NSG118-Wk 4 EAQ-Psych-Meds
The nurse is assessing a patient who is prescribed a benzodiazepine. When reviewing the patient's history, what may the nurse ask? "Have you undergone any surgery?" "Have you ever experienced trauma?" "Are you taking oral contraceptives?" "Are you taking calcium supplements?"
"Are you taking oral contraceptives?" During the assessment, the nurse should ask the patient about the use of oral contraceptives. Oral contraceptives interact with benzodiazepines, resulting in reduced elimination of benzodiazepines. This increases the serum concentrations of benzodiazepines and thus causes severe depression of the central nervous system. Surgery and trauma are not contraindications for administering benzodiazepine to a patient. Calcium supplements do not interact with benzodiazepines.
The nurse is assessing a patient who has been prescribed alprazolam to treat panic disorder. Which adverse effects will the nurse monitor for in the patient? Ataxia Dizziness Confusion Blurred vision Paradoxical anxiety
Ataxia Dizziness Confusion Ataxia, dizziness, and confusion are adverse effects of alprazolam caused by the mechanism of action of the drug. Blurred vision and paradoxical anxiety are not the adverse effects of alprazolam. These are the adverse effects of buspirone.
A male patient tells the nurse that he wants to stop taking citalopram because of the sexual side effects. Which instruction should the nurse provide while educating the patient to help relieve the patient's sexual dysfunction? Avoid alcoholic beverages. Discontinue the medication. Decrease the regular dosage. Take infrequent "drug holidays." Report complaints to the psychiatrist. Maintain the current pharmacotherapy.
Avoid alcoholic beverages. Take infrequent "drug holidays." Report complaints to the psychiatrist. Maintain the current pharmacotherapy. Sexual dysfunction is managed in several ways, including reduction of the regular dosage, "drug holidays," the addition of a medication for erectile dysfunction, change of antidepressant, and avoidance of alcohol. The nurse encourages the patient to continue taking selective serotonin reuptake inhibitors such as citalopram because the adverse effects of therapy often diminish in intensity and frequency over time; this strategy helps prevent disruptions in therapy. After providing this information, the nurse encourages the patient to voice complaints to the psychiatrist who prescribes the antidepressant, but the nurse does not depend on the patient to ensure that the psychiatrist is notified of the complaint. The nurse avoids instructing the patient to discontinue therapy or to alter the dosage because these actions are not within the scope of nursing practice.
The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with? Bipolar disorder Absence seizures Paranoid schizophrenia Obsessive-compulsive disorder
Bipolar disorder Lithium is an antimanic drug used to treat manic episodes associated with bipolar disorder. Therapeutic effects of the mood stabilizer lithium are decreased mania and stabilization of the patient's mood. Lithium is not used to treat absence seizures, paranoid schizophrenia, or obsessive-compulsive disorder.
A patient with a history of abusing opioid analgesics needs an antianxiety agent. Which medication should the nurse expect to administer? Multiple choice question Diazepam Buspirone Venlafaxine Escitalopram
Buspirone Because the potential for abuse is low, buspirone is a suitable antianxiety agent for this patient. Diazepam is contraindicated because benzodiazepines are highly addictive. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor, and escitalopram is a selective serotonin reuptake inhibitor; both medications have a low potential for abuse and are first-line antidepressant therapies. The nurse does not know whether the patient has depression along with the anxiety, so these drugs are not indicated.
A patient who is receiving an antidepressant medication shows signs of serotonin syndrome. Which other drug may have caused the serotonin syndrome if given together with the antidepressant medication? Buspirone Diazepam Lorazepam Alprazolam
Buspirone Buspirone, when prescribed with serotonin-influencing antidepressants, causes serotonin syndrome. The syndrome is characterized by delirium, agitation, tachycardia, and sweating. Diazepam, alprazolam, and lorazepam do not interact with antidepressant drugs because they have different mechanisms of action.
Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine? Multiple choice question Renal panel Liver function tests Complete blood count Immunoglobulin levels
Complete blood count Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis, evidenced by a severe reduction in the number of white blood cells. Renal panels, liver function tests, and immunoglobulin levels are not factors.
A female patient who takes lorazepam for anxiety tells the nurse that she plans to become pregnant. What is the best instruction for the nurse to give the patient? Eat a well-balanced diet that includes milk. Stop taking the drug and form another plan to manage anxiety. Discuss tapering the drug with the health care provider before conception. Visit an obstetrician to determine the correct dose of lorazepam during pregnancy.
Discuss tapering the drug with the health care provider before conception. The best instruction for the nurse to provide includes health promotion for the patient and the fetus, so the nurse instructs the patient to taper therapy as a means of avoiding the adverse effects of withdrawal and to prevent fetal harm. Therapy must be stopped before conception because benzodiazepines are lipid soluble and cross the placenta, increasing the risk of fetal harm. To promote fetal development, the nurse instructs the patient to visit an obstetrician for folic acid and prenatal vitamin prescriptions and to eat a well-balanced diet. To help prevent a crisis, the nurse instructs the patient to develop an alternative plan for managing anxiety with the assistance of a primary health care provider.
What is the main receptor in the central nervous system (CNS) that is blocked by conventional antipsychotic drugs? Serotonin Dopamine Acetylcholine Norepinephrine
Dopamine Conventional antipsychotic agents block dopamine receptors, primarily in the CNS. The blockade of dopamine receptors is responsible for the therapeutic and toxic effects of these medications. Atypical antipsychotic agents block dopamine 2 receptors and serotonin receptors, offering improved therapeutic effectiveness and a more favorable side effect profile. Serotonin, acetylcholine, and norepinephrine are not blocked by conventional antipsychotic drugs.
A patient is admitted to the emergency department after an overdose of oxazepam. Which antagonist may be used to treat this patient? Multiple choice question Naloxone Naltrexone Nalmefene Flumazenil
Flumazenil Oxazepam is a benzodiazepine drug. Flumazenil is an antidote for benzodiazepine overdoses. Naloxone, naltrexone, and nalmefene are not antidotes for benzodiazepine overdoses.
A patient develops neuroleptic malignant syndrome after being administered antipsychotic drugs. Which symptoms does the nurse expect to find in the patient? Akathisia High fever Acute dystonia Myoglobinemia Unstable blood pressure
High fever Myoglobinemia Unstable blood pressure Antipsychotic drugs are associated with many side effects. Neuroleptic malignant syndrome is a life-threatening condition characterized by high fever, myoglobinemia (presence of myoglobin in the blood), and unstable blood pressure. Akathisia (distressing motor restlessness) and acute dystonia (painful muscle spasms) are extrapyramidal symptoms.
Which adverse effects result from antipsychotic drugs' action on alpha-adrenergic receptors? Weight gain Lightheadedness Reflex tachycardia Tardive dyskinesia Postural hypotension
Lightheadedness Reflex tachycardia Postural hypotension Antipsychotics are a group of drugs used to treat serious mental illnesses. They act on the various receptors in the central nervous system to produce a therapeutic effect. Adverse effects of these drugs occur as a result of a blockage of certain receptors or because of abnormal activity. The action of antipsychotics on alpha-adrenergic receptors results in lightheadedness, reflex tachycardia, and postural hypotension. Weight gain is an adverse effect of antipsychotic drugs due to the involvement of histamine receptors. Tardive dyskinesia is an abnormal and uncontrollable movement that occurs because of the involvement of dopamine receptors.
A patient with bipolar disorder has involuntary wavelike movements of the legs. Which drug is responsible for this adverse effect in the patient? Diazepam Buspirone Alprazolam Lithium citrate
Lithium citrate The involuntary wavelike movements of the legs are called choreoathetotic movements. This is an adverse effect of lithium citrate, which is a mood stabilizer used to treat bipolar disorder. Diazepam, buspirone, and alprazolam are not associated with choreoathetotic movements and are not used to treat bipolar disorder.
The nurse is caring for a patient who is being treated with anxiolytic drugs. What is the most important nursing responsibility for ensuring patient safety? Monitor the postural blood pressure. Instruct the patient not to miss doses. Teach the patient about the side effects. Monitor the patient's response to therapy.
Monitor the postural blood pressure. Anxiolytic drugs tend to affect the blood pressure, causing postural hypotension, which may cause dizziness in the patient and increase the risk of fall. Therefore the nurse should monitor the postural blood pressure of the patient to avoid falls and ensure safety. The nurse should tell the patient not to miss any doses to ensure the maintenance of the therapeutic levels. However, this is a secondary intervention. The nurse should teach the patient about the side effects of the drugs. However, this can be done only when the patient is stabilized on the anxiolytics. The nurse should monitor the patient's response to the therapy. This helps to assess in cases where the dose needs to be adjusted, but it does not help prevent falls in the patient.
The primary health care provider reviews the medical history of a patient who is receiving buspirone. The health care provider instructs the nurse to continuously monitor the patient's blood pressure to prevent hypertension due to a drug interaction. Which other medication is the patient taking? Iron supplement Oral contraceptives Nonsteroidal antiinflammatory drugs Monoamine oxidase inhibitor (MAOI)
Monoamine oxidase inhibitor (MAOI) Buspirone should not be given to the patient receiving MAOIs because it causes hypertension by increasing the sympathomimetic activity. The drug should be administered to the patient after a washout period of 14 days after discontinuation of MAOIs. Therefore the health care provider informs the nurse to continuously monitor the patient's blood pressure. Iron supplements, oral contraceptives, and nonsteroidal antiinflammatory medications do not alter the neurotransmitters. Hence these drugs do not cause hypertension by altering the sympathomimetic transmissions.
Which mood-stabilizing drugs are used to treat bipolar disorder? Bupropion Imipramine Isocarboxazid Oxcarbazepine Lithium carbonate
Oxcarbazepine Lithium carbonate Mood stabilizers are drugs that are used to treat the cycles of mania, hypomania, and depression by regulating the metabolism of catecholamines. Examples of mood stabilizers include oxcarbazepine and lithium carbonate. Imipramine is a tricyclic antidepressant, not a mood stabilizer. It is a second-line therapeutic drug for bipolar disorders. Bupropion is a drug that is categorized under a miscellaneous group and is used for the treatment of depression. Isocarboxazid is a monoamine oxidase inhibitor used for the treatment of depression.
A patient is taking tricyclic antidepressant (TCA) therapy for the treatment of insomnia. On reviewing the prescription, the nurse finds that the patient is also taking phenelzine. Which symptoms does the nurse monitor for in the patient? Lethargy Shivering Hyperthermia Muscle spasms Paradoxical anxiety
Shivering Hyperthermia Muscle spasms The patient on TCA therapy is taking phenelzine, which is a monoamine oxidase inhibitor. Therefore the patient is likely to have serotonin syndrome due to enhanced serotonergic effects. The symptoms of serotonin syndrome include shivering, hyperthermia, and muscle spasms. Lethargy and paradoxical anxiety are not associated with serotonin syndrome. Lethargy is an adverse effect of benzodiazepines, whereas paradoxical anxiety is an adverse effect of buspirone.
Which medication increases the rate of urinary elimination of tricyclic antidepressants (TCAs) in the event of an overdose? Diazepam Antidysrhythmic Activated charcoal Sodium bicarbonate
Sodium bicarbonate Sodium bicarbonate alkalizes the urine and enhances the elimination of medication; therefore it is used to speed up the elimination of high doses of TCAs. Diazepam is used to reduce central nervous system damage associated with high doses of TCAs. Antidysrhythmics are drugs used to treat cardiovascular events that occur as a result of an overdose of TCAs. The administration of activated charcoal reduces the absorption of TCAs.
The nurse prepares a patient who is taking sertraline for discharge. Which instruction should the nurse include in patient education? Report any increase in mania. Expect to feel better in 4 to 6 days. Take sertraline at the same time each day. Avoid overheating and direct sun exposure.
Take sertraline at the same time each day. Sertraline is a selective serotonin reuptake inhibitor, and the patient is most likely to experience therapeutic effectiveness if the medication is taken at the same time every day. Lithium is used to treat bipolar disorder, of which mania is a characteristic. The nurse instructs the patient to adhere to therapy for 4 to 6 weeks to determine the effectiveness of sertraline. Hyperpyrexia is an adverse effect of antipsychotic agents.
A patient diagnosed with depression is started on a tricyclic antidepressant (TCA) after failure to improve symptoms on a selective serotonin reuptake inhibitor. The nurse should include which teaching point when educating the patient about the new medication? There are no contraindications to this medication. The medication is safe; it has been used longer than many others. There is a risk of toxicity when this medication is taken with alcohol. This class of medications has no other use and is only for depression.
There is a risk of toxicity when this medication is taken with alcohol. There is an increased risk of toxicity and a high rate of morbidity with TCAs when taken with alcohol.
