Pharm EAQ CH 16-17

Which statements made by a nursing student indicate effective learning about akathisia? Select all that apply.

"Anticholinergic agents are not the only treatments for akathisia." "Both subjective and objective symptoms are associated with akathisia."

The nurse who is discussing ways to prevent lithium toxicity with a patient currently on lithium will include which of the following? Select all that apply.

"Be sure to report symptoms of persistent vomiting and/or profuse diarrhea." " You need to drink 10 glasses of water (8oz) each daily." "Be sure to report symptoms of lethargy and weakness."

Which information does the nurse provide to a patient who has been taking imipramine for the past year concerning parkinsonian symptoms noted during assessment?

"Have you been taking any antihistamines? They can cause these types of symptoms to appear."

Which statement made by the patient indicates a need for further teaching about antipsychotic medications?

"I must have at least 30 minutes in the sun each day."

In a patient taking an antipsychotic medication, how many weeks after therapy is started will there be a reduction in delusions?

6 to 8 Rationale: Reductions of hallucinations, delusions, and thought disorders often require 6 to 8 weeks of treatment with antipsychotic medication to achieve the full therapeutic effect. Some therapeutic effects, such as reduced psychomotor agitation and insomnia, are observed within 1 week of therapy with antipsychotic medication. White blood cell counts must be monitored weekly for at least 4 weeks after the discontinuation of clozapine.

A patient has been prescribed trazodone hydrochloride and is being taken off a monoamine oxidase inhibitor (MAOI). How soon can the patient start taking the trazodone?

At least 14 days after discontinuing the MAOI

Which drug is a low-potency antipsychotic drug?

Chlorpromazine Rationale: Chlorpromazine is a low-potency antipsychotic drug. Trifluoperazine, haloperidol, and fluphenazine are high-potency antipsychotic drugs.

Which drug is a typical antipsychotic agent?

Chlorpromazine Rationale: Chlorpromazine is a typical antipsychotic agent. Asenapine, lurasidone, and aripiprazole are atypical antipsychotic agents.

Which physical symptom is seen in a patient with depression?

Chronic fatigue Rationale: Chronic fatigue is a common physical symptom seen in patients with depression. Slowed thinking is a cognitive symptom found in patients with depression. Patients with depression exhibit a change in personality because of emotional impairment. Retarded movement is a psychomotor symptom of depression.

Which term is the milder form of bipolar illness?

Cyclothymia Rationale: Cyclothymia is a mild form of bipolar illness. Its symptoms are episodes of depression and hypomania; note that these symptoms are not severe enough to meet the full criteria for bipolar disorder. Elation is characteristic of mania, and distinct episodes of mania are seen in bipolar disorder. A heightened mood (euphoria) is a symptom of acute mania. Dysthymia is a unipolar disorder in which the patient suffers from chronic, ongoing symptoms of depression that last for at least 2 years.

Which condition is a patient experiencing when he or she answers questions with completely unrelated, garbled, and unrecognizable words?

Disorganized thinking Rationale: Disorganized thinking is commonly associated with psychosis. The speaker jumps from one idea or topic to another unrelated one in an illogical, inappropriate, or disorganized way. A delusion is a false or irrational belief that is firmly held despite evidence to the contrary. Hallucinations are false sensory perceptions that are experienced without an external stimulus that seem real to the patient. Disorganized behavior is a characteristic of psychosis that manifests as problems in carrying out any form of goal-directed behavior, such as organizing meals or maintaining hygiene.

Which disorder is associated with a loosening of associations?

Disorganized thinking Rationale: Disorganized thinking is a thought disorder that may consist of a loosening of associations or a flight of ideas. This condition causes the speaker to jump from one idea or topic to another one in an illogical, inappropriate, or disorganized way. A delusion is a false or irrational belief that is firmly held despite obvious evidence to the contrary. Hallucinations are false sensory perceptions that are experienced without an external stimulus and seem real to the patient. Disorganized behavior is associated with difficulty in performing activities of daily living, such as organizing meals or maintaining hygiene.

Which information is included in the selection of an antipsychotic medication?

Drug selection is based primarily on adverse effects to be avoided. Rationale: All antipsychotic drugs are equal in efficacy when used in equipotent doses, although some unpredictable variation between patients can occur. As a result, selection of medication should be based on the need to avoid certain adverse effects that have an effect on concurrent medical or psychiatric disorders. Low and high potency refers only to the milligram doses used for medications and does not suggest any difference in effectiveness or use. Expected duration of therapy is neither a basic guide to drug selection nor the cause of the problem, which is most often not clearly understood. All antipsychotic agents are similar in that they act by blocking the action of dopamine in the brain. Atypical antipsychotic agents also block serotonin receptors. They are all equal in efficacy when used in equipotent doses. Selection of a drug is based on a different factor.

Which assessment tool specifically describes the type of tardive dyskinesia and allows diagnoses to change over time?

Dyskinesia Identification System: Condensed User Scale (DISCUS) Rationale: The DISCUS evaluation specifically describes the type of tardive dyskinesia and allows diagnoses to change over time. The CGI and BPRS are used for baseline clinical evaluation. The AIMS rates dyskinetic movements, but it is not exclusively diagnostic for tardive dyskinesia.

Which nursing action is most appropriate when a patient with mania becomes aggressive?

Ensuring the availability of another staff member in the vicinity

Which adverse effect is the most troublesome and the most common cause of nonadherence associated with antipsychotic therapy?

Extrapyramidal symptoms Rationale: Extrapyramidal symptoms are the most troublesome and the most common cause of nonadherence associated with antipsychotic therapy. Sedation, hypotension, and anticholinergic effects are adverse effects associated with antipsychotic medications, but these do not cause the most troublesome adverse effects of antipsychotic therapy.

The nurse instructs a patient taking a monoamine oxidase inhibitor (MAOI) to avoid which food?

Grilled cheese sandwiches Rationale: Patients taking MAOIs should avoid tyramine-rich foods, such as cheese, because they may cause a hypertensive crisis. Orange juice and milk products, such as ice cream, have not been shown to affect MAOIs. Patients should not be concerned about eating eggs while taking MAOIs.

When monitoring a patient who began lithium therapy 3 weeks ago to treat bipolar disorder, which signs and symptoms potentially indicate serious adverse effects? Select all that apply.

Hyperreflexia Profuse diarrhea Lethargy and weakness

Which statement best describes unipolar disorder? Select all that apply.

It begins during the late 20s. Unipolar disorder is manifested by varying degrees of depression. Dysthymia is a form of unipolar depression.

Which statement regarding the effectiveness of electroconvulsive therapy for depression and bipolar illness is correct?

It is safer for patients with cardiovascular disease. Rationale: Electroconvulsive therapy is a form of nonpharmacologic treatment for depression and bipolar illness that is more effective and safer for patients with cardiovascular disease than many drug therapies. After electroconvulsive therapy, drug therapy is done to minimize the rate of relapse. The aim of maintenance therapy (not electroconvulsive therapy) is to prevent recurrences of the mood disorder. Lithium is more effective in preventing the signs and symptoms of mania than those of depression.

Which antidepressant therapy can cause a metallic taste?

Lithium Rationale: Lithium is a monovalent cation that may cause metallic taste as a rare adverse effect. Vilazodone adverse effects include diarrhea, nausea, and vomiting. Trazodone is a triazolopyridine antidepressant that may cause orthostatic hypotension. Vortioxetine antagonizes serotonin receptors and may cause abnormal dreams.

The nurse expects fluvoxamine to be prescribed for a patient with which condition?

Obsessive-compulsive disorder (OCD) Rationale: Fluvoxamine is used to treat OCD when obsessions or compulsions cause marked distress, are time consuming, or interfere substantially with social or occupational responsibilities. Hydroxyzine (Vistaril) is used to control PONV and pruritus associated with allergic reactions. Meprobamate (Miltown) is used for short-term relief of anxiety and as a mild skeletal muscle relaxant.

Which atypical antipsychotic agent would be prescribed for a patient undergoing initial pharmacologic treatment for bipolar disorder as monotherapy?

Olanzapine Rationale: Olanzapine is an atypical antipsychotic agent used for the initial treatment of a patient with acute mania as monotherapy. Valproate is also used for the initial treatment of acute mania as a monotherapy, but valproate is not an atypical antipsychotic agent. Lamotrigine and carbamazepine are used for patients who do not adequately respond to lithium.

A nurse is assessing a patient who has been admitted to the psychiatric unit and who has been hearing voices that told her to lock all her doors and to not answer any phone calls. The nurse should administer which scale specific for schizophrenia?

PANSS

Which patient is expected to show irritability, increased muscle tone, shivering, myoclonus, and reduced consciousness? Patient A : Primary drug Fluxetine; secondary drug haloperiodol Patient B: Primary drug Fluoxetine; secondary drug lithium Patient C: Primary drug isocarboxazid; secondary drug oral sulfonylureas Patient D Primary drug phenelzine; secondary drug meperidine

Patient B Rationale: Concurrent use of lithium with fluoxetine causes serotonin toxicity/serotonin syndrome. Signs of serotonin toxicity include irritability, increased muscle tone, shivering, myoclonus, and reduced consciousness. Fluoxetine increases haloperidol levels and increases the frequency of extrapyramidal symptoms. Monoamine oxidase inhibitors such as isocarboxazid have an additive hypoglycemic effect when combined with oral sulfonylureas. Concurrent use of meperidine and monoamine oxidase inhibitors such as phenelzine may cause hyperpyrexia, restlessness, hypertension, hypotension, convulsions, and coma.

Four patients are undergoing antipsychotic therapy. Which patient has been assessed using the correct set of assessment scales?

Patient C The PANSS is used for baseline clinical evaluation, whereas the Fahn-Marsden Scale is used to assess the adverse effects associated with dystonias. The CGI scale is indeed used for baseline clinical evaluation, but the TWSTRS is used specifically to assess the adverse effects associated with dystonias, not those of other EPSs. The AIMS is used to assess for EPSs, but the Fahn-Marsden Scale is used to check for dystonias, not for baseline clinical evaluation. The DISCUS is used for EPSs, and the BPRS is used for baseline clinical evaluation.

Which antipsychotic medication is the most potent alpha-1 blocker?

Thioridazine Rationale: Thioridazine, along with chlorpromazine, is the most potent alpha-1 blocker. Trifluoperazine and fluphenazine are not as potent as thioridazine. Haloperidol has almost no effect on alpha-1 receptors.

When planning care for a patient taking antipsychotic drug therapy, which goal is the nurse's priority?

To promote adherence to the medication regimen Rationale: Promoting adherence to the medication regimen is a priority goal. The medication can be effective only if taken as prescribed. Nonadherence to the medication regimen is thought to be a major cause of repeat hospitalization. Preventing or controlling side effects, monitoring for hallucinations, and establishing a consistent sleep-wake cycle are important for specific patients but do not treat the basic problem.

Which antidepressant medications require the nurse to monitor a patient's blood pressure in the supine, sitting, and standing positions before initiating therapy? Select all that apply.

Trazodone therapy Mirtazapine therapy Selective serotonin reuptake inhibitor therapy Rationale: Trazodone, mirtazapine, nefazodone, and selective serotonin reuptake inhibitor therapies require the nurse to record the patient's baseline blood pressures in the supine, sitting, and standing positions. For monoamine oxidase inhibitor therapy, the nurse obtains the patient's blood pressure and pulse rate before and at regular intervals after initiating the therapy. Serotonin-norepinephrine reuptake inhibitor therapy requires the nurse to obtain the patient's baseline weight and blood pressure.

Which drugs are first-generation antidepressants? Select all that apply.

Tricyclic antidepressants Monoamine oxidase inhibitors Rationale: tricyclic antidepressants and monoamine oxidase inhibitors are first-generation antidepressants. Vortioxetine is a miscellaneous agent used to treat depression. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are second-generation antidepressants.

Which first-generation antipsychotic drug is available as tablets?

Trifluoperazine Rationale: Trifluoperazine is a first-generation antipsychotic drug that is available only as tablets. Thiothixene and loxapine are available only as capsules. Fluphenazine is available in the forms of tablets, elixirs, concentrates, and injections.

Which drugs increase serotonin levels in patients undergoing selective serotonin reuptake inhibitor therapy?

Tryptophan amphetamines pseudoephedrine Rationale: Tryptophan, amphetamines, and pseudoephedrine increase serotonin levels when used concurrently with selective serotonin reuptake inhibitors. The supervision of a healthcare provider is required if these drugs are used together. Cimetidine inhibits the metabolism of paroxetine and sertraline. Patients undergoing cimetidine and paroxetine therapies simultaneously should be closely monitored. Concurrent use of carbamazepine and fluoxetine increases the concentration of carbamazepine, causing toxicity.

Which statements regarding the antidepressant drug vortioxetine are correct? Select all that apply.

Vortioxetine is an agonist of the serotonin 5-HT A patient taking vortioxetine may experience episodes of dizziness. Use of monoamine oxidase inhibitors (MAOIs) with vortioxetine may cause excitement, diaphoresis, rigidity, convulsions, and possible death.

Which statement by the nursing student indicates effective learning regarding the action of antipsychotic medications?

"Antipsychotic medications stimulate or block alpha-adrenergic neurotransmitter receptors."

Which statement made by the student nurse regarding dystonic reactions and pseudoparkinsonism is correct?

"Dystonias are controlled by injections of lorazepam or benztropine, whereas pseudoparkinsonism is treated with benztropine."

What questions should the nurse ask to assess the psychomotor function of a patient with a mood disorder? Select all that apply.

"when did you last go to work?" "Do you visit your parents or friends regularly?" "Did you brush your teeth this morning?"

When can a patient who has been started on a selective serotonin reuptake inhibitor (SSRI) expect to no longer feel depressed?

2 to 4 weeks Rationale: It takes it takes 2 to 4 weeks of therapy with an SSRI to obtain the full therapeutic benefit when treating depression. A period of 1 week or 10 days is not enough time to establish a blood level of the medication, and a decrease in depression is not expected to be seen. Patients will see improvement before 4 to 6 months of SSRI therapy.

How soon after treatment with antipsychotic medications is neuroleptic malignant syndrome (NMS) likely to develop?

3 to 9 days Rationale: NMS typically occurs after 3 to 9 days of treatment with antipsychotic medications. Once NMS begins, symptoms rapidly progress over 24 to 72 hours. Pseudoparkinsonian symptoms associated with the extrapyramidal symptoms of using antipsychotic medication begin after 2 to 3 weeks of antipsychotic drug therapy. Tardive dyskinesia develops in about 20% to 25% of patients receiving typical antipsychotic medications on a long-term basis (months to years).

Which statement regarding diagnosable mood disorders in the United States for all age groups is correct?

About 15% to 20% of people will have a diagnosable mood disorder during their lifetimes. Rationale: About 15% to 20% of people in the United States will experience a diagnosable mood disorder during their lifetimes. About 45% to 60% of patients with depression suffer from endocrine abnormalities, such as excessive secretion of cortisol and abnormal thyroid-stimulating hormone. About 20% to 30% of patients with major depression recover fully and do not experience another bout of depression. The prevalence rate of bipolar disorder is 0.4% to 1.6% of the adult population of the United States.

Which statement about patients with depression is correct?

About 45% to 60% of patients with depression have endocrine abnormalities. Rationale: Excessive secretion of cortisol and abnormal thyroid-stimulating hormone are the results of endocrine abnormalities. These abnormalities are found in 45% to 60% of patients with depression. The frequency of depressive symptoms is about 26% for women and 12% for men. Bipolar disorders were once known as manic depression, not unipolar disorder. Beta-adrenergic blocking agents are used to control hypertension; in fact, these drugs are known to cause depression.

The Nurse knows that lithium can be used to treat which of these multiple different mental health issues? Select all that apply.

Acute mania Bipolar disorder Unipolar disorder

Which is the most important action the healthcare team that should take to help improve the therapeutic success of tricyclic antidepressants?

Adjusting the antidepressant dosage by monitoring therapeutic serum levels

Which symptoms will a nurse expect to observe in a patient diagnosed with psychosis and exhibits negative symptoms? Select all that apply.

Alogia poor eye contact reduced spontaneous movement

Which type of adverse reaction is occurring in a patient taking amitriptyline and experiencing blurred vision and constipation?

Anticholinergic effects Rationale: Anticholinergic effects include blurred vision; constipation; dryness of the mouth, nose, and throat; and urinary retention. Amitriptyline has the most anticholinergic activity and desipramine the least. Dryness of the mouth may be relieved by sucking hard candy or ice chips or by chewing gum. Stool softeners should be used for constipation. Cholinergic effects include increased heart rate, constipation, urinary retention, and decreased sweating. Akathisia symptoms include pacing and inability to sit still. Tardive dyskinesia symptoms are random movements in the tongue, lips, or jaw, and facial grimacing; movements of arms, legs, fingers, and toes; or even swaying movements of the trunk or hips. The movements disappear during sleep, and they can be mild, moderate, or severe.

Which statement is a major advantage of using selective serotonin reuptake inhibitors (SSRIs) over tricyclic antidepressants in the treatment of depression?

Anticholinergic or cardiovascular effects do not occur with SSRIs.

The nurse is explaining to the patient taking MAOI of the need to be aware of which condition developing?

Hypertension

Which atypical antipsychotic agent causes low sedation in a patient?

Aripiprazole Rationale: Aripiprazoleis an atypical antipsychotic that causes low sedation as a drug side effect. Asenapine and iloperidone are atypical antipsychotics that cause moderate sedation. Clozapine is an atypical antipsychotic that causes high sedation.

Which drug can be given as a sublingual tablet to a patient requiring a moderately sedating atypical antipsychotic?

Asenapine

Which atypical antipsychotic drug causes moderate levels of extrapyramidal symptoms (EPSs)?

Asenapine Rationale: Asenapine causes moderate levels of EPSs. Aripiprazole, iloperidone, and olanzapine cause lower levels of EPSs.

Which premedication assessments does the nurse complete for patients who have been prescribed antipsychotic agents? Select all that apply.

Baseline rating scales ( BPRS, CGI) Height and waist circumference positional blood pressure reading

Which nursing assessment is priority for a patient taking a monoamine oxidase inhibitor (MAOI) and who reports a severe occipital headache, stiff neck, sweating, nausea, and vomiting?

Blood pressure Rationale: Severe occipital headache, stiff neck, sweating, nausea, and vomiting along with sharply elevated blood pressure are common prodromal symptoms of hypertensive crisis, which is a major potential complication of MAOI therapy. If a patient taking an MAOI experiences these symptoms, blood pressure should be checked immediately. Changes in white blood cells are not seen with the described side effects from MAOIs. Assessment of deep tendon reflexes is not indicated by the clinical manifestations expressed by the patient. Measurement of an MAOI serum level is not indicated by these clinical manifestations.

Patients who are being treated for depression should continually be monitored for thoughts of suicide. Which behavior may indicate suicidal ideation?

Comments from the patient such as, "things will get better after I'm gone".

A patient came into the clinic complaining of drowsiness and nausea after being started on duloxetine (cymbalta). The nurse knows that these symptoms from SNRIs may mean what?

Common adverse effect

When planning care for a patient receiving tricyclic antidepressants, which potential problem does the nurse consider?

Constipation Rationale: Constipation is an anticholinergic effect common in patients taking tricyclic antidepressants. Patients must be monitored for this problem and preventive measures taken. Tricyclic antidepressants do not cause GI bleeding, renal calculi formation, or hypernatremia.

Which action would the nurse take when a patient taking phenelzine is also prescribed meperidine?

Contact the healthcare provider for another analgesic.

A patient is prescribed doxepin. At which time does the nurse instruct the patient to take doxepin?

During the evening hours. Rationale: Doxepin should be taken in the evening because increased sedation is a known side effect of this medication, especially during the onset of therapy. Doxepin causes increased sedation and should not be taken at the beginning of the day. Doxepin does not cause insomnia. Taking doxepin with meals does not affect its absorption.

Which first-generation antipsychotic drug is available as an elixir?

Fluphenazine Rationale: Fluphenazine is available as an elixir. Loxapine is available only in capsule form. Haloperidol is available in the form of tablets, concentrates, and injections. Prochlorperazine is available as tablets, injections, and suppositories.

Which behaviors will a nurse expect to observe in a patient with psychosis who displays an extreme form of disorganized thinking? Select all that apply.

Garbled or unrecognizable speech Overly concrete and inexpressive speech Obliquely related or completely unrelated answers to questions

Which term is used to document behavior that includes a patient stating loudly, "I am God and I created the world."

Grandiose delusions Rationale: Patients with grandiose delusions believe that they are famous, omnipotent, wealthy, or otherwise very powerful. Two-thirds of patients in the manic state of bipolar disorder develop this symptom. When mood swings are observed, the patient is said to be in a labile mood. A heightened mood is termed euphoria. Cognitive symptoms (such as the inability to concentrate, slowed thinking, confusion, and poor memory of recent events) are particularly common in older patients with major depressive disorder.

Which condition is a patient experiencing when he or she reports seeing snakes on the ceiling and hearing cows "mooing" in the room?

Hallucinations Rationale: Hallucinations are false sensory perceptions that are experienced without an external stimulus that seem real to the patient. Psychosis is a general clinical descriptor that means being out of touch with reality. This patient's symptom is more specific. A delusion is a false or irrational belief that is firmly held despite evidence to the contrary. Changes in affect may be a symptom of psychosis. Emotional expressiveness is diminished, and there is poor eye contact and reduced spontaneous movement. Patients with affect changes appear to be withdrawn from others.

The nurse was assessing the patient who came in with depression. Which components are part of the baseline assessment? Seletct all that apply.

History if previous depression episodes and treatments Sleep pattern Suicidal ideation

Which antipsychotic medication is correct as shown?

Iloperidone

Which tricyclic antidepressant is approved for treating enuresis in children 6 years of age and older?

Imipramine Rationale: Imipramine is effective in treating enuresis in children aged 6 years and older. Clomipramine is approved to treat obsessive-compulsive disorder. Trimipramine is not indicated for treatment of enuresis in children. Amitriptyline has been shown to be effective in treating depression in older individuals.

Which disorder currently ranks as the leading cause of disease burden in the United States?

Ischemic heart disease Rationale: Ischemic heart disease is the leading cause of disease burden (years lived with the disability) in the United States. About 0.4% to 1.6% of the adult population in the United States suffers from bipolar disorder. Major depression currently ranks as the second leading cause of disease burden. About 45% to 60% of patients with depression suffer from endocrine abnormalities.

Which statement precisely differentiates between isoniazid and iproniazid?

Isoniazid cannot inhibit monoamine oxidase, whereas iproniazid can.

Why would a nurse plan a stimulating activity during the day for a patient with mania?

It helps the patient sleep during the night.

Which chart entry contains the correct information about the adverse reactions associated with a particular antipsychotic drug?

Loxapine Rationale: loxapine causes moderate sedation and hypotension, and it has high EPSs. Fluphenazine does have low sedation and hypotension, but it has very high EPSs. Chlorpromazine does have moderate EPSs and a high hypotensive effect; however, it also has a high sedative effect. Prochlorperazine is associated with low sedation and hypotension and high EPSs.

The nurse knows to assess for a severe reaction, such as excitement, diaphoresis, rigidity, and convulsions, that can occur between SSRIs and which drugs?

MAOIs

Which intervention would the nurse expect to do when caring for patient on warfarin therapy while taking a selective serotonin reuptake inhibitor (SSRI)?

Monitor prothrombin time and international normalized ratio.

Which is defined as a sustained emotional feeling perceived along a normal continuum of sad to happy that affects the patient's perception of the surroundings?

Mood Rationale: A mood is a sustained emotional feeling perceived along a normal continuum of sad to happy that affects our perception of our surroundings. Mania is an abnormally elated mental state characterized by feelings of euphoria, racing thoughts, talkativeness, and irritability. A patient with chronic, ongoing symptoms of depression that last for at least 2 years is said to be suffering from dysthymia. Patients with depression display varying degrees of emotional, physical, cognitive, and psychomotor symptoms.

Which chart entry related to adverse effects associated with typical antipsychotic drugs is correct?

Thiothixene

Which extrapyramidal adverse effect can occur within 3 to 4 days of treatment with an antipsychotic medication?

Neuroleptic malignant syndrome (NMS)

Patients who are taking doxepin should be aware of which of the following adverse effects common to TCAs? Select all that apply

Orthostatic hypotension Parkinsonism symptoms Dry mouth and throat Blurred vision

Which typical antipsychotic drugs have similar levels of anticholinergic effects? Select all that apply.

Perphenazine Chlorpromazine

Which symptoms will be experienced by a patient with major depressive disorder?

Physical symptoms Cognitive symptoms Emotional symptoms Psychomotor symptoms Rationale: A patient with major depressive disorder exhibits varying degrees of depression. Patients with depression display physical, cognitive, emotional, and psychomotor symptoms. Patients with major depressive disorder do not experience symptoms of mania.

Which feature is common among depressive and bipolar disorders?

Presence of irritable mood Rationale: The presence of an irritable mood is one of the features in both depressive and bipolar disorders. Duration, timing, and assumed etiology of the irritable mood differ between these disorders.

Which medication does the nurse anticipate will be ordered by the healthcare provider for a patient on antipsychotic therapy who develops akathisia?

Propranolol

Which type of extrapyramidal symptom is most likely to occur in a 68-year-old patient 2 to 3 weeks after starting antipsychotic drug therapy?

Pseudoparkinsonism

What second-generation antipsychotic agent is available as extended-release tablets?

Quetiapine Rationale: Quetiapine is available as extended-release tablets. Lurasidone and iloperidone are also available as tablets, but not extended-release tablets. Ziprasidone is available in capsule and injection forms.

Which statement about side effects of clozapine, olanzapine, quetiapine, and aripiprazole is true?

Quetiapine causes moderate weight gain, increased serum triglyceride levels, and unchanged cholesterol levels.

Which adverse effects would the nurse expect to observe in a patient taking an antipsychotic medication that blocks histamine-1 receptors? Select all that apply.

sedation drowsiness appetite stimulation

Which information noted in the health history of a patient with atypical depression prevents the nurse from giving the prescribed monoamine oxidase inhibitors (MAOIs) and requires consultation with the prescriber?

Recurrent congestive heart failure

Which action will the nurse take to regularly monitor a patient taking clozapine?

Scheduling checks of white blood cell (WBC) counts

Which class of antidepressants is chemically unrelated to other antidepressants?

Selective serotonin reuptake inhibitors

Which premedication assessments should the nurse perform before initiating selective serotonin reuptake inhibitor therapy?

Send the patient's blood sample to the laboratory for a liver function test. Assess the patient for the presence of any gastrointestinal symptoms.

Which neurotransmitters are known to change in the brains of patients with depression? Select all that apply.

Serotonin Dopamine Norepinephrine Rationale: Brain neurotransmitters such as serotonin, dopamine, and norepinephrine are changed in patients with depression. Glutamate is a neurotransmitter that plays a role in learning and memory. Epinephrine is a neurotransmitter involved in stimulation of the sympathetic nervous system.

Which patient action would the nurse document as a psychomotor symptom?

Shouting suddenly without any cause Rationale: An outburst of shouting without any cause is a psychomotor symptom of depression. A patient with depression often has feelings of guilt. This is an emotional symptom of depression. Poor memory of recent events is a cognitive symptom commonly found in older patients with depression. Terminal insomnia (a condition where a patient frequently wakes up early in the morning) is a physical symptom of depression.

Which symptom of depression would be improved in a patient after 2 to 4 weeks of antidepressant therapy at an effective dosage?

Social withdrawal Rationale: Social withdrawal is a psychological symptom of depression. The optimum antidepressant dosage typically improves psychological symptoms after 2 to 4 weeks of therapy. Palpitations, sleep disturbances, and change in appetite are physiologic manifestations of depression that should lessen within the first week of therapy.

Which nursing intervention is best when a patient with major depressive disorder and congestive heart failure is prescribed a monoamine oxidase inhibitor?

Stop the medication and consult the prescriber.

Which symptoms may occur if the patient consumes overripe bananas and mozzarella cheese while taking tranylcypromine? Select all that apply.

Sweating Stiff neck Severe occipital headache

Which alteration could be occurring in a patient with dysthymia who reports frequent early morning awakening?

Terminal insomnia Rationale: Terminal insomnia is a type of sleep disturbance often seen in patients with depression in which a patient frequently wakes early in the morning. Substance abuse is a risk factor for depression; however, it does not cause terminal insomnia. Manic depression is seen in patients suffering from bipolar disorder; however, a patient with dysthymia does not exhibit manic depression. Frequent early morning awakening is a physical symptom of depression, not an emotional symptom.

Which alteration can occur in a patient taking an antipsychotic medication and lorazepam? Select all that apply.

The dosage of the antipsychotic medication would be low. The risk of serious adverse effects of antipsychotic medication would be reduced.

Why are second-generation antidepressants recommended as first-line agents to treat depression?

They are less toxic in the case of an overdose.

Which pseudoparkinsonian symptoms may occur 2 to 3 weeks after antipsychotic therapy is started? Select all that apply.

Tremor Rigidity Drooling

Which specific test does the nurse anticipate will be ordered by the healthcare provider for a patient who has been prescribed clozapine?

White blood cell count WBC Rationale: With clozapine therapy, there is a high incidence of agranulocytosis; WBCs should be monitored for patients taking this drug. For a patient taking an antipsychotic medication, check the patient's electrolyte levels, body weight, waist circumference, height, blood glucose level, lipid profile, hepatic function, cardiac function, and thyroid function before initiating therapy and periodically throughout the course of treatment.

Which atypical antipsychotic drug causes the least weight gain?

Ziprasidone Rationale: Ziprasidone causes the least weight gain. Olanzapine causes the most weight gain. Quetiapine and risperidone cause moderate weight gain.

Which atypical antipsychotic agent is available as capsules?

Ziprasidone Rationale: Ziprasidone is available in a capsule form. Lurasidone, iloperidone, and quetiapine are available as tablets.

When are a patient's next white blood cell (WBC) counts

after 2 weeks

Which second-generation antipsychotic agent can be administered as a 1 mg/mL solution?

aripiprazole Rationale: aripiprazole can be administered as a 1 mg/mL solution. Iloperidone is administered as tablets. Olanzapine is administered in a tablet or injection form. Ziprasidone is administered as capsules or an injection.

Which medicine does the nurse expect to find in the prescription of a patient with high blood pressure who reports a recent development of depression?

clonidine Rationale: Clonidine is an antihypertensive known to contribute to depression. Serotonin is a neurotransmitter and not a drug. Levodopa is a medicine used by patients suffering from Parkinson's disease; it is not an antihypertensive drug. Progestins are hormones that may contribute to depression.

Which medication is an atypical antipsychotic?

clozapine Rationale: The patient has been prescribed clozapine, which is an atypical antipsychotic agent. Thiothixene, haloperidol, and fluphenazine are typical antipsychotic agents.

Which symptom of schizophrenia may be reduced within a week of antipsychotic therapy in a patient with schizophrenia?

psychomotor agitation Rationale: Reduced psychomotor agitation is a therapeutic effect of antipsychotic therapy that is observed within 1 week. Reduction in delusions, hallucinations, and thought disorders often requires 6 to 8 weeks of treatment to achieve the full therapeutic effect.

Which condition is characterized by a false or irrational belief that is firmly held despite evidence to the contrary?

delusion Rationale: This is the correct definition of a delusion. Psychosis does not have a single definition but is a clinical descriptor that means being out of touch with reality. Hallucinations are false sensory perceptions that are experienced without an external stimulus that seem real to the patient. Disorganized behavior is another common characteristic of psychosis. Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living such as organizing meals or maintaining hygiene.

Which nonphenothiazine antipsychotic medication has a low hypotensive effect?

haloperidol

Which medication is a second-generation antipsychotic agent?

iloperido Rationale: Second-generation antipsychotic agents are known as atypical antipsychotic agents . Iloperidone is an example of an atypical antipsychotic agent. Trifluoperazine, loxapine, and fluphenazine are typical, or first-generation, antipsychotic agents.

Which antiparkinsonian medicine may cause depression?

levodopa Rationale: Levodopa is an antiparkinsonian medication that may contribute to depression. Reserpine and methyldopa are antihypertensive drugs that may cause depression. Progestin is a hormone that causes depression.

Which typical antipsychotic medication is available as a suppository?

prochlorperazine Rationale: Prochlorperazine is the only typical antipsychotic agent available as a suppository. Loxapine, fluphenazine, and chlorpromazine are not available as suppositories.

Which atypical antipsychotic drug has the lowest hypotensive effects?

ziprasidone Rationale: Of the four drugs listed, ziprasidone has the lowest hypotensive effects. (four listed ilperidone, asenapine, lurasidone ziprasidone)