Chapter 22 PrepU

The history of a child newly diagnosed with ADHD reveals that the child is experiencing sleeping difficulties. Which agent would the nurse expect to be most likely to have been prescribed?

Atomoxetine

For which patient is clozapine, an antipsychotic, contraindicated?

The 45-year-old with bone marrow depression

The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response?

"ADHD usually starts in childhood and may persist through adulthood."

The wife of a patient who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be:

"Continue the prescribed dose. It may take several days to work."

A client asks the nurse dopamine is. What is a correct response by the nurse?

"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."

A bipolar client is being discharged home in 48 hours. What statement by the client indicates an understanding of treatment with lithium?

"I will increase my fluid intake."

A female client asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be:

"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse."

An African American male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the physician's office with signs of tardive dyskinesia, and his physician modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?

"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in African Americans."

A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?

Antipsychotics do not improve memory loss and may further impair cognitive functioning.

A patient is being prescribed a central nervous system stimulant. Which will have the lowest risk of abuse and dependence?

Atomoxetine (Strattera)

A 3-year-old child is brought to the pediatric clinic by his mother. She states, "I don't know what to do with him. He is in constant motion. He won't sit for more than 15 minutes and he is doing something else. He often throws his toys and yells loudly." The child is diagnosed with attention deficit hyperactivity disorder. Which medications will be administered in conjunction with treatment?

Central nervous system stimulants

The nurse expects to monitor a client's white blood count weekly when the client is prescribed:

Clozapine

A patient is prescribed olanzapine (Zyprexa) for the treatment of acute bipolar disorder. The patient tells the nurse he is voiding three times at night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed?

Diabetes mellitus

A patient is to be started on amphetamine therapy for attention deficit hyperactivity disorder. Which medication has less physical dependence and abuse than other amphetamines?

Lisdexamfetamine (Vyvanse)

A male client's physician orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?

Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.

A nurse works at a weight management clinic. To which overweight patients could the nurse safely administer dextroamphetamine?

A 48-year-old Caucasian man who has adult-onset diabetes

What client is being treated with a typical antipsychotic?

An agitated client who was given haloperidol during acute psychosis

A nurse is charting a client who has repetitive tongue thrusting, jaw movements, and a facial tick. What term could the nurse use in charting to describe these findings?

Tardive dyskinesia

A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior?

Tardive dyskinesia

A female client is diagnosed with renal insufficiency. The nurse develops a teaching plan based on the diagnosis and antipsychotic drug usage. The client asks the nurse why it is so important to have renal function tests routinely. The nurse replies that if renal function test results become abnormal, what may be a consequence?

The drug may need to be lowered in dosage or discontinued.

A nurse is explaining to a friend why CNS medications are addictive. What is one reason CNS medications are addictive?

The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine.

During periods of dehydration, the client is at risk for lower serum lithium levels.

False

Which drug shares the abuse potential of amphetamines and is a Drug Enforcement Administration (DEA) schedule II controlled substance?

Methylphenidate, a centrally acting CNS stimulant

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.

Which CNS stimulant is used in the treatment of obesity?

Phentermine (Adipex-P)

A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may:

have undiagnosed diabetes.

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse's priority assessment would be

height and weight.

A patient has been administered modafinil (Provigil) for narcolepsy. Which interventions should the nurse perform while caring for the patient? (Select all that apply.)

-Avoid coffee, tea, and carbonated beverages. -Keep a suction machine nearby.

The nurse should suspect lithium toxicity in a client that experiences which symptoms? (Select all that apply.)

-Diarrhea -Lack of coordination -Muscle weakness

The nursing student learned in anatomy and physiology class that the nervous system has how many divisions?

2

A patient asks the nurse how much caffeine is safe to consume per day. What is the recommended amount of caffeine for a nonpregnant woman?

250 mg

A dose of 60 mg Doxapram HCL has been prescribed for a patient to be administered intravenously. The drug is available in 20-mL vials containing 400 mg of the drug. How many mL of the available solution should be administered to the patient?

3

A male client comes into the emergency department and is agitated, swiping his arms at "the bugs" and screaming that Harry Potter sent the bugs to take him away. After two security officers help to restrain the client, the doctor orders 5 mg of Haldol STAT. How would the nurse administer this drug?

5 mg IM in the client's gluteus maximus

A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation?

Antipsychotic

A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?

It reduces the likelihood of drug dependence or diversion.

Moderate CNS depression is characterized by:

Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.

A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?

Increased blood glucose

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.

Which medication is used to treat narcolepsy and does not cause cardiac and other systemic stimulatory effects like other CNS stimulants?

Provigil

A female client relates that she is taking Valium for a muscle relaxant and Provigil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of client education, the nurse would include:

Provigil may decrease the effects of her contraceptive, and she may need to use other protection.

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

Respiratory pattern Blood pressure Respiratory rate Pulse Review recent lab work

The nurse is caring for a patient who is receiving drug therapy for a psychotic disorder. Which goals should the nurse include in a care plan for the patient following discharge from the hospital?

The patient will take medications as prescribed.

A client is being treated with clozapine. What should the nurse monitor most closely?

White blood cell count

During an intake assessment, the nurse notes that the client cannot sit still and continually stands up and walks around the room. The nurse knows that the term for this behavior is:

akathisia.

A pediatric patient has been admitted to the floor and began on ritalin therapy for AHDH. The nurse knows that an important daily intervention for this patient would be to:

record a daily summary of child's behavior.

While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:

tardive dyskinesia.