More Psych Pharm

The nurse is caring for a client who is taking a maintenance dosage of lithium carbonate (Lithobid). What is the most important nursing action in the client's plan of care? 1. Monitor intake and output. 2. Monitor daily serum lithium levels. 3. Observe for remission of a depressive state. 4. Perform a weekly electrocardiogram (ECG).

1

Neuroleptic malignant syndrome develops in a client taking chlorpromazine. The nurse checks the nursing unit medication cart to see if which medication is available to treat this adverse reaction? 1. Protamine sulfate 2. Bromocriptine (Parlodel) 3. Phytonadione (vitamin K) 4. Enalapril maleate (Vasotec)

2

The nurse is caring for a client with neuroleptic malignant syndrome (NMS) that resulted from the use of antipsychotic medications. Which assessment finding would the nurse anticipate to note resulting from this syndrome? 1. Dysphagia 2. Bradycardia 3. Hypotension 4. Hyperpyrexia

4

The nurse has given instructions to a client taking lithium carbonate (Lithobid). What statement by the client indicates that the client needs further information? 1. "I will take the lithium with meals." 2. "I will decrease fluid intake while taking the lithium." 3. "Lithium blood levels must be monitored very closely." 4. "I will call my health care provider (HCP) if excessive diarrhea, vomiting, or sweating occurs."

2

The nurse is describing the medication side and adverse effects to a client who is taking oxazepam (Serax). What information should the nurse incorporate in the discussion? 1. Consume a low-fiber diet. 2. Increase fluids and bulk in the diet. 3. Rest if the heart begins to beat rapidly. 4. Take antidiarrheal agents if diarrhea occurs.

2

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? 1. Parkinsonism 2. Tardive dyskinesia 3. Hypertensive crisis 4. Neuroleptic malignant syndrome

2

A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the primary nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response will the nurse give? 1 Citalopram 2 Ziprasidone 3 Benztropine 4 Acetaminophen with hydrocodone

2 Ziprasidone [GEODON] is a neuroleptic, which will reduce psychosis by affecting the action of both dopamine and serotonin. Citalopram [Celexa] is a selective serotonin reuptake inhibitor antidepressant. Benztropine [Cogentin] is an anticholinergic. Acetaminophen with hydrocodone is an analgesic/opioid.

A client with anxiety is starting therapy with lorazepam (Ativan). The nurse who is preparing to administer the first dose reviews the client's medical record. Which factor in the client's history should prompt the nurse to consult with the health care provider before administering the medication? 1. Hypothyroidism 2. Diabetes mellitus 3. Narrow angle glaucoma 4. Coronary artery disease

3

A nurse is administering thioridazine hydrochloride. The nurse should monitor the client carefully for which adverse effect? 1. Weight gain 2. Photosensitivity 3. Cardiac dysrhythmias 4. Extrapyramidal movements

3

The health care provider is planning to prescribe a medication for a client with major depression. Which medication should the nurse expect to be prescribed? 1. Clozapine (Clozaril) 2. Amitriptyline (Elavil) 3. Paroxetine hydrochloride (Paxil) 4. Tranylcypromine sulfate (Parnate)

3

A client who is receiving lithium carbonate (Lithobid) complains of loose, watery stools and difficulty walking. The nurse would expect the client's serum lithium level to be at which value? 1. 0.7 mEq/L 2. 1.0 mEq/L 3. 1.3 mEq/L 4. 1.8 mEq/L

4

A client with depression who is taking tranylcypromine sulfate (Parnate) has been instructed on the appropriate diet. The nurse determines that the client understands the diet if which foods are selected from the dietary menu? 1. Pickled herring, French fries, and milk 2. Pepperoni pizza, salad, and a cola drink 3. Roasted chicken, roasted potatoes, and beer 4. Fried haddock, baked potato, and a cola drink

4

A client diagnosed with schizophrenia has a new prescription for risperidone (Risperdal). The nurse should assess baseline laboratory results for which study before administering the first dose of this medication? 1. Platelet count 2. Blood clotting tests 3. Liver function studies 4. Complete blood count

3 Liver Function Tests

A hospitalized client is started on phenelzine (Nardil) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply. 1. Figs 2. Yogurt 3. Crackers 4. Aged cheese 5. Tossed salad 6. Oatmeal raisin cookies

3, 5

A client with an anxiety disorder is taking buspirone (BuSpar) orally. The client tells the nurse that it is difficult to swallow the tablets. Which is the best instruction to provide to the client? 1. Crush the tablets before taking them. 2. Mix the tablet uncrushed in apple sauce. 3. Purchase the liquid preparation with the next refill. 4. Call the health care provider (HCP) for a change in medication.

1

The mother of a child with attention deficit hyperactivity disorder (ADHD) has been given instructions about how to administer methylphenidate (Ritalin) to the child. Which response by the mother shows she understands the information about the best way to administer the medication? 1. At bedtime 2. After breakfast 3. At the evening meal 4. With a bedtime snack

2

The nurse is teaching a client who is being started on imipramine (Tofranil) about the medication. The nurse should inform the client to expect maximum desired effects at what time period following initiation of the medication? 1. In 2 months 2. In 2 to 3 weeks 3. During the first week 4. During the sixth week of administration

2

A client's medication sheet contains a prescription for sertraline (Zoloft). To ensure safe administration of the medication, how should the nurse administer the dose? 1. On an empty stomach 2. At the same time each evening 3. Evenly spaced around the clock 4. As needed when the client complains of depression

2. At the same time each evening

A client taking lithium carbonate reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L. This level is indicative of which finding? 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

1

A nurse is providing dietary instructions to a client who is taking tranylcypromine sulfate (Parnate). The nurse emphasizes that which needs to be avoided while the client is taking this medication? 1. Salami 2. Scallops 3. Pineapple 4. Mashed potatoes

1

The nurse is providing instructions to a client regarding the side effects of chlorpromazine (Thorazine). The nurse instructs the client that which may occur with the use of this medication? 1. Dry mouth 2. Hand tremors 3. Lip smacking 4. Increased urinary output

1

What are the adverse effects of mirtazapine? Select all that apply. 1 Asthenia 2 Dyskinesia 3 Drowsiness 4 Gynecomastia 5 Abnormal dreams

1, 3, 5 Mirtazapine is a second-generation antidepressant drug with potential adverse effects of asthenia, drowsiness, and abnormal dreams. Dyskinesia and gynecomastia are the side effects of first-generation antidepressant drugs.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side/adverse effects of the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

2

The nurse taking a medication history for a client who has been admitted to the nursing unit notes that the client is receiving olanzapine (Zyprexa). The nurse interprets that this client most likely has a history of which disorder? 1. Hypertension 2. Schizophrenia 3. Diabetes mellitus 4. Diabetes insipidus

2

The nurse is caring for a client who has been prescribed disulfiram (Antabuse). Which statement by the client indicates to the nurse the need for further teaching about this medication? 1. "I'll have to check my aftershave lotion." 2. "I must be careful taking cold medicines." 3. "As long as I don't drink alcohol, I'll be fine." 4. "I'll have to be more careful with the ingredients I use for cooking."

3

The nurse is describing medication side effects to a client who is taking a benzodiazepine. The nurse should tell the client to take the medication only as prescribed because of which most serious risk? 1. Headache 2. Skin rashes 3. Dependence 4. Gastrointestinal side effects

3

A client who is going to be discharged has been receiving 3 mg of risperidone three times a day. What will the nurse teach the client about the medication? 1 May be reduced if the client feels better at home 2 May be discontinued after the client is discharged 3 May cause sedation if taken concurrently with alcohol 4 Should be taken early in the day to be sure that it is not forgotten

3 Risperidone potentiates the action of alcohol and can cause oversedation if the drug and alcohol are taken together. This medication should be taken consistently to prevent recurrence of symptoms and maintain a therapeutic blood drug level. Medications should be taken as prescribed; taking them all at one time may interrupt the maintenance of a constant therapeutic blood level.

A client with a psychotic disorder is receiving haloperidol (Haldol). The nurse should assess for which toxic effect of this medication? 1. Nausea 2. Hypotension 3. Blurred vision 4. Excessive salivation

4

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse reviews the result of which laboratory study to detect which adverse effect of this medication? 1. Platelet count 2. Liver function 3. Blood glucose level 4. White blood cell (WBC) count

4

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1. Platelet count 2. Blood glucose level 3. Liver function studies 4. White blood cell count

4

The nurse is caring for a client receiving haloperidol (Haldol). To determine whether the client is experiencing akathisia as an adverse effect of the medication, what should the nurse observe the client for? 1. Lip smacking 2. Puffing of the cheeks 3. Rapid tongue movements 4. Restlessness or constant generalized movement

4

A client is being treated for depression with amitriptyline hydrochloride. During the initial phases of treatment, the most important nursing intervention is which action? 1. Obtain frequent drug blood levels. 2. Provide the client a tyramine-free diet. 3. Assess the client for anticholinergic effects. 4. Obtain postural blood pressures before the administration of each dose.

4

A client is prescribed tranylcypromine (Marplan). The nurse should instruct the client to avoid which item? 1. All dairy products 2. Exposure to sunlight 3. Green leafy vegetables 4. A glass of wine with dinner

4

A nurse employed in the mental health clinic is interviewing a client who has had clomipramine hydrochloride (Anafranil) prescribed. The nurse interprets that the client is noncompliant with taking the medication as prescribed if the client exhibits which behavior? 1. Tired, fatigued appearance 2. Complaints of hunger and fatigue 3. Slight dizziness when standing up quickly 4. Frequently checking her purse for her keys

4

Fluoxetine hydrochloride (Prozac) is prescribed for a client. The nurse should teach the client to take the medication by which method? 1. Just before bedtime 2. With the evening meal 3. At noon with an antacid 4. In the morning on first arising

4

The primary healthcare provider informs the registered nurse that the client must be monitored on a regular basis because he or she is prescribed haloperidol. Which client conditions would warrant these instructions? Select all that apply. 1 Glaucoma 2 Comatose 3 Adynamic ileus 4 Parkinson disease 5 Prostatic hypertrophy

1, 3, 5 Haloperidol is a first-generation antipsychotic drug. Clients with glaucoma should use the drug with caution. Adynamic ileus may cause paralysis to the intestinal motility; the drug should be cautiously used in the client. Clients with prostatic hypertrophy should be given haloperidol with caution because prostatic hyperplasia is a side effect of haloperidol. Haloperidol is contraindicated in comatose clients and clients with Parkinson disease.

The nurse is developing a teaching plan for a client who will be receiving phenelzine sulfate (Nardil). The nurse should instruct the client to avoid which item? 1. Vasodilators 2. Aged cheeses 3. Digitalis preparations 4. Cherries and blueberries

2

A client begins to experience extrapyramidal side effects from an antipsychotic medication. The nurse anticipates that the health care provider will prescribe which medication to treat this condition? 1. Haloperidol 2. Benztropine 3. Chlorpromazine 4. Prochlorperazine

2

A client is receiving fluphenazine (Prolixin) daily. The nurse should teach the client to take which measure to minimize common side effects of this medication? 1. Monitor the temperature daily. 2. Use hard sour candy or sugarless gum. 3. Eat snacks at midmorning and at bedtime. 4. Have the blood pressure checked once a week.

2

A client is starting to take imipramine (Tofranil) once each day. The nurse determines that additional client teaching is needed on the basis of which statement by the client? 1. "I need to avoid alcohol while taking this medication." 2. "I'll take the medication in the morning before breakfast." 3. "I won't notice any medication effects for at least 2 weeks." 4. "I'll be sure to take a missed medication dose as soon as possible unless it is almost time for the next dose."

2

A client receiving thioridazine hydrochloride complains of feeling faint when trying to get out of bed in the morning. The nurse recognizes this complaint as a symptom of which disorder? 1. Cardiac dysrhythmias 2. Postural hypotension 3. Psychosomatic disorder 4. Respiratory insufficiency

2

A client who has been taking buspirone (Buspar) for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred? 1. Paranoid thought process 2. Rapid heartbeat or anxiety 3. Alcohol withdrawal symptoms 4. Thought broadcasting or delusions

2

A client with bipolar disorder is receiving lithium carbonate (Lithobid). The nurse who administers the medication knows that lithium is used primarily to treat which condition? 1. Hypertensive emergencies 2. The manic phase of bipolar disease 3. Both depressive and manic episodes 4. The depressive phase of bipolar disease

2

A hospitalized client has begun taking bupropion (Wellbutrin) as an antidepressant agent. The nurse understands that which is an adverse effect, indicating that the client is taking an excessive amount of medication? 1. Constipation 2. Seizure activity 3. Increased weight 4. Dizziness when getting upright

2

A monoamine oxidase inhibitor (MAOI) is prescribed for a client. Which sign or symptom is indicative of toxicity? 1. Lethargy 2. Restlessness 3. Lack of energy 4. Feelings of fatigue

2

Buspirone hydrochloride (BuSpar) is prescribed for a client with an anxiety disorder. The nurse plans to include which teaching point when reviewing this medication with the client? 1. The medication is addicting. 2. Dizziness and nervousness may occur. 3. Tolerance can develop with this medication. 4. The medication can produce a sedating effect.

2

A recently married 22-year-old woman is brought to the trauma center by the police. She has been robbed, beaten, and sexually assaulted. The client, although anxious and tearful, appears to be in control. The primary healthcare provider prescribes 0.25 mg of alprazolam for agitation. The nurse will administer this medication when what event occurs? 1 The client's crying increases. 2 The client requests something to calm her. 3 The nurse determines a need to reduce her anxiety. 4 The primary healthcare provider is getting ready to perform a vaginal examination

2 Because a sexual assault is a threat to the sense of control over one's life, some control should be given back to the client as soon as possible. Crying is a typical way to express emotions; the client should be told that medication is available if desired. The nurse determining a need to reduce the client's anxiety or administering the medication when the primary healthcare provider is getting ready to do a vaginal examination takes control away from the client; the client may view these actions as an additional assault on the body, which increases feelings of vulnerability and anxiety and does not restore control.

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse should teach the client about which side/adverse effects of this medication? Select all that apply. 1. Diarrhea 2. Sedation 3. Dry mouth 4. Weight loss 5. Orthostatic hypotension 6. Presence of a fixed stare

2, 3, 5, 6

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1. Client reports not going to work for this past week. 2. Client complains of not being able to "do anything" anymore. 3. Client arrives at the clinic neat and appropriate in appearance. 4. Client reports sleeping 12 hours per night and 3 to 4 hours during the day.

3

A client taking buspirone hydrochloride for 1 month is scheduled for a follow-up appointment. The nurse gathers data from the client and interprets that the medication is effective if the client reports an absence of which? 1. Delusions 2. Paranoid thoughts 3. Palpitations and anxiety 4. Alcohol withdrawal symptoms

3

A client has a lithium level of 2.4 mEq/L. The nurse should immediately assess the client for which sign or symptom? 1. Diarrhea 2. Weakness 3. Blurred vision 4. No assessment is needed because this is a therapeutic value.

3

A client has been given a prescription for tacrine (Cognex) to control moderate dementia of the Alzheimer's type, and the nurse provides instructions to the client and the spouse. What statement by the spouse should the nurse use to determine that they understand information about the medication? 1. "I should not administer food with the medication." 2. "If a dose is missed, I should double the next dose." 3. "If jaundice develops, I need to notify the health care provider (HCP)." 4. "If flulike symptoms such as muscle aches occur, I should call the health care provider immediately."

3

A client has been started on therapy with lithium carbonate (Lithobid). The nurse instructs the client to be sure to take which action while taking the medication? 1. Limit salt intake. 2. Limit food intake. 3. Maintain a fluid intake of 2 to 3 L/day. 4. Stop the medication if gastrointestinal (GI) disturbances occur.

3

A client is taking a monoamine oxidase inhibitor (MAOI). What is the primary reason the nurse needs to assess this client closely? 1. Hypotension may indicate toxicity. 2. These medications increase the amount of MAO in the liver. 3. Headache, hypertension, and nausea and vomiting may indicate toxicity. 4. Hypotensive crisis may be precipitated by foods rich in tyramine and tryptophan.

3

A client who has been taking ziprasidone (Geodon) reports to the health care clinic for a follow-up visit. The nurse assesses for a therapeutic effect of the medication by asking the client which question? 1. "Have you had more restful sleep during daytime naps?" 2. "Have you experienced relief of heartburn and indigestion with meals?" 3. "Have you experienced an increase in concentration during daily activities?" 4. "Have you had a decrease in heart palpitations with outside physical activities?"

3

A client who is on lithium carbonate complains of nausea. Later that day the client complains of drowsiness, muscle weakness, and lack of coordination. It is time for the client's 4:00 pm dose of lithium. What is the best nursing action? 1. Give the 4:00 pm dose and document the client's complaints. 2. Give the 4:00 pm dose, and notify the health care provider of the client's complaints. 3. Withhold the 4:00 pm dose, and notify the health care provider of the client's complaints. 4. Withhold the 4:00 pm dose for 30 minutes before administering, and reeducate the client that these are normal side effects of the medication.

3

A client with bipolar mood disorder has been given a prescription for carbamazepine (Tegretol). The nurse teaching the client about medication side effects and adverse effects instructs the client to notify the health care provider (HCP) if which symptom develops? 1. Nausea 2. Dizziness 3. Sore throat 4. Drowsiness

3

A client with depression has a prescription for sertraline (Zoloft). The nurse should withhold the medication and question the prescription if which is documented in the client's record? 1. History of diabetes mellitus 2. History of myocardial infarction 3. Use of phenelzine sulfate (Nardil) 4. History of irritable bowel syndrome

3

A nurse is discussing the past week's activities with a client receiving amitriptyline hydrochloride. The nurse determines that the medication is most effective for this client if the client reports which? 1. A decrease in appetite 2. Sleeping 14 to 16 hours each day 3. Ability to get to work on time each day 4. Having difficulty concentrating on an activity

3

A nurse working in the ambulatory care center is providing medication instructions about methylphenidate (Ritalin) to the mother of a child with attention-deficit/hyperactivity disorder (ADHD). At which time does the nurse recommend that the mother give the medication to the child? 1. At bedtime 2. With the evening meal 3. Just before the noontime meal 4. In the morning, 2 hours before breakfast

3

A client gives the home health nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication? 1. Complaints of insomnia 2. Complaints of hunger and fatigue 3. A pulse rate less than 60 beats/minute 4. Frequent hand-washing with hot soapy water

4

A client has been started on medication therapy with alprazolam (Xanax). When the nurse teaches the client that the medication should not be discontinued abruptly, the client asks why. The nurse should incorporate which when formulating a reply? 1. The client is likely to suffer irreversible kidney damage. 2. The client is likely to become resistant to medication effects. 3. It will make the medication much less effective if it must be restarted. 4. Rebound central nervous system (CNS) excitation could occur, including seizure activity.

4

A client is scheduled for discharge and will be taking phenobarbital sodium (Luminal) for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety? 1. Take the medication only with meals. 2. Take the medication at the same time each day. 3. Use a dose container to help prevent missed doses. 4. Avoid drinking alcohol while taking this medication.

4

A client receiving long-term therapy with lithium carbonate (Lithobid) exhibits muscle tremors, confusion, vomiting, and diarrhea. The nurse anticipates that the results of the latest test of the serum lithium level will be between which laboratory value range? 1. 0 and 0.5 mEq/L 2. 0.6 and 1.0 mEq/L 3. 1.0 and 1.3 mEq/L 4. 1.5 and 2.0 mEq/L

4

A client with a diagnosis of schizophrenia is taking haloperidol (Haldol). The nurse understands that this medication will exert its therapeutic effect through which mechanism? 1. Blocking serotonin reuptake 2. Inhibiting the breakdown of released acetylcholine 3. Blocking the uptake of norepinephrine and serotonin 4. Blocking dopamine from binding to postsynaptic receptors in the brain

4

The 26-year-old female client with schizophrenia has been prescribed chlorpromazine hydrochloride (Thorazine). The client calls the mental health clinic and tells the nurse that her urine has become dark. The client has no other urinary symptoms. The nurse should provide which information to the client? 1. To seek treatment for a urinary tract infection 2. That this symptom indicates medication toxicity 3. To increase her intake of acid-ash foods and liquids 4. That this is an expected side effect of the medication

4

The nurse is administering risperidone (Risperdal) to a client who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? 1. Get adequate sunlight. 2. Continue driving as usual. 3. Avoid foods rich in potassium. 4. Get up slowly when changing positions.

4

The nurse is caring for a client who has been treated with long-term antipsychotic medication. During the assessment, the nurse checks the client for tardive dyskinesia. If tardive dyskinesia is present, what would the most likely assessment findings be? 1. Severe headache, flushing, tremors, and ataxia 2. Abnormal breathing through the nostrils, accompanied by a thrill 3. Severe hypertension, migraine headache, and "marbles in the mouth" syndrome 4. Abnormal movements and involuntary movements of the mouth, tongue, and face

4

A nurse is caring for a group of clients on the psychiatric unit. What clinical findings will alert the nurse that serotonin syndrome has developed in one of the clients? 1 Continuous involuntary movement of the tongue and jaw 2 Extremely high blood pressure with headache and flushing 3 Blurred vision, urine retention, dry mouth, and constipation 4 Restlessness, tachycardia, fever, diarrhea, and altered mental status

4 1: Tardive dyskinesia (antipsychotics) 2: hypertensive crisis (MAOIS & tyramine) 3: Anticholinergic (from TCAs): [see, pee, spit, shit] 4: serotonin syndrome Restlessness, tachycardia, fever, diarrhea, and altered mental status are related to serotonin syndrome, an excessive accumulation of serotonin that can lead to death if not identified and treated quickly. Continuous involuntary movement of the tongue and jaw is related to tardive dyskinesia, which results from long-term use of an antipsychotic medication. Extremely high blood pressure with headache and flushing indicate a possible hypertensive crisis from the intake of tyramine-containing foods by a client receiving a monoamine oxidase inhibitor antidepressant. Blurred vision, urine retention, dry mouth, and constipation are common anticholinergic side effects of tricyclic antidepressants and some antipsychotic medications.

A client has begun taking phenelzine (Nardil). At the initiation of therapy, which items does the nurse teach the client are acceptable to consume? Select all that apply. 1. Avocados 2. Figs and raisins 3. Bologna or salami 4. Carrots or radishes 5. Sweet potatoes and squash 6. Red wine, such as Chianti or sherry

4, 5