Pharm Chapter 22 - Psychotherapeutic Agents
a
The nurse is interviewing a new client and their family shortly after a hospital admission. The client has been diagnosed with schizophrenia. What would be an appropriate question to ask the family members of this client? a. What inappropriate response to stimuli has the client had? b. Does the client take illicit drugs? c. Does the client have any close friends? d. Is the client easy to manage?
C
The nurse is presenting an in-service at a children's unit on hyperactivity. The nurse is told that a 6- year-old on the unit is being treated with methylphenidate (Ritalin). The presenting nurse talks about discharge teaching for this patient and the importance of monitoring what? A) Long bone growth B) Visual acuity C) Weight and complete blood count D) Urea and nitrogen levels
B
The nurse is teaching the mother of a child diagnosed with attention-deficit hyperactivity disorder how to administer methylphenidate (Ritalin). When would the nurse instruct the mother to administer this drug? A) Administer at lunch every day. B) Administer at breakfast every day. C) Administer at dinner every day. D) Administer at bedtime.
B
The nurse, providing teaching about a typical antipsychotic newly prescribed for the patient, cautions against use of alcohol with the drug by explaining it will have what effect? A) Prolonged QT interval B) Increased central nervous system (CNS) depression C) Increased anticholinergic effects D) Increased gastrointestinal (GI) adverse effects
b
A client, prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD) has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement? a. Take an over-the-counter (OTC) laxative daily. b. Increase fiber intake. c. Take diphenoxylate hydrochloride. d. Take metronidazole.
b
A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask the client to confirm why the medication was prescribed? a. "Do you have a history of depression?" b. "Have you ever been diagnosed with narcolepsy?" c. "Do you have a problem with sleepwalking?" d. "Do you have trouble falling asleep?"
C
A patient's medication has been changed to clozapine (Clozaril). The nurse evaluates this patient for which life-threatening adverse effect? A) Renal insufficiency B) Emphysema C) Neuroleptic malignant syndrome D) Cerebrovascular accident (CVA)
B
A patient, in the manic phase of bipolar disorder, is being discharged home on an antimanic drug. What antimanic drug is used for long-term maintenance of bipolar disorders? A) Aripiprazole (Abilify) B) Lamotrigine (Lamictal) C) Quetiapine (Seroquel) D) Ziprasidone (Geodon)
c
The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention? a. Restoring b. Deteriorating c. Improving d. Contravening
a
The nurse observes that a client with a long history of chlorpromazine therapy demonstrates lip smacking and appears to be chewing continually. The nurse should recognize that this client is likely experiencing what adverse effect of the medication? a. Tardive dyskinesia b. Akathisia c. Dystonia d. Neuroleptic malignant syndrome
C
A psychotic patient is admitted through the emergency department. The physician has ordered chlorpromazine (Thorazine) 25 mg intramuscularly. After administration of the medication, what is the nurse's priority to evaluate? A) The patient's ability to ambulate B) Return of the patient's appetite C) A decrease in psychotic symptoms D) Blood pressure and pulse
D
The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what patient would the nurse expect to require a standard dosage? A) African American adolescent diagnosed with schizophrenia B) Malaysian middle adult diagnosed with bipolar disorder C) Iranian older adult diagnosed with schizophrenia D) Caucasian young adult diagnosed with bipolar disorder
A
The physician has ordered olanzapine (Zyprexa) for a new patient. What laboratory test should be done before administration of olanzapine? A) Blood glucose B) Urine specific gravity C) Cholesterol D) Hemoglobin and hematocrit
A, B, C, D
The nurse is caring for a patient newly diagnosed with schizophrenia. His parents say they have heard the term before but do not really understand exactly what schizophrenia means. How would the nurse describe the disorder? (Select all that apply.) A) Thought disorder B) Difficulty functioning in society C) Hallucinations can be auditory, visual, or sensory D) Can be cured with the correct medications E) Enter into fugue state in most cases
c
A black, male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the health care provider's (HCP's) office with signs of tardive dyskinesia, and his HCP modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen? a. "The signs of tardive dyskinesia will diminish over time." b. "Black clients always experience tardive dyskinesia with antipsychotics." c. "When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients." d. "The olanzapine does not produce side effects in black males."
b
Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include: a. insomnia and hypertension. b. dry mouth, hypotension, and glaucoma. c. diarrhea and excessive urination. d. increased sexual drive and improved concentration.
Renal, CNS, CV and endocrine function
If a child is given Lithium they should be closely monitored for:
C
A 16-year-old youth has just been diagnosed with schizophrenia. The parents ask the nurse what causes schizophrenia. What would be the nurse's best response? A) Schizophrenia is caused by pain that the brain perceives. B) Schizophrenia is thought to occur due to trauma experienced in childhood. C) Schizophrenia is thought to reflect a fundamental biochemical abnormality. D) Schizophrenia is caused by seizure activity in the brain
C
A 7-year-old boy is admitted to the pediatric behavioral health unit with a diagnosis of an acute psychotic episode. Aripiprazole has been ordered. Before administering the medication, what is the nurse's first priority? A) Weigh the patient. B) Obtain baseline vital signs. C) Call the physician. D) Administer the medication between meals.
d
A 9-year-old child receives antipsychotics to manage her disease. The child's mother asks why her daughter receives such a high dose of the medication compared with an adult. How will the nurse explain this to the mother? a. "Children usually have a slower metabolic rate than adults and may therefore require relatively high doses for their size and weight." b. "Children usually have a faster metabolic rate than adults and may therefore require relatively low doses for their size and weight." c. "Children usually have a slower metabolic rate than adults and may therefore require relatively low doses for their size and weight." d. "Children usually have a faster metabolic rate than adults and may therefore require relatively high doses for their size and weight."
b
A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain? a. The risk for cumulative adverse effects is greater if the child doesn't have a break. b. It needs to be determined if the child still has symptoms that require treatment. c. The drug must be occasionally stopped to prevent anticholinergic effects d. The drug likely needs to be switched to another agent that is less toxic.
d
A client has been receiving chlorpromazine as treatment for psychosis. Which assessment finding indicates to the nurse that the client is experiencing an extrapyramidal effect of the medication? a. fatigue b. dizziness c. slurred speech d. motor restlessness
b
A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia? a. Urinary tract infection b. Diabetes mellitus c. Renal calculi d. Hyperthyroidism
d
A female client relates that she is taking diazepam for a muscle relaxant and modafinil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of client education, the nurse would include: a. Modafinil may decrease the effects of diazepam. b. Modafinil will not interfere with any of the medications she is taking. c. Modafinil should not be taken if the client is on a contraceptive. d. Modafinil may decrease the effects of her contraceptive, and she may need to use other protection.
B
A group of patients are being screened to see which patients would be the best candidate for a psychotherapeutic drug trial that helps people concentrate longer on activities. Which patient would be best suited for this trial? A) A 28-year-old salesperson who alternates between overactivity and periods of depression B) A 32-year-old hyperactive nursing student who cannot focus long enough to take a test C) A 55-year-old physician who suddenly falls asleep during the day without warning D) A 16-year-old youth who say he can make the light turn on by pointing at it and hears voices
b, c, d, e, f
A nurse has administered the first dose of Didrex to a client for weight loss. The nurse should be monitoring for which side effects? Select all that apply. a. low blood glucose level b. disorientation c. apprehension d. excessive CNS stimulation e. nervousness f. headache
b
A nurse is caring for a patient who is taking haloperidol. The patient has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on a(n): a. decreased risk for toxic effects of haloperidol therapy. b. increased risk for toxic effects of haloperidol therapy. c. decreased risk for muscular contractions and spasms. d. high drug efficacy of haloperidol.
C
A nurse is caring for a patient who is taking lithium for mania. The nurse's assessment includes a notation of a lithium serum level of 2.4 mEq/L. The nurse anticipates seeing what? A) Fine tremors of both hands B) Slurred speech C) Clonic movements D) Nausea and vomiting
c
Anticonvulsive medications are sometimes used in the treatment of bipolar disorder. What other drug is used to treat bipolar disorder? a. Valium b. Flexeril c. Lithium d. Restoril
a
Antipsychotic drugs are also known as neuroleptic drugs because a. they cause numerous neurological effects. b. they frequently cause epilepsy. c. they are also minor tranquilizers. d. they are the only drugs known to directly affect nerves.
c
Antipsychotic drugs are basically a. serotonin reuptake inhibitors. b. norepinephrine blockers. c. dopamine receptor blockers. d. acetylcholine stimulators.
d
Attention-deficit/hyperactivity disorder (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are both most effectively treated with the use of; a. neuroinhibitors. b. dopamine receptor blockers. c. major tranquilizers. d. CNS stimulants.
a, b, c, d
Before administering lithium to a patient, the nurse should check for the concomitant use of which drugs, which could cause serious adverse effects? a. Ibuprofen b. Haloperidol c. Thiazide diuretics d. Antacids e. Ketoconazole f. Theophylline
a, b, d
Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which actions? Select all that apply: a. Positioning to decrease discomfort of dyskinesias b. Implementing safety measures to prevent injury c. Encouraging the patient to chew tablets to prevent choking d. Careful teaching to alert the patient and family about this adverse effect e. Applying ice to the joints to prevent damage f. Pureeing all food to decrease the risk of aspiration
a
Haloperidol (Haldol) is a potent antipsychotic that is associated with: a. severe extrapyramidal effects. b. severe hyperactivity. c. severe hypotension. d. severe anticholinergic effects.
C
Haloperidol is a typical antipsychotic drug. What adverse effect is associated with this drug? A) Bradycardia B) Bradypnea C) Extrapyramidal effects D) Hypoglycemia
b
Lithium does not have a recommended pediatric dose, and the drug should not ordinarily be used in children. If it is used, the dose should be carefully calculated from the child's age and weight and adjusted to maintain a level between: a. 1.0 and 2.2 mEq/L b. 0.8 and 1.2 mEq/L c. 2.0 and 3.2 mEq/L d. 3.0 and 4.2 mEq/L
c
Lithium toxicity can be dangerous. Patient assessment to evaluate for appropriate lithium levels would look for: a. serum lithium levels >3 mEq/L. b. serum lithium levels >4 mEq/L. c. serum lithium levels <1.5 mEq/L. d. undetectable serum lithium levels.
d
Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include: a. depression. b. anxiety. c. seizures. d. schizophrenia.
A
Parents bring a 15-year-old boy into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What symptoms, if described by the family, would support their conclusion? A) He hears and interacts with voices no one else can hear. B) He is overactive and always so excitable. C) He falls asleep in the middle of a sentence. D) He cannot concentrate and his grades are suffering.
A
Psychosis is a severe mental illness characterized by what? A) Disordered thought B) Increased social interaction C) Hypoactivity with aggressiveness D) Paranoid hallucinations
c
Serotonin abnormalities are thought to be involved in the following disorders: a. Epilepsy and strokes. b. Attention deficit disorder. c. Mental depression and sleep disorders. d. Severe anxiety and hyperactivity.
A
The mother of a child diagnosed with attention-deficit syndrome receives a prescription for a central nervous system (CNS) stimulant to treat her child. The mother asks the nurse, I don't understand why we're giving a stimulant to calm him down? What is the nurse's best response to this mother? A) It helps the reticular activating system (RAS), a part of the brain, to be more selective in response to incoming stimuli. B) It helps energize the child so they use up all of their available energy and then they can focus on quieter stimuli. C) No one truly understands why it works but it has been demonstrated to be very effective in treating ADHD. D) The drugs work really well and you will see a tremendous change in your child within a few weeks without any other treatment.
a
The nurse is caring for a client who takes clozapine. The nurse would be most concerned if this client displays what symptom? a. Temperature of 102°F b. Blood sugar of 108 c. Weight gain of 1 lb in the last week d. Blood pressure of 98/64
D
The patient taking an antipsychotic drug asks the nurse how long he will continue to feel the effects of the drug after stopping the medication. What is the nurse's best response? A) 2 to 4 hours B) 2 to 4 weeks C) 2 to 4 months D) 6 months
B
The pharmacology instructor is explaining to their class the difference between the typical and the atypical groups of antipsychotic drugs. What medication would the instructor explain to the students has fewer extrapyramidal effects and greater effectiveness than older antipsychotic drugs in relieving negative symptoms of schizophrenia? A) Chlorpromazine (Thorazine) B) Clozapine (Clozaril) C) Thiothixene (Navane) D) Haloperidol (Haldol)
C
What antiepileptic medication might the nurse administer to treat bipolar disorder? A) Apriprazole (Abilify) B) Cyclobenzaprine (Flexeril) C) Lamotrigine (Lamictal) D) Temazepam (Restoril)
a
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia? a. Lip smacking b. Disorientation c. Abnormal eye movements d. Urinary incontinence
a
What disease process is haloperidol used to treat? a. Tourette's syndrome b. early-onset dementia c. muscular dystrophy d. myasthenia gravis
C
What nursing intervention is appropriate for a 70-year-old female patient receiving lithium? A) Instruct the patient to use barrier contraceptives. B) Monitor blood glucose levels. C) Monitor fluid and sodium intake. D) Encourage the patient to check daily for weight loss
c
When writing a plan of care for a client beginning drug therapy for treatment of schizophrenia, which might be an appropriate nursing diagnosis? a. Self-Care Deficit related to hyperactivity b. Risk for Injury related to hyperactivity c. Impaired Physical Mobility related to sedation d. Altered Tissue Perfusion related to hypertension
d
Your patient, a 6-year-old boy, is starting a regimen of methylphenidate (Ritalin) to control an attention deficit disorder. Family teaching should include which of the following? a. This drug can be shared with other family members who might seem to need it. b. This drug may cause insomnia, weight loss, and GI upset. c. Do not alert the school nurse to the fact that this drug is being taken because the child could have problems later. d. This drug should not be stopped for any reason for several years.
B
Which drug does not have a recommended pediatric dose? A) Pimozide (Orap) B) Lithium salts (Lithotabs) C) Haloperidol (Haldol) D) Risperidone (Risperdal)
b, c
A presurgical client has reported a history of illicit amphetamine use. The nurse is concerned because of the effect this type of abuse has on what physiological functions? Select all that apply. a. parasympathetic nervous system (PSNS) b. central nervous system (CNS) c. sympathetic nervous system (SNS) d. gastrointestinal (GI) system e. respiratory system
A
A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits what is a priority nursing assessment for this child? A) Weight and height B) Breath sounds and respiratory rate C) Urine output and kidney function D) Electrocardiogram (ECG) and echocardiogram
b
A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse? a. "Dopamine is an enzyme that regulates your temperature." b. "Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." c. "Dopamine is a medication that is given to fight infections and help with pain." d. "Dopamine is a part of the brain that controls your impulses and thoughts."
a
A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client? a. history of seizure disorder b. vegetarian eating plan c. treatment for rheumatoid arthritis d. remote work in customer service
c
A nurse works at a weight management clinic. To which overweight client could the nurse safely administer dextroamphetamine? a. A 38-year-old Caucasian woman with glaucoma b. A 60-year-old African-American man who experiences angina c. A 48-year-old Caucasian man who has adult-onset diabetes d. A 28-year-old African-American woman with hyperthyroidism
c
A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling? a. epinephrine b. serotonin c. dopamine d. norepinephrine
B
A patient diagnosed with bipolar disorder is to be discharged home in 48 hours. The nurse has completed patient teaching regarding the use of lithium. What statement by the patient indicates an understanding of their responsibility? A) I will increase my salt intake. B) I will increase my fluid intake. C) I will decrease my salt intake. D) I will decrease my fluid intake.
A
A patient has just been prescribed a phenothiazine. During patient teaching about this drug, what would be important for the nurse to tell the patient? A) The urine can turn pink or reddish. B) The urine output will be decreased. C) Diarrhea can be an adverse effect. D) Hyperexcitability can occur
A
A patient on chlorpromazine is feeling better and decides they no longer need their medication. The nurse teaches the patient that abrupt withdrawal of a typical antipsychotic medication can result in what? A) Insomnia B) Tardive dyskinesia C) Somnolence D) Constipation
B, D
A patient, who is 77 years old, is admitted with a diagnosis of dementia. Haloperidol (Haldol) has been ordered for this patient. What nursing considerations would govern the nurse's actions? (Select all that apply.) A) It is classed as an atypical antipsychotic. B) A lowered dosage is indicated for older adult. C) It often has a hyperactive effect on patients. D) It should not be used to control behavior with dementia. E) It should only be given every other day.
D
The nurse is teaching the soon-to-be-discharged patient, diagnosed with schizophrenia, about his medications. What is a priority teaching point for this patient? A) The patient must eat three nutritious meals daily B) Over-the-counter medications may be taken with antipsychotic drugs. C) Cough medicines potentiate the actions of antipsychotic drugs. D) Alcohol consumption should be avoided.
A
The nurse administers chlorpromazine intramuscularly to the preoperative patient who is extremely anxious about surgery in the morning. What priority teaching point will the nurse provide this patient? A) Remain recumbent for at least 30 minutes after the injection. B) Do not eat for 1 hour after the drug is administered. C) Encourage fluids with the goal of 3,000 mL/d. D) Avoid eating avocados and oranges when taking this medication.
c
The nurse expects to monitor a client's white blood count weekly when the client is prescribed: a. Aripiprazole b. Olanzapine c. Clozapine d. Quetiapine
b
The parents of a male child with attention deficit-hyperactivity disorder (ADHD) bring the child to the health care provider's office for a follow-up visit. During the visit, the parents tell the nurse that the child receives his first dose of Ritalin at 7:30 every morning. The child's teacher and school nurse have reported that his ADHD symptoms return just before his second daily dose, which coincides with the lunch period at noon. Which might the nurse suggest to help better control the child's symptoms during school hours? a. Delaying the first dose until the child arrives at school b. Talking to the health care provider about switching to a longer acting preparation c. Splitting the first dose so that half is taken before leaving for school and half is taken upon arriving at school d. Asking the teacher to allow the child to attend a different lunch period so that he can take his second dose earlier in the day
A
The nurse admits a patient newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason for why the nurse includes the family when collecting the nursing history? A) The patient may not be able to provide a coherent history. B) The patient may not be able to speak due to reduced level of consciousness. C) The family will feel better if they are included in the process. D) The patient will be less anxious if the family listens while he answers questions.
A
The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to the pediatric intensive care unit following repeated seizures after a closed head injury. The physician orders phenytoin to control seizures and lorazepam to be administered every time the child has a seizure. What is the nurse's priority action? A) Call the doctor and question the administration of phenytoin. B) Call the doctor and question the administration of lorazepam. C) Wait 24 hours before beginning to administer phenytoin. D) Wait 24 hours before beginning to administer lorazepam
b
The nurse working with the family of a child prescribed methylphenidate should implement what strategy to address possible adverse effects? a. A strategy to ensure that the child maintains normal bladder function b. A plan to address the child's loss of appetite c. A plan to address the child's loss of self-esteem d. A strategy to regularly monitor the child's blood glucose levels
D
The nurse is caring for a patient taking an oral neuroleptic medication. What is the nurse's priority assessment to monitor for? A) Urge incontinence B) Orthostatic hypotension C) Bradycardia D) Tardive dyskinesia
d
The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching? a. Urge incontinence b. Orthostatic hypotension c. Bradycardia d. Tardive dyskinesias
A
The nurse is caring for an adolescent patient who began taking an antipsychotic drug last month to treat newly diagnosed schizophrenia. The drug has not been effective and the mother asks the nurse if this means the adolescent's symptoms cannot be controlled by drugs. What is the nurse's best response? A) Patients commonly have to try different drugs until the most effective drug is identified. B) Some patients do not respond to drugs and have to rely solely on behavior therapy. C) Most likely your child was not taking the medication properly as prescribed. D) He may need to take multiple drugs before effects will be seen that control his symptoms
D
The nurse is caring for four patients. Which patient would the nurse know that clozapine (Clozaril) is contraindicated for? A) 17-year-old adolescent B) 23-year-old with diabetes insipidus C) 32-year-old with osteoarthritis D) 45-year-old with bone marrow depression
a
The psychiatric nurse is conducting health education addressing the adverse effects of clozapine. What teaching point should the nurse convey to the client? a. "There's a possibility that this drug might cause you to gain weight and have high blood sugar levels." b. "It is important to drink plenty of fluids while taking this drug, as it can potentially cause constipation." c. "There's a chance that you could develop breathing problems when using this drug, making you vulnerable to pneumonia." d. "You'll have to eat more protein while you're taking this drug to help heal any wounds."
c
The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy? a. increase the ability to study for long periods of time. b. use the drugs as they are ordered. c. relieve the symptoms for which they were prescribed. d. increase productivity and work longer hours.
D
The nurse is preparing to administer methylphenidate to the child admitted to the pediatric unit after breaking a leg when jumping off the garage roof at home. Where will the nurse find the medication? A) In the patient's drawer B) In the refrigerator C) At the patient's bedside D) In the controlled substance cabinet
a
The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy? a. "I may always have to take this medication." b. "I will need medication if my hallucinations get worse." c. "If I take good care of myself, I'll be off medications soon." d. "Medications are less effective once my symptoms subside."
b
The nurse is providing education to a client who has been prescribed clozapine. During teaching, the nurse should inform the client of the need for regular monitoring of what laboratory test during the initial months of therapy and periodically thereafter? a. partial thromboplastin time (PTT) b. Complete blood count (CBC) c. Prothrombin time (PT) d. blood urea nitrogen (BUN)
a
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an a. electrocardiogram (ECG). b. electromyelogram (EMG). c. electroencephalogram (EEG). d. electrophysiologic study (EPS).
