CHAPTER 4 CONCEPTS RELATED TO PHARMACOLOGY

26. Which atypical antipsychotic medication has the most potential for a client to experi-ence sedation, weight gain, and hypersalivation? 1. Haloperidol (Haldol). 2. Chlorpromazine (Thorazine). 3. Risperidone (Risperdal). 4. Clozapine (Clozaril).

1. Although haloperidol (Haldol) can have the listed side effects, haloperidol is a "typical" antipsychotic. The question is asking for an "atypical" antipsychotic medication. 2. Although chlorpromazine (Thorazine) can have the listed side effects, chlorpromazine is a "typical" antipsychotic. The question is asking for an "atypical" antipsychotic medication. 3. Risperidone (Risperdal) is an atypical, or new-generation, antipsychotic medication. The new-generation medications are used primarily because of the decreased risk for the listed side effects. ✅4. Clozapine (Clozaril), an "atypical" antipsychotic, has side effects including sedation, weight gain, and hypersalivation. Because of these side effects and the life- threatening side effect of agranulocytosis, clozapine usually is used as a last resort after all other medications have been tried. Diagnostic lab tests need to be performed bimonthly. TEST-TAKING HINT: The test taker must note important words in the question. When the word "atypical" is noted, "1" and "2" can be eliminated immediately because they are "typical" antipsychotics.

20. A client currently hospitalized for the third alcohol detoxification in 1 year believes relapses are partially due to an inability to control cravings. Which prescribed medication would meet this client's need? 1. Buspirone (BuSpar). 2. Disulfiram (Antabuse). 3. Naltrexone (ReVia). 4. Lorazepam (Ativan).

1. Buspirone (BuSpar), an antianxiety agent, would not assist this client in decreasing cravings and does not answer the question. 2. Disulfiram(Antabuse)is a medication prescribed to assist individuals to avoid alcohol consumption. The client described in the stem is complaining of cravings; disulfiram does not decrease an individual's cravings, but instead deters alcohol use because of the potential uncomfortable symptoms that occur with use of alcohol. An individual taking disulfiram and consuming alcohol experiences symptoms such as flushed skin, throbbing head and neck, respiratory difficulty, dizziness, nausea and vomiting, sweating, hyperventilation, tachycardia, hypotension, weakness, blurred vision, and confusion. ✅3. Naltrexone (ReVia), a narcotic antagonist, can be used in the treatment of alcohol dependence. It works on the same receptors in the brain that produce the feelings of pleasure when heroin or other opiates bind to them, but it does not produce the "narcotic high" and is not habit forming. Naltrexone would help the client be successful by decreasing cravings. 4. Lorazepam (Ativan) is a benzodiazepine that is used to assist clients going through alcohol withdrawal, and it would not be given to someone on completion of detoxification. TEST-TAKING HINT: To answer this question correctly, the test taker must distinguish between medications used to decrease cravings, to deter alcohol consumption, and to assist with alcohol withdrawal.

3. Which functions does the limbic system regulate? 1. Perceptions and interpretations of most sensory information. 2. Auditory functions and short-term memory. 3. Emotional experiences. 4. Visual reception and interpretation.

1. The parietal lobes, not the limbic system, control perceptions and interpretation of most sensory information. 2. The temporal lobes, not the limbic system, control auditory functions and short-term memory. ✅3. The limbic system, which has some connection with the frontal lobe, plays a role in emotional experiences, as evidenced by changes in mood and character after damage to this area. These alterations include, but are not limited to, fear, rage, aggressiveness, apathy, irritability, and euphoria. 4. The occipital lobes, not the limbic system, control visual reception and interpretation. TEST-TAKING HINT: Understanding regulatory functions of different areas of the brain assists the test taker to answer this question correctly.

9. Which nursing intervention would assist the client experiencing bothersome hallucinations to be medication compliant? 1. Using liquid or IM injection to avoid cheeking of medications. 2. Teaching the client about potential side effects from prescribed medications. 3. Reminding the client that the medication addresses the bothersome hallucinations. 4. Notifying the client of the action, peak, and duration of the medication.

1. There is nothing in the question stating that the client is cheeking medications, and liquid or IM injections are not indicated. 2. Although it is important for the nurse to ensure the client understands potential side effects of medications, this intervention alone would not increase the client's medication compliance. ✅3. When the nurse is able to link the medication prescribed to specific bothersome symptoms experienced by the client, the client is more likely to understand why the medication is needed. 4. It is important for the nurse to understand these concepts; however, teaching this information to the client would not increase compliance. TEST-TAKING HINT: When answering the question, the test taker should avoid adding information. There is no information in the question regarding the client's cheeking medications, and by choosing "1" an incorrect assumption is made that all psychiatric clients cheek their medications.

28. A woman in an out-patient clinic is prescribed olanzapine (Zyprexa) 10 mg QHS. At her 3-month follow-up, the client states, "I knew it was a possible side effect, but I can't believe I am not getting my period anymore." Which is a priority teaching need? 1. "Sometimes amenorrhea is a temporary side effect of medications and should resolve itself." 2. "Iamsurethiswasveryscaryforyou.Howlonghaveyoubeenwithoutyourperiod?" 3. "Although your periods have stopped, there is still a potential for you to become pregnant." 4. "Maybetheamenorrheaisnotduetoyourmedication.Haveyourperiodsbeenreg- ular in the past?"

1.Amenorrhea is a side effect of antipsychotic medications, such as olanzapine (Zyprexa), and when it occurs it resolves only if the client is taken off the medication. 2. Empathyrelatedtotheconcernisappropriate, but asking the client further questions, such as how long she has been without her period, is an assessment. The question is asking for further teaching needs, and assessing further does not answer the question. ✅3. It is important for nurses to teach clients taking antipsychotic medications about the potential for amenorrhea and that, even though they are not regularly having their menstrual cycle, ovulation still may occur. Asking the client more information regarding her amenorrhea would be appropriate, but it does not answer the question. The question is asking for further teaching needs, and asking about regularity of past periods is an assessment. TEST-TAKING HINT: The test taker must note important words in the question, such as "teaching." In this question, answers "2" and "4" can be eliminated immediately because they are assessment interventions and not teaching interventions.

29. A client is exhibiting sedation, auditory hallucinations, dystonia, and grandiosity. The client is prescribed haloperidol (Haldol) 5 mg tid and trihexyphenidyl (Artane) 4 mg bid. Which statement about these medications is accurate? 1. Trihexyphenidyl (Artane) would assist the client with sedation. 2. Trihexyphenidyl (Artane) would assist the client with auditory hallucinations. 3. Haloperidol (Haldol) would assist the client to decrease grandiosity. 4. Haloperidol (Haldol) would assist the patient with dystonia.

1.Trihexyphenidyl (Artane), an anticholinergic medication, is prescribed to counteract extrapyramidal symptoms, which are side effects of all antipsychotic medications. Dystonia, involuntary muscular movements (or spasms) of the face, arms, legs, and neck, is an extrapyramidal symptom. Sedation is a side effect of haloperidol, not an extrapyramidal symptom, and is not affected by trihexyphenidyl (Artane). 2. Haloperidol (Haldol), an antipsychotic, is used to treat auditory hallucinations. ✅3. Haloperidol (Haldol), an antipsychotic, would decrease an individual's grandiosity, which is one of many symptoms of a thought disorder. 4. Haloperidol (Haldol), similar to all antipsychotic medications, causes dystonia. Medications such as trihexyphenidyl (Artane) are used to counteract extrapyramidal symptoms, such as dystonia. TEST-TAKING HINT: This is essentially a true/false question. The test taker should check the accuracy of the information presented in the answer choices. The test taker also must understand the meaning of the terms "dystonia" and "grandiosity" to answer this question correctly.

53. A client is prescribed risperidone (Risperdal) 4 mg bid. After the client is caught cheek- ing medications, liquid medication is prescribed. The label reads 0.5 mg/mL. How many milliliters would be administered daily?

53. The nurse will administer 16 mL daily. 0.5 mg/ 1mL = 4 mg /XmL = 8mL 8 mL X 2 doses (bid) = 16 mL TEST-TAKING HINT: The test taker must note key words in the questions, such as "daily." The individual dose for this medication calculates as 8 mL, but the daily dose is 16 mL. Set up the ratio and proportion problem based on the number of milligrams contained in 1 mL. The test taker can solve this problem by cross multiplication and solving for "X" by division.

11. Which statements indicate the client diagnosed with bipolar disorder who is taking lithium (Eskalith), an antimania medication, understands the medication teaching? Select all that apply. 1. "I must monitor my daily lithium level." 2. "I will make sure I do not get dehydrated." 3. "I need to taper the dose if I quit taking it." 4. "I should take the medication with food." 5. "I will not eat foods high in tyramine."

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

12. 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 intervention should the nurse implement? 1. Administer the medication. 2. Hold the medication. 3. Notify the health-care provider. 4. Verify the lithium level.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

1. The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) reports feeling confused and restless and having an elevated temperature. Which intervention should the clinic psychiatric nurse implement? 1. Determine if the client has flulike symptoms. 2. Instruct the client to stop taking the SSRI. 3. Recommend the client take the medication at night. 4. Explain that these are expected side effects.

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

10. 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 psychi- atric nurse is most appropriate? 1. "Why do you think the medication is not helping you?" 2. "You think your medication is not helping you." 3. "You need to come to the clinic so we can discuss this." 4. "It takes about 3 weeks for your medication to work."

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

19. A client currently in treatment for alcohol dependency enters the emergency depart- ment complaining of throbbing head and neck pain, dizziness, sweating, and confusion. Blood pressure is 100/60 mm Hg, pulse is 130, and respiratory rate is 26. Which question should the nurse ask to assess this situation further? 1. "Are you currently on any medications for the treatment of alcohol dependence?" 2. "How long have you been abstinent from using alcohol?" 3. "Are you currently using any illegal street drugs?" 4. "Have you had any diarrhea or vomiting?"

A client with a history of alcohol dependence can be prescribed disulfiram (Antabuse) to deter the drinking of alcohol. If the client drinks alcohol while taking disulfiram, the client may experience symptoms such as flushed skin, throbbing head and neck, respiratory difficulty, dizziness, nausea and vomiting, sweating, hyperventilation, tachycardia, hypotension, weakness, blurred vision, and confusion. ✅1. In asking about medications for the treatment of alcohol dependence, the nurse understands that the symptoms assessed are similar to the symptoms of a client who consumes alcohol while taking disulfiram. 2. Asking about abstinence does not address the symptoms assessed. 3. Asking about any illegal street drugs may be important; however, this does not address the symptoms assessed. 4. Although some of the symptoms, such as low blood pressure and tachycardia, can be signs of dehydration, the other symptoms assessed are not. It is important for the nurse to think critically about all of the symptoms presented. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize signs and symptoms that indicate alcohol has been consumed while taking disulfiram. Also, the test taker should note that this client is currently in treatment for alcohol dependency. This information would lead the test taker to consider the possibility of disulfiram use.

Which of the following is most likely a sign or symptom of benzodiazepine intoxication? Splenomegaly Confusion Vaginal Discharge Absent Bowel Sounds Nasal Polyps Enlargement of Hands and Feet

Confusion Confusion and slurred speech is a symptom of acute benzodiazepine toxicity. Chronic abuse may also manifest with symptoms of headaches and insomnia.

Benzodiazepines like diazepam are most likely indicated for which of the following conditions? Acute Migraine Ataxia Hypertension Alcohol Withdrawal Schizophrenia Delirium

Alcohol Withdrawal Diazepam (Valium) is indicated in the management alcohol withdrawal symptoms by helping stabilize vital signs, reduce anxiety, prevent delirium and possible seizure activity that could occur during withdrawals.

23. Which of the following medications rarely causes extrapyramidal side effects (EPS)? A) Ziprasidone (Geodon) B) Chlorpromazine (Thorazine) C) Haloperidol (Haldol) D) Fluphenazine (Prolixin)

Ans: A Feedback: First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs.

Which of the following is most likely a sign or symptom of benzodiazepine intoxication? Vaginal Discharge Barrel Chest Hypotension Russell's Sign Strawberry Cervix Painless chancre

Hypotension Benzodiazepines act on the central nervous system to produce muscle relaxation. Hypotension is a symptom of benzodiazepine abuse.

41. When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods

Ans: A Feedback: Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine- containing foods.

29. A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to A) get a stat. order for a serum drug level. B) hold the client's medication until the symptoms subside. C) place an urgent call to the client's physician. D) give a PRN dose of benztropine (Cogentin) IM.

Ans: D Feedback: The client is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.

20. A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of A) extrapyramidal side effects B) loss of voluntary muscle control C) posturing D) tardive dyskinesia

Ans: D Feedback: The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the long- term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing.

36. A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time.

Ans: D Feedback: The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic. Answers A, B, and C are not appropriate interventions for the given lithium level.

32. Which of the following are examples of anticholinergic side effects from tricyclic anti- depressants? Select all that apply. 1. Urinary hesitancy. 2. Constipation. 3. Blurred vision. 4. Sedation. 5. Weight gain.

Anticholinergic side effects include urinary hesitancy, constipation, blurred vision, and dry mouth. ✅1. Urinary hesitancy is an anticholinergic side effect. ✅2. Constipation is an anticholinergic side effect. ✅3. Blurred vision is an anticholinergic side effect. 4. Sedation is a histamine effect. 5. Weight gain is a histamine effect TEST-TAKING HINT: A way for the test taker to remember anticholinergic effects is to remember that they "dry" the system. When dry, the client exhibits urinary hesitancy, constipation, blurred vision, and dry mouth.

Benzodiazepines like diazepam are most likely indicated for which of the following conditions? Anxiety Fatigue Tinnitus Decreased Libido Cluster Headache Muscle Weakness

Anxiety Diazepam (Valium) contributes to central nervous system depression via an increase in the inhibitory effect of GABA, resulting in the patient feeling relaxed and demonstrating its utility in treating anxiety.

30. A client is prescribed aripiprazole (Abilify) 10 mg QAM. The client complains of seda- tion and dizziness. The client's vital signs are blood pressure 100/60 mm Hg, pulse 80, respiration rate 20, and temperature 97.4°F. Which nursing diagnosis takes priority? 1. Risk for noncompliance R/T irritating side effects. 2. Knowledge deficit R/T new medication prescribed. 3. Risk for injury R/T orthostatic hypotension. 4. Activity intolerance R/T dizziness and drowsiness.

Aripiprazole (Abilify) is an atypical antipsychotic medication. It is prescribed for individuals with thought disorders. 1. Noncompliance is a concern; however, it is not a priority nursing diagnosis. 2. Knowledge deficit is a concern; however, it is not a priority nursing diagnosis. ✅3. Risk for injury R/T orthostatic hypotension, which is a side effect of the medica- tion, is a priority diagnosis. It is important for nurses to recognize when a client is at increased risk for injury because of side effects such as orthostatic hypotension. 4. Activity intolerance is a concern; however, it is not a priority nursing diagnosis. TEST-TAKING HINT: When a question calls for prioritization, the test taker must consider the problem that would place the client in immediate danger.

7. Which of the following medications can cause confusion, depression, and increased anxiety? Select all that apply. 1. Codeine (generic). 2. Dextromethorphan (Robitussin). 3. Loratadine (Claritin). 4. Levodopa (Sinemet). 5. Pseudoephedrine (Sudafed).

Aside from those noted here, other medications that can cause confusion, depression, and increased anxiety are meperidine (Demerol) and propoxyphene (Darvon). Many hypertensive medications can cause confusion, depression, nightmares, psychosis, or anxiety. ✅1. Codeine, in generic form only, can cause confusion, depression, mania, nightmares, and potentially psychosis and anxiety. 2. Dextromethorphan (Robitussin) can cause confusion, delusions, hallucination, or paranoia, but not anxiety. 3. Loratadine (Claritin) can cause confusion, delusions, hallucination, or paranoia, but not anxiety. 4.Levodopa (Sinemet) can cause confusion, depression, mania, nightmares, psychosis, or anxiety. 5.Pseudoephedrine (Sudafed) can cause confusion, delusions, hallucinations, paranoia, and psychosis, but not anxiety. TEST-TAKING HINT: Certain medications, including over-the-counter drugs, can cause symptoms associated with mental illness. The test taker must review these medications and their specific side effects

51. A 7-year-old client has been prescribed atomoxetine (Strattera). An appropriate nurs- ing diagnosis is imbalanced nutrition: less than body requirements R/T a side effect of anorexia. Which short-term outcome is appropriate? 1. The client will eat meals in the dining area while socializing. 2. The client will maintain expected parameters of growth over the next 6 months. 3. The client will verbalize importance of eating all meals at 100%. 4. The client will eat 80% of all three meals throughout the hospital stay.

Atomoxetine (Strattera) is a medication used in the treatment of attention-deficit hyperactivity disorder. 1. This outcome does not relate to the stated nursing diagnosis and does not have a timeframe. 2. This is a long-term, not short-term, outcome for the stated nursing diagnosis. 3. This outcome does not have a timeframe and is not measurable. ✅4. The outcome of the client eating 80% of meals is realistic, has a timeframe, and is appropriate for the stated nursing diagnosis. TEST-TAKING HINT: To answer this question correctly, the test taker must pair the stated outcome with the nursing diagnosis presented in the question. Correctly stated outcomes are client centered, realistic, and measurable. Including a timeframe in the outcome makes the outcome measurable.

A patient who is taking a benzodiazepine such as diazepam is at risk of developing which of the following side effects? Hyperkalemia Polydipsia Behavioral Changes Malignant Hyperthermia Hypokalemia Muscle Spasms

Behavioral Changes Some individuals may experience a paradoxical effect when taking diazepam (Valium). While reactions vary, these patients may experience agitation, loss of impulse control and/or aggression.

Which of the following is most likely a sign or symptom of benzodiazepine intoxication? Asterixis Ptosis Boggy Uterus Cullen Sign Coma Kyphosis

Coma Benzodiazepines act on the central nervous system to produce sedation. Excessive doses of benzodiazepine may lead to respiratory depression and coma.

21. The client admitted to the psychiatric unit diagnosed with schizophrenia is pre- scribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate? 1. The client's clozapine therapeutic level. 2. The client's white blood cell count. 3. The client's red blood cell count. 4. The client's arterial blood gases.

CHAPTER 12 MENTAL HEALTH DISORDERS

22. The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone (Risperdal), an atypical antipsychotic. Which intervention should the nurse implement? 1. Provide the client with a low tyramine diet. 2. Assess the client's respiration for 1 full minute. 3. Instruct the client to change positions slowly. 4. Monitor the client's intake and output.

CHAPTER 12 MENTAL HEALTH DISORDERS

24. The client diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which information should the nurse discuss with the client concerning this medication? Select all that apply. 1. Discuss the need for regular exercise. 2. Instruct the client to monitor for weight gain. 3. Tell the client to take the medication with food. 4. Explain to the client the need to stop taking aspirin. 5. Encourage the client to quit smoking cigarettes.

CHAPTER 12 MENTAL HEALTH DISORDERS

25. 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? 1. It decreases the anxiety associated with hallucinations and delusions. 2. It increases the dopamine secretion in the brain tissue to improve speech. 3. It reduces positive symptoms of schizophrenia and improves negative symptoms. 4. It blocks the cholinergic receptor sites in the diseased brain tissue.

CHAPTER 12 MENTAL HEALTH DISORDERS

26. Which information should the nurse discuss with the client diagnosed with schizo- phrenia who is prescribed an atypical antipsychotic medication? Select all that apply. 1. Drink decaffeinated coffee and tea. 2. Decrease the dietary intake of salt. 3. Eat six small, high-protein meals a day. 4. Report muscle spasms and rigidity. 5. Monitor glucose levels and lipid levels.

CHAPTER 12 MENTAL HEALTH DISORDERS

27. The nurse is discussing the prescribed antipsychotic medication with a family mem- ber of a client diagnosed with schizophrenia. Which information should the nurse discuss with the family member? 1. Explain the need for the family member to give the client the medication. 2. Encourage the family member to learn cardiopulmonary resuscitation (CPR). 3. Discuss the need for the client to participate in a community support group. 4. Teach the family member what to do in case the client has a seizure.

CHAPTER 12 MENTAL HEALTH DISORDERS

A patient who is taking a benzodiazepine such as diazepam is at risk of developing which of the following side effects? Confusion/Amnesia Muscle Spasms Oculomotor nerve palsy Polydipsia Fever Seizure

Confusion/Amnesia Two particularly significant sites affected by diazepam (Valium) are the hippocampus and cerebral cortex. By acting on these areas, confusion and amnesia can occur. It is important to note that at higher doses, diazepam may cause sufficient sedation to result in patients becoming stuporous.

MNEMONICS Benzodiazepines Donuts And TLC

D-Diazepam A-Alprazolam T-Temazepam L-Lorazepam C-Clonazepam When you feel anxious, you need Donuts And TLC. These are the most common Benzodiazepines

A patient who is taking a benzodiazepine such as diazepam is at risk of developing which of the following side effects? Proximal Muscle Weakness Dizziness/Vision Changes Fever Restlessness Dyspnea Palpitations

Dizziness/Vision Changes By facilitating the inhibitory effect of GABA activity in the brain, diazepam (Valium) induces a slowed CNS which can contribute to developing dizziness and blurred vision as side effects.

Which of the following is most likely a sign or symptom of benzodiazepine intoxication? Clay Colored Stools Long Face Drowsiness Hyperactivity Simian Crease Splenomegaly

Drowsiness Benzodiazepines act on the central nervous system to produce sedation. Drowsiness is a symptom of benzodiazepine abuse. Chronic abuse may also lead to weakness and anorexia.

Which of the following is the most appropriate consideration regarding a patient taking benzodiazepines? Low Abuse Potential Bleeding Precautions Avoid with G6PD Deficiency Fall Precaution Teratogenic Seizure Precautions

Fall Precaution Creating a "safe" exit from the bed is important to eliminate potential falls. Educate the patient on the potential for falls and how to prevent falls while on this medication. Assist the patient to the bathroom when needed.

Which of the following medications is considered a reversal agent for benzodiazepines? Naloxone (Antidote) Flumazenil (Romazicon) Atropine (Antidote) Sodium Bicarbonate (Antidote) Fomepizole (Antidote) Digibind

Flumazenil (Romazicon) Flumazenil (Romazicon) is the reversal agent for benzodiazepines like diazepam (Valium). Prompt administration is imperative in cases of overdose or vital sign destabilization.

Buspirone/Buspar

Generic Name Buspirone Trade Name Buspar Indication Management of anxiety Action Relieves anxiety by binding to dopamine and serotonin receptors Therapeutic Class Antianxiety Pharmacologic Class Azapirone

22. For the past year, a client has received haloperidol (Haldol). The nurse administering the client's next dose notes a twitch on the right side of the client's face and tongue movements. Which nursing intervention takes priority? 1. Administer haloperidol (Haldol) along with benztropine (Cogentin) 1 mg IM PRN per order. 2. Assess for other signs of hyperglycemia resulting from the use of the haloperidol 3. Check the client's temperature, and assess mental status. 4. Hold the haloperidol (Haldol), and call the physician.

Haloperidol (Haldol) is a typical antipsychotic used in the treatment of thought disorders. A side effect of antipsychotic medications is tardive dyskinesia, a syndrome characterized by bizarre facial and tongue movements, a stiff neck, and difficulty swallowing. All clients receiving long- term treatment with antipsychotic medications are at risk, and the symptoms are potentially irreversible. 1. Although benztropine (Cogentin) may be given to assist with the signs of tardive dyskinesia, because tardive dyskinesia is potentially irreversible, it is important that the nurse hold the medication and talk with the physician before giving the next dose of haloperidol. 2. Antipsychotic medications, such as haloperidol, can cause metabolic changes, and the client would need to be monitored. However, the symptoms in the question do not reflect hyperglycemia. 3. Another side effect of antipsychotic medications is neuroleptic malignant syndrome (NMS). The signs and symptoms of NMS are muscle rigidity, hyperpyrexia (107°F), tachycardia, tachypnea, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor or coma. The symptoms in the question do not reflect NMS. ✅4. The symptoms noted in the question reflect tardive dyskinesia, and the nurse must hold the medications to avoid permanent damage and call the physician TEST-TAKING HINT: The test taker should review and understand different side effects of antipsychotic medications and appropriate nursing interventions to deal with the symptoms of these side effects. Also, remember that if a portion of a choice is incorrect, the entire choice is incorrect, as in "1."

Benzodiazepines like diazepam are most likely indicated for which of the following conditions? Drowsiness Muscle Spasms Proximal Muscle Weakness Depression Opioid Withdrawal Serotonin Syndrome

Muscle Spasms Diazepam's (Valium) binding to benzodiazepine receptors on postsynaptic GABA neurons in the CNS causes increased chloride permeability of neuronal membranes which results in their being hyperpolarized. As such, these neurons are more stabilized and less excitable, demonstrating CNS depression and alleviating neuronal overactivity related to muscle spasms.

44. Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder? 1. Lithium carbonate (lithium), loxapine (Loxitane), and carbamazepine (Tegretol). 2. Gabapentin (Neurontin), thiothixene (Navane), and clonazepam (Klonopin). 3. Divalproex sodium (Depakote), verapamil (Calan), and olanzapine (Zyprexa). 4. Lamotrigine (Lamictal), risperidone (Risperdal), and benztropine (Cogentin).

Many medications are used off-label for the treatment of bipolar affective disorder (BPAD). If a client is diagnosed with BPAD with psychotic features, an antipsychotic medication may be prescribed. 1. Lithium carbonate (lithium) is an antimanic medication, and carbamazepine (Tegretol) is an anticonvulsant medication; both are used to assist with mood stabilization. Loxapine (Loxitane) is an antipsychotic medication used for symptoms related to alterations in thought, and not FDA approved to be used to stabilize mood. 2. Gabapentin (Neurontin) is an anticonvulsant medication used to assist with mood stabilization. Thiothixene (Navane) is an antipsychotic medication and is used for symptoms related to alterations in thought, not FDA approved to stabilize mood. Clonazepam (Klonopin) is a benzodiazepine used for clients with anxiety. Benzodiazepines can be used on a short-term basis to assist clients with agitation related to mania or depression; however, they are not used for long-term treatment to stabilize mood. ✅3. Divalproex sodium (Depakote), an anticon- vulsant, and verapamil (Calan), a calcium channel blocker, are used in the long-term treatment of BPAD. Olanzapine (Zyprexa), an antipsychotic, has been approved by the Food and Drug Administration for the treatment of acute manic episodes. 4. Lamotrigine(lamictal)isusedasamood stabilizer. Risperidone (Risperdal) is an antipsychotic medication and is used for symptoms related to alterations in thought, and not FDA approved to stabilize mood. Benztropine (Cogentin) is an antiparkinsonian agent and is used to assist clients with extrapyramidal symptoms from antipsychotic medications, such as risperidone. TEST-TAKING HINT: The test taker must understand that all parts of the answer must be correct for the answer to be correct. The test taker should review all medications used to stabilize mood. Many medications are used off- label to treat BPAD.

2. Which of the following are true statements about neurotransmitters? Select all that apply. 1. Neurotransmitters are responsible for essential functions in human emotion and behavior. 2. Neurotransmitters are targets for the mechanism of action of many psychotropic medications. 3. Neurotransmitters are limited to the study of psychiatric disease processes alone. 4. Neurotransmitters are nerve cells that generate and transmit electrochemical impulses. 5. Neurotransmitters are cholinergics, such as serotonin, norepinephrine, dopamine, and histamine.

Neurotransmitters are released from the presynaptic neuron and are considered the first messengers. They then connect to the postsynaptic neuron to provide a message. ✅1. The message sent through a neurotransmitter plays a role in human emotion and behavior. ✅2. Because neurotransmitters send messages specific to emotions and behaviors, they have been found to be useful targets of psychotropic medications. 3. Neurotransmitters are not limited to psychiatric disease processes alone, and are useful in the study and treatment of many disease processes. 4. Neurons are nerve cells that generate and transmit electrochemical impulses. Neurotransmitters assist the neurons in transmitting their message from one neuron to the next. 5. There are many different groups of neurotransmitters, such as cholinergics, monoamines, amino acids, and neuropeptides. Those listed in this answer choice are all monoamines, not cholinergics TEST-TAKING HINT: The test taker needs to understand the role of a neurotransmitter in psychopharmacology to answer this question correctly. A review of the different chemical classifications of neurotransmitters would assist with this understanding.

34. A client admitted to the hospital with suicidal ideations is prescribed paroxetine (Paxil). The client has a nursing diagnosis of knowledge deficit R/T newly prescribed medica- tion. Which nursing intervention addresses this client's problem? 1. Teaching client regarding risk for discontinuation syndrome. 2. Maintaining safe milieu and monitoring for suicidal ideation. 3. Assessing mood using a 1-to-10 mood scale. 4. Reinforcing the need to take the medication on an empty stomach.

Paroxetine (Paxil) is a selective serotonin reuptake inhibitor used to treat depressive symptoms and anxiety. When the medication is stopped abruptly, the client may experience discontinuation syndrome. ✅1. Dizziness, lethargy, headache, and nausea are signs of discontinuation syndrome, which can occur when long-term therapy with selective serotonin reuptake inhibitors or venlafaxine (Effexor) is stopped abruptly. It is important for the client to know this to understand the importance of taking the medication as prescribed. Teaching about discontinua- tion syndrome directly relates to the nurs- ing diagnosis knowledge deficit R/T newly prescribed medication. 2. Maintaining a safe milieu and monitoring for suicidal ideations are important interventions; however, they are not related to the stated nursing diagnosis of knowledge deficit R/T newly prescribed medication. 3. Assessment of mood is important in understanding how the medication is working; however, it does not relate to the stated nursing diagnosis of knowledge deficit R/T newly prescribed medication. 4. Paroxetine (Paxil) can be taken with or without food with equal effectiveness TEST-TAKING HINT: If there is a nursing diagnosis in the question, the test taker needs to make sure the answer chosen relates to all aspects of the noted nursing diagnosis: the NANDA stem, the "related to" statement, and the "as evidenced by" information. Although maintaining a safe milieu, monitoring for suicidal ideations, and assessing mood are important, they do not relate to the nursing diagnosis of knowledge deficit R/T newly prescribed medication.

A patient who is taking a benzodiazepine such as diazepam is at risk of developing which of the following side effects? Palpitations Respiratory Depression Malignant Hyperthermia Insomnia Seizure Sweating

Respiratory Depression As a CNS depressant, diazepam (Valium) administration may also result in respiratory depression, the effects of which are amplified when used in combination with other CNS depressants (alcohol, opioids, etc.). Monitor patient's breathing pattern and oxygen saturation when high doses or multiple doses are being administered.

Benzodiazepines like diazepam are most likely indicated for which of the following conditions? Bradycardia Amnesia Dizziness ADHD Seizures and Status Epilepticus Bradypnea

Seizures and Status Epilepticus Diazepam (Valium) is indicated to treat generalized seizure disorder as well as status epilepticus, which is defined as a prolonged seizure lasting more than 5 minutes or multiple seizures occurring consecutively without complete recovery of consciousness. Seizures lasting greater than 30 minutes place the patient at significant risk for severe consequences like neuronal injury, neuronal death, or other long-term alterations to the neuronal network. Diazepam is often administered IV or via rectal suppository for acute treatment.

5. A client is hearing voices saying, "Kill mother soon." The client states, "I am a prophet." The nurse understands that these symptoms are exhibited because of which brain alteration? 1. A decrease in dopamine in the mesocortical dopamine pathway. 2. An increase in dopamine in the mesolimbic dopamine pathway. 3. An increase in dopamine in the nigrostriatal dopamine pathway. 4. A decrease in dopamine in the tuberoinfundibular dopamine pathway.

The client is exhibiting auditory hallucinations and delusions, which are positive symptoms of schizophrenia. 1. A decrease in dopamine in the mesocortical dopamine pathway may be one of the potential causes of negative, not positive, symptoms of schizophrenia, such as affective flattening, alogia, avolition, anhedonia, and social isolation. There also is debate about antipsychotic medications being a causative factor in the worsening of negative symptoms of schizophrenia by decreasing the amount of dopamine in the mesocortical dopamine pathway. ✅2. An increase in dopamine in the mesolimbic dopamine pathway is thought to have an important role in emotional behaviors, especially auditory hallucinations, delusions, and thought disorders. Medications prescribed for these symptoms decrease the amount of dopamine in the mesolimbic pathway and decrease positive symptoms. 3. An increase of dopamine in the nigrostriatal dopamine pathway is thought to be the underlying cause of movement disorders, such as hyperkinetic movement, dyskinesias, and tics, and not the cause of the positive symptoms described in the question stem. A decrease, not increase, in dopamine in this pathway causes movement disorders, such as Parkinson's disease. When clients are prescribed antipsychotic medications, which decrease dopamine in this pathway, pseudoparkinsonian symptoms, such as tremor, shuffling gait, drooling, and rigidity, can occur. 4. A decrease in dopamine in the tuberoin- fundibular dopamine pathway results in inhibition of prolactin release, a side effect of antipsychotic medications and not the cause of the positive symptoms described in the question stem. In the postpartum state, neuronal activity is decreased, and prolactin levels can increase for breastfeeding. Antipsychotic medications decrease the dopamine level in all dopamine pathways, and a side effect of the decrease in the tuberoinfundibular dopamine pathway could be galactorrhea (breast secretions, which can occur in men and women), amenorrhea, and potentially some sexual dysfunction. TEST-TAKING HINT: The test taker must recognize the symptoms presented in the question as positive symptoms of schizophrenia. To answer this question correctly, the test taker must be familiar with brain chemistry and its effects on the symptoms of schizophrenia.

38. A client on an in-patient psychiatric unit has been prescribed tranylcypromine (Parnate) 30 mg QD. Which client statement indicates that discharge teaching has been successful? 1. "I can't wait to order liver and fava beans with a nice Chianti." 2. "Chicken teriyaki with soy sauce, apple sauce, and tea sound great." 3. "I have been craving a hamburger with lettuce and onion, potato chips, and milk." 4. "For lunch tomorrow I'm having bologna and cheese, a banana, and a cola."

Tranylcypromine (Parnate) is a monoamine oxidase inhibitor (MAOI) used in the treatment of major depression. When MAOIs are prescribed, important teaching related to drug- food interactions is necessary because of the potential for a hypertensive crisis. 1. Liver, fava beans, and Chianti ingested when taking an MAOI would cause a hypertensive crisis. 2. Soy sauce ingested when taking an MAOI would cause a hypertensive crisis. ✅3. All of the foods chosen in this meal are safe to ingest when taking an MAOI. 4. Bologna, aged cheese, bananas, and cola ingested when taking an MAOI would cause a hypertensive crisis TEST-TAKING HINT: To answer this question correctly, the test taker must recognize Parnate as an MAOI, and then understand which foods would be contraindicated while taking this medication.

A patient who is taking a benzodiazepine such as diazepam is at risk of developing which of the following side effects? Polydipsia Tremor Urinary Incontinence Hypokalemia Dyspnea Bell's Palsy

Urinary Incontinence In some patients, urinary incontinence may occur while taking diazepam (Valium). This may be a result of its muscular relaxant effect discussed earlier and/or diminished awareness about the need to urinate.

39. A client recently prescribed venlafaxine (Effexor) 37.5 mg bid complains of dry mouth, orthostatic hypotension, and blurred vision. Which nursing intervention is appropriate? 1. Hold the next dose, and document symptoms immediately. 2. Reassure the client that side effects are transient, and teach ways to deal with them. 3. Call the physician to receive an order for benztropine (Cogentin). 4. Notify the dietary department about restrictions related to monoamine oxidase inhibitors.

Venlafaxine (Effexor) is an antidepressant prescribed for the treatment of depressive symptoms. Venlafaxine affects serotonin and norepinephrine. 1. Dry mouth, orthostatic hypotension, and blurred vision all are transient symptoms and usually dissipate after 1 or 2 weeks. These symptoms are not life-threatening, so it is not necessary for the medications to be held. ✅2. The nurse needs to teach the client about acceptable side effects, and what the client can do to deal with them. The nurse can suggest that the client use ice chips, sip small amounts of water, or chew sugar-free gum or candy to moisten the dry mouth. For orthostatic hypotension, the nurse may encourage the client to change positions slowly. For blurred vision, the nurse may encourage the use of moisturizing eye drops. 3. Benztropine (Cogentin) is an antiparkinson medication used to treat extrapyramidal side effects caused by antipsychotic medications, not antidepressants. 4. Venlafaxine is not a monoamine oxidase inhibitor, and dietary restrictions are not indicated. TEST-TAKING HINT: To answer this question correctly, the test taker needs to distinguish the difference between life-threatening side effects and side effects that may be transient and acceptable.

23. A client has been prescribed ziprasidone (Geodon) 40 mg bid. Which of the following interventions are important related to this medication? Select all that apply. 1. Obtain a baseline EKG initially and periodically throughout treatment. 2. Teach the client to take the medication with meals. 3. Monitor the client's pulse because of the possibility of palpitations. 4. Institute seizure precautions, and monitor closely. 5. Watch for signs and symptoms of a manic episode.

Ziprasidone (Geodon) is an atypical antipsychotic used to treat symptoms related to altered thought processes. ✅1. Ziprasidone (Geodon) has the potential, in rare cases, to elongate the QT interval; a baseline and periodic EKG would be necessary. ✅2. Ziprasidone (Geodon) needs to be taken with meals for it to be absorbed effectively. It is important for the nurse to teach the client the need to take ziprasidone with meals. ✅3. Palpitations can be a side effect of ziprasidone (Geodon) and would need to be monitored. 4. Seizure precautions are needed with bupropion (Wellbutrin) and clozapine (Clozaril), not ziprasidone (Geodon). 5. A manic episode is not a side effect of ziprasidone. TEST-TAKING HINT: To choose the appropriate interventions, the test taker must be aware of potential risks and special needs of clients who are prescribed ziprasidone (Geodon).

Lithium-Mood Stabilizers

⏺General Most commonly used = Lithium Increases serotonin and decreases norepinephrine Used for Bipolar Disorder ⏺Nursing Considerations • do not administer with NSAIDs • monitor drug blood levels frequently • may cause seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors • Ace Inhibitors may increase serum levels • instruct patient to maintain adequate fluid intake • therapeutic level: 0.5-1.5 mEq/L ⏺Toxicity Lithium toxicity 1️⃣Can be mild, moderate, or severe 2️⃣Kidneys cannot excrete it; builds up 3️⃣Usually when serum levels are 1.5 - 2 mEq/L 🔘Know symptoms N/V/D Weakness Tremor Seizures Hallucinations 🔘Interventions Assess patient Full set of VS EKG LOC Hold dose, notify Provider Obtain labs: CBC, lithium level, CMP/BMP Initiate suicide precautions

The nurse is caring for a client with a history of addiction to alcohol. What medication class should be avoided for chronic treatment of anxiety in the client with an addiction to ETOH? MAO inhibitors Tricyclic antidepressants Antipsychotic medications Benzodiazepines

✅ Benzodiazepines Benzodiazepines produce enhanced psychoactive effects in clients who abuse alcohol. They are also addictive, so they should be avoided in clients with a history of alcohol addiction. Antipsychotic medications This is not addictive substances. Tricyclic antidepressants This is not addictive substances. MAO inhibitors This is not addictive substances.

A client has overdosed on diazepam. Which of the following are signs of an overdose of this medication? Select all that apply. Tachypnea Seizure Muscle spasticity Bluish fingernails Unresponsiveness

✅ Bluish fingernails This is a sign of a benzodiazepine overdose. ✅ Unresponsiveness Diazepam (Valium) is a benzodiazepine. When a client has overdosed on a benzodiazepine, the nurse can expect to see bluish lips and fingernails, double vision, unresponsiveness, bradypnea, dizziness, and/or rapid side-to-side eye movement. Muscle spasticity This is not a symptom of a benzodiazepine overdose. Seizure This is not a symptom of a benzodiazepine overdose. Tachypnea This is not a symptom of a benzodiazepine overdose.

6. Which of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA

✅Ans: A Feedback: Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory neurotransmitters. GABA is an inhibitory neurotransmitter.

Question 10 of 10 The nurse is caring for a client who has been taking a benzodiazepine. For which of the following conditions is the medication taken? Select all that apply. Psychosis Anxiety Obesity ADHD Convulsions

✅Anxiety Benzodiazepines are prescribed for the treatment of severe anxiety, convulsions, as a sedative-hypnotic, and as a muscle relaxant. These medications depress the CNS, and should be used with caution in clients who are taking other CNS medications due to their additive effect. Obesity A CNS stimulant is appropriate for obesity, but not a benzodiazepine. ✅ Convulsions Convulsions are an indication for the administration of benzodiazepines. ADHD Benzodiazepines are not used for this condition. A more appropriate drug class used for ADHD and as a weight-loss drug are CNS stimulants Psychosis A benzodiazepine is not an antipsychotic drug. Antipsychotic drugs act on dopamine receptors in the brain, while benzodiazepines increase the effects of GABA.

The nurse is admitting a client who reports drinking a pint of vodka everyday. What signs or symptoms in this client indicate that the client may require lorazepam? Select all that apply. Bradycardia Shaking Hallucinations Delusions Sweating

✅Sweating Clients experiencing alcohol withdrawal are at risk for seizures, which is typically treated with lorazepam. Signs and symptoms of alcohol withdrawal include sweating, tremors, nausea/vomiting/diarrhea, tachycardia, hallucinations, and delusions. Many facilities will have a set of protocols, such as CIWA, to help you recognize and alcohol withdrawal. ✅ Shaking This is one of the signs of alcohol withdrawal. ✅ Hallucinations This is one of the signs of alcohol withdrawal. ✅ Delusions This is one of the signs of alcohol withdrawal. Bradycardia Tachycardia is noted when a client goes into alcohol withdrawal, not bradycardia.

2. 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 antide- pressants?" Which statement by the nurse is most appropriate? 1. "Probably it is the medication that your insurance will pay for." 2. "You should ask your psychiatrist why the SSRI was ordered." 3. "SSRIs have fewer side effects than the other classifications." 4. "The SSRI medications work faster than the other medications."

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8. A client on an in-patient psychiatric unit states, "They're putting rat poison in my food." Which intervention would assist this client to be medication compliant while on the in-patient psychiatric unit? 1. Remind the client that the psychiatrist ordered the medication for him or her. 2. Maintain the same routine for medication administration. 3. Use liquid medication to avoid cheeking. 4. Keep medications in sealed packages, and open them in front of the client.

. "Paranoia" is a term that implies extreme suspiciousness. 1. Telling a client that the psychiatrist ordered a medication for the client does not assist the client in understanding the benefits of taking the medications. 2. When working with a client experiencing paranoia, it is important to keep a routine; however, routine by itself would not help the client to understand why it is important to take the medications. 3. If staff members believed the client were cheeking the medication, a liquid form would be helpful; however, there is nothing in the stem of the question indicating that the client is doing this. The nurse should not assume all clients exhibiting paranoia are cheeking their medications; however, the nurse should watch for signs of this behavior. ✅4. When a client is exhibiting paranoia, it is important for the nurse to take further actions to encourage compliance. Presenting the client with medication that is labeled and sealed shows that no one has tampered with the medication and may assist with client compliance. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize the symptoms of paranoia presented in the question. Then the test taker must understand how this thinking affects nursing interventions related to medication compliance.

10. A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

. An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. ✅1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. ✅2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 3. Lithium carbonate (lithium) is a mood stabilizer, an antimanic, and would not be used to treat signs and symptoms of anxiety. 4. Clozapine (Clozaril) is an atypical antipsychotic and would not be used to treat signs and symptoms of anxiety. ✅5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. TEST-TAKING HINT: The test taker first must recognize the signs and symptoms presented in the question as an indication of increased levels of anxiety. Next, the test taker must recognize the medications that address these symptoms. Also, it is common to confuse lithium carbonate (lithium) and Librium and clozapine and clonazepam. To answer this question correctly, the test taker needs to distinguish between medications that are similar in spelling.

47. A client on an in-patient psychiatric unit is prescribed lamotrigine (Lamictal) 50 mg QD. After client teaching, which client statement reflects understanding of important information related to lamotrigine? 1. "I know the importance of reporting any alteration in my medication schedule." 2. "I will schedule an appointment for my blood to be drawn at the lab next week." 3. "I will call the doctor immediately if my temperature rises above 100°F." 4. "I will stop my medication if I start having muscle rigidity of my face or neck."

. Lamotrigine (Lamictal) is an anticonvulsant medication used as a mood stabilizer. This medication needs to be titrated slowly, or Stevens-Johnson syndrome, a potentially deadly rash, can result. Nurses need to be aware of this side effect and teach clients to follow dosing directions accurately. ✅1. When the medication is titrated incorrectly, the risk for Stevens-Johnson syndrome increases. Clients need to be taught the importance of taking the medication as prescribed and accurately reporting compliance. 2. Lamotrigine (Lamictal) does not require ongoing lab monitoring. 3. Fever is a potential sign of neuroleptic malignant syndrome, a side effect of antipsychotic medications, not lamotrigine (Lamictal). 4. Muscle rigidity of the face and neck is a potential side effect of all antipsychotic medications, not mood stabilizers such as lamotrigine (Lamictal). TEST-TAKING HINT: To answer this question correctly, the test taker must understand the importance of titrating lamotrigine (Lamictal) to avoid Stevens-Johnson syndrome.

52. A client diagnosed with attention-deficit hyperactivity disorder and juvenile diabetes is prescribed methylphenidate (Ritalin). Which nursing intervention related to both diag- noses takes priority? 1. Teach the client and family to take the methylphenidate (Ritalin) in the morning because it can affect sleep. 2. Teach the client and family to report restlessness, insomnia, and dry mouth to the physician. 3. Teach the client and family to monitor fasting blood sugar levels regularly. 4. Teach the client and family to take methylphenidate (Ritalin) exactly as prescribed.

1 Methylphenidate (Ritalin) can affect sleep; however, this answer does not relate to juvenile diabetes, and because the question clearly asks for interventions related to both diagnoses, the answer is incorrect. 2. Reporting these potential side effects of methylphenidate (Ritalin) is important, but it does not relate to juvenile diabetes; because the question clearly asks for interventions related to both diagnoses, the answer is incorrect. ✅3. Methylphenidate (Ritalin) lowers the client's activity level, which decreases the use of glucose and increases glucose levels. Because of this, it is necessary to monitor fasting blood sugar levels regularly. 4. It is important to take methylphenidate (Ritalin) as prescribed, but this answer does not relate to juvenile diabetes; because the question clearly asks for interventions related to both diagnoses, the answer is incorrect. TEST-TAKING HINT: The test taker must note key words in the question, such as "both diagnoses." If the answers presented address only one diagnosis, as in "1," "2," and "4," they can be eliminated.

12. In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and pre-operative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.

1.Benzodiazepines, used to decrease anxiety symptoms, are not intended to be prescribed for long-term treatment. They can be prescribed for individuals diagnosed with posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. ✅2. Benzodiazepines are prescribed for short- term treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation. 3. Although benzodiazepines are prescribed for short-term treatment, they are not prescribed for essential hypertension.Benzodiazepines are prescribed for short-term treatment of obsessive-compulsive disorder and skeletal muscle spasms. 4. Benzodiazepines are not intended to be prescribed for long-term treatment. They can be prescribed for short-term treatment for individuals diagnosed with panic disorder; for alcohol withdrawal, not dependence; and for agitation related to a manic episode. TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in the answers. Benzodiazepines are prescribed in the short-term because of their addictive properties. The test taker must understand that when taking a test, if one part of the answer is incorrect, the whole answer is incorrect, as in answer choice "3."

13. To which client should the nurse question administering lithium (Eskalith), an antimania medication? 1. The 54-year-old client on a 4-g sodium diet. 2. The 23-year-old client taking an antidepressant medication. 3. The 42-year-old client taking a loop diuretic. 4. The 30-year-old client with a urine output of 40 mL/hour.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

14. 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? 1. "Have you ever had a migraine headache?" 2. "Are you taking any type of birth control?" 3. "When was the last time you had a seizure?" 4. "How long since you have had a manic episode?"

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

15. The client diagnosed with bipolar disorder is taking lithium (Eskalith), an antima- nia medication. Which statement by the client warrants further clarification by the nurse? 1. "I will limit the amount of caffeine I drink." 2. "I really enjoy playing soccer on weekends." 3. "I will drink at least 2000 mL of water a day." 4. "I need to call my HCP if I develop diarrhea."

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

16. The client with bipolar disorder who is taking lithium (Eskalith), an antimania med- ication, has a lithium level of 3.1 mEq/L. Which treatments should the nurse expect the health-care provider to prescribe? Select all that apply. 1. No treatment because this is within the therapeutic range. 2. Initiate intravenous therapy with isotonic sodium chloride. 3. Prepare the client for immediate hemodialysis. 4. Administer the antidote for lithium toxicity. 5. Monitor the client's cardiac status on telemetry.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

17. The client with bipolar disorder is prescribed carbamazepine (Tegretol), an anticon- vulsant. Which data indicates the medication is effective? 1. The client is able to control extremes between mania and depression. 2. The client's serum Tegretol level is within the therapeutic range. 3. The client reports a 3 on a depression scale of 1-10, with 10 indicating severely depressed. 4. The client has a decrease in delusional thoughts and hallucinations.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

18. The client with bipolar disorder who is prescribed lithium (Eskalith), an antimania medication, is admitted to the psychiatric unit in an acute manic state. Which inter- vention should the nurse implement first? 1. Determine the client's serum lithium level. 2. Assess why the client quit taking the lithium. 3. Implement care for the client's physiological needs. 4. Administer a stat dose of lithium to the client.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

19. Which information should the nurse discuss with the client diagnosed with bipolar disorder who is taking the anticonvulsant carbamazepine (Tegretol)? 1. Instruct the client to use a soft-bristled toothbrush. 2. Encourage the client to get ophthalmic examinations annually. 3. Teach the client to monitor the blood pressure daily. 4. Tell the client to avoid hazardous activities.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

20. The client diagnosed with bipolar disorder is prescribed lithium (Eskalith), an anti-mania medication. Which interventions should the nurse discuss with the client? Select all that apply. 1. Monitor serum therapeutic levels. 2. Maintain an adequate fluid intake. 3. Decrease sodium intake in diet. 4. Do not take medication if the radial pulse is <60. 5. Explain ways to prevent orthostatic hypotension.

A Client With Bipolar Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

23. The male client diagnosed with schizophrenia is prescribed ziprasidone (Geodon), an atypical antipsychotic. Which statement to the nurse indicates the client understands the medication teaching? 1. "I need to keep taking this medication even if I become impotent." 2. "I should not go out in the sun without wearing protective clothing." 3. "This medication may cause my breast size to increase." 4. "I may have trouble sleeping when I take this medication."

A Client With Schizophrenia CHAPTER 12 MENTAL HEALTH DISORDERS

3. The client diagnosed with pneumonia is admitted to the medical unit. The nurse notes the client is taking an antidepressant medication. Which data best indicates the antide- pressant therapy is effective? 1. The client reports a 2 on a 1-10 scale, with 10 being very depressed. 2. The client reports not feeling very depressed today. 3. The client gets out of bed and completes activities of daily living. 4. The client eats 90% of all meals that are served during the shift.

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

4. 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? 1. "I am taking the herb ginseng to help my attention span." 2. "I drink extra fluids, especially coffee and iced tea." 3. "I am eating three well-balanced meals a day." 4. "At a family cookout I had chicken instead of a hotdog."

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

5. The client with major depressive disorder is suicidal. The client was prescribed the tricyclic antidepressant imipramine (Tofranil) 3 weeks ago. Which priority interven- tion should the nurse implement? 1. Determine if the client has a plan to commit suicide. 2. Assess if the client is sleeping better at night. 3. Ask the family if the client still wants to kill himself or herself. 4. Observe the client for signs of wanting to commit suicide.

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

6. The client with major depressive disorder has been taking amitriptyline (Elavil), a tricyclic antidepressant, for more than 1 year tells the psychiatric clinic nurse the client wants to quit taking the antidepressant. Which intervention is most important for the nurse to discuss with the client? 1. Ask questions to determine if the client is still depressed. 2. Ask the client why he or she wants to stop taking the medication. 3. Tell the client to notify the HCP before stopping medication. 4. Explain the importance of tapering off the medication.

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

7. The client with major depressive disorder is prescribed duloxetine (Cymbalta), an atypical antidepressant. The client tells the nurse, "I am going to take my medication at night instead of in the morning." Which statement is the nurse's best response? 1. "You really should take the medication in the morning for the best results." 2. "It is all right to take the medication at night. It may help you sleep at night." 3. "The medication should be taken with food so you should not take it at night." 4. "Have you discussed taking the medication at night with your psychiatrist?"

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

8. The client admitted to the psychiatric unit for major depressive disorder with an attempted suicide is prescribed an antidepressant medication. Which interventions should the psychiatric nurse implement? Select all that apply. 1. Assess the client's apical pulse and blood pressure. 2. Check the client's serum antidepressant level. 3. Monitor the client's liver function status. 4. Provide for and ensure the client's safety. 5. Evaluate the effectiveness of the medication.

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

9. The client diagnosed with major depression who attempted suicide is being dis- charged from the psychiatric facility after a 2-week stay. Which discharge interven- tion is most important for the nurse to implement? 1. Provide the family with the phone number to call if the client needs assistance. 2. Encourage the client to keep all follow-up appointments with the psychiatric clinic. 3. Ensure the client has no more than a 7-day supply of antidepressants. 4. Instruct the client not to take any over-the-counter medications without consult- ing with the HCP.

A Client With a Major Depressive Disorder CHAPTER 12 MENTAL HEALTH DISORDERS

33. A client diagnosed with major depressive disorder and experiencing suicidal ideation is showing signs of anxiety. Alprazolam (Xanax) is prescribed. Which assessment should be prioritized? 1. Monitor for signs and symptoms of physical and psychological withdrawal. 2. Teach the client about side effects of the medication, and how to handle these side effects. 3. Assess for nausea, and give the medication with food if nausea occurs. 4. Ask the client to rate his or her mood on a mood scale, and monitor for suicidal ideations.

Alprazolam (Xanax) is a benzodiazepine used to treat symptoms of anxiety. Benzodiazepines depress the central nervous system, and clients can exhibit increased depressive symptoms. 1. Although physical withdrawal can occur when clients abruptly stop their benzodiazepine, this is not a priority intervention when the medication is first prescribed. 2. Although the nurse would need to teach the client about the newly prescribed medication and ways of handling any side effects, the question is asking for an assessment, not the intervention of teaching. 3. A side effect of alprazolam may be nausea, and to decrease this side effect, clients can take the medication with food; however, this is not the nurse's priority assessment in this situation. ✅4. Alprazolam (Xanax) is a central nervous system depressant, and it is important for the nurse in this situation to monitor for worsening depressive symptoms and possible worsening of suicidal ideations. TEST-TAKING HINT: The test taker needs to note important words in the question, such as "assessment" and "priority," to choose the correct answer. Although some of the answers may be correct statements, as in "2," they do not meet the criteria of assessment.

1. The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala

Ans: A Feedback: The frontal lobes of the cerebrum control the organization of thought, body movement, memories, emotions, and moral behavior. The cerebellum is located below the cerebrum and is the center for coordination of movements and postural adjustments. The medulla, located at the top of the spinal cord, contains vital centers for respiration and cardiovascular functions. The hippocampus and amygdala are involved in emotional arousal and memory.

34. When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication.

Ans: B Feedback: Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are not mild side effects because these are very uncomfortable symptoms. These symptoms would not be an idiosyncratic reaction because this is the expected reaction. These symptoms are not indicative of a severe allergy to the medication.

22. Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? A) Opisthotonus B) Oculogyric crisis C) Torticollis D) Pseudoparkinsonism

Ans: B Feedback: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects.

35. When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic? A) "This is a good medication! It will be effective within 20 minutes of the first dose." B) "You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication." C) "It will probably take months for the medication to work. In the meantime, you should work on improving your attitude." D) "If you believe it will work, then it will. You have to have faith!"

Ans: B Feedback: SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these drugs are an ìinitiating eventî and that eventual therapeutic effectiveness results when neurons respond more slowly, making serotonin available at the synapses. The medication will not be effective within 20 minutes of the first dose, and it will not likely take months for the medication. Attitude and faith will improve with the medication's effectiveness.

39. The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time.

Ans: B, C, E Feedback: Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stool softeners are permissible, but the client should avoid laxatives. The use of sunscreen is recommended because photosensitivity can cause the client to sunburn easily. If the client forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose.

38. Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy

Ans: B, E Feedback: Lethargy and weight gain are difficult to manage or minimize and frequently lead to noncompliance.

24. Which of the following increases the risk for neuroleptic malignant syndrome (NMS)? A) Overhydration B) Intake of vitamins C) Dehydration D) Vegetarian diet

Ans: C Feedback: Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritional status. Vegetarian diet would not relate to NMS.

33. A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports A) feeling sleepy and less energetic. B) weight gain of 7 pounds in the last 6 months. C) minimal mood swings. D) increased feelings of self-worth.

Ans: C Feedback: Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment.

37. A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The patient is symptom-free and therefore does not need to adhere to the medication regimen. B) The patient cannot clearly see the instructions written on the prescription bottle. C) The patient dislikes the weight gain associated with antipsychotic therapy. D) The patient sells the antipsychotics to addicts in the neighborhood.

Ans: C Feedback: Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally balanced diets; this pattern decreases the likelihood that they can minimize potential weight gain or lose excess weight. Antipsychotics should be taken regularly and not omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do they have addictive potential.

40. The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements? A) "I'm glad I can eat pizza since it's my favorite food." B) "I must follow this diet or I will have severe vomiting." C) "It will be difficult for me to avoid pepperoni." D) "None of the foods that are restricted are part of a regular daily diet."

Ans: C Feedback: Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular concern to this client is the potential life-threatening hypertensive crisis if the client ingests food that contains tyramine. Answer choices A, B, and D are inappropriate statements toward effective teaching for the client receiving a monoamine oxidase inhibitor.

31. A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see? A)Constipation and postural hypotension B)Fever, muscle rigidity, and disorientation C)Nausea, diarrhea, and confusion D)None; the serum level is in therapeutic range

Ans: C Feedback: Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.

26. Which of the following is the primary consideration with clients taking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep

Ans: C Feedback: Suicide is always a primary consideration when treating clients with depression.

30. One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of A) acute dystonic reaction. B) extrapyramidal side effects. C) neuroleptic malignant syndrome. D) tardive dyskinesia.

Ans: C Feedback: The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing.

25. Which of the following was the first nonstimulant medication specifically designed and tested for ADHD? A) Methylphenidate (Ritalin) B) Amphetamine (Adderall) C) Atomoxetine (Strattera) D) Pemoline (Cylert)

Ans: C Feedback: Strattera was the first nonstimulant medication specifically designed and tested for ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin), amphetamine (Adderall), and pemoline (Cylert).

21. A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following? A) Tardive dyskinesia B) Neuroleptic malignant syndrome C) Dystonia D) Akathisia

Ans: D Feedback: Akathisia is reported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.

28. Which drug classification is the primary medication treatment for schizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics

Ans: D Feedback: Antipsychotic drugs are the primary medical treatment for clients diagnosed with schizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis.

27. Which of the following would not be included as a symptom of drug-induced parkinsonism? A) Stooped posture B) Cogwheel rigidity C) Drooling D) Tachycardia

Ans: D Feedback: Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse pill-rolling movements of the thumb and fingers while at rest.

32. For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivity reaction D) Sore throat and malaise

Ans: D Feedback: Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects.

27. A client has been compliant with risperidone (Risperdal) 4 mg QHS for the past year. On assessment, the nurse notes that the client has bizarre facial and tongue movements. Which is a priority nursing intervention? 1. With the next dose of risperidone (Risperdal), give the ordered PRN dose of benztropine(Cogentin). 2. Hold the next dose of risperidone(Risperdal),and notify the physician to discontinue the medication. 3. Ask the physician to increase the dose of risperidone (Risperdal) to assist with the bizarre behaviors. 4. Explain to the client that these side effects are temporary and should subside in 2 to 3 weeks.

Bizarre facial and tongue movements, stiff neck, and difficulty swallowing all are signs of tardive dyskinesia (TD). All clients receiving long-term antipsychotic medications, from months to years, are at risk. The symptoms are potentially permanent, and the medication should be discontinued as soon as symptoms are noted. 1. Benztropine(Cogentin),ananticholinergic medication, works for extrapyramidal symptoms, such as pseudoparkinsonism (tremor, shuffling gait, drooling, and rigidity), akinesia (muscular weakness), akathisia (restlessness and fidgeting), dystonia (involuntary muscular movements or spasms of the face, arms, legs, and neck), and oculogyric crisis (uncontrolled rolling back of the eyes). If the nurse continues to administer risperidone (Risperdal), the TD will continue to worsen and have the potential to be irreversible. ✅2. When the nurse notes signs of TD, the medication needs to be held and the physician notified to discontinue the medication. It is important for nurses to assess for the beginning signs of TD throughout antipsychotic therapy to avoid permanent damage. 3. These bizarre behaviors are not signs of psychosis, and if more risperidone (Risperdal) is given, the symptoms may worsen and potentially become irreversible. 4. TD can be a permanent side effect of long- term antipsychotic medications; however, if the medication is discontinued immediately when symptoms arise, the chance decreases that TD will become permanent. Because this answer does not mention discontinuing the medication, it is incorrect. TEST-TAKING HINT: Recognize that in answer "1," giving benztropine (Cogentin) may be appropriate; however, if the nurse continues to give the risperidone (Risperdal), TD could become irreversible. The test taker must recognize that if one part of the answer is incorrect, the entire answer is incorrect.

36. A client has been taking bupropion (Wellbutrin) for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the emergency department. For which reason would the nurse question the continued use of this medication? 1. The client may have a possible injury to the gastrointestinal system. 2. The client is at risk for seizures from a potential closed head injury. 3. The client is at increased risk of bleeding while taking bupropion. 4. The client may experience sedation from bupropion, making assessment difficult

Bupropion (Wellbutrin) is an antidepressant that has a side effect of lowering the seizure threshold. 1. There is not a concern with injury to the gastrointestinal system while taking bupropion. ✅2. Bupropion lowers the seizure threshold. Bupropion is contraindicated for clients who have increased potential for seizures, such as a client with a closed head trauma injury. 3. Bupropion does not place a client at risk for increased bleeding. 4. Although some individuals initially may be sedated while taking bupropion, the client in the question has taken the medication for more than 1 year, and sedation would not be a concern. TEST-TAKING HINT: The test taker must understand that bupropion lowers the seizure threshold, and that clients with a head injury are at high risk for seizure activity. The combination of these two facts would lead the nurse to question the use of this medication.

49. A client diagnosed with bipolar affective disorder is prescribed carbamazepine (Tegretol). The client exhibits nausea, vomiting, and anorexia. Which is an appropriate nursing intervention at this time? 1. Stop the medication, and notify the physician. 2. Hold the next dose until symptoms subside. 3. Administer the next dose with food. 4. Ask the physician for a stat carbamazepine (Tegretol) level.

Carbamazepine (Tegretol) is classified as an anticonvulsant and used as a mood stabilizer in the treatment of clients diagnosed with bipolar affective disorder. Nausea, vomiting, and anorexia all are acceptable side effects of carbamazepine. 1. Because nausea, vomiting, and anorexia all are acceptable side effects, the nurse would not need to stop the medication and notify the physician. 2. Because nausea, vomiting, and anorexia all are acceptable side effects, the nurse would not need to hold the next dose until symptoms subside. ✅3. When clients prescribed carbamazepine (Tegretol) experience nausea, vomiting, and anorexia, it is important for the nurse to administer the medication with food to decrease these uncomfortable, but accept- able, side effects. If these side effects do not abate, other interventions may be necessary. 4. Although a carbamazepine (Tegretol) level may need to be obtained, it is unnecessary for the nurse to request a stat carbamazepine level because these symptoms are acceptable TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that nausea, vomiting, and anorexia are uncomfortable, but acceptable, side effects of carbamazepine (Tegretol) therapy

15. In which situation would the nurse expect an additive central nervous system depres- sant effect? 1. When the client is prescribed chloral hydrate (Noctec) and thioridazine (Mellaril). 2. When the client is prescribed temazepam (Restoril) and pemoline (Cylert). 3. When the client is prescribed zolpidem (Ambien) and buspirone (BuSpar). 4. When the client is prescribed zaleplon (Sonata) and verapamil (Calan).

Chloral hydrate (Noctec), temazepam (Restoril), zolpidem (Ambien), and zaleplon (Sonata) all are sedative/hypnotic medications. Additive central nervous system (CNS) depression can occur when sedative/hypnotic medications are taken concomitantly with alcohol, antihistamines, antidepressants, phenothiazines, or any other CNS depressant. ✅1. Chloral hydrate is a sedative/hypnotic, and thioridazine (Mellaril) is a phenothiazine. When they are given together, the nurse needs to watch for an additive CNS depressant effect. 2. Temazepam, a sedative/hypnotic, is a CNS depressant; pemoline (Cylert), a medication used to treat attention-deficit hyperactivity disorder, is not a CNS depressant. There are no additive effects. 3. Zolpidem, a sedative/hypnotic, is a CNS depressant; buspirone (BuSpar), an antianxiety medication, does not have a CNS depressant effect. 4. Zaleplon, a sedative/hypnotic, is a CNS depressant; verapamil (Calan), used to assist individuals having flashbacks from posttraumatic stress TEST-TAKING HINT: To answer this question correctly, the test taker must review medication actions and recognize potential CNS depressive effects.

40. A client comes to the hospital complaining of depression with suicidal ideations. The physician prescribes citalopram (Celexa). Approximately 4 days later, the client has pressured speech and is noted wearing heavy makeup. What may be a potential reason for this client behavior? 1. The client is in a manic episode caused by the citalopram (Celexa). 2. The client is showing improvement and is close to discharge. 3. The client is masking depression in an attempt to get out of the hospital. 4. The client has "cheeked" medications and taken them all at once in an attempt to overdose.

Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) prescribed for depressive disorders. Frequently, clients are admitted to an in-patient psychiatric unit complaining of depressive symptoms and are not asked about possible history of manic or hypomanic episodes. These symptoms may indicate a diagnosis of bipolar affective disorder, either type 1 (with at least one manic episode) or type 2 (with at least one hypomanic episode). ✅1. When an SSRI is prescribed for clients with bipolar affective disorder, it can cause alterations in neurotransmitters and trigger a hypomanic or manic episode. 2. This client is exhibiting signs of a manic episode and is not ready for discharge. 3. Although clients may attempt to mask their depression to be discharged, the symptoms noted in the question are signs of a manic episode. 4. When a client has decided not to take the medications and chooses not to share this decision with the team, the client may choose to "cheek" or hide medications in the mouth. This allows the client either to discard or hoard the medication for use at another time If an individual takes SSRIs in an attempt to overdose, it would not cause a client to experience a manic episode. TEST-TAKING HINT: It is important for the test taker to understand the effects of psychotropic medications on neurotransmitters, and how these may generate signs and symptoms of mania in clients with a diagnosis of bipolar affective disorder.

13. A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.

Clonazepam, a benzodiazepine, acts quickly to assist clients with anxiety symptoms. Buspirone, an antianxiety agent, and citalopram, a selective serotonin reuptake inhibitor, are used in the long-term treatment of anxiety symptoms. Buspirone and citalopram take about 4 to 6 weeks to take full effect, and the quick-acting benzodiazepine would be needed to assist the client with decreasing anxiety symptoms before these other medications take effect. All of these medications affect the neurotransmitter serotonin. 1. Although it is important for all clients to be assessed for depression and suicidal ideation, it is not stated in the stem that this client is exhibiting signs of depression. The question is asking for the nurse to note important information related to using all the medications at the same time, and this statement is incorrect. ✅2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor. 3. These symptoms are signs of neuroleptic malignant syndrome, a rare but potentially deadly side effect of all antipsychotic medications, such as haloperidol (Haldol), but not of the medications listed in the stem. 4. These symptoms are signs of tardive dyskinesia and dystonia, which are potential side effects of all antipsychotic medications, but not of the medications listed in the question. TEST-TAKING HIN TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the signs and symptoms of serotonin syndrome and which psychotropic medications affect serotonin, potentially leading to this syndrome.

11. A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam (Klonopin) is to be used for long-term therapy in conjunction with buspirone (BuSpar). 2. The client verbalizes that buspirone (BuSpar) can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam (Klonopin) is to be used short-term until the buspirone (BuSpar) takes full effect. 4. The client verbalizes that tolerance can result with long-term use of buspirone(BuSpar).

Clonazepam, a benzodiazepine, is a central nervous system (CNS) depressant; buspirone, an antianxiety medication, does not affect the CNS. 1. Clonazepam is used in the short-term, not long-term, while waiting for buspirone to take full effect, which can take 4 to 6 weeks. 2. Buspirone does not cause sedation because it is not a CNS depressant. ✅3. Clonazepam would be used for short- term treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks. 4. Tolerance can result with long-term use of clonazepam, but not with buspirone. TEST-TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients prescribed different classifications of antianxiety medications.

50. A 10-year-old client prescribed dextroamphetamine (Dexedrine) has a nursing diagno- sis of imbalanced nutrition: less than body requirements R/T a side effect of anorexia. Which nursing intervention addresses this client's stated problem? 1. Monitor output and sleep patterns daily. 2. Take medications with food to avoid nausea. 3. Schedule medication administration after meals. 4. Increase fiber and fluid intake to avoid constipation.

Dextroamphetamine (Dexedrine) is a stimulant used in the treatment of attention-deficit hyperactivity disorder. It is important for the nurse to monitor the client's development because stimulant medications can stunt growth. 1. Monitoring output and sleep patterns would not assist in meeting this client's nutritional needs. 2. In the stated situation, the imbalanced nutrition is due to the side effect of anorexia, and not to nausea and vomiting. If the client were experiencing nausea and vomiting, a side effect of atomoxetine (Strattera) and bupropion (Wellbutrin), taking the medication with food would be an appropriate intervention. ✅3. The nurse should administer stimulants after meals for clients to be able to consume a balanced diet before experiencing the potential side effect of anorexia. 4. The imbalanced nutrition in this situation is not being caused by constipation; it is being caused by the side effect of anorexia. Constipation is a common side effect for atomoxetine (Strattera) and bupropion (Wellbutrin). Increasing fiber and fluid intake would then be appropriate, if not contraindicated by other factors. TEST-TAKING HINT: To answer this question correctly, the test taker must pair the nursing intervention with the nursing diagnosis presented in the question.

14. Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. ✅1. Insomnia is correct. ✅2. Tremor is correct. ✅3. Delirium is correct. 4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. 5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. TEST-TAKING HINT: The test taker must distinguish between benzodiazepine side effects and symptoms of withdrawal to answer this question correctly

48. A client diagnosed with bipolar affective disorder is prescribed divalproex sodium (Depakote). Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply. 1. Platelet count and bleeding time. 2. Aspartate aminotransferase (AST). 3. Fasting blood sugar (FBS). 4. Alanine aminotransferase (ALT). 5. Valproic acid level.

Divalproex sodium (Depakote) is classified as an anticonvulsant and used as a mood stabilizer in the treatment of clients diagnosed with bipolar affective disorder. Side effects of this medication include prolonged bleeding times and liver toxicity. ✅1. Platelet counts and bleeding times need to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effects of blood dyscrasias and prolonged bleeding time. ✅2. Aspartate aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium (Depakote) because of the poten- tial side effect of liver toxicity. 3. Fasting blood sugar measurements are not affected and are not indicated during treatment with valproic acid. ✅4. Alanine aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effect of liver toxicity. ✅5. Divalproex sodium (Depakote) levels need to be monitored to determine therapeutic levels and assess potential toxicity. TEST-TAKING HINT: To answer this question correctly, the test taker first must understand that AST and ALT are liver function studies. Then the test taker must recognize that side effects of divalproex sodium (Depakote) therapy may include prolonged bleeding time, liver toxicity, and the potential for divalproex sodium toxicity.

Which of the following is the most appropriate recommendation to give to a patient taking benzodiazepines? Avoid if Sulfa Allergy Take with Flumazenil Monitor Blood Pressure Closely Do Not Stop Abruptly Increase Potassium Glucose Monitoring

Do Not Stop Abruptly Patients that use benzodiazepines like diazepam (Valium) at home should not abruptly stop their medication. They should be tapered off to prevent any withdrawal symptoms. Signs of withdrawal syndrome include altered mental status, anxiety, tachycardia, and vomiting.

17. A client is prescribed estazolam (ProSom) 1 mg QHS. In which situation would the nurse clarify this order with the physician? 1. A client with a blood urea nitrogen of 16 mmol/L and creatine of 1.0 mg/dL. 2. A client with an aspartate aminotransferase of 60 mcg/L and an alanine aminotransferase of 70 U/L. 3. A client sleeping 2 to 3 hours per night. 4. A client rating anxiety level at night to be a 5 out of 10.

Estazolam (ProSom) is prescribed to assist clients with sleep. Before an initial dose of estazolam (ProSom), the nurse needs to ensure the client's kidney and liver functions are normal. 1. A client with a blood urea nitrogren of 16 mg/dL (normal range 10 to 26 mg/dL) and a creatine of 1.0 mg/dL (normal range 0.6 to 1.4 mg/dL) is within the normal range for both, and there is no concern related to the use of estazolam. ✅2. A nurse would be concerned if a client's aspartate aminotransferase (normal range 16 to 40 mcg/L) and alanine aminotransferase (normal range 8 to 54 U/L) were elevated. A client needs to have normal liver function to metabolize estazolam (ProSom) properly, and the nurse would need to check with the physician to clarify the safety of this order. 3. A client sleeping only 2 to 3 hours a night would be an appropriate candidate for any sedative that would assist with sleep. 4. A client's having an anxiety rating of 5 out of 10 should not deter the nurse from administering estazolam (ProSom) because this agent is being prescribed for sleep TEST-TAKING HINT: To answer this question correctly, the test taker first has to understand that sedative/hypnotics are metabolized through the liver, and then recognize that aspartate aminotransferase and alanine aminotransferase are liver function studies, and the values presented are outside the normal range.

25. A client is prescribed hydroxyzine (Atarax) 50 mg QHS and clozapine (Clozaril) 25 mg bid. Which is an appropriate nursing diagnosis for this client? 1. Risk for injury R/T serotonin syndrome. 2. Risk for injury R/T possible seizure. 3. Risk for injury R/T clozapine (Clozaril) toxicity. 4. Risk for injury R/T depressed mood.

Hydroxyzine (Atarax) is an antianxiety medication, and clozapine (Clozaril) is an atypical antipsychotic with many side effects. 1. Although hydroxyzine (Atarax) affects serotonin, clozapine (Clozaril) does not have much impact on serotonin, and the risk for serotonin syndrome is low. ✅2. A side effect of clozapine is that it lowers the seizure threshold. The nurse would need to place the client taking clozapine (Clozaril) on seizure precautions. 3. There is no test for clozapine (Clozaril) blood levels. Signs that too much clozapine (Clozaril) has been taken include, but are not limited to, excessive sedation or hypersalivation. 4. Hydroxyzine (Atarax) and clozapine (Clozaril) are not used for treating depression, and this answer is incorrect. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that a potential side effect of clozapine is seizure activity, and that this can place the client at risk for injury.

46. A client prescribed lithium carbonate (lithium) 300 mg bid 3 months ago is brought into the hospital emergency department with mental confusion, excessive diluted urine output, and consistent tremors. Which lithium level would the nurse expect? 1. 1.2 mEq/L. 2. 1.5 mEq/L. 3. 1.7 mEq/L. 4. 2.2 mEq/L.

Lithium carbonate (lithium) is a mood stabilizer that is prescribed for individuals diagnosed with bipolar affective disorder. The usual range of therapeutic serum concentration is 0.6 to 1.2 mEq/L for maintenance and 1.0 to 1.5 mEq/L for acute mania. The margin between the therapeutic and toxic levels of lithium carbonate is very narrow. Serum lithium levels should be monitored once or twice a week after initial treatment until dosage and serum levels are stable. 1. 1.2 mEq/L is within the normal maintenance range for lithium, and the client would not exhibit the symptoms listed in the question. 2. The level necessary for managing acute mania is 1.0 to 1.5 mEq/L, and 1.5 mEq/L is within the range for managing acute mania. The client would not exhibit the symptoms listed in the question. 3. When the serum lithium level is 1.5 to 2.0 mEq/L, the client exhibits signs such as blurred vision, ataxia, tinnitus, persistent nausea, vomiting, and diarrhea. 4. When the serum lithium level is 2.0 to 3.5 mEq/L, the client may exhibit signs such as excessive output of diluted urine, increased tremors, muscular irritability, psychomotor retardation, mental confu- sion, and giddiness. TEST-TAKING HINT: The test taker must be able to pair the lithium level with the client symptoms presented in the question. Lithium has a narrow therapeutic range, and levels outside this range place the client at high risk for injury

43. A client is newly prescribed lithium carbonate (lithium). Which teaching point by the nurse takes priority? 1. "Make sure your salt intake is consistent." 2. "Limit your fluid intake to 2000 mL/day." 3. "Monitor your caloric intake because of potential weight gain." 4. "Get yourself in a daily routine to assist in avoiding relapse."

Lithium carbonate (lithium) is a mood stabilizer that is used in clients diagnosed with bipolar affective disorder. The margin between the therapeutic and toxic levels of lithium carbonate is very narrow. Serum lithium levels should be monitored once or twice a week after initial treatment until dosage and serum levels are stable. ✅1. Lithium is similar in chemical structure to sodium, behaving in the body in much the same manner and competing with sodium at various sites in the body. If sodium intake is reduced, or the body is depleted of its normal sodium, lithium is reabsorbed by the kidneys, and this increases the potential for toxicity. 2. When a client is prescribed lithium carbonate (lithium), it is important for the client to keep fluid intake around 2500 to 3000 mL/d. 3. Weight gain is a potential side effect of lithium carbonate (lithium) therapy and would need to be monitored; however, risk for toxicity is a higher priority than weight gain. 4. It is important for clients to have some routine to assist them in remembering to take their medications regularly. This also helps clients maintain their sleep-wake cycle, which has been shown to be important to avoid relapse in clients diagnosed with bipolar affective disorder. Although it is important to talk to the client about this, risk for toxicity is the highest priority because it is life- threatening. TEST-TAKING HINT: When a question is asking for the "priority," it is important for the test taker always to address safety concerns. In this question, the risk for toxicity related to salt intake could cause the client serious injury and possibly death. This intervention takes highest priority.

42. A client prescribed lithium carbonate (lithium) 300 mg QAM and 600 mg QHS enters the emergency department experiencing impaired consciousness, nystagmus, and arrhythmias. Earlier today the client had two seizures. Which serum lithium level would the nurse expect to assess? 1. 3.7 mEq/L. 2. 3.0 mEq/L. 3. 2.5 mEq/L. 4. 1.9 mEq/L.

Lithium carbonate (lithium) is a mood stabilizer that is used in clients diagnosed with bipolar affective disorder. The margin between the therapeutic and toxic levels of lithium carbonate is very narrow. Serum lithium levels should be monitored once or twice a week after initial treatment until dosage and serum levels are stable. The maintenance level for lithium carbonate is 0.6 to 1.2 mEq/L. ✅1. Clients with a serum level greater than 3.5 mEq/L may show signs such as impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, or cardiovascular collapse. 2. When the serum lithium level is 2.0 to 3.5 mEq/L, the client may exhibit signs such as excessive output of diluted urine, increased tremors, muscular irritability, psychomotor retardation, mental confusion, and giddiness. 3. When the serum lithium level is 2.0 to 3.5 mEq/L, the client may exhibit signs such as excessive output of diluted urine, increased tremors, muscular irritability, psychomotor retardation, mental confusion, and giddiness. 4. When the serum lithium level is 1.5 to 2.0 mEq/L, the client exhibits signs such as blurred vision, ataxia, tinnitus, persistent nausea, vomiting, and diarrhea. TEST-TAKING HINT: The test taker must be able to pair the serum lithium level with the client's symptoms presented in the question. Lithium has a narrow therapeutic range, and levels outside this range place the client at high risk for injury

45. The nurse is evaluating lab test results for a client prescribed lithium carbonate (lithium). The client's lithium level is 1.9 mEq/L. Which nursing intervention takes priority? 1. Give next dose because the lithium level is normal for acute mania. 2. Hold the next dose, and continue the medication as prescribed the following day. 3. Give the next dose after assessing for signs and symptoms of lithium toxicity. 4. Immediately notify the physician, and hold the dose until instructed further.

Lithium carbonate (lithium) is a mood stabilizer that is used in clients diagnosed with bipolar affective disorder. The margin between the therapeutic and toxic levels of lithium carbonate is very narrow. The maintenance level for lithium carbonate is 0.6 to 1.2 mEq/L. 1. The level necessary for managing acute mania is 1.0 to 1.5 mEq/L, and 1.9 mEq/L falls outside the therapeutic range. When the serum lithium level is 1.5 to 2.0 mEq/L, the client exhibits signs such as blurred vision, ataxia, tinnitus, persistent nausea, vomiting, and diarrhea. 2. The nurse should hold the next dose, and before administering any future doses, discuss the lab results with the physician. 3. Whether or not the client exhibits signs and symptoms of toxicity, based on the lab value noted in the question, the nurse would not give the next dose of lithium. If the serum level is not discussed with the physician, the client may be at risk for toxicity. ✅4. The nurse needs to notify the physician immediately of the serum level, which is outside the therapeutic range, to avoid any risk for further toxicity. TEST-TAKING HINT: The test taker must understand the therapeutic lab value range for lithium carbonate (lithium). If one part of the answer is incorrect, the entire answer is incorrect. In "2," the nurse's holding the medication but continuing the dose the next day would place the client at risk for injury and is an incorrect answer

41. Lithium carbonate (lithium) is to mania as clozapine (Clozaril) is to: 1. Anxiety. 2. Depression. 3. Psychosis. 4. Akathisia.

Lithium carbonate (lithium) is a mood stabilizing medication that is used to treat symptoms of bipolar affective disorder (BPAD). Symptoms of BPAD include, but are not limited to, mania, labile mood, and depression. 1. Benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) are medications to assist clients with anxiety. Nurses need to remember that SSRIs begin to show an effect in 2 to 3 weeks and reach full effect around 4 to 6 weeks of regular use. 2. Medications that assist clients with depression are monoamine oxidase inhibitors, tricyclic antidepressants, and SSRIs. ✅3. Clozapine (Clozaril), an atypical antipsy- chotic, is used to treat symptoms of thought disorders, such as, but not limited to, psychoses. 4. Akathisia is an extrapyramidal symptom that occurs as a result of the use of antipsychotic medications. Medications to treat extra- pyramidal symptoms such as akathisia are anticholinergic or antihistamine drugs. TEST-TAKING HINT: When answering an analogy, the test taker must recognize the relationships of subject matter within the question

30. The 43-year-old female client diagnosed with schizophrenia has been taking the con- ventional antipsychotic medication chlorpromazine (Thorazine) for 20 years. Which assessment data warrants discontinuing the medication? 1. The client has had menstrual irregularities for the past year. 2. The client has to get up very slowly from a sitting position. 3. The client complains of having a dry mouth and blurred vision. 4. The client has fine, wormlike movements of the tongue.

Menstrual irregularity is a common side effect of conventional antipsychotic med- ications like Thorazine and would not warrant discontinuing the medication. Orthostatic hypotension is a common side effect of conventional antipsychotic med- ications and would not warrant discontin- uing the medication. Anticholinergic effects are common side effects of conventional antipsychotic med- ications and would not warrant discontin- uing the medication. ✅ 4. Exhibiting fine, wormlike movements of the tongue is a symptom of tardive dyskinesia, which is an adverse effect that may develop after months or years of continuous therapy with a conven- tional antipsychotic medication. The medication should be discontinued, and a benzodiazepine should be administered.

37. A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Mirtazapine (Remeron) is prescribed. Which nursing intervention takes priority? 1. Remind the client that medication effectiveness may take 2 to 3 weeks. 2. Teach the client to take the medication with food to avoid nausea. 3. Check the client's blood pressure every shift to monitor for hypertension. 4. Monitor closely for signs that the client might be "cheeking" medications.

Mirtazapine (Remeron) is a tetracyclic antidepressant used to treat depressive symptoms. When a client has decided not to take the medications and chooses not to share this decision with the team, the client may choose to "cheek" or hide medications in the mouth. This allows the client either to discard the medication or, as in the question, hoard the medication for use at another time. 1. Although the medication may take 2 to 3 weeks to begin taking effect, the question is asking for a priority intervention. The priority in this situation is to ensure the client is not cheeking the medication to follow through with his or her suicidal plan. 2. Mirtazapine can be taken with food if nausea occurs; however, this intervention is not the priority. 3. Monitoring blood pressure is a priority; however, mirtazapine can cause hypotension, not hypertension, so this statement is incorrect. ✅4. If a client comes into the in-patient psy- chiatric unit with a plan to overdose, it is critical that the nurse monitor for cheek- ing and hoarding of medications. Clients may cheek and hoard medications to take, as an overdose, at another time TEST-TAKING HINT: The test taker needs to note important words in the question, such as "priority." Although "1" is a correct statement, when a client is initially admitted to an in-patient psychiatric unit with a plan to overdose, the nurse's priority is to monitor for cheeking and hoarding of medications to prevent a future suicide attempt.

35. Which situation would place a client at high risk for a life-threatening hypertensive crisis? 1. A client is prescribed tranylcypromine (Parnate) and eats chicken salad. 2. A client is prescribed isocarboxazid (Marplan) and drinks hot chocolate. 3. A client is prescribed venlafaxine (Effexor) and drinks wine. 4. A client is prescribed phenelzine (Nardil) and eats fresh roasted chicken.

Monoamine oxidase inhibitors (MAOIs) are used to treat depression. A nurse working with a client prescribed one of these medications must provide thorough instruction regarding interactions with other medications and foods. While taking MAOIs, clients cannot consume a long list of foods, which include, but are not limited to, the following: aged cheese, wine (especially Chianti), beer, chocolate, colas, coffee, tea, sour cream, beef/chicken livers, canned figs, soy sauce, overripe and fermented foods, pickled herring, preserved sausages, yogurt, yeast products, smoked and processed meats, cold remedies, or diet pills. Clients must be reminded that they must talk with their physician before taking any medication, including over-the-counter medications, to avoid a life-threatening hypertensive crisis. If a client consumes these foods or other medications during, or within 2 weeks after stopping, treatment with MAOIs, a life-threatening hypertensive crisis could occur. 1. Chicken salad is safe to eat with MAOIs such as tranylcypromine. ✅2. Isocarboxazid is an MAOI, and the intake of chocolate would cause a life-threaten- ing hypertensive crisis. 3. Venlafaxine is a nonselective reuptake inhibitor. Although it should not be taken with wine, concurrent use would not cause a hypertensive crisis. 4. Fresh roasted chicken is safe to eat with MAOIs such as phenelzine. TEST-TAKING HINT: To answer this question correctly, the test taker must take special note of medications, such as MAOIs, that have potentially serious side effects when drug-drug or drug-food interactions occur.

24. A client prescribed quetiapine (Seroquel) 50 mg bid has a nursing diagnosis of risk for injury R/T sedation. Which nursing intervention appropriately addresses this client's problem? 1. Assess for homicidal and suicidal ideations. 2. Remove clutter from the environment to avoid injury. 3. Monitor orthostatic changes in pulse or blood pressure. 4. Evaluate for auditory and visual hallucinations.

Quetiapine (Seroquel) is an atypical antipsychotic used in the treatment of thought disorders. A significant side effect of quetiapine is sedation. 1. Although the nurse would want to monitor for homicidal and suicidal ideations, this answer does not relate to the nursing diagnosis noted in the question. ✅2. Removing clutter from the client's environment would assist the client in avoiding injury due to tripping and falling. It is important for the nurse to ensure the environment is clutter-free, especially when the client may be sedated. 3. There is a potential for orthostatic changes when a client is prescribed quetiapine (Seroquel). However, orthostatic changes are not related to the "sedation" noted in the nursing diagnosis. 4. Although it is important for the nurse to evaluate for auditory and visual hallucinations while a client is taking quetiapine (Seroquel), such evaluation does not relate to the stated nursing diagnosis. TEST-TAKING HINT: When a nursing diagnosis is presented in the question, the test taker should make sure the intervention chosen relates to all aspects of the stated nursing diagnosis: the NANDA stem, the "related to" statement, and the "as evidenced by" data.

21. Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to: 1. Anxiety. 2. Depression. 3. Mania. 4. Alcohol dependency.

Risperidone (Risperdal) is an antipsychotic medication that decreases excessive dopamine, a neurotransmitter, and decreases hallucinations. ✅1. Clonazepam (Klonopin) is a benzodiazepine that works quickly to relieve anxiety. 2. Medications prescribed for depression include monoamine oxidase inhibitors, tricyclic antidepressants, or selective serotonin reuptake inhibitors. 3. Medications to assist with manic symptoms are atypical antipsychotics and mood stabilizers (e.g., anticonvulsants). 4. Clients who are dependent on alcohol sometimes are placed on medications to assist with their cravings, such as naltrexone (ReVia). Individuals going through alcohol withdrawal are placed on a short-acting benzodiazepine to assist with withdrawal symptoms. TEST-TAKING HINT: When answering an analogy, it is important for the test taker to recognize the relationships of subject matter within the question.

31. A client recently prescribed fluphenazine (Prolixin) complains to the nurse of severe muscle spasms. On examination, heart rate is 110, blood pressure is 160/92 mm Hg, and temperature is 101.5°F. Which nursing intervention takes priority? 1. Check the chart for a PRN order of benztropine mesylate (Cogentin) because of increased extrapyramidal symptoms. 2. Hold the next dose of fluphenazine (Prolixin), and call the physician immediately to report the findings. 3. Scheduleanexaminationwiththeclient'sphysiciantoevaluatecardiovascularfunction. 4. Ask the client about any recreational drug use, and ask the physician to order a drug screen.

Severe muscle spasms, increased heart rate, hypertension, and hyperpyrexia all are symptoms of neuroleptic malignant syndrome (NMS). NMS is a rare but potentially fatal complication of treatment with neuroleptic drugs. 1. The symptoms are not indicative of extrapyramidal symptoms, which include, but are not limited to, tremors, dystonia, akinesia, and akathisia. ✅2. Because NMS is related to the use of neu- roleptic medications, such as fluphenazine (Prolixin), the next dose should be held, and the client's physician should be notified immediately because this is a life- threatening situation. 3. Elevated blood pressure and pulse rate in this situation are not due to cardiac problems, but are due to NMS from the use of neuroleptic medications. 4. Drug use can cause the listed symptoms, but when the nurse understands the relationship between neuroleptics and NMS, the nurse understands the client is at risk for this life-threatening condition. TEST-TAKING HINT: The test taker should review the side effects of neuroleptic medications, such as NMS, extrapyramidal symptoms, and tardive dyskinesia, to prioritize nursing interventions.

18. A client complains of poor sleep and loss of appetite. When prescribed trazodone (Desyrel) 50 mg QHS, the client states, "Why am I taking an antidepressant? I'm not depressed." Which nursing response is most appropriate? 1. "Sedation is a side effect of this low dose of trazodone. It will help you sleep." 2. "Trazodone is an appetite stimulant used to prevent weight loss." 3. "Trazodone is an antianxiety medication that decreases restlessness at bedtime." 4. "Weight gain is a side effect of trazodone. It will improve your appetite."

Trazodone (Desyrel) is an antidepressant that is often used at low doses, such as 50 mg, for its side effect of sleep. High doses of trazodone are needed for an antidepressant affect, and because these doses are poorly tolerated owing to sedation, it is not often prescribed for its antidepressant properties. ✅1. Trazodone is an antidepressant, and when prescribed at a low dose is being used to assist with sleep. 2. Trazodone is not an appetite stimulant. 3. Trazodone is not an antianxiety medication. 4. Trazodone is not an antipsychotic medication. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize that this dosage is lower than the normal range for trazodone. The test taker should review the normal dosage range for medications and think critically about potential alternative reasons for prescribing these medications.

16. Which of the following clients would have to be monitored closely when prescribed tri- azolam (Halcion) 0.125 mg QHS? Select all that apply. 1. An 80-year-old man diagnosed with major depressive disorder. 2. A 45-year-old woman diagnosed with alcohol dependence. 3. A 25-year-old woman admitted to the hospital after a suicide attempt. 4. A 60-year-old man admitted after a panic attack . 5. A 50-year-old man who has a diagnosis of Parkinson's disease.

Triazolam (Halcion) is a benzodiazepine used in the treatment of anxiety or sleep disturbances. ✅1. An80-year-old is at risk for injury,and giving this client a central nervous system (CNS) depressant can increase the risk for falls. This client needs to be monitored closely. ✅2. Triazolam is a benzodiazepine and can be addictive. Individuals with alcohol dependence may have increased risk of abusing a benzodiazepine and would need to be monitored closely. ✅3. Triazolam is a CNS depressant and has a side effect of increasing depressive symptoms. It would be important that the nurse monitor this client closely for suicidal ideations 4. There are no risk factors in this situation that would warrant close observation. ✅5. A client who is diagnosed with Parkinson's disease is at increased risk for injury because of altered gate and poor balance, and giving this client a CNS depressant can increase the risk for falls. This client needs to be monitored closely. TEST-TAKING HINT: To answer this question correctly, the test taker first must understand that triazolam is a CNS depressant. Next, the test taker must choose a client whose situation would be exacerbated by the addition of a sedative/hypnotic.

Which best describes how benzodiazepines work in the body? Enhancing the effects of GABA by inhibiting its binding to receptors Increasing renal excretion of norepinephrine Inhibiting neural impulses by blocking dopamine Blocking the reuptake of serotonin

✅ Enhancing the effects of GABA by inhibiting its binding to receptors Benzodiazepines are used as sedative medications that may be helpful for chronic anxiety or to induce sleep among people who have sleep difficulties. Benzodiazepines work by enhancing the effects of GABA in the body by inhibiting its binding to specific receptors. Benzodiazepines, while useful, may also be abused and taken inappropriately because of their desired effects. Inhibiting neural impulses by blocking dopamine Benzodiazepines do not block dopamine. Blocking the reuptake of serotonin Benzodiazepines do not block the reuptake of serotonin. SSRIs block the reuptake of serotonin Increasing renal excretion of norepinephrine Benzodiazepines do not cause excretion of norepinephrine

A client has overdosed on alprazolam. Which of the following medication would the nurse expect to give? Flumazenil Sodium bicarbonate Naloxone Physostigmine

✅ Flumazenil Alprazolam (Xanax) is a benzodiazepine. Flumazenil is the antidote for this class of drugs. Sodium bicarbonate This medication is used as an antidote for some antidepressants, but not benzodiazepines. Naloxone This is the antidote for opioids. Physostigmine This medication is used as an antidote for some antidepressants, but not benzodiazepines.

A nurse is assembling a client's daily medications and notes that one of the medications is a benzodiazepine. Which of the following medications is in this class of drugs? Lorazepam Lamitrogine Levofloxacin Lisinopril

✅ Lorazepam Lorazepam is a benzodiazepine. Lamitrogine Lamitrogine is an anticonvulsant and mood stabilizer. Lisinopril Lisinopril is an ACE inhibitor. cancel Levofloxacin Levofloxacin is an antibiotic.

The nurse is caring for a client who has become lethargic. A friend at the bedside reports that the client takes alprazolam. The nurse should prepare which medication? Romazicon Epinephrine Adenosine Narcan

✅ Romazicon Alprazolam is a benzodiazepine. Romazicon is the antidote to reverse the effects of this class of drugs Adenosine This is given to clients in supra-ventricular tachycardia to help slow cardiac electrical activity. Epinephrine This is given to clients with an allergic reaction. . Narcan This is the antidote to opioids.

A client has overdosed on a benzodiazepine. The nurse has given the client flumazenil as the antidote, and begins to monitor for which type of reaction from the effects of the antidote? Pain Sedation Depression Seizure

✅ Seizure Giving an antidote to a drug overdose is necessary, but can result in some adverse events for the client. With a benzodiazepine overdose, flumazenil is given. This abrupt lack of benzodiazepine in the body can lead to irritability, restlessness, nausea, vomiting, tremors and even seizures. Pain This is not an effect of flumazenil, nor is it an effect of a reduced level of benzodiazepine in the body. Sedation This is not an effect of flumazenil, nor is it an effect of a reduced level of benzodiazepine in the body. Depression This is not an effect of flumazenil, nor is it an effect of a reduced level of benzodiazepine in the body.

A client informs the nurse that she has difficulty falling asleep and is only able to sleep a couple of hours each night while in the hospital. Which of the following describes a difference between sleep and induced sedation through medication? Select all that apply. Sleep causes temperature dysregulation, but sedation does not Sleep is biologically essential but sedation is not Sleep occurs naturally but sedation is not Sleep follows a circadian rhythm but sedation can occur at any time Sleep is not necessarily reversible with stimulation, while sedation can be reversed

✅ Sleep occurs naturally but sedation is not Sedation is induced by medication, while sleep occurs most frequently in a circadian rhythm. Each person needs sleep on a regular basis. ✅ Sleep is biologically essential but sedation is not A hospitalized client may suffer from sleep deprivation when unable to achieve natural sleep. The client may be sedated through medication, which induces a type of sleep and is similar in some manners, but it is not biologically essential and can happen at any time of day. Alternatively, sleep is natural and follows a circadian rhythm. ✅ Sleep follows a circadian rhythm but sedation can occur at any time Sedation occurs when a client is given medications that cause this effect. Sleep is not necessarily reversible with stimulation, while sedation can be reversed A person who is sleeping naturally can be stimulated and wakes up, while a person who is sedated is more difficult to awaken. The sedated client has medications acting on the CNS that must be metabolized by the body in order for the effects to go away. Sleep causes temperature dysregulation, but sedation does not It is a lack of sleep that can cause temperature dysregulation in the body.

The nurse is providing discharge teaching to a client regarding their new prescription for diazepam. The client asks why he can't drink while taking this medication. The best response by the nurse is which of the following? Taking both together puts you at an increased risk for addiction You'll get high if you take both When alcohol and diazepam are mixed they can stop your breathing effort Alcohol increases metabolism of diazepam in your body which lessens the effect

✅ When alcohol and diazepam are mixed they can stop your breathing effort Both diazepam and alcohol are CNS depressants. Taking the two together can lower or even halt their respiratory drive. You'll get high if you take both These two substances are depressants, so the client will not feel high. Alcohol increases metabolism of diazepam in your body which lessens the effect Alcohol does not increase drug metabolism. Taking both together puts you at an increased risk for addiction The reason a client should not take both is to avoid the risk of apnea.

1. Which statement is true as it relates to the history of psychopharmacology? 1. Before 1950, only sedatives and amphetamines were available as psychotropics. 2. Phenothiazines were initially used in pain management for their sedative effect. 3. Atypical antipsychotics were the first medications used to assist clients with positive symptoms of schizophrenia. 4. Psychotropic medications have assistedclients in their struggle to cure mental illness

✅1. Sedatives and amphetamines were the only medications available before 1950, and they were used sparingly because of their toxicity and addictive properties. 2.Phenothiazines were not used for pain management, but were used initially to prepare clients for anxiety related to postoperative recovery. 3. Phenothiazines, not atypical antipsychotics, were the first medications that attempted to assist clients with positive symptoms of schizophrenia. 4. Although psychotropic medications assist with symptoms of mental illness, currently there is no cure. TEST-TAKING HINT: To answer this question correctly, the test taker must review the history of psychiatry and its impact on client care. Phenothiazine is a chemical classification that includes many typical antipsychotic medications, such as chlorpromazine (Thorazine), perphenazine (Trilafon), and thioridazine (Mellaril). By understanding that these medications are not used for pain, "2" can be eliminated.

10. A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on? A) Aripiprazole (Abilify) B) Risperidone (Risperdal Consta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac)

✅Ans: A Feedback: New-generation antipsychotics are preferred over conventional antipsychotics because they control symptoms without some of the side effects. Injectable antipsychotics, such as Risperdal Consta, are indicated after the client's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms.

4. Regarding the etiology of schizophrenia, which of the following support(s) a biological theory? Select all that apply. 1. Dopamine hypothesis. 2. High incidence of schizophrenia after prenatal exposure to influenza. 3. Ventricular and sulci atrophy. 4. Downward drift hypothesis. 5. Increased level of serotonin.

✅1. The dopamine hypothesis suggests that an excess of the neurochemical dopamine in the brain causes schizophrenia. An alteration in neurochemicals is an example of a biological theory. ✅2. There are studies to suggest that exposure to a viral infection is most significant if it occurs during the second trimester of pregnancy. Further research is required to understand this biological theory better, called psychoimmunology. 3. Althoughchangesintheventricularandsulci areas of the brain fall under a biological theory of etiology, enlargement, not atrophy, is found in clients diagnosed with schizophrenia. 4.The downward drift hypothesis holds that individuals diagnosed with schizophrenia are more likely to live in low socioeconomic areas and tend to be socially isolated. 5✅This is an example of sociocultural theory. It has been found that individuals diagnosed with schizophrenia have increased amounts of serotonin TEST-TAKING HINT: The test taker must recognize that the question is asking for biological theory; the downward drift hypothesis ("4") can be eliminated immediately because it is a sociocultural theory.

6. Which situation supports the biological theory of the development of bipolar affective disorder? 1. A client is prescribed a selective serotonin reuptake inhibitor and then exhibits impulsive behaviors, expansive mood, and flight of ideas. 2. A client has three jobs, which require increased amounts of energy and the ability to multitask. 3. A client experiences thoughts of negative self-image and then expresses grandiosity when discussing abilities at work. 4. A client has been raised in a very chaotic household where there was a lack of impulse control related to excessive spending.

✅1. When a client diagnosed with bipolar affective disorder (BPAD) is prescribed a selective serotonin reuptake inhibitor, there is potential for alterations in neurochemicals that could generate a manic episode. Alterations in neurochemicals support a biological theory in the development of BPAD. 2. Multiple jobs and the ability to multitask are not related to being diagnosed with BPAD. It has been found that an increased number of individuals diagnosed with BPAD come from upper socioeconomic backgrounds; however, the specific reason behind this is unknown. There are thoughts that the higher incidence may be because of increased education, creativity, and type "A" personality. This would be an example of a psychosocial theory. 3. A negative self-image would relate to a cognitive, not biological, theory, and at this time there are no specific data to support a cognitive theory in the development of BPAD. 4. Being raised in a chaotic family with poor impulse control would relate to a psychosocial, not biological, theory, and at this time no specific data support this. TEST-TAKING HINT: The test taker must note the key words "biological theory" to answer this question correctly. Information about other theories may be correct, but would not support a biological theory perspective

29. The client diagnosed with paranoid schizophrenia has been taking haloperidol (Haldol), a conventional antipsychotic, for several years. Which statement indicates the client needs additional teaching concerning this medication? 1. "I know that if I have any rigidity or tremors I must call my HCP." 2. "I eat high-fiber foods and drink extra water during the day." 3. "I am more susceptible to colds and the flu when taking this medication." 4. "This medication will make my hallucinations and delusions go away."

✅3. Haldol causes agranulocytosis, which diminishes the client's ability to fight infection, but the medication (if the client does not develop the adverse effect of agranulocytosis) does not cause the client to have increased susceptibility to colds and the flu. If the client has a fever or sore throat, the HCP should be notified, and if the white blood cell count is elevated, the medication will be discontinued. 4. This statement indicates the client under- stands why the medication is being taken; this indicates the medication teaching is effective. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medica- tion and has flulike symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the white blood cell count, leaving the body defenseless against bacterial invasion.

3. A patient with bipolar disorder asks the nurse, "Why did I get this illness? I don't want to be sick." The nurse would best respond with, A) "People who develop mental illnesses often had very traumatic childhood experiences." B) "There is some evidence that contracting a virus during childhood can lead to mental disorders." C) "Sometimes people with mental illness have an overactive immune system." D) "We don't fully understand the cause, but mental illnesses do seem to run in families."

✅ANS: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervous system may contribute to mental illness.

A client with bipolar disorder has been prescribed carbamazepine to control symptoms. The nurse should anticipate using which intervention to control the side effects of this drug? Encouraging the client to decrease sodium intake Have the client increase water intake Obtaining baseline thyroid levels Administering antihistamine medications

✅Administering antihistamine medications Carbamazepine (Tegretol) is an anticonvulsant medication that is used to control seizures in clients with epilepsy, but it is also used as an alternative mood stabilizing agent for people with bipolar disorder when lithium and valproate therapy has failed. Carbamazepine may cause side effects of dermatitis or rash, so the nurse may need to administer antihistamine medications. Encouraging the client to decrease sodium intake One side effect reported from carbamazepine use is SIADH, or syndrome of inappropriate anti-diuretic hormone. This results in hyponatremia. There is no need to decrease sodium intake while taking this drug. Obtaining baseline thyroid levels Carbamazepine does not affect thyroid levels. Have the client increase water intake The client should maintain their normal water intake amount while taking carbamazepine.

14. Which one of the following drugs should the nurse expect the patient to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac

✅Ans: C Feedback: Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. For clients taking lithium and the anticonvulsants, monitoring blood levels periodically is important.

15. Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women

✅Ans: A, B, D Feedback: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast tenderness in men and women is also a potential side effect of antipsychotic drugs that cause elevated prolactin levels, but it is not an extrapyramidal symptom.

2. An abnormality of which of the following structures of the cerebrum would be associated with schizophrenia? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes

✅Ans: B Feedback: Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of taste and touch and assist in spatial orientation. The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The occipital lobe assists in coordinating language generation and visual interpretation, such as depth perception.

5. Which of the following is an inhibitory neurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine

✅Ans: B Feedback: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.

7. A nurse is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications. The best response is, A) "When studies are published they can be trusted to be accurate." B) "We need to look at the research very closely to see how reliable the studies are." C) "Your prescribed medication is the best for your condition, so you should not read those studies." D) "Switching medications will alter the course of your illness. It is not advised."

✅Ans: B Feedback: Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their families to understand. The nurse must ensure that clients and families are well informed about progress in these areas and must also help them to distinguish between facts and hypotheses. The nurse can explain if or how new research may affect a client's treatment or prognosis. The nurse is a good resource for providing information and answering questions.

9. How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease.

✅Ans: B Feedback: Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. These conditions previously could be diagnosed only through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests.

16. Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine (Parnate) B) Sertraline (Zoloft) C) Imipramine (Tofranil) D) Phenelzine (Nardil)

✅Ans: B Feedback: SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound.

13. A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose

✅Ans: B Feedback: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause less weight gain than other antidepressants. Dry mouth and nasal passages are common anticholinergic side effects associated with all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychotic medication. Furthermore, sedation is a common side effect of Paxil.

11. Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects? A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers

✅Ans: B Feedback: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.

18. A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially? A) Instruct the client to stop the medication for a few days to see if the nausea goes away. B) Reassure the client that this is an expected side effect that will improve with time. C) Suggest that the client take the medication with food. D) Tell the client to contact the physician for a change in medication.

✅Ans: C Feedback: Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The client should not stop taking the drug. It would be appropriate to reassure the client that this is an expected side effect that will improve with time, but that would not be done initially. A change in medication may be indicated if the nausea is intolerable or persistent, but that would not be done initially.

17. The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements? A) "I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate." B) "Certain foods will cause me to have sexual dysfunction when I take this medication." C) "Foods that are high in tyramine will reduce the medication's effectiveness." D) "I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels."

✅Ans: D Feedback: Because the enzyme MAO is necessary to break down the tyramine in certain foods, its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias. Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common side effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness.

19. In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose

✅Ans: D Feedback: Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision. More severe anticholinergic effects such as agitation, delirium, and ileus may occur, particularly in older adults. Other common side effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients may develop tolerance to anticholinergic effects (such as orthostatic hypotension and worsening of narrow-angle glaucoma, but these side effects are common reasons that clients discontinue drug therapy. The risk of seizures is increased by bupropion, which is a different type of antidepressant.

12. A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be A) increasing the amount of serotonin and norepinephrine in the brain. B) decreasing the amount of an enzyme that breaks down neurotransmitters. C) normalizing the levels of serotonin, norepinephrine, and dopamine. D) blocking dopamine receptors in the brain.

✅Ans: D Feedback: The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.

8. The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient, A) "Have you ever had an allergic reaction to radioactive dye?" B) "Have you had anything to eat in the last 24 hr?" C) "Does your insurance cover the cost of this scan?" D) "Are you anxious about being in tight spaces?"

✅Ans: D Feedback: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans require radioactive substances to be injected into the bloodstream. A patient is not required to fast before brain imaging studies. Verifying insurance benefits is not a primary role of the nurse.

4. Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors.

✅Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studies involving viral theories have focused on schizophrenia, but so far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specific stressor with a specific disease have been unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common.