psych meds evolve questions

When comparing benzodiazepines to barbiturates, the nurse identifies which statements about benzodiazepines as true? Benzodiazepines have a high safety profile. Benzodiazepines have a significant ability to depress central nervous system (CNS) function. Benzodiazepines are associated with a high suicide potential. Benzodiazepines have a low ability to cause tolerance. Benzodiazepines have a low abuse potential.

* Benzodiazepines have a high safety profile. Benzodiazepines have a low ability to cause tolerance. Benzodiazepines have a low abuse potential.* Statements A, D, and E are true. Compared to barbiturates, benzodiazepines have a low suicide potential and low ability to cause CNS depression.

Which statements about the treatment of bipolar disorder does the nurse identify as true? Mood stabilizers are used to prevent recurrent manic-depressive episodes. Antipsychotics are used to treat depressive episodes. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. Lithium and valproate are the preferred mood stabilizers for BPD. A lithium level of 2.0 mEq/L is considered therapeutic.

* Mood stabilizers are used to prevent recurrent manic-depressive episodes. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. Lithium and valproate are the preferred mood stabilizers for BPD. * The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? "Have you noticed dry mouth or blurred vision?" "Have you had any changes in your urine function?" "When was your last bowel movement?" "Have you had any changes in your mood or anxiety level?"

* "Have you had any changes in your mood or anxiety level?"* In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention. (TCA)

The nurse is caring for a patient taking buspirone [BuSpar]. Which statement by the patient indicates a need for further teaching about this drug? "This medication should not make me feel drowsy." "This medication should help me feel less anxious." "I will drink grapefruit juice instead of coffee with breakfast." "I will take my medication three times per day."

* "I will drink grapefruit juice instead of coffee with breakfast."* Grapefruit juice can greatly increase buspirone levels and should be avoided. The other statements are appropriate.

Which instruction does the nurse include when teaching a patient about phenelzine [Nardil] therapy? "Take the medication as needed when you are feeling depressed." "If you experience a severe headache, inform your healthcare provider." "Profuse sweating is an expected side effect of this medication and will diminish with time." "Ginseng can be used to treat headache, which patients often experience when they first take phenelzine." "Avoid eating avocados when taking this drug."

* "If you experience a severe headache, inform your healthcare provider." "Avoid eating avocados when taking this drug."* Patients should be instructed to take MAOIs every day as prescribed—not PRN. They should be warned not to discontinue treatment once mood has improved, because doing so may result in relapse. Patients should be informed of the symptoms of hypertensive crisis--severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—and instructed to seek immediate medical attention if these develop. Patients should be forewarned of the hazard of hypertensive crisis and the need to avoid tyramine-rich foods, such as aged cheese, Chianti, and avocados. (Patients on low-dose transdermal selegiline need not avoid foods containing tyramine.) Patients taking MAOIs should not take ginseng, because headache, tremulousness, and manic-like reactions have occurred.

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." "When you stop taking this medication, you should not withdraw it abruptly." "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." "This medication often causes drowsiness. You should take it at bedtime." "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

* "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." "When you stop taking this medication, you should not withdraw it abruptly." "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."* Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

The nurse is teaching a patient with a new prescription for alprazolam [Xanax]. Which statement is the most appropriate to include in the teaching plan? "When it is time to discontinue this drug, you will need to taper it off slowly." "Protect your skin from the sun to prevent rash and exaggerated sunburn." "Increase your intake of fluid and high-fiber foods to prevent constipation." "Take this medication on an empty stomach at least 2 hours after meals."

* "When it is time to discontinue this drug, you will need to taper it off slowly."* Alprazolam [Xanax] is a benzodiazepine for which abrupt discontinuation can precipitate withdrawal symptoms. Patients should withdraw the drug gradually over several weeks. The other statements are not related to alprazolam [Xanax].

The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." "No, all of the sleep medications are controlled substances." "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." "Yes, but it is not for chronic insomnia."

* "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." * Ramelteon [Rozerem] is a relatively new hypnotic with a unique mechanism of action: activation of receptors for melatonin. The drug is approved for treating chronic insomnia characterized by difficulty with sleep onset, but not with sleep maintenance. Long-term use is permitted. Of the major drugs for insomnia, ramelteon is the only one not regulated as a controlled substance.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

* A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L* Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? Dystonia Tardive dyskinesia Parkinsonism Akathisia

* Akathisia* Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture.

The nurse is caring for a patient with severe generalized anxiety disorder. Which agent would be most effective for immediate stabilization? Venlafaxine [Effexor] Buspirone [BuSpar] Paroxetine [Paxil] Alprazolam [Xanax]

* Alprazolam [Xanax]* Alprazolam, a benzodiazepine, would provide the most rapid onset of relief. Buspirone, paroxetine, and venlafaxine are also first-line agents for the treatment of generalized anxiety disorder, but their onset is delayed. They are preferred for long-term management.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Ibuprofen [Motrin] for muscle pain Hydrochlorothiazide (HCTZ) for edema Aspirin (ASA) for mild headache Diphenhydramine [Benadryl] for cold symptoms

* Aspirin (ASA) for mild headache* Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

The selective serotonin reuptake inhibitors (SSRIs) are recommended therapy for a number of psychologic disorders. The nurse identifies the SSRIs as effective for the treatment of patients with which psychologic disorders? Depression Panic disorder Social anxiety disorder Post-traumatic stress disorder Obsessive-compulsive disorder Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

* Depression Panic disorder Social anxiety disorder Obsessive-compulsive disorder* Neither the SSRIs nor any other drugs, for that matter, have proved effective in the treatment of post-traumatic stress disorder. SSRIs are used to treat the other psychologic disorders listed.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? Consumed some foods high in tyramine Not taken the lithium as directed Developed tolerance to the lithium Developed lithium toxicity

* Developed lithium toxicity* Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

The nurse is caring for a patient receiving buspirone [BuSpar] for the treatment of anxiety. Which symptom is most likely explained as an adverse effect of this drug? Diarrhea Risk for abuse Dizziness Weight gain

* Dizziness* Buspirone is an antianxiety medication with few side effects. The most common effects are dizziness, nausea, headache, nervousness, lightheadedness, and excitement. Buspirone does not cause drowsiness, risk for abuse, or weight gain.

The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? Naloxone [Narcan] Flumazenil [Romazicon] Acetylcysteine [Mucomyst] Vitamin K

* Flumazenil [Romazicon]* Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol]overdose. Vitamin K is used to reverse warfarin toxicity.

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? Bupropion [Wellbutrin] Imipramine [Tofranil] Fluoxetine [Prozac] Desvenlafaxine [Pristiq] Sertraline [Zoloft]

* Fluoxetine [Prozac] Sertraline [Zoloft]* Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

lprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? Norepinephrine Acetylcholine Serotonin (5-HT) Gamma-aminobutyric acid (GABA)

* Gamma-aminobutyric acid (GABA)* Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used in the treatment of severe manic episodes to do what? Help control symptoms during the severe manic episode Elevate mood during the severe manic episode Produce sedating effects during the severe manic episode Reduce the amount of physical pain the patient experiences during the severe manic episode

* Help control symptoms during the severe manic episode* Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? Lithium Risperidone Divalproex sodium [Depakote] Carbamazepine Venlafaxine [Effexor]

* Lithium Divalproex sodium [Depakote] Carbamazepine* Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

The nurse identifies which most common serious adverse effect of TCA therapy? Excitation Orthostatic hypotension Skin rash Sexual dysfunction

* Orthostatic hypotension* Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? Incorrect Dry mouth Temperature of 101°F BP of 104/72 mm Hg Drowsiness

* Temperature of 101°F* Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? To reduce the risk of suicide with overdose To avoid weight gain and other gastrointestinal (GI) effects To help prevent sexual dysfunction To prevent the risk of serotonin syndrome

* To reduce the risk of suicide with overdose* The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? Blood urea nitrogen level of 25 mg/dL Blood glucose level of 60 mg/dL Bilirubin level of 2.5 mg/dL White blood cell (WBC) count of 2000/mm3

* White blood cell (WBC) count of 2000/mm3* Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine.

Which statements about zaleplon [Sonata] does the nurse identify as true? Zaleplon [Sonata] is a benzodiazepine. Zaleplon [Sonata] is indicated for long-term management of insomnia. Zaleplon [Sonata] is used to maintain sleep throughout the night. Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. Zaleplon [Sonata] interacts with the neurotransmitter GABA.

* Zaleplon [Sonata] should not be administered with cimetidine [Tagamet]. Zaleplon [Sonata] interacts with the neurotransmitter GABA.* Zaleplon [Sonata] belongs to a new class of drugs called the pyrazolopyrimidines. It is indicated for short-term management of insomnia. Zaleplon has a rapid onset and short duration of action and therefore is beneficial for initiating sleep but not for maintaining it throughout the night. Zaleplon and cimetidine should not be administered together. Zaleplon interacts with the neurotransmitter GABA.

A patient asks the nurse about treatments for post-traumatic stress disorder (PTSD). Which statement by the nurse is the most helpful? Correct "The primary treatment is therapy, but there are some medications that have been somewhat effective." "The primary treatment is monotherapy with an SSRI." "The primary treatment is a combination of multiple medications." "The primary treatment is benzodiazepine for anxiety."

*"The primary treatment is therapy, but there are some medications that have been somewhat effective."* Post-traumatic stress disorder can be treated with psychotherapy and with drugs. There are multiple therapy types and strategies. Regarding drugs, evidence of efficacy is strongest for three SSRIs (fluoxetine, paroxetine, and sertraline) and one SNRI (venlafaxine). Of these four drugs, only two—paroxetine [Paxil] and sertraline [Zoloft]—are FDA-approved for PTSD. If none of the first-line drugs are effective, the guidelines suggest several alternatives: mirtazapine, a TCA (amitriptyline or imipramine), or an MAOI (phenelzine). Current evidence does not support the use of monotherapy with either bupropion, buspirone, trazodone, or a benzodiazepine.

Which statement does the nurse include when teaching a patient about antipsychotic drug therapy? "Restrict the use of antipsychotic drugs to 3 months to prevent the development of addiction." "Dilute oral preparations in fruit juice to improve their palatability." "Store oral preparations in a dark area." "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." "Take an over-the-counter sleep aid if you have trouble falling asleep at night."

*- "Dilute oral preparations in fruit juice to improve their palatability." - "Store oral preparations in a dark area." - "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs."* Patients should be informed that antipsychotic drugs do not cause addiction and that they should be taken as prescribed. Patients should be instructed to avoid all drugs with anticholinergic properties, including antihistamines and certain over-the-counter sleep aids, to prevent drug interactions. All of the other statements are appropriate to include in teaching the patient about the use of antipsychotic medications.

When teaching the patient and family about clozapine therapy, which statements should the nurse include? "It is important for you to obtain ordered blood tests when taking this medication." "Most patients who take this medication lose weight, so you should increase the number of calories you consume each day." "If you experience increased urination, increased thirst, or increased appetite, contact your healthcare provider." "Inform your healthcare provider if you are taking any medications to control seizures." "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations."

*- "It is important for you to obtain ordered blood tests when taking this medication." - "If you experience increased urination, increased thirst, or increased appetite, contact your healthcare provider." - "Inform your healthcare provider if you are taking any medications to control seizures." - "Contact your healthcare provider if you experience any unexplained tiredness, shortness of breath, increased respirations, chest pain, or heart palpitations."* Clozapine can cause agranulocytosis. Patients should be taught that clozapine will not be dispensed without repeated proof of blood counts. Patients taking clozapine are at increased risk of weight gain and dyslipidemia; they should be taught about the risk of weight gain and encouraged to control caloric intake and get regular exercise. Patients should be informed about early signs of infection (fever, sore throat, fatigue, mucous membrane ulceration) and instructed to notify their healthcare provider immediately if these should develop. Patients taking clozapine are at increased risk for the development of diabetes mellitus; they should be taught about the symptoms of diabetes (eg, hyperglycemia, polyuria, polydipsia, polyphagia, dehydration) and instructed to contact the prescriber if these occur. Clozapine should be used with caution in patients with seizure disorders. In rare cases, clozapine causes myocarditis; patients should be informed about the signs and symptoms (eg, unexplained fatigue, dyspnea, tachypnea, chest pain, palpitations) and advised to seek immediate medical attention if these develop. Clozapine should be withheld until myocarditis has been ruled out. If myocarditis is diagnosed, the drug should never be used again.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? The second-generation antipsychotics generally are more effective than the first-generation agents. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. The lipid levels of patients receiving second-generation antipsychotics should be monitored. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

*- Most antipsychotic agents increase the risk of mortality in elderly patients with dementia - The lipid levels of patients receiving second-generation antipsychotics should be monitored. - Schizophrenia is characterized by disordered thinking and loss of touch with reality.* The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

A nurse is caring for several patients. In which patient is it appropriate to use the drug chlorpromazine [Thorazine]? 85-year-old man with Alzheimer's disease 78-year-old man with intractable hiccups 76-year-old woman with severe dementia 48-year-old woman with schizoaffective disorder 30-year-old man with anxiety and depression

*78-year-old man with intractable hiccups 76-year-old woman with severe dementia 48-year-old woman with schizoaffective disorder* The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups. Antipsychotics are not used for dementia because of increased mortality. Chlorpromazine is not a primary treatment for Alzheimer's disease or depression.

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? Aged cheese and sherry Grapefruit and other citrus juices Coffee, colas, and tea Potato and corn chips

*Aged cheese and sherry* Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines

Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders? Alcoholism Bulimia Schizophrenia Hypertension Glucocorticoid-induced psychosis

*Alcoholism Bulimia Schizophrenia Glucocorticoid-induced psychosis* Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? It increases the risk of suicide in the early phase. It is less effective than the tricyclic antidepressants. It increases the risk of psychoses and parkinsonism. It has more side effects and drug interactions.

*It has more side effects and drug interactions.* Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants

The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? Morning sedation A respiratory rate of 30 breaths per minute Constipation A blood pressure of 160/88 mm Hg

*Morning sedation* The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills).

A distraught patient is admitted to the emergency department with symptoms of palpitations, tachycardia, chest pain, and shortness of breath. The physical examination reveals no physiologic basis for the symptoms. Which diagnosis therefore is most likely? Panic disorder Bipolar disorder Generalized anxiety disorder Clinical depression

*Panic disorder* Panic disorder is characterized by symptoms similar to those of a myocardial infarction (MI). Patients often fear losing control and dying and also may experience dizziness, nausea, depersonalization, and tingling or numbness in the hands. Generalized anxiety disorder is characterized by excessive worrying about events, but it also can include trembling, muscle tension, restlessness, palpitations, tachycardia, sweating, and clammy hands. Bipolar disorder is characterized by mood swings with periods of mania and depression.

The nurse is caring for a group of patients who have been prescribed sedative-hypnotic agents. Which agent has the greatest abuse potential? Diazepam [Valium] Triazolam [Halcion] Zolpidem [Ambien] Phenobarbital [Luminal Sodium]

*Phenobarbital [Luminal Sodium]* Phenobarbital is a barbiturate drug that carries a higher abuse potential than the benzodiazepine or benzodiazepine-like drugs.

A patient has been diagnosed with performance anxiety. The nurse anticipates use of which drug to treat this psychologic disorder? Incorrect Clonazepam [Klonopin] Alprazolam [Xanax] Propranolol [Inderal] Sertraline [Zoloft]

*Propranolol [Inderal]* Propranolol [Inderal] and other beta blockers can benefit patients with performance anxiety. When taken 1 to 2 hours before a scheduled performance, beta blockers can reduce symptoms caused by autonomic hyperactivity (eg, tremors, sweating, tachycardia, palpitations). Doses are relatively small (eg, only 10 to 80 mg for propranolol).

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? Blood pressure of 160/90 mm Hg Insomnia and diarrhea Sedation and dry mouth Tachypnea and wheezing

*Sedation and dry mouth* Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? Depressive psychosis Serotonin syndrome Escitalopram overdose Cholinergic crisis

*Serotonin syndrome* Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? Sexual dysfunction Dry mouth Orthostatic hypotension Bradycardia

*Sexual dysfunction* Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? Sodium level of 128 mEq/L Prothrombin time of 8 seconds Blood urea nitrogen level of 25 mg/dL Potassium level of 5.6 mEq/L

*Sodium level of 128 mEq/L* The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of BPD. The nurse anticipates which dosing schedule? Starting at a high dose to quickly control mania Starting at a low dose and titrating up Starting at a high dose and titrating down Starting with a loading dose and then a low maintenance dose

*Starting at a low dose and titrating up* Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of BPD. The goal is to prevent affective relapses into mania or depression. To minimize the risk of serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased.

The nurse identifies which antidepressant as effective in the treatment of generalized anxiety disorder (GAD)? Fluoxetine [Prozac] Venlafaxine [Effexor XR] Paroxetine [Paxil] Escitalopram [Lexapro] Duloxetine [Cymbalta]

*Venlafaxine [Effexor XR] Paroxetine [Paxil] Escitalopram [Lexapro] Duloxetine [Cymbalta]* Fluoxetine [Prozac] is not approved for the treatment of generalized anxiety disorder. All the other medications listed are approved for the treatment of GAD.

Which agent is most likely to be prescribed today for short-term management of insomnia? Secobarbital [Seconal Sodium] Meprobamate [Miltown] Zolpidem [Ambien] Flumazenil [Romazicon]

*Zolpidem [Ambien]* Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines.