Pharm - Archer Review (4/4) - Psychiatric Medications, Neurologic, Reproductive and Maternity

Choices A and C are correct. Lorazepam is a CNS depressant, and the client should avoid potentiating the effects of this medication. Herbal products such as kava and valerian are CNS depressant medications that should not be given concurrently while a client is receiving lorazepam. Lorazepam and one of these medications may cause profound sedation.

The nurse is caring for a client receiving lorazepam. Which of the following reported herbal supplements would require follow-up? Select all that apply. Kava Glucosamine Valerian Garlic Saw palmetto

Choices C and D are correct. Mirtazapine is a tetracyclic antidepressant that causes an increase in serotonin and norepinephrine. This medication is used for depressive and anxiety disorders. Mirtazapine is quite sedating and is often used for insomnia associated with depressive disorders.

The nurse is caring for a client who is receiving prescribed mirtazapine. Which of the following statements, if made by the client, would indicate a therapeutic response? Select all that apply. "I am not smoking cigarettes anymore." "My blood glucose has decreased." "My depression has gotten better." "I am sleeping eight hours a night." "My blood pressure is back to normal."

Choice B is correct. Akathisia is the most common extrapyramidal side effect (EPS) associated with antipsychotic medications. Propranolol is an effective treatment for akathisia as this helps with treating the internal sense of restlessness characterized by this effect.

The nurse is caring for a client with akathisia. The nurse should anticipate a prescription for which medication? A. Modafinil B. Propranolol C. Venlafaxine D. Duloxetine

Choice C is correct. Sumatriptan is a 5-hydroxytryptamine (5-HT))-receptor agonist indicated for abortive migraine headache treatment. Sumatriptan stops headaches after they have begun ( abortive therapy), but it does not prevent them.

The nurse is caring for a client with newly prescribed sumatriptan. The nurse understands that this medication is intended to treat which condition? A. Peripheral artery disease B. Accelerated hypertension C. Migraine headache D. Angina

Choice D is correct. Schizophrenia is treated with antipsychotic medications. Typical (or first-generation) antipsychotic drugs include haloperidol, fluphenazine, and chlorpromazine. Atypical (second generation) antipsychotic medications include quetiapine, ziprasidone, and risperidone.

The nurse is caring for a client with schizophrenia. The nurse should anticipate a prescription for which medication? A. Lithium B. Bupropion C. Sertraline D. Risperidone

Choice A is correct. Phenytoin is a hydantoin medication indicated in the prevention of seizures. This medication requires a patent, large-bore peripheral vascular access device because it is a vesicant, and if it should leak into the surrounding tissue, it could cause extravasation. Phenytoin may cause a client to develop lethal cardiac dysrhythmias, and continuous cardiac monitoring is required during the infusion. Fosphenytoin is commonly preferred over administering phenytoin because it does not require a filter for administration and has fewer cardiovascular adverse effects.

The nurse is preparing to administer prescribed intravenous phenytoin to a client with epilepsy. Prior to starting the infusion, the nurse should A. establish continuous cardiac monitoring. B. obtain the serum peak level prior to infusion. C. initiate continuous electroencephalography (EEG) monitoring. D. insert an indwelling urinary catheter.

Choice B is correct. Mannitol is an osmotic diuretic indicated for cerebral edema. Mannitol may crystallize when exposed to low temperatures. Because of this, mannitol is always administered intravenously through intravenous tubing with a filter.

The nurse is preparing to administer the prescribed mannitol. The nurse plans to administer the infusion using A. microdrip intravenous tubing. B. filtered intravenous tubing. C. vented intravenous tubing. D. non-vented intravenous tubing.

Choice A is correct. The therapeutic VPA level is 50-125 mcg/mL. A 40 mcg/mL VPA level is considered sub-therapeutic and requires follow-up as the client is at risk of seizure. A cause of this level being subtherapeutic may be caused by non-adherence to the medication.

The nurse is reviewing laboratory data for a client with epilepsy taking prescribed valproic acid (VPA). The client's VPA level is 40 mcg/mL(50-125 mcg/mL). Which action should the nurse take next? A. Evaluate the client for non-adherence B. Instruct the client to skip the next scheduled dose C. Assess the client for VPA toxicity D. Document the result as within normal limits

Choice B is correct. A client taking lithium should be instructed to avoid dehydration and hyponatremia. Lithium is a salt, and when the client has decreased fluid volume, the drug will accumulate and raise the lithium level. HCTZ is a thiazide diuretic and is contraindicated for a client taking lithium because of its ability to decrease fluid and sodium levels.

The nurse is reviewing newly prescribed medications for a client taking lithium. Which medication requires further follow-up? A. Venlafaxine B. Hydrochlorothiazide C. Gabapentin D. Verapamil

Choice B is correct. The most common side effects of rivastigmine are flu-like symptoms, dizziness, and weight loss. The FDA has approved limited drugs for Alzheimer's Disease. The most effective medications act by intensifying the effect of acetylcholine at the cholinergic receptor. Acetylcholine is naturally degraded in the synapse by the enzyme acetylcholinesterase. When acetylcholinesterase is inhibited, acetylcholine levels increase and significantly affect the receptors.

The nurse should assess an Alzheimer's patient who has been started on rivastigmine for which of the following side effects? A. Liver toxicity B. Weight loss C. Renal failure D. Extrapyramidal side effects

Choice A is correct. The gold standard for treating bipolar disorder is mood stabilizers. Valproic acid (VPA) is a mood stabilizer and is efficacious in treating mania because it has a fast onset. This medication can be given by mouth or intravenously. When a client receives valproic acid, the nurse must monitor the client's liver function tests to determine if the client is experiencing the adverse effect of hepatotoxicity.

A client is admitted to the behavioral health unit and diagnosed with bipolar I disorder and has acute mania. The nurse anticipates that the primary healthcare provider (PHCP) will prescribe which medication? A. valproic acid B. haloperidol C. bupropion D. fluoxetine

Choice A is correct. An increase in the Glasgow Coma Scale (GCS) is a favorable finding when tPA is administered (intravenous alteplase) for an ischemic stroke. The highest score on a GCS is 15.

The nurse is caring for a client receiving intravenous (IV) alteplase for a cerebrovascular accident (CVA). The nurse understands that this medication has reached its therapeutic effect when the client is assessed to have A. increase in the Glasgow Coma Scale. B. unintelligible speech. C. bleeding at their gum line. D. increase in pulse and decrease in blood pressure.

Choice B is correct. Methotrexate (MTX) may be used to medically treat an ectopic pregnancy that has not ruptured, and the woman is hemodynamically stable. Methotrexate is a folic acid antagonist and may be given a variety of routes.

The nurse is caring for a client with an ectopic pregnancy. The primary healthcare provider (PHCP) recommends medical treatment over surgical treatment. The nurse anticipates a prescription for which medication? A. Terbutaline B. Methotrexate C. Methylergonovine D. Nifedipine

Choice D is correct. Skeletal muscle paralysis is the intent of this medication. Succinylcholine is a neuromuscular blocking medication typically given immediately prior to intubation to assist with the procedure.

The primary healthcare provider (PHCP) is preparing to intubate a client. The PHCP prescribes succinylcholine. The nurse understands that this medication is intended to A. sedate the client during the procedure. B. decrease oral and airway secretions. C. increase heart rate in case of a vagal response. D. cause skeletal muscle paralysis.

Choice D is correct. Citalopram is an antidepressant. This selective serotonin reuptake inhibitor (SSRI) is prescribed for depressive and anxiety disorders. If a client has depression, one of the associated manifestations is decreased self-esteem/self-worth. This may cause clients to reduce their ability to engage with others and become socially withdrawn.

This nurse is caring for a client who is receiving prescribed citalopram. Which of the following findings would indicate a therapeutic response? A. Improved muscle coordination B. Circumstantial speech pattern C. Longer attention span D. Increased self-esteem

Choice B is correct. Narcolepsy is a disorder characterized when a client unexpectedly falls asleep in the middle of normal daily activities. Agents to keep the client awake during the day are the treatment goal. A common medication used is modafinil. Modafinil is a central nervous stimulant dosed during daylight hours to keep the client alert.

The nurse is caring for a client with narcolepsy. The nurse anticipates which prescription from the primary healthcare provider? A. Trazodone B. Modafinil C. Diazepam D. Fluoxetine

Weight Reports of thirst

The nurse reviews the clinical data Which two (2) findings from the clinical data requires follow-up? Weight Pulse Reports of occasional headache Flattened affect Speech patterns Reports of thirst

Choice A is correct. Haloperidol is a typical antipsychotic which may adversely cause extrapyramidal side effects (EPS). These effects include akathisia, dystonia, pseudo parkinsonism, and/or tardive dyskinesia.

The nurse is interviewing a client who is assessed to have poor muscle coordination, stooped posture, and slow movements. Which medication on the client's daily medication list would most likely cause these findings? A. Haloperidol B. Nifedipine C. Venlafaxine D. Prazosin

Choice D is correct. The excessive ingestion of tricyclic antidepressants (TCAs) results in life-threatening wide QRS complex tachycardia. Tricyclic antidepressants are approved by the Food and Drug Administration (FDA) for treating several types of depression, obsessive-compulsive disorder, and bedwetting. Also, they are used for several off-label (non-FDA approved) uses such as: Panic disorder Bulimia Chronic pain (for example, migraine, tension headaches, diabetic neuropathy, and postherpetic neuralgia) Phantom limb pain Chronic itching Premenstrual symptoms Tricyclic antidepressants should be used cautiously in patients with seizures since they can increase the risk of seizures. They may cause a worsening of urinary retention and narrow-angle glaucoma. Abnormal heart rhythms and sexual dysfunction have also been associated with TCAs.

The most serious adverse effect of tricyclic antidepressant (TCA) overdose is: A. Seizures B. Hyperpyrexia C. Metabolic acidosis D. Cardiac arrhythmias

Choice B is correct. Midazolam is a benzodiazepine used for various indications, including aggression, seizure activity, and cocaine intoxication. Midazolam causes a reduction in respiratory rate because of its CNS depressant effect. If the client already has respiratory acidosis, administering a benzodiazepine, such as midazolam, would worsen the acidosis because the medication reduces the respiratory rate, further causing the retention of CO2.

The nurse has received a prescription for midazolam. Which of the following client findings requires follow-up with the physician prior to administering this medication? A. cocaine intoxication B. respiratory acidosis C. tonic-clonic seizures D. aggression

Choice A is correct. Donepezil is an acetylcholinesterase inhibitor indicated in the treatment of mild, moderate, and severe Alzheimer's disease and dementia. This medication has demonstrated some efficacy in slowing cognitive decline and, to a lesser extent, behavioral disturbances. The major adverse reaction of this medication is bradycardia, which may cause syncope. The nurse should monitor the client's pulse throughout therapy because bradycardia would lead to a decline in cardiac output.

The nurse is assessing a client receiving prescribed donepezil. Throughout the duration of therapy, the nurse should monitor the client's A. pulse. B. fasting blood glucose. C. total cholesterol. D. pulse oximetry.

Choice B is correct. Skin blistering associated with lamotrigine therapy is a critical finding to report. This is a feature of Steven-Johnson syndrome (SJS). Lamotrigine has been implicated as causing this adverse finding.

The nurse is assessing a client taking prescribed lamotrigine. Which client finding requires immediate follow-up? A. Abnormal dreams B. Skin blistering C. Dyspepsia D. Xerostomia

Choice D is correct. Multiple Sclerosis (MS) may produce symptoms such as muscle spasticity, optic neuritis, fatigue, heat intolerance, and symptoms that seem to intensify on occasion (relapses). Muscle spasticity is best controlled with muscle relaxers such as baclofen.

The nurse is caring for a client diagnosed with Multiple Sclerosis (MS). The nurse should anticipate a prescription for which medication? A. Topiramate B. Risperidone C. Prazosin D. Baclofen

Choice A is correct. Labor dystocia is a broad term indicating difficult labor that is not progressing. One of the medications that may be used to assist in labor progression is oxytocin. This medication stimulates uterine contractions.

The nurse is caring for a client experiencing labor dystocia. Which medication does the nurse anticipate from the primary healthcare provider (PHCP)? A. Oxytocin B. Terbutaline C. Magnesium sulfate D. Betamethasone

Choice C is correct. ECT is a safe therapy that induces seizures theorized to release monoamines, which may assist in treating psychiatric illnesses such as major depressive disorder. If a client takes an anticonvulsant, like phenytoin, this will increase the seizure threshold and may attenuate the efficacy of ECT. Benzodiazepines and anticonvulsants should therefore be avoided in clients receiving ECT.

The nurse is caring for a client scheduled for electroconvulsive therapy (ECT). Which medication should the nurse question? A. citalopram B. pantoprazole C. phenytoin D. risperidone

Choice B is correct. Methylergonovine is an alkaloid medication used to manage postpartum hemorrhage (PPH). This medication causes vasoconstriction, therefore, decreasing postpartum bleeding.

The nurse is caring for a client who is receiving prescribed methylergonovine. Which of the following client findings would indicate a therapeutic response? A. Increased blood pressure B. Decreased post-partum bleeding C. Decreased uterine tone D. Increased urinary output

Choices A, C, and D are correct. Quetiapine is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. Fever is an adverse reaction because this could be strongly suggestive of Neuroleptic Malignant Syndrome (NMS). Stooped posture and shuffling gait are quite concerning because these are symptoms of an extrapyramidal syndrome (EPS). These symptoms should be reported to the primary healthcare provider.

The nurse is caring for a client who is receiving prescribed quetiapine. Which of the following findings would indicate the client has an adverse effect? Select all that apply. Fever Drowsiness Stooped posture Shuffling gait Increased appetite

Choice C is correct. Venlafaxine is a medication that is indicated for depression. The client's comment of not wanting to go on anymore should concern the nurse because anti-depressants may cause thoughts of suicide.

The nurse is caring for a client who is taking prescribed venlafaxine. Which statements made by the client would be highly concerning to the nurse? A. "I have trouble sleeping at night." B. "I experience diarrhea at least once a day." C. "I just cannot go on like this anymore." D. "I am using artificial tears for my dry eyes."

Choice C is correct. An adolescent taking prescribed paroxetine, a selective serotonin reuptake inhibitor (SSRI), should be monitored for suicidal ideations. Statements suggesting a sense of hopelessness are highly concerning and should be the immediate priority.

The nurse is caring for an adolescent taking prescribed paroxetine. Which of the following statements, if made by the client, would require immediate follow-up? A. "This medication makes me feel so tired." B. "I have gained weight since starting this medicine." C. "Since starting this medicine, I feel like giving up." D. "This medicine always makes my stomach upset."

Choices A, D, and F are correct. Typical antipsychotics were the first generation of medications used to treat schizophrenia. These medications are dopamine receptor antagonists.

The nurse is educating staff on antipsychotics. It would be correct to identify which medication is a typical (first generation) antipsychotic? Select all that apply. Chlorpromazine Olanzapine Risperidone Fluphenazine Clozapine Haloperidol

Choice C is correct. When the minor is seeking birth control treatments, the minor's consent is sufficient and does not warrant the permission of her parents.

A 15-year-old female comes into the gynecology clinic asking for an oral contraceptive pills prescription. Fifteen minutes later, her mother comes in and scolds the teenager about her decision. She tells the doctor not to give her daughter the pills because she is still too young. What should be the most appropriate action by the nurse? A. Withdraw the prescription for contraceptive pills. B. Call Child Protective Services. C. Explain to the mother that in cases of birth control services, her daughter has the right to give consent on her own. D. Explain to the teenager that her mother still has consenting authority over her decisions.

Choice A is correct. Bupropion is an atypical antidepressant medication primarily indicated in major depressive disorder, seasonal affective disorder, smoking cessation, and antidepressant-induced smoking cessation. Bupropion is contraindicated if a client has conditions that may cause seizures, such as epilepsy. Bupropion tends to cause weight loss and is contraindicated for clients with anorexia nervosa or bulimia nervosa, as further weight loss would be detrimental in these conditions.

The nurse has received a prescription for bupropion for a client with major depressive disorder. Which of the following conditions in the client's medical history would be a contraindication to administering this medication? Select all that apply. anorexia nervosa epilepsy seasonal affective disorder attention deficit hyperactivity disorder antidepressant induced sexual dysfunction

Choice C is correct. Thiamine (vitamin B1) is dosed for individuals at risk of developing Wernicke encephalopathy. This encephalopathy may cause an individual to experience an array of neurological abnormalities that may not be reversible. Manifestations include nystagmus, ataxia, neuropathy in the lower extremities, and altered mental status. If not treated, these manifestations may become permanent.

The nurse has received a prescription to administer thiamine to a client. The nurse understands that this medication is intended to treat A. systemic lupus erythematosus. B. pernicious anemia. C. Wernicke encephalopathy. D. iron deficiency anemia.

Choice D is correct. Risperidone is an atypical (second-generation) antipsychotic indicated in treating disorders such as schizophrenia, autism with behavioral disturbances, delusional disorder, and bipolar disorder. Risperidone is notorious for causing increased prolactin levels. This increase in prolactin levels may cause a client to develop gynecomastia and/or galactorrhea.

The nurse is assessing a client taking prescribed risperidone. Which of the following findings would indicate the client is having an adverse effect? A. ptosis B. gingival hyperplasia C. polycythemia D. gynecomastia

Choice A is correct. Children receiving psychostimulant medications such as methylphenidate should be monitored closely for weight loss which may inhibit their ability to meet their growth milestones. This finding of a three-kilogram weight loss is necessary to report to the PHCP.

The nurse is caring for a child who is receiving prescribed methylphenidate. Which of the following findings should be reported to the primary healthcare provider (PHCP)? A. Weight loss of 3 kilograms B. Dry mouth C. Trouble falling asleep D. Occasional headaches

Choice C is correct. ADHD may be treated by psychostimulants such as amphetamines or methylphenidate. These medications work by projecting dopamine and norepinephrine in the front of the brain to ameliorate the symptoms of inattention, impulsivity, and hyperactivity.

The nurse is caring for a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse should anticipate a prescription for which medication? A. Citalopram B. Risperidone C. Methylphenidate D. Carbamazepine

Choices A and E are correct. Epilepsy is an idiopathic condition that requires maintenance treatment by using anticonvulsants. Topiramate is an anticonvulsant that may be used in the prevention of seizures. Lorazepam is also indicated in epilepsy in the event of a patient experiencing an acute seizure. The topiramate should be used for maintenance purposes, and the lorazepam would be indicated for an acute seizure.

The nurse is caring for a client diagnosed with epilepsy. The nurse should anticipate a prescription for which of the following medications? Select all that apply. Topiramate Risperidone Prazosin Hydroxyzine Lorazepam

Choice A is correct. Trichotillomania is a syndrome that causes a client to engage in hair-pulling. This disorder is categorized as an obsessive-compulsive disorder. Common sites for hair pulling include the eyebrows, scalp hair, and chin. Selective serotonin reuptake inhibitors (SSRIs) combined with psychotherapy are effective treatments for this disorder. Medications that may be used include fluoxetine, citalopram, or paroxetine.

The nurse is caring for a client diagnosed with trichotillomania. The nurse anticipates a prescription for which medication from the primary healthcare provider (PHCP)? A. Fluoxetine B. Amphetamine C. Haloperidol D. Bupropion

Choice A is correct. A tonic-clonic seizure requires a client to be placed on their side and have their clothing loosened. Prompt intervention with benzodiazepines. In this case, prescribed lorazepam is given to break the seizure.

The nurse is caring for a client experiencing a tonic-clonic seizure. Which of the following medications should the nurse be prepared to administer? A. Lorazepam B. Phenytoin C. Carbamazepine D. Benztropine

Choice B is correct. Midazolam is a benzodiazepine used for acute anxiety attacks. Midazolam is preferred in this setting because of its rapid onset (2 to 5 minutes after IV administration) and short duration of action (3 to 8 hours). It can be administered intravenously or orally. Given these benefits, midazolam would be the most useful for clients experiencing an acute anxiety attack before or during endoscopic procedures or surgery. Additional benefits of midazolam during procedures are sedation and amnesia. Midazolam, as a continuous IV infusion, is also used in sedating mechanically ventilated clients in critical care settings. The nurse should keep flumazenil as an antidote ready in case severe respiratory depression occurs with benzodiazepines.

The nurse is caring for a client experiencing severe anxiety prior to an endoscopy procedure. The nurse anticipates a prescription for which medication from the primary healthcare provider (PHCP)? A. Oxycodone B. Midazolam C. Citalopram D. Haloperidol

Choice C is correct. Lamotrigine is a mood stabilizer indicated in the treatment of bipolar disorder. Lamotrigine is also used to manage epilepsy because it doubles as an anticonvulsant. Lamotrigine is efficacious for both bipolar mania and depression.

The nurse is caring for a client newly diagnosed with bipolar disorder. The nurse anticipates a prescription for A. sertraline. B. haloperidol. C. lamotrigine. D. buspirone.

Choice A is correct. Mastitis is commonly caused by Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), E. coli, and streptococci. Thus, antibiotics such as cephalexin are effective in the treatment of mastitis.

The nurse is caring for a client newly diagnosed with mastitis. The nurse anticipates a prescription for which medication? A. Cephalexin B. Acyclovir C. Fluconazole D. Imiquimod

Choices B, C, and D are correct. Essential labs to monitor while a client takes lithium include the lithium level, thyroid panel (lithium may cause hypothyroidism), creatinine (risk of nephrotoxicity), and sodium (hyponatremia may precipitate lithium toxicity).

The nurse is caring for a client prescribed lithium. Which laboratory tests would be necessary for the nurse to monitor? Select all that apply. Troponin Creatinine Thyroid-stimulating hormone Sodium Potassium

Choice B is correct. Tizanidine is a muscle relaxant and is utilized in the treatment of multiple sclerosis. Other indications for a muscle relaxant include an injury such as a motor vehicle crash that may cause muscle spasms.

The nurse is caring for a client prescribed tizanidine. The nurse understands that this medication has had a therapeutic effect when the client reports A. increased ability to focus. B. decreased muscle spasms. C. improved short-term memory. D. sleeping without awakening at night.

Choice C is correct. Angina is a concerning finding and requires follow-up by the nurse. Vasoconstriction may occur with this medication, and thus, the client with a medical history of coronary artery disease, uncontrolled hypertension, and a previous stroke should not take this medication.

The nurse is caring for a client receiving prescribed sumatriptan. Which client report would indicate that the client is experiencing an adverse response? A. Nervousness B. Warm sensation C. Angina D. Tingling sensation

Choice C is correct. ECT is a safe therapy that induces seizures theorized to release monoamines, which may assist in treating psychiatric illnesses such as major depressive disorder. If a client is taking the anticonvulsant topiramate, this will increase the seizure threshold and may attenuate the efficacy of ECT.

The nurse is caring for a client scheduled for electroconvulsive therapy (ECT). Which medication should the nurse question? A. Venlafaxine B. Esomeprazole C. Topiramate D. Lurasidone

Choice D is correct. Follow-up laboratory work is essential for a client taking clozapine. The medication may adversely cause neutropenia. The client will be instructed to obtain this necessary laboratory work to ensure they are not experiencing agranulocytosis, which may make the client susceptible to infection.

The nurse is caring for a client that was newly prescribed clozapine. It would be essential to teach the client to do which of the following? A. Maintain a healthy diet because of weight gain B. Exercise regularly and maintain hydration C. Expect excessive secretions in the mouth D. Obtain follow-up laboratory work

Choice A is correct. Nortriptyline is a tricyclic antidepressant (TCA) used to manage depressive and obsessive-compulsive disorders. Overdoses of tricyclics can be fatal because of their cardiotoxicity. Discerning how many pills were consumed would be very helpful. The priority for this client is to complete a 12-lead electrocardiogram followed by continuous cardiac monitoring.

The nurse is caring for a client who arrives with an intentional overdose of nortriptyline. Which information is essential to obtain? A. The number of pills that were consumed. B. The indication for the medication. C. Previous suicide attempts and methods. D. Circumstances leading up to the overdose.

Choice A is correct. Olanzapine is an atypical antipsychotic drug. Adverse reactions of olanzapine include neuroleptic malignant syndrome, which is manifested by tachycardia, delirium, fever, and muscle rigidity. Thus, muscle rigidity should be reported to the provider immediately.

The nurse is caring for a client who has been prescribed olanzapine. Which of the following assessment findings would warrant immediate notification to the primary healthcare physician (PHCP)? A. Muscle rigidity B. Weight gain C. Hyperglycemia D. Fatigue

Choice D is correct. Suicidal ideation is always a concern whether a client is taking an SSRI like sertraline or not. SSRIs have demonstrated the ability to ameliorate depressive and anxiety symptoms; however, the risk of suicidal ideation may adversely occur and should be reported immediately.

The nurse is caring for a client who has been prescribed sertraline for major depressive disorder. It would be a priority for the nurse to assess for which of the following? A. Insomnia B. Sexual side-effects C. Weight gain D. Suicidal ideation

Choice A is correct. Diphenhydramine is an anticholinergic and is utilized for dystonic reactions associated with antipsychotic use (such as fluphenazine, a typical antipsychotic). Dystonia is one of the earliest adverse effects and should be promptly reported to the prescriber.

The nurse is caring for a client who has developed dystonia following the administration of fluphenazine. Which medication does the nurse anticipate that the primary healthcare provider (PHCP) will prescribe? A. diphenhydramine B. mannitol C. thiamine D. haloperidol

Choice B is correct. Follow-up laboratory work is essential for a client taking clozapine. The medication may adversely cause neutropenia. The client will be instructed to obtain this necessary laboratory work to ensure they are not experiencing agranulocytosis, which enhances the risk of infection. This WBC count is quite low and requires follow-up.

The nurse is caring for a client who is receiving clozapine. Which of the following findings would warrant immediate follow-up? A. Total cholesterol 206 mg/dL B. WBC 3,000 mm3 C. Weight gain 1 kilogram D. Blood glucose 255 mg/dL

Choice A is correct. Aripiprazole is an atypical (second generation) antipsychotic indicated in treating schizophrenia and certain mood disorders such as bipolar. If the client reports no hallucinations or delusions, a positive symptom associated with schizophrenia, this medication has exerted its therapeutic effect.

The nurse is caring for a client who is receiving prescribed aripiprazole. Which of the following client findings would indicate a therapeutic response? A. Reports of no hallucinations and delusions B. Increased concentration and attention C. Improved muscle coordination and gait D. No reports of insomnia or night terrors

Choice D is correct. Risperidone is an atypical (second generation) antipsychotic indicated in psychotic disorders such as schizophrenia. If the client reported decreasing thoughts of persecution (and was observed to have fewer thoughts of persecution), this would be a therapeutic effect.

The nurse is caring for a client who is receiving prescribed risperidone. Which of the following findings would indicate a therapeutic response? The client demonstrates A. a reduction in weight. B. increased mood lability. C. an appropriate gait pattern. D. decreased thoughts of persecution.

Choice C is correct. Trazodone is a serotonergic medication indicated in the treatment of insomnia. Adversely, this medication may cause priapism which is a prolonged, painful erection of the penis. Prompt treatment is necessary because this may result in ischemia.

The nurse is caring for a client who is receiving prescribed trazodone. Which of the following findings would indicate the client is having an adverse effect? A. Dizziness B. Sedation C. Priapism D. Dry mouth

Choice D is correct. Ziprasidone is an atypical (second-generation) antipsychotic indicated in psychotic disorders such as schizophrenia. This would be a therapeutic effect if the client reported decreasing thoughts of persecution (and was observed to have fewer thoughts of persecution).

The nurse is caring for a client who is receiving prescribed ziprasidone. Which of the following findings would indicate a therapeutic response? The client demonstrates A. a reduction in weight. B. increased mood lability. C. an appropriate gait pattern. D. decreased thoughts of persecution.

Choice B is correct. Lamotrigine is approved to treat epilepsy to prevent seizures. This medication is also indicated in maintaining bipolar disorder to provide mood stabilization. Lamotrigine is safe during pregnancy which makes this medication quite attractive for a client with bipolar disorder and epilepsy who wants to consider family planning.

The nurse is caring for a client who was prescribed lamotrigine. The nurse understands that this medication is intended to treat A. acute spinal shock. B. epilepsy. C. Parkinson's disease. D. multiple sclerosis.

Choice B is correct. Lurasidone is an atypical antipsychotic indicated to treat bipolar disorder (it provides mood stabilization) and schizophrenia. Lurasidone is a newer atypical antipsychotic and may cause fewer metabolic effects when compared to other atypical such as olanzapine, quetiapine, etc.

The nurse is caring for a client who was prescribed lurasidone. The nurse understands that this medication is intended to treat A. attention deficit hyperactivity disorder. B. bipolar disorder. C. obsessive-compulsive disorder. D. antisocial personality disorder.

Choices A and D are correct. Bell's palsy classically causes facial nerve paralysis. It is usually idiopathic. However, etiologies such as herpes simplex virus may be present. Exacerbations of Bell's palsy are treated with corticosteroids (prednisone, choice A) and antivirals (valacyclovir, choice D). Corticosteroids decrease facial nerve inflammation, and antivirals address the possible underlying viral etiology.

The nurse is caring for a client with an acute exacerbation of Bell's palsy. Which of the following prescriptions would the nurse anticipate? Select all that apply. Prednisone Donepezil Pyridostigmine Valacyclovir Topiramate

Choice B is correct. Carbamazepine has been implicated in causing blood dyscrasias. These blood dyscrasias include pancytopenia (low red blood cells, white blood cells, and platelets). Therefore, the nurse should contact the health care provider (HCP) to obtain an order to draw a baseline complete blood count (CBC) with differential before administering carbamazepine to this client. This lab result will serve as the baseline result for this client, as this lab result includes the client's baseline leukocytes, neutrophils, and thrombocytes (among other CBC results).

The nurse is caring for a client with bipolar disorder and has been prescribed carbamazepine. Which laboratory tests would need to be monitored for adverse effects? A. Urine analysis B. Complete Blood Count (CBC) C. Cardiac enzymes D. Lipid Panel

Choice C is correct. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and is the only approved medication for bulimia nervosa. This medication effectively treats this disorder, especially when coupled with psychotherapy. Fluoxetine assists in increasing a client's weight and may mitigate comorbid disorders such as generalized anxiety disorder.

The nurse is caring for a client with bulimia nervosa. The nurse anticipates a prescription for which medication? A. metformin B. bupropion C. fluoxetine D. clozapine

Choice B is correct. Bupropion is contraindicated in the treatment of bulimia because of its weight negative effects. Weight loss is not a treatment goal for a clie

The nurse is caring for a client with bulimia nervosa. Which newly prescribed medication requires clarification with the primary healthcare provider (PHCP)? A. fluoxetine B. bupropion C. sertraline D. fluvoxamine

Choice D is correct. Zolpidem is a non-benzodiazepine indicated in the treatment of insomnia.

The nurse is caring for a client with newly prescribed zolpidem. The nurse understands that this medication is indicated for which condition? A. Attention Deficit Hyperactivity Disorder B. Generalized Anxiety Disorder C. Narcolepsy D. Insomnia

Choice A is correct. Clozapine is an atypical (second-generation) antipsychotic indicated in treating schizophrenia. Clozapine causes the worst metabolic disturbances, including hyperglycemia, weight gain, and hyperlipidemia. These manifestations may drive the client into metabolic syndrome. The nurse must obtain a baseline weight to trend at future visits. Additional baseline data needed prior to starting clozapine include the client's neutrophil count, liver function tests, fasting blood glucose, and hemoglobin.

The nurse is caring for a client with schizophrenia and has received a new prescription for clozapine. Prior to administering the first dose, the nurse plans on obtaining the client's A. weight. B. pulmonary function tests. C. urine analysis. D. visual acuity.

Choice B is correct. Guidelines recommend administering Rho(D) Immune Globulin at 28 weeks of pregnancy and within 72 hours of delivery. Maternal sensitization occurs in approximately 72 hours following the exposure of material circulation to the Rh-positive fetal RBCs. Giving Rho(D) Immune Globulin (RhoGAM) too early will not provide adequate prophylaxis against Rh isoimmunization. Giving RhoGAM after 28 weeks of gestation would be too late to prevent isoimmunization during pregnancy because Rh antibodies have already formed.

The nurse is counseling a group of students on the dosing schedule of Rho(D) Immune Globulin. It would indicate effective understanding if the student states that Rho(D) Immune Globulin should be administered at A. 12 weeks of pregnancy and within 72 hours of delivery B. 28 weeks of pregnancy and within 72 hours of delivery C. 25 weeks of pregnancy and within 96 hours of delivery D. 16 weeks of pregnancy and within 12 hours of delivery

Choice C is correct. Calcium carbonate (Tums) should not be taken at the same time as Phenytoin because taking them together can decrease the effects of phenytoin. Antacids containing calcium carbonate reduce the bioavailability of phenytoin by reducing both the rate of absorption and the amount of intake. Phenytoin is an anticonvulsant and not getting it at a therapeutic dose may result in the client having a recurrent seizure. Clients should be cautioned against the concomitant use of antacids/tums and phenytoin. If the client needs calcium carbonate, he should be instructed to separate the times of intake of calcium carbonate and phenytoin by at least two to three hours.

The nurse is educating a patient who is taking phenytoin. To make sure phenytoin does not fail, which over-the-counter (OTC) medication should the nurse advise the patient not to take at the same time? A. Acetaminophen B. Ibuprofen C. Calcium carbonate D. Ranitidine

Choice C is correct. Guanfacine is an alpha2A-adrenergic receptor agonist and is approved to treat symptoms of attention deficit hyperactivity disorder (ADHD). The medication comes in an extended-release form to lessen the common side-effect of sedation. Guanfacine is efficacious for individuals with ADHD, especially if they possess motor hyperactivity and impaired concentration. The client reporting improving academic performance indicates that the client is receiving the therapeutic benefit of the medication, as individuals with ADHD usually have decreased work and scholastic performance.

The nurse is performing a follow-up visit on an adolescent recently prescribed guanfacine. Which of the following assessments indicates a therapeutic response to the medication? A. Euthymic mood B. Less social anxiety C. Improved academic performance D. No suicidal ideations

Choices B, C, and D are correct. FHR patterns, UA, and BP are three monitoring parameters essential to monitor an infusion of oxytocin. Oxytocin may cause nonreassuring FHR patterns such as tachycardia, bradycardia, decreased variability, and pathologic (late, variable, or prolonged) decelerations. Oxytocin may cause excessive uterine activity (UA) (tachysystole, hypertonus, inadequate relaxation time). Rapid infusion of oxytocin may cause maternal hypotension. BP monitoring is recommended.

The nurse is preparing to administer a prescribed infusion of oxytocin to a client with labor dystocia. During the infusion, the nurse plans to monitor which of the following? Select all that apply. Deep tendon reflexes (DTR) Fetal heart rate (FHR) patterns Uterine activity (UA) Blood pressure (BP) Urine specific gravity (USG)

Choice B is correct. Haloperidol is a typical (first-generation) antipsychotic that is indicated for schizophrenia. Typical antipsychotics, such as haloperidol, may raise the client's risk for extrapyramidal symptoms (EPS).

The nurse is preparing to administer haloperidol to a client. The nurse understands that this medication is prescribed to treat which of the following? A. dementia B. schizophrenia C. major depressive disorder D. bipolar disorder

Choice C is correct. Tamsulosin is an alpha-1 antagonist medication indicated in the treatment of benign prostatic hypertrophy. This medication causes vasodilation, and the biggest side effect is orthostatic hypotension. The nurse should educate the client to change positions slowly while taking this medication to reduce the risk of orthostasis.

The nurse is teaching a client about newly prescribed tamsulosin. Which of the following statements should the nurse include? A. "This medication may turn your urine reddish/orange." B. "You will urinate more often with this medication." C. "Change positions slowly while you take this medication." D. "Avoid calcium-containing foods while on this medication."

Choice A is correct. Phenelzine is a monoamine oxidase inhibitor (MAOI) medication indicated for treating severe depression. Smoke bacon is contraindicated because it contains a high level of tyramine which may cause a client to develop a life-threatening hypertensive crisis. Other foods contraindicated when the client takes an MAOI for depression include bananas, raisins, cheeses, sour cream, yogurt, beer, red wines, and Italian green beans.

The nurse is teaching a client newly prescribed phenelzine. Which dietary items should the nurse instruct the client to avoid while taking this medication? A. smoked bacon B. scrambled eggs C. milk D. kale

Choices A, B, and C are correct. Rho(D) Immune Globulin should be administered to Rh-negative women exposed to Rh-positive blood. Such exposures may be linked to Delivering an Rh-positive infant Chorionic villus sampling Aborting an Rh-positive fetus Receiving accidental transfusion of Rh-positive blood Amniocentesis Intraabdominal trauma while carrying an Rh-positive fetus.

The nurse is teaching a group of students about Rho(D) Immune Globulin. It would be correct if the student states that this medication is indicated when the mother is Rh-negative and Select all that apply. delivering an Rh-positive infant. aborting an Rh-positive fetus. undergoing chorionic villus sampling. having a transvaginal ultrasound. non-stress testing (NST).

Sodium 130 mEq/L 135-145 mEq/L Blood Urea Nitrogen 29 mg/dL 10-20 mg/dL Lithium Level 1.5 mEq/L 0.6 - 1.2 mEq/L

The nurse working in the clinic reviews laboratory data for a client prescribed lithium White Blood Cell 10,500 mm³ 5,000 - 10,000 mm³ Sodium 130 mEq/L 135-145 mEq/L Potassium 3.7 mEq/L 3.5 - 5.0 mEq/L Blood Urea Nitrogen 29 mg/dL 10-20 mg/dL Creatinine 1.0 mg/dL 0.6-1.2 mg/dL Lithium Level 1.5 mEq/L 0.6 - 1.2 mEq/L

Choice B is correct. A hypertensive crisis can occur if a monoamine oxidase inhibitor (MAOI) is ingested concurrently with a food containing tyramine. This effect is called the cheese reaction because mature cheese has a high tyramine content. MAOIs are used infrequently because of concern about this reaction. To prevent a hypertensive crisis, clients taking MAOIs should avoid fermented, aged, or smoked foods (i.e., malted beers, Chianti wines, sherry, liqueurs, and overripe or aged foods (such as aged cheeses or meats)), as these all contain high amounts of tyramine. Therefore, Swiss cheese should be avoided.

A nurse is conducting client education regarding medication for a client receiving a monoamine oxidase inhibitor (MAOI). Which of the following should the client avoid? A. Cream cheese B. Swiss cheese C. Milk D. Ice cream

Choice B is correct. Phenytoin is an anticonvulsant and is indicated for epilepsy. Therapeutic levels must be maintained to ensure the effectiveness of the drug. The therapeutic drug levels of phenytoin are 10-20 mcg/mL.

A nurse is instructing a client about a newly prescribed medication, phenytoin. Which statements, if made by the client, indicate effective teaching? A. "If my gums get irritated and large, I can stop this medication." B. "I will need laboratory work to monitor the medication level." C. "It is okay for me to increase this medication if I have a seizure." D. "I should take this medication with low protein foods."

Choice B is correct. Risperidone is a second-generation antipsychotic used in delirium, schizophrenia, and some childhood disorders. Weekly white blood cell tests are not required with risperidone as this is appropriate for an individual receiving clozapine.

A nurse is instructing a client about prescribed risperidone. Which statements, if made by the client, require follow-up? A. "I should report any abnormal movements that I develop." B. "I will need to have weekly tests to monitor my white blood cells." C. "If I get muscle stiffness, I should notify my physician." D. "I will need to chew sugarless gum if I develop a dry mouth."

Choice A is correct. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) indicated in treating depressive, eating, and anxiety disorders. Fluoxetine is activating and may cause the client insomnia if taken at night. The client should be instructed to take the medication in the morning and with food if they experience gastrointestinal upset. Fluoxetine may take six to twelve weeks to exert an effect on the client.

A nurse is teaching a client about newly prescribed fluoxetine. Which of the following statements by the client would indicate effective teaching? A. "I should take this medication in the morning." B. "I may notice a better result if I take this with St. John's Wort." C. "I should chew the capsule until it is dissolved." D. "This medication will help me with my attention deficit disorder."

Choice A is correct. Levonorgestrel (LNG) is available over the counter for emergency contraception. This medication is indicated to be used up to 72 hours following unprotected intercourse, where pregnancy could be possible. It may be used off-label up to 120 hours following the event. This medication works by postponing (or inhibiting) ovulation.

A client presents to the clinic asking the nurse about emergency contraception. The nurse anticipates that the primary healthcare provider (PHCP) will prescribe which medication? A. Levonorgestrel B. Tamoxifen C. Finasteride D. Methotrexate

Choice B is correct. Varenicline is a medication intended to assist an individual with smoking cessation. This medication should be started seven days before the planned quit date and gradually increased in dose. The medication may be prescribed for twelve weeks to ensure appropriate abstinence.

A client who smokes cigarettes has a new prescription for varenicline. The nurse instructs the client to take this medication how many days before their planned quit date? A. 14 days B. 7 days C. 2 days D. 21 days

Choice B is correct. Valerian root is a common herbal remedy used to treat occasional insomnia but may interact with some medications. Clients should be encouraged to discuss herbal remedies with their doctors.

A client asks the nurse about an herbal product used to treat insomnia. The nurse should recommend the client ask their physician about which herbal supplement to promote sleep? A. Raspberry leaf tea B. Valerian root C. Glucosamine D. Black Cohosh

The nurse is administering a continuous infusion of magnesium sulfate to a client with preeclampsia. Which assessment data is necessary to monitor during the infusion? A. capillary blood glucose B. urine specific gravity C. temperature D. heart rate and rhythm

Choice D is correct. Heart rate and rhythm must be monitored during the infusion of magnesium sulfate. Magnesium sulfate infusions are used to prevent seizure activity associated with preeclampsia and eclampsia and delay labor progress to prevent preterm labor. During an infusion, the nurse needs to monitor several pieces of clinical data, including the heart rate and rhythm, as magnesium sulfate may cause heart block.

Choice A is correct. Although rare, one of terbutaline's most serious adverse effects is pulmonary edema. The nurse should monitor the client's breath sounds and assess for respiratory crackles and difficulty breathing to detect if pulmonary edema is present

The client admitted to the gynecology ward for premature labor is given terbutaline to arrest labor. The nurse should monitor which of the following parameters when administering this medication? A. Breath sounds B. Urine output C. Pain D. Level of consciousness

Choice A is correct. The average lithium level is 0.6 mEq to 1.2 mEq/L. Any level over 1.5 mEq/L indicates a toxic serum lithium level. Vomiting, diarrhea, blurred vision, abdominal pain, tremors, and tinnitus are symptoms of lithium toxicity.

The client taking lithium for bipolar disorder is experiencing vomiting, diarrhea, and blurred vision. Their lithium level is 2.5 mEq/L(0.6 - 1.2 mEq/L). The nurse suspects which finding is occurring? A. Lithium toxicity B. An allergic reaction to the medication C. A normal reaction to lithium D. This lithium level is too low

Choice B is correct. Lorazepam is a benzodiazepine used in the management of alcohol withdrawal symptoms. The client is exhibiting these symptoms as evidenced by perspiration on the forehead, nystagmus, coarse tremors, and visual hallucinations.

The nurse is caring for a client with the following clinical data. Which prescription would the nurse request from the primary healthcare provider (PHCP)? A. Diphenhydramine B. Lorazepam C. Phenytoin D. Clozapine

Choices A and C are correct. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). This medication is used to treat depression and anxiety. It may take two to four weeks for the client to experience a therapeutic response. If no effect is achieved by six weeks, the prescriber may change the medication. Venlafaxine may increase thoughts of suicidal ideation, and the client should be educated to seek help if these thoughts should occur.

The nurse has provided medication instructions to a client who has been prescribed venlafaxine. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching? Select all that apply. "I may not notice an improvement in my mood right away." "This medication may lower my blood pressure." "If I have thoughts of harming myself, I should call 911." "I will need to have weekly laboratory tests." "I may continue taking St. John's Wort."

Choice D is correct. Sertraline is an antidepressant medication used to treat generalized anxiety disorder and major depressive disorder. This medication is a selective serotonin reuptake inhibitor (SSRI).

The nurse receives a prescription for sertraline. The nurse understands that this medication is used to treat which condition? A. Schizophrenia B. Bipolar disorder C. Bulimia D. Major depressive disorder

Choices A, C, and D are correct. Panic disorder is a category of anxiety disorder. It is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom. It is accompanied by increased autonomic nervous system activity. Panic attacks usually last less than 10 minutes. However, many patients may describe them as seemingly "endless." Amitriptyline is an antidepressant that is also used to treat panic disorder. Diazepam is a benzodiazepine that is used to treat, anxiety, insomnia, and panic. Phenelzine is an MAOI that is used to treat social anxiety, depression, and panic disorder.

The psychiatric nurse knows that which of the following medications are often used in the treatment of panic disorders? Select all that apply. Amitriptyline Amobarbital Diazepam Phenelzine Fentanyl

Choice A is correct. Carbamazepine is indicated for the prevention of seizures—neuropathic pain. And the treatment of certain mood disorders. The client demonstrating decreased mood lability would be the desired outcome.

This nurse is caring for a client who is receiving prescribed carbamazepine. Which of the following findings would indicate a therapeutic response? A. Decreased mood lability B. Steady gait C. Urinary continence D. Increased bone mass

Choice B is correct. Nitrous oxide may be used for dental procedures or brief obstetrical or surgical procedures. It may also be used together with other general anesthetics, which makes it possible to decrease the dosages of each with greater effectiveness. There are two primary methods of causing general anesthesia. IV agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia.

Which of the following is the reason a patient receives nitrous oxide in addition to thiopental sodium? A. To provide the additional anesthesia to put him in a sleep-like state B. To increase the effectiveness of each drug at lower dosages C. Because thiopental sodium is not effective when used alone D. Because nitrous oxide is not effective when used alone