Psychiatric Medications example questions

The nurse should monitor the client prescribed thioridazine hydrochloride carefully for which adverse effect?

*Cardiac dysrhythmias* Thioridazine hydrochloride is an antipsychotic medication that may be prescribed for the schizophrenic client when other medications have failed to manage the symptoms. Cardiac dysrhythmias are an adverse effect of thioridazine. Weight gain and extrapyramidal movements are not associated with this medication. Photosensitivity is a rare side effect.

The health care provider is planning to prescribe a medication for a client with major depression. Which medication should the nurse expect to be prescribed?

*Paroxetine hydrochloride* Paroxetine is an antidepressant used in the treatment of major depression. Diazepam and lorazepam are benzodiazepines and are used to treat anxiety. Phenobarbital is a barbiturate used for the short-term treatment of insomnia.

A monoamine oxidase inhibitor is prescribed for a client. Which sign or symptom is indicative of toxicity?

*Restlessness* Acute toxicity of monoamine oxidase inhibitors (MAOIs) is manifested by restlessness, anxiety, and insomnia. Dizziness and hypertension also can occur in acute toxicity. The remaining options are not signs of toxicity related to MAOIs.

The nurse taking a medication history for a client who has been admitted to the nursing unit notes that the client is receiving olanzapine. The nurse interprets that this client most likely has a history of which disorder?

*Schizophrenia* Olanzapine is an antipsychotic medication that targets both the positive and the negative symptoms of schizophrenia. The other options listed are not indications for use of this medication.

The nurse gathers data from the client who was prescribed buspirone hydrochloride 1 month ago. The nurse interprets that the medication is effective when the client reports an absence of which event?

*Severe anxiety* Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression. It is not recommended for the treatment of thought disorders (delusions), drug or alcohol cravings, or schizophrenia (paranoid thoughts)

A client diagnosed with bipolar mood disorder has been given a prescription for carbamazepine. The nurse teaching the client about medication side and adverse effects instructs the client to notify the health care provider if which symptom develops?

*Sore throat* Carbamazepine may be prescribed for a client with a bipolar mood disorder to provide symptomatic control of the disorder. An adverse effect of carbamazepine is blood dyscrasia. With development of a fever, sore throat, mouth ulcerations, unusual bleeding, bruising, or joint pain, the health care provider should be notified because these findings may indicate a blood dyscrasia. Nausea, dizziness, drowsiness, and vomiting are frequent side effects associated with the medication.

A client prescribed chlorpromazine hydrochloride calls the mental health clinic to report urine that is much darker than usual. The client currently has no other urinary symptoms. What instructions should the nurse provide the client based on this information?

*That this is an expected side effect of the medication* Chlorpromazine hydrochloride is an antipsychotic medication. A side effect of this medication is that the color of urine may darken. The client should be aware that this effect is harmless. The other options are incorrect and not associated with this medication.

A client diagnosed with bipolar disorder is prescribed lithium carbonate. The nurse who administers the medication knows that lithium is used primarily to treat which condition?

*The manic phase of bipolar disease* Lithium is an antimanic medication and is used to treat the manic phase of a manic-depressive disorder. The remaining options are incorrect.

A client taking lithium reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L (2.5 mmol/L). The nurse plans care based on which representation of this level?

*Toxic* Maintenance serum levels of lithium are 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). Symptoms of toxicity begin to appear at levels of 1.5 to 2 mEq/L (1.5 to 2 mmol/L). Lithium toxicity requires immediate medical attention with lavage and possible peritoneal dialysis or hemodialysis.

Over the course of a few hours, a client receiving lithium carbonate reports being nauseous, then drowsy and "achy." What action should the nurse take when considering the client's next scheduled dose of lithium?

*Withhold the next scheduled dose and notify the health care provider of the client's complaints.* The side/adverse effects of lithium include fine hand tremors, polyuria, mild thirst, and mild nausea. Diarrhea, vomiting, nausea, drowsiness, muscle weakness, and lack of coordination may be early signs of toxicity. The medication needs to be withheld and the health care provider notified so that the client can be further evaluated to determine the presence of toxicity. The remaining options are inappropriate actions.

The nurse assesses for a therapeutic effect of ziprasidone by asking the client which question?

*"Have you experienced an increase in concentration during daily activities?"* Ziprasidone is an antipsychotic used as a mood stabilizer. The nurse should evaluate a therapeutic response by determining if the client obtained an increase in concentration. None of the remaining options are related to the use of this medication.

A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how should the nurse administer the dose?

*At the same time each evening* Sertraline is classified as an antidepressant. Sertraline generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline is not prescribed for use as needed.

A client is prescribed a monoamine oxidase inhibitor. What is the primary reason the nurse needs to assess this client closely?

*Headache, hypertension, and nausea and vomiting may indicate toxicity.* Headache, hypertension, tachycardia, nausea, and vomiting are precursors to hypertensive crisis brought about by the ingestion of foods rich in tyramine and tryptophan while the client is taking monoamine oxidase inhibitors (MAOIs). These medications act by decreasing the amount of monoamine oxidase in the liver, which is necessary for the breakdown and use of tyramine and tryptophan. Hypertensive crisis may lead to circulatory collapse, intracranial hemorrhage, and death.

Which assessment finding would the nurse anticipate when monitoring a client who is at risk for developing neuroleptic malignant syndrome?

*Hyperpyrexia* Hyperpyrexia with body temperatures up to 107°F may be present in neuroleptic malignant syndrome (NMS). Manifestations develop suddenly and may include respiratory distress and muscle rigidity. As the condition progresses, evidence of tachycardia, hypertension, increasing respiratory distress, confusion, and delirium may appear. Dysphagia is not associated with this condition.

The nurse is teaching a client who is being started on imipramine about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication?

*In 2 to 3 weeks* The maximum therapeutic effects of imipramine may not occur for 2 to 3 weeks after antidepressant therapy has been initiated. Options 1, 3, and 4 are incorrect time periods.

A hospitalized client has begun taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect, indicating that the client is taking an excessive amount of medication?

*Seizure activity* Seizure activity can occur in clients taking bupropion dosages greater than 450 mg daily. Weight gain is an occasional side effect, whereas constipation is a common side effect of this medication. This medication does not cause significant orthostatic blood pressure changes.

The nurse is caring for a client who has been prescribed disulfiram. Which statement by the client indicates to the nurse the need for further teaching about this medication?

*"As long as I don't drink alcohol, I'll be fine."* Clients who are taking disulfiram must be taught that substances containing alcohol can trigger an adverse reaction. Sources of hidden alcohol include foods (soups, sauces, vinegars), medicine (cold medicine), mouthwashes, and skin preparations (alcohol rubs, aftershave lotions).

The nurse has given instructions to a client prescribed lithium carbonate. What statement by the client indicates that the client needs further information?

*"I will decrease fluid intake while taking the lithium."* A normal diet and normal salt and fluid intake (1500 to 3000 mL per day) should be maintained because lithium decreases sodium reabsorption by the renal tubules, leading to sodium depletion. A low sodium intake causes a relative increase in lithium retention and could lead to toxicity. Lithium is irritating to the gastric mucosa and should be taken with meals. Because therapeutic and toxic dosage ranges are narrow, lithium blood levels must be monitored closely. They are measured more frequently when the client begins the medication and then once every several months after the levels stabilize. The client should be instructed to stop taking the medication and call the health care provider if excessive diarrhea, vomiting, or diaphoresis occurs.

A client is prescribed imipramine once daily. The nurse determines that additional teaching is needed on the basis of which statement by the client?

*"I'll take the medication in the morning before breakfast."* Imipramine is a tricyclic antidepressant. The client should be instructed to take a single daily dose of the medication at bedtime, not in the morning, because of its side effect of sedation. The client should avoid alcohol or other central nervous system depressants during therapy. The medication effects may not be noticed for at least 2 weeks. The client should take the medication exactly as directed, but if a dose is missed the client should take it as soon as possible unless it is almost time for another dose.

The nurse is discussing the past week's activities with a client receiving amitriptyline hydrochloride. The nurse determines that the medication is most effective for this client if the client reports which information?

*Ability to get to work on time each day* This medication is prescribed for the management of depression. Depressed individuals may demonstrate a lack of energy that results in sleeping for extended periods and being unable to fulfill employment obligations. The therapeutic effect of this medication is intended to help resolve these symptoms. Sleeping 14 to 16 hours is still a demonstration of depression-associated fatigue. The medication is not intended to manage intrusive thoughts (delusions) or to improve memory.

The mother of a child diagnosed with attention deficit hyperactivity disorder has been given instructions about how to administer methylphenidate. Which response by the mother shows she understands the information about the best way to administer the medication?

*After breakfast* Children with attention deficit hyperactivity disorder should take the morning dose after breakfast and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. The other options are incorrect.

The nurse developing a teaching plan for a client being prescribed phenelzine sulfate should instruct the client to avoid which item?

*Aged cheeses* Phenelzine sulfate is in the monoamine oxidase inhibitor (MAOI) class of antidepressant medications. A client taking an MAOI must avoid foods that contain tyramine such as aged cheeses, alcoholic beverages, avocados, bananas, and caffeine drinks. Other food items to avoid include chocolate, meat tenderizers, pickled herring, raisins, sour cream, yogurt, and soy sauce. Medications that should be avoided include amphetamines, antiasthmatics, and certain antidepressants. Clients taking MAOI medications also should avoid levodopa and meperidine. The items identified in the other options need not be avoided.

A client is scheduled for discharge and will be taking phenobarbital for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety?

*Avoid drinking alcohol while taking this medication.* Phenobarbital is an anticonvulsant and hypnotic agent. The client should avoid taking any other central nervous system depressants such as alcohol while taking this medication. The medication may be given without regard to meals. Taking the medication at the same time each day enhances compliance and maintains more stable blood levels of the medication. Using a dose container or "pillbox" may be helpful for some clients.

A client begins to experience extrapyramidal side effects from an antipsychotic medication. The nurse anticipates that the health care provider will prescribe which medication to treat this condition?

*Benztropine* Benztropine is an anticholinergic medication used to treat drug-induced extrapyramidal reactions (except tardive dyskinesia). The remaining options are antipsychotic medications. Antipsychotic medications can cause extrapyramidal reactions.

A client diagnosed with schizophrenia is taking haloperidol. The nurse understands that this medication will exert its therapeutic effect through which mechanism?

*Blocking dopamine from binding to postsynaptic receptors in the brain* Haloperidol is an antipsychotic. Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Fluoxetine hydrochloride is a potent serotonin reuptake blocker. Donepezil hydrochloride inhibits the breakdown of released acetylcholine. Imipramine hydrochloride blocks the uptake of norepinephrine and serotonin.

A client has a lithium level of 2.4 mEq/L. The nurse should immediately assess the client for which sign or symptom?

*Blurred vision* At lithium levels of 2.0 to 2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2.0 mEq/L the client experiences vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3.0 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.

When a client develops neuroleptic malignant syndrome, the nurse ensures that which medication is available on the unit to address this complication?

*Bromocriptine* Clients taking antipsychotic medications are at risk for neuroleptic malignant syndrome. Bromocriptine, an antiparkinsonian prolactin inhibitor, is used in the treatment of neuroleptic malignant syndrome. Phytonadione is the antidote for warfarin overdose. Protamine sulfate is the antidote for heparin overdose. Enalapril maleate is an angiotensin-converting enzyme inhibitor used to treat hypertension.

A client has begun taking phenelzine. At the initiation of therapy, the client is taught which foods are acceptable to consume? Select all that apply.

*Carrots or radishes* *Sweet potatoes and squash* Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid foods that are high in tyramine because they could trigger a potentially fatal hypertensive crisis. Foods to avoid include aged cheeses, smoked or processed meats, red wines, avocados, raisins, and figs. Vegetables are generally acceptable, with the exception of broad beans, including fava beans.

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly?

*Client arrives at the clinic neat and appropriate in appearance.* Depressed individuals sleep for long periods, are unable to go to work, and feel as if they cannot "do anything." When these clients have had some therapeutic effect from their medication, they report resolution of many of these complaints and exhibit an improvement in their appearance. Options 1, 2, and 4 identify continued depression.

A hospitalized client is started on phenelzine for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply.

*Crackers* *Tossed salad* Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid ingesting foods that are high in tyramine. Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked or processed meats; red wines; and fruits such as avocados, raisins, or figs.

A client diagnosed with an anxiety disorder is prescribed buspirone orally. The client tells the nurse that it is difficult to swallow the tablets. Which is the best instruction to provide the client?

*Crush the tablets before taking them.* Buspirone may be administered without regard to meals, and the tablets may be crushed. Mixing the tablet uncrushed in apple sauce will not ensure ease in swallowing. This medication is not available in liquid form. It is premature to advise the client to call the health care provider (HCP) for a change in medication without first trying alternative interventions.

What is the most serious risk associated with the use of benzodiazepine?

*Dependence* A benzodiazepine carries with it a high risk for abuse and physical and psychological dependence. For this reason, limited amounts of these medications are given to a client at one time. The other symptoms may be side effects of some benzodiazepines but are not as serious as the risk of dependence.

Buspirone hydrochloride is prescribed for a client with an anxiety disorder. The nurse plans to include which teaching point when reviewing this medication with the client?

*Dizziness and nervousness may occur.* Buspirone hydrochloride is an anxiolytic medication. Dizziness, nausea, headaches, nervousness, lightheadedness, and excitement, which generally are not major problems, are side effects. Buspirone hydrochloride is not addicting, tolerance does not develop, and it is not sedating.

A client is prescribed tranylcypromine. The nurse educating a client about tranylcypromine should instruct the client to avoid which activity?

*Drinking any amount of wine* Tranylcypromine is a monoamine oxidase inhibitor (MAOI) that is used to treat depression. Food and fluids containing tyramine, such as aged cheese, smoked or pickled meats or poultry, fermented meat, beer, wine, and liqueurs, should not be used concurrently with MAOIs because they can cause sudden and severe hypertensive reactions. The remaining options are not contraindicated with the use of this medication.

The nurse should provide instructions concerning which side effect to a client prescribed chlorpromazine?

*Dry mouth* Chlorpromazine is an antipsychotic medication that belongs to the phenothiazine group. Side effects of chlorpromazine can include hypotension, dizziness, and fainting, especially with parenteral use. Additional side effects include drowsiness, blurred vision, dry mouth, lethargy, constipation or diarrhea, nasal congestion, peripheral edema, and urinary retention. The remaining options are not associated with this medication.

The nurse should assess for which toxic effect when managing the care of a client prescribed haloperidol?

*Excessive salivation* Haloperidol is an antipsychotic medication. Toxic effects include marked drowsiness and lethargy, excessive salivation, a fixed stare, akathisia, acute dystonia, and tardive dyskinesia. Nausea, hypotension, and blurred vision are occasional side effects.

A client gives the home health nurse a bottle of clomipramine. The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication?

*Frequent hand washing with hot, soapy water* Clomipramine is a tricyclic antidepressant used to treat obsessive-compulsive disorder. Sedation sometimes occurs. Insomnia seldom is a side effect. Weight gain and tachycardia are side and adverse effects of this medication.

The nurse suspects that a client prescribed clomipramine hydrochloride has been noncompliant with taking the medication as prescribed. Which client behavior would support the nurse's suspicion?

*Frequently checking for the car key* Clomipramine is an antidepressand that is commonly used in the treatment of obsessive-compulsive disorder. Frequent checking for the car key is a nonproductive repetitive activity that is characteristic of this disorder. Reappearance of symptoms may indicate noncompliance with medication therapy. The incorrect options are common side/adverse effects of the medication.

A client diagnosed with depression and prescribed tranylcypromine sulfate has been instructed on the appropriate diet. The nurse determines that the client understands the diet if which foods are selected from the dietary menu?

*Fried haddock, baked potato, and a cola drink* Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI) that is used to treat depression. A tyramine-restricted diet is required while on this medication to avoid hypertensive crisis, a life-threatening effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or pickled fish, beef or chicken liver, and dry sausage (salami, pepperoni, bologna). In addition, figs; bananas; aged cheese; yogurt and sour cream; beer, red wine, and other alcoholic beverages; soy sauce; yeast extract; chocolate; caffeine; and aged, pickled, fermented, or smoked foods need to be avoided.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication?

*Gastrointestinal dysfunctions* The most common side and adverse effects related to fluoxetine include central nervous system and gastrointestinal system dysfunction. Fluoxetine affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side and adverse effects associated with this medication.

The nurse is administering risperidone to a client who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client?

*Get up slowly when changing positions* Risperidone can cause orthostatic hypotension. Sunlight should be avoided by the client taking this medication. With any psychotropic medication, caution needs to be taken (such as with driving or other activities requiring alertness) until the individual can determine whether his or her level of alertness is affected. Food interaction is not a concern.

When should the nurse advise a client being prescribed fluoxetine hydrochloride to take the medication?

*In the morning on first arising* Fluoxetine hydrochloride is an antidepressant and is administered in the early morning so that the client will experience an elevated mood during the daytime hours. In addition, fluoxetine can cause insomnia so taking the medication early in the day will prevent interference with sleep. The other options are incorrect.

The nurse is describing the medication side and adverse effects to a client who is taking oxazepam. Which information should the nurse incorporate in the discussion?

*Increase fluids and bulk in the diet* Oxazepam causes constipation, and the client is instructed to increase fluid intake and bulk (high fiber) in the diet. If the heart begins to beat fast, the health care provider (HCP) is notified because this could indicate overdose. In addition, diarrhea could indicate an incomplete intestinal obstruction and, if this occurs, the HCP is notified.

At what time of day does the nurse recommend that a child prescribed methylphenidate be given the last dose of the day of the medication?

*Just before the noontime meal* Methylphenidate is used to treat attention deficit hyperactivity disorder and has stimulant effects. Children with should take the morning dose after breakfast and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. Usually the health care provider recommends that the last dose be given just before the noontime meal. The other options are incorrect.

A client diagnosed with schizophrenia has a new prescription for risperidone. Which baseline laboratory result should the nurse review before administering the first dose of this medication?

*Liver function studies* Risperidone is an atypical antipsychotic. A baseline assessment of renal and liver function should be done before the initiation of therapy with risperidone. The medication is used with caution in clients with renal or hepatic impairment, in those with underlying cardiovascular disorders, and in geriatric or debilitated clients. These clients are started on the medication at a reduced dosage level. None of the other diagnostics are relevant to this medication.

The nurse instructs the client to be sure to take which action while taking newly prescribed lithium carbonate?

*Maintain a fluid intake of 2 to 3 L/day.* Lithium carbonate is prescribed for clients requiring mood stabilization. The client who begins taking lithium carbonate must maintain a fluid intake between 2 and 3 L/day. The client should also maintain normal salt intake. Both of these are necessary to avoid dehydration. Gastrointestinal disturbances generally disappear during continued therapy. It is not necessary to limit food intake.

A client who is receiving lithium carbonate has a serum level of 1.8 mEq/L. Which intervention will the nurse implement in response to this diagnostic result?

*Monitor the client for behaviors that suggests ataxia.* A serum lithium level of 1.8 mEq/L indicates moderate toxicity. Serum lithium concentrations of 1.5 to 2.5 mEq/L may produce vomiting, diarrhea, ataxia, incoordination, muscle twitching, and slurred speech. The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level below that indicates a need for an increase in dosage. Fatigue is a common side effect of this medication.

The nurse is caring for a client who is taking a maintenance dosage of lithium carbonate. What nursing action should be included in the client's plan of care?

*Monitoring intake and output* This medication is very dependent on stable body fluid levels, and so monitoring daily intake and output is critical. Lithium is used to treat manic disorders, not depression. Side/adverse effects of lithium are nausea, tremors, polyuria, and polydipsia. Serum lithium concentration is assessed approximately every 2 to 4 days during initial therapy and at longer intervals thereafter. Toxic levels of lithium may induce electrocardiogram changes; however, performing weekly ECGs is unnecessary if therapeutic levels are maintained.

Which assessment findings suggest to the nurse that the client is experiencing tardive dyskinesia?

*Movements of the mouth, tongue, and face that are both abnormal and involuntary* Tardive dyskinesia is an adverse effect associated with long-term use of antipsychotic medication. The clinical manifestations include abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue ("fly-catcher tongue"), and face. In its more severe form, tardive dyskinesia involves the fingers, arms, trunk, and respiratory muscles. None of the remaining options are manifestations associated with this adverse effect.

A client diagnosed with anxiety is starting therapy with lorazepam. Which factor in the client's history should prompt the nurse to consult with the health care provider before administering the medication?

*Narrow-angle glaucoma* Lorazepam is a benzodiazepine and is contraindicated in hypersensitivity, cross-sensitivity with other benzodiazepines, comatose state, preexisting central nervous system depression, uncontrolled severe pain, and narrow-angle glaucoma. It also is contraindicated in pregnancy and in women who are breast-feeding. None of the other options are relevant to the administration of lorazepam.

A client diagnosed with depression is prescribed amitriptyline hydrochloride. During the initial phases of treatment, the client's care plan should include which nursing intervention?

*Obtain postural blood pressure prior to each medication administration* Amitriptyline hydrochloride is a tricyclic antidepressant. A common side/adverse effect is orthostatic blood pressure changes, which can produce hypotension and tachycardia. The tachycardia can be frightening to the client, and the hypotension is dangerous because it may result in dizziness and falling. The client must be instructed to move slowly from a lying to a sitting or standing position to avoid injury if these changes are experienced. The client may experience some side/adverse effects, such as sedation, dry mouth, constipation, and blurred vision (anticholinergic effects). However, these effects are transient and will diminish with time. A tyramine-free diet is initiated for a client on a monoamine oxidase inhibitor. Blood levels are required for the client taking lithium.

A client diagnosed with depression has a prescription for sertraline. The nurse should withhold the medication and question the prescription if the client has a history of which disorder?

*Phenelzine sulfate use* Sertraline is a selective serotonin reuptake inhibitor. Fatal reactions may occur if sertraline is administered concurrently with phenelzine, a monoamine oxidase inhibitor (MAOI). MAOIs should be stopped at least 14 days before initiation of sertraline therapy. Likewise, sertraline should be stopped at least 14 days before initiation of MAOI therapy. The other options are incorrect

A client prescribed thioridazine hydrochloride reports feeling faint when trying to get out of bed in the morning. The nurse recognizes this complaint as a symptom of which disorder?

*Postural hypotension* Thioridazine hydrochloride, an antipsychotic, can cause postural hypotension. The client needs to be taught to get out of bed slowly and to rise from a sitting position slowly because of this untoward effect of the medication. None of the other options are related to this medication.

A client receiving long-term therapy with lithium carbonate has a serum lithium level of 1.0 mEq/L. Which nursing intervention should the nurse be prepared to implement based on this result?

*Provide positive support for the client's compliance with the therapy* The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L, and the client's medication compliance should be acknowledged. Serum lithium concentrations of 1.5 to 2.0 mEq/L may produce a variety of toxicity symptoms, including vomiting, diarrhea, drowsiness, incoordination, coarse hand tremors, muscle tremors, and mental confusion.

A client who has been taking buspirone for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred?

*Rapid heartbeat or anxiety* Buspirone is not recommended for the treatment of paranoid thought disorders, drug or alcohol withdrawal, or schizophrenia. Buspirone most often is indicated for the treatment of anxiety.

When providing client education on the medication alprazolam, why is it essential to include the importance of avoiding abrupt discontinuation of the medication?

*Rebound central nervous system excitation could cause seizure activity.* Alprazolam is a benzodiazepine used to manage anxiety disorders. The abrupt withdrawal of alprazolam could result in seizure activity from central nervous system excitation. All clients receiving this medication should be warned of this danger. The other options are incorrect.

To determine whether the client is experiencing akathisia as an adverse effect of the medication haloperidol, what should the nurse observe the client for?

*Restlessness or constant generalized movement* Akathisia is restlessness or an urge to keep moving. It may appear within 6 hours of administration of the first dose and may be difficult to distinguish from psychotic agitation. The other options describe tardive dyskinesia, which is manifested by uncontrolled rhythmic movements of the mouth, face, and extremities. These movements can include lip smacking or puckering, puffing of the cheeks, uncontrolled chewing, and the presence of rapid or undulating (wormlike) movements of the tongue.

The nurse is providing dietary instructions to a client who is prescribed tranylcypromine sulfate. The nurse emphasizes that it is important to avoid eating which food?

*Salami* Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI) that is used to treat depression. A tyramine-restricted diet is required during therapy to avoid hypertensive crisis, a life-threatening effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or pickled fish, beef liver, chicken liver, and dry sausage (salami, pepperoni, and bologna). In addition, figs, bananas, aged cheese, yogurt and sour cream, beer, red wine, alcoholic beverages, soy sauce, yeast extract, chocolate, caffeine, and foods that are aged, pickled, fermented, or smoked need to be avoided. Many over-the-counter medications also include tyramine and must be avoided as well.

A client diagnosed with schizophrenia has been prescribed clozapine. The nurse should monitor the client for which side/adverse effects of this medication? Select all that apply.

*Sedation* *Dry mouth* *Orthostatic hypotension* *Presence of a fixed stare* Clozapine is an antipsychotic medication used to treat schizophrenia. Hallucinations, delusions, and altered thought processes are characteristic of this disorder and should decrease with effective treatment. Fixed stare, dry mouth, orthostatic hypotension, and sedation are side/adverse effects of therapy. The other options are unrelated to this medication.

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication?

*Tardive dyskinesia* Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, masklike facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of monoamine oxidase inhibitors and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

A client is prescribed fluphenazine daily. The nurse teaches the client to take which measure to minimize a common side/adverse effect of this medication?

*Use hard sour candy or sugarless gum* Fluphenazine is an antipsychotic. Dry mouth is a common side effect of this medication. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Mild leukopenia may occur, but the temperature does not need to be taken daily. Weight gain is a common side effect, and frequent snacks would worsen the problem. Hypotension and hypertension are rare side effects of fluphenazine.

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication?

*White blood cell count* A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.

A client has been prescribed clozapine. The nurse reviews the result of which laboratory study to detect a serious adverse effect associated with this medication?

*White blood cell count* Clozapine is an antipsychotic medication. The client taking clozapine may experience agranulocytosis as an adverse effect, which is monitored by obtaining weekly white blood cell counts. Treatment is withheld if the level drops below 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other options are incorrect.