mental health med
Benztropine mesylate (Cogentin) and levodopa (Dopar) are prescribed for a client with Parkinson's disease. After a few days of therapy, the client complains of a "dry mouth" and "dizziness." What response by the nurse would be most appropriate?
"Chew gum to relieve the dry mouth and move slowly when assuming a standing position to reduce the dizziness
A client has been taking diazepam (Valium) for three months. The nurse determines the outcome of medication therapy has been successful when the client makes which statement?
"I feel like I am able to cope with routine stress at my job."
A health care provider has ordered imipramine (Tofranil) for each of these clients. A nurse would question the order for the client with: 1. Seizure Disorders 2. Depression 3. Enuresis 4. Neuropathic Pain
1
Muscarinic agents, such as benztropine (Cogentin) are most often contraindicated in glaucoma because these drugs can 1. Increase intraocular pressure 2. Promote ocular infections 3. Cause miosis which leads to blindness 4. Detach the retina
1
The nurse who is monitoring a client is taking phenytoin (Dilantin) has noted symptoms of nystagmus, confusion, and ataxia. Considering these findings, the nurse would suspect that the dose of the drug should be: 1. Reduced 2. Increased 3. Maintained 4. Discontinued
1
Which statement made by the client who is taking lithium carbonate (Eskalith) indicates that further teaching is necessary? 1. I will be sure to remain on a low sodium diet 2. I will have blood levels drawn every 2 to 3 months even when I have no symptoms 3. Lithium has a narrow margin of safety so toxicity is a very real concern 4. I will not be able to breast-feed my baby.
1
The nurse is monitoring the client for early lithium carbonate (Eskalith) toxicity. Which symptoms, if manifested by the client, would indicate that toxicity may be developing? Select all that apply. 1. Persistent GI upset. 2. Confusion. 3. Polyuria. 4. Convulsions. 5. Ataxia.
1,2
A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1. Client reports not going to work for this past week. 2. Client arrives at the clinic neat and appropriate in appearance. 3. Client complains of not being able to "do anything" anymore. 4. Client reports sleeping 12 hours per night and 3 to 4 hours during the day
2
A nurse is teaching a client who is being started on imipramine (Tofranil) about the medication. The nurse informs the client that the maximum desired effects may: 1. Start during the first week of administration 2. Not occur for 2 to 3 weeks of administration 3. Start during the second week of administration 4. Not occur until after 2 months of administration
2
A 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: 1. Parkinsonism 2. Tardive dyskinesia 3. Hypertensive crisis 4. Neuroleptic malignant syndrome
2
The client is receiving levodopa/carbidopa for parkinsonism. Which drug would the nurse expect to be added to the client's regimen to help control tremors? 1. Amantadine (Symmetrel) 2. Benztropine (Cogentin) 3. Haloperidol (Haldol) 4. Donepezil (Aricept)
2
The nurse has given medication instructions to the client receiving phenytoin (Dilantin). The nurse determines that the client has an adequate understanding if the client states that: 1. "Alcohol is not contraindicated while taking this medication." 2. "Good oral hygiene is needed, including brushing and flossing." 3. "The medication dose may be self-adjusted, depending on side effects." 4. "The morning dose of the medication should be taken before a serum drug level is drawn."
2
Which therapeutic outcome would the nurse consider more significant in evaluating a client who started atomoxetine (Strattera) 6 months ago? 1. Decrease in attention 2. Decrease in hyperactivity 3. Development of mydriasis 4. Elevated liver enzymes
2
A 10 year old child has been evaluated for a learning disability and has been diagnosed with absence seizures. Ethosuximide (Zarontin) has been ordered and the nurse is teaching the client and family about the drug. Because of the client's age, it is important to include instructions to: 1. Curtail after-school sports activities because the drug's metabolism may be increased with physical activity. 2. Increase intake of calcium rich foods and vitamin D to prevent bone loss. 3. Monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth. 4. Increase fluid intake to avoid dehydration caused by the drug.
3
A high school student taking atomoxetine (Strattera) for ADHD disorder visits the school nurse's office and confides "I am so depressed. The world would be better off without me." Which actions would the nurse take for this client. 1. Tell the client to stop taking atomoxetine immediately and not to take it until checking with the provider. 2. Assure the client that these are normal symptoms because the drug may 3 or 4 weeks to work. 3. Alert the family or caregiver that immediate attention and treatment are needed for these symptoms. 4. Have the client increase intake of caffeine by consuming cola products, coffee, or tea to counteract the depressive effect.
3
A nurse should advise a client who is receiving lorazepam (Ativan) about the adverse effects of this medication which include 1. Tachypnea 2. Astigmatism 3. Ataxia 4. Euphoria
3
The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which of the following information should the nurse include in the teaching plan? 1. Pregnancy should be avoided while taking phenytoin. 2. The client may stop the medication if it is causing severe gastrointestinal effects. 3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.
3
The client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which of the following symptoms would be expected as a result of this laboratory result? 1. Hypotension 2. Tachycardia 3. Slurred speech 4. No symptoms, because this is a normal therapeutic level
3 (Why not number 1 as well?)
A nurse is administering risperidone (Risperdal) to a client who is scheduled to be discharged. Before discharge, which of the following should the nurse teach the client? 1. Get adequate sunlight. 2. Avoid foods rich in potassium. 3. Continue driving as usual. 4. Get up slowly when changing positions.
4
Carbidopa-levodopa (Sinemet) is prescribed for the client with Parkinson's disease. The nurse monitors the client for side effects to the medication. Which of the following would indicate that the client is experiencing a side effect? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements
4
Which statement made by the client who is taking risperidone (Risperdal) indicates that further teaching is necessary? 1. I'll monitor my weight every month. 2. I can increase my intake of fluids and fiber if I have any GI problems. 3. I'll have my blood pressure monitored regularly. 4. There is no problem if I want to drink alcohol on the weekends.
4
A female client who has a history of seizure went to a health care facility to ask the nurse regarding the use of birth control pills while on phenytoin therapy. The nurse correctly states to the client that: A. Taking phenytoin decreases the effectivity of the birth control pills. B. Pregnancy is not allowed while taking phenytoin. C. There is no known interaction between these medicines so there is nothing to worry about. D. To discontinue phenytoin and proceed with the oral contraceptive.
A
A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of Parkinson's disease. The nurse tells the client that which of the following is a side effect of the medication? A. Difficulty performing a voluntary movement. B. Increased blood pressure. C. Increased heart rate. D. Itchiness of the skin.
A
The nurse is aware of which fact regarding lorazepam (Ativan)? a. It may cause confusion and blurred vision. b. It has a maximum adult dose of 25 mg/day. c. When combined with cimetidine, it causes plasma levels to be decreased. d. It interferes with the binding of dopamine receptors.
A
The nurse understands that antipsychotics act in which way? a. By blocking actions of dopamine b. By blocking actions of epinephrine c. By promoting prostaglandin synthesis d. By enhancing the action of gamma-aminobutyric acid
A
When benztropine (Cogentin) is ordered for a client, the nurse acknowledges that this drug is an effective treatment for which condition? a. Parkinsonism b. Paralytic ileus c. Motion sickness d. Urinary retention
A
Which antidepressive drug class is associated with severe food and medication interactions? A. MAOIs B. SSRIs C. SNRIs D. TCAs
A
A client with tonic-clonic seizure is receiving Phenobarbital (Luminal) and Valproic acid (Depakene). The nurse tells the client that: A. Valproic acid decreases phenobarbital metabolism. B. Valproic acid increases phenobarbital metabolism. C. There is no interaction between the two. D. Increase the dosage of the two medications.
A Valproic acid appear to decrease phenobarbital metabolism, thus there is increase levels of phenobarbital in the body. Therefore, phenobarbital blood levels should be monitored and appropriate dosage adjustments made as indicated.
Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions? A. Use sunscreen because of photosensitivity. B. Take the antipsychotic medication with food. C. Have routine blood tests to determine levels of the medication. D. Abstain from eating aged cheese.
A, B
Which can decrease efficacy of levodopa? A. Phenytoin B. Pyridoxine C. Niacin D. Both A and B
A, B
A client is admitted to the emergency department with status epilepticus. Which drug should the nurse most likely prepare to administer to this client? (Select all that apply.) a. diazepam (Valium) b. midazolam (Versed) c. gabapentin (Neurontin) d. levetiracetam (Keppra)
A,B
What should the client who is taking anticholinergic therapy for parkinsonism be taught? (Select all that apply.) a. To avoid alcohol, cigarettes, and caffeine b. To relieve dry mouth with hard candy or ice chips c. To use sunglasses to reduce photophobia d. To urinate 2 hours after taking the drug e. To receive routine eye examinations
A,B,C,E
A client is taking lithium. The nurse should be aware of the importance of which nursing intervention(s)? (Select all that apply.) a. Observe the client for motor tremors. b. Monitor the client for orthostatic hypotension. c. Draw lithium blood levels immediately after a dose. d. Advise the client to drink 750 mL/day of fluid in hot weather. e. Advise the client to avoid caffeinated foods and beverages, such as coffee, tea, colas, and chocolate. f. Teach the client to take lithium with meals to decrease gastric irritation.
A,B,E,F
An older male client with Tourette syndrome takes haloperidol (Haldol) to control tics and vocalizations. He has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. What action should the nurse take?
Assess for poor skin turgor, sunken eyeballs, and concentrated urine output.
A client has been taking lorazepam (Ativan) for several weeks for treatment of anxiety. The nurse should plan to assess the client for potential development of what side effect?
Ataxia Rationale: When taken in high doses for a prolonged period of time, side effects for this medication include amnesia, weakness, disorientation, ataxia, blurred vision, diplopia, nausea, and vomiting.
The nurse providing discharge teaching for a client recently started on a tricyclic antidepressant (TCA) must include the importance of:
Avoiding driving or operating dangerous equipment.
A client is taking zolpidem (Ambien) for insomnia. The nurse prepares a care plan that includes monitoring of the client for side effects/adverse reactions of this drug. Which is a side effect of zolpidem? a. Insomnia b. Headache c. Laryngospasm d. Blood dyscrasias
B
A client with parkinsonism asks the nurse to explain what causes this condition. The most accurate response by the nurse is that parkinsonism is caused by the degeneration of which? a. Cholinergic neurons b. Dopaminergic neurons c. Acetylcholine neurotransmitters d. Monamine oxidase-B neurotransmitters
B
A nurse is giving dietary instructions to a client receiving levodopa. Which of the following food items should be avoided by the client? A. Goat yogurt. B. Whole grain cereal. C. Asparagus. D. Apples.
B
A nurse is teaching a client about zolpidem. Which is important for the nurse to include in the teaching of this drug? a. Maximum dose is 20 mg/d b. May lead to psychological dependence c. For older adults, dose is 15 mg at bedtime d. Should only be used for 21 days or less
B
A nurse was giving health teaching to a client newly prescribed with lithium medication. Which of the following client statements indicates understanding about the medication? A. "When my mood fluctuates, I can increase the dosage of the medication" B. "I can still eat my favorite salty food" C. "I can crush an extended-release tablet, if ever it will be difficult for me to take it whole by mouth" D. "Drinking too much cranberry juice will help maintain a desirable lithium level"
B
A patient taking Dilantin (phenytoin) for a seizure disorder is experiencing breakthrough seizures. A blood sample is taken to determine the serum drug level. Which of the following would indicate a sub-therapeutic level? A. 15 mcg/mL. B. 4 mcg/mL. C. 10 mcg/dL. D. 5 mcg/dL.
B
Nurse Martha is teaching her students about anxiety medications, she explains that benzodiazepines affect which brain chemical? A. Acetylcholine B. Gamma-aminobutyric acid (GABA) C. Norepinephrine D. Serotonin
B
Nursing interventions for the client taking carbidopa-levodopa for parkinsonism include which? a. Encouraging client to adhere to a high-protein diet b. Informing client that perspiration may be dark and stain clothing c. Advising client that glucose levels should be checked through urine testing d. Warning client that it may take 4 to 5 days before symptoms are controlled
B
Phenytoin (Dilantin) has been prescribed for a client with seizures. The nurse should include which appropriate nursing intervention in the plan of care? a. Reporting an abnormal phenytoin level of 18 mcg/mL b. Monitoring CBC levels for early detection of blood dyscrasias c. Encouraging the client to brush teeth vigorously to prevent plaque buildup d. Teaching the client to stop the drug immediately when passing pinkish-red or reddish-brown urine
B
The nurse realizes that facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face are indicative of which condition? a. Akathisia b. Acute dystonia c. Tardive dyskinesia d. Pseudoparkinsonism
B
The nurse should monitor the client receiving phenytoin (Dilantin) for which adverse effect? a. Psychosis b. Nosebleeds c. Hypertension d. Gum erosion
B
Your patient is taking valproic acid (Depakote). Which of the following is a false statement? a. Valproic acid requires hepatic monitoring b. Valproic acid has the lowest seizure relapse rate when discontinued c. Valproic acid is also used in migraine therapy d. Valproic acid is also used in bipolar disorder therapy
B
Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A. The absence of anticholinergic effects B. A lower incidence of extrapyramidal effects C. Photosensitivity and sedation D. No incidence of neuroleptic malignant syndrome
B Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.
A client is receiving haloperidol (Haldol). Which nursing intervention(s) should the nurse perform? (Select all that apply.) a. Monitor vital signs to detect bradycardia. b. Remain with the client until medication is swallowed. c. Monitor vital signs to detect orthostatic hypotension. d. Assess the client for evidence of neuroleptic malignant syndrome. e. Observe the client for acute dystonia, akathisia, and tardive dyskinesia.
B,C,DE
Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin (Dilantin) for seizure control?
Brush and floss teeth daily.
A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A. Take the medication 1 hour before a meal. B. Decrease the dosage if signs of illness decrease. C. Apply a sunscreen before being exposed to the sun. D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
C
A client receiving lithium therapy for the treatment of his bipolar disorder has a lithium level of 0.85 mEq/L. The appropriate nursing action is: A. Notify the physician immediately B. Observe the client for signs of toxicity C. Record the laboratory result in the client's chart D. Hold the next dose of lithium
C
A client taking lorazepam (Ativan) asks the nurse how this drug works. The nurse should respond by stating that it is a benzodiazepine that acts by which mechanism? a. Depressing the central nervous system (CNS), leading to a loss of consciousness b. Depressing the CNS, including the motor and sensory activities c. Increasing the action of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) to GABA receptors d. Creating an epidural block by placement of the local anesthetic in the outer covering of the spinal cord
C
An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat: A. dyskinesia. B. dementia. C. psychosis. D. tardive dyskinesia.
C
The nurse witnesses a client's seizure involving generalized contraction of the body followed by jerkiness of arms and legs. The nurse reports that this is which type of seizure? a. Myoclonic b. Petit mal c. Tonic clonic d. Psychomotor
C
When administering phenytoin (Dilantin), the nurse realizes more teaching is needed if the client makes which statement? a. "I must shake the oral suspension very well before pouring in the dose cup." b. "I cannot drink alcoholic beverages when taking phenytoin." c. "I should take phenytoin 1 hour before meals." d. "I will need to get periodic dental checkups."
C
Which information should be given to the client taking phenytoin (Dilantin)? A. Taking the medication with meals will increase its effectiveness. B. The medication can cause sleep disturbances C. More frequent dental appointments will be needed for special gum care. D. The medication decreases the effects of oral contra- ceptives.
C
Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? A. Assume that the client is posturing. B. Tell the client to lie down and relax. C. Evaluate the client for adverse reactions to haloperidol. D. Put the client on the list for the physician to see tomorrow.
C
20. Diazepam (Valium) is prescribed to a client with alcohol withdrawal. Which of the following statements made by the client indicates an understanding of the treatment regimen? A. "This medication causes a blurring of vision". B. "This medication will cause a decrease platelet and white blood cell count in my blood". C. "I'll have my physician to lower my dosage once I started to feel okay". D. "Drinking grapefruit can increase the side effects with this medication".
D
A 17-year-old client is taking Phenytoin (Dilantin) for the treatment of seizures. Phenytoin blood level reveals to be 25 mcg/ml. Which of the following symptoms would be expected as a result of the laboratory result? A. No symptoms, because the value is within the normal range. B. Hypoglycemia. C. Tachycardia. D. Nystagmus.
D
A client is receiving carbidopa-levodopa for parkinsonism. What should the nurse know about this drug? a. Carbidopa-levodopa may lead to hypertension. b. Carbidopa-levodopa may lead to excessive saliva. c. Dopaminergic and anticholinergic therapy may lead to drowsiness and sedation. d. Dopaminergics and anticholinergics are contraindicated in clients with glaucoma.
D
A client is taking valproic acid (Depakote). The nurse should monitor the client for a which therapeutic serum range? a. 10 to 20 mcg/mL b. 15 to 40 mcg/mL c. 20 to 80 ng/mL d. 40 to 100 mcg/mL
D
A client who has been taking lithium medication for the past few years, recently got pregnant, and she is very concerned about the effects of the medication on her unborn child. Which of the following statements is true that would address the client's concern? A. Lithium does not cross the placental barrier and poses no risk for the fetus B. Pregnant women with a diagnosis of bipolar disorder should not take lithium medication C. Oral contraceptive and lithium medication may result to a false-positive pregnancy test. D. Lithium should be avoided during the latter part of the first trimester if possible.
D
A client with bipolar disorder is taking lithium and is experiencing diarrhea and vomiting. Which of the following nursing interventions should the nurse do first? A. Recognize this as a drug interaction B. Give the client Cogentin C. Reassure the client that these are common side effects of lithium therapy D. Hold the next dose and obtain an order for a stat serum lithium level
D
An individual with depression has a deficiency in which neurotransmitters, based on the biogenic amine theory? A. Dopamine and thyroxin B. GABA and acetylcholine C. Cortisone and epinephrine D. Serotonin and norepinephrine
D
The nurse is giving instructions to a client receiving Phenytoin (Dilantin). The nurse concludes that the client has a sufficient knowledge if the client states that: A. "Wearing a medical alert tag is not required". B. "Alcohol is permitted in while taking this medication". C. "I can take the medicine with milk". D. "To take the morning dosage before a blood sample is taken".
D
Which statement is true concerning lithium? a. The maximum dose is 3.4 g/day. b. The therapeutic drug range is 2.5 to 3.5 mEq/L. c. Lithium increases receptor sensitivity to GABA. d. Concurrent NSAIDs may increase lithium levels.
D
Important teaching for a client receiving risperidone (Risperdal) would include advising the client to: A. double the dose if missed to maintain a therapeutic level. B. be sure to take the drug with a meal because it's very irritating to the stomach. C. discontinue the drug if the client reports weight gain. D. notify the physician if the client notices an increase in bruising.
D Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Don't double the dose. This drug doesn't irritate the stomach, and weight gain isn't a problem.
The nurse reviews the client's lithium serum drug level, noting that it is 0.95 mEq/L. The appropriate nursing action is to:
File the lab result in the medical record.
The nurse notes that a client receiving phenytoin (Dilantin) 300 mg PO daily has a serum phenytoin level of 14 mcg/ml. What intervention should the nurse implement?
Make sure that the client is performing thorough oral care.
A client receiving phenytoin (Dilantin) has been experiencing fluctuating serum blood levels of the medication. Development of which symptoms in the client should prompt the nurse to notify the primary health care provider immediately? (Select all that apply.)
Migraine headaches and nausea Double vision and lethargy
A client receiving digoxin (Lanoxin) therapy is being treated for status epilepticus with diazepam (Valium). The nurse places priority on:
Monitoring the client for nausea and GI cramping.
A client is prescribed zolpidem (Ambien). Which of these outcomes should the nurse include in a plan of care?
Normal sleep pattern will be restored.
A client who is receiving phenytoin (Dilantin) begins to exhibit nystagmus and diplopia. Which physiologic manifestation is consistent with these findings?
Phenytoin toxicity
The client, age 8, is prescribed valproic acid (Depokene) for treatment of a seizure disorder. The nurse should monitor the client closely for:
Restlessness and agitation. Valproic acid can produce an idiosyncratic response in children, including restlessness and psychomotor agitation.
A nurse is assessing an elderly client who has been taking zolpidem (Ambien) for three months. Which of these findings would require immediate follow-up by the nurse?
The client is agitated and combative. Rationale: Ambien is indicated only for short-term management (7-10 days) of insomnia. The elderly client who is on long-term therapy for insomnia might experience brain dysfunction as the medication accumulates in the brain. Symptoms of agitation and combative behavior require immediate nursing interventions.
The nurse encourages the client to remain compliant with TCA therapy in spite of the common side effect of:
Weight gain.