antipsychotic drugs called dopamine system stabilizers. B. It must be administered on an empty stomach. C. Gynecomastia is a common adverse effect. D. It is safe to use in older adult patients with dementia-related psychosis.

Correct answer: *A* Aripiprazole is well absorbed in the presence and absence of food, and gynecomastia is not a side effect. Increased mortality is seen when aripiprazole is used in the treatment of older adult patients with dementia-related psychosis.

*Question:*Which statement will the nurse include when teaching a patient about atomoxetine [Strattera]? A. Atomoxetine has no potential for abuse. B. Atomoxetine is a central nervous system stimulant. C. Atomoxetine exerts its therapeutic effect by increasing the release of dopamine. D. Atomoxetine is not approved for the treatment of adults with attention-deficit/hyperactivity disorder.

Correct answer: *A* Atomoxetine [Strattera] is a nonstimulant drug. It increases the release of norepinephrine, and it is approved for the treatment of adults with attention-deficit/hyperactivity disorder. It has no potential for abuse.

*Question:*The nurse is teaching a patient with attention-deficit/hyperactivity disorder (ADHD) about his prescription for methylphenidate [Ritalin LA]. Which statement by the patient indicates that the teaching was effective? A. "I will take my medication once per day in the morning." B. "I will chew this medication and take it with my ice cream." C. "I will take this medication right before my evening meal." D. "I will use an alarm to remind me to take this medicine three times daily."

Correct answer: *A* Ritalin LA is an extended-release formulation designed to be taken once daily. It should be taken in the morning and should not be crushed or chewed.

*Question:*The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? A. To reduce the risk of suicide with overdose B. To avoid weight gain and other gastrointestinal (GI) effects C. To help prevent sexual dysfunction D. To prevent the risk of serotonin syndrome

Correct answer: *A* The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

*Question:*The healthcare provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer? A. 0.25 B. 0.5 C. 1 D. 4

Correct answer: *A* The available medication is 2 mg/mL. Divide 2 mg/mL by 4/4 to equal 0.5 mg/0.25 mL. This is the same as recognizing that 2 mg/mL equals 1 mg/0.5 mL, which equals 0.5 mg/0.25 mL. Continue dividing the top and bottom numbers in half.

*Question:*The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? A. Sodium level of 128 mEq/L B. Prothrombin time of 8 seconds C. Blood urea nitrogen level of 25 mg/dL D. Potassium level of 5.6 mEq/L

Correct answer: *A* The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

*Question:*Which statement about tricyclic antidepressants for ADHD is true? A. TCA drugs decrease hyperactivity. B. TCA drugs decrease inattention. C. TCA drugs work rapidly. D. TCA drugs can be taken as needed (PRN).

Correct answer: *A* These drugs decrease hyperactivity but have little effect on impulsivity and inattention. Responses develop slowly. Beneficial effects begin in 2 to 3 weeks and reach a maximum at around 6 weeks. Tolerance frequently develops within a few months. In contrast to the stimulants, which can be discontinued on weekends, antidepressants must be taken continuously.

*Question:*Which statement does the nurse include when teaching a patient about antipsychotic drug therapy? (Select all that apply.) A. "Restrict the use of antipsychotic drugs to 3 months to prevent the development of addiction." B. "Dilute oral preparations in fruit juice to improve their palatability." C. "Store oral preparations in a dark area." D. "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." E. "Take an over-the-counter sleep aid if you have trouble falling asleep at night."

Correct answer: *B C D* Patients should be informed that antipsychotic drugs do not cause addiction and that they should be taken as prescribed. Patients should be instructed to avoid all drugs with anticholinergic properties, including antihistamines and certain over-the-counter sleep aids, to prevent drug interactions. All of the other statements are appropriate to include in teaching the patient about the use of antipsychotic medications.

*Question:*The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? (Select all that apply.) A. The second-generation antipsychotics generally are more effective than the first-generation agents. B. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. C. Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. D. The lipid levels of patients receiving second-generation antipsychotics should be monitored. E. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

Correct answer: *B D E* The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

*Question:*The healthcare provider orders clonidine [Kapvay] 0.1 mg BID for a patient with ADHD. What will the total dose be for a 24-hour period? A. 0.1 mg B. 0.2 mg C. 0.4 mg D. 0.25 mg

Correct answer: *B* BID means twice per day. 0.1 mg times 2 (2 doses in 1 day) equals 0.2 mg.

*Question:*The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? A. Naloxone [Narcan] B. Flumazenil [Romazicon] = C. Acetylcysteine [Mucomyst] D. Vitamin K

Correct answer: *B* Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

*Question:*The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A. A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting B. A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L C. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction D. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

Correct answer: *B* Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

*Question:*The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? A. Depressive psychosis B. Serotonin syndrome C. Escitalopram overdose D. Cholinergic crisis

Correct answer: *B* Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

*Question:*The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? A. Dry mouth B. Temperature of 101°F C. BP of 104/72 mm Hg D. Drowsiness

Correct answer: *B* Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.

*Question:*Which drug does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Fluoxetine [Prozac] D. Desvenlafaxine [Pristiq] E. Sertraline [Zoloft]

Correct answer: *C E* Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

*Question:*The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? A. Blood pressure of 160/90 mm Hg B. Insomnia and diarrhea C. Sedation and dry mouth D. Tachypnea and wheezing

Correct answer: *C* Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

*Question:*The nurse is preparing to administer the aripiprazole extended-release 400-mg injection. The nurse is aware that this medication is scheduled to be given how often? A. Daily B. Weekly C. Monthly D. As needed

Correct answer: *C* Aripiprazole for IM therapy is available in single-use vials (7.5 mg/mL) sold as Abilify, and extended-release injections as Abilify Maintena. The extended-release injection is available in 300-mg and 400-mg doses to be given once monthly.

*Question:*The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? A. Ibuprofen [Motrin] for muscle pain B. Hydrochlorothiazide (HCTZ) for edema C. Aspirin (ASA) for mild headache D. Diphenhydramine [Benadryl] for cold symptoms

Correct answer: *C* Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

*Question:*Which patient would the nurse anticipate being prescribed atomoxetine [Strattera] for ADHD? A. An 18-year-old male effectively being treated with Adderall B. A 10-year-old female with no previous treatment for ADHD C. A 24-year-old male with a history of stimulant abuse D. A 30-year-old female with a history of depression and ADHD

Correct answer: *C* Atomoxetine is recommended for treatment of ADHD in cases where there may be concern for stimulant abuse or there exists a strong aversion to treatment with stimulant medications. Accordingly, because CNS stimulants are more effective and have a long record of safety and efficacy, it would seem prudent to reserve atomoxetine for patients who are unresponsive to or intolerant of the stimulants. In the absence of a compelling reason, patients doing well on the stimulants shouldn't switch.

*Question:*A patient is started on a trial of dextroamphetamine/amphetamine [Adderall] for ADHD. What is the most likely nursing diagnosis for inclusion in the plan of care? A. Decreased cardiac output B. Imbalanced nutrition, more than body requirements C. Sleep pattern disturbance D. Diversional activity deficit

Correct answer: *C* Insomnia is a common adverse effect of CNS stimulants.

*Question:*The nurse is preparing to administer quetiapine extended release 400 mg PO every day as ordered. The available medication is quetiapine 200-mg extended-release tablets. How many tablets should the nurse administer? A. 0.5 B. 1 C. 2 D. 4

Correct answer: *C* The ordered dose is 400 mg, and the available tablets are 200 mg. 200 mg × 2 tablets equals the 400-mg ordered dose.

*Question:*The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? A. 250 mg B. 500 mg C. 750 mg D. 1000 mg

Correct answer: *C* The patient taking a medication every 8 hours will take it three times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.

*Question:*Which agent is most likely to be prescribed today for short-term management of insomnia? A. Secobarbital [Seconal Sodium] B. Meprobamate [Miltown] C. Zolpidem [Ambien] D. Flumazenil [Romazicon]

Correct answer: *C* Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines.

*Question:*Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? A. Norepinephrine B. Acetylcholine C. Serotonin (5-HT) D. Gamma-aminobutyric acid (GABA)

Correct answer: *D* Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

*Question:*The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? A. Blood urea nitrogen level of 25 mg/dL B. Blood glucose level of 60 mg/dL C. Bilirubin level of 2.5 mg/dL D. White blood cell (WBC) count of 2000/mm3

Correct answer: *D* Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

*Question:*A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? A. Consumed some foods high in tyramine B. Not taken the lithium as directed C. Developed tolerance to the lithium D. Developed lithium toxicity

Correct answer: *D* Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

*Question:*A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? A. Dystonia B. Tardive dyskinesia C. Parkinsonism D. Akathisia

Correct answer: *D* Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

*Question:*The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? A. "Have you noticed dry mouth or blurred vision?" B. "Have you had any changes in your urine function?" C. "When was your last bowel movement?" D. "Have you had any changes in your mood or anxiety level?"

Correct answer: *D* In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

*Question:*The nurse is caring for a patient taking dextroamphetamine [Dexedrine]. Which symptom, if present, is most likely an adverse effect of this drug? A. Heart rate of 60 beats per minute B. Respiratory rate of 10 breaths per minute C. Weight gain D. Restlessness

Correct answer: *D* The adverse effects of amphetamines include central nervous system (CNS) stimulation (insomnia, restlessness, talkativeness), weight loss, cardiac stimulation (dysrhythmias, angina, hypertension), and psychosis (paranoia).

*Question:* nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine [Thorazine]? (Select all that apply.) A. An 85-year-old man with Alzheimer's disease B. A 78-year-old man with intractable hiccups C. A 76-year-old woman with severe dementia D. A 48-year-old woman with schizoaffective disorder E. A 30-year-old man with anxiety and depression

Correct answer:*B D* The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups. Antipsychotics are not used for dementia because of increased mortality. Chlorpromazine is not a primary treatment for Alzheimer's disease or depression.

*Question:*The nurse identifies the mechanism of action of the amphetamines as what? (Select all that apply.) A. Causing the release of norepinephrine B. Causing the release of epinephrine C. Causing the release of dopamine D. Inhibiting the reuptake of norepinephrine E. Inhibiting the reuptake of dopamine

Correct answers: *A C D E* The amphetamines act primarily by causing the release of norepinephrine (NE) and dopamine (DA) and partly by inhibiting the reuptake of both transmitters. These actions take place in the CNS and in peripheral nerves. Most pharmacologic effects result from the release of NE.

*Question:*Which statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.) A. Mood stabilizers are used to prevent recurrent manic-depressive episodes. B. Antipsychotics are used to treat depressive episodes. C. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. D. Lithium and valproate are the preferred mood stabilizers for BPD. E. A lithium level of 2.0 mEq/L is considered therapeutic.

Correct answers: *A C D* The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

*Question:*When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? (Select all that apply.) A. Benzodiazepines have a high safety profile. B. Benzodiazepines have a significant ability to depress central nervous system (CNS) function. C. Benzodiazepines are associated with a high suicide potential. D. Benzodiazepines have a low ability to cause tolerance. E. Benzodiazepines have a low abuse potential.

Correct answers: *A D E* Statements A, D, and E are true. Compared to barbiturates, benzodiazepines have a low suicide potential and low ability to cause CNS depression