PHARM - Psychiatric

The nurse is caring for a client who has been prescribed citalopram and checks the client for which signs/symptoms of serotonin syndrome? Select all that apply.

Diarrhea, Abdominal pain, Increased blood pressure Rationale:Serotonin syndrome signs/symptoms include diarrhea, abdominal pain, elevated blood pressure, hyperactivity (not lethargy), tachycardia (not bradycardia), fever, altered mental status, irrationality, seizures, myoclonus, bloating, and apnea.

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

"I should take the medication in the morning when I first arise." Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It is administered in the early morning without consideration to meals.

An older mental health client diagnosed with chronic neuropathic pain is starting therapy with a tricyclic antidepressant called imipramine hydrochloride. The client is complaining of constipation. The nurse knows that which signs/symptoms are other adverse effects of this medication? Select all that apply.

Dry mouth, Drowsiness, Acute confusion, Urinary retention Rationale:Adverse effects of tricyclic antidepressants besides constipation include urinary retention (which can lead to infection), dry mouth, drowsiness, and acute confusion. Clients must be instructed to notify their primary health care provider to report these changes, but they do not stop these drugs abruptly.

A hospitalized client is prescribed phenelzine sulfate for the treatment of depression. The nurse reinforces instructions to the client and tells the client to avoid consuming which foods while taking this medication? Select all that apply.

Figs, Yogurt, Aged Cheese Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor. The client should avoid consuming foods that are high in tyramine. Eating these foods could trigger a potentially fatal hypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins, and figs.

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

Frequent hand washing with hot, soapy water Rationale: Frequent hand washing is a common obsessive-compulsive behavior. Clomipramine is commonly used in the treatment of obsessive-compulsive disorder. Weight gain is a common side effect of this medication. Tachycardia and sedation are also side effects. Insomnia may occur but is seldom a side effect.

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

Hyperpyrexia Rationale: Hyperpyrexia up to 107° F may be present in neuroleptic malignant syndrome. Signs/symptoms develop suddenly and may include respiratory distress and muscle rigidity. As the condition progresses, there is evidence of tachycardia, hypertension, increasing respiratory distress, confusion, and delirium. The presence and severity of signs/symptoms are compounded when two or more antipsychotics are taken concomitantly.

A nursing student is assigned to care for a client with a diagnosis of schizophrenia. Haloperidol is prescribed for the client, and the nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication?

It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain. Rationale: Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Imipramine hydrochloride blocks the reuptake of norepinephrine and serotonin. Donepezil hydrochloride inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride is a potent serotonin reuptake blocker.

A client taking buspirone hydrochloride for 1 month is scheduled for a follow-up appointment. The nurse gathers data from the client and interprets that the medication is effective if the client reports an absence of which sign/symptom?

Palpitations and anxiety Rationale:The nurse interprets that the medication is effective if the client reports an absence of palpitations and anxiety. Buspirone hydrochloride is indicated most often for the treatment of anxiety and aggression. It is not recommended for the treatment of thought disorders such as delusions, schizophrenia including paranoid thoughts, or drug or alcohol withdrawal signs/symptoms.

A client has been started on medication therapy with alprazolam. When the nurse teaches the client that the medication should not be discontinued abruptly, the client asks why. The nurse should incorporate which information in formulating a reply?

Rebound central nervous system (CNS) excitation could occur, including seizure activity. Rationale:The information the nurse would include in formulating a reply to the client is that rebound central nervous system (CNS) excitation could occur, including seizure activity. Alprazolam is a benzodiazepine anxiolytic. The abrupt withdrawal of alprazolam could result in seizure activity from CNS excitation. All clients receiving this medication need to be warned of this danger. The other options are incorrect and unrelated to this medication.

A client receiving long-term therapy with lithium carbonate has a toxic serum lithium level of 1.5 and 2 mEq/L. Which organ functions are the major long-term risk factors? Select all that apply.

Renal function, Thyroid function Rationale:The organ functions that are major long-term risk factors for lithium toxicity are renal and thyroid function. Primary long-term risks of lithium therapy can cause hypothyroidism and impairment of the kidney's ability to concentrate urine. A client receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Before lithium is administered, a medical evaluation is performed to assess the client's ability to tolerate the drug. Besides thyroid and renal disease, lithium therapy is generally contraindicated in clients with cardiovascular disease, brain damage, or myasthenia gravis. Whenever possible, lithium is not given to women who are pregnant because it may harm the fetus.

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

Slurred speech, Muscle weakness, Lethargy 0.7 mEq/L, Diarrhea 10. mEq/L Rationale: Lethargy, diarrhea, slurred speech, muscle weakness, nausea, vomiting, thirst, polyuria, and fine hand tremor are all early signs/symptoms of toxicity. The therapeutic serum level of lithium carbonate ranges from 0.6 to 1.2 mEq/L. Serum lithium carbonate levels above the therapeutic level will produce signs of toxicity. When early signs/symptoms of toxicity occur, lithium carbonate needs to be withheld, blood lithium levels measured, and dosage reevaluated. Weight gain is an expected side effect. Blurred vision is a severe sign/symptom of lithium carbonate toxicity.

A client is taking a monoamine oxidase (MAO) inhibitor. The nurse plans care, knowing which information?

Symptomatology of MAO toxicity includes headache, hypertension, and nausea and vomiting. Rationale:Headache, hypertension, tachycardia, and nausea and vomiting are precursors to hypertensive crisis. Hypertensive crisis is caused by the ingestion of foods that contain tyramine and tryptophan while a client is taking monoamine oxidase inhibitors. These medications act by decreasing the amount of monoamine oxidase in the liver, which is necessary for the breakdown and utilization of tyramine and tryptophan. Hypertensive crisis may lead to circulatory collapse, intracranial hemorrhage, and death. The identified side effects do not relate to the classification of medications.

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

Toxic Rationale: The therapeutic serum level of lithium is 0.8 to 1.2 mEq/L (0.8 to 1.2 mmol/L). A level of 3 mEq/L indicates toxicity.

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

White blood cell count Rationale: Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be checked before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever.

A client taking buspirone for 1 month returns to the clinic for a follow-up visit. Which should indicate medication effectiveness?

No rapid heartbeats or anxiety Rationale: Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for the treatment of anxiety and aggression.

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

Seizure activity Rationale:Bupropion is an atypical antidepressant and does not cause significant orthostatic blood pressure changes. Seizure activity is common in dosages greater than 450 mg daily. Bupropion frequently causes a drop in body weight. Insomnia is a side effect, but seizure activity causes a greater client risk.

A client in the mental health unit is administered haloperidol. What should the nurse check to determine its effectiveness?

The client's orientation and delusional status Rationale: To determine medication effectiveness, the nurse would check the client's orientation and delusional status. Haloperidol is used to treat clients exhibiting psychotic features. Vital signs are routine and not specific to this situation. The physical safety of other clients is not a direct assessment of this client. Monitoring nutritional intake is not related to this situation.

A client is receiving a daily dose of oral fluphenazine. The nurse should reinforce instructions to the client to practice which intervention to minimize common side effects of this medication?

Use hard, sour candy or sugarless gum. Rationale:To minimize common side effects of this medication, the nurse would reinforce to the client to use hard, sour candy or sugarless gum. Fluphenazine is classified as an antidepressant and a selective serotonin reuptake inhibitor. Dry mouth is a common side effect. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Hypotension and hypertension are rare side effects of oral fluphenazine. Fluphenazine does not affect the pulse. Weight gain is a common side effect, and frequent snacks will worsen the problem.

A tricyclic antidepressant is administered to a client daily. The nurse plans to alleviate the common side effects of the medication and includes which in the plan of care?

Offer hard candy or gum periodically. Rationale: Dry mouth is a common side effect of tricyclic antidepressants. Frequent mouth rinsing with water, sucking on hard candy, and chewing gum will alleviate this common side effect. It is not necessary to monitor the blood pressure every 2 hours. In addition, it is not necessary to check the WBC count daily. Weight gain is a common side effect and frequent snacks will aggravate this problem.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine. Which information should be important for the nurse to gather regarding the adverse effects related to the medication?

Gastrointestinal dysfunctions Rationale: The most common adverse effects related to fluoxetine include CNS and GI system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea.

Fluoxetine hydrochloride is prescribed for a client being treated for depression, and the nurse reinforces instructions to the client regarding the medication. Which statement by the client would indicate that the client understands this medication therapy?

"It takes approximately 2 to 4 weeks before improvement is noted." Rationale:The time frame in which the therapeutic effects of fluoxetine hydrochloride are seen is usually 2 to 4 weeks after initiation of therapy. It is important to advise clients to comply with the prescribed regimen so that therapeutic levels are maintained. Dry mouth is a side effect of the medication, and the client would be instructed to relieve the dry mouth by chewing sugarless gum or sipping tepid water.

A client has begun taking phenelzine. At the initiation of therapy, the nurse teaches the client that which items are allowed in the diet?

Carrots, sweet potatoes, and squash Rationale:Carrots, sweet potatoes, and squash are allowed in the client's diet. Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid foods high in tyramine because they could trigger a potentially fatal hypertensive crisis. Foods to avoid include aged cheeses; smoked or processed meats; red wines; and avocados, raisins, or figs. Vegetables are generally acceptable, with the exception of broad bean pods.

The nurse is caring for a client who has been admitted for alcohol abuse and knows that which medications may be prescribed in the treatment of this disorder? Select all that apply.

Diazepam, Disulfiram, Chlordiazepoxide Rationale:Medications used in the treatment of alcohol abuse include diazepam, disulfiram, chlordiazepoxide, carbamazepine, acamprosate calcium, phenobarbital, quetiapine fumarate, and naltrexone. Bupropion is used in the treatment of nicotine addiction, and methadone hydrochloride is used in the treatment of opiate addiction.

The nurse is caring for a client who is receiving lithium carbonate for the treatment of bipolar disorder and monitors the client for signs/symptoms of lithium toxicity. Which sign/symptom should alert the nurse to the potential for toxicity?

Vomiting Rationale:One of the most common early sign/symptom of lithium toxicity is the presence of gastrointestinal (GI) disturbances, such as nausea, vomiting, and diarrhea. The other signs/symptoms are unrelated to lithium toxicity.

A client with schizophrenia has been started on medication therapy with loxapine. The nurse determines that the client is experiencing the intended effects of the medication if which client behavior is observed?

Absence of delusional statements Rationale:The nurse knows that the client is experiencing the intended effects of Loxapine if there is an absence of delusional statements. Loxapine is an antipsychotic medication used to treat psychotic symptoms in clients. Hallucinations, delusions, and altered thought processes are characteristic of this disorder and would decrease with effective treatment. Presence of fixed stare and taking sips of water for dry mouth are side effects of therapy. Decreased appetite is unrelated to the question.

A client's medication sheet contains a prescription for sertraline hydrochloride. To ensure safe administration of the medication, which action should the nurse take?

Administer at the same time each evening. Rationale:The nurse would administer the medication at the same time each evening. Sertraline is classified as an antidepressant and a selective serotonin reuptake inhibitor. It is generally administered once every 24 hours. It may be administered in the morning or evening, but evening may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. It is not prescribed for use on an as-needed basis.

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

Desired effects do not occur for 2 to 3 weeks of administration. Rationale: The therapeutic effects of administration of imipramine hydrochloride may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated.

A client who is taking lithium carbonate is scheduled for surgery. The nurse would reinforce what information in the preoperative teaching about this medication?

The medication will be discontinued 1 to 2 days before the surgery and resumed as soon as full oral intake is allowed. Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is prescribed after the surgery.

The nurse is caring for a client on the mental health unit who has been declared incompetent through a formal legal proceeding. A guardian has been appointed. The nurse knows that guardians are typically selected from among family members. From the list of family members, what is the order of selection of a guardian for this client? List in descending order of importance from the first to the last choice. All options must be used.

Spouse, Adult children or grandchildren, Parents, Adult siblings, Adult nieces and nephews Rationale: Guardians are typically selected from among family members. The order of selection is usually (1) spouse, (2) adult children or grandchildren, (3) parents, (4) adult siblings, and (5) adult nieces and nephews. If found incompetent, the client may be appointed a legal guardian or representative who is legally responsible for giving or refusing consent for the client, while always considering the patient's wishes. In the event a family member is either unavailable or unwilling to serve as guardian, the court may also appoint a court-trained and approved social worker, representing the county, state, or member of the community.

The nurse is caring for a mental health client who has been prescribed a benzodiazepine called chlorazapate. Which are the principal indications for this medication? Select all that apply.

Anxiety, Insomnia, Seizure disorders, Alcohol withdrawal Rationale:Benzodiazepines have three principal indications: (1) anxiety, (2) insomnia, and (3) seizure disorders. In addition, they are used as preoperative medications and to treat muscle spasm and withdrawal from alcohol. Although all benzodiazepines share the same pharmacological properties, and therefore might be equally effective for all applications, not every benzodiazepine is actually employed for all potential uses. Benzodiazepines are not prescribed to treat postpartum depression or OCD.

A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan?

Arrives at the clinic neat and appropriate in appearance Rationale: Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints, as well as demonstrate an improvement in their appearance.

The nurse is reinforcing medication discharge instructions for a client who has just begun taking isocarboxazid for depression and knows that the client needs further teaching after stating that which foods are safe to eat? Select all that apply.

Avocado, Bologna Rationale:The client who is taking isocarboxazid needs further teaching after stating that avocado and bologna are safe to eat. Foods that are restricted for clients who take monoamine oxidase inhibitors (MAOIs) are foods that contain tyramine and include avocados; figs; fermented, smoked, and organ meats; dried and cured fish and most cheeses; foods with yeast; imported beers and Chianti wines; and some soups that contain protein extract. Apples, tomatoes, and broccoli do not contain tyramine and are safe to eat.

A client has a history of seizures. The primary health care provider has prescribed amitriptyline three times daily. The nurse seeks clarification of the prescription, knowing that the client is at risk for injury because of which adverse effect of the amitriptyline?

Decreased seizure threshold Rationale:Amitriptyline, a tricyclic antidepressant, lowers the seizure threshold, increasing the risk of seizures. This may not be the medication of choice for a client who is already at risk for seizure activity. The other adverse effects are unrelated to the use of this medication.

A client with fibromyalgia has not achieved pain relief with opioid pain medication. The client has a history of diabetes mellitus and atherosclerosis. The nurse anticipates that which single medications may be selected by the primary health care provider to be given in conjunction with the opioid pain medication? Select all that apply.

Duloxetine, Pregabalin, Alprazolam Rationale:The nurse anticipates that duloxetine, pregabalin, or alprazolam will be given in conjunction with the opioid pain medication. Serotonin-norepinephrine reuptake inhibitors (duloxetine) are used for chronic pain disorders, as are certain anticonvulsants (pregabalin) and benzodiazepines (alprazolam). Each of these is used as an adjunct to the opioid medication. Tricyclic antidepressants are also used as adjuncts for chronic pain. However, in this case, the tricyclic antidepressants (imipramine and amitriptyline) are contraindicated because the client has atherosclerosis.

A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, which is the most important nursing intervention?

Getting baseline postural blood pressures before administering the medication and each time the medication is administered Rationale: The most important nursing intervention is getting baseline postural blood pressures before administering the medication and each time the medication is administered. Amitriptyline hydrochloride is a tricyclic antidepressant often used to treat depression. It causes orthostatic changes and can produce hypotension and tachycardia. This can be frightening to the client and dangerous because it can result in dizziness and client falls. The client must be instructed to move slowly from a lying to a sitting to a standing position to avoid injury if these effects are experienced. The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient and will diminish with time.

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

Postural hypotension Rationale: Anxiolytic medications can cause postural hypotension. The client needs to be taught to rise to a sitting position and get out of bed slowly because of this adverse effect related to the medication.

A client who is on lithium carbonate will be discharged at the end of the week. In reinforcing a discharge teaching plan, the nurse should include which instructions?

Check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Rationale:The client needs to check with the psychiatrist before using any over-the-counter (OTC) medications or prescription medications. Many OTC medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is the medication of choice to treat manic-depressive illness. Lithium is not addicting, and although serum lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet or one including soy sauce, wine, and aged cheese, is associated with monoamine oxidase inhibitors.

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

Dementia Rationale: Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer's type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease.

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

When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

A hospitalized client is started on phenelzine sulfate for the treatment of depression. At lunchtime, a tray is delivered to the client. Which food item on the tray should the nurse remove?

Yogurt Rationale: Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client needs to avoid taking in foods that are high in tyramine. These foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked or processed meats; red wines; and fruits such as avocados, raisins, or figs.