Psychopharm PrepU

Which antipsychotic medications have antiemetic effects?

Chlorpromazine (Thorazine) Prochlorperazine (Compazine)

A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter?

Cholinergic

A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action?

Inform the prescriber and monitor for GI and CNS effects

A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?

Intramuscularly

A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain?

It needs to be determined if the child still has symptoms that require treatment.

A 46-year-old client sustained a closed-head injury 4 hours ago. The client now presents to the emergency department because the client is having difficulty breathing. This is a result of swelling surrounding which brain structure?

Medulla oblongata

A nurse caring for a client with narcolepsy may administer which CNS stimulants?

Methylphenidate Modafinil Armodafinil Dextroamphetamine

The brain stem consists of which structure?

Midbrain

A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?

Middle insomnia The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep)

A female client 70 years of age is receiving lithium. Which nursing intervention is appropriate for this client?

Monitor fluid and sodium intake every 12 hours. Older clients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly

A client receives the first dose of fluphenazine. The next day, during the follow-up appointment, the nurse finds the client is confused and the client's temperature is 103°F, pulse rate is 116 beats per minute, respirations are 34 breaths per minute, and blood pressure is 100/50 mmHg. The nurse should investigate further for which condition?

Neuroleptic malignant syndrome The most serious and potentially fatal side effect of the typical antipsychotics is neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered consciousness, disorientation, dysphagia, elevated creatinine phosphokinase, stupor, catatonia, hyperpyrexia, and labile pulse and blood pressure. This life-threatening condition can occur after a single dose of a neuroleptic; however, it is more common in the first 2 weeks of administration or with an increase in dose. It can continue for up to 2 weeks after discontinuation of the medication.

A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what?

Positron emission tomography (PET) scan

A drug that is an antagonist functions to do what?

Prevent natural or other substances from activating cell function Drug antagonists block the actions of everything in the agonist spectrum. These chemicals bind to and block a receptor, producing no response and preventing agonists from binding or attaching to the receptor.

A client has admitted to the nurse that the client is "tempted to end it all." How can the nurse prevent a future malpractice lawsuit if the client makes a suicide attempt?

Promptly act on, and document, the client's statement. Prompt action and documentation are the best defenses against a future lawsuit.

A nurse is working on developing a safety plan with a client who is a survivor of violence. Which would the nurse address first?

Recognizing the signs of danger One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs, and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route.

A nurse is developing a plan of care for a client with panic disorder that will include pharmacologic therapy. Which would the nurse most likely expect to administer?

Selective serotonin reuptake inhibitor (SSRI

Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?

Sexual dysfunction

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what?

Side effect Lithium has many side effects that can be handled with interventions. For diarrhea, the nurse can instruct the client to take the medication with meals and provide for fluid replacement. The nurse should tell the client to notify the prescriber if the diarrhea becomes severe—this development can be an early sign of lithium toxicity, which would warrant a change in medication. Diarrhea is not a toxic or desired effect.

In the discharge instructions for a client who is taking alprazolam, the nurse should include what?

Sudden cessation of alprazolam can cause rebound insomnia and nightmares.

A college student wakes up and notices a racing heart and dilated pupils. The student is scheduled to write an exam later that morning. Which system is responsible for this physiological response?

Sympathetic nervous system

The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?

The foods contain tyramine, which may provoke hypertensive crisis.

A nurse is caring for a family in which the elderly mother has been a victim of abuse and neglect by her son 48 years of age. Which of the following would be most important for the nurse to keep in mind before interviewing the family?

The nurse must allow the older adult mother to decide whether she wants to leave the situation Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate the involvement of other professionals in placing the child or older adult in a foster home or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem, even if the choice is to remain in the abusive situation. Forcing someone to do something against his or her wishes is in itself a form of victimization and denies autonomous decision making.

tardive dyskinesia Sx

The symptoms of tardive dyskinesia include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature.

Benzodiazepines work by the following mechanism of action

They act directly on GABA receptors and are thought to increase the amount of GABA

The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?

White blood cell count

For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months?

White blood cells

When conducting a suicide risk assessment, the nurse understands that which method has the least lethality?

Wrist slashing The least lethal of the options is wrist slashing. Hanging, overdose of benzodiazepines, and jumping are more lethal methods of suicide.

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

agranulocytosis

A nursing student is learning about drugs that affect the central nervous system. The student knows that some clients with schizophrenia are given which drugs? Select all that apply.

antipsychotic drugs neuroleptics

the nurse educates a class on factors that enhance the risk of suicide. The instructor determines the need for additional education when the class identifies what as one of these factors?

cautiousness Impulsivity, rather than cautiousness, enhances suicide risk. Other factors include a family member having completed suicide, psychotic thoughts such as delusions, and loss.

A nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the client will have difficulty in what area?

concept formation

A client is prescribed olanzapine for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of olanzapine, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?

diabetes mellitus

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which?

height and weight. these drugs have been associated with growth suppression.

A nurse is caring for a patient who is taking haloperidol. The patient has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on a(n):

increased risk for toxic effects of haloperidol therapy.

All of the following pharmacological agents are useful in treating anxiety disorders except which ones

Ca channel blocker

A nurse is caring for a client who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the client will have difficulty with what activity?

Calculating a math problem

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?

Carbamazepine Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.

The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain?

Cerebellum

The nurse is caring for a mental health client who has developed difficulty with balance and muscle tone after a car accident that involved a head injury. Based on this information, what area of the brain was most likely injured in the accident?

Cerebellum

A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family?

"You may experience noticeable weight gain while taking this medication." Weight gain is a common side effect of the atypical antipsychotics, particularly clozapine and olanzapine, which can cause a weight gain of up to 20 pounds within 1 year

A Cuban American client has been prescribed an antipsychotic medication. Which response is most important for the nurse to make to this client?

"Call the doctor immediately if you experience any of the side effects we talked about."

The nurse is working with a 12 year-old client who has been diagnosed with attention-deficit hyperactivity disorder and prescribed methylphenidate (Ritalin). What statement by the client would suggest the presence of adverse drug effects?

"I just don't feel hungry very much these days." Anorexia is a common adverse effect

A female client 25 years of age has begun taking lithium for treatment of bipolar disorder. Which statement indicates that the client needs further instruction?

"I will need to stop taking my birth control pills while I take lithium."

A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating?

"Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness."

An adult client, diagnosed with narcolepsy, admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?

"This is the result of neurological factors over which you have no direct control."

A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client?

"You may not notice an improvement in your symptoms for 2 to 6 weeks." In general, all antidepressants act at the level of the neuron. Their effects include changing the receptor itself, altering metabolism and breakdown of the neurochemical, or blocking reuptake of the neurochemical at the presynaptic receptor. These changes occur soon after the medication is administered; however, reduction in depressive signs and symptoms usually takes between 2 to 6 weeks, depending on the drug.

A 12-year-old has been prescribed dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take the initial daily dose of dextroamphetamine at what times?

07:00 and 11:30 take the first dose of dextroamphetamine on awakening or early in the day and the last dose at least 6 hours before bedtime. Twice-daily dosing is most common.

Akathisia is

Akathisia is reported by the client as an intense need to move about.

A client in the operating room goes into malignant hyperthermia due to an abnormal reaction to the anesthetic. The nurse knows that the area of the brain that regulates body temperature is what?

Hypothalamus

During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate?

Assessing the client for target symptoms and side effects

What should the nurse's ongoing assessment of a client receiving a CNS stimulant for respiratory depression include? (Select all that apply.)

Blood pressure Pulse Respiratory rate Respiratory pattern Level of consciousness

When noted in an assessment of a child, the nurse should suspect child abuse if which common physical findings signaling abuse are present?

Bruises, burns, lacerations, missing teeth, and skeletal injuries The most common indicators of physical abuse of a child are as follows: (1) bruises involving no breaks in skin integrity, (2) burns, usually due to immersion in hot water, contact with cigarettes, tying with a rope, or the application of a hot iron, (3) lacerations, abrasions, welts, and scars noted on the lips, eyes, face, and external genitalia, (4) missing or loosened teeth, and (5) skeletal injuries such as fractured bones, epiphyseal separation, or stiff, swollen, enlarged joints.

The major difference between bipolar I and bipolar II disorder is what?

Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.

Which is the primary role of neurotransmitters?

Communicate information from one cell or cell group to another

Clients taking benzodiazepines need education about what?

Concomitant use of alcohol

When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?

Confusion After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short-term memory impairment. Numbness and tingling in the extremities is not an expected symptom of ECT.

A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms?

Damage to the hippocampus

A nurse is studying the positron emission tomography (PET) report of a client with Alzheimer's disease. What findings should the nurse expect to find in the report? Select all that apply.

Decreased blood flow to the brain Presence of amyloid plaques and tangles Decreased glucose metabolism in the brain

A teenage client, treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years, is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions?

Discontinue the dextroamphetamine.

The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis?

Disorganized and often bizarre thinking

Which is an anticonvulsant used as a mood stabilizer?

Divalproex Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.

The nurse is conducting an interview with an adult client who is being treated for major depression. What question should the nurse prioritize in an effort to determine the client's risk for suicide?

Do you ever feel like your situation is hopeless?

Extrapyramidal side effects are characterized by a triad of symptoms, including what?

Dystonia, akathisia, and pseudoparkinsonism

A nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, "I'm just so beautiful. Everyone just stops and stares at how gorgeous I am. People constantly want to have sex with me." The nurse interprets these statements as indicative of which type of mood?

Expansive The client's statements reflect an expansive mood, which is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions.

Abnormalities in which lobe is believed to be associated with schizophrenia?

Frontal

When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible?

Frontal lobes

Benzodiazepines increase which neurotransmitter function?

GABA

A client, prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD), has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement?

Increase fiber intake

A nursing assessment of a client who has been diagnosed with neuroleptic malignant syndrome (NMS) would most likely reveal which signs?

Hyperpyrexia, severe hypertension, and diaphoresis Fever, hypertension, and diaphoresis are cardinal symptoms of NMS and should be immediately addressed.

Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?

Hypertensive crisis

A client who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine. The client has been taking the medication for more than 40 years. What adverse effect will the client most likely experience?

Tardive dyskinesia

An older adult client has been taking diazepam on a daily basis for several years. On the advice of the client's daughter, the client now wants to stop taking it. Due to the possible effects of discontinuation, the nurse should perform what intervention?

Teach the client nonpharmacologic strategies for promoting sleep

An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply.

The client makes repetitive movements with the fingers The client often smacks lips when at rest

The nurse is assessing a client who has presented to the emergency department in emotional distress. What client data represents the greatest risk for suicide?

The client overdosed on pills 2 years earlier

A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority?

The client will remain safe.

Which test should be scheduled every week for a patient taking clozapine?

WBC count

The nurse is caring for a client diagnosed with Parkinson's disease. How would the nurse explain which transmitter is increased by taking antiparkinson's medication?

dopamine

One of the most common ways in which neurotransmitters are deactivated within the nervous system at the neuronal level is:

enzymatic degradation, primarily by monoamine oxidase (MAO).

In order to reduce the client's risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsychotic, the care team should implement which intervention?

gradually taper the dose of haloperidol

The nurse is working with a client that has not been diagnosed yet. The client is aggressive, unable to control anger, and violent at times. The client was brought to the emergency deparment by local police. The nurse selects what system as the etiology for the clients' behavior? Classify the symptoms according to origin in the body.

limbic system

What is the central nervous system stimulant of choice to treat narcolepsy?

modafinil

Neuroleptic malignant syndrome SX

potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.

Which is the greatest predictor of a future suicide attempt?

previous attempt The greatest predictor of a future suicide attempt is a previous attempt, in part because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning.

the nurse observes cogwheel rigidity, tremors, and drooling. The nurse interprets this as:

pseudoparkinsonism.

A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenager who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite?

reduced adverse effects

Monitoring what laboratory test is most important in the first months of clozapine therapy?

regular complete blood counts

he main goal of therapy when using CNS stimulants is to:

relieve the symptoms for which they were prescribed.

A client who has attempted suicide has an underlying diagnosis of depression. Which would the nurse anticipate being ordered for the client?

selective serotonin reuptake inhibitor Medication management focuses on treating the underlying psychiatric disorder. For depression, a nonlethal antidepressant (e.g., selective serotonin reuptake inhibitor) usually is prescribed. For clients with schizophrenia and schizoaffective disorder, antipsychotics may be used; however, only clozapine, an atypical antipsychotic, has been shown to be effective.