NURS 133 MEDS

Fluoxetine (Prozac) is prescribed, and the nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about the administration of this medication?

"I should take the medication in the morning when I first arise."

The nurse is preparing to administer lithium (Eskalith), an antimania medication, to a client diagnosed with bipolar disorder. The lithium level is 1.4 mEq/L. Which action should the nurse implement? 1. Administer the medication 2. Hold the medication 3. Notify the health-care provider 4. Verify the lithium level

1. Administer the medication The therapeutic serum level is 0.6 to 1.5 mEq/L. Because the lithium level is within those parameters, the nurse should administer the medication.

A client who is receiving thioridazine (Mellaril) 100 mg tid comes to the clinic with the chief complaint of a "dry mouth." To what should the nurse conclude this side effect is related? 1. High anticholinergic effects of thioridazine 2. Extrapyramidal side effects (EPSE) 3. Weight loss effect from the medication 4. Neuroleptic malignant syndrome (NMS) side effect.

1. High anticholinergic effects of thioridazine. With thioridazine, the anticholinergic side effects of dry mouth, constipation, urinary retention, and blurred vision are usually severe. Dry mouth is not usually associated with extrapyramidal side effects or neuroleptic malignant syndrome. There is usually not a weight gain.

The client with bipolar disorder who is taking lithium (Eskalith), an anti mania medication, has a lithium level of 3.1 mEq/L. Which treatment would the nurse expect the health-care provider to prescribe? 1. No treatment because this is within the therapeutic range. 2. Intravenous therapy with an 18-gauge angiocath 3. Preparation for immediate hemodialysis 4. The antidote for lithium toxicity

3. Preparation for immediate hemodialysis Extremely high toxic levels of lithium require hemodialysis and supportive care

A client is experiencing severe EPS effects. In addition to administering a lower dose of the antipsychotic agents, the nurse would anticipate administering a medication in which category? a. Cholinergics b. Anticholinergics c. Antidepressants d. Dopamine agonists

B ~ Anticholinergics, such as benztropine (Cogentin), are used to decrease the EPS effects associated with antipsychotic medications.

The nurse is preparing a dose of Thioridazine (Mellaril). What is the highest priority intervention for the nurse while preparing the dose? a. Draw up the dosage of the liquid in an oral syringe. b. Use a 21-gauge needle to administer the injection. c. Start a new IV site before administering the drug. d. Avoid spilling the liquid on exposed skin.

D ~ If Mellaril is allowed to come in contact with exposed skin, contact dermatitis can result.

Which information should the nurse discuss with the client diagnosed with bipolar disorder who is taking the anticonvulsant carbamazepine (Tegretol)? 1. Instruct the client to use a soft-bristled toothbrush 2. Encourage the client to get ophthalmic examinations annually. 3. Teach the client to monitor the blood pressure daily. 4. Tell the client to avoid hazardous activities

The client should avoid driving and other hazardous activities until the effects of Tegretol are known because this medication may cause sedation and drowsiness

A client taking lithium carbonate reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up, and the level is 3.0 mEq/L (3.0 mmol/L). The nurse knows that this is which level?

Toxic

Disulfiram is prescribed for a client and the nurse is collecting data on the client and is reinforcing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication?

When the last alcoholic drink was consumed

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? a. Aged cheese and sherry b. Grapefruit and other citrus juices c. Coffee, colas, and tea d. Potato and corn chips

a. Aged cheese and sherry Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? a. Blood pressure of 160/90 mm Hg b. Insomnia and diarrhea c. Sedation and dry mouth d. Tachypnea and wheezing

c. Sedation and dry mouth Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

Which agent is most likely to be prescribed today for short-term management of insomnia? a. Secobarbital [Seconal Sodium] b. Meprobamate [Miltown] c. Zolpidem [Ambien] d. Flumazenil [Romazicon]

c. Zolpidem [Ambien] Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines.

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? a. Dystonia b. Tardive dyskinesia c. Parkinsonism d. Akathisia

d. Akathisia Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

The nurse is collecting data from a client, and the client's spouse reports that the client is taking donepezil hydrochloride. Which disorder should the nurse suspect that this client may have based on the use of this medication?

dementia

A client receiving an anxiolytic medication complains that he feels very "faint" when he tries to get out of bed in the morning. The nurse explains to the client that which side effect is associated with this type of medication?

orthostatic hypotension

The client admitted to the psychiatric unit for major depressive disorder with an attempted suicide is prescribed an antidepressant medication. Which interventions should the psychiatric nurse implement? SELECT ALL THAT APPLY. 1. Assess the client's apical pulse and blood pressure 2. Check the client's serum antidepressant level 3. Monitor the client's liver function status 4. Provide for and ensure the client's safety 5. Evaluate the effectiveness of the medication

1. Assess the client's apical pulse and blood pressure 3. Monitor the client's liver function status 4. Provide for and ensure the client's safety Antidepressant medications may cause orthostatic hypotension, and the nurse should question administering the medication if the blood pressure is less than 90/60.Many antidepressants may cause hepatotoxicity; therefore, the nurse should monitor the client's liver function tests.The nurse should ensure the client's safety. Many antidepressants may cause orthostatic hypotension and increase the risk for dizziness, falls, and injuries

The client with major depressive disorder is suicidal. The client was prescribed the tricyclic antidepressant imipramine (Tofranil) 3 weeks ago. Which priority intervention should the nurse implement? 1. Determine if the client has a plan to commit suicide 2. Assess if the client is sleeping better at night 3. Ask the family if the client still wants to kill himself or herself 4. Observe the client for signs of wanting to commit suicide

1. Determine if the client has a plan to commit suicideThe nurse should ask if the client has a plan to commit suicide. As the client begins to recover from both psychological and physical depression, the client's energy level increases, making the client more prone to commit suicide during this time. It takes 2-6 weeks for therapeutic effects of tricyclic antidepressants to be effective

The client diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which information should the nurse discuss with the client concerning this medication? 1. Discuss the need for regular exercise 2. Instruct the client to monitor for weight loss 3. Tell the client to take the medication with food 4. Explain to the client the need to decrease alcohol intake

1. Discuss the need for regular exercise Clozaril can promote significant weight gain; therefore, the client should exercise regularly, monitor weight, and reduce caloric intake

The client diagnosed with bipolar disorder is prescribed lithium (Eskalith), an antimania medication. Which interventions should the nurse discuss with the client? SELECT ALL THAT APPLY. 1. Monitor serum therapeutic levels 2. Maintain an adequate fluid intake 3. Decrease sodium intake in diet 4. Do not take medication if the radial pulse is <60 5. Explain ways to prevent orthostatic hypotension

1. Monitor serum therapeutic levels 2. Maintain an adequate fluid intake Lithium has a narrow therapeutic serum level. The level is monitored every 3-5 days initially and every 2-3 months thereafter.Lithium is a salt and may cause dehydration; therefore, the client should maintain an adequate fluid intake of at least 2000 mL or more a day

The client with bipolar disorder is prescribed carbamazepine (Tegretol), an anticonvulsant. Which data indicates the medication is effective? 1. The client is able to control extremes between mania and depression 2. The client's serum Tegretol level is within the therapeutic range 3. The client reports a "3" on a depression scale of 1-10, with 10 indicating severely depressed 4. The client has a decrease in delusional thoughts and hallucinations

1. The client is able to control extremes between mania and depression Tegretol is an anticonvulsant medication that is prescribed as a mood stabilizer. Mood stabilizers are prescribed because they have the ability to moderate extreme shifts in emotions between mania and depression. Therefore, this data indicates the medication is effective.

The 24-year-old female client with bipolar disorder is prescribed valproic acid (Depakote), an anticonvulsant medication. Which question should the nurse ask the client? 1. "Have you ever had a migraine headache?" 2. "Are you taking any type of birth control?" 3. "When was the last time you had a seizure?" 4. "How long since you have had a manic episode?"

2. "Are you taking any type of birth control" Depakote is a category D drug, which means it will cause harm to the fetus and should not be prescribed to a female of childbearing age who is not taking the birth control pill

Which statement indicates the client diagnosed with bipolar disorder who is taking lithium (Eskalith), an anti mania medication, understands the medication teaching? 1. "I will monitor my daily lithium level." 2. "I will make sure I do not get dehydrated." 3. "I need to taper the dose if I quit taking it." 4. "I need to take the medication on an empty stomach."

2. "I will make sure I do not get dehydrated" Lithium acts like sodium in the body so dehydration can cause lithium toxicity; therefore, the client should not become dehydrated

The client with major depressive disorder is prescribed nefazodone (Serzone), an atypical antidepressant. The client tells the nurse, "I am going to take my medication at night instead of in the morning." Which statement would be the nurse's best response? 1. "You really should take the medication in the morning for the best results" 2. "It is all right to take the medication at night. It may help you sleep at night" 3. "The medication should be taken with food so you should not take it at night" 4. "Have you discussed taking the medication at night with your psychiatrist?"

2. "It is all right to take the medication at night. It may help you sleep at night" Antidepressants may cause central nervous depression, which causes drowsiness. Therefore, taking the medication at night may help the client sleep at night and relieve daytime sedation. This is the nurse's best response.

The client is taking carbamazepine (Tegretol) for treatment of mania. For what weekly laboratory testing should the nurse remind the client? 1. Neuroleptic malignant disorder 2. Agranulocytosis 3. Thrombocytopenia 4. Anemia

2. Agranulocytosis The most serious side effect of carbamazepine is agranulocytosis (low WBC count). The other answers are just not related.

In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of post traumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.

2. Benzodiazepines are prescribed for short-term treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation. TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in the answers. Benzodiazepines are prescribed in the short-term because of their addictive properties. The test taker must understand that when taking a test, if one part of the answer is incorrect, the whole answer is incorrect, as in answer choice "3."

The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) calls the psychiatric clinic and reports feeling confused and restless and having an elevated temperature. Which action should the psychiatric nurse take? 1. Determine if the client has flulike symptoms 2. Instruct the client to stop taking the SSRI 3. Recommend the client take the medication at night. 4. Explain that these are expected side effects

2. Instruct the client to stop taking the SSRI - Serotonin syndrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservation treatment includes stopping the SSRI and supportive treatment. If untreated, ESE can lead to death

A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.

2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyper reflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the signs and symptoms of serotonin syndrome and which psychotropic medications affect serotonin, potentially leading to this syndrome.

Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continually as prescribed because on set of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine need for additional buspirone (BuSpar) PRN. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that buspirone (BuSpar) has a delayed onset of action, which can affect medication compliance. If the effects of the medication are delayed, the client is likely to stop taking the medication. Teaching about delayed onset is an important nursing intervention

The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate? 1. The client's clozapine therapeutic level 2. The client's white blood cell count 3. The client's red blood cell count 4. The client's arterial blood gases

2. The client's white blood cell count. Weekly WBCs are taken because the client is at risk for fatal agranulocytosis. Initially the medication will not be administered if the WBC is not available

The nurse is reinforcing medication teaching with a client about clozapine (Clozaril). The nurse should include information about what weekly intervention? 1. Physical exam by psychiatrist 2. Weekly blood test 3. Follow up visits with a physician 4. Urinalysis

2. Weekly blood test In order to safely monitor clozapine, a weekly blood test is mandatory. If the client does not have the hematologic exam, the medications is not given for the following week. This is to monitor for agranulocytosis (decreased WBC's), the drug's major adverse effect. A weekly physical exam is unnecessary. Follow-up visits are done periodically, but might not be needed weekly with the physician. Weekly urinalysis is unnecessary when taking clozapine.

A client is taking trazodone (Desyrel). The nurse recognizes that the client understands the desired effects and major side effects of the drug by making which statement? SATA 1. "I can go downstairs to the bathroom during the night if I have a nightlight." 2. "I am drinking more fluids so the medication will work effectively." 3. "I should not worry about becoming addicted to this medication." 4. "I have been prescribed this medication to treat my insomnia." 5. "If I have a problem with priapism, I will notify my doctor immediately."

3. "I should not worry about becoming addicted to this medication." 4. "I have been prescribed this medication to treat my insomnia." 5. "If I have a problem with priapism, I will notify my doctor immediately." The abuse potential for trazodone is minimal. Trazodone is an atypical antidepressant that is used more for insomnia than for depression. Priapism is a penile erection that occurs without stimulation, and is not an adverse effect to trazodone; the doctor should be notified. For safety reasons, it is not a good practice when taking trazodone as a sleep aid to ambulate in low lighting because the drug produces a profound sedative effect. Taking more fluids will not increase the effectiveness of the medication.

The client diagnosed with a major depressive disorder asks the nurse, "Why did my psychiatrist prescribe an SSRI medication rather than one of the other types of anti-depressants?" Which statement by the nurse would be most appropriate? 1. "Probably it is the medication that your insurance will pay for" 2. "You should ask your psychiatrist why the SSRI was ordered" 3. "SSRIs have fewer side effects than the other classifications" 4. "The SSRI medications work faster than the other medications"

3. "SSRIs have fewer side effects than the other classifications. "SSRIs have the same efficacy as MAO inhibitors and tricyclics, but SSRIs are safer because they do not have the sympathomimetic effects (tachycardia and hypertension) and anticholinergic effects (dry mouth, blurred vision, urinary retention, and constipation) of the MAO inhibitors and tricyclics.

A client with schizophrenia has been taking haloperidol (Haldol) fro three weeks with good effect. Today, he comes to group, but reports feeling like his legs are on fire. The nurse notes that he is moving continuously and leaves group early. The nurse should document and report that the client is experiencing which medication side effect? 1. Anticholinergic effects 2. Gustatory hallucinations 3. Akathisia 4. Oculogyric crisis

3. Akathisia Akathisia is an uncontrolled need to move; a common extrapyramidal side effect after long-term use of haloperidol. Anticholinergic effects would include dry mouth, urinary hesitance, constipation, mydriasis, tachycardia, and diminished lacrimation. Gustatory hallucination is tasting something that is not present. Oculogyric crisis involves painful twisting and turning of the head and neck.

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam (Klonopin) is to be used for long-termtherapy in conjunction with buspirone (BuSpar). 2. The client verbalizes that buspirone (BuSpar) can cause sedation and should betaken at night. 3. The client verbalizes that clonazepam (Klonopin) is to be used short-term until thebuspirone (BuSpar) takes full effect. 4. The client verbalizes that tolerance can result with long-term use of buspirone(BuSpar).

3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks. TEST-TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients prescribed different classifications of antianxiety medications.

The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone (Risperdal), an atypical antipsychotic. Which intervention should the nurse implement? 1. Provide the client with a low tyramine diet 2. Assess the client's respiration for 1 full minute 3. Instruct the client to change positions slowly 4. Monitor the client's intake and output

3. Instruct the client to change positions slowly A side effect of all types of antipsychotics is orthostatic hypotension (lightheadedness, dizziness), which can be minimized by moving slowly when assuming an erect posture.

The nurse is assigned to care for a client who is prescribed fluphenazine (Prolixin) 1 mg daily at bedtime. The nurse will implement which intervention because of side effects of the medication? 1. Remind the client to rise slowly when getting out of bed or a chair. 2. Assess for dizziness or lightheadedness frequently during the day. 3. Make sugarless hard candy, gum, and water available during the day. 4. Monitor the client frequently for manifestations of confusion.

3. Make sugarless hard candy, gum, and water available during the day. Dry mouth occurs from the anticholinergic effects seen with fluphenazine. Orthostatic hypotension is not a major side effect of fluphenazine. Dizziness or light-headedness is a sign of orthostatic hypotension, which is not a major side effect of fluphenazine. Confusion is not a side effect of fluphenazine.

What should be the nurse's highest priority when caring for a client who, after withdrawing from alcohol, is beginning to use disulfiram (Antabuse)? 1. Becoming socially reintegrated. 2. Learning about the disease process. 3. Remaining abstinent. 4. Remaining in the rehabilitation unit.

3. Remaining abstinent The principal of remaining abstinent is one of the three most important goals of treatment for alcoholism. It is critical when taking disulfiram, in order to avoid adverse effects from the interaction of the medication and alcohol. The other two goals of amelioration (the act of making something better) of concurrent psychiatric conditions and long-term prevention f relapse. Other options important but not priority.

To which client would the nurse question administering lithium (Eskalish), an antimania medication? 1. The 54-year-old client on a 4-g sodium diet 2. The 23-year-old client taking an antidepressant medication 3. The 42-year-old client taking a loop diuretic 4. The 30-year-old client with a urine output of 40 mL/hour

3. The 42-year-old client taking a loop diuretic Diuretics increase the excretion of lithium from the kidneys; therefore, the nurse would question administering lithium to this client

The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective? 1. "I am taking the herb ginseng to help my attention span" 2. "I drink extra fluids, especially coffee and iced tea" 3. "I am eating three well-balanced meals a day" 4. "At a family cookout I had chicken instead of a hotdog"

4. "At a family cookout I had chicken instead of a hotdog." Taking MAOIs requires adherence to strict dietary restrictions concerning tyramine-containing foods, such as processed meat (hot dogs, bologna, and salami), yeast products, beer, and red wines. Eating these foods can cause a life-threatening hypertensive crisis

The male client diagnosed with schizophrenia is prescibed ziprasidone (Geodon), an atypical antipsychotic. Which statement to the nurse indicates the client understands the medication teaching? 1. "I need to keep taking this medication even if I become impotent." 2. "I should not go out in the sun without wearing protective clothing." 3. "This medication may cause my breast size to increase." 4. "I may have trouble sleeping when I take this medication"

4. "I may have trouble sleeping when I take this medication" Geodon is well-tolerated, but the most common side effect is difficulty in sleeping, perhaps because of the histamine antagonist blockade effect of the drug. This comment indicates the client understands the teaching.

A client is taking phenelzine (Nardil). The visiting nurse is monitoring for client safety. What should the nurse reinforce as a priority regarding client teaching? 1. Limiting daily intake of salt 2. Encourage a fluid intake of at least 2000 mL 3. Encourage the client to have a scheduled blood test time 4. Eliminating foods containing tyramine

4. Eliminating foods containing tyramine With an MAOI, such as phenelzine, the client must eliminate foods that contain tyramine. Intake of tyramine-containing foods could lead to severe hypertension and other complications. The other options are not major teaching considerations.

The client with major depressive disorder has been taking amitriptyline (Elavil), a tricyclic antidepressant, for more than 1 year. The client tells the psychiatric clinic nurse that the client wants to quit taking the antidepressant. Which intervention is most important for the nurse to discuss with the client? 1. Ask questions to determine if the client is still depressed 2. Ask the client why he or she wants to stop taking the medication 3. Tell the client to notify the HCP before stopping medication 4. Explain the importance of tapering off the medication

4. Explain the importance of tapering off the medication The client must first know the importance of needing to taper off the medication because rebound dysphoria, irritability, or sleepiness may occur if the medication is discontinued abruptly. Then the client should see the HCP to determine what action doesn't want to take the medication.

If an overdose of benzodiazepines is suspected, the nurse obtains which of the following medications to reverse that drug's effects as ordered? 1. Diazepam (Valium) 2. Triazolam (Halcion) 3. Fluvoxamine (Luvox) 4. Flumazenil (Romazicon)

4. Flumazenil (Romazicon) Flumazenil is the only drug available that acts as an antagonist to the benzodiazepines. Diazepam and triazolam are benzos. Fluvoxamine is an SSRI antidepressant.

A client is taking an anxiolytic agent secondary to grief-related anxiety. The client questions the nurse about abruptly discontinuing these agents. The nurses response is based on the knowledge that, when discontinuing these medications: a. the dosage must be tapered to avoid withdrawal. b. the client must be evaluated for hyperglycemia. c. hangover syndrome must be planned for. d. blood levels must be monitored.

A ~ Discontinuing anxiolytic agents abruptly may lead to withdrawal symptoms.

A client is ordered to receive chlordiazepoxide (Librium) for severe anxiety. The nurse monitors for which symptoms of severe anxiety or panic attack? a. Dyspnea and heart palpitations b. Trembling, shaking, and gastrointestinal upset c. Dizziness and anorexia d. Drowsiness and blurred vision

A ~ Dyspnea and heart palpitations are symptoms of severe anxiety; also experienced is chest pain, dizziness, or faintness.

The client has been placed on Ativan. The nurse is planning a client instructional session. Which herbal preparation should the nurse emphasize that the client avoid taking with Ativan? a. Kava kava b. St. Johns wort c. Ginseng d. Ginger

A ~ Kava kava in combination with Ativan will increase the sedation effects of the Ativan.

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

ANS: A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in white blood cells can occur

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

ANS: CT The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications ANS: DThe nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply .1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. 1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed toaddress signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed toaddress signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. TEST-TAKING HINT: The test taker first must recognize the signs and symptoms presented in the question as an indication of increased levels of anxiety. Next, the test taker must recognize the medications that address these symptoms. Also, it is common to confuse lithium carbonate (lithium) and Librium and clozapine and clonazepam. To answer this question correctly, the test taker needs to distinguish between medications that are similar in spelling.

A client is brought to the emergency department unconscious. The clients spouse tells the nurse that the client was found in bed with an empty pill bottle nearby. The clients spouse believes that there were 20 to 25 diazepam (Valium) pills in the bottle. What represents an appropriate nursing priority? a. Administer an emetic agent followed by activated charcoal. b. Lavage the stomach using a nasogastric tube. c. Prepare the client for emergency surgery. d. Monitor the client because there is no antidote.

B ~ Because the client is unconscious, this is the correct course of action.

What anxiolytic drugs would be given to a premenopausal patient who is a registered nurse planning to return to work at the hospital after anxiety is controlled? A) Alprazolam (Xanax) B) Buspirone (BuSpar) C) Diazepam (Valium) D) Clorazepate (Tranxene)

B ~ Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the patient needs to be alert such as when driving or working. Alprazolam, diazepam, and clorazepate are benzodiazepines, which cause drowsiness, sedation, depression, lethargy, confusion, and decreased mental alertness. It would be unsafe for a nurse to function in her role while taking one of these drugs.

The client has been placed on Risperdal. He complains to the nurse of experiencing headaches. The highest priority action on the part of the nurse is to recognize that this is a(n) ________ the medication and call the physician. a. adverse reaction to b. expected side effect of c. life-threatening reaction to d. anaphylactic reaction to

B ~ Headaches are an expected side effect of treatment with Risperdal.

The client is known to have overdosed on a benzodiazepine medication. The nurse anticipates that which medication will most likely be ordered? a. Tranxene b. Romazicon c. BuSpar d. Librium

B ~ Romazicon is considered to be the benzodiazepine antagonist.

A nurse is discussing the use of alprazolam (Xanax) with a 68-year-old patient. What statement indicates that the patient has an understanding of the drug? A) When I stop having panic attacks, I can stop taking the drug. B) This drug will calm me down in about 30 minutes after I take it. C) One dose will keep me calm for about 24 hours. D) I am taking an increased dose because of my age.

B ~ The onset of alprazolam is about 30 minutes. The drug must be tapered after long-term use and the duration is approximately 4 to 6 hours. Elderly patients usually have a reduced dosage.

A patient arrives at the emergency room after attempting suicide by taking an entire bottle of diazepam. What antidote will the nurse most likely administer? A) Phenobarbital (Luminal) B) Dexmedetomidine (Precedex) C) Flumazenil (Romazicon) D) Ramelteon (Rozerem)

C ~ Flumazenil is an antidote to benzodiazepine overdose and is administered to reverse the effects of benzodiazepines when used for anesthesia. Phenobarbital, a barbiturate, would further depress the body functions of this patient. Dexmedetomidine is a new hypnotic drug used in the intensive care unit for mechanically ventilated patients. Ramelteon is also new; it is used as a hypnotic. Adverse effects of this drug include depression and suicidal ideation.

A client is to be treated with Fluphenazine (Prolixin). The highest priority nursing intervention related to the clients vital signs is to monitor for: a. bradycardia. b. hypertension. c. hypotension. d. tachypnea.

C ~ The phenothiazine groups major side effect is hypotension.

A client is ordered to receive fluphenazine (Prolixin) to manage the psychotic symptoms of schizophrenia. The nurse assesses for which signs of anticholinergic effects? a. Bradycardia and orthostatic hypotension b. Diarrhea and tachycardia c. Urinary retention and dry mouth d. Constipation and hypertension

C ~ Urinary retention & dry mouth are the side effects of anticholinergics.

The nurse is monitoring a client taking an antipsychotic medication for signs/symptoms of neuroleptic malignant syndrome (NMS). The nurse should expect to note which sign/symptom if NMS occurred?

Caused by not enough dopamine in the system S/S -confusion -fever -rhabdomyolysis -Myoglobinuria -Muscle rigidity -Tachycardia - Leukocytosis (increase WBC) - Mutism (inability to speak)

A client is receiving lithium carbonate. The client's lithium carbonate level is 1.5 mEq/L, which indicates an early sign of toxicity. Which are some early signs/symptoms of toxicity?

Confusion, blurred vision, diarrhea, tinnitus (ringing in ears), slurred speech, coma, convulsion

A client is receiving an antipsychotic agent. Which laboratory result is of most concern? a. Serum sodium level of 138 mEq/L b. Blood glucose level of 100 mg/dl c. White blood cell count of 6000/mm3 d. Serum medication level below normal limit

D ~ A serum medication level below normal limits is a concern because subtherapeutic levels may allow for breakthrough psychotic symptoms.

A nurse is caring for a 9-year-old patient and has received an order for diazepam (Valium) 10 mg given orally q.i.d. What is the nurses priority action? A) Perform hand hygiene and prepare the drug. B) Send the order to the hospital pharmacy. C) Determine when to administer the first dose. D) Call the physician and question the order.

D ~ The first action of the nurse would be to call the physician and question the order. The normal oral dosage for a pediatric patient is 1 to 2.5 mg t.i.d. or q.i.d. The ordered dose would be unsafe for this patient. If the dosage was changed and the correct amount administered, the nurse would order the medication from the pharmacy if necessary and determine what time to start the medication. She would then wash her hands in preparation for administering the medication, but not until obtaining an appropriate dosage of medication.

When teaching a client who is being started on imipramine hydrochloride, when should the nurse tell the client that the medication would have the desired effects?

Desired effects do not occur for 2 to 3 weeks of administration.

Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. 1. Insomnia is correct. 2. Tremor is correct. 3. Delirium is correct. 4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. 5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. TEST-TAKING HINT: The test taker mustdistinguish between benzodiazepine side effectsand symptoms of withdrawal to answer thisquestion correctly.

A client admitted to the hospital gives the nurse a bottle of clomipramine (anafranil) . The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication?

OCD rituals

A client arrives at the health care clinic and tells the nurse that they have been doubling their daily dosage of bupropion hydrochloride to help them get better faster. The nurse understands that the client is now at risk for which problem?

Seizure activity

A hospitalized client is taking clozapine for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client should the nurse specifically review to monitor for an adverse effect associated with the use of this medication?

White blood cell count

When teaching the patient and family about clozapine therapy, which statements should the nurse include? (Select all that apply.) a. "It is important for you to obtain ordered blood tests when taking this medication." b. "Most patients who take this medication lose weight, so you should increase the number of calories you consume each day." c. "If you experience increased urination, increased thirst, or increased appetite, contact your healthcare provider." d. "Inform your healthcare provider if you are taking any medications to control seizures." e. "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations."

a. "It is important for you to obtain ordered blood tests when taking this medication." c. "If you experience increased urination, increased thirst, or increased appetite, contact your healthcare provider." d. "Inform your healthcare provider if you are taking any medications to control seizures." e. "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations." Clozapine can cause agranulocytosis. Patients should be taught that clozapine will not be dispensed without repeated proof of blood counts. Patients taking clozapine are at increased risk of weight gain and dyslipidemia; they should be taught about the risk of weight gain and encouraged to control caloric intake and get regular exercise. Patients should be informed about early signs of infection (fever, sore throat, fatigue, mucous membrane ulceration) and instructed to notify their healthcare provider immediately if these should develop. Patients taking clozapine are at increased risk for the development of diabetes mellitus; they should be taught about the symptoms of diabetes (eg, hyperglycemia, polyuria, polydipsia, polyphagia, dehydration) and instructed to contact the prescriber if these occur. Clozapine should be used with caution in patients with seizure disorders. In rare cases, clozapine causes myocarditis; patients should be informed about the signs and symptoms (eg, unexplained fatigue, dyspnea, tachypnea, chest pain, palpitations) and advised to seek immediate medical attention if these develop. Clozapine should be withheld until myocarditis has been ruled out. If myocarditis is diagnosed, the drug should never be used again.

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statements are appropriate to include in the teaching plan? (Select all that apply.) a. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." b. "When you stop taking this medication, you should not withdraw it abruptly." c. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." d. "This medication often causes drowsiness. You should take it at bedtime." e. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

a. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." b. "When you stop taking this medication, you should not withdraw it abruptly." e. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety." Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? a. "When it is time to discontinue this drug, you will need to taper it off slowly." b. "Protect your skin from the sun to prevent rash and exaggerated sunburn." c. "Increase your intake of fluid and high-fiber food to prevent constipation." d. "Take this medication on an empty stomach at least 2 hours after meals."

a. "When it is time to discontinue this drug, you will need to taper it off slowly." Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? a. "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." b. "No, all of the sleep medications are controlled substances." c. "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." d. "Yes, but it is not for chronic insomnia."

a. "Yes, there is a medication that works with your body's melatonin and is not a controlled substance. "Ramelteon [Rozerem] is a relatively new hypnotic with a unique mechanism of action: activation of receptors for melatonin. The drug is approved for treating chronic insomnia characterized by difficulty with sleep onset, but not with sleep maintenance. Long-term use is permitted. Of the major drugs for insomnia, ramelteon is the only one not regulated as a controlled substance.

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? (Select all that apply.) a. Depression b. Panic disorder c. Social anxiety disorder d. Post-traumatic stress disorder e. Obsessive-compulsive disorder

a. Depression b. Panic disorder c. Social anxiety disorder e. Obsessive-compulsive disorder Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) a. Lithium b. Risperidone c. Divalproex sodium [Depakote] d. Carbamazepine [Tegretol] e. Venlafaxine [Effexor]

a. Lithium c. Divalproex sodium [Depakote] d. Carbamazepine [Tegretol] Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug?a. Sexual dysfunction b. Dry mouth c. Orthostatic hypotension d. Bradycardia

a. Sexual dysfunction Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient with bipolar disorder who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? a. Sodium level of 128 mEq/L b. Prothrombin time of 8 seconds c. Blood urea nitrogen level of 25 mg/dL d. Potassium level of 5.6 mEq/L

a. Sodium level of 128 mEq/L The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? a. To reduce the risk of suicide with overdose b. To avoid weight gain and other gastrointestinal (GI) effects c. To help prevent sexual dysfunction d. To prevent the risk of serotonin syndrome

a. To reduce the risk of suicide with overdose The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

Which instructions does the nurse include when teaching a patient about phenelzine [Nardil] therapy? (Select all that apply.) a. "Take the medication as needed when you are feeling depressed." b. "If you experience a severe headache, inform your healthcare provider." c. "Profuse sweating is an expected side effect of this medication and will diminish with time." d. "Ginseng can be used to treat headache, which patients often experience when they first take phenelzine." e. "Avoid eating avocados when taking this drug."

b. "If you experience a severe headache, inform your healthcare provider." e. "Avoid eating avocados when taking this drug." Patients should be instructed to take MAOIs every day as prescribed—not PRN. They should be warned not to discontinue treatment once mood has improved, because doing so may result in relapse. Patients should be informed of the symptoms of hypertensive crisis—severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—and instructed to seek immediate medical attention if these develop. Patients should be forewarned of the hazard of hypertensive crisis and the need to avoid tyramine-rich foods, such as aged cheese, Chianti, and avocados. (Patients on low-dose transdermal selegiline need not avoid foods containing tyramine.) Patients taking MAOIs should not take ginseng, because headache, tremulousness, and manic-like reactions have occurred.

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine [Thorazine]? (Select all that apply.) a. An 85-year-old man with Alzheimer's disease b. A 78-year-old man with intractable hiccups c. A 76-year-old woman with severe dementia d. A 48-year-old woman with schizoaffective disorder e. A 30-year-old man with anxiety and depression

b. A 78-year-old man with intractable hiccups d. A 48-year-old woman with schizoaffective disorder The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups. Antipsychotics are not used for dementia because of increased mortality. Chlorpromazine is not a primary treatment for Alzheimer's disease or depression.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? a. A female patient with Bipolar disorder who takes valproic acid [Depakene] and who reports nausea and vomiting b. A male patient with Bipolar Disorder who takes lithium and who has a lithium level of 1.6 mEq/L c. A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction d. A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

b. A male patient with Bipolar Disorder who takes lithium and who has a lithium level of 1.6 mEq/L Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? a. Naloxone [Narcan] b. Flumazenil [Romazicon] c. Acetylcysteine [Mucomyst] d. Vitamin K

b. Flumazenil [Romazicon] Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity.

The nurse identifies which most common serious adverse effect of TCA therapy?a. Excitation b. Orthostatic hypotension c. Skin rash d. Sexual dysfunction

b. Orthostatic hypotension Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of Bipolar disorder. The nurse anticipates which dosing schedule? a. Starting at a high dose to quickly control mania b. Starting at a low dose and titrating up c. Starting at a high dose and titrating down d. Starting with a loading dose and then a low maintenance dose

b. Starting at a low dose and titrating up Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of Bipolar disorder. The goal is to prevent affective relapses into mania or depression. To minimize the risk of serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased.

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? a. Dry mouth b. Temperature of 101°F c. BP of 104/72 mm Hg d. Drowsiness

b. Temperature of 101°F Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? (Select all that apply.) a. Fluoxetine [Prozac] b. Venlafaxine [Effexor XR] c. Paroxetine [Paxil] d. Escitalopram [Lexapro] e. Duloxetine [Cymbalta] \

b. Venlafaxine [Effexor XR] c. Paroxetine [Paxil] d. Escitalopram [Lexapro] e. Duloxetine [Cymbalta] Fluoxetine [Prozac] is not approved for the treatment of generalized anxiety disorder. All the other medications listed are approved for the treatment of GAD.

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? a. "This medication should not make me feel drowsy." b. "This medication should help me feel less anxious." c. "I will drink grapefruit juice instead of coffee with breakfast." d. "I will take my medication three times per day."

c. "I will drink grapefruit juice instead of coffee with breakfast." Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? a. Ibuprofen [Motrin] for muscle pain b. Hydrochlorothiazide (HCTZ) for edema c. Aspirin (ASA) for mild headache d. Diphenhydramine [Benadryl] for cold symptoms

c. Aspirin (ASA) for mild headache Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? a. Diarrhea b. Risk for abuse c. Dizziness d. Weight gain

c. Dizziness Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

Which drugs does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) a. Bupropion [Wellbutrin] b. Imipramine [Tofranil] c. Fluoxetine [Prozac]d. Desvenlafaxine [Pristiq] e. Sertraline [Zoloft]

c. Fluoxetine [Prozac] e. Sertraline [Zoloft] Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

he nurse is preparing to administer the aripiprazole extended-release 400-mg injection. The nurse is aware that this medication is scheduled to be given how often? a. Daily b. Weekly c. Monthly d. As needed

c. Monthly Aripiprazole for IM therapy is available in single-use vials (7.5 mg/mL) sold as Abilify, and extended-release injections as Abilify Maintena. The extended-release injection is available in 300- and 400-mg doses to be given once monthly.

A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder? a. Clonazepam [Klonopin] b. Alprazolam [Xanax] c. Propranolol [Inderal] d. Sertraline [Zoloft]

c. Propranolol [Inderal] Propranolol [Inderal] and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (eg, tremors, sweating, tachycardia, palpitations). Doses are relatively small (eg, only 10 to 80 mg for propranolol). 35 / 48

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? a. "Have you noticed dry mouth or blurred vision?" b. "Have you had any changes in your urine function?" c. "When was your last bowel movement?" d. "Have you had any changes in your mood or anxiety level?"

d. "Have you had any changes in your mood or anxiety level? "In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? a. Venlafaxine [Effexor] b. Buspirone [BuSpar] c. Paroxetine [Paxil] d. Alprazolam [Xanax]

d. Alprazolam [Xanax] Alprazolam, a benzodiazepine, would provide the most rapid onset of relief. Buspirone, paroxetine, and venlafaxine are also first-line agents for the treatment of generalized anxiety disorder, but their onset is delayed. They are preferred for long-term management.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? a. Consumed some foods high in tyramine b. Not taken the lithium as directed c. Developed tolerance to the lithium d. Developed lithium toxicity

d. Developed lithium toxicity Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? a. Norepinephrine b. Acetylcholine c. Serotonin (5-HT) d. Gamma-aminobutyric acid (GABA)

d. Gamma-aminobutyric acid (GABA) Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression?a. It increases the risk of suicide in the early phase. b. It is less effective than the tricyclic antidepressants. c. It increases the risk of psychoses and parkinsonism. d. It has more side effects and drug interactions.

d. It has more side effects and drug interactions. Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.

The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? a. Blood urea nitrogen level of 25 mg/dL b. Blood glucose level of 60 mg/dL c. Bilirubin level of 2.5 mg/dL d. White blood cell (WBC) count of 2000/mm3

d. White blood cell (WBC) count of 2000/mm3 Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.