Pharm Additional Chapters + 10 Random Question on Antidepressants

Which neurotransmitter communicates between nerves and muscles? A) Acetylcholine B) Dopamine C) Gamma-aminobutyric acid (GABA) D) Serotonin

Ans: A Feedback: Acetylcholine, which communicates between nerves and muscles, is also important as the preganglionic neurotransmitter throughout the autonomic nervous system and as the postganglionic neurotransmitter in the parasympathetic nervous system and in several pathways in the brain. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual. GABA inhibits nerve activity. Serotonin is important in arousal and sleep.

A nurse is caring for a patient who is having an adverse drug reaction. The patient is experiencing tremors, is unable to hold his or her head up, and is having difficulty sitting up in bed. The nurse suspects that this is due to what? A) An interference with the extrapyramidal system B) A faulty engram C) An alteration in the reticular activating system D) An interference with a neurotransmitter

Ans: A Feedback: The extrapyramidal system coordinates unconscious motor activity that regulates control of position and posture. An engram is a reverberating circuit of action potentials that becomes a long-term, permanent memory in the presence of the proper neurotransmitters and hormones. The reticular activating system, which is located in the hindbrain, controls arousal and awareness of stimuli and contains the sleep center. A neurotransmitter is a chemical that stimulates postsynaptic cells either by exciting or by inhibiting them.

Two nursing students are giving an oral presentation on the forebrain. What information will they include about this area? (Select all that apply.) A) Coordinates speech and communication B) Area where learning takes place C) Houses the extrapyramidal motor system D) Cranial nerves emerge from here. E) The swallowing center is here.

Ans: A, B, C Feedback: The forebrain is made up of two cerebral hemispheres joined together by the corpus callosum. The two hemispheres contain the sensory and motor neurons. It also contains areas that coordinate speech and communication and is thought to be where learning takes place. Cranial nerves emerge from the hindbrain, which is where the swallowing center is located as well.

Ch 19 What part of the neuron carries information into the neuron from other neurons? A) Axon B) Dendrite C) Nucleus D) Soma

Ans: B Feedback: Dendrites carry information to the nerve and axons; they also carry information from a nerve to be transmitted to effector cells, which are found in muscles, glands, or another nerve. Soma refers to the cell body. The nucleus is the central part of a cell, which is responsible for the cells growth, reproduction, and metabolism.

The anatomy and physiology instructor is discussing neurotransmitters with the prenursing anatomy and physiology class. What neurotransmitter would the instructor tell the students is a catecholamine classified as a hormone when it is released from the adrenal medulla? A) Ephedrine B) Norepinephrine C) Dopamine D) Acetylcholine

Ans: B Feedback: Norepinephrine and epinephrine are catecholamines, which are released by nerves in the sympathetic branch of the autonomic nervous system and are classified as hormones when they are released from cells in the adrenal medulla. Therefore, options A, C, and D are incorrect.

The nurse is caring for a patient with meningitis who is not responding to the prescribed antibiotic and whose condition continues to deteriorate. What rationale will the nurse give the family to explain why the antibiotic is not as effective as it was hoped? A) The meninges do not have a blood supply. B) The bloodbrain barrier prevents the antibiotics from crossing into the brain. C) The circle of Willis redirects the antibiotic elsewhere. D) The pressure in the hindbrain prevents entry into the skull.

Ans: B Feedback: The bloodbrain barrier works to keep large molecules out of the brain and away from the nerves. Most antibiotics are protein bound and cannot pass through the bloodbrain barrier. When the infection becomes severe, the bloodbrain barrier will stop being effective and the antibiotics can pass into the brain. The brain has a unique blood supply to protect the neurons from lack of oxygen and glucose. After the bloodbrain barrier allows the antibiotic to pass through, the circle of Willis distributes the blood to the areas of need. If someone has an occluded carotid artery, which could build pressure up in the area, the circle of Willis can redirect the blood supply and provide a full blood supply to the affected areas.

The nurse is caring for a patient who has an injured hindbrain. What would the nurse expect to find altered when assessing the patient? A) Arousal and awareness B) Basic vital functions C) Coordination and motor activity D) Learning and motivation

Ans: B Feedback: The hindbrain contains centers that control basic vital functions (e.g., blood pressure, respirations, vomiting). The reticular activating system in the medulla controls arousal and awareness. Learning and motivation occur in the cerebral cortex. Coordination and motor activity are controlled through the cerebellum and basal ganglia.

Neurotransmission is important in the function of the central nervous system (CNS). For neurotransmission to occur, how do neurons communicate with other cells? A) Selectively B) Chemically C) Excitably D) Accessibly

Ans: B Feedback: The transmission of information between two nerves or between a nerve and a gland or muscle is chemical. Options A, C, and D are incorrect.

When a neuron is stimulated and causes depolarization of the nerve, what occurs? A) Calcium rushes into the cell. B) Sodium rushes into the cell. C) Potassium rushes into the cell. D) Sodium and potassium are actively pumped out to the cell.

Ans: B Feedback: When depolarization occurs, sodium rushes into the cell. During repolarization, potassium is pumped out of the cell and the resting membrane potential is reestablished. Calcium ions decrease the cell membranes permeability to sodium and increase the threshold needed to depolarize the cell.

What neurotransmitter inhibits overexcitability and is important in preventing seizure activity in a patient? A) Acetylcholine B) Dopamine C) Gamma-aminobutyric acid (GABA) D) Serotonin

Ans: C Feedback: GABA is found in the brain and inhibits nerve activity. It is important in preventing overexcitability or stimulation such as seizure activity. Acetylcholine communicates between nerves and muscles. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual. Serotonin is found in the limbic system and is important in arousal and sleep as well as in preventing depression and promoting motivation.

While discussing the central nervous system (CNS), the nursing instructor tells the students that the major inhibitory neurotransmitter in the CNS is what? A) Acetylcholine B) Dopamine C) Gamma-aminobutyric acid (GABA) D) Serotonin

Ans: C Feedback: GABA, which is found in the brain, inhibits nerve activity and is important in preventing overexcitability or stimulation such as seizure activity. Acetylcholine, which communicates between nerves and muscles, is also important as the preganglionic neurotransmitter throughout the autonomic nervous system and as the postganglionic neurotransmitter in the parasympathetic nervous system and in several pathways in the brain. Dopamine is involved in the coordination of impulses and responses, both motor and intellectual. Acetylcholine, dopamine, and serotonin are not the major inhibitory neurotransmitter in the CNS. Serotonin is important in arousal and sleep.

A nurse is working on a surgical unit and has several patients who require preoperative teaching. Which patient demonstrates behavior indicating this is an appropriate time to begin teaching? A) A patient who is wide eyed and extremely frightened about being put to sleep B) A patient who appears to be unconcerned about what is happening and wants to watch his favorite TV show C) A patient who is clearing her throat several times while asking the nurse questions during their conversation and who appears to be slightly stressed D) A patient who is getting up and down from the bed, talking very fast, and appears to be extremely anxious

Ans: C Feedback: Several substances appear to affect learning. Antidiuretic hormone (ADH), which is released during reactions to stress, is one such substance. Although too much stress prevents learning, feeling slightly stressed may increase a persons ability to learn. A patient who is a little nervous about upcoming surgery, for example, seems to display a better mastery of facts about the surgery and postoperative procedures than a patient who is very stressed and scared or one who appears to show no interest or concern.

The nursing instructor is talking about neurotransmitters, including which of these chemicals? A) Calcium ion B) Acetylcholinesterase C) Acetylcholine D) Monoamine oxidase

Ans: C Feedback: The cholinergic system uses acetylcholine as its neurotransmitter. A calcium ion is an electrolyte circulating in the serum. Acetylcholinesterase is an enzyme that breaks down acetylcholine. Monoamine oxidase is an enzyme that breaks down the neurotransmitter norepinephrine.

The physiology instructor is discussing the limbic system. What would the instructor say occurs with stimulation of this area? A) Intelligence B) Heart rate C) Mood D) Reflexes

Ans: C Feedback: The limbic system is an area of the brain that contains high levels of three neurotransmitters: epinephrine, norepinephrine, and serotonin. Stimulation of this area appears to be responsible for the expression of emotions (e.g., anger, pleasure, motivation, stress).

A female patient has experienced a stroke affecting the right side of her brain. What will the nurse expect to assess in this patient? A) Inability to recall the name of her best friend B) Inability to state her telephone number C) Inability to distinguish a spoon from a fork D) Inability to recall how to apply her makeup

Ans: C Feedback: The right side of the brain is the artistic side and is concerned with forms and shapes. This patient could have difficulty distinguishing the roundness of the spoon with the straight line of the top of the fork. The left side of the brain is more analytical and is concerned with names, numbers, and process.

The anatomy and physiology instructor discusses the thalamus with the nursing class. The instructor tells the students that the thalamus does what? A) Relays motor impulses from the cortex to the spinal cord B) Is responsible for voluntary movement C) Sends information into the cerebrum to transfer sensations D) Helps maintain red blood cell (RBC) production

Ans: C Feedback: The thalamus sends direct information into the cerebrum to transfer sensations, such as cold, heat, pain, touch, and muscle sense. Motor fibers from the cortex cross to the other side of the spinal cord before emerging to interact with peripheral effectors. In this way, motor stimuli coming from the right side of the brain affect motor activity on the left side of the body. The limbic system is not responsible for voluntary movement or RBC production.

An 87-year-old woman undergoes extensive surgery for an acoustic neuroma (a benign tumor of the inner ear), and 6 hours after surgery, she hemorrhages and goes into a coma. After awaking and 2 months of therapy, she is transferred to a long-term care facility. Due to damage in the midbrain, the nurse caring for the patient will expect the patient to exhibit what? A) Difficulty in sleeping B) Difficulty in hearing C) Difficulty in distinguishing hot and cold D)Difficulty in speaking

Ans: C Feedback: The thalamus, located in the midbrain, is responsible for temperature control. The patient will have difficulty distinguishing hot and cold. Centers of control for sleep and hearing are found in the hindbrain and areas that control speech and communication are found in the forebrain.

A 46-year-old male patient sustained a closed-head injury 4 hours ago. He presents to the emergency department with difficulty breathing. What area of the brain does the nurse suspect is injured based on the patients symptoms? A) Thalamus B) Cerebrum C) Pituitary D) Medulla oblongata

Ans: D Feedback: The hindbrain, which runs from the top of the spinal cord into the midbrain, is the most primitive area of the brain and contains the brainstem, where the pons and medulla oblongata are located. This area of the brain controls basic vital functions such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; the swallowing center, which coordinates the complex swallowing reflex; and the reticular activating system (RAS), which controls arousal and awareness of stimuli and contains the sleep center. The midbrain contains the thalamus and hypothalamus and the limbic system that transfer sensations into the cerebrum and control temperature. The pituitary gland is known as the master gland, controlling other glands with hormones secreted here.

The nursing instructor explains the limbic system contains what neurotransmitters? A) Acetylcholine, epinephrine, and serotonin B) Gamma-aminobutyric acid, dopamine, and serotonin C) Epinephrine, dopamine, and gamma-aminobutyric acid D) Epinephrine, norepinephrine, and serotonin

Ans: D Feedback: The limbic system contains high levels of epinephrine, norepinephrine, and serotonin. Dopamine, acetylcholine, and gamma-aminobutyric acid are found in the brain but not primarily in the limbic system. Options A, B, and C are incorrect.

What would a nurse describe to a peer as a factor in increasing synaptic transmission? A) Enzymes B) Electrical impulse C) Calcium reaction D) Neurotransmitter

Ans: D Feedback: The nerve axon, called the presynaptic nerve, releases a chemical called a neurotransmitter into the synaptic cleft; the neurotransmitter reacts with a very specific receptor site on the postsynaptic cell to cause a reaction that increases synaptic transmission. Enzymes break down the neurotransmitter. The synaptic transmission is an electrical impulse. Calcium is an electrolyte but does not increase synaptic transmission.

29. The nurse is caring for a patient treated with flumazenil (Anexate) for benzodiazepine toxicity. After administering flumazenil what will the nurse carefully assess for? A) Agitation, confusion, and seizures B) Cerebral hemorrhage and dystonia C) Hypertension and renal insufficiency D) Hypotension, dysrhythmias, and cardiac arrest

Ans: A Feedback: Administration of flumazenil blocks the action of benzodiazepines. If the patient has been taking these medications for an extended period of time, the blockage of the drug's effects could precipitate an acute benzodiazepine withdrawal syndrome with symptoms including agitation, confusion, and seizures. Anexate does not cause cerebral hemorrhage and dystonia, hypertension, renal insufficiency, hypotension, dysrhythmias, and cardiac arrest.

30. The nurse administers promethazine (Phenergan) to the patient before sending the patient to the preoperative holding area. What is the rationale for administration of this drug? A) Sedation B) Oral secretions C) Hypotension and bradycardia D) Confusion

Ans: A Feedback: Antihistamines (promethazine, diphenhydramine [Benadryl]) can be very sedating in some people. They are used as preoperative medications and postoperatively to decrease the need for narcotics. Promethazine is not given for hypotension, bradycardia, confusion, or oral secretions.

17. A 75-year-old patient is brought to the emergency department by his family. The family relates that the patient is complaining of confusion, seizures, and abnormal perception of movement. The nurse reviews all of the medication bottles found in the house and suspects the patient overdosed on what medication? A) Benzodiazepine B) Antihypertensive C) Sedative D) Analgesi

Ans: A Feedback: Common manifestations of benzodiazepine toxicity include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures. These symptoms are not found in association with options B, C, or D.

Ch 20 1. The nurse is caring for a patient in a state of hypnosis, which means the patient is in what state? A) A state of extreme sedation in which the person no longer senses or reacts to incoming stimuli. B) A state of tranquility in which the person can be made to do whatever is suggested by others. C) A feeling of tension, nervousness, apprehension, or fear with high levels of awareness. D) A state in which the brain is no longer sending out signals to the body

Ans: A Feedback: Hypnosis is an extreme state of sedation in which the person no longer senses or reacts to incoming stimuli. A state of tranquility is produced through minor tranquilizers by decreasing anxiety. Anxiety is a feeling of tension, nervousness, apprehension, or fear. Sedation is the loss of awareness and reaction to environmental stimuli, which may lead to drowsiness. The state of suggestibility often seen in television programs is not an appropriate definition of hypnosis. If the brain stopped sending signals, the patient would stop breathing and death would follow.

15. For what purpose would the nurse choose to administer a hypnotic instead of another classification of antianxiety drug? A) Treating insomnia B) Treating seizure disorder C) Treating panic attach D) Treating confusion and agitation

Ans: A Feedback: Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system (RAS) and block the brain's response to incoming stimuli. Hypnotics would not be the most effective drugs to treat seizure disorders, panic attack, or confusion with agitation

33. The nurse is caring for a newborn who was delivered from a woman who took benzodiazepines for anxiety during the last 2 months of her pregnancy after her husband was killed in war. What will the nurse assess for in this newborn? A) Newborn withdrawal syndrome B) Hepatic dysfunction C) Failure to thrive D) Learning deficiencies

Ans: A Feedback: Neonatal withdrawal syndrome may result in a baby born to a mother who was taking benzodiazepines in the final weeks of pregnancy. The neonate may be given very small doses of benzodiazepines that are withdrawn gradually to prevent symptoms. Hepatic dysfunction in the neonate is not associated with use of benzodiazepines. Failure to thrive and learning deficiencies would be long-term problems and are not assessed during the neonatal period.

END of Ch 20 35. The nurse is caring for an older adult in the long-term care facility who has begun to display signs of anxiety and insomnia. What is the priority nursing action? A) Assess the patient for physical problems. B) Call the provider and request an antianxiety drug order. C) Increase the patient's social time, encouraging interaction with others. D) Suggest the family visit more often to reduce the resident's stress level.

Ans: A Feedback: The patient should be screened for physical problems, neurological deterioration, or depression, which could contribute to the insomnia or anxiety. Only after physical problems are ruled out would the nurse consider nondrug measures such as increased socialization with other residents or family members. If nothing else is effective, pharmacological intervention may be necessary.

The nurse is working on the telemetry unit and has noted that many postmyocardial- infarction (MI) patients experience depression. What medication would the nurse question if ordered for one of these patients? A) Amitriptyline B) Escitalopram C) Fluoxetine D) Fluvoxamine

Ans: A Feedback: Amitriptyline is a tricyclic antidepressant (TCA). One contraindication to the use of TCAs includes recent myocardial infarction because of the potential occurrence of reinfarction or extension of the infarct with the cardiac effects of the drug. Selective serotonin reuptake inhibitors would be the safest antidepressant to give so there would be no need to question an order for escitalopram, fluoxetine, or fluvoxamine.

End of Ch 21 The nurse is caring for a young female patient who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate? A) Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk. B) Antidepressants are contraindicated and must be discontinued if pregnancy occurs. C) Antidepressants must be chosen carefully because only a few are safe during pregnancy. D) Most antidepressants are safe during pregnancy but those that are contraindicated should be avoided.

Ans: A Feedback: Antidepressants should be used very cautiously during pregnancy and lactation because of the potential for adverse effects on the fetus and possible neurological effects on the baby. Use should be reserved for situations in which the benefits to the mother far outweigh the potential risks to the neonate.

A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). Page 1 The patient is confused and does not understand why his medication was changed. The nurse's best response to the patient would be what? A) These drugs are similar but some patients respond better to one drug than another. B) Did you take the amitriptyline like you should have? C) Maybe the old medicine wasn't working anymore. D) Clomipramine is newer and will be much better for you.

Ans: A Feedback: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A patient who does not respond to one TCA may respond to another drug from this class. In addition, the nurse might inform the physician of the patient's question so the physician can explain his or her rationale for changing medications. By asking the patient if he took the medication as prescribed, the nurse is insinuating that he may not have and could damage the trusting nursepatient relationship. The nurse has no basis for commenting that the medication might not be working or that another drug would work better

Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD? A) Clomipramine B) Imipramine C) Nortriptyline D) Amitriptyline

Ans: A Feedback: Clomipramine is now also approved for use in the treatment of OCD. Imipramine, nortriptyline, and amitriptyline are not approved for use in treating OCD.

A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD? A) Fluvoxamine B) Phenelzine C) Desipramine D) Amitriptyline

Ans: A Feedback: Fluvoxamine is indicated for the treatment of OCD and is classified as a selective serotonin reuptake inhibitor (SSRI). SSRIs are indicated for the treatment of depression, OCD, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorder, social phobias, and social anxiety disorders. Phenelzine is indicated for depression not responsive to other agents. Desipramine and amitriptyline are tricyclic antidepressants indicated for treatment of depression especially if accompanied by anxiety or sleep disturbances.

A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression. What interaction will the nurse assess for with this drug combination? A) Increased risk of hypoglycemia B) Increased risk of hyperglycemia C) Increase in appetite D) Increased total cholesterol

Ans: A Feedback: MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral diabetic agents. This patient would have to be monitored closely and appropriate dosage adjustments made; he should be taught the importance of more frequent blood sugar monitoring. The drug combination in this question would not cause an increase in appetite or increased total cholesterol.

The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking? A) Monoamine oxidase inhibitors (MAOIs) B) Selective serotonin reuptake inhibitors (SSRIs) C) Tricyclic antidepressants (TCAs) D) Antianxiety antidepressants

Ans: A Feedback: MAOIs have several serious adverse effects that can be fatal. This patient's symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs Page 4 are not associated with these particular symptoms. Antianxiety antidepressants are not a classification of antidepressants

A 75-year-old male patient is brought to the emergency department by his family because he is talking to people who aren't there. During the initial admission assessment, his daughter mentions that her mother died 4 months ago and Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication. What would the nurse suspect is happening to this patient? A) The patient is having hallucinations as an adverse effect of his antidepressant medication. B) The mental status change is due to the patient's age. C) The patient probably has a urinary tract infection. D) The patient is having delusions because of his depression over the loss of his wife.

Ans: A Feedback: Older patients may be more susceptible to the adverse effects of antidepressants from unanticipated central nervous system effects to increased sedation, dizziness, and even hallucinations. Although an infection cannot be ruled out without further testing, the history would lead the nurse to the antidepressants as the most likely cause.

The nurse is caring for an 8-year-old clinic patient who takes imipramine. The nurse assesses the patient who does not have a history for or signs of depression, so the nurse suspects this drug was prescribed as treatment for what? A) Enuresis B) Obsessive compulsive disorder (OCD) C) Peripheral neuropathy D) Panic disorder

Ans: A Feedback: One of the indications for use of the drug imipramine is enuresis in children older than 6 years. Imipramine is not indicated for the treatment of OCD, peripheral neuropathy, or panic disorder.

A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says that she would like to try Sarafem because her friend is taking it and she says it works great. The nurse's best response is what? A) Sarafem and Prozac are different brand names for the same generic medication. B) Before changing drugs it is important to consider how well you responded to Prozac. C) You cannot take both drugs at the same time so it will be important to decide which is best. D) When taking both of these drugs, it is best to take one in the morning and one at night.

Ans: A Feedback: Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the patient's medication regimen and, if taken together, would result in a drug overdose. The other three responses are incorrect or inappropriate because they do not recognize that both drugs are the same.

What drugs would the nurse consider contraindicated for the patient taking a monoamine oxidase inhibitor (MAOI)? A) Selective serotonin reuptake inhibitor (SSRI) B) Insulin C) Acetaminophen D) Docusate (Colace)

Ans: A Feedback: SSRIs are contraindicated because of a life-threatening serotonin syndrome that could occur. If a patient requires insulin the benefit outweighs the risk but careful monitoring of glucose levels is needed because effects of insulin may be additive with an MAOI. There is no known contraindication for acetaminophen or docusate.

16. The nurse assesses the patient who had an abrupt withdrawal of benzodiazepines for withdrawal syndrome and would recognize what symptoms as part of the syndrome? (Select all that apply.) A) Headache B) Nightmares C) Malaise D) Bradycardia E) Hypotensio

Ans: A, B, C Feedback: Abrupt cessation of benzodiazepines may lead to a withdrawal syndrome characterized by nausea, headache, vertigo, malaise, and nightmares. Withdrawal symptoms may be caused by the abrupt separation of benzodiazepine molecules from their receptor sites and the resulting acute decrease in gamma-aminobutyric acid (GABA) neurotransmission. Because GABA is an inhibitory neurotransmitter, less GABA may produce a less inhibited central nervous system (CNS) and therefore symptoms of hyperarousal or CNS stimulation. The nurse would not categorize hypotension or bradycardia as indicating benzodiazepine withdrawal.

34. The nurse is caring for a patient who received a new diagnosis of cancer. The patient exhibits signs of a sympathetic stress reaction. What signs and symptoms will the nurse assess in this patient consistent with an acute reaction to stress? (Select all that apply.) A) Profuse sweating B) Fast heart rate C) Rapid breathing D) Hypotension E) Inability to interact with others

Ans: A, B, C Feedback: Anxiety is often accompanied by signs and symptoms of the sympathetic stress reaction that may include sweating, fast heart rate, rapid breathing, and elevated blood pressure. Chronically anxious people may be afraid to interact with other people but this is not usually seen in an acute stress reaction.

The nurse works in a mental health clinic. When a new patient arrives reporting feelings of depression, what conditions are screened for before prescribing antidepressants? (Select all that apply.) A) Thyroid disease B) Hormonal imbalance C) Cardiovascular disorders D) Parkinson's disease E) Diabetes mellitus

Ans: A, B, C Feedback: Adults using these drugs should have physical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinson's disease or diabetes is manifested by depression.

The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patient's plan of care? (Select all that apply.) A) Recent suicide attempts B) Gastrointestinal (GI) obstruction C) Affect D) Physical pain E) Personal responsibilities

Ans: A, B, C Feedback: When caring for a patient with a diagnosis of depression it is always important for the nurse to assess for recent suicide attempts, suicidal ideation, and any suicidal plans. After starting the medication, as the patient begins to feel better, risk of suicide increases, so ongoing assessment is essential to the patient's safety. Other assessments include allergies, liver and kidney function, glaucoma, benign prostatic hypertrophy, cardiac dysfunction, GI obstruction, surgery, or recent myocardial infarction, all of which could be exacerbated by the effects of the drug. Assess history of psychiatric problems, or myelography within the past 24 hours or in the next 48 hours, or is taking a monoamine oxidase inhibitor to avoid potentially serious adverse reactions. Physical pain and personal responsibilities may be assessed but are not priority assessments unless indicated by other diagnoses.

32. The nurse is teaching a class for nurses working in prenatal clinics about the danger associated with use of benzodiazepines during pregnancy and explains that what fetal anomalies result from maternal use of benzodiazepines during the first trimester of pregnancy? (Select all that apply.) A) Cleft lip or palate B) Inguinal hernia C) Cardiac defects D) Microencephaly E) Gastroschises

Ans: A, B, C, D Feedback: Benzodiazepines are contraindicated in pregnancy because a predictable syndrome of cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, or pyloric stenosis occurs when they are taken in the first trimester. Gastroschises, when the abdominal organs are found outside the abdominal cavity, is not associated with use of benzodiazepine use in the first trimester

31. What reasons can the nurse give for why barbiturates are no longer considered the mainstay for treatment of anxiety? (Select all that apply.) A) Adverse effects are more severe. B) There is an increased risk of physical tolerance. C) There is an increased risk of psychological dependence. D) The most common adverse effects are related to cardiac arrhythmias. E) Hypersensitivity reactions can sometimes be fatal.

Ans: A, B, C, E Feedback: The adverse effects caused by barbiturates are more severe than those associated with other, newer sedatives/hypnotics. For this reason, barbiturates are no longer considered the mainstay for the treatment of anxiety. In addition, the development of physical tolerance and psychological dependence is more likely with the barbiturates than with other anxiolytics. The most common adverse effects are related to central nervous system (CNS) depression. Hypersensitivity reactions to barbiturates are sometimes fatal.

It has been postulated that depression may be a syndrome that reflects either activity or lack of activity in what areas of the brain? (Select all that apply.) A) Limbic system B) Corpus callosum C) Reticular activating system (RAS) D) Substantia nigra E) Basal ganglia

Ans: A, C, E Feedback: Depression also may occur as a result of other, yet unknown causes. This condition may be a syndrome that reflects either activity or lack of activity in a number of sites in the brain, including the arousal center (i.e., RAS), the limbic system, and basal ganglia. It is not theorized that depression is associated with the corpus callosum or the substantia nigra.

A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.) A) Agitation B) Agglutination C) Insomnia D) Intermittent tachycardia E) Dry mouth

Ans: A, C, E Feedback: The adverse effects associated with selective serotonin reuptake inhibitors, which are related to the effects of increased 5-hydroxytriptamine levels, include central nervous system effects (e.g., headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, seizures). Gastrointestinal effects (e.g., nausea, vomiting, diarrhea, dry mouth, anorexia, constipation, changes in taste) often occur, as do genitourinary effects (e.g., painful menstruation, cystitis, sexual dysfunction, urgency, impotence). Adverse effects of sertraline do not include agglutination of blood cells or intermittent tachycardia

11. Why would the nurse expect the patient with liver disease to receive a smaller dose of benzodiazepines? A) Excretion of the drug relies on liver function. B) The drugs are metabolized extensively in the liver. C) They are lipid soluble and well distributed throughout the body. D) The drugs are well absorbed from the gastrointestinal tract.

Ans: B Feedback: The benzodiazepines are metabolized extensively in the liver. Patients with liver disease must receive a smaller dose and be monitored closely. Excretion is primarily through the urine. All of the answer options are true, but only the fact that the benzodiazepines are metabolized in the liver explains why a patient with liver disease would require smaller dosages.

27. The nurse is caring for a patient who has a sedative hypnotic ordered. The nurse would consider this drug contraindicated if the patient had what disorder? A) Neurological diseases B) Liver failure C) Endocrine disorders D) Heart disease

Ans: B Feedback: Benzodiazepines undergo extensive hepatic metabolism. In the presence of liver disease, the metabolism of most benzodiazepines is slowed, with resultant accumulation and increased risk of adverse effects. Neurological disorders, endocrine disorders, and heart disease are not contraindications for the use of benzodiazepines.

7. What anxiolytic drugs would be given to a premenopausal patient who is a registered nurse planning to return to work at the hospital after anxiety is controlled? A) Alprazolam (Xanax) B) Buspirone (BuSpar) C) Diazepam (Valium) D) Clorazepate (Tranxene

Ans: B Feedback: Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the patient needs to be alert such as when driving or working. Alprazolam, diazepam, and clorazepate are benzodiazepines, which cause drowsiness, sedation, depression, lethargy, confusion, and decreased mental alertness. It would be unsafe for a nurse to function in her role while taking one of these drugs.

12. When compared with benzodiazepines, buspirone (BuSpar) stands out as unique among antianxiety drugs because of what factor? A) Increases the central nervous system (CNS) depression of alcohol and other drugs. B) Lacks muscle relaxant and anticonvulsant effects. C) Causes significant physical and psychological dependence. D) Rapidly absorbed from the gastrointestinal (GI) tract and metabolized in the liver.

Ans: B Feedback: Buspirone, a newer antianxiety agent, has no sedative, anticonvulsant, or muscle-relaxant properties, and its mechanism of action is unknown. However, it reduces the signs and symptoms of anxiety without many of the central nervous system effects and severe adverse effects associated with other anxiolytic drugs. Most of the antianxiety drugs are rapidly absorbed from the GI tract, metabolized in the liver, have a significant drug​drug interaction with alcohol and other drugs, and can result in psychological dependence.

10. An elderly patient has been taking zolpidem (Ambien) as a sleep aid for the past 2 months. On admission to the assisted-living facility, it is determined that the drug is no longer needed. What is an important nursing consideration concerning this drug? A) Hallucinations are common. B) The drug needs to be withdrawn gradually. C) Another anxiolytic will need to be substituted. D) Sundowning is common with withdrawal from this drug.

Ans: B Feedback: It is important for the nurse to understand that zolpidem must be withdrawn gradually over a 2-week period after prolonged use. If chloral hydrate is stopped suddenly, it will result in serious adverse effects. Hallucinations and sundowning are not common with withdrawal of the drug. The prescriber and the patient would determine the need for chloral hydrate to be substituted for another anxiolytic.

9. The nurse is caring for a resident in a long-term care facility who is African American with a history of an anxiety disorder. The patient is receiving oral lorazepam (Ativan) 2 mg t.i.d. When developing this patient's plan of care, what priority assessment will the nurse include? A) Depression B) Extreme sedation C) Phlebitis D) Nightmares

Ans: B Feedback: Special care should be taken when anxiolytic or hypnotic drugs are given to African Americans. About 15% to 20% of African Americans are genetically predisposed to delayed metabolism of benzodiazepines. As a result, they may develop high serum levels of these drugs, with increased sedation and an increased incidence of adverse effects. Depression is not a common adverse effect. Phlebitis can occur at injection sites but this patient is taking the medication orally. Nightmares occur during drug withdrawal.

14. The nurse is caring for a patient in intensive care unit receiving IV lorazepam (Ativan) to reduce anxiety related to mechanical ventilation. While injecting the medication the nurse notes a decrease in blood pressure and bradycardia. What is the nurse's priority action? A) Discontinue drug administration. B) Give the IV drug more slowly. C) Notify the patient's health care provider. D) Document the reaction to the drug.

Ans: B Feedback: The nurse's priority action is to slow the rate of injection because rapid injection of benzodiazepines can result in hypotension and bradycardia and can lead to cardiac arrest.

4. A nurse is discussing the use of alprazolam (Xanax) with a 68-year-old patient. What statement indicates that the patient has an understanding of the drug? A) ​When I stop having panic attacks, I can stop taking the drug.​ B) ​This drug will calm me down in about 30 minutes after I take it.​ C) ​One dose will keep me calm for about 24 hours.​ D) ​I am taking an increased dose because of my age.​

Ans: B Feedback: The onset of alprazolam is about 30 minutes. The drug must be tapered after long-term use and the duration is approximately 4 to 6 hours. Elderly patients usually have a reduced dosage.

28. The nurse evaluates teaching as effective when a patient taking a benzodiazepine states, A) ​I should always take the medication with meals.​ B) ​I should not stop taking this drug without talking to my health care provider first.​ C) ​I cannot take aspirin with this medication.​ D) ​I will have to take this medication for the rest of my life

Ans: B Feedback: The patient makes a correct statement when saying the drug should not be stopped without talking to the health care provider first because withdrawal of benzodiazepines require careful monitoring and should be gradually withdrawn. Medications do not have to be taken with food, aspirin is not Test Bank - Focus on Nursing Pharmacology (7th Edition by Amy Karch) 332 contraindicated, and the medication need only be taken while the condition being treated continues. Patients with anxiety may only need the medication for a few weeks whereas those with a seizure disorder may take it for longer periods of time.

23. The nurse is caring for a patient who is taking a benzodiazepine. The nurse knows that caution should be used when administering a benzodiazepine to the elderly because of what possible adverse effect? A) Acute renal failure B) Unpredictable reactions C) Paranoia D) Hallucination

Ans: B Feedback: Use benzodiazepines with caution in elderly or debilitated patients because of the possibility of unpredictable reactions and in patients with renal or hepatic dysfunction, which may alter the metabolism and excretion of these drugs, resulting in direct toxicity. Dosage adjustments usually are needed for such patients. Acute renal failure, paranoia, and hallucinations are not commonly related to therapy with these medications in the elderly

Antidepressants carry a black box warning about the increased risk of suicide in what age group? A) Infants and children B) Children and adolescents C) Adolescents and adults D) Adults and older adults

Ans: B Feedback: A black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. Therefore, the other age groups are incorrect.

Ch 21 The mental health nursing instructor is talking with the class about depression. What deficiency does the instructor explain will result in depression? A) Epinephrine, norepinephrine, and acetylcholine B) Norepinephrine, dopamine, and serotonin C) Acetylcholine, gamma-aminobutyric acid, and serotonin D) Gamma-aminobutyric acid, dopamine, and epinephrine

Ans: B Feedback: A current hypothesis regarding the cause of depression is a deficiency of norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of the brain. Acetylcholine is a neurotransmitter that communicates between nerves and muscles. Epinephrine is a catecholamine that serves as a neurotransmitter that is released in the sympathetic branch of the autonomic nervous system and can be hormones when released from cells in the adrenal medulla. Gamma-aminobutyric acid is a neurotransmitter that inhibits nerve activity and prevents over excitability or stimulation.

The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patient's chart before administering the medication. What preexisting condition would require cautious use of this drug? A) Osteosarcoma B) Cardiovascular disorders C) Closed head injury D) Bleeding ulcer

Ans: B Feedback: Caution should be used with tricyclic antidepressants in patients with preexisting cardiovascular (CV) disorders because of the cardiac stimulatory effects of the drug and with any condition that would be exacerbated by the anticholinergic effects (e.g., angle-closure glaucoma, urinary retention, prostate hypertrophy, GI or genitourinary surgery). There is no indication that caution is needed with patients diagnosed with osteosarcoma, closed head injury, or bleeding ulcer.

A 10-year-old patient is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant could the nurse safely administer to a child? A) Trazodone B) Nortriptyline C) Fluvoxamine D) Phenelzine

Ans: B Feedback: Nortriptyline has established pediatric doses and can be used in children older than 6 years but such children should be monitored closely for adverse effects. Phenelzine is a monoamine oxidase inhibitor (MAOI), a class of drugs that should be avoided in children if at all possible because of the potential for drugfood interactions and the serious adverse effects. Trazodone can be used with children but is not a first-line drug because it has many adverse effects on the central nervous system associated with its use. Luvox is an SSRI that can be used in children to treat obsessive-compulsive disorder but selective serotonin reuptake inhibitors can cause serious adverse effects in children

A patient comes to the clinic because she is feeling depressed and has gained some weight. The physician prescribes oral tranylcypromine (Parnate) 10 mg twice daily for an atypical depression. When prescribed in this manner, when would the nurse tell the patient to expect the drug to reach peak levels in the body? A) 1 to 2 hours B) 2 to 3 hours C) 3 to 4 days D) 4 to 5 weeks

Ans: B Feedback: The monoamine oxidase inhibitors are well absorbed from the GI tract, reaching peak levels in 2 to 3 hours. The other time frames are incorrect.

What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors? A) Imipramine (Tofranil) B) Venlafaxine (Effexor) C) Fluvoxamine (Luvox) D) Tranylcypromine (Parnate)

Ans: B Feedback: Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, social anxiety disorder; it also diminishes addictive behavior. Fluvoxamine is a selective serotonin reuptake inhibitor, tranylcypromine is a monoamine oxidase inhibitor, and imipramine is a tricyclic antidepressant that are not indicated for treatment of anxiety disorder and addictive behavior.

A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Select all that apply.) A) Fever B) Myocardial Infarction C) Stroke D) Dry mouth E) Gynecomastia

Ans: B, C, D Feedback: Use of tricyclic antidepressants may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea. Cardiovascular effects (e.g., orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, stroke) may occur. Fever and gynecomastia are not normally attributed to amitriptyline therapy.

What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.) A) Take medication at bedtime. B) Monitor blood pressure. C) Do not take over-the-counter (OTC) drugs without talking to physician. D) Report double vision right away E) Reduce tyramine intake

Ans: B, C, E Feedback: MAOIs can cause drugdrug and drugfood interactions, which can precipitate cardiovascular effects that include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. Priority teaching points include monitoring blood pressure which will elevate with tyramine ingestion and the importance of not taking any OTC without physician or pharmacist consultation due to multiple drugdrug interactions. When taking an MAOI, you would not necessarily take the drug at bedtime or drink lots of fluid. Blurred, but not double, vision is an adverse effect of an MAOI.

13. What would the nurse assess for when benzodiazepines are abruptly stopped? A) Urinary retention and change in sexual functioning B) Dry mouth, constipation, nausea, and vomiting C) Nausea, headache, vertigo, malaise, and nightmares D) In most cases nothing significant

Ans: C Feedback: Abrupt cessation of these drugs may lead to a withdrawal syndrome characterized by nausea, headache, vertigo, malaise, and nightmares. When benzodiazepines are stopped abruptly the likelihood of withdrawal symptoms increases with the length of time the patient took the medication. Urinary retention, change in sexual functioning, dry mouth, constipation, nausea, and vomiting are all common adverse effects of the medications classified as benzodiazepines.

22. A patient presents at the free clinic complaining of nervousness, worrying about everything, and feeling very tense. What diagnose would the nurse suspect? A) Neurosis B) Psychosis C) Anxiety D) Depression

Ans: C Feedback: Anxiety is a common disorder that may be referred to as nervousness, tension, worry, or using other terms that denote an unpleasant feeling. The other options would not be described by these symptoms.

8. A patient arrives at the emergency room after attempting suicide by taking an entire bottle of diazepam. What antidote will the nurse most likely administer? A) Phenobarbital (Luminal) B) Dexmedetomidine (Precedex) C) Flumazenil (Romazicon) D) Ramelteon (Rozerem)

Ans: C Feedback: Flumazenil is an antidote to benzodiazepine overdose and is administered to reverse the effects of benzodiazepines when used for anesthesia. Phenobarbital, a barbiturate, would further depress the body functions of this patient. Dexmedetomidine is a new hypnotic drug used in the intensive care unit for mechanically ventilated patients. Ramelteon is also new; it is used as a hypnotic. Adverse effects of this drug include depression and suicidal ideation.

20. Hypnotic drugs are used to aid people in falling asleep. What physiological system does a hypnotic act on to be effective in helping a patient to sleep? A) Limbic system B) Sympathetic nervous system C) Reticular activating system D) Lymph system

Ans: C Feedback: Hypnotics are used to help people fall asleep by causing sedation. Drugs that are effective hypnotics act on the reticular activating system and block the brain's response to incoming stimuli. Hypnosis, therefore, is the extreme state of sedation, in which the person no longer senses or reacts to incoming stimuli. The other options are incorrect.

6. The nurse is caring for a 36-year-old man who experienced a seizure 30 minutes before coming into the emergency room, where he begins to have another. What barbiturate has the fastest onset and would be most appropriate to give to the patient to quickly stop the seizure? A) Amobarbital (Amytal Sodium) B) Mephobarbital (Mebaral) C) Phenobarbital (Luminal) D) Secobarbital (Seconal

Ans: C Feedback: Phenobarbital's onset is between 10 and 60 minutes, depending on the route administered, and most likely this would be given to the patient. Amobarbital is given for convulsions and the onset is between 15 and 60 minutes. Mephobarbital's onset is between 30 and 60 minutes. Secobarbital is given for convulsive seizures of tetanus and has an onset of 1 to 4 hours.

2. A nurse is caring for a 4-year-old child who is receiving a barbiturate. What common adverse effect would the nurse assess for? A) Decrease in respirations B) Vomiting C) Excitability D) Dry mucous membranes

Ans: C Feedback: The barbiturates, being older drugs, have established pediatric dosages. These drugs must be used with caution because of the often unexpected responses. Children must be monitored very closely for central nervous system (CNS) depression and excitability. The most common adverse effects are related to general CNS depression. Other CNS effects may include drowsiness, somnolence, lethargy, ataxia, vertigo, a feeling of a ​hangover,​ thinking abnormalities, paradoxical excitement, anxiety, and hallucinations. Alteration in respirations and dried mucous membranes are adverse effects of antihistamines, which can be given to calm children or induce sleep. Vomiting could occur with the use of paraldehyde due to the unpleasant taste and odor of the drug.

18. The nurse is caring for a patient who experiences anxiety and insomnia and is prescribed benzodiazepines. When developing the plan of care, what would be an appropriate nursing diagnosis related to potential adverse effects of the drug? A) Provide patient teaching about drug therapy. B) Anxiety related to drug therapy. C) Risk for injury related to central nervous system (CNS) effects. D) Avoid preventable adverse effects, including abuse and dependence.

Ans: C Feedback: The most appropriate nursing diagnosis related to adverse effects of the drug is risk for injury related to CNS effects because benzodiazepines can have many CNS adverse effects. Anxiety is the condition for which drug therapy is prescribed not related to drug therapy. Patient teaching and avoiding adverse effects are interventions and not nursing diagnoses.

5. A nurse is about to administer a parenteral benzodiazepine to a female patient in the hospital before the performance of a procedure. What is the priority nursing action before administration of the drug? A) Make sure that the side rails are up and the bed is in the lowest position. B) Close the blinds and ensure appropriate room temperature for the patient. C) Help the patient out of bed to the bathroom and encourage her to void. D) Ask all visitors to leave the room and remain in the waiting area.

Ans: C Feedback: The priority action would be to help the patient up to void. After the medication is administered the patient should not get out of bed because of possibly injury due to drowsiness. Safety should always be the priority concern. After administration of the drug the nurse would ask visitors to leave before beginning the procedure, make the room conducive to rest and sleep, and make sure that both side rails are up and the bed is in the lowest position.

The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects? A) If chest pain occurs an over-the-counter pain reliever will help. B) Nasal congestion indicates a respiratory virus is beginning. C) Measure and record your blood pressure daily. D) Adverse effects will subside as you adjust to the medication.

Ans: C Feedback: Cardiovascular effects of amitriptyline include orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, and stroke. Miscellaneous reported effects include alopecia, weight gain or loss, flushing, chills, and nasal congestion. Teaching the patient how and when to monitor blood pressure would be an important teaching point. Chest pain could be a serious finding and patients should be taught to call 911. Nasal congestion is a possible adverse effect of the drug and not an indication of a respiratory virus infection. Adverse effects often will not subside and may continue so long as the drug is taken.

A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan)

Ans: C Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drugfood interactions and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.

The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient? A) Risk for infection B) Establish suicide precautions C) Disturbed thought processes related to central nervous system (CNS) effects of medication D) Dysfunctional Family Processes

Ans: C Feedback: Nursing diagnoses related to SSRI therapy might include: Disturbed thought processes related to central nervous system effects because adverse effects of SSRIs include headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures. There would be no reason to expect the patient is at increased risk for infection, there is not enough information known about the patient's family to know if processes are dysfunctional. Establishing suicide precautions is an intervention and not a nursing diagnosis.

The biogenic amine theory of depression states that depression results from a deficiency of biogenic amines in key areas of the brain. Why might a deficiency of these biogenic amines exist? A) A slowing of the action of the neurons may lead to their depletion. B) Monoamine oxidase (MAO) strengthens the impact of biogenic amines. C) The number or sensitivity of postsynaptic receptors may increase. D) Norepinephrine may be depleted because biogenic amines feed off of loose particles of the neurotransmitter.

Ans: C Feedback: The three reasons for depression according to the biogenic amine theory include (1) MAO may break down biogenic amine to be recycled or restored in the neuron. (2) Rapid fire of the neurons may lead to their depletion. (3) The number or sensitivity of postsynaptic receptors may increase, thus depleting neurotransmitter levels.

26. An older adult African American patient comes to the clinic and is diagnosed with generalized anxiety disorder (GAD). The physician orders oral flurazepam 30 mg. What is the nurse's priority action? A) Teach the patient about the prescribed medication. B) Administer the first dose of medication. C) Tell patient to take first dosage after driving home. D) Talk to the physician about the dosage

Ans: D Feedback: If an anxiolytic or hypnotic agent is the drug of choice for an African American patient, the smallest possible dose should be used, and the patient should be monitored very closely during the first week of treatment. Dosage adjustments are necessary to achieve the most effective dose with the fewest adverse effects. In addition, older adults also require careful titration of dosage. Older patients may be more susceptible to the adverse effects of these drugs, from unanticipated central nervous system (CNS) adverse effects including increased sedation, dizziness, and even hallucinations. Dosages of all of these drugs should be reduced and the patient should be monitored very closely for toxic effects and to provide safety measures if CNS effects do occur. As a result, the priority action is to talk to the physician about the dosage. The other actions may be appropriate after a proper dosage is ordered.

. A nurse is caring for a 9-year-old patient and has received an order for diazepam (Valium) 10 mg given orally q.i.d. What is the nurse's priority action? A) Perform hand hygiene and prepare the drug. B) Send the order to the hospital pharmacy. C) Determine when to administer the first dose. D) Call the physician and question the order.

Ans: D Feedback: The first action of the nurse would be to call the physician and question the order. The normal oral dosage for a pediatric patient is 1 to 2.5 mg t.i.d. or q.i.d. The ordered dose would be unsafe for this patient. If the dosage was changed and the correct amount administered, the nurse would order the medication from the pharmacy if necessary and determine what time to start the medication. She would then wash her hands in preparation for administering the medication, but not until obtaining an appropriate dosage of medication

19. A patient is being discharged home from the hospital after receiving treatment for pneumonia. The patient is going home and continuing to take the same drugs he or she was taking before he or she was hospitalized. These drugs include an antianxiety medication and a medication for insomnia. The home care nurse is following this patient. On the initial visit what is the nurse's priority teaching point? A) The names and purposes of medications prescribed B) How to contact the provider if needed C) The importance of taking medications for insomnia only occasionally D) Warning signs that may indicate serious adverse effects

Ans: D Feedback: The home care nurse should provide thorough patient teaching, with a priority teaching point being the warning signs the patient may experience that indicate a serious adverse effect. Although this may have been discussed by the discharging nurse in the hospital, this is essential information for the patient to thoroughly understand. By the time the home care nurse visits, the patient should already have filled the prescriptions and know the names and purposes of the medications prescribed from the hospital nurse but it is a good idea to review this information, although it is not a priority. Medications for insomnia should be taken as prescribed. The patient should have received the provider's contact information when leaving the hospital but the home care nurse may need to review this, even though it is not the priority teaching point.

25. The nurse is caring for a patient who has not been able to sleep. The physician orders a barbiturate medication for this patient. What adverse effect should the nurse teach the patient about? A) Double vision B) Paranoia C) Tinnitus D) Thinking abnormalities

Ans: D Feedback: The most common adverse effects are related to general central nervous system (CNS) depression. CNS effects may include drowsiness, somnolence, lethargy, ataxia, vertigo, a resembling a ​hangover,​ thinking abnormalities, paradoxical excitement, anxiety, and hallucinations. Barbiturate drugs generally do not cause double vision, paranoia, or tinnitus.

21. A patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening and gives the nurse an almost empty bottle of benzodiazepines. What other adverse effects would the nurse assess this patient for? A) Seizures B) Tachycardia C) Headache D) Coma

Ans: D Feedback: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Anexate) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Seizures, tachycardia, and headache would not normally be associated with benzodiazepine toxicity.

24. A 72-year-old patient presents at the emergency department with respiratory depression and excessive sedation. The family tells the nurse that the patient has been taking medication throughout the evening. The nurse suspects benzodiazepine overdose and would expect what drug to be ordered? A) Valium B) Phenergan C) Hydroxyzine D) Flumazenil

Ans: D Feedback: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil is an antidote for the benzodiazepines. Hydroxyzine is an antihistamine with anticholinergic effects and would not be appropriate for this patient. Valium would enhance the effects of benzodiazepines. Phenergan is not indicated for this patient; it is similar in actions to hydroxyzine

A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) Teaching the patient about healthy eating to maintain weight B) Congratulating the patient on his weight loss and commenting how well he looks C) Encouraging the patient to increase fluid intake to avoid further weight loss D) Reassuring the patient that a decrease in weight is a common adverse effect with this medication

Ans: D Feedback: Adverse effects of fluoxetine include anorexia and weight loss. Although teaching about healthy eating is a good idea, it is more important to teach the patient how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The patient should increase caloric intake, not just fluid intake. The patient should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. More information about the patient's baseline weight is needed before congratulating the patient because a patient who is already too thin would not appreciate the nurse's comment.

A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication? A) Take medication after eating breakfast. B) Take medication with at least 8 ounces of liquid. C) The dosage may need to be increased if the patient is not feeling better in 2 weeks. D) The medication should be taken once a day before bedtime.

Ans: D Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that should be taken once a day before bedtime. The medication does not require 8 ounces of fluid for absorption. It should be taken for at least 4 weeks before a therapeutic effect is noted.

The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen? A) A chop salad with blue cheese, sardines, and pepperoni B) A sandwich with turkey, avocado, and Swiss cheese C) Corned beef hash, eggs, and hash browns D) A hamburger, French fries, and a strawberry milkshake

Ans: D Feedback: Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a patient taking an MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed.

A patient is admitted with a presumed diagnosis of colon cancer who takes a monoamine oxidase inhibitor for depression. What drug will the nurse keep on hand for this patient in case of the onset of an adverse reaction? A) Epinephrine B) Injectable naloxone (Narcan) C) Phenylalanine D) Phentolamine

Ans: D Feedback: Have phentolamine or another adrenergic blocker on standby as treatment in case of hypertensive crisis. The other options are distracters for this question.

The nurse is caring for a patient who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication does the nurse consider appropriate for this patient? A) Chlorpromazine (Thorazine) 25 mg three times daily orally B) Benztropine (Cogentin) 2 mg twice daily orally C) Clozapine (Clozaril) 200 mg twice daily orally D) Paroxetine (Paxil) 10 mg once daily orally

Ans: D Feedback: Paroxetine is a selective serotonin reuptake inhibitor indicated for the treatment of depression, obsessive compulsive disorder, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorders, social phobias, and social anxiety disorders. Chlorpromazine and clozapine are antipsychotic medications whereas benztropine is a drug used to treat Parkinson's disease. None of these would be appropriate options to treat anxiety disorders.

A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient? A) Monitor food intake for levels of tyramine. B) Assess for weight loss and difficulty sleeping. C) Monitor the patient for severe headaches. D) Implement suicide precautions.

Ans: D Feedback: Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine- containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patient's safety.

What is the physiological action of tricyclic antidepressants (TCAs)? A) Inhibiting monoamine oxidase inhibitors that break down norepinephrine B) Inhibiting nerve activity, which prevents over excitability or stimulation C) Blocking the reuptake of serotonin, which increases the levels of norepinephrine D) Inhibiting reuptake of norepinephrine and serotonin

Ans: D Feedback: TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.

What reason might the nurse give for why venlafaxine (Effexor) has become more popular with adults in treating their depression? A) It is taken orally. B) It does not have adverse effects. C) It can be taken during pregnancy. D) An extended release form is available.

Ans: D Feedback: Venlafaxine mildly blocks reuptake of norepinephrine, 5-hydroxytriptamine, and dopamine. It has fewer adverse central nervous system effects than trazodone. Its popularity has increased with the introduction of an extended-release form that does away with the multiple daily doses that are required with the regular form. Venlafaxine is readily absorbed from the gastrointestinal (GI) tract, extensively metabolized in the liver, and excreted in urine. Adequate studies have not been done in pregnancy and lactation, so that it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is taken orally, which is the case with most antidepressants

Extra Question A client reports that he thinks he is taking an antidepressant, but he is not sure. In reviewing his medication history, which of the following drugs would be considered antidepressants a. tetracyclic drugs b. cholinergics c. SSRIs d. MAOIs e. angiotensin II receptor blockers f. benzodiazepines

a,c,d

Extra Question Depression is a very common affective disorder that strikes many people. In assessing a client who might be suffering from depression, the nurse would expect to find which of the following a. lack of energy b. hyperactivity c. sleep disturbances d. libido problems e. confusion f. decreased reflexes

a,c,d

Extra Question You might question an order for a monoamine oxidase inhibitor (MAOI) as a first step in the tx of depression, remembering that these drugs are reserved for use in cases in which there has been no response to other agents because a. MAOIs can cause hair loss b. MAOIs are associated with potentially serious drug-food interactions c. MAOIs are mostly recommended for use in surgical pts d. MAOIs are more expensive than other agents

b. MAOIs are associated with potentially serious drug-food interactions

Extra Question The drug of choice for a pt with a documented obsessive-compulsive disorder who is also suffering from depression and occasional panic disorder would be a. Celexa b. Paxil c. Luvox d. Prozac

b. Paxil

Extra Question Depression is an affective disorder that is a. always precipitated by a specific event b. most common in pts with head injuries c. characterized by overwhelming sadness, despair, and hopelessness d. very evident and easy to diagnose in the clinical setting

c. characterized by overwhelming sadness, despair, and hopelessness

Extra Question The biogenic amine theory of depression states that depression is a result of a. an unpleasant childhood b. GABA inhibition c. deficiency of norepinephrine, dopamine, or 5HT in key areas of the brain d. blockages within the limbic system, which controls emotions and affect

c. deficiency of norepinephrine, dopamine, or 5HT in key areas of the brain

Extra Question When teaching a pt receiving tricyclic anidepressants (TCAs), it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of a. increased libido and increased appetite b. polyuria and polydipsia c. urinary retention, arrhythmias, and constipation d. hearing changes, cataracts, and nightmares

c. urinary retention, arrhythmias, and constipation

Extra Question Your pt is being treated for depression and is started on a regimen of Prozac (fluoxetine). She calls you 10 days after the drug therapy has started to report that nothing has changed and she wants to try a different drug. You should a. tell her to try sertraline (Zoloft) because some pts respond to one selective serotonin reuptake inhibitor (SSRI) and not another b. ask her to try a few days without the drug to see whether there is any difference c. add an MAOI to her drug regimen to get an increased antidepressant effect d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect

d. encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect

Extra Question Venlafaxine (Effexor) is a relatively new antidepressant that might be very effective for use in pts who a. have proven to be responsive to other antidepressants b. can tolerate multiple side effects c. are reliable at taking multiple daily dosings d. have not responded to other antidepressants and would benefit from once-a-day dosing

d. have not responded to other antidepressants and would benefit from once-a-day dosing

Extra Question Adverse effects may limit the usefulness of TCAs with some pts. Nursing interventions that could alleviate some of the unpleasant aspects of these adverse effects include a. always administering the drug when the pt has an empty stomach b. reminding the pt not to void before taking the drug c. increasing the dose to override the adverse effects d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects

d. taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects