NUR326 Mental Health Medications

a nurse is discussing routine follow up needs with a client who has a new prescription for valproate. the nurse should inform the client of the need for routine monitoring of which of the following? a. AST/ALT and LDH b. creatinine and BUN c. WBC and granulocyte counts d. blood sodium and potassium

A

A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. the nurse should instruct the client to ensure an adequate intake of which of the following dietary elements? a. sodium b. potassium c. vitamin k d. vitamin c

A

a nurse is providing teaching to a client who has schizophrenia and is to begin taking haloperidol. which of the following information should the nurse include in the teaching? a. you may experience dizziness upon standing while taking this med b. this med will decrease your symptoms of OCD c. this med may cause excessive salivation d. you can stop taking this med of the adverse effects are bothersome

A haloperidol may cause dry mouth, abruptly stopping haloperidol can cause extrapyramidal symptoms, must be tapered slowly under direction of provider

a charge nurse is discussing mirtazapine with a newly licensed nurse. which of the following statements by the newly licensed nurse indicates understanding? a. this med increases the release of serotonin and norepinephrine b. i should tell the client about the likelihood of insomnia while taking this med c. this med is contraindicated for clients who have an eating disorder d. sexual dysfunction is a common adverse effect of this med

A wrong answers: B: inform client likelihood of drowsiness, not insomnia C: eating disorders are contraindicated with bupropion D: this is an adverse effect of SSRIs

A nurse is caring for a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. the nurse should assess the client for which of the following adverse effects? a. dysrhythmias b. cataracts c. pancreatitis d. bleeding

A, cardiac dysrhythmias are a risk. the client should be monitored for changes in vital signs, tachycardia, and ECG changes (including prolonged QT interval); risk for cardiac arrest due to torsades de pointes other risks include: glaucoma and hepatitis

a nurse is providing teaching for a client who has schizophrenia and a new prescription for risperidone. which of the following statements should the nurse include in the teaching? a. increase your fluid and fiber intake to prevent constipation b. have your blood pressure checked frequently for hypertension c. expect to have your blood checked weekly for serum electrolyte imbalances d. increase caloric intake to prevent weight loss

A, constipation is a common adverse effect of risperidone CBC and liver function will be checked monthly weight gain, dyslipidemia, and increases in blood glucose are common adverse effects of risperidone

A nurse is teaching a client who has a new prescription for diazepam. Which of the following information should the nurse include in the teaching? a. diazepam can cause drowsiness b. this medication must be swallowed whole c. it is important to avoid foods that contain tyramine d. grapefruit juice inactivates this medication

A, diazepam has sedative properties Wrong answers: B: diazepam can be crushed and taken with food C: MAOIs must avoid tyramine foods D: cimetidine increases diazepam blood levels

a nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. prior to administration of lithium carbonate, the client's lithium blood level is 1.2mEq/L. which of the following actions should the nurse take? a. administer the next dose of lithium carbonate as scheduled b. prepare for administration of aminophylline c. notify the provider for a possible increase in the dosage of lithium carbonate d. request a stat repeat of the client's lithium blood level

A, during a manic episode lithium levels should be between 0.8 - 1.4 mEq/L aminophylline is administered for >1.4mEq/L

A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse should teach the client that which of the following factors puts her at risk for lithium toxicity? a. client runs 4 miles outdoors every afternoon b. client drinks 2 liters of liquids daily c. client eats 2-3g of Na containing foods daily d. client eats foods high in tyramine

A, exposure to outdoor heat can lead to dehydration --> increasing the risk for lithium toxicity Wrong answers: BC: this decreases risk of lithium toxicity D: does not matter

a nurse is caring for a client who has schizophrenia and is taking haloperidol. the nurse should monitor for which of the following adverse effects of haloperidol? a. extrapyramidal symptoms b. fever c. intractable hiccups d. excessive salivation

A, extrapyramidal symptoms include movement disorders and are associated with typical antipsychotic meds

A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication? a. insomnia b. bradycardia c. hearing loss d. hypertension

A, paradoxical effects (insomnia and excitation) are an adverse effect of this drug Wrong answers: B: more likely to cause tachycardia C: can cause tinnitus but not hearing loss D: can cause hypotension and orthostatic hypotension

a nurse is assessing a client who has schizophrenia and is taking riperidone. which of the following findings should the nurse expect? a. weight gain b. dependent edema c. nightmares d. bradycardia

A, weight gain is an expected adverse effect tachycardia is a potentially serious adverse effect

a nurse is caring for a client who takes paroxetine to treat PTSD. the client states "I grind my teeth during the night, which causes pain in my mouth". the nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (SATA) a. concurrent administration of buspirone b. administration of a different SSRI c. use of a mouth guard d. changing to a different class of antianxiety med e. increasing the dose of paroxetine

ACD other SSRIs will also have adverse effect of bruxism

a nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. which of the following instructions should the nurse include in the teaching? (SATA) a. void just before taking the med b. increase the dietary intake of potassium c. wear sunglasses when outside d. change positions slowly when getting up e. chew sugarless gum

ACE

a nurse is providing teaching for a client who has schizophrenia and a new prescription for fluphenazine. which of the following information should the nurse provide? a. this med might turn your urine orange b. sleepiness should subside within a week c. stop the med if hypotension occurs d. a low-grade fever is expected with first doses

B, may cause sedation with early treatment might turn urine pink to reddish brown, may cause orthostatic hypotension but should not be stopped abruptly may cause leukopenia or agranulocytosis, notify provider immediately if experience sore throat/fever/malaise

a nurse working in an ED is caring for a client who has benzodiazepine toxicity. which of the following actions is the nurse's priority? a. administer flumazenil b. identify the client's level of orientation c. infuse IV fluids d. prepare the client for gastric lavage

B, part of the initial step of "assessment" wrong answers: flumazenil will reverse effects, IV fluids will maintain normal BP, gastric lavage will remove excess benzos but "B" needs to be done first

a nurse is caring for a client who is prescribed lithium therapy. the client tells of the plan to take ibuprofen for osteoarthritis pain relief. which of the following statements should the nurse make? a. that is a good choice. ibuprofen does not interact with lithium b. regular aspirin would be a better choice than ibuprofen c. lithium decreases the effectiveness of ibuprofen d. the ibuprofen will make your lithium level fall too low

B, ibuprofen increases the risk for lithium toxicity

a nurse is providing teaching to a client who has a new prescription for amitriptyline. which of the following statements by the client indicates an understanding of the teaching? a. i can expect to experience diarrhea while taking this med b. i may feel drowsy for a few weeks after starting this med c. i cannot eat my favorite pizza with peperoni while taking this med d. this med will help me lose the weight that i have gained over the last year

B, sedation is an adverse effect during the first few weeks of therapy wrong answers: A: constipation is an adverse effect because of anticholinergic effects C: TCAs don't have food restrictions D: observe for manifestations of hypomania or mania caused by CNS stimulation with phenelzine

A nurse is reviewing medications for a newly admitted client who has bipolar disorder and is experiencing mania. Which of the following client prescriptions should the nurse realize is expected to reduce the client's mania? a. fluvastatin b. carbamazepine c. lorazepam d. propranolol

B: antiseizure med and mood stabilizer, prescribed to treat and prevent mania in clients who have bipolar disorder Wrong answers: A: antilipemic med used to reduce cholesterol levels C: sedative/hypnotic med used to treat anxiety D: beta blocker used to treat HTN, heart conditions, certain anxiety disorders

A nurse in a mental health clinic is caring for a client who has bipolar disorder and a prescription for an antipsychotic med. The provider and nursing staff suspect the client is not adhering to his med therapy. Which of the following interventions should the staff use to encourage the client's adherence? (SATA) a. perform mouth checks following the administration of the med b. provide for once-daily dosing c. use sustained-release forms d. engage the client in conversation following med administration e. rotate staff that administer the meds

BCD: once daily and sustained release meds require less frequent dosing and simplifies the med therapy, if the client is speaking it is harder for them to hid meds in their mouth Wrong answers: A: ma not find meds hidden in mouth E: increases risk of nonadherence

a nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. the nurse should include which of the following manifestations in the teaching? (SATA) a. constipation b. polyuria c. rash d. muscle weakness e. tinnitus

BD wrong answers: A: diarrhea is an early indication C: nope E: indication of severe, not early, toxicity

a nurse is caring for a client who is taking phenelzine. for which of the following manifestations should the nurse monitor as an adverse effect of this med? (SATA) a. elevated BG level b. orthostatic hypotension c. priapism d. hypomania e. bruxism

BD, headache may indicate hypomania

a nurse is assessing a client 4 hr after receiving an initial dose of fluozetine. which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (SATA) a. hypothermia b. hallucinations c. muscular flaccidity d. diaphoresis e. agitation

BDE muscle tremors and fever are also indications of serotonin syndrome

a nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. which of the following statements indicates the client understands the use of this med? a. i will take the med at bedtime b. i will follow a low sodium diet while taking this med c. i will need to discontinue this med slowly d. i will be at risk for weight loss with long term use of this med

C wrong answers: A: take in the morning to minimize sleep disturbances B: client is at risk for hyponatremia when taking fluoxetine D: client is at risk for weight gain with long term use

A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this med? a. thyroid function tests should be performed every 6m b. a pretreatment EEG will be done c. liver function tests must be monitored d. high serum sodium levels can cause toxic levels of valproate

C, adverse effects of this med include: pancreatitis, hepatic dysfunction, and thrombocytopenia Wrong answers: A: hypothyroidism is a long term risk for clients taking lithium B: only necessary when clients are taking valproate as an anticonvulsant, not as a mood stabilizer D: sodium levels do not effect valproate

A nurse is teaching a client who has a new prescription for alprazolam to treat insomnia. Which of the following instructions should the nurse include? a. take this medication every night before sleep b. take this medication with a high fat meal c. avoid activities that require alertness such as driving d. monitor for urinary retention

C, alprazolam is a benzo that causes sedation and dizziness Wrong answers: A: the med should be taken intermittently (3 or 4 nights/wk) to prevent physical dependence B: fatty foods reduce the absorption of this med D: benzos dont cause this

A nurse is providing dietary teaching for a client who has a new prescription for a MAOI. When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? a. glass of whole milk b. celery sticks c. bologna sandwhich d. sliced apples

C, bologna has a high tyramine content - other examples are: strong/aged cheeses, cured meat, smoked/processed meats, pickled/fermented foods, soy sauce, fish sauce, teriyaki sauce, soy beans, alcoholic beverages

A nurse is assessing a client who has been taking sertraline for 2 weeks. The nurse should identify which of the following findings as an indication that the medication is effective? a. the clients BP is within the expected reference range b. the client reports a recent weight loss c. the client reports increase in mood d. the client's legs are not swollen

C, sertraline is a SSRI used to treat major depressive disorders, therapeutic effects include an increase in mood, and an increased interest in activities

a nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. which of the following findings is the priority for the nurse to report to the provider? a. the client has a family history of seasonal pattern depression b. the client currently smokes 1.5 packs of cigarettes per day c. the client had a motor vehicle crash last year and sustained a head injury d. the client has a bmi of 25 and has gained 10 lb over the last year

C, the greatest risk to the client is development of seizures. bupropion can lower the seizure threshold and should be avoided by clients who have a history of a head injury, super important to report to provider other answers should still be reported but C is the priority

A nurse is teaching a client who has bipolar disorder about lithium. Which of the following statements should the nurse include in the teaching? a. "decrease your fluid intake to 1L/day" b. "you might produce extra saliva while taking this med" c. "notify your provider if you experience vomiting or diarrhea" d. "take the med on an empty stomach"

C, these are manifestations of lithium toxicity and can cause dehydration leading to lithium toxicity Wrong answers: A: no B: dry mouth and dry hair are adverse effects of lithium D: take this med with meals

a nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. which of the following information should the nurse provide? a. three to six weeks of treatment is required to achieve therapeutic benefit b. combining alcohol with alprazolam will produce a paradoxical response c. alprazolam has a lower risk for dependence than other antianxiety meds d. report confusion as a potential indication of toxicity

D wrong answers: combining alcohol and alprazolam can produce CNS and respiratory depression. alprazolam is short term use usually because of increased risk of dependence

a nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. when collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? a. current medical conditions include diabetes that is controlled by diet b. recent manifestations include a course of prednisone for acute bronchitis c. current vaccinations include a flu vaccine last month d. current medications include furosemide for congestive heart failure

D, diuretics are contraindicated for use with lithium due to risk for toxicity

A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? a. I should expect to feel better after 24 hrs of starting this med b. I should not take this med with grapefruit juice c. I'll take this med with food d. I'll take this med first thing in the morning

D, this will decrease the risk for insomnia Wrong answers: A: therapeutic effects take 1-4 wks to occur B: grapefruit juice does not affect fluoxetine C: can be taken with or without food