Psych Med Quiz Fall 2022

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

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

Lorazepam (Ativan) is often given along with a neuroleptic agent. What is the purpose of administering the drugs together? A. To reduce anxiety and potentiate the sedative action of the neuroleptic B. To counteract extrapyramidal effects of the neuroleptic C. To manage depressed clients D. To increase the client's level of awareness and concentration

A. To reduce anxiety and potentiate the sedative action of the neuroleptic Lorazepam, when given with a neuroleptic such as haloperidol (Haldol), potentiates the sedating effect and is used to treat severely agitated clients. Haloperidol places the client at risk for extrapyramidal effects and, therefore, wouldn't be used to treat extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. Concentration would be decreased because of the depressant effect.

Lithium side effects include all of the following except A. Urinary retention B. Dry mouth and thirst C. Weight gain D. Decreased thyroid function

A. Urinary retention Polyuria, not urinary retention. Also, hand tremor, impaired memory, muscle weakness, poor concentration, drowsiness.

To treat acute mania in a client with bipolar disorder, the physician prescribes lithium. During lithium carbonate (Lithonate) therapy, this client's serum lithium level should be maintained within which range? A. 0.2 to 1.6 mEq/L B. 0.6 to 1.2 mEq/L C. 1 to 1.4 mEq/L D. 10 to 15 mEq/L

B. 0.6 to 1.2 mEq/L To treat acute mania, the client's serum lithium level should range from 1 to 1.4 mEq/L. To prevent or control mania, the serum lithium level should measure 0.6 to 1.2 mEq/L. The serum lithium level shouldn't exceed 2 mEq/L. The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy.

The mother of a child diagnosed with attention deficit hyperactivity disorder has been given instructions about how to administer methylphenidate. Which response by the mother shows she understands the information about the best way to administer the medication? A. At bedtime B. After breakfast C. At the evening meal D. With a bedtime snack

B. After breakfast Children with attention deficit hyperactivity disorder should take the morning dose after breakfast and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. The other options are incorrect.

Which foods are contraindicated for a client taking tranylcypromine (Parnate)? A. Whole grain cereals and bagels B. Chicken livers, Chianti wine, and beer C. Oranges and vodka D. Chicken, rice, and apples

B. Chicken livers, Chianti wine, and beer A client taking a monoamine oxidase inhibitor antidepressant such as tranylcypromine (Parnate) shouldn't eat foods containing tyramine. Such foods include chicken livers, Chianti wine, beer, ale, aged game meats, broad beans, aged cheeses, sour cream, avocados, yogurt, pickled herring, yeast extract, chocolate, excessive caffeine, vanilla, and soy sauce. The client also must refrain from taking cold and hay fever preparations that contain vasoconstrictive agents.

A 6-year-old child is admitted to the emergency department with status epilepticus. The parents report that the seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer? A. Phenytoin B. Diazepam C. Phenobarbital D. Carbamazepine

B. Diazepam Diazepam is the drug of choice for treatment of status epilepticus. Options A, C, and D are used for the long-term management of seizure disorders but are not as useful in the emergency management of status epilepticus.

The psychiatrist orders lithium carbonate 600 mg p.o t.i.d for a female client. Nurse Katrina would be aware that the teaching about the side effects of this drug were understood when the client state, "I will call my doctor immediately if I notice any: A. Sensitivity to bright light or sun. B. Fine hand tremors or slurred speech. C. Sexual dysfunction or breast enlargement. D. Inability to urinate or difficulty when urinating.

B. Fine hand tremors or slurred speech.

The nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor? A. Hypotensive episodes B. Hypertensive crisis C. Muscle flaccidity D. Hypoglycemia

B. Hypertensive crisis The most serious adverse reaction associated with high doses of MAO inhibitors is hypertensive crisis, which can lead to death. Although not a crisis, orthostatic hypotension is also common and may lead to syncope with high doses. Muscle spasticity (not flaccidity) is associated with MAO inhibitor therapy. Hypoglycemia isn't an adverse reaction of MAO inhibitors.

The nurse is aware that antipsychotic medications may cause which of the following adverse effects? A. Increased production of insulin B. Lower seizure threshold C. Increased coagulation time D. Increased risk of heart failure

B. Lower seizure threshold Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents.

The risk of experiencing serotonin syndrome when SSRI's are given with monoamine oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in which of the following? A. Hypotension and urinary retention. B. Muscle rigidity and high fever. C. A productive cough and vomiting. D. Tea-colored urine and constipation.

B. Muscle rigidity and high fever.

The nurse taking a medication history for a client who has been admitted to the nursing unit notes that the client is receiving olanzapine. The nurse interprets that this client most likely has a history of which disorder? A. Hypertension B. Schizophrenia C. Diabetes mellitus D. Diabetes insipidus

B. Schizophrenia Olanzapine is an antipsychotic medication that targets both the positive and the negative symptoms of schizophrenia. The other options listed are not indications for use of this medication.

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? A. Calcium B. Sodium C. Chloride D. Potassium

B. Sodium Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day.

Miranda, a psychiatric client is to be discharged with orders for haloperidol (Haldol) therapy. When developing a teaching plan for discharge, the nurse should include cautioning the client against: A. Driving at night. B. Staying in the sun. C. Ingesting wines and cheeses. D. Taking medications containing aspirin.

B. Staying in the sun. Haloperidol can cause photosensitivity and precipitate severe sunburn.

Nursing implications for a client taking central nervous system (CNS) stimulants include monitoring the client for which of the following conditions? A. Hyperpyrexia, slow pulse, and weight gain B. Tachycardia, weight loss, and mood swings C. Hypotension, weight gain, and listlessness D. Increased appetite, slowing of sensorium, and arrhythmias

B. Tachycardia, weight loss, and mood swings Stimulants produce mood swings, anorexia and weight loss, and tachycardia. The other symptoms indicate CNS depression.

The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered? A. To reduce psychotic symptoms B. To reduce extrapyramidal symptoms C. To control nausea and vomiting D. To relieve anxiety

B. To reduce extrapyramidal symptoms Benztropine is an anticholinergic medication administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting.

An adolescent has been prescribed an amphetamine to help manage a diagnosis of attention deficient hyperactivity disorder. To best minimize the risk of abuse and/or overdose, the nurse expects that the medication will be administered via which method? A. Sublingual tablets B. Transdermal patch C. Rectal suppository D. Weekly intramuscular injections

B. Transdermal patch The application of an transdermal patch is the method best suited to minimizing the risk of abuse and/or overdose from an amphetamine because it manages the release of the medication without requiring the client's handling of the medication. The remaining options lack that component.

A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to: A. reassure the client and administer as-needed lorazepam (Ativan) I.M. B. administer an as-needed dose of benztropine (Cogentin) I.M. as ordered. C. administer an as-needed dose of benztropine (Cogentin) by mouth as ordered. D. administer an as-needed dose of haloperidol (Haldol) by mouth.

B. administer an as-needed dose of benztropine (Cogentin) I.M. as ordered. The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.

The nurse notices that a depressed client taking amitriptyline (Elavil) for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client A. is responding to the antipsychotic. B. may be experiencing increased energy and is at an increased risk for suicide. C. is ready to be discharged from treatment. D. is experiencing a split personality.

B. may be experiencing increased energy and is at an increased risk for suicide. As antidepressants take effect, individuals suffering from depression may begin to feel energetic enough to mobilize a suicide plan. Option 1 is incorrect because Elavil is an antidepressant, not an antipsychotic. The client shouldn't be discharged until the risk of suicide has diminished. The elevated mood is a response to the antidepressant, not a split personality

The nurse is preparing to administer the benzodiazepine alprazolam (Xanax) to a client who has a generalized anxiety disorder. Which intervention should the nurse implement prior to administering the medication? A. Assess the client's apical pulse B. Assess the client's respiratory rate C. Assess the client's anxiety level D. Assess the client's blood pressure

C. Assess the client's anxiety level The nurse must assess the client's anxiety level on a scale of 1 to 10, with 10 being the most anxious, before administering the Xanax. If the nurse does not do this, there is no way to evaluate the effectiveness of the medication later

A client enters the crisis unit complaining of increased stress from her studies as a medical student. She states that she has been increasingly anxious for the past month. Her physician prescribes alprazolam (Xanax), 25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when given concomitantly with alprazolam? A. Levodopa (Dopar) B. Famotidine (Pepcid) C. Diphenhydramine (Benadryl) D. Norgestrel (Ovrette)

C. Diphenhydramine (Benadryl) The major drug interactions relate to the use of benzodiazepines with other central nervous system depressants such as diphenhydramine, producing additive effects. Alprazolam doesn't cause clinically significant drug interactions with levodopa, famotidine, or hormonal contraceptives such as norgestrel.

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? A. Assume that the client is posturing. B. Tell the client to lie down and relax. C. Evaluate the client for adverse reactions to haloperidol. D. Put the client on the list for the physician to see tomorrow

C. Evaluate the client for adverse reactions to haloperidol. An antipsychotic agent such as haloperidol can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.

The nurse suspects that a client prescribed clomipramine hydrochloride has been noncompliant with taking the medication as prescribed. Which client behavior would support the nurse's suspicion? A. Tired, fatigued appearance B. Complaints of hunger and fatigue C. Frequently checking for the car key 4. Slight dizziness when standing up quickly

C. Frequently checking for the car key Clomipramine is an antidepressant that is commonly used in the treatment of obsessive-compulsive disorder. Frequent checking for the car key is a nonproductive repetitive activity that is characteristic of this disorder. Reappearance of symptoms may indicate noncompliance with medication therapy. The incorrect options are common side/adverse effects of the medication.

Which is the drug of choice for treating Tourette syndrome? A. Fluoxetine (Prozac) B. Fluvoxamine (Luvox) C. Haloperidol (Haldol) D. Paroxetine (Paxil)

C. Haloperidol (Haldol) Haldol is the drug of choice for treating Tourette syndrome. Prozac, Luvox, and Paxil are antidepressants and aren't used to treat Tourette syndrome.

Nurse Amy is providing care for a male client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: A. Barbiturates B. Amphetamines C. Methadone D. Benzodiazepines

C. Methadone Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.

A client diagnosed with anxiety is starting therapy with lorazepam. Which factor in the client's history should prompt the nurse to consult with the primary health care provider before administering the medication? A. Hypothyroidism B. Diabetes mellitus C. Narrow-angle glaucoma D. Coronary artery disease

C. Narrow-angle glaucoma Lorazepam is a benzodiazepine and is contraindicated in hypersensitivity, cross-sensitivity with other benzodiazepines, comatose state, preexisting central nervous system depression, uncontrolled severe pain, and narrow-angle glaucoma because these medications can further increase the intraocular pressure. It also is contraindicated in pregnancy and in women who are breast-feeding. None of the other options are relevant to the administration of lorazepam.

A client with bipolar disorder is being treated with lithium for the first time. The nurse should observe the client for which common adverse effect of lithium? A. Sexual dysfunction B. Constipation C. Polyuria D. Seizures

C. Polyuria Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Sexual dysfunction isn't a common adverse effect of lithium; it's more common with sedatives and tricyclic antidepressants. Diarrhea, not constipation, occurs with lithium. Constipation can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures may be a later sign of lithium toxicity

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

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

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? A. Nasogastric tube B. Paracentesis tray C. Resuscitation equipment D. Central line insertion tray

C. Resuscitation equipment The nurse administering naloxone for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors

During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)? A. "Discontinue the medication immediately if you experience nausea." B. "Notify the physician if you experience urine retention." C. "Apply sunscreen to prevent photosensitivity." D. "Inform the physician if you become pregnant or intend to do so."

D. "Inform the physician if you become pregnant or intend to do so." Because alprazolam is contraindicated during pregnancy, the client should be instructed to inform the physician if she becomes pregnant. Nausea, urine retention, and photosensitivity are adverse reactions that may occur, but aren't contraindicated.

The client prescribed an antidepressant 1 week ago tells the psychiatric clinic nurse, "I really don't think this medication is helping me." Which statement by the psychiatric nurse would be most appropriate? A. "Why do you think the medication is not helping you?" B. "You think your medication is not helping you?" C. "You need to come to the clinic so we can discuss this." D. "It takes about 3 weeks for your medication to work"

D. "It takes about 3 weeks for your medication to work" The client probably was told this information but may have forgotten it, or the client may not have been told, but the most appropriate response is to provide information so that the client realizes it takes 3 weeks for the medication to work and that he or she may not feel better until that time has elapsed.

Your client is taking clozapine (Clozaril) and complains of a sore throat. This symptom may be an indication of which adverse reaction? A. Extrapyramidal reaction B. Tardive dyskinesia C. Reye's syndrome D. Agranulocytosis

D. Agranulocytosis The complaint of a sore throat may indicate an infection caused by agranulocytosis, a depletion of white blood cells. Although extrapyramidal reaction and tardive dyskinesia may occur, a sore throat isn't an indication of these conditions. Reye's syndrome is caused by a virus unrelated to clozapine.

Which of the following medications that treat Alzheimer's disease causes slowing of the heart rate and fainting episodes? A. Tacrine (Cognex). B. Galantamine (Razadyne). C. Donepezil (Aricept). D. All of the above.

D. All of the above.

Jose is diagnosed with amphetamine psychosis and was admitted to the emergency room. Nurse Ronald would most likely prepare to administer which of the following medication? A. Librium B. Valium C. Ativan D. Haldol

D. Haldol

A newly admit client has started taking bupropion (Wellbutrin). The nurse monitors in which of the following side effects that would indicate an overdosage of the medication? A. Headache. B. Dizziness. C. Constipation. D. Seizure.

D. Seizure.

A client arrives in the emergency room with a tricyclic antidepressant overdose. The nurse do all of the following EXCEPT: A. Maintain a patent airway. B. Administration of sodium bicarbonate. C. Gastric lavage with activated charcoal. D. Obtain an electrocardiogram. E. Administration of an antipyretic.

E. Administration of an antipyretic.

A client who is recovering from benzodiazepine dependence says, "I've lost so many people. First, my brother dies of cancer; then my husband leaves me for a 20-year-old. I wish I had 1 of those pills right now." Which statement by the nurse would be therapeutic? A. "Can you tell me what you think the pills can do for you?" B. "It sounds as if you feel that all of this has just happened to you." C."It must have been a terrible loss for you when your brother died." D. "How did your husband's interest in a younger woman make you feel?

A. "Can you tell me what you think the pills can do for you?" In the correct option, the nurse reflects back to the client what she is verbalizing and assists her to assess coping strategies. It is nontherapeutic for the nurse to change the focus from the client's expression of feelings related to the benzodiazepine. Asking the client to self-assess her own behavior in events is premature

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

A. Administer the medication The therapeutic serum level is 0.6 to 1.2 mEq/L, but levels are not considered toxic until 1.5 mEq/L.

Methylphenidate is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

A. Administer the medication in the morning before the child goes to school. Methylphenidate is a central nervous system (CNS) stimulant. To be most effective in affecting the child's behavior, the dose of the drug should be administered in the morning before the child goes to school. Drug holidays are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time. Options C and D are worthwhile instructions but do not have the priority of option A.

Which medications have been found to help reduce or eliminate panic attacks? A. Antidepressants B. Anticholinergics C. Antipsychotics D. Mood stabilizers

A. Antidepressants Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn't clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don't relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks aren't psychotic. Mood stabilizers aren't indicated because panic attacks are rarely associated with mood changes.

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction? A. Ataxia B. Hepatomegaly C. Urticaria D. Rash

A. Ataxia Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, they aren't dose-related.

A nurse is giving instructions to a client receiving lithium citrate. The nurse tells the client to do which of the following to prevent lithium toxicity: A. Avoid becoming dehydrated during exercise. B. Instruct the client to change positions slowly. C. Restrict salt intake in the diet. D. Limit fluid intake.

A. Avoid becoming dehydrated during exercise. Low sodium leads to elevated levels of lithium. High sodium leads to below-therapeutic levels.

Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, the nurse should incorporate which of the following instructions in her teaching plan? A. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants. B. Avoid taking antianxiety drugs at bedtime. C. Avoid taking antianxiety drugs on an empty stomach. D. Avoid consuming aged cheese when taking antianxiety agents.

A. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants. Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium.

A nurse is giving instructions to a client taking risperidone (Risperdal). The nurse advise the client to which of the following? A. Change position slowly. B. Get a daily source of sunlight. C. Discontinue medication once the symptoms went away. D. Take it on an empty stomach.

A. Change position slowly. May cause orthostatic hypotension.

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

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

The nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to prescribe which psychotropic drug regimen on a short-term basis? A. Diazepam (Valium), 5 mg orally three times per day B. Benztropine (Cogentin), 2 mg orally twice per day C. Chlorpromazine (Thorazine), 25 mg orally three times per day D. Clozapine (Clozaril), 200 mg orally twice per day

A. Diazepam (Valium), 5 mg orally three times per day Diazepam is the most appropriate medication for this client because of its antianxiety properties. Benztropine is an antiparkinsonian agent used to control the extrapyramidal effects of such antipsychotic agents as chlorpromazine hydrochloride and thioridazine hydrochloride. Chlorpromazine is used to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis. Clozapine is used to manage symptoms of schizophrenia in clients who don't respond to other antipsychotic drugs.

Discharge instructions for clients receiving tricyclic antidepressants include which of following information? A. Don't consume alcohol. B. Discontinue if dry mouth and blurred vision occur. C. Restrict fluid and sodium intake. D. It's safe to continue taking during pregnancy.

A. Don't consume alcohol. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. Fluid and sodium intake must be monitored during lithium (Lithobid) treatment. Safe use during pregnancy and breast-feeding hasn't been established.

Which of the following statements should be included when teaching clients about monoamine oxidase (MAO) inhibitor antidepressants? A. Don't take prescribed or over-the-counter medications without consulting the physician. B. Avoid strenuous activity because of the cardiac effects of the drug. C. Have blood levels screened weekly for leukopenia. D. Don't take with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

A. Don't take prescribed or over-the-counter medications without consulting the physician. MAO inhibitors when combined with a number of drugs can cause life-threatening hypertensive crisis. It's imperative that a client check with his physician and pharmacist before taking any other medications. Activity doesn't need to be limited. Blood dyscrasias aren't a common problem with MAO inhibitors. Aspirin and NSAIDs are safe to take with MAO inhibitors

Which information should the nurse discuss with the client diagnosed with schizophrenia who is prescribed an antipsychotic medication? A. Drink decaffeinated coffee and tea B. Decrease the dietary intake of salt C. Eat six small, high-protein meals a day D. Limit alcohol intake to one glass of wine a day

A. Drink decaffeinated coffee and tea Caffeine-containing substances will negate the effects of antipsychotic medication; therefore, the client should drink caffeine-free beverages such as decaffeinated coffee and tea and caffeine-free colas

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? A. Dystonia B. Akinesia C. Akathisia D. Tardive dyskinesia

A. Dystonia Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.

A nurse provides instructions to a client taking fluoxetine (Prozac) a selective serotonin reuptake inhibitors (SSRI) antidepressant. The nurse tells the client to take the medication: A. Early in the morning. B. During lunch time. C. At snack time. D. At bedtime.

A. Early in the morning.

A client who has been taking buspirone (BuSpar) for two months returns to the clinic for a follow-up. The nurse determines that the medication is effective if there is an absent display of? A. Feelings of panic, fear, and uneasiness. B. Thought broadcasting or delusions. C. Paranoid and suicidal thought process. D. Alcohol withdrawal symptoms.

A. Feelings of panic, fear, and uneasiness.

A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? A. Ineffective protection related to blood dyscrasias B. Reflex urinary incontinence related to adverse effects of antipsychotic medication C. Risk for injury related to a severely decreased level of consciousness D. Risk for injury related to electrolyte disturbances

A. Ineffective protection related to blood dyscrasias Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Reflex urinary incontinence isn't an adverse effect of these medications. Although antipsychotic medications may cause sedation, they don't severely decrease the level of consciousness, eliminating option 3. These drugs don't cause electrolyte disturbances, eliminating option 4.

A client is brought to the crisis intervention center by his wife, who states that he has been increasingly listless and less involved with his family recently. She reports that he sleeps poorly, eats little, and can barely perform basic self-care activities. She also reveals that 3 months ago he was in a car accident in which his best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: A. Paroxetine (Paxil), 20 mg by mouth (P.O.) every morning. B. Amitriptyline (Elavil), 20 mg P.O. daily. C. Doxepin (Sinequan), 500 mg daily. D. Imipramine (Tofranil), 500 mg daily.

A. Paroxetine (Paxil), 20 mg by mouth (P.O.) every morning. All of the drugs listed are antidepressants that may be prescribed for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg.

Hormonal effects of the antipsychotic medications include which of the following? A. Retrograde ejaculation and gynecomastia B. Dysmenorrhea and increased vaginal bleeding C. Polydipsia and dysmenorrhea D. Akinesia and dysphasia

A. Retrograde ejaculation and gynecomastia Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Polydipsia, akinesia, and dysphasia aren't hormonal effects.

Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect? A. Seizures B. Shivering C. Anxiety D. Chest pain

A. Seizures Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.

Patient should notify the physician if the following symptoms of Neuroleptic Malignant syndrome (NMS) appear with the use antipsychotic medications: (SATA) A. Severe muscle rigidity B. Elevated temperature C. Bradycardia D. Altered level of consciousness E. Drooling

A. Severe muscle rigidity B. Elevated temperature D. Altered level of consciousness E. Drooling Tachycardia, not bradycardia. Also, diaphoresis and increased BP.

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline? A. Sodium bicarbonate B. Naloxone C. Phentolamine mesylate D. Atropine sulfate

A. Sodium bicarbonate Sodium bicarbonate is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline to reverse QRS prolongation. Options B, C, and D are not the preferred agents for treating this drug overdose.

A client with schizophrenia is taking the atypical antipsychotic medication clozapine (Clozaril). Which signs and symptoms indicate the presence of adverse effects associated with this medication? A. Sore throat B. Pill-rolling movements C. Polyuria D. Fever E. Polydipsia F. Orthostatic hypotension

A. Sore throat D. Fever Sore throat, fever, and sudden onset of other flulike symptoms are signs of agranulocytosis, a condition in which there is an insufficient number of granulocytes (a type of white blood cell [WBC]), which causes the individual to be susceptible to infection. The client's WBC count should be monitored at least weekly throughout the course of treatment. Pill-rolling movements can occur in clients experiencing adverse extrapyramidal effects associated with antipsychotic medication that has been prescribed for much longer than a medication such as clozapine. Polydipsia (excessive thirst) and polyuria (increased urine output) are common adverse effects of lithium therapy. Orthostatic hypotension is an adverse effect of tricyclic antidepressant therapy.

A client is receiving chlordiazepoxide (Librium) to control the symptoms of alcohol withdrawal. The chlordiazepoxide has been ordered as needed. Which symptom may indicate the need for an additional dose of this medication? A. Tachycardia B. Mood swings C. Elevated blood pressure and temperature D. Piloerection E. Tremors F. Increasing anxiety

A. Tachycardia C. Elevated blood pressure and temperature E. Tremors F. Increasing anxiety Benzodiazepines are usually administered based on elevations in heart rate, blood pressure, and temperature as well as on the presence of tremors and increasing anxiety. Mood swings are expected during the withdrawal period and aren't an indication for further medication administration. Piloerection isn't a symptom of alcohol withdrawal.

Rudolf is admitted for an overdose of amphetamines. When assessing the client, the nurse should expect to see: A. Tension and irritability B. Slow pulse C. Hypotension D. Constipation

A. Tension and irritability An amphetamine is a nervous system stimulant that is subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Options 2 and 3 are incorrect because amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. Diarrhea is a common adverse effect, so option 4 is incorrect.

On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to: A. avoid all products containing alcohol. B. adhere to concomitant vitamin B therapy. C. return for monthly blood drug level monitoring. D. limit alcohol consumption to a moderate level.

A. avoid all products containing alcohol. To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.

The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam (Ativan), 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to: A. avoid caffeine. B. avoid aged cheeses. C. stay out of the sun. D. maintain an adequate salt intake.

A. avoid caffeine. Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.

A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms? A. benztropine (Cogentin) B. dantrolene (Dantrium) C. clonazepam (Klonopin) D. diazepam (Valium)

A. benztropine (Cogentin) Benztropine is an anticholinergic administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine, is administered to reduce anxiety.

When teaching a client about lithium (Lithobid), the nurse should instruct the client to: A. drink at least six to eight glasses of water per day and avoid caffeine. B. limit the use of salt in his diet. C. discontinue medicine when feeling better. D. increase the amount of sodium in his diet.

A. drink at least six to eight glasses of water per day and avoid caffeine. Caffeine should be avoided because it increases urine output. Clients need to maintain adequate fluid intake to avoid lithium toxicity. Don't limit or increase salt intake because the kidneys will hold onto lithium or excrete it if salt intake varies. Clients should remain on medication even though they are feeling better.

An elderly client's lithium (Lithobid) level is 1.4 mEq/L. She complains of diarrhea, tremors, and nausea. The nurse's first action is to: A. hold the lithium and notify the physician. B. reassure the client that these are normal adverse effects C. administer another lithium dose. D. discontinue the lithium.

A. hold the lithium and notify the physician. The client has symptoms of lithium toxicity. Therefore, her lithium should be held and the physician notified immediately. These aren't normal adverse effects, and administering another dose would increase the toxic effects. A nurse can't discontinue a medication without a physician's order.

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

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

During the client-teaching session, which instruction should the nurse give to a client receiving the second-generation antidepressant paroxetine (Paxetil)? A. "Be aware that your vision may become blurred." B. "Include high-fiber foods in your diet." C. "Report polyuria to the physician immediately." D. "Avoid tyramine-rich foods such as red wine."

B. "Include high-fiber foods in your diet." Because constipation may occur with paroxetine therapy, the client should eat foods rich in fiber. Blurred vision and polyuria aren't common adverse reactions to paroxetine. Avoiding tyramine-rich foods is an important instruction for a client taking a monoamine oxidase inhibitor — not a second-generation antidepressant such as paroxetine.

A client seeks care because she feels depressed and has gained weight. To treat her atypical depression, the physician prescribes tranylcypromine sulfate (Parnate), 10 mg by mouth twice per day. When this drug is used to treat atypical depression, what is its onset of action? A. 1 to 2 days B. 3 to 5 days C. 6 to 8 days D. 10 to 14 days

B. 3 to 5 days Monoamine oxidase inhibitors such as tranylcypromine have an onset of action of approximately 3 to 5 days. A full clinical response may be delayed for 3 to 4 weeks. The therapeutic effects may continue for 1 to 2 weeks after discontinuation.

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A. The absence of anticholinergic effects B. A lower incidence of extrapyramidal effects C. Photosensitivity and sedation D. No incidence of neuroleptic malignant syndrome

B. A lower incidence of extrapyramidal effects Risperdal has a lower incidence of extrapyramidal effects than do the typical antipsychotics. Risperdal does produce anticholinergic effects, and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.

A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect? A. Phenytoin (Dilantin) B. Amantadine (Symmetrel) C. Benztropine (Cogentin) D. Diphenhydramine (Benadryl)

B. Amantadine (Symmetrel) An antiparkinsonian agent such as amantadine may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.

A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how should the nurse administer the dose? A. On an empty stomach B. At the same time each evening C. Evenly spaced around the clock D. As needed when the client complains of depression

B. At the same time each evening Sertraline is classified as an antidepressant. Sertraline generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline is not prescribed for use as needed.

A depressed client is found unconscious on the floor in the dayroom of a health care facility. The nurse finds several empty bottles of a prescribed tricyclic antidepressant lying near the client. Which is the priority action of the nurse? A. Call the poison control center. B. Call the emergency response team. C. Determine the exact number of pills taken. D. Induce vomiting and notify the primary health care provider.

B. Call the emergency response team. Tricyclic antidepressants can be fatal when taken as an overdose, regardless of the amount ingested. Life-threatening symptoms can develop after an overdose. Immediate emergency medical attention and cardiac monitoring are necessary with an overdose of tricyclic antidepressants. Options that delay immediate intervention would not be the priority actions. Vomiting is not induced in an unconscious client.

Tranylcypromine sulfate (Parnate) is prescribed for a depressed client who has not responded to the tricyclic antidepressants. After teaching the client about the medication, Nurse Marian evaluates that learning has occurred when the client states, "I will avoid: A. Citrus fruit, tuna, and yellow vegetables." B. Chocolate milk, aged cheese, and yogurt" C. Green leafy vegetables, chicken, and milk." D. Whole grains, red meats, and carbonated soda."

B. Chocolate milk, aged cheese, and yogurt" When taking an MAOI, the client should avoid consuming high-tyramine foods, such as aged cheese, yogurt and chocolate because the interaction may cause a life-threatening hypertensive crisis.

A physician starts a client on the antipsychotic medication haloperidol (Haldol). The nurse is aware that this medication has adverse extrapyramidal effects. Which nursing measures should be taken during haloperidol administration? A. Review subcutaneous (S.C.) injection technique. B. Closely monitor vital signs, especially temperature. C. Provide the client with the opportunity to pace. D. Monitor blood glucose levels. E. Provide the client with hard candy. F. Monitor the client for signs and symptoms of urticaria.

B. Closely monitor vital signs, especially temperature. C. Provide the client with the opportunity to pace. E. Provide the client with hard candy. Neuroleptic malignant syndrome is a life-threatening adverse extrapyramidal effect of antipsychotic medications such as haloperidol. It's associated with a rapid increase in temperature. The most common adverse extrapyramidal effect, akathisia, is a form of psychomotor restlessness that can often be relieved by pacing. Haloperidol and the anticholinergic medications that are provided to alleviate its extrapyramidal effects can result in dry mouth. Providing the client with hard candy to suck on can help alleviate this problem. Haloperidol isn't given S.C. and doesn't affect blood glucose level. Urticaria isn't usually associated with haloperidol administration

The nurse is assigned to a client who, after a medication teaching session with the nurse, began receiving amitriptyline (Elavil) 1 week ago to treat depression. The client now refuses to take the medication, stating that it has caused blurred vision, dry mouth, and constipation, but hasn't improved the mood. Which nursing diagnosis is most appropriate for this client? A. Noncompliance (treatment regimen) related to treatment resistance B. Deficient knowledge (treatment regimen) related to inadequate understanding of teaching C. Anxiety related to unconscious conflict D. Ineffective coping related to personal vulnerability

B. Deficient knowledge (treatment regimen) related to inadequate understanding of teaching The nurse should assume that the client doesn't have the information necessary to make an informed decision about using the medication. Therefore, Deficient knowledge related to inadequate understanding of teaching is the most appropriate nursing diagnosis. The nurse also should assume that the client wants to feel better; a nursing diagnosis of noncompliance related to treatment resistance would imply that the client is deliberately choosing to be ill. No data support a nursing diagnosis of anxiety related to unconscious conflict or ineffective coping related to personal vulnerability.

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse should suspect that the client has suddenly discontinued taking which prescribed medication? A. Sertraline B. Diazepam C. Fluoxetine D. Haloperidol

B. Diazepam The only benzodiazepine presented in the options is diazepam. Benzodiazepines are effective only when used for short-term therapy. Short-acting benzodiazepines can produce withdrawal symptoms within 1 to 2 days, whereas long-acting benzodiazepines take 5 to 10 days for withdrawal symptoms to occur following discontinuation. Manifestations include insomnia, agitation, anxiety, irritability, nausea, and diaphoresis. The other options list an antipsychotic (sertraline), and antidepressants (fluoxetine and haloperidol).

Patients taking MAOIs have the tendency to experience hypertensive crisis especially during an interaction with other drugs such as epinephrine. Which of the following is a sign of hypertensive crisis? A. Orthostatic hypotension. B. Diplopia. C. Delay in ejaculation. D. Hair loss

B. Diplopia. Double vision.

The client diagnosed with alcoholism has been prescribed medication therapy to assist in the maintenance of sobriety. The nurse will provide the client with education focused on which medication that will most likely be prescribed? A. Clonidine B. Disulfiram C. Pyridoxine hydrochloride D. Chlordiazepoxide hydrochloride

B. Disulfiram Disulfiram is a medication used for alcoholism, and it aids in the maintenance of sobriety. Clonidine is an antihypertensive medication. Pyridoxine hydrochloride is used in the treatment of vitamin B6 deficiency. Chlordiazepoxide hydrochloride is an antianxiety medication (a benzodiazepine) that is used in the management of acute alcohol withdrawal symptoms.

Buspirone hydrochloride is prescribed for a client with an anxiety disorder. The nurse plans to include which teaching point when reviewing this medication with the client? A. The medication is addicting. B. Dizziness and nervousness may occur. C. Tolerance can develop with this medication. D. The medication can produce a sedating effect.

B. Dizziness and nervousness may occur. Buspirone hydrochloride is an anxiolytic medication. Dizziness, nausea, headaches, nervousness, lightheadedness, and excitement, which generally are not major problems, are side effects. Buspirone hydrochloride is not addicting, tolerance does not develop, and it is not sedating.

A client diagnosed with major depression has started taking amitriptyline (Elavil), a tricyclic antidepressant. What is a common adverse effect of this drug? A. Weight loss B. Dry mouth C. Hypertension D. Muscle spasms

B. Dry mouth Tricyclic antidepressants can have anticholinergic adverse effects, with dry mouth being the most common. Hypotension would be expected, rather than hypertension. Weight gain — not loss — is typical when taking this medication. Muscle spasms aren't an adverse effect of tricyclic antidepressants.

The nurse is teaching a client who is being started on imipramine about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication? A. In 2 months B. In 2 to 3 weeks C. During the first week D. During the sixth week of administration

B. In 2 to 3 weeks The maximum therapeutic effects of imipramine may not occur for 2 to 3 weeks after antidepressant therapy has been initiated. Options 1, 3, and 4 are incorrect time periods.

A 23-year-old client in the manic phase of bipolar disorder is admitted to the facility. Which agents would be appropriate for this client? A. Bupropion (Wellbutrin) and lithium (Lithobid) B. Lithium (Lithobid) and valproic acid (Depakote) C. Haloperidol (Haldol) and fluphenazine (Prolixin) D. Risperidone (Risperdal) and clozapine (Clozaril)

B. Lithium (Lithobid) and valproic acid (Depakote) Lithium and valproic acid are the drugs of choice for manic depression. Bupropion is an antidepressant, not an antimanic. Haloperidol, fluphenazine, clozapine, and risperidone are antipsychotic agents.

During the manic phase of bipolar disorder, a client's lithium carbonate (Lithonate) level measures 0.15 mEq/L. The client dresses flamboyantly, acts provocatively, and has seriously impaired judgment. What is the nurse's first priority when planning this client's care? A. Administer lithium carbonate I.M. B. Observe the client's behavior closely in the milieu. C. Begin aversion therapy to extinguish undesirable behaviors. D. Initiate suicide precautions because the client's judgment is impaired.

B. Observe the client's behavior closely in the milieu. Because a client with manic symptoms has impaired judgment, the nurse should observe closely to prevent the client from acting on dangerous impulses. Although lithium carbonate is used to control mania, it's available only in oral form. Aversion therapy is inappropriate because the client can't control the behavior. Suicide precautions also are inappropriate because the client hasn't displayed suicidal intentions.

A client who has been taking buspirone for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred? A. Paranoid thought process B. Rapid heartbeat or anxiety C. Alcohol withdrawal symptoms D. Thought broadcasting or delusions

B. Rapid heartbeat or anxiety Buspirone is not recommended for the treatment of paranoid thought disorders, drug or alcohol withdrawal, or schizophrenia. Buspirone most often is indicated for the treatment of anxiety.

A client reported to the nurse that he has been taking an extra dose of his tricyclic antidepressant for a week because he has been feeling more depressed than usual. Hearing this, the nurse knows which are the most appropriate actions to take? Select all that apply. A. Tell the client that taking an extra dose is ok as long as it is not longer than 1 week. B. Re-educate the client because tricyclic antidepressant overdoses can be life threatening. C. Advise the client to take in more liquids while an extra dose is being taken because dry mouth is a side effect of this medication. D. Tell the client to continue taking the extra dose; the client knows how he is feeling and can stop the extra dose when he is feeling more himself. E. Inform the client that if he experiences any symptoms of dysrhythmias, dry mouth, confusion, agitation, or hallucinations, he should seek medical attention right away.

B. Re-educate the client because tricyclic antidepressant overdoses can be life threatening. E. Inform the client that if he experiences any symptoms of dysrhythmias, dry mouth, confusion, agitation, or hallucinations, he should seek medical attention right away. A tricyclic antidepressant overdose can be life threatening. Signs and symptoms include dysrhythmias, including tachycardia, intraventricular blocks, complete atrioventricular block, and ventricular fibrillation; hypothermia; flushing; dry mouth; dilation of the pupils; confusion, agitation, and hallucinations; and seizures followed by coma. Medical attention should be sought if any of the following occur. Extra doses are not appropriate and can lead to overdose. Advising the client to take in more liquids will not prevent overdose. The client needs re-education.

Which information is most important for the nurse Trinity to include in a teaching plan for a male schizophrenic client taking clozapine (Clozaril)? A. Monthly blood tests will be necessary. B. Report a sore throat or fever to the physician immediately. C. Blood pressure must be monitored for hypertension. D. Stop the medication when symptoms subside.

B. Report a sore throat or fever to the physician immediately. Sore throat, fever, and sudden onset of other flulike symptoms are signs of agranulocytosis, a condition in which there is an insufficient number of granulocytes (a type of white blood cell [WBC]), which causes the individual to be susceptible to infection.

A client diagnosed with schizophrenia has been prescribed clozapine. The nurse should monitor the client for which side/adverse effects of this medication? Select all that apply. A. Diarrhea B. Sedation C. Dry mouth D. Weight loss E. Orthostatic hypotension F. Presence of a fixed stare

B. Sedation C. Dry mouth E. Orthostatic hypotension F. Presence of a fixed stare Clozapine is an antipsychotic medication used to treat schizophrenia. Hallucinations, delusions, and altered thought processes are characteristic of this disorder and should decrease with effective treatment. Fixed stare, dry mouth, orthostatic hypotension, and sedation are side/adverse effects of therapy. The other options are unrelated to this medication

A physician prescribes lithium for a client diagnosed with bipolar disorder. The nurse needs to provide appropriate education for the client receiving this drug. Which topics should the nurse cover? A. The potential for addiction B. Signs and symptoms of drug toxicity C. The potential for tardive dyskinesia D. Information regarding a low-tyramine diet E. The need to report for laboratory testing to monitor blood levels. F. Changes in his mood may take 7 to 21 days

B. Signs and symptoms of drug toxicity E. The need to report for laboratory testing to monitor blood levels. F. Changes in his mood may take 7 to 21 days Client education should cover the signs and symptoms of drug toxicity as well as the need to report them to the physician. The client should be instructed to report for follow-up laboratory studies to monitor his lithium level to avoid toxicity. The nurse should explain that 7 to 21 days may pass before the client notes a change in his mood. Lithium doesn't have addictive properties. Tyramine is a potential concern for clients taking monoamine oxidase inhibitors.

A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan? A. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur B. Sitting up for a few minutes before standing to minimize orthostatic hypotension C. Notifying the physician if her thoughts don't normalize within 1 week D. Expecting symptoms of tardive dyskinesia to occur and to be transient

B. Sitting up for a few minutes before standing to minimize orthostatic hypotension The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may take several weeks to appear. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing action should the nurse take first? A. Place a nasogastric tube. B. Take the child's vital signs. C. Draw a blood specimen for a phenobarbital level. D. Teach the mother safe medication storage practices.

B. Take the child's vital signs. Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs. Options A, C, and D are actions that may all be used in the treatment of this child, but they do not have the priority of option B.

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? A. Parkinsonism B. Tardive dyskinesia C. Hypertensive crisis D. Neuroleptic malignant syndrome

B. Tardive dyskinesia Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, mask-like facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of monoamine oxidase inhibitors and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

The nurse is administering atropine sulfate to a client about to undergo electroconvulsive therapy (ECT). Which assessment indicates that the medication is effective? A. The client's heart rate is 48 beats/minute. B. The client states that his mouth is dry. C. The client appears calm and relaxed. D. The client falls asleep.

B. The client states that his mouth is dry. Atropine sulfate is administered approximately 30 minutes before ECT to reduce oral secretions; therefore, the client's mouth would feel dry. Atropine also blocks the vagal stimulation of the heart, causing a rise in heart rate (much higher than 48 beats/minute). Atropine sulfate isn't given to make the client feel calm and relaxed, nor does it induce sleep.

A client is being seen at his primary health care provider (PHCP) office. The client has a history of schizophrenia and has been taking a new psychotropic medication for 3 weeks. Which finding(s) indicate a need for follow-up? Select all that apply. A. The client has reported sleeping less. B. The client's cholesterol level is elevated. C. The client reports a decrease in appetite. D. The client gained 8 pounds since the last visit. E. The client's blood pressure is increased from baseline.

B. The client's cholesterol level is elevated. D. The client gained 8 pounds since the last visit. E. The client's blood pressure is increased from baseline. Clients with schizoaffective disorders are at higher incidence for metabolic syndrome and diabetes mellitus due to the side effects experienced while taking psychotropic medications, such as increase in appetite, weight gain, increased cholesterol levels, and increased blood pressure. Psychotropic medications cause sedation; therefore option A is incorrect.

A client with suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information? A. The client may next become suicidal. B. These are signs of opioid withdrawal. C. These effects will last only a few moments. D. The client may otherwise sign out against medical advice.

B. These are signs of opioid withdrawal. Signs of opioid withdrawal include increased temperature and blood pressure, abdominal cramping, vomiting, and restlessness. Time of onset may be anywhere from a few minutes to a few hours after administration of naloxone hydrochloride, depending on the opioid involved, the degree of dependence, and the dose of naloxone. The remaining options are incorrect interpretations.

A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as: A. Normal level. B. Toxic level. C. Below normal level. D. Above normal level.

B. Toxic level. Therapeutic level is 0.6-1.2 mEq/L. Toxicity can occur at 1.5 mEq/L

A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client? A. Take with antacids to reduce gastrointestinal irritation. B. Use sunglasses and sunscreen when outdoors. C. Eat foods low in fiber and salt. D. Count the pulse before each dose.

B. Use sunglasses and sunscreen when outdoors. Photosensitivity is a common adverse effect of haloperidol (Haldol); therefore, the use of sunglasses and sunscreen should be included in the discharge teaching for this client. Options A, C, and D are not pertinent to client teaching regarding the use of haloperidol (Haldol).

For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take? A. Give the next dose of fluphenazine, call the physician, and monitor vital signs. B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. C. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation. D. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake.

B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher.

During a shift report, the nurse learns that she will be providing care for a client who's vulnerable to panic attack. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as: A. barbiturates. B. antianxiety drugs. C. depressants. D. amphetamines.

B. antianxiety drugs. Antianxiety drugs provide symptomatic relief. Barbiturates and amphetamines can precipitate panic attacks. Depressants aren't appropriate for treating panic attacks.

Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by: A. decreasing the anxiety causing muscle rigidity. B. blocking the cholinergic activity in the central nervous system (CNS). C. increasing the level of acetylcholine in the CNS. D. increasing norepinephrine in the CNS.

B. blocking the cholinergic activity in the central nervous system (CNS). Option B is the action of benztropine. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS.

Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction? A. prochlorperazine (Compazine) B. diphenhydramine (Benadryl) C. haloperidol (Haldol) D. midazolam (Versed)

B. diphenhydramine (Benadryl) Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.

What medication would probably be ordered for the acutely aggressive schizophrenic client? A. chlorpromazine (Thorazine) B. haloperidol (Haldol) C. lithium carbonate (Lithonate) D. amitriptyline (Elavil)

B. haloperidol (Haldol) Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client expects the resident to prescribe: A. haloperidol (Haldol). B. lorazepam (Ativan). C. bupropion (Wellbutrin). D. paroxetine (Paxil).

B. lorazepam (Ativan). Lorazepam is a schedule IV drug used to treat anxiety. Reducing the client's anxiety will help her cope with stress. Haloperidol is an antipsychotic agent. Bupropion is an antidepressant. Paroxetine is a selective serotonin reuptake inhibitor used to treat depression.

A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective? A. Personal hygiene is maintained by the client for the first time in a week. B. The client has an average resting heart rate of 120 beats/min. C. The staff observes the client sitting in the day room reading a book. D. The nurse records that the client lost 2 lb of body weight in the past week.

C. The staff observes the client sitting in the day room reading a book. The ability to sit and concentrate on reading indicates decreased anxiety. Options A, B, and D are not related to the use of alprazolam for anxiety.

The nurse is caring for a client who has been prescribed disulfiram. Which statement by the client indicates to the nurse the need for further teaching about this medication? A. "I'll have to check my aftershave lotion." B. "I must be careful taking cold medicines." C. "As long as I don't drink alcohol, I'll be fine." D. "I'll have to be careful with the ingredients I use for cooking."

C. "As long as I don't drink alcohol, I'll be fine." Clients who are taking disulfiram must be taught that substances containing alcohol can trigger an adverse reaction. Sources of hidden alcohol include foods (soups, sauces, vinegars), medicine (cold medicine), mouthwashes, and skin preparations (alcohol rubs, aftershave lotions).

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

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

Which medication can control the extrapyramidal effects associated with antipsychotic agents? A. Perphenazine (Trilafon) B. Doxepin (Sinequan) C. Amantadine (Symmetrel) D. Clorazepate (Tranxene)

C. Amantadine (Symmetrel) Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia. Other anticholinergic agents used to control extrapyramidal reactions include benztropine mesylate (Cogentin), trihexyphenidyl (Artane), biperiden (Akineton), and diphenhydramine (Benadryl). Perphenazine is an antipsychotic agent; doxepin, an antidepressant; and chlorazepate, an antianxiety agent. Because these medications have no anticholinergic or neurotransmitter effects, they don't alleviate extrapyramidal reactions.

Additive central nervous system (CNS) depression can occur when combining a sedative-hypnotic with which drug? A. Methylphenidate (Ritalin) B. Cocaine C. Amitriptyline (Elavil) D. Amphetamine (Adderall)

C. Amitriptyline (Elavil) Additive effects occur with concomitant use of CNS depressants, antihistamines, antidepressants, and antipsychotics. Elavil is an antidepressant and the only correct answer. All the other drugs are classified as stimulants.

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A. Take the medication 1 hour before a meal. B. Decrease the dosage if signs of illness decrease. C. Apply a sunscreen before exposure to the sun. D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

C. Apply a sunscreen before exposure to the sun. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it.

The nurse is providing care for a female client with a history of schizophrenia who's experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse's best action? A. Administer the haloperidol orally if the client agrees to take it. B. Call the physician to clarify whether the haloperidol should be given orally or I.M. C. Call the physician to clarify the order because the dosage is too high. D. Withhold haloperidol because it may worsen hallucinations.

C. Call the physician to clarify the order because the dosage is too high. The dosage is too high (normal dosage ranges from 5 to 10 mg daily). Options 1 and 2 may lead to an overdose. Option 4 is incorrect because haloperidol helps with symptoms of hallucinations.

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? A. Client reports not going to work for the past week. B. Client complains of not being able to "do anything" anymore. C. Client arrives at the clinic neat and appropriate in appearance. D. Client reports sleeping 12 hours per night and 3 to 4 hours during the day.

C. Client arrives at the clinic neat and appropriate in appearance. Depressed individuals sleep for long periods, are unable to go to work, and feel as if they cannot "do anything." When these clients have had some therapeutic effect from their medication, they report resolution of many of these complaints and exhibit an improvement in their appearance. Options 1, 2, and 4 identify continued depression.

A client with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which of the following statements? A. Clonazepam may interact with organ meats. B. The medications shouldn't be taken together. C. Clonazepam is a minor depressant and may aggravate symptoms of depression. D. The order needs to be clarified; call the physician.

C. Clonazepam is a minor depressant and may aggravate symptoms of depression. Clonazepam is a central nervous system depressant and can aggravate symptoms in depressed clients. It doesn't interact with organ meats and can be taken with antidepressant medication. There is no need to call the physician; the medications can be safely taken together.

Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following? A. Occurrence of increased libido due to medication adverse effects B. Increased incidence of dysmenorrhea while taking the drug C. Continuing previous use of contraception during periods of amenorrhea D. Instruction that amenorrhea is irreversible

C. Continuing previous use of contraception during periods of amenorrhea Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation; therefore, the client can still become pregnant. The client should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and libido generally decreases because of the depressant effect.

Most antipsychotic medications exert which of following effects on the central nervous system (CNS)? A. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. B. Sedate the CNS by stimulating serotonin at the synaptic cleft. C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. D. Depress the CNS by stimulating the release of acetylcholine.

C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. The exact mechanism of antipsychotic medication action is unknown, but these drugs appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.

The female client taking lorazepam (Ativan), a benzodiazepine, for panic attacks tells the clinic nurse that she is trying to get pregnant. Which action should the nurse take first? A. Tell the client to inform the obstetrician of taking Ativan. B. Instruct the client to quit taking the medication C. Determine how long the client has been taking the medication D. Encourage the client to stop taking Ativan prior to getting pregnant

C. Determine how long the client has been taking the medication The nurse should first determine how long the client has been taking Ativan and what dosage (or how many pills) to determine if the medication can be discontinued abruptly or if it must be gradually decreased

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? A. Experiences dry mouth B. Experiences dizziness C. Develops a sore throat D. Develops gingival hyperplasia

C. Develops a sore throat Blood dyscrasias (aplastic anemia, leukopenia, anemia, and thrombocytopenia) can be an adverse effect of carbamazepine. Flulike symptoms, such as pallor, fatigue, sore throat, and fever, are indications of such dyscrasias. Options A and B are expected reactions. Option D is a side effect of phenytoin, not carbamazepine.

The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent? A. Combativeness, sweating, and confusion B. Agitation, hyperactivity, and grandiose ideation C. Emotional lability, euphoria, and impaired memory D. Suspiciousness, dilated pupils, and increased blood pressure

C. Emotional lability, euphoria, and impaired memory Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory. Phencyclidine overdose can cause combativeness, sweating, and confusion. Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation. Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure

The nurse is providing care to a 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. The nurse anticipates a prescription for which medication? A. Chlorpromazine HCl B. Lithium carbonate C. Fluphenazine decanoate D. Diazepam

C. Fluphenazine decanoate Fluphenazine, an antipsychotic drug that can be given IM, has a rapid onset (1 to 2 hours) and a long duration of action (up to 3 or 4 weeks), so it would be the drug of choice for a noncompliant psychotic client. Option A is an antipsychotic drug used to treat schizophrenia and is usually administered PO (IM doses are short-acting). The client must be compliant in taking this drug for it to be effective. Option B is most effective with manic and depressive bipolar affective disorders. Option D is an antianxiety drug and would not be effective for a psychotic disorder.

A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation? A. Ask the client to sit still or leave the room because he is distracting the other clients. B. Ask the client if he is nervous or anxious about something. C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia. D. Administer an as needed dose of haloperidol to decrease agitation.

C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia. Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can't control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn't address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn't stop them from occurring. Giving more antipsychotic medication would worsen akathisia.

A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? A. Hepatitis B. Infection C. Granulocytopenia D. Systemic dermatitis

C. Granulocytopenia Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions of clozapine therapy.

The client with paranoid schizophrenia is prescribed aripiprazole (Abilify), a dopamine system stabilizer (DDS). Which statement best describes the scientific rationale for administering this medication? A. It decreases the anxiety associated with hallucinations and delusions B. It increases the dopamine secretion in the brain tissue to improve speech C. It reduces positive symptoms of schizophrenia and improves negative symptoms D. It blocks the cholinergic receptor sites in the diseased brain tissue

C. It reduces positive symptoms of schizophrenia and improves negative symptoms Like other antipsychotics, Abilify treats the positive and negative symptoms of schizophrenia--but it does so with fewer side effects than other antipsychotics. This medication does not cause significant weight gain, hypotension, or prolactin release, and it poses no risk of anticholinergic effects or dysrhythmias

At what time of day does the nurse recommend that a child prescribed methylphenidate be given the last dose of the day of the medication? A. At bedtime B. With a bedtime snack C. Just before the noontime meal D. In the morning, 2 hours before breakfast

C. Just before the noontime meal Methylphenidate is used to treat attention deficit hyperactivity disorder and has stimulant effects. Children with attention deficit hyperactivity disorder should take the morning dose after breakfast, and the last daily dose should be taken at least 6 hours before bedtime (14 hours for extended-release forms) to prevent insomnia. Usually the primary health care provider recommends that the last dose be given just before the noontime meal. The other options are incorrect.

Which commonly administered psychiatric medication is prescribed in individualized dosages according to the blood levels of the drug? A. Chlorpromazine (Thorazine) B. Alprazolam (Xanax) C. Lithium carbonate (Lithane) D. Thioridazine (Mellaril)

C. Lithium carbonate (Lithane) Dosages for lithium, an antimania drug, usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEq/L. The maximum daily dosage of thioridazine, an antipsychotic agent, is 800 mg. Dosages exceeding this amount are associated with retinitis pigmentosa, an irreversible condition that can be avoided by observing dosage limits. The recommended maintenance dosage range for thioridazine is 300 to 800 mg/day. Recommended dosage ranges for chlorpromazine, an antipsychotic agent, and alprazolam, an antianxiety agent, are 300 to 1,400 mg/day and 0.5 to 4 mg/day, respectively.

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity

C. Myelosuppression Myelosuppression is the highest priority complication that can potentially affect clients managed with carbamazepine therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered, but this complication does not have as great a potential for occurrence as option C. Options A and B are not typical complications of carbamazepine therapy.

For which adverse reaction should the nurse monitor a client during the initial phase of lithium carbonate (Lithonate) therapy? A. Anemia B. Dehydration C. Nausea and vomiting D. Decreased cerebral perfusion

C. Nausea and vomiting During the initial phase of lithium therapy, the nurse should monitor the client for GI symptoms such as nausea and vomiting, which occur most frequently in the initial stages of therapy and after dosage adjustments. GI symptoms are associated with increasing blood levels of lithium. Lithium therapy may cause leukocytosis, not anemia. The drug isn't associated with dehydration or decreased cerebral perfusion. Although lithium toxicity may cause confusion, it isn't due to decreased cerebral perfusion.

A client with major depression sleeps 18 to 20 hours per day, shows no interest in previously enjoyed activities, and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to prescribe: A. Phenelzine (Nardil). B. Thiothixene (Navane). C. Nortriptyline (Pamelor). D. Trifluoperazine (Stelazine).

C. Nortriptyline (Pamelor). Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't prescribed initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, are inappropriate for clients with uncomplicated depression

Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered? A. Phencyclidine (PCP) intoxication B. Alcohol withdrawal C. Opioid withdrawal D. Cocaine withdrawal

C. Opioid withdrawal Clonidine is used as adjunctive therapy in opioid withdrawal. Benzodiazepines such as chlordiazepoxide (Librium) and neuroleptic agents such as haloperidol are used to treat alcohol withdrawal. Benzodiazepines and neuroleptic agents are typically used to treat PCP intoxication. Antidepressants and medications with dopaminergic activity in the brain, such as fluoxetine (Prozac), are used to treat cocaine withdrawal.

A client diagnosed with depression has a prescription for sertraline. The nurse should withhold the medication and question the prescription if the client has a history of which disorder? A. Diabetes mellitus B. Myocardial infarction C. Phenelzine sulfate use D. Irritable bowel syndrome

C. Phenelzine sulfate use Sertraline is a selective serotonin reuptake inhibitor. Fatal reactions may occur if sertraline is administered concurrently with phenelzine, a monoamine oxidase inhibitor (MAOI). MAOIs should be stopped at least 14 days before initiation of sertraline therapy. Likewise, sertraline should be stopped at least 14 days before initiation of MAOI therapy. The other options are incorrect.

The physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the past 6 months. The nurse should take which action? A. Administer the medication as ordered. B. Discontinue the medication. C. Question the order with the physician. D. Inform the client that he should discuss the MI with the physician.

C. Question the order with the physician. Cardiovascular toxicity is a problem with tricyclic antidepressants, and the nurse should question their use in a client with cardiac disease. Administering the medication would be an act of negligence. A nurse can't discontinue a medication without a physician's order. It's the nurse's responsibility, not the client's, to discuss questions of care with the physician.

The nurse is administering venlafaxine (Effexor), 75 mg by mouth daily, to a client diagnosed with depression. What type of agent is venlafaxine? A. Monoamine oxidase inhibitor B. Tricyclic antidepressant C. Second-generation antidepressant D. Lithium derivative

C. Second-generation antidepressant Physicians prescribe venlafaxine to treat depressive disorders; the drug is a second-generation antidepressant agent

A client diagnosed with bipolar mood disorder has been given a prescription for carbamazepine. The nurse teaching the client about medication side and adverse effects instructs the client to notify the primary health care provider if which symptom develops? A. Nausea B. Dizziness C. Sore throat D. Drowsiness

C. Sore throat Carbamazepine may be prescribed for a client with a bipolar mood disorder to provide symptomatic control of the disorder. An adverse effect of carbamazepine is blood dyscrasia. With development of a fever, sore throat, mouth ulcerations, unusual bleeding, bruising, or joint pain, the primary health care provider should be notified because these findings may indicate a blood dyscrasia. Nausea, dizziness, drowsiness, and vomiting are frequent side effects associated with the medication.

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

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

A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client? A. This medication will reduce the side effect of urinary retention. B. This drug potentiates the effect of chlorpromazine HCl. C. The benztropine is used to control extrapyramidal symptoms. D. The combined effect of these drugs will modify psychotic behavior.

C. The benztropine is used to control extrapyramidal symptoms. Benztropine, an anticholinergic drug, is used to control extrapyramidal symptoms associated with chlorpromazine HCl (Thorazine) use. Options A, B, and D are not accurate statements regarding the use of benztropine for clients who are treated with chlorpromazine HCl for the control of psychosis.

The nurse is evaluating a client's ECG taken in the morning. Which ECG change can result from amitriptyline (Elavil) therapy? A. Presence of U waves B. Depressed ST segment C. Widening QT interval D. Prolonged PR interval

C. Widening QT interval Amitriptyline therapy may cause a conduction delay, demonstrated by a widening QT interval on the ECG. U waves, a depressed ST segment, and a prolonged PR interval aren't typically induced by amitriptyline therapy.

Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication acts as: A. an antianxiety agent. B. a central nervous system (CNS) depressant. C. a CNS stimulant. D. a mood stabilizer

C. a CNS stimulant. Dextroamphetamine is a psychostimulant and acts on the CNS. It would increase anxiety and elevate mood. CNS depressants and antianxiety agents would worsen the symptoms of narcolepsy. Mood stabilizers aren't indicated for narcolepsy

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: A. deeper sleep than CNS depressants. B. greater sedation than CNS depressants. C. a calming effect from which the client is easily aroused. D. more prolonged sedative effects, making the client more difficult to arouse.

C. a calming effect from which the client is easily aroused. Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

Which of the following drugs may be abused because of tolerance and physiologic dependence. A. lithium (Lithobid) and divalproex (Depakote). B. verapamil (Calan) and chlorpromazine (Thorazine) C. alprazolam (Xanax) and phenobarbital (Luminal) D. clozapine (Clozaril) and amitriptyline (Elavil)

C. alprazolam (Xanax) and phenobarbital (Luminal) Both benzodiazepines such as alprazolam and barbiturates such as phenobarbital are addictive, controlled substances. All the other drugs listed aren't addictive substances.

Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD): A. benztropine (Cogentin) and diphenhydramine (Benadryl). B. chlordiazepoxide (Librium) and diazepam (Valium) C. fluvoxamine (Luvox) and clomipramine (Anafranil) D. divalproex (Depakote) and lithium (Lithobid)

C. fluvoxamine (Luvox) and clomipramine (Anafranil) The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Librium and Valium may be helpful in treating anxiety related to OCD but aren't drugs of choice to treat the illness. The other medications mentioned aren't effective in the treatment of OCD.

Which non-antipsychotic medication is used to treat some clients with schizoaffective disorder? A. phenelzine (Nardil) B. chlordiazepoxide (Librium) C. lithium carbonate (Lithane) D. imipramine (Tofranil)

C. lithium carbonate (Lithane) Lithium carbonate, an antimania drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including maniclike activity. Lithium helps control the affective component of this disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification.

A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug? A. clozapine (Clozaril) B. thiothixene (Navane) C. lorazepam (Ativan) D. lithium carbonate (Eskalith)

C. lorazepam (Ativan) The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren't used to manage alcohol withdrawal syndrome.

An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat: A. dyskinesia. B. dementia. C. psychosis. D. tardive dyskinesia.

C. psychosis. By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.

A client is brought into the emergency department for suspected tricyclic antidepressant overdose. Place the actions that the nurse should take in order of priority. All options must be used. Select the correct sequence number for each item. 1.Administer oxygen. 2.Check and monitor vital signs. 3.Obtain an electrocardiogram. 4.Check airway and maintain patency. 5.Prepare gastric lavage with activated charcoal. 6.Prepare to administer prescribed medications.

Correct Answer: 4, 1, 2, 3, 5, 6 A tricyclic antidepressant overdose can be life threatening. Signs and symptoms include dysrhythmias, including tachycardia, intraventricular blocks, complete atrioventricular block, and ventricular fibrillation; hypothermia; flushing; dry mouth; dilation of the pupils; confusion, agitation, and hallucinations; and seizures followed by coma. The immediate action is to check the airway and institute measures such as oxygen to maintain an adequate oxygenation level. Vital signs are checked and monitored, and an electrocardiogram is obtained to check for dysrhythmias. Gastric lavage with activated charcoal is done to prevent further absorption of the medication. Medications to counteract anticholinergic effects may be prescribed, as well as antidysrhythmics. The nurse documents the event, actions taken, and the client's response.

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

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

A heroin-addicted client who is taking methadone hydrochloride discontinues the methadone without consulting the primary health care provider. The client says to the nurse, "I thought I didn't need the methadone after 1 year. I had a job and was even saving money. I can't believe I ruined everything." Which statement by the nurse is therapeutic? A. "It sounds as if everything you do is either all or nothing." B. "Talk to your counselor; maybe everything isn't ruined yet." C. "You will need to restart your recovery starting from the beginning." D. "We need to prepare you to recognize those things that trigger you to relapse."

D. "We need to prepare you to recognize those things that trigger you to relapse." The therapeutic statement is the one that helps the client to reframe with more moderation. In reframing, the nurse focuses on the positive aspects of learning to overcome failure. The nurse must avoid being condescending or overly negative. The nurse uses an example of 1 support system that still exists to detour the faulty thinking. However, the nurse does not have the ability to know whether the counselor is supportive, so this is not the therapeutic statement.

How long after amitriptyline (Elavil) therapy begins can the nurse expect the client to show improved psychological symptoms? A. 2 to 4 days B. 4 to 6 days C. 6 to 8 days D. 10 to 14 days

D. 10 to 14 days Because tricyclic antidepressants have long half-lives, a noticeable response may not occur for 10 to 14 days; a full response may take up to 30 days.

A client diagnosed with anxiety disorder is prescribed buspirone (BuSpar). Teaching instructions for newly prescribed buspirone should include which of the following? A. A warning that immediate sedation can occur with a resultant drop in pulse B. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug C. A warning about the incidence of neuroleptic malignant syndrome (NMS) D. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days

D. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days The client should be informed that the drug's therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Blood level checks aren't necessary. NMS hasn't been reported with this drug, but tachycardia is frequently reported.

A client is prescribed with sertraline (Zoloft). To guarantee a safe administration of the medication, a nurse would administer the dse: A. As needed only for depressions. B. Early in the morning. C. Take on an empty stomach. D. At bedtime.

D. At bedtime.

A client diagnosed with schizophrenia is taking haloperidol. The nurse understands that this medication will exert its therapeutic effect through which mechanism? A. Blocking serotonin reuptake B. Inhibiting the breakdown of released acetylcholine C. Blocking the uptake of norepinephrine and serotonin D. Blocking dopamine from binding to postsynaptic receptors in the brain

D. Blocking dopamine from binding to postsynaptic receptors in the brain Haloperidol is an antipsychotic. Haloperidol acts by blocking the binding of dopamine to the postsynaptic dopamine receptors in the brain. Fluoxetine hydrochloride is a potent serotonin reuptake blocker. Donepezil hydrochloride inhibits the breakdown of released acetylcholine. Imipramine hydrochloride blocks the uptake of norepinephrine and serotonin.

Which instruction should the nurse include in the teaching plan for a client who is receiving phenytoin for seizure control? A. Maintain consistent sodium intake. B. Use sunscreen when outdoors. C. Return for monthly urinalysis. D. Brush and floss teeth daily.

D. Brush and floss teeth daily. Brushing and flossing the teeth daily prevent gingival hyperplasia (gum disease) that is common with long-term phenytoin therapy. Options A, B, and C are not indicated for client instruction regarding phenytoin.

In formulating a discharge teaching plan, the nurse should include which precaution for a client with bipolar disorder who is prescribed lithium carbonate therapy? A. Avoid soy sauce, wine, and aged cheese. B. Have the blood lithium level checked every 2 weeks. C. Take the medication only as prescribed to avoid becoming addicted. D. Check with the psychiatrist before using any over-the-counter medications.

D. Check with the psychiatrist before using any over-the-counter medications. Lithium is a mood stabilizer and a medication to treat bipolar disorder. Its exact mechanism of action remains speculative; however, equilibrium of sodium and potassium must be maintained at the intracellular membrane to maintain therapeutic effects. Lithium competes with sodium in the cell. Many over-the-counter medications contain sodium, and often prescription medications (diuretics) change the sodium-potassium ratios of the cell, thereby affecting lithium concentrations so that it is more difficult to achieve therapeutic levels of the medication. Food restriction (tyramine-restricted diet) is associated with monoamine oxidase inhibitors. Lithium blood levels are recommended for the client taking lithium, but these tests generally are prescribed every 3 to 4 months. Lithium is not addictive.

A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal? A. Naloxone (Narcan) B. Haloperidol (Haldol) C. Magnesium sulfate D. Chlordiazepoxide (Librium)

D. Chlordiazepoxide (Librium) Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Haloperidol (Haldol) may be given to treat clients with psychosis, severe agitation, or delirium. Naloxone (Narcan) is administered for opioid overdose. Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client? A. Capsule contents can be sprinkled on pudding or applesauce. B. Chew the medication thoroughly to enhance absorption. C. Take the medication with a large glass of water or juice. D. Contact the health care provider for another form of medication.

D. Contact the health care provider for another form of medication. Venlafaxine is administered PO in capsule form. Capsules that are extended-release (XR) or continuous-release (CR) contain delayed-release, enteric-coated granules to prevent decomposition of the drug in the acidic pH of the stomach. The client should notify the health care provider about the inability to swallow the capsule. This medication should not be chewed or opened so that the delayed-release, enteric-coated granules can remain intact. Water or juice will not affect the medication.

A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase. The physician decides to start the client on lithium carbonate (Lithonate) therapy. One week after this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the nurse do? A. Call the physician immediately to report the laboratory result. B. Observe the client closely for signs and symptoms of lithium toxicity. C. Withhold the next dose and repeat the laboratory test. D. Continue to administer the medication as ordered.

D. Continue to administer the medication as ordered. The serum lithium level should be maintained between 1 and 1.4 mEq/L during the acute manic phase; therefore, the nurse should continue to administer the medication as ordered. Unless the client has signs or symptoms of lithium toxicity, the nurse has no need to call the physician, withhold the medication, or repeat the laboratory test. Nonetheless, the nurse should continue to monitor the client's serum lithium level and watch for indications of toxicity if the level begins to rise.

Josefina is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include: A. Advising the client to watch the diet carefully. B. Suggesting that the client take the pills with milk. C. Reminding the client that a CBC must be done once a month. D. Encouraging the client to have blood levels checked as ordered.

D. Encouraging the client to have blood levels checked as ordered.

A client gives the home health 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? A. Complaints of insomnia B. Complaints of hunger and fatigue C. A pulse rate less than 60 beats per minute D. Frequent hand washing with hot, soapy water

D. Frequent hand washing with hot, soapy water Clomipramine is a tricyclic antidepressant used to treat obsessive-compulsive disorder. Sedation sometimes occurs. Insomnia seldom is a side effect. Weight gain and tachycardia are side and adverse effects of this medication.

A client diagnosed with depression and prescribed tranylcypromine sulfate has been instructed on the appropriate diet. The nurse determines that the client understands the diet if which foods are selected from the dietary menu? A. Pickled herring, french fries, and milk B. Pepperoni pizza, salad, and a cola drink C. Roasted chicken, roasted potatoes, and beer D. Fried haddock, baked potato, and a cola drink

D. Fried haddock, baked potato, and a cola drink Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI) that is used to treat depression. A tyramine-restricted diet is required while on this medication to avoid hypertensive crisis, a life-threatening effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or pickled fish, beef or chicken liver, and dry sausage (salami, pepperoni, bologna). In addition, figs; bananas; aged cheese; yogurt and sour cream; beer, red wine, and other alcoholic beverages; soy sauce; yeast extract; chocolate; caffeine; and aged, pickled, fermented, or smoked foods need to be avoided.

The nurse is administering risperidone to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? A. Get adequate sunlight. B. Continue driving as usual. C. Avoid foods rich in potassium. D. Get up slowly when changing positions.

D. Get up slowly when changing positions. Risperidone can cause orthostatic hypotension. Sunlight should be avoided by the client taking this medication. With any psychotropic medication, caution needs to be taken (such as with driving or other activities requiring alertness) until the individual can determine whether his or her level of alertness is affected. Food interaction is not a concern.

Methylphenidate (Ritalin) is prescribed to an 8-year-old child for the treatment of attention deficit hyperactivity disorder (ADHD). The nurse will most likely monitor which of the following during the medication therapy? A. Deep tendon reflex. B. Intake and output. C. Temperature and breath sound. D. Height and weight.

D. Height and weight.

A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone (BuSpar), 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs? A. Beta-adrenergic blockers B. Antineoplastic drugs C. Antiparkinsonian drugs D. Monoamine oxidase (MAO) inhibitors

D. Monoamine oxidase (MAO) inhibitors Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.

A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy? A. Agranulocytosis B. Extrapyramidal effects C. Anticholinergic effects D. Neuroleptic malignant syndrome (NMS)

D. Neuroleptic malignant syndrome (NMS) NMS is a rare but potentially fatal condition of antipsychotic medication. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism.

A client diagnosed with depression is prescribed amitriptyline hydrochloride. During the initial phases of treatment, the client's care plan should include which nursing intervention? A. Obtain daily drug blood levels. B. Provide the client a tyramine-free diet. C. Assess the client for anticholinergic effects. D. Obtain postural blood pressure prior to each medication administration.

D. Obtain postural blood pressure prior to each medication administration. Amitriptyline hydrochloride is a tricyclic antidepressant. A common side/adverse effect is orthostatic blood pressure changes, which can produce hypotension and tachycardia. The tachycardia can be frightening to the client, and the hypotension is dangerous because it may result in dizziness and falling. The client must be instructed to move slowly from a lying to a sitting or standing position to avoid injury if these changes are experienced. The client may experience some side/adverse effects, such as sedation, dry mouth, constipation, and blurred vision (anticholinergic effects). However, these effects are transient and will diminish with time. A tyramine-free diet is initiated for a client on a monoamine oxidase inhibitor. Blood levels are required for the client taking lithium.

When providing client teaching about the administration of methylphenidate to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication with breakfast and after the child eats lunch.

D. Offer the child the medication with breakfast and after the child eats lunch. Administering the medication at breakfast and after lunch provides the correct spacing of the doses to maximize the child's attention span and helps prevent the appetite suppression associated with the drug. Doses should be spaced at 6-hour intervals, not option A. Option B is likely to increase insomnia. Option C disrupts the normal dosing schedule, resulting in ineffective treatment. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely.

The primary health care provider is planning to prescribe a medication for a client with major depression. Which medication should the nurse expect to be prescribed? A. Diazepam B. Lorazepam C. Phenobarbital D. Paroxetine hydrochloride

D. Paroxetine hydrochloride Paroxetine is an antidepressant used in the treatment of major depression. Diazepam and lorazepam are benzodiazepines and are used to treat anxiety. Phenobarbital is a barbiturate used for the short-term treatment of insomnia.

Which adverse reaction to lithium should the client with bipolar disorder report? A. Black tongue B. Increased tearing C. Periods of disorientation D. Persistent GI upset

D. Persistent GI upset Persistent GI upset indicates a mild to moderate toxic reaction that should be reported. Black tongue is an adverse reaction to mirtazapine (Ramaron), not lithium. Increased tearing isn't an adverse reaction to lithium. Periods of disorientation don't occur with lithium use.

Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? A. Hypertension B. Respiratory arrest C. Tourette syndrome D. Retinal pigmentation

D. Retinal pigmentation Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options don't occur as a result of exceeding this dose.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated? A. Several minutes B. Several hours C. Several days D. Several weeks

D. Several weeks Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

Aira has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it "doesn't help" and refuses to take it. What should the nurse say or do? A. Withhold the drug. B. Record the client's response. C. Encourage the client to tell the doctor. D. Suggest that it takes a while before seeing the results.

D. Suggest that it takes a while before seeing the results. Patient may start to feel better after 1 to 2 weeks but it can take 4 to 6 weeks for amitriptyline to work fully.

A client with depression who has been taking amitriptyline for three months returns to the clinic for a follow-up. The nurse observes the client in which of the following symptoms? A. Lack of energy. B. Loss of interest in personal appearance. C. Neglect of responsibilities. D. Suicidal thoughts.

D. Suicidal thoughts.

A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia

The nurse is assessing a client receiving an antipsychotic medication. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia Tardive dyskinesia is a permanent effect of long-term phenothiazine administration. Options A, B, and C are side effects of phenothiazines but do not have the characteristics of being permanent and irreversible.

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

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

Which assessment data indicates the atypical antipsychotic quetiapine (Seroquel) is effective for the client diagnosed with paranoid schizophrenia? A. The client does not exhibit any tremors or rigidity B. The client reports a "2" on an anxiety scale of 1-10 C. The family reports the client is sleeping all night D. The client denies having auditory hallucinations

D. The client denies having auditory hallucinations Antipsychotic medications are prescribed to decrease the signs or symptoms of schizophrenia. If the client denies auditory hallucinations, the medication is effective.

When discharging a client after treatment for a dystonic reaction, the emergency department nurse must ensure that the client understands which of the following? A. Results of treatment are rapid and dramatic but may not last. B. Although uncomfortable, this reaction isn't serious. C. The client shouldn't buy drugs on the street. D. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms.

D. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms. An oral anticholinergic agent such as benztropine (Cogentin) is commonly prescribed to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn't appropriate.

A client with bipolar disorder has been taking lithium carbonate (Lithonate), as prescribed, for the past 3 years. Today, family members brought this client to the hospital. The client hasn't slept, bathed, or changed clothes for 4 days; has lost 10 lb (4.5 kg) in the last month; and woke the entire family at 4 a.m. with plans to fly them to Hawaii for a vacation. Based on this information, what can the nurse assume? A. The family isn't supportive of the client. B. The client has stopped taking the prescribed medication. C. The client hasn't accepted the diagnosis of bipolar disorder. D. The lithium level should be measured before the client receives the next lithium dose.

D. The lithium level should be measured before the client receives the next lithium dose. Measuring the lithium level is the best way to evaluate the effectiveness of lithium therapy and begin to assess the client's current status. The other options may contribute to the client's manic episode, but the nurse can't assume them to be true until after assessing the client and family more fully

Which classification of drugs is the most potentially fatal if the client takes an overdose? A. Antihistamines B. Dopaminergics C. Phenothiazine antipsychotics D. Tricyclic antidepressants

D. Tricyclic antidepressants Tricyclic antidepressants can create fatal cardiac arrhythmias. Overdose of the other medications is rarely fatal.

Before giving the client the initial dose of disulfiram, what should the psychiatric home health nurse determine? A. If there is a history of hyperthyroidism B. When the last full meal was consumed C. If there is a history of diabetes insipidus D. When the last alcoholic drink was consumed

D. When the last alcoholic drink was consumed Disulfiram is an adjunctive treatment for some clients with chronic alcoholism to assist in maintaining enforced sobriety. Because clients must abstain from alcohol for at least 12 hours before the initial dose, the most important assessment is when the last alcoholic intake was consumed. The medication should be used cautiously in clients with hypothyroidism, diabetes mellitus, epilepsy, cerebral damage, nephritis, and hepatic disease. It is contraindicated in persons with severe heart disease, psychosis, or hypersensitivity to the medication. Food is not a consideration with this medication.

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? A. Platelet count B. Blood glucose level C. Liver function studies D. White blood cell count

D. White blood cell count A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.

Low doses of central nervous system (CNS) depressants produce an initial excitatory response. This reaction is caused by: A. a stimulating effect on the CNS. B. the depression of acetylcholine. C. the stimulation of dopamine by depressant drugs. D. inhibitory synapses in the brain being depressed before excitatory synapses.

D. inhibitory synapses in the brain being depressed before excitatory synapses. Excitation can occur when inhibitory synapses are depressed. The other options are incorrect because depressants don't stimulate the CNS or dopamine and don't depress acetylcholine.

Important teaching for a client receiving risperidone (Risperdal) would include advising the client to: A. double the dose if missed to maintain a therapeutic level. B. be sure to take the drug with a meal because it's very irritating to the stomach. C. discontinue the drug if the client reports weight gain. D. notify the physician if the client notices an increase in bruising.

D. notify the physician if the client notices an increase in bruising. Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Don't double the dose. This drug doesn't irritate the stomach, and weight gain isn't a problem with risperidone therapy.

A client with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that: A. this medication may be habit forming and will be discontinued as soon as the client feels better. B. this medication has no serious adverse effects. C. the client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication. D. this medication may initially cause tiredness, which should become less bothersome over time.

D. this medication may initially cause tiredness, which should become less bothersome over time. Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops. Antidepressants aren't habit forming and don't cause physical or psychological dependence. However, after a long course of high-dose therapy, the dosage should be decreased gradually to avoid mild withdrawal symptoms. Serious adverse effects, although rare, include myocardial infarction, heart failure, and tachycardia. Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic antidepressant.

The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid: A. has a more predictable onset of action. B. produces fewer anticholinergic effects. C. produces fewer drug interactions. D. has a longer duration of action.

A. has a more predictable onset of action. A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.

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

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