EAQ Rationale

A client asks the nurse how psychotropic medications work. How should the nurse reply?

"These medications affect the chemicals used in communication between the nerve cells." Most psychotropic medications affect neurotransmitters such as dopamine and norepinephrine, which enter the synapses between neurons, allowing them to signal each other. Psychotropic medications do not work by changing the metabolic needs of the brain. Psychotropic medications do not increase the production of nervous tissue. Although there may be some effect on sensory input, this is because of the change in neurotransmitters.

A hospitalized, depressed, suicidal client has been taking a mood-elevating medication for several weeks. The client's energy is returning and the client no longer talks about suicide. What should the nurse do in response to this client's behavior?

Keep the client under closer observation -As the client's motivation and energy return, the likelihood that suicidal ideation will be acted out increases. There are no data regarding visitation rights; the priority concern is the greater risk for suicide. Although engaging the client in preliminary discharge planning eventually will be done, the priority is determining the potential for suicide. Although the client should be observed for side effects of the medication, the greater risk of suicide takes precedence.

When a nurse enters a room to administer an oral medication to an agitated and angry client with schizophrenia, paranoid type, the client shouts, "Get out of here!" What is the most therapeutic response?

"I'll be back later and we can talk.." Saying, "I'll be back in a few minutes so we can talk," allows the angry client time to regain self-control; announcing a plan to return will ease fears of abandonment or retribution. Staying and insisting that the client take the medication may provoke increased anger and further loss of control. Clients will not accept logical explanations when angry. Alternative nursing interventions should be attempted before withholding the medication and notifying the practitioner may become necessary. Test-Taking Tip: Anxiety leading to an exam is normal. Reduce your stress by studying often, not long. Spend at least 15 minutes every day reviewing the "old" material. This action alone will greatly reduce anxiety. The more time you devote to reviewing past material, the more confident you will feel about your knowledge of the topics. Start this review process on the first day of the semester. Don't wait until the middle to end of the semester to try to cram information.

A client is lonely and extremely depressed, and the health care provider prescribes a tricyclic antidepressant. The client asks the nurse what the medication will do. What is the best response by the nurse?

"This medication will increase your appetite and help you feel better." Tricyclic antidepressants create a general sense of well-being, increase appetite, and help lift depression. The client might not know the reason for depression, and the drug does not cause amnesia. Symptomatic relief usually begins after 2 to 3 weeks of therapy. Concomitant use of monoamine oxidase inhibitors and tricyclic antidepressants is contraindicated.

The nurse anticipates that which medication will be used to prevent symptoms of withdrawal in clients with a long history of alcohol abuse?

Ativan (Lorazepam) Lorazepam (Ativan) is most effective in preventing the signs and symptoms associated with withdrawal from alcohol. It depresses the central nervous system by potentiating Γ-aminobutyric acid, an inhibitory neurotransmitter. Phenobarbital (Luminal) is used to prevent withdrawal symptoms associated with barbiturate use. Chlorpromazine (Thorazine), an antipsychotic medication, is not used for alcohol withdrawal. Methadone hydrochloride (Methadone) is used to prevent withdrawal symptoms associated with opioid use.

An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider? Select all that apply.

Blurred vision Suicidal ideation Difficult urination Tardive dyskinesia Transient hypoglycemia Abnormal vision (e.g., blurred or double vision) is a side effect of venlafaxine (Effexor). Central nervous system effects such as emotional lability, vertigo, anxiety, insomnia, and suicidal ideation in children and adolescents are side effects of venlafaxine. Difficult or painful urination is a serious side effect of venlafaxine; impairment of urine flow can lead to urinary tract infection and renal failure. Extrapyramidal side effects such as tardive dyskinesia do not occur with venlafaxine. Transient hypoglycemia is not a side effect of venlafaxine.

A nonviolent client on the psychiatric unit suddenly refuses to take the prescribed antipsychotic medication. What should the nurse do?

Honor the client's decision and document the behavior and all interventions A client has the right to refuse treatment and should not be forcibly medicated unless the client is deemed dangerous to him- or herself or others. An authoritarian approach is not therapeutic and may compromise the nurse-client relationship. Calling the health care provider is premature; first the nurse should attempt therapeutic interventions to meet the client's needs. Starting proceedings to have the client declared incompetent is appropriate for a client who is considered to be dangerous to him- or herself or others, or incompetent to evaluate necessary treatment.

A nurse is administering medications to clients on a psychiatric unit. What does the nurse identify as the reason that so many psychiatric clients are given the drug benztropine (Cogentin) or trihexyphenidyl in conjunction with the phenothiazine derivatives neuroleptic medications?

It combats the extrapyramidal side effects of the other drug. Benztropine and trihexyphenidyl control the extrapyramidal (parkinsonian) manifestations associated with the neuroleptics and are classified as antiparkinsonian drugs. These drugs do not reduce postural hypotension, nor do they potentiate phenothiazine derivatives or have an effect on depression.

The parents of a child with attention deficit hyperactivity disorder ask the nurse about using medication. What is the most frequently prescribed medication for this disorder?

Ritalin Methylphenidate (Ritalin) appears to act by stimulating release of norepinephrine from nerve endings in the brainstem. Lorazepam (Ativan) is a benzodiazepine used to treat anxiety and insomnia. Haloperidol (Haldol) is an antipsychotic medication. Methocarbamol (Robaxin) is a muscle relaxant.

When reviewing the medications for a group of clients on a psychiatric unit, the nurse concludes that the pharmacotherapy for anxiety disorders is moving away from benzodiazepines and moving toward what?

SSRIs Selective serotonin reuptake inhibitors have better safety profiles and do not carry the risk of substance abuse and tolerance. Anticholinergics are administered concurrently with antipsychotics to minimize extrapyramidal side effects. Lithium carbonate is a drug used to treat bipolar disorder. Antipsychotics are administered to clients with thought disorders.