Psychiatric Medications
The nurse is teaching a client who is being started on imipramine (Tofranil) about the medication. The nurse should inform the client to expect maximum desired effects at what 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 Rationale: The maximum therapeutic effects of imipramine (Tofranil) may not occur for 2 to 3 weeks after antidepressant therapy has been initiated. Options 1, 3, and 4 are incorrect.
A client taking lithium carbonate reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is b)5 mEq/L. This level is indicative of which finding? a) Toxic b) Normal c) Slightly above normal d) Excessively below normal
a) Toxic Rationale: Maintenance serum levels of lithium are 0.6 to 1.2 mEq/L. Symptoms of toxicity begin to appear at levels of 1.5 to 2 mEq/L. Lithium toxicity requires immediate medical attention with lavage and possible peritoneal dialysis or hemodialysis.
A client's medication sheet contains a prescription for sertraline (Zoloft). 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 Rationale: Sertraline (Zoloft) is classified as an antidepressant. Sertraline (Zoloft) 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 (Zoloft) is not prescribed for use as needed.
The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side/adverse effects of the medication? a) Cardiovascular symptoms b) Gastrointestinal dysfunctions c) Problems with mouth dryness d) Problems with excessive sweating
b) Gastrointestinal dysfunctions Rationale: The most common side/adverse effects related to this medication include central nervous system and gastrointestinal system dysfunction. Fluoxetine (Prozac) affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side/adverse effects associated with this medication.
The nurse is describing the medication side and adverse effects to a client who is taking oxazepam (Serax). What information should the nurse incorporate in the discussion? a) Consume a low-fiber diet. b) Increase fluids and bulk in the diet. c) Rest if the heart begins to beat rapidly. d) Take antidiarrheal agents if diarrhea occurs.
b) Increase fluids and bulk in the diet. Rationale: Oxazepam (Serax) causes constipation, and the client is instructed to increase fluid intake and bulk (high fiber) in the diet. If the heart begins to beat fast, the health care provider (HCP) is notified because this could indicate overdose. In addition, diarrhea could indicate an incomplete intestinal obstruction and, if this occurs, the HCP is notified.
A client who has been taking buspirone (Buspar) 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 Rationale: Buspirone (Buspar) is not recommended for the treatment of paranoid thought disorders, drug or alcohol withdrawal, or schizophrenia. Buspirone (Buspar) most often is indicated for the treatment of anxiety.
A hospitalized client has begun taking bupropion (Wellbutrin) as an antidepressant agent. The nurse understands that which is an adverse effect, indicating that the client is taking an excessive amount of medication? a) Constipation b) Seizure activity c) Increased weight d) Dizziness when getting upright
b) Seizure activity Rationale: Seizure activity can occur in clients taking bupropion (Wellbutrin) dosages greater than 450 mg daily. Weight gain is an occasional side effect, whereas constipation is a common side effect of this medication. This medication does not cause significant orthostatic blood pressure changes.
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 Rationale: 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, masklike 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.
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 this 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. Rationale: 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 hospitalized client is started on phenelzine (Nardil) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply. a) Figs b) Yogurt c) Crackers d) Aged cheese e) Tossed salad f) Oatmeal raisin cookies
c, e Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). The client should avoid ingesting foods that are high in tyramine. Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked or processed meats; red wines; and fruits such as avocados, raisins, or figs.
A client is scheduled for discharge and will be taking phenobarbital sodium (Luminal) for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety? a) Take the medication only with meals. b) Take the medication at the same time each day. c) Use a dose container to help prevent missed doses. d) Avoid drinking alcohol while taking this medication.
d) Avoid drinking alcohol while taking this medication. Rationale: Phenobarbital is an anticonvulsant and hypnotic agent. The client should avoid taking any other central nervous system depressants such as alcohol while taking this medication. The medication may be given without regard to meals. Taking the medication at the same time each day enhances compliance and maintains more stable blood levels of the medication. Using a dose container or "pillbox" may be helpful for some clients.
A client gives the home health nurse a bottle of clomipramine (Anafranil). 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/minute d) Frequent hand-washing with hot soapy water
d) Frequent hand-washing with hot soapy water Rationale: Clomipramine (Anafranil) 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/adverse effects of this medication.
The nurse is administering risperidone (Risperdal) to a client 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. Rationale: Risperidone (Risperdal) 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.
A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). 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 Rationale: A client taking clozapine (Clozaril) 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 cells/mmc) Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.
