Psych Quiz
Pharmacokinetics (ADME)
Absorption—How is the drug absorbed into the body? Distribution—How is the drug distributed throughout the body? Metabolism—How is the drug transformed for use and eventual excretion? Excretion—How is the drug excreted from the body?
Anti anxiety and Hypnotic Drugs
Benzodiazepines: Cool, Calm Diazepam (Valium) Clonazepam (Klonopin) Alaprazolam (Xanax) Lorazepam (Ativan) Avoid all alcohol- CNS Depression
Antidepressant Drugs- Norepinephrine- Dopamine Reuptake Inhibitors
Bupropion (Wellbutrin) (Zyban)
Drugs for Alzheimer's Disease
Cholinesterase Inhibitors (Slow the destruction of Acetylcholine): Slows: Cholinesterase Tacrine (Cognex) Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Excelon) Glutamate- Blocking Agent (GABA) Memantine (Namenda, Namenda XR)
Antipsychotic Drugs- Second Generation (Atypical)
Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Olanzapine (Zyprexa, Zyprexa Relprevv) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) Iloperidone (Fanapt) Lurasidone (Latuda) Asenapine (Saphris)
Antipsychotic Drugs- First Generation
Conventional, Typical of Standard They act on Dopamine receptor Use is usually for Schizophrenia (Positive Symptoms) Strong Antagonists (Blocking Agents) Bind to D2 Receptors Block Attachment to Dopamine Reduce Dopaminergic Transmission Significant Side Effects: Weight Gain Sedation
Pharmacogenetics
Effects of genetic variation on drug responses
Neurotransmitter- Norepinephrine
Fight or Flight
Neurotransmitter- Dopamine
Fine Motor Movement, Emotions and Thoughts, Decision Making
Antidepressant Drugs- Selective Serotonin Reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine (Luvox)- maybe an outpatient drug *Blocks reuptake of Serotonin *Ups Mood *Dry mouth, Sexual Dysfunction, GI Issues
Mood Stabilizers: Lithium
Lithium (Eskalith, Lithobid)- Pregnant women CANT take *DO labs for toxicity & MONITOR Sodium and Potassium For Bipolar Disorder
Antidepressant Drugs- Serotonin & Dopamine
MAOI (Monomamine) - Prolonged use leads to increased neurotrophic factor production
Attention Deficit Hyperactivity Disorder Drugs
Methylphenidate (Ritalin, Daytrana)- Gives energy and Focus Dextroamphetamine (Adderall, Vyvanse) Atomoxetine (Strattera) Guanfacine (Intuniv) Clonidine (Kapay)
Antidepressant Drugs- Norepinephrine and Serotonin- Specific Antidepressant
Mirtazapine (Remeron)
Antidepressant Drugs- Monoamine Oxidase Inhibitors (MAOIs)
Monoamine Oxidase (MAO)= Enzyme that destroys Monoamine Inhibitors- inhibit MAOs action MAOIs increase the synaptic level of neurotransmitters (Serotonin, Dopamine & Norepinephrine) Diet: Avoid Tyramine- no deli meats, fish, wine, aged cheese *Hypertensive Crisis
Lithium
Mood Stabilizing drug used for Bipolar Disorder Narrow Therapeutic Range Above 1.5 is toxic Toxicity caused by: Fluid Loss, Low Sodium (Hyponatremia), Decreased Renal Function, NSAIDS, Thiazide Diuretics Side Effects: Early Sign- GI Distress (NVD), Late sign- Neurological Changes (Confusion, Ataxia, Tremors, Sedation, Seizures, Polydipsia, Polyuria) Teratogenic: should not be given during pregnancy
Antidepressant Drugs- Serotonin Antagonists and Reuptake Inhibitors
Nefazodone (formerly sold as Serzone) Trazodone (formerly sold as Desyrel) (Oleptro)- Can be used as a Sleep Aid Brexpiprazole (Rexulti) Vilazodone (Viibryd) Vortioxetine (Trintellix)
Antidepressant Drugs -Tricyclic Antidepressants (TCAs)
Nortriptyline (Pamelor) Amitriptyline (Elavil) Imipramine (Tofranil) *Works on Serotonin and Norepinephrine *Blocks Acetylcholine *Can be Lethal
Antipsychotic Drugs- Second Generation (Atypical)
Produce Fewer Extrapyramidal Side Effects (EPS) Target both Negative & Positive Symptoms Predominantly D2 (Dopamine)band 5-HT2A (Serotonin) Antagonists (Blockers) Often chosen first line Treatment (Fingersticks & Labs)
Anti anxiety and Hypnotic Drugs- Melatonin Receptor Agonists
Ramelteon (Rozerem) Doxepin (Silenor) Suvorexant (Beolsomra) Buspirone (Buspar)
Neurotransmitter- Serotonin
Sleep Regulation, Hunger, Mood, Sexual Behavior
MAOIs
Treating Depression (Many side effects) Isocarboxazid Phenelzine Tranylcypromine Causes: Hypertensive Crisis Serotonin Syndrome (medical emergency, agitation, restlessness, tachycardia, hypertension, muscle rigidity) Avoid Food containing Tyramine: Wine, Cheese, Meats, Chocolate, Fermented Food Don't take SSRI or TCAs within two weeks of a MAOI
Benzodiazepines
Used for Anxiety, Seizures and Alcohol Withdrawal (CNS Depressants) Clonazepam Lorazepam Diazepam Midazolam Alprazolam Chlordiazepoxide Causes: Sedation (best taken in evening , caution against driving) Respiratory Depression Tolerance/ Dependance ( don't stop abruptly, taper slowly) Antidote: Flumazenil (reverse effects)
Tricyclic Antidepressants (TCAs)
Used for Depression (increases serotonin and norepinephrine in the brain, not first line, many side effects) Amitriptyline Nortriptyline Imipramine Clomipramine Desipramine Doxepin Takes weeks to take effect Treats nerve pain (from neuropathy or fibromyalgia) Side effects (causes): Orthostatic Hypotension Anticholinergic Effects LETHAL in Overdose! - can cause fatal cardiac arrhythmias
Typical Antipsychotics (First Generation)
Used for Psychosis And Schizophrenia ( A lot of side effects, not first line, only treats Positive Symptoms) Haloperidol (Pharmacological restraint) Fluphenazine Treats: Acute Agitation and Aggression Side Effects (Causes): Extrapyramidal Symptoms (EPS)- shaky tremors, muscle spasms, stiffness, restlessness, lip smacking , sticking out tongue (pseudoparkinsonism , dystonia ,tardive dyskinesia) Neuroleptic Malignant Syndrome (emergency, muscle rigidity, fever, altered mental status) Sedation (Avoid Benzos and Alcohol) Anticholinergic Effects (inhibition of rest and digest) QT Prolongation/ Torsades de Pointes
Atypical Antipsychotics (Second Generation)
Used for Psychosis, Schizophrenia (First line treatment, can treat positive and negative symptoms), Bipolar Disorder Clozapine- causes Agranulocytosis (low neutrophils/ WBC) Olanzapine Aripiprazole Risperidone Quetiapine Ziprasidone- causes QT Prolongation (Torsades de Pointes) Side effects (Causes): Extrapyramidal Symptoms (EPS) Metabolic Syndrome/ Weight Gain Sedation Anticholinergic Effects- Dry mouth, Tachycardia, Constipation, Urinary Retention, Blurred Vision Neuroleptic Malignant Syndrome- medical emergency
SSRI Antidepressants
Used to treat Depression & Anxiety (preferred as first line) High risk for suicide (priority) takes up to 4 weeks for increased mood Causes: Sexual Dysfunction Weight Gain Serotonin Syndrome Avoid MAOIs - do not take within 14 days of each other Avoid St Johns Wort Avoid Grafefruit
Buspirone (Buspar)
Used to treat Generalized Anxiety (second line treatment after SSRIs and SNRIs, fewer side effects) Releases Dopamine and Norepinephrine Stimulates Serotonin (Partial agonist) Takes 2 weeks for it to take effect Side effects (causes): Dizziness Does not carry same risk of tolerance or dependance
Mood Stabilizers- Anticonvulsant Drugs
Valproate (Depakote, Depakene)- Pregnant women CANT take Carbamazepine (Equetro, Tegretol) Lamotrigine (Lamictal)- Buccal Gabapentin (Neurontin)
Antidepressant Drugs- Serotonin- Norepinephrine Reuptake Inhibitors (SNRIs)
Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Levomilnacipran (Fetzima) *Inhibits reuptake of Serotonin and Norepinephrine * Makes it more Available in the Synaptic Cleft (Gap) * For the first few weeks: Low Appetite, Sexual Dysfunction
Anti anxiety and Hypnotic Drugs- Short Acting Sedative Hypnotic Sleep Agents
Z- Hypnotics Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta)
An elderly adult presents with symptoms of delirium. The family reports, "Everything was fine until yesterday." What is the most important assessment information for the nurse to gather? a. A list of all medications the person currently takes b. Whether the person has experienced any recent losses c. Whether the person has ingested aged or fermented foods d. The person's recent personality characteristics and changes
a. A list of all medications the person currently takes ANS: A
An acutely violent client diagnosed with schizophrenia received several doses of haloperidol. Two hours later the nurse notices the client's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine 50 mg IM from the prn medication administration record. b. Reassure the client that the symptoms will subside. Practice relaxation exercises with the client. c. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the prn medication administration record.
a. Administer diphenhydramine 50 mg IM from the prn medication administration record. ANS: A
A client diagnosed with major depressive disorder tells the nurse, "I want to try supplementing my selective serotonin reuptake inhibitor (SSRI) with St. John's wort." Which action should the nurse take first? a. Advise the client of the danger of serotonin syndrome. b. Suggest that aromatherapy may produce better results. c. Assess the client for depression and risk for suicide. d. Suggest the client decrease the antidepressant dose.
a. Advise the client of the danger of serotonin syndrome. ANS: A
A client diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the client is calm. Two hours later the nurse sees the client's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. An acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia
a. An acute dystonic reaction ANS: A
Which statement provides the best rationale for closely monitoring a severely depressed client during antidepressant medication therapy? a. As depression lifts, physical energy becomes available to carry out suicide. b. Clients who previously had suicidal thoughts need to discuss their feelings. c. For most clients, antidepressant medication results in increased suicidal thinking. d. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.
a. As depression lifts, physical energy becomes available to carry out suicide. ANS: A
A client diagnosed with bipolar disorder will be discharged tomorrow. The client is taking a mood stabilizing medication. What is the priority nursing intervention for the client as well as the client's family during this phase of treatment? a. Attending psychoeducation sessions b. Decreasing physical activity c. Increasing food and fluids d. Meeting self-care needs
a. Attending psychoeducation sessions ANS: A
A client reports, "The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills. Now my insomnia is worse than ever. I had nightmares the last 2 nights." Which type of medication did the health care provider most likely prescribe? a. Benzodiazepine b. Tricyclic antidepressant c. Conventional antipsychotic d. Central nervous system (CNS) stimulant
a. Benzodiazepine ANS: A
A child diagnosed with attention deficit hyperactivity disorder (ADHD) will begin medication therapy. The nurse should prepare a plan to teach the family about which classification of medications? a. CNS stimulants b. Tricyclic antidepressants c. Antipsychotics d. Anxiolytics
a. CNS stimulants ANS: A
A nurse plans health teaching for a client diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? (Select all that apply.) a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach
a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives ANS: A, C, D
A nurse plans health teaching for a client diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? (Select all that apply.) a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach
a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives ANS: A, C, D
An older adult is prescribed digoxin and hydrochlorothiazide daily as well as lorazepam as needed for anxiety. Over 2 days, the client developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. What is the most likely reason for the client's change in mental status? a. Drug actions and interactions b. Benzodiazepine withdrawal c. Hypotensive episodes d. Renal failure
a. Drug actions and interactions ANS: A
An older adult is prescribed digoxin and hydrochlorothiazide daily as well as lorazepam as needed for anxiety. Over 2 days, the client developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. What is the most likely reason for the client's change in mental status? a. Drug actions and interactions b. Benzodiazepine withdrawal c. Hypotensive episodes d. Renal failure
a. Drug actions and interactions ANS: A
A client diagnosed with major depressive disorder has lost 20 pounds in one month, has chronic low self-esteem, and a plan for suicide. The client has taken antidepressant medication for 1 week. Which nursing intervention has the highest priority? a. Implement suicide precautions. b. Offer high-calorie snacks and fluids frequently. c. Assist the client to identify three personal strengths. d. Observe client for therapeutic effects of antidepressant medication.
a. Implement suicide precautions. ANS: A
When a client diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The client now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the client? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose
a. Sedation and muscle stiffness ANS: A
It has been 5 days since a suicidal client was hospitalized and prescribed an antidepressant medication. The client is now more talkative and shows increased energy. What is the highest priority nursing intervention? a. Supervise the client 24 hours a day. b. Begin discharge planning for the client. c. Refer the client to art and music therapists. d. Consider discontinuation of suicide precautions.
a. Supervise the client 24 hours a day. ANS: A
A client being treated with paroxetine 50 mg po daily reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? (Select all that apply.) a. Vital signs b. Urinary frequency c. Psychomotor retardation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness
a. Vital signs d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness ANS: A, D, E
The child prescribed an antipsychotic medication to manage violent behavior is one most likely diagnosed with what disorder? a. attention deficit hyperactivity disorder (ADHD). b. posttraumatic stress disorder (PTSD). c. communication disorder. d. an anxiety disorder.
a. attention deficit hyperactivity disorder (ADHD). ANS: A
A nurse leads a psychoeducational group for clients experiencing depression. The nurse plans to implement an exercise regime for each client. What rationale will the nurse use when presenting this plan to the treatment team concerning the benefit of exercise? a. has been identified as having a diminishing effect on cytokines b. prevents damage from overstimulation of the sympathetic nervous system. c. detoxifies the body by removing metabolic wastes and other toxins. d. improves mood stability for clients with bipolar disorders.
a. has been identified as having a diminishing effect on cytokines ANS: A
The nurse should be most alert for problems associated with fluid and electrolyte imbalance when a client is prescribed which medication? a. lithium. b. clozapine. c. fluoxetine. d. venlafaxine.
a. lithium. ANS: A
A client says, "I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep." Which medication would the nurse expect a health care provider to prescribe for this client? a. zolpidem b. flurazepam c. risperidone d. methylphenidate
a. zolpidem ANS: A
Which instruction has priority when teaching a client about clozapine? a. "Avoid unprotected sex." b. "Report sore throat and fever immediately." c. "Reduce foods high in polyunsaturated fats." d. "Use over-the-counter preparations for rashes."
b. "Report sore throat and fever immediately." ANS: B
Which prescription medication would the nurse expect to be prescribed for a client diagnosed with a somatic symptom disorder? a. Narcotic analgesics for use as needed for acute pain b. Antidepressant medications to treat co-morbid depression c. Long-term use of benzodiazepines to support coping with anxiety d. Conventional antipsychotic medications to correct cognitive distortions
b. Antidepressant medications to treat co-morbid depression ANS: B
An adult outpatient client diagnosed with major depressive disorder has a history of several suicide attempts by overdose. Given this client's history and diagnosis, which antidepressant medication would the nurse expect to be prescribed? a. Amitriptyline b. Fluoxetine c. Desipramine d. Tranylcypromine sulfate
b. Fluoxetine ANS: B
By which mechanism do selective serotonin reuptake inhibitors (SSRIs) medications improve depression? a. Destroying increased amounts of serotonin b. Making more serotonin available at the synaptic gap c. Increasing production of acetylcholine and dopamine d. Blocking muscarinic and á1 norepinephrine receptors
b. Making more serotonin available at the synaptic gap ANS: B
A client diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group? a. Psychostimulants b. Mood stabilizers c. Anticholinergics d. Antidepressants
b. Mood stabilizers ANS: B
A client diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The client reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed? a. Benzodiazepine b. Mood stabilizing medication c. Monoamine oxidase inhibitor (MAOI) d. Cholinesterase inhibitor
b. Mood stabilizing medication ANS: B
A client diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the client continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol b. Olanzapine c. Chlorpromazine d. Diphenhydramine
b. Olanzapine ANS: B
A client diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the client grimaces and constantly smacks both lips. The client's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourette's syndrome d. Anticholinergic effects
b. Tardive dyskinesia ANS: B
A client demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen? a. To minimize the side effects of lithium. b. To bring hyperactivity under rapid control. c. To enhance the antimanic actions of lithium. d. To be used for long-term control of hyperactivity.
b. To bring hyperactivity under rapid control. ANS: B
Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group? a. Galantamine b. Valproate c. Buspirone d. Tacrine
b. Valproate ANS: B
Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group? a. Galantamine b. Valproate c. Buspirone d. Tacrine
b. Valproate ANS: B
Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group? a. Galantamine b. Valproate c. Buspirone d. Tacrine
b. Valproate ANS: B
A nurse caring for a client taking a selective serotonin reuptake inhibitors (SSRIs) will develop outcome criteria related to what? a. coherent thought processes. b. improvement in depression. c. reduced levels of motor activity. d. decreased extrapyramidal symptoms.
b. improvement in depression. ANS: B
The therapeutic action of neurotransmitter inhibitors that block reuptake bring about what response? a. decreased concentration of the blocked neurotransmitter in the central nervous system. b. increased concentration of the blocked neurotransmitter in the synaptic gap. c. destruction of receptor sites specific to the blocked neurotransmitter. d. limbic system stimulation.
b. increased concentration of the blocked neurotransmitter in the synaptic gap. ANS: B
A client experiences a sudden episode of severe anxiety. Of these medications in the client's medical record, which is most appropriate to give as a prn anxiolytic? a. buspirone b. lorazepam c. amitriptyline d. desipramine
b. lorazepam ANS: B
A hospitalized client diagnosed with alcohol use disorder believes the window blinds are snakes trying to get in the room. The client is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe what medication intervention? a. narcotic analgesic, such as hydromorphone. b. sedative, such as lorazepam or chlordiazepoxide. c. antipsychotic, such as olanzapine or thioridazine. d. monoamine oxidase inhibitor antidepressant, such as phenelzine.
b. sedative, such as lorazepam or chlordiazepoxide. ANS: B
A client being treated for depression has taken sertraline daily for a year. The client calls the clinic nurse and says, "I stopped taking my antidepressant 2 days ago. Now I am having nausea, nervous feelings, and I can't sleep." The nurse will advise the client to: a. "Go to the nearest emergency department immediately." b. "Do not to be alarmed. Take two aspirin and drink plenty of fluids." c. "Take a dose of your antidepressant now and come to the clinic to see the healthcare provider." d. "Resume taking your antidepressants for 2 more weeks and then discontinue them again."
c. "Take a dose of your antidepressant now and come to the clinic to see the healthcare provider." ANS: C
A client diagnosed with depression confidently tells the nurse, "I've been supplementing my prescribed antidepressant with St. John's wort. It has helped a great deal." What is the nurse's priority action? a. Assess changes in the client's level of depression. b. Remind the client to use a secondary form of birth control. c. Educate the client about the risks of selective serotonin syndrome. d. Suggest adding valerian to the treatment regimen to further improve results.
c. Educate the client about the risks of selective serotonin syndrome. ANS: C
A client diagnosed with depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. What information should the nurse provide to the client and family? a. Need to restrict sodium intake to 1 gram daily. b. Need to minimize exposure to bright sunlight. c. Importance of reporting increased suicidal thoughts. d. Importance of maintaining a tyramine-free diet.
c. Importance of reporting increased suicidal thoughts. ANS: C
Which medication prescribed to clients diagnosed with Alzheimer's disease antagonizes N-methyl-D-aspartate (NMDA) channels rather than cholinesterase? a. Donepezil b. Rivastigmine c. Memantine d. Galantamine
c. Memantine ANS: C
A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Information will focus on which medication likely to be prescribed? a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine
c. Methylphenidate ANS: C
A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Information will focus on which medication likely to be prescribed? a. Paroxetine b. Imipramine c. Methylphenidate d. Carbamazepine
c. Methylphenidate ANS: C
Which prescribed medication should a nurse administer to provide immediate intervention for a psychotic client whose aggressive behavior continues to escalate despite verbal intervention? a. Lithium b. Trazodone c. Olanzapine d. Valproic acid
c. Olanzapine ANS: C
Which prescribed medication should a nurse administer to provide immediate intervention for a psychotic client whose aggressive behavior continues to escalate despite verbal intervention? a. Lithium b. Trazodone c. Olanzapine d. Valproic acid
c. Olanzapine ANS: C
A client diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisia
c. Pseudoparkinsonism ANS: C
A newly admitted client diagnosed with major depressive disorder has gained 20 pounds over a few months and has suicidal ideations. The client has taken antidepressant medication for 1 week without remission of symptoms. What is the priority nursing diagnosis? a. Imbalanced nutrition: more than body requirements b. Chronic low self-esteem c. Risk for suicide d. Hopelessness
c. Risk for suicide ANS: C
A person intentionally overdosed on antidepressants. Which nursing diagnosis has the highest priority? a. Powerlessness b. Social isolation c. Risk for suicide d. Compromised family coping
c. Risk for suicide ANS: C
What is the nurse's priority focused assessment for side effects in a child taking methylphenidate for attention deficit hyperactivity disorder (ADHD)? a. Dystonia, akinesia, and extrapyramidal symptoms b. Bradycardia and hypotensive episodes c. Sleep disturbances and weight loss d. Neuroleptic malignant syndrome
c. Sleep disturbances and weight loss ANS: C
A client diagnosed with schizophrenia begins a new prescription for ziprasidone. The client is 5'6'' and currently weighs 204 lbs. The client has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the client's plan of care? a. Skin care techniques b. Scheduling a colonoscopy c. Weight management strategies d. Teaching to limit caffeine intake
c. Weight management strategies ANS: C
When alprazolam is prescribed for a client who experiences acute anxiety, health teaching should include which instruction? a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.
c. avoid alcoholic beverages. ANS: C
A client diagnosed with major depressive disorder began taking escitalopram 5 days ago. The client now says, "This medicine isn't working." What is the nurse's best intervention? a. discuss with the health care provider the need to increase the dose. b. reassure the client that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. d. critically assess the client for symptoms of improvement.
c. explain the time lag before antidepressants relieve symptoms. ANS: C
A nurse instructs a client taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of a. cardiac dysrhythmia. b. hypotensive shock. c. hypertensive crisis. d. hypoglycemia.
c. hypertensive crisis. ANS: C
A nurse can anticipate anticholinergic side effects are likely when a client is prescribed which medication? a. lithium. b. buspirone. c. imipramine. d. risperidone.
c. imipramine. ANS: C
Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin. Which medication also belongs to this classification? a. clonazepam b. risperidone c. lamotrigine d. aripiprazole
c. lamotrigine ANS: C
The nurse will order a special diet for the client who is prescribed which medication? a. carbamazepine. b. haloperidol. c. phenelzine. d. trazodone.
c. phenelzine. ANS: C
A client is hospitalized for severe major depressive disorder. The nurse can expect to provide the client with teaching about what medication? a. chlordiazepoxide. b. clozapine. c. sertraline. d. tacrine.
c. sertraline. ANS: C
A client is hospitalized for severe major depressive disorder. The nurse can expect to provide the client with teaching about what medication? a. chlordiazepoxide. b. clozapine. c. sertraline. d. tacrine.
c. sertraline. ANS: C
A client diagnosed with major depressive disorder began taking a tricyclic antidepressant 1 week ago. Today the client says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will implement which intervention? a. limit the client's activities to those that can be performed in a sitting position. b. withhold the drug, force oral fluids, and notify the health care provider. c. teach the client strategies to manage postural hypotension. d. update the client's mental status examination.
c. teach the client strategies to manage postural hypotension. ANS: C
A health care provider considers which antipsychotic medication to prescribe for a client diagnosed with schizophrenia who has auditory hallucinations and poor social function. The client is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole
d. Aripiprazole ANS: D
A client has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the client about medication from which group? a. Tricyclic antidepressants b. Antipsychotic drugs c. Mood stabilizers d. Benzodiazepines
d. Benzodiazepines ANS: D
A client experiencing psychosis became aggressive, struck another client, and so required seclusion. What is the best documentation regarding this situation? a. Client struck another client who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two clients away from each other for 24 hours. b. Seclusion ordered by primary health care provider at 1415 after command hallucinations told the client to hit another client. Careful monitoring of client maintained during period of seclusion. c. Seclusion ordered by Dr. Smith for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Client calmer and apologized for outburst. d. Client pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 client yelled, "I'll punch anyone who gets near me," and struck another client with fist. Physically placed in seclusion at 1420. Seclusion order obtained from Dr. Smith at 1430.
d. Client pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 client yelled, "I'll punch anyone who gets near me," and struck another client with fist. Physically placed in seclusion at 1420. Seclusion order obtained from Dr. Smith at 1430. ANS: D
A person is prescribed sertraline 100 mg PO daily. Which change in sleep is likely secondary to this medication? a. More dreams. b. Excessive sleepiness. c. Less slow-wave sleep. d. Less rapid eye movement (REM) sleep.
d. Less rapid eye movement (REM) sleep. ANS: D
A person is prescribed sertraline 100 mg PO daily. Which change in sleep is likely secondary to this medication? a. More dreams. b. Excessive sleepiness. c. Less slow-wave sleep. d. Less rapid eye movement (REM) sleep.
d. Less rapid eye movement (REM) sleep. ANS: D
A client receiving risperidone reports severe muscle stiffness at 1030. By 1200, the client has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The client is diaphoretic. What is the nurse's best analysis and action? a. Agranulocytosis; institute reverse isolation. b. Tardive dyskinesia; withhold the next dose of medication. c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome; notify health care provider stat.
d. Neuroleptic malignant syndrome; notify health care provider stat. ANS: D
A client diagnosed with major depressive disorder is receiving imipramine 200 mg at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? a. Dry mouth b. Blurred vision c. Nasal congestion d. Urinary retention
d. Urinary retention ANS: D
A client diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin b. clonidine c. risperidone d. carbamazepine
d. carbamazepine ANS: D
A nurse provided medication education for a client diagnosed with major depressive disorder who began a new prescription for phenelzine. Which behavior indicates effective learning? The client a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting. c. can identify foods with high selenium content that should be avoided. d. confers with a pharmacist when selecting over-the-counter medications.
d. confers with a pharmacist when selecting over-the-counter medications. ANS. D
A client tells the nurse, "My doctor prescribed paroxetine for my depression. I assume I'll have side effects like I had when I was taking imipramine." The nurse's reply should be based on the knowledge that paroxetine is included in what class of medication? a. selective norepinephrine reuptake inhibitor (SNRI). b. tricyclic antidepressant. c. monoamine oxidase (MAO) inhibitor. d. selective serotonin reuptake inhibitors (SSRIs)
d. selective serotonin reuptake inhibitors (SSRIs) ANS: D
