Pharm quizlet

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

ANS: 1 Rationale: The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt.

A client with a history of suicide attempts has been taking fluoxetine (Prozac) for one month. The client suddenly presents with a bright affect, rates mood at 9 out of 10, and is much more communicative. Which action should be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase the level of this client's suicide precautions. 4. Request that the psychiatrist reevaluate the current medication protocol.

ANS: 3 Rationale: The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behavior.

A male patient tells the nurse that he wants to stop taking citalopram (Celexa) because of the sexual side effects. Which instruction should the nurse provide in patient teaching to help relieve the patient's sexual dysfunction? (Choose all that apply.) A) Discontinue the medication. B) Take infrequent "drug holidays." C) Decrease the regular dosage by 50%. D) Report complaints to the psychiatrist. E) Maintain the current pharmacotherapy. F) Avoid alcoholic beverages.

B, D, E, F Sexual dysfunction is managed in several ways, including reduction in the regular dosage, "drug holidays," addition of a medication for erectile dysfunction, change of antidepressant, and avoidance of alcohol. The nurse encourages the patient to continue taking an SSRI such as citalopram because the adverse effects of therapy often diminish in intensity and frequency over time and this strategy helps prevent disruptions in therapy. After providing this information the nurse encourages the patient to voice complaints to the psychiatrist who prescribes the antidepressant, but the nurse does not depend on the patient to ensure that the psychiatrist is notified of the complaint. The nurse avoids instructing the patient to discontinue therapy or to alter the dosage, because these actions are not within the scope of nursing practice.

A client who was started on anticonvulsant therapy with clonazepam (Klonopin) tells the nurse of increasing clumsiness and unsteadiness since starting the medication. The client is visibly upset by these manifestations and asks the nurse what to do. The nurse's response is based on the understanding that these symptoms: 1. Usually occur if the client takes the medication with food 2. Are probably the result of an interaction with another medication 3. Indicate that the client is experiencing a severe untoward reaction to the medication 4. Are worse during initial therapy and decrease or disappear with long-term use

4. Are worse during initial therapy and decrease or disappear with long-term use Rationale: Drowsiness, unsteadiness, and clumsiness are expected effects of the medication during early therapy. They are dose related and usually diminish or disappear altogether with continued use of the medication. It does not indicate that a severe side effect is occurring. It is also unrelated to interaction with another medication. The client is encouraged to take this medication with food to minimize gastrointestinal upset. *Eliminate options 2 and 3 first because they are comparable or alike and because of the word "severe" in option 3*

A man has been taking imipramine (Tofranil) for 1 week for depression. He tells the nurse that he is going to stop taking this medication because it is not working. The best response is which of the following? A. "Contact your prescriber about taking a different antidepressant medication." B. "It may take up to 4 weeks before this medication makes you feel better." C. "You should slowly taper rather than suddenly discontinue this medication." D. "You should take an extra dose today to build up your blood level and get faster results."

B. With tricyclic antidepressants (TCAs), therapeutic effects occur 2 to 4 weeks after initiation of therapy. Contacting the prescriber, changing the medication, tapering the medication, or increasing doses are inappropriate given the delayed onset of action with TCAs and the risk of toxic effects if too much of the drug is taken. It is not appropriate for a nurse to advise a patient to take a dose that has not been prescribed of a medication.

A client with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which statement?

"Clonazepam is a minor depressant and may aggravate symptoms of depression."

The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to

increase levels of acetylcholine in the brain by blocking its breakdown

A client with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that:

this medication may initially cause tiredness, which should become less bothersome over time.

A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient indicates understanding of medication instructions? "I can stop taking my amitriptyline and start taking the citalopram as ordered." "I can expect fewer cardiovascular side effects with the citalopram." "The doctor is switching me to this medication because it is less expensive but just as effective." "I will need to limit my intake of cheese when taking citalopram to prevent a rise in my blood pressure."

"I can expect fewer cardiovascular side effects with the citalopram."

Which drug has replaced lithium as the treatment of choice for bipolar disorder? 1. Clonidine 2. Valproic acid 3. Olanzapine 4. Risperidone

2

Patient has been taking paxil for several years, the patient says he would like to take a drug holiday. What should you instruct the patient.

You can not abruptly stop taking your paxil

(SELECT ALL THAT APPLY) A client is prescribed sertraline (Zoloft), a selective serotonin reuptake inhibitor. Which adverse effects would the nurse include in the medication teaching plan?

(1) Agitation, (3) Sleep disturbance, (5) Dry mouth

A health care provider has ordered imipramine (Tofranil) for each of these clients. A nurse would question the order for the client with: 1. Seizure Disorders 2. Depression 3. Enuresis 4. Neuropathic Pain

1. Seizure disorders.

Which statement made by the client who is taking lithium carbonate (Eskalith) indicates that further teaching is necessary? 1. I will be sure to remain on a low sodium diet 2. I will have blood levels drawn every 2 to 3 months even when I have no symptoms 3. Lithium has a narrow margin of safety so toxicity is a very real concern 4. I will not be able to breast-feed my baby.

1. I will be sure to remain on a low sodium diet

The client is receiving imipramine. It is most important for the nurse to instruct the client to immediately report which symptoms? Select all that apply. 1. Fever. 2. Dry mouth. 3. Increased fatigue. 4. Vomiting and diarrhea. 5. Staggering gait. 6. Sore throat.

1) CORRECT— imipramine is a tricyclic antidepressant and hyperthermia can be a side effect. 2) CORRECT— imipramine is a tricyclic antidepressant and dry mouth is a side effect. 3) CORRECT— imipramine is a tricyclic antidepressant and increased fatigue is a side effect. 4) CORRECT— imipramine is a tricyclic antidepressant and N/V/D are side effects. 5) Staggering gait is not a side effect of this medication 6) CORRECT— imipramine is a tricyclic antidepressant and a sore throat can be a side effect.

On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to: A. avoid all products containing alcohol. B. adhere to concomitant vitamin B therapy. C. return for monthly blood drug level monitoring. D. limit alcohol consumption to a moderate level.

16. A. avoid all products containing alcohol. **Rationale: To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren't necessary during disulfiram therapy.

A nurse on the Geropsychiatric unit receives a call from the son of a recently discharged client. He reports that his father just got a prescription for memantine (Namenda) to take "on top of his donepezil (Aricept)." The son then asks, "Why does he have to take extra medicines?" The nurse should tell the son: 1. "Maybe the Aricept alone isn't improving his dementia fast enough or well enough." 2. "Namenda and Aricept are commonly used together to slow the progression of dementia." 3. "Namenda is more effective than Aricept. Your father will be tapered off the Aricept." 4. "Aricept has a short half-life and Namenda has a long half-life. They work well together."

2. The two medicines are commonly given together. Neither medicine will improve dementia, but may slow the progression. Neither medicine is more effective than the other; they act differently in the brain. Both medicines have a half-life of 60 or more hours.

A 17-year-old client is started on fluoxetine (Prozac) for treatment of depression. When teaching the client and his family, what would the nurse include? Select all that apply. 1. Report any sedation to the provider and exercise caution with activities requiring mental alertness. 2. Fluctuations in weight may be managed with a healthy diet and adequate amounts of exercise. 3. Report any thoughts of suicide to the provider immediately, especially during early initiation of the drug. 4. The drug may be safely stopped if unpleasant side effects occur and reported to the provider at the next scheduled visit. 5. The drug may cause excessive thirst but dramatic increase in fluid intake should be avoided

2. Fluctuations in weight may be managed with a healthy diet and adequate amounts of exercise. 3. Report any thoughts of suicide to the provider immediately, especially during early initiation of the drug.

The nurse is caring for a patient with depression who takes citalopram [Celexa], an antidepressant. The nurse understands that the full therapeutic effects are not seen until about 3 to 4 weeks after beginning this drug. What is the best description of this process? A. Adaptive changes in the brain B. Drug tolerance and dependence C. A wide therapeutic index D. Improved neuronal transmission

A The brain adapts to CNS agents over time. The beneficial effects of antidepressants are believed to be delayed because they result from adaptive changes.

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).

3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks.

A hospitalized client is having the dosage of clonazepam (Klonopin) adjusted. The nurse should plan to: 1. Weigh the client daily. 2. Observe for ecchymosis. 3. Institute seizure precautions. 4. Monitor blood glucose levels.

3. Institute seizure precautions. Rationale: Clonazepam is a benzodiazepine used as an anticonvulsant. During initial therapy and during periods of dosage adjustment, the nurse should initiate seizure precautions for the client. Options 1, 2, and 4 are not associated with the use of this medication.

When comparing the effects and efficacy of valproic acid with those of lithium, the nurse should understand that valproic acid: 1. does not have gastrointestinal side effects. 2. does not cause weight gain. 3. is associated with unintentional weight loss. 4. has a greater therapeutic index.

4

The provider has ordered donepezil (Aricept) for the patient, and the patient states "I have no idea why I take this medication." What is the most common diagnosis associated with the administration of donepezil (Aricept)?

Alzheimer's disease

A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? Select all that apply. a. Vital signs b. Urinary frequency c. Psychomotor retardation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness

A, D, E The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. The patient may have urinary retention, but frequency would not be expected.

A nurse is providing education to nurses in the psychiatric unit on antidepressant medications. To evaluate their learning, the educator asks one of the nurses, "How does fluoxetine (Prozac) achieve its effects?" The nurse would be correct to state that fluoxetine (Prozac) achieves its effects by which of the following mechanisms of action? a. Selectively inhibiting serotonin reuptake b. Blocking the uptake of monoamines c. Inhibiting monoamine oxidase-A in nerve terminals d. Direct stimulation of serotonin receptors

ANS: A Fluoxetine produces selective inhibition of serotonin reuptake and intensifies transmission at serotonergic synapses. Fluoxetine does not act by blocking uptake of monoamines or inhibiting monoamine oxidase-A nerve terminals, nor does it directly stimulate serotonin receptors.

A patient taking fluoxetine (Prozac) complains of decreased sexual interest. A prescriber orders a "drug holiday." What teaching by the nurse would best describe a "drug holiday"? a. Don't take the medication on Friday and Saturday. b. Cut the tablet in half anytime to reduce the dosage. c. Take the drug every other day. d. Discontinue the drug for 1 week.

ANS: A Sexual dysfunction may be managed by having the patient take a "drug holiday" which involves discontinuing medication on Fridays and Saturdays. Cutting the tablet in half any time to reduce the dosage is an inappropriate way to effectively manage drug administration. In addition, it does not describe a "drug holiday." The patient should not take the drug every other day, nor should it be discontinued for a week at a time as this will diminish the therapeutic levels of the drug, thereby minimizing the therapeutic effects. In addition, neither option describes a "drug holiday."

A patient taking fluoxetine (Prozac) complains of insomnia. The nurse reports the patient's complaint to the prescriber and should anticipate that which of the following medications would be ordered? a. Trazodone (Desyrel) b. Ramelteon (Rozerem) c. Diphenhydramine (Nytol) d. Zolpidem (Ambien)

ANS: A Trazodone is especially useful for treating insomnia resulting from the use of antidepressants that cause significant central nervous system stimulation. Ramelteon is indicated for long-term therapy of insomnia. Diphenhydramine and zolpidem are not indicated for antidepressant insomnia.

A patient with a history of gastric ulcers is admitted to the unit. A nurse reviews the admission medications. During the health history, the nurse notes that the patient has been taking nonsteroidal anti-inflammatory drugs and fluoxetine (Prozac). Which of the following laboratory tests would be the priority for the nurse to make sure that the prescriber has ordered? a. Sodium level b. Platelet level c. Fluoxetine (Prozac) level d. Potassium level

ANS: B Fluoxetine and other selective serotonin reuptake inhibitors can increase the risk of bleeding in the gastrointestinal tract, and caution is advised in patients taking nonsteroidal anti-inflammatory drugs; together, these drugs put this patient, who has a history of ulcers, at great risk for bleeding episodes. Sodium, fluoxetine, and potassium levels are not indicated as a priority for this patient.

A patient recently diagnosed with bipolar disorder has been admitted to the unit with severe mania. Home medications include valproic acid (Depakene). An antipsychotic medication is added to the medication regimen as a STAT order. After the new medication is explained to the patient, he states, "I'm not crazy. Why am I receiving this antipsychotic medication?" What is the nurse's most appropriate response to the patient? a. "The antipsychotic drug reduces your manic episode." b. "The antipsychotic will help control symptoms during severe manic episodes." c. "The antipsychotic allows higher levels of valproic acid without signs of toxicity." d. "The antipsychotic is actually the primary drug therapy for bipolar disorder."

ANS: B In patients with bipolar disorder, antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. The antipsychotic drugs usually are given in combination with a mood stabilizer. The antipsychotic drug addresses the symptoms, not the duration, of the manic episode. Antipsychotic medications do not affect valproic acid levels. Antipsychotics are not the primary therapy for bipolar disorder.

A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine

ANS: C Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include but are not limited to flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.

Sertraline (Zoloft) has been prescribed for a client complaining of poor appetite, fatigue, and anhedonia. Which consideration should the nurse recognize as influencing this prescriptive choice? A. Zoloft is less expensive for the client. B. Zoloft is extremely sedating and will help with sleep disturbances. C. Zoloft has less adverse side effects than other antidepressants. D. Zoloft begins to improve depressive symptoms quickly.

ANS: C Zoloft is a selective serotonin reuptake inhibitor (SSRI) that has a relatively benign side effect profile as compared with other antidepressants.

A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."

ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.

A 16-year-old client has taken an overdosage of citalopram (Celexa) and is brought to the emergency department. What symptoms would the nurse expect to be present? 1. Seizures, hypertension, tachycardia, extreme anxiety 2. Hypotension, bradycardia, hypothermia, sedation 3. Miosis, respiratory depression, absent bowel sounds, hypoactive reflexes 4. Manic behavior, paranoia, delusions, tremors

Answer: 1 Rationale: An overdose of citalopram (Celexa) causes symptoms similar to serotonin syndrome including seizures, hypertension, tachycardia, and extreme anxiety. Options 2, 3, and 4 are incorrect. These are not symptoms of an SSRI overdosage.

A client ingested a full bottle of imipramine hydrochloride (Tofranil). What toxic effect is most important for the nurse monitor?

Arrhythmias. (With a Tricyclic antidepressant (TCA) overdose, there is a high risk for serious cardiac problems, including arrhythmias, tachycardia and myocardial infarction)

A patient taking methylphenidate (Ritalin) is nauseous and vomiting. What is the nurse's best action? Monitor the patient's vital signs. Ask the patient if he or she has been taking the medication regularly. Assess the patient's temperature. Administer an antiemetic medication.

Ask the patient if he or she has been taking the medication regularly Nausea, vomiting, and headache are symptoms of withdrawal. The nurse should find out if the patient has been taking the medication regularly

Which drug does the nurse identify as a selective serotonin reuptake inhibitor? (Select all that apply.) A. Bupropion [Wellbutrin] B. Imipramine [Tofranil] C. Fluoxetine [Prozac] D. Desvenlafaxine [Pristiq] E. Sertraline [Zoloft]

C,E Fluoxetine [Prozac] and sertraline [Zoloft] are selective serotonin reuptake inhibitors. Bupropion [Wellbutrin] is an atypical antidepressant. Imipramine [Tofranil] is a tricyclic antidepressant. Desvenlafaxine [Pristiq] is a serotonin/norepinephrine reuptake inhibitor (SNRI).

Which of the following is most important to teach a patient who is being administered lamotrigine (Lamictal)? A. to report the development of edema B. to report anxiety C. to report the development of a skin rash D. to report anorexia

C. It is necessary to instruct the patient to report the development of skin rash when administered lamotrigine (Lamictal). The U.S. Food and Drug Administration has issued a Black Box Warning concerning potential development of serious dermatologic reactions.

The blood serum level of imipramine is determined in a client who is being treated for depression with Tofranil-PM. The laboratory test indicates a concentration of 250 ng/mL. On the basis of this result, the nurse should:

Document the laboratory result in the client's record

Fluoxetine (Prozac) is prescribed for a client with depression. The nurse recognizes that the advantage to using this drug rather than tricyclic antidepressants is that fluoxetine: Does not have cardiotoxicity as a side effect. Does not cause GI distress. Can be used for a shorter time. Does not cause sexual dysfunction.

Does not have cardiotoxicity as a side effect. Rationale: Fluoxetine (Prozac) is an SSRI. These drugs are safer than MAOI and TCAs, and they have fewer side effects.

A nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to gather regarding the adverse effects related to the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

Gastrointestinal dysfunctions Rationale: The most common adverse effects related to fluoxetine include central nervous system (CNS) and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of this medication.

The nurse is assessing a client with bipolar disorder who is taking lithium carbonate and who has a lithium level of 1.7 mEq/L. The nurse would expect to find which sign/symptoms of lithium toxicity associated with this level? Select all that apply.

Incoordination, Mental confusion, Muscle hyperirritability

The parent of a child with attention-deficit/hyperactivity disorder (ADHD) asks the nurse how a drug like methylphenidate (Ritalin), a CNS stimulant, can help the child. What is the nurse's best response?

Methylphenidate has a paradoxical effect in children Methylphenidate (Ritalin), a CNS stimulant, has a paradoxical effect in children, producing calmness in children with hyperactive behavior. The exact mechanism of action is not clearly understood.

The nurse administered donepezil (Aricept) to a client. Which finding indicates that the medication is therapeutic?

The client has increased cognition. Donepezil (Aricept) is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.

A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug.

Weight gain is a common, but troubling, side effect."

A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. For which of the following would she instruct the client to be on the alert?

b. Tinnitus, severe diarrhea, ataxia

A client has been diagnosed with major depressive episode. The psychiatrist prescribes imipramine (Tofranil). Which of the following medication information should the nurse include in discharge teaching? Select all that apply. a. The medication may cause dry mouth. b. The medication may cause urinary incontinence. c. The medication should not be discontinued abruptly. d. The medication may cause photosensitivity. e. The medication may cause nausea.

a. The medication may cause dry mouth. c. The medication should not be discontinued abruptly. d. The medication may cause photosensitivity. e. The medication may cause nausea.

The physician has ordered lithium carbonate (Eskalith) for a client diagnosed with bipolar disorder. What is the most likely rationale for prescribing this drug?

a. To decrease hyperactivity

A selective serotonin reuptake inhibitor (SSRI) is prescribed for a patient. The nurse knows that which drug is an SSRI? a. paroxetine (Paxil) b. amitriptyline (Elavil) c. divalproex sodium (Depakote) d. bupropion HCl (Wellbutrin)

a. paroxetine (Paxil)

An older female client who is hospitalized for depression is receiving citalopram (Celexa). During discharge teaching, she asks the nurse whether there is anything she should know about taking this medication. The nurse replies: a) "You're concerned about taking this medication." b) "You should take each dose of medication as prescribed." c) "You must discontinue the medication if side effects occur." d) "You may find it necessary to adjust the dosage if side effects occur."

b) "You should take each dose of medication as prescribed." The client should be encouraged to follow the medical regimen to maximize her response to drug therapy. The client asked a direct question; telling her that she should take each dose as prescribed does not answer her question. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for discontinuing a medication. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for adjusting a medication dosage.

Your patient is taking valproic acid (Depakote). Which of the following is a false statement? a. Valproic acid requires hepatic monitoring b. Valproic acid has the lowest seizure relapse rate when discontinued c. Valproic acid is also used in migraine therapy d. Valproic acid is also used in bipolar disorder therapy

b. Valproic acid has the lowest seizure relapse rate when discontinued

A client is taking valproic acid (Depakote). The nurse should monitor the client for a which therapeutic serum range? a. 10 to 20 mcg/mL b. 15 to 40 mcg/mL c. 20 to 80 ng/mL d. 40 to 100 mcg/mL

d. 40 to 100 mcg/mL

Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication? 1. "I should take the medication with my evening meal." 2. "I should take the medication at noon with an antacid." 3. "I should take the medication in the morning when I first arise." 4. "I should take the medication right before bedtime with a snack."

"I should take the medication in the morning when I first arise." Rationale: Fluoxetine hydrochloride is administered in the early morning without consideration to meals. *Eliminate options 1, 2, and 4 because they are comparable or alike and indicate taking the medication with an antacid or food.*

A client tells a nurse: "I have decided to stop taking sertraline (Zoloft) because I don't like the nightmares, sex dreams and obsessions I have had since starting on the medication." What is an appropriate response by the nurse? "This medication should be continued despite unpleasant symptoms." "Many medications have potential side effects." "Side effects and benefits should be discussed with your health care provider." "It is unsafe to abruptly stop taking any prescribed medication."

"It is unsafe to abruptly stop taking any prescribed medication." Abrupt withdrawal the short-acting SSRI sertraline (Zoloft) causes SSRI Discontinuation Syndrome. A slow tapering of the medication will be prescribed to avoid the symptoms associated with this syndrome, which may include insomnia, headache, dry mouth, nausea and diarrhea.

A 20-year-old client who is receiving sertraline (Zoloft) 50 mg once a day for depression complains that she feels no better after taking three doses of the drug. Which response by the nurse is best?

"Sertraline typically takes at least 2 weeks to become effective."

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? A. Symptoms indicate consumption of foods high in tyramine. B. Symptoms indicate lithium carbonate discontinuation syndrome. C. Symptoms indicate the development of lithium carbonate tolerance. D. Symptoms indicate lithium carbonate toxicity.

D. Symptoms indicate lithium carbonate toxicity

A client with bipolar disorder has been taking lithium for the past 2 years. Recently, the client has been experiencing a recurrence of manic symptoms approximately once a month. The psychiatrist has added clonazepam (Klonopin) to help manage the client's mood swings. Which of the following statements should the nurse include in medication teaching?

"This medication will help to steady your moods by reducing the overstimulation of chemical messengers in your brain."

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the appropriate nursing response? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

"Zyprexa calms hyperactivity until the Eskalith takes effect."

A patient taking fluoxetine informs a nurse, "I started taking St. John's wort to help my depression." The nurse should: 1. add the herbal preparation to the medications listed in the patient's chart. 2. assess the patient for signs of hypotensive crisis. 3. explain the risk of serotonin syndrome and discourage the use of the herbal preparation. 4. recommend that the patient stop both medications.

3

A client diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the client? Select all that apply. 1. Monitor the client for suicidal ideations related to depressed mood. 2. Discuss the need to take medications, even when symptoms improve. 3. Instruct the client about the risks of abruptly stopping the medication. 4. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects. 5. Remind the client that the medication's full effect does not occur for 4 to 6 weeks.

2. Discussing the need for medication compliance, even when symptoms improve, is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 3. Instructing the client about the risk for discontinuation syndrome is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 4. Alerting the client to the risks of dry mouth, sedation, nausea, and sexual side effects is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline. 5. Reminding the client that sertraline's full effect does not occur for 4 to 6 weeks is a teaching point that the nurse would need to review with a client who is newly prescribed sertraline

Sertraline (Zoloft) is prescribed to treat depression. The nurse reviews the client's record and consults the physician if which of the following is noted? 1. A history of diabetes mellitus 2. Use of phenelzine sulfate (Nardil) 3. A history of myocardial infarction 4. A history of irritable bowel syndrome

2. Use of phenelzine sulfate (Nardil) Rationale: Sertraline (Zoloft) is a serotonin reuptake inhibitor and antidepressant medication. Potentially fatal reactions may occur if sertraline is administered concurrently with a monoamine oxidase inhibitor (MAOI) such as phenelzine sulfate, MAOIs should be stopped at least 14 days before sertraline therapy. Conversely, sertraline should be at least 14 days before MAOI therapy. Options 1, 3, and 4 are not concerns of use of this medication.

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. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety.

A client taking the drug disulfiram (Antabuse) is admitted to the ER. Which clinical manifestations are most indicative of recent alcohol ingestion? "A. Vomiting, heart rate 120, chest pain B. Nausea, mild headache, bradycardia C. Respirations 16, heart rate 62, diarrhea D. Temp 101°F, tachycardia, respirations 20"

Answer A is correct. Vomiting, a heart rate of 120, and chest pain are symptoms of drinking alcohol while taking Antabuse. Additional symptoms include severe headache, nausea, ardiac collapse, respiratory collapse, convulsions, and death. Answers B, C, and D contain incomplete or inaccurate clinical signs of the combination of alcohol and Antabuse.

A home-health patient with Alzheimer's disease (AD) and mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication? a. Setting the medications up weekly in a medication box b. Calling the patient daily with a reminder to take the medication c. Having the patient's spouse administer the medication d. Posting reminders to take the medications in the patient's house

Correct Answer: C Rationale: Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the Aricept. The other nursing actions will not be as effective in ensuring that the patient takes the medications.

A client has a prescription for valproic acid (Depakene) orally once daily. The nurse plans to: 1. Administer the medication with an antacid. 2. Administer the medication with a carbonated beverage. 3. Ensure that the medication is administered at the same time each day. 4. Ensure that the medication is administered 2 hours before breakfast only, when the client's stomach is empty.

3. Ensure that the medication is administered at the same time each day. Rationale: Valproic acid is an anticonvulsant, antimanic, and antimigraine medication. It may be administered with or without food. It should not be taken with an antacid or carbonated beverage because these products will affect medication absorption. The medication is administered at the same time each day to maintain therapeutic serum levels. *Use general pharmacology guidelines to assist in eliminating options 1 and 2. Eliminate option 4 because of the closed-ended word "only."*

The nurse prepares a patient who is taking sertraline (Zoloft) for discharge. Which instruction should the nurse include in patient teaching? A) Take sertraline at same time each day. B) Expect to feel better in 4 to 6 days. C) Avoid overheating and direct sun. D) Report any increase in mania.

A) Take sertraline at same time each day. Sertraline is a selective serotonin reuptake inhibitor, and the patient is most likely to experience therapeutic effectiveness if the medication is taken at the same time every day. The nurse instructs the patient to adhere to therapy for 4 to 6 weeks to determine the medication's effectiveness. Hyperpyrexia is an adverse effect of antipsychotic agents; lithium is used to treat bipolar disorder, of which mania is a characteristic.

A patient receiving valproic acid (Depakote) should be monitored for which side effects? (Select all that apply.) A) Tremors B) Weight gain C) Hepatoxicity D) Hypoglycemia E) Insomnia

A) Tremors B) Weight gain C) Hepatoxicity

A nurse is reviewing medications for a patient with bipolar disorder. The nurse has received an order to discontinue the lithium and begin valproic acid (Depakene). The nurse understands the prescriber's change of order based on which mechanism of action? a. Valproic acid works slower and has a lower therapeutic index. b. Valproic acid has no serious side effects. c. Valproic acid does not require plasma drug levels. d. Valproic acid works faster and has a higher therapeutic index.

ANS: D Valproic acid works faster and has a higher therapeutic index than lithium, as well as a better side effect profile. This is incorrect; in fact, valproic acid works faster and has a higher therapeutic index than lithium. Valproic acid can have serious side effects. Any anticonvulsant, including valproic acid, when used in a patient with bipolar disorder requires monitoring with periodic plasma drug levels.

A 77-year-old female client is diagnosed with depression with anxiety and is started on imipramine. Because of this client's age, the nurse will take precautions for care related to which adverse effects? 1. Dry mouth and photosensitivity 2. Anxiety, headaches, insomnia 3. Drowsiness and sedation 4. Urinary frequency

Answer: 3 Rationale: Tricyclic antidepressants such as imipramine (Tofranil) may cause drowsiness and sedation. Because of this client's age, these effects may increase the risk of falls. Options 1, 2, and 4 are incorrect. Headache, insomnia, and anxiety are not common adverse effects associated with imipramine. The drug may cause photosensitivity, dry mouth, and urinary retention, but these would not be a priority considering the fall risk. The drug does not cause urinary frequency.

The nurse is caring for a child taking methylphenidate for ADHD. Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's best action?

Assess for over-the-counter medication use. This medication interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.

A female patient who has been taking lithium carbonate (Lithobid) for 1 week tells the nurse that she is experiencing dizziness. What is the best nursing intervention to implement in this situation? A) Tell the patient to continue therapy. B) Direct the patient to change positions slowly. C) Check the serum drug level of lithium. D) Ask the patient about her sodium and fluid intake.

B) Direct the patient to change positions slowly. As a means of maintaining the patient's safety, the most important nursing intervention is instructing the patient to change positions slowly to prevent dizziness. Once action has been taken to maintain patient safety, the nurse gathers additional patient data by investigating possible causes of the dizziness, such as a high lithium level or altered levels of fluids and electrolytes. Unless the nurse has patient data to support the discontinuation of therapy, the nurse instructs the patient to continue taking lithium to prevent disruption of therapy.

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

Valproic acid (Depakote)

A client diagnosed with major depressive episode is being discharged from the hospital with a prescription for fluoxetine (Prozac). The nurse's discharge teaching should include which of the following? Select all that apply. a. "It may take a few weeks before you begin to feel better; however, continue taking Prozac as prescribed" b. "Make sure that you follow up with scheduled outpatient psychotherapy." c. "If significant mood elevation is noted, your psychiatrist may discontinue this medication within 6 months to a year." d. "You should avoid foods with tyramine, including beer, beans, processed meats, and red wine." e. "You can discontinue the Prozac when you are feeling better."

a. "It may take a few weeks before you begin to feel better; however, continue taking Prozac as prescribed" b. "Make sure that you follow up with scheduled outpatient psychotherapy." c. "If significant mood elevation is noted, your psychiatrist may discontinue this medication within 6 months to a year."

The nurse determines that the teaching plan for a client prescribed sertraline (Zoloft) has been effective when the client makes which statement? 1. "I should not decrease my sodium or water intake." 2. "The drug can be taken concurrently with the phenelzine (Nardil) that I'm taking." 3. "It may take up to a month for the drug to reach full therapeutic effects and I'm feeling better." 4. "There are no other drugs I need to worry about; Zoloft doesn't react with them."

Answer: 3 Rationale: SSRI antidepressant drugs such as sertraline (Zoloft) may not have full effects for a month or longer but some improvement in mood and depression should be noticeable after beginning therapy. Options 1, 2, and 4 are incorrect. Sodium and fluid intake is a concern with lithium but does not adversely affect the SSRIs. The SSRIs should not be used concurrently with MAOIs because of an increased risk of hypertensive crisis. They also have many interactions with other drugs.

The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products? A. Carbonated beverages B. Aftershave lotion C. Toothpaste D. Cheese

B. Aftershave lotion **Rationale: Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Carbonated beverages, toothpaste, and cheese don't contain alcohol and don't need to be avoided by the client.

After the first three dose of Paroxetine (Paxil) 20 mg, the client complains that the medication upsets his stomach. Which of the following instructions would the nurse give to the client? A) "Take the medication with 4 ounces of orange juice." B) "Take the medication an hour before breakfast." C) "Take the medication at bedtime." D) "Take the medication with some foods.

D = Nausea and gastrointestinal upset is a common but usually temporary side effects of Paroxetine (Paxil). Therefore, the nurse would instruct the client to take the medication with food to minimize nausea and stomach upset.

Which would indicate to the nurse that the child taking methylphenidate requires more teaching?

Answer: The child drinking a carbonated beverage Rationale: The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should be checked twice a week for weight loss. The drug should be taken 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping.

The nurse is assessing a patient receiving valproic acid (Depakene) for potential adverse effects associated with this drug. Which item represents the most common problem with this drug? A) Increased risk for infection B) Reddened, swollen gums C) Nausea, vomiting, and indigestion D) Central nervous system depression

D) Central nervous system depression Valproic acid is generally well tolerated. It does not cause hematologic effects resulting in increased risk for infection nor does it cause gingival hyperplasia. It causes minimal sedation. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by giving with food.

Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? 1. A history of hyperthyroidism 2. A history of diabetes insipidus 3. When the last full meal was consumed 4. When the last alcoholic drink was consumed

When the last alcoholic drink was consumed Rationale: Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12 hours before the initial dose of the medication is administered. The most important data are to determine when the last alcoholic drink was consumed. The medication is used with caution in clients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepatic disease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related to the medication.

A 21-year-old female client takes clonazepam (Klonopin). What should the nurse ask this client about? Select all that apply. 1. Seizure activity. 2. Pregnancy status. 3. Alcohol use. 4. Cigarette smoking. 5. Intake of caffeine and sugary drinks.

1, 2, 3. The nurse should assess the number and type of seizures the client has experienced since starting clonazepam monotherapy for seizure control. The nurse should also determine if the client might be pregnant because clonazepam crosses the placental barrier. The nurse should also ask about the client's use of alcohol because alcohol potentiates the action of clonazepam. Although the nurse may want to check on the client's diet or use of cigarettes for health maintenance and promotion, such information is not specifically related to clonazepam therapy.

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.

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.

The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? A. Sexual dysfunction B. Dry mouth C. Orthostatic hypotension D. Bradycardia

A Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation.

A patient takes sertraline (Zoloft) for depression related to chronic pain. The nurse avoids administering which analgesic agent to help prevent serotonin syndrome? A) Tramadol (Ultram) B) Ibuprofen (Motrin) C) Fentanyl (Duragesic) D) Oxycodone (OxyContin

A) Tramadol (Ultram) The nurse avoids administering tramadol to a patient who takes a selective serotonin reuptake inhibitor, because it increases the risk for serotonin syndrome. This is because tramadol exerts its analgesia by blocking the reuptake of norepinephrine and serotonin. Ibuprofen is unlikely to provide relief to a patient with chronic pain unless the pain has developed an inflammatory aspect. Fentanyl and oxycodone are reasonable choices of analgesics for this patient, but both agents require careful monitoring of the patient.

A client suffering posttraumatic stress disorder is prescribed sertraline (Zoloft), 50 mg by mouth once daily. Which actions should the nurse take when administering this drug? Select all that apply: 1. Administer the drug at bedtime. 2. Mix the oral concentrate with 4 oz (120 ml) of water, ginger ale, or lemon-lime soda. 3. Administer the oral solution immediately after dilution. 4. Instruct the client to check with the prescriber or pharmacist before taking over-the-counter preparations. 5. Advise the client to use caution when performing hazardous tasks that require alertness.

Correct Answer: 2,3,4,5 RATIONALES: Sertraline should be administered once daily, either in the morning or evening (but not at bedtime). The oral concentrate should be mixed with 4 oz of water, ginger ale, or lemon-lime soda, and it should be administered immediately after mixing. The client should be advised to check with the prescriber or pharmacist before taking any over-the-counter preparations. The nurse should also advise the client to use caution when performing hazardous tasks that require alertness.

A patient who is has taken fluoxetine (Prozac) for 2 weeks to treat an anxiety disorder complains that he is not satisfied with the therapy. What is the best information for the nurse to include in patient teaching to promote adherence to the therapeutic regimen? A) The adverse effects can be managed well. B) This medication usually requires titration. C) Relaxation exercises can offer some relief. D) A therapeutic effect is expected 2 to 4 weeks after the start of therapy.

D) A therapeutic effect is expected 2 to 4 weeks after the start of therapy. The full therapeutic effects of selective serotonin reuptake inhibitor (SSRI) therapy may take 4 to 6 weeks to appear, so this patient can anticipate experiencing a therapeutic effect in 2 to 4 more weeks. Knowing the timeframe offers the patient realistic hope and provides a justification for adherence to therapy. Adverse effects can usually be managed, and relaxation exercises may provide some relief from anxiety. The patient must fulfill these tasks to get the full therapeutic effect of the medication, but it can be difficult for a patient with depression to do so. SSRIs can require considerable titration, but, because of the nature of the patient's illness, this information is unlikely to promote adherence to therapy.

Which of the following adverse effects of imipramine (Tofranil) is considered the most serious? A. dry mouth B. constipation C. urinary retention D. orthostatic hypotension

D. Although urinary retention, constipation, and dry mouth are adverse effects related to the anticholinergic properties of imipramine, orthostatic hypotension poses the greatest safety risk to the patient. The nurse should instruct the patient to rise slowly from a lying or sitting position to a standing one. Additionally, it is necessary to avoid activities that require changes in position until the patient knows how he or she is affected by the risk of orthostatic hypotension.

The serum lithium level of a patient who takes lithium carbonate (Lithobid) is 1.8 mEq/L. The nurse assesses the patient for which clinical indicators consistent with this concentration of the drug? (Choose all that apply.) A) Frequent diarrhea B) Minor weight loss C) Muscle irritability D) Fine hand tremors E) Adherence to the therapeutic regimen F) Irregular heartbeat

A, C, E, F The therapeutic drug level for lithium is 1 to1.5 mEq/L. This patient's lithium level is above normal, so the nurse expects to observe clinical indicators of lithium toxicity, including diarrhea, muscle irritability, adherence to the therapeutic regimen, and an irregular heartbeat. The adverse effects of lithium therapy are proportionate to the serum level, so the patient's assessment findings are abnormal but not severe. The nurse concludes that the patient has been compliant with the therapeutic regimen, because it is unlikely that a toxic drug level could occur with missed doses. A toxic level of lithium is more likely to increase weight, as a result of sodium retention; coarse tremors are associated with toxicity.

The spouse of the client with Alzheimer's disease (AD) is listening to the hospice nurse explaining the client's drug regimen. Which statement by the spouse indicates an understanding of the nurse's instruction? A. "Donepezil (Aricept) will treat the symptoms of Alzheimer's disease." B. "Memantine (Namenda)is indicated for treatment of early symptoms of Alzheimer's disease. C. "Rivastigmine (Excelon) is used to treat depression." D. "Sertraline (Zoloft) will treat the symptoms of Alzheimer's disease."

A. "Donepezil (Aricept) will treat the symptoms of Alzheimer's disease." Rationale A. Cholinesterase inhibitors (e.g., donepezil) are approved for the symptomatic treatment of Alzheimer's disease. B. Memantine (Namenda) is indicated for advanced Alzheimer's disease. C. Rivastigmine (Excelon) is a cholinesterase inhibitor that is used to treat Alzheimer's symptoms. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants and may be used in Alzheimer's clients who develop depression. D. Some clients with Alzheimer's disease experience depression and may be treated with antidepressants such as sertraline.

An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication should the nurse expect the physician to prescribe? 1. Haloperidol (Haldol) 2. Donepezil (Aricept) 3. Diazepam (Valium) 4. Sertraline (Zoloft)

ANS: 4 Rationale: The nurse should expect the physician to prescribe sertraline to improve the client's social functioning and concentration levels. Sertraline is an selective serotonin reuptake inhibitor (SSRI) antidepressant. Depression is the most common mental illness in older adults and is often misdiagnosed as a neurocognitive disorder.

An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

ANS: 4 Rationale: The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.