Psychopharmacology 31-36

A 7-year-old child is taking methylphenidate twice daily. The nurse should instruct the parent that the second dose should be administered: 1. before 4 PM. 2. 2 hours after the first dose. 3. at bedtime. 4. at any time; timing is not relevant because of the long half-life.

1

A major difference between paraldehyde and other CNS depressants is its: 1. poisoning profile. 2. site of action. 3. primary effect. 4. route of elimination.

1

A nurse assesses a newly admitted hospital patient. Which finding should alert the nurse that the patient may be experiencing major depression? The patient who: 1. reports sleeping 14 to 16 hours per day for the past 3 months. 2. states, "I realize I'm not able to play 18 holes of golf anymore. Now I play 9." 3. comments, "I have asked my sister to help me at home until I am feeling stronger." 4. says, "I've asked my supervisor to reduce my work schedule to 20 hours a week."

1

A nurse compares the actions of benzodiazepines with those of buspirone. Which statement is correct regarding buspirone? 1. It is not a CNS depressant. 2. The effects are more rapid. 3. It is suitable for PRN use. 4. There is a higher abuse potential.

1

A nurse counsels a patient with bipolar disorder, manic phase, who recently started on a mood stabilizer and an antipsychotic. The patient questions the rationale for the antipsychotic drug. Select the nurse's best response. 1. "The antipsychotic drug reduces mania while waiting for the lithium to take effect." 2. "Antipsychotics are long-term components of therapy for bipolar disorder." 3. "Antipsychotics allow higher levels of lithium without signs of toxicity." 4. "The antipsychotic drug is actually the mainstay of bipolar disorder therapy."

1

A patient in the emergency department is being treated for amphetamine toxicity. The nurse plans to administer: 1. an alpha-adrenergic blocker. 2. an alpha agonist. 3. a calcium channel blocker. 4. an ACE inhibitor.

1

A toddler is brought to the emergency department after an accidental ingestion. Because the child exhibited stiffness in the face and neck before tonic contraction of all involuntary muscles, ingestion of which agent is suspected? 1. Strychnine 2. Cocaine 3. Methamphetamine 4. Modafinil

1

An important component of education for a patient on buspirone is to: 1. not take the medication with grapefruit juice. 2. avoid alcohol-containing products. 3. never take the medication with food. 4. beware of signs of dependence and abuse.

1

As a group of agents, benzodiazepines differ from one another in terms of: 1. onset and duration of action. 2. depth of CNS depression. 3. pharmacologic actions. 4. side effects.

1

Most barbiturates are considered nonselective CNS depressants. The major exception is: 1. phenobarbital. 2. thiopental. 3. secobarbital. 4. butabarbital.

1

The only benzodiazepine commonly used to relieve muscle spasm is: 1. diazepam. 2. lorazepam. 3. estazolam. 4. clonazepam

1

Which statement about chloral hydrate use in practice is accurate? 1. The drug has an abuse pattern similar to that of the barbiturates. 2. It allows for prolonged use without the development of tolerance. 3. Addiction potential is low. 4. There are no gastrointestinal adverse effects.

1

. Which category of drugs is used for all types of anxiety disorders? 1. Benzodiazepines 2. Selective serotonin reuptake inhibitors 3. Barbiturates 4. Anticonvulsants

2

A patient complains of feelings of helplessness and fear after being stranded on a rooftop for 3 days after a major hurricane. Which diagnosis is the most likely? 1. Generalized anxiety disorder 2. Post-traumatic stress disorder 3. Obsessive-compulsive disorder 4. Panic disorder

2

A patient is brought to the ED after taking a 30-day supply of benzodiazepines at one time. Which drug should the nurse have available to administer? 1. Naloxone 2. Flumazenil 3. Calcium carbonate 4. Magnesium sulfate

2

A patient reports awakening at 1 AM after only 2 hours of sleep and being unable to return to sleep for several hours. The patient is becoming increasingly anxious and requests a sleeping medication that will not cause a hangover. The nurse anticipates that which drug will be prescribed? 1. Zolpidem 2. Zaleplon 3. Flurazepam 4. Trazodone

2

Barbiturates should not be used in patients with: 1. a history of anxiety. 2. suicidal tendencies. 3. an allergy to benzodiazepines. 4. a history of drowsiness with the use of these agents.

2

In contrast to the barbiturates, the benzodiazepines: 1. cannot cross the blood-brain barrier. 2. have a built-in limit to the depth of CNS depression that they can produce. 3. are not lipid soluble. 4. have more difficulty affecting the CNS.

2

The actions of zolpidem are similar to the benzodiazepines, although this agent will not: 1. induce sleep. 2. reduce anxiety. 3. affect REM sleep patterns. 4. prolong sleep duration

2

The parents of a child who has been prescribed methylphenidate (Ritalin) for ADHD should be educated that: 1. hypersomnolence is a major side effect. 2. long-term use does not usually affect the adult height that the child will attain. 3. drug holidays are not warranted. 4. allergic reactions are common.

2

When teaching a patient who has been prescribed modafinil, the nurse should explain that this drug differs from the more traditional amphetamines in that it: 1. has a higher abuse potential. 2. will not disrupt nighttime sleep. 3. is safer for patients with liver disease. 4. is approved for narcolepsy.

2

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

2

Which information would be used by the nurse and multidisciplinary team to evaluate whether the prescribed medication regimen is the most effective one for a patient with bipolar disorder? 1. The patient's report of compliance with the regimen 2. Evidence and acuity of symptoms of the disease 3. Weight changes and daily blood glucose values 4. Serum blood levels of the medication

2

Which statement is correct regarding IV amphetamines? 1. They are indicated for severe hypotension. 2. They are not legally available. 3. They are used in patients unable to take PO medications. 4. They are contraindicated in patients with heart failure.

2

Zaleplon is best suited for patients who: 1. cannot maintain sleep. 2. need or want to fall asleep quickly. 3. are also taking cimetidine. 4. require an agent with a long half-life.

2

A patient is being treated in the emergency department for barbiturate toxicity. Select the findings in the "triad" of symptoms seen in this situation. You may select more than one answer. 1. Tachycardia 2. Pinpoint pupils 3. Unresponsiveness 4. Hypertension 5. Respiratory depression

235

Select the accurate statement(s) about differences between bupropion and SSRIs. You may select more than one answer. 1. Bupropion is more likely to cause weight gain. 2. Bupropion will increase seizure activity in a patient with epilepsy. 3. Bupropion is less likely to cause sexual dysfunction. 4. SSRIs are an effective aid to smoking cessation. 5. Bupropion is less likely to cause weight gain.

235

A patient takes amphetamines. Which assessment finding(s) would the nurse expect? You may select more than one answer. 1. Increased fatigue 2. Insomnia 3. Increased appetite 4. Tachycardia 5. Restlessness

245

A nurse counsels a patient who has just started taking buspirone. When should the nurse instruct the patient to expect to see an effect from the drug? 1. 1 hour 2. 24-48 hours 3. 1 week 4. 8-12 weeks

3

A nurse monitors a patient with bipolar disorder who has taken carbamazepine for 2 years. Which laboratory value requires the most diligent surveillance? 1. Serum urea nitrogen 2. Direct bilirubin 3. Complete blood count 4. Thyroid function studies

3

A patient with bipolar disorder has been on lithium therapy for 3 years. The patient develops hypertension. Which drug added for treatment of the hypertension would cause the most concern? 1. An ACE inhibitor 2. A vasodilator 3. A diuretic 4. A calcium channel blocker

3

A patient with bipolar disorder takes lamotrigine. Which complaint by the patient would prompt the nurse to hold the drug and refer the patient to the physician for further assessment? 1. "I get a little dizzy sometimes." 2. "I had a headache last week that lasted for about an hour." 3. "I've broken out in a rash on my chest and back." 4. "Last night I woke up twice with a bad dream."

3

A patient with major depression is started on sertraline. Which statement by the patient shows a correct understanding of the possible side effects of this medicine? 1. "I may have trouble with stiff muscles." 2. "I need to have frequent, complete blood tests." 3. "I may feel nervous and have trouble sleeping." 4. "I should drink 8 to 10 glasses of water daily."

3

A patient's lithium level is 0.6 mEq/L. The nurse's accurate understanding of lithium therapeutics is best reflected by which statement? 1. The patient's plasma level is below the toxic level of 3.0 mEq/L and is considered therapeutic. 2. The patient's plasma level exceeds 0.5 mEq/L and is therefore toxic. 3. The patient's plasma level is between 0.4 and 1.0 mEq/L and is considered therapeutic. 4. The patient's plasma level is below the 2.5-mEq/L level that would indicate toxicity

3

The nurse counsels an 8-year-old child and the parents about the methylphenidate (Concerta) that was just prescribed for ADHD. What information should the nurse give regarding the administration of the drug? 1. Chew one tablet twice daily. 2. Dissolve a tablet in juice or milk in the AM. 3. Swallow the tablet whole once in the AM. 4. Swallow one tablet every 6 hours.

3

Which agent is an alternative to SSRIs for obsessive-compulsive disorder? 1. Fluoxetine 2. Amitriptyline 3. Clomipramine 4. Desipramine

3

Which benzodiazepine is preferred in the elderly because it is the least likely to accumulate with repeated dosing? 1. Diazepam 2. Clonazepam 3. Lorazepam 4. Estazolam

3

Which statement is correct about caffeine? 1. Caffeine in cola drinks is limited to the amount derived from the cola nut. 2. Caffeine can counteract CNS depression caused by alcohol. 3. Large amounts of caffeine may cause convulsions. 4. Caffeine causes vasodilation of blood vessels throughout the body.

3

. Alprazolam is prescribed for an adult with panic attacks. The nurse recognizes that this drug works on which neurotransmitter? 1. Norepinephrine 2. Acetylcholine 3. Serotonin (5-HT) 4. Gamma-aminobutyric acid (GABA)

4

A current indication for CNS stimulants is: 1. depression. 2. to counteract poisoning by CNS depressants. 3. appetite stimulation. 4. narcolepsy.

4

A nurse assesses a newly admitted patient with pneumonia. The patient reports, "I've been taking some medicine to help me sleep. I can't remember the name, but it makes me have a bitter taste in my mouth." Which drug would the nurse suspect the patient has been taking? 1. Chloral hydrate 2. Meprobamate 3. Paraldehyde 4. Eszopiclone

4

A nurse prepares to collect a health history for a patient with narcolepsy. Which strategy should be used to complete this assessment? 1. Provide a structured form for the patient to complete in writing. 2. Seek information from significant others rather than the patient. 3. Use the patient's past medical records to locate important information. 4. Use short, focused interview sessions with active participation by the patient.

4

A patient being treated for anxiety with a selective serotonin reuptake inhibitor antidepressant drug asks about the rationale for the use of this agent rather than a benzodiazepine. Select the nurse's best response. 1. "The SSRI antidepressants are better for the control of somatic symptoms than the benzodiazepines." 2. "The SSRI antidepressants provide a more rapid and durable response to the uncomfortable anxiety symptoms." 3. "The benzodiazepines currently have no role in the treatment of anxiety." 4. "The SSRI antidepressants are better for decreasing the cognitive and psychic symptoms of anxiety than the benzodiazepines."

4

A patient being treated with drug therapy for panic disorder asks the nurse, "How long will I need to take the medication?" How should the nurse respond? 1. "At least one week after the last attack." 2. "Indefinitely." 3. "Just take the medication when you are feeling anxious." 4. "Usually 6 to 9 months or more."

4

A patient has difficulty sleeping well. The patient says, "I wake up a lot during the night and feel tired when I get up in the morning." Which finding best indicates that interventions to improve sleep were effective? 1. The patient is compliant with self-administration of hypnotic medications. 2. The patient has not experienced any falls or injuries. 3. The patient verbalizes an understanding of the causes of insomnia. 4. The patient reports an increased sense of feeling rested.

4

A patient has taken a benzodiazepine for 2 years. With which condition is tolerance to the agent likely to develop? 1. Anxiety 2. Insomnia 3. Sedation 4. Seizures

4

A patient is brought to the emergency department in a state of extreme, uncontrolled anxiety. Why would a benzodiazepine be the drug of choice in this situation? 1. It also helps treat associated depression. 2. There is no risk of physical dependence. 3. This is a drug category shown to cure the disorder. 4. It has a rapid onset of action.

4

A patient takes 300 mg of lithium carbonate 4 times a day. The serum lithium level yesterday was 1.8 mEq/L. The nurse should: 1. continue administering the drug as prescribed. 2. increase the dose to 450 mg. 3. decrease the dose to 150 mg. 4. hold the next dose and notify the prescriber.

4

If taken alone, large doses of oral benzodiazepines: 1. cause significant toxicity. 2. antagonize the effects of other CNS drugs. 3. cause profound respiratory depression. 4. are rarely lethal.

4

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

Which action would be produced by the administration of caffeine? 1. Vasodilation of blood vessels in the CNS 2. Elevated levels of serum sodium 3. Promotion of fluid retention 4. Bronchodilation

4

Which statement is accurate in reference to the use of antidepressants in a breast-feeding mother? 1. No drugs are safe for a breast-feeding mother and the baby. 2. MAOIs are the safest category for the patient population. 3. None of the SSRIs can be used in pregnant or breast-feeding women. 4. Desipramine and nortriptyline have been safely used.

4

The nurse assesses a patient for possible lithium toxicity. Which finding(s) would be consistent with excessive levels of lithium? You may select more than one answer. 1. Weight gain 2. Decreased urine output 3. Constipation 4. ECG changes 5. Ataxia

45

. Patients starting treatment with an SSRI should be told to expect an initial response in about: 1. 1-2 days. 2. 1-2 weeks. 3. 2-4 weeks. 4. 4-6 weeks.

2

In patients treated with MAOIs, the nurse should be particularly concerned about the risk of hypertensive crisis in response to: 1. an overdose of the drug. 2. stress. 3. vasodilation. 4. food containing tyramine.

4

When comparing the effects of olanzapine with those of clozapine, which statement is correct? 1. Olanzapine produces more tardive dyskinesia. 2. Olanzapine does not cause somnolence. 3. Clozapine has fewer serious side effects. 4. The drugs are similar in structure and actions.

4

An obesity-prone patient who takes an antipsychotic agent has been trying diligently to lose weight. The patient expresses her concern to the nurse and asks, "Is there a medication that I can take that causes less weight gain than the others? The nurse would be correct to suggest to the patient that she discuss with the prescriber the possibility of switching to which drug to address her concern? a. Thioridazine (Mellaril) b. Quetiapine (Seroquel) c. Olanzapine (Zyprexa) d. Ziprasidone (Geodon)

ANS: D Ziprasidone (Geodon) has been shown to cause only a small weight gain compared to other antipsychotic medications. Thioridazine and quetiapine cause moderate weight gain. Olanzapine causes high weight gain.

When considering an antipsychotic agent for a patient with a cardiac disorder, which characteristic would most affect the decision to use haloperidol rather than risperidone? 1. Second-degree AV block 2. Positive symptoms 3. Hypertension 4. Tachypnea

1

A depot preparation of an antipsychotic drug is prescribed. What information would the nurse include in counseling this patient? 1. Depot agents are associated with a higher rate of relapse. 2. The drug will be administered by injection every 2 to 4 weeks. 3. There is an increased incidence of neuroleptic malignant syndrome. 4. This agent may be associated with a higher incidence of tardive dyskinesia.

2

As part of the discharge teaching for a patient taking amitriptyline, the nurse should instruct the patient on the importance of avoiding: 1. caffeine. 2. alcohol. 3. cheese products. 4. exercise.

2

Haloperidol is classified as: 1. a low-potency antipsychotic drug. 2. a medium-potency antipsychotic drug. 3. a high-potency antipsychotic drug. 4. an atypical antipsychotic drug.

3

How long should patients generally continue antidepressant medications? 1. Until their symptoms have resolved 2. Until side effects develop 3. For 6-12 months after symptoms have resolved 4. For 1 month after symptoms have improved

3

The nurse monitors a patient on clozapine. Which laboratory parameter is the most crucial to monitor on a weekly basis? 1. Renal function studies 2. Hepatic function studies 3. Complete blood count 4. Serum clozapine levels

3

The preferred agent for the treatment of Tourette's syndrome is: 1. loxapine. 2. chlorpromazine. 3. haloperidol. 4. perphenazine

3

A patient on fluphenazine elixir should be instructed that: 1. the drug can be diluted in any beverage. 2. it is acceptable to mix the drug with apple juice. 3. mixing the drug with tea can decrease some of the side effects. 4. water or orange juice can be used to dilute the elixir.

4

Blurred vision, dry mouth, and constipation are adverse effects of antidepressants such as amitriptyline. How are these adverse effects classified? 1. Akathisia symptoms 2. Cholinergic effects 3. Tardive dyskinesia symptoms 4. Anticholinergic effects

4

For a patient taking an MAOI, which breakfast choice would indicate the need for additional teaching? 1. Orange juice 2. Sausage 3. Fried eggs 4. Cheese omelet

4

Which agent stands out from the other antipsychotics in that it causes less weight gain? 1. Thioridazine (Mellaril) 2. Quetiapine (Seroquel) 3. Olanzapine (Zyprexa) 4. Ziprasidone (Geodon)

4

Which statement is correct regarding the use of atypical antipsychotic agents? 1. They affect only the positive symptoms of schizophrenia. 2. They affect only the negative symptoms of schizophrenia. 3. They cause more extrapyramidal symptoms. 4. They commonly cause weight gain.

4

A toddler is brought to the emergency department by ambulance. The parents state that they think the child "got into something" at a friend's house. The nursing assessment reveals stiffness in the face and neck and hyperreflexes. The nurse is correct to suspect ingestion of which of the following agents? a. Strychnine b. Cocaine c. Methamphetamine d. Modafinil (Provigil)

ANS: A A common cause of strychnine poisoning is accidental ingestion from strychnine-based rodenticides. The first manifestation of poisoning is stiffness in the muscles of the face and neck, followed by a generalized increase in reflex excitability. The assessment findings are inconsistent with cocaine or methamphetamine overdose. The assessment findings are not consistent with modafinil overdose or ingestion.

A nurse has just admitted a female patient to the medical-surgical unit for a recurrent urinary tract infection. Which finding should alert the nurse that the patient may be experiencing major depression? a. A patient who reports sleeping 14 to 16 hours per day for the past 3 months. b. A patient who states, "I feel pretty emotional about once a month." c. A patient who comments, "I have asked my sister to help me at home until I am feeling stronger." d. A patient who says, "I'm a bit of a loner. I love to read and surf the Internet."

ANS: A A major depressive episode may manifest as hypersomnia or insomnia; these patients also take no pleasure or interest in their usual activities or pastimes. Feeling emotional once a month may be premenstrual syndrome and is not indicative of major depression. Asking a sister to assist at home is a positive action and not indicative of major depression. Being a loner is not problematic, especially when the person is interested in other pastimes; therefore, this is not indicative of major depression.

A patient taking amitriptyline (Elavil) is brought to the emergency department confused and agitated. As time progresses, her assessment reveals a heart rate of 120/minute, temperature 104° F, flushing, mydriasis, and blood pressure 170/90. Based on her assessment, which of the following would be the nurse's priority action? a. Gastric lavage, activated charcoal, and physostigmine b. Epinephrine and propranolol (Inderal) c. Gastric lavage, activated charcoal d. Cool IV fluids and a cooling blanket

ANS: A Amitriptyline overdose should be suspected based on the patient's assessment findings. The patient should be treated with gastric lavage, followed by ingestion of activated charcoal, which will bind with the medication so that it is removed from the body. Physostigmine is given to counteract the anticholinergic actions of the amitriptyline. Epinephrine and propranolol are not indicated as treatment for amitriptyline overdose. There is no reason to suspect that alcohol toxicity is the issue. Physostigmine should be included as part of the management of amitriptyline overdose. Bringing down the patient's temperature is not indicated for amitriptyline overdose.

A patient is brought to the emergency department by friends, who say that they were all partying with alcohol and a mix of barbiturates and benzodiazepines. They state that the patient had "a lot to drink and took a handful of pills a couple of hours ago." Upon assessment, the patient is nonresponsive and has pinpoint pupils and respirations of 6/minute. After oxygen is administered, the nurse should prepare the patient for which of the following interventions? a. Both gastric lavage and hemodialysis b. Both naloxone (Narcan) and a cathartic c. Both activated charcoal and flumazenil (Romazicon) d. Both a central nervous system stimulant and IV fluids

ANS: A Because over 2 hours have elapsed, enough medication is present in the system to warrant elimination by hemodialysis, and the remainder in the stomach may be eliminated by gastric lavage. Naloxone, a narcotic antagonist, is not effective for barbiturates and benzodiazepines. Although activated charcoal may assist in absorption of medication in the gut, flumazenil will be effective only for the benzodiazepines. A central nervous system stimulant is contraindicated, and intravenous fluids do not address the overdose.

A nurse compares the actions of benzodiazepines with those of buspirone (BuSpar). Which statement is correct regarding buspirone (BuSpar)? a. Buspirone is not a central nervous system depressant. b. The effects of buspirone are more rapid than those of benzodiazepines. c. Buspirone is suitable for an as-needed medication use. d. The potential for abuse is higher with buspirone than with the benzodiazepines.

ANS: A Buspirone is not a central nervous system depressant. The effects of buspirone manifest less rapidly than those of the benzodiazepines. Buspirone is not suitable for an as-needed medication because of the delay in therapeutic effects. The potential for abuse is lower with buspirone than with the benzodiazepines.

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 is being discharged from the hospital on buspirone (BuSpar). A nurse is providing education on the effects and side effects of the medication. What statement made by the patient would most concern the nurse? a. "I will take the medication with grapefruit juice." b. "I will limit alcohol-containing products." c. "I can take the medication with food." d. "This drug is not addicting."

ANS: A Grapefruit juice can increase levels of buspirone, which can cause drowsiness and dysphoria; this statement indicates a need for further teaching. The patient is correct in stating that alcohol-related products should be limited. The patient is correct that the medication may be taken with food. The patient is correct in stating that buspirone is not addicting.

A nurse assesses a patient who is actively hallucinating and delusional. Which term would most accurately describe these findings? a. Positive symptoms b. Negative symptoms c. Affective flattening d. Attention impairment

ANS: A Positive symptoms can be viewed as an exaggeration or distortion of normal psychological function. Positive symptoms include hallucination, delusions, agitation, tension, and paranoia. Negative symptoms can be viewed as a loss or diminution of normal function. Negative symptoms include a lack of motivation, poverty of speech, blunted affect, poor self-care, and social withdrawal. Affective flattening is not descriptive of hallucinations or delusion. Hallucinations and delusions are not described by attention impairment.

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 7-year-old child is to begin taking methylphenidate (Ritalin SR) twice daily. The nurse should teach the parents to monitor the child closely for which of the following side effects of methylphenidate? a. Insomnia b. Lethargy c. Increased appetite d. Urticaria

ANS: A Side effects of methylphenidate include insomnia, reduced appetite, and emotional lability. Lethargy, increased appetite, and urticaria are not side effects of methylphenidate.

A nurse is making patient rounds and determines that one of her patients is having paradoxical symptoms related to the use of benzodiazepines. Which of the following symptoms would the patient manifest? a. Insomnia, excitation, euphoria, and rage b. Laryngeal edema, hypotension, and wheals c. Vasodilation, flushing, and orthostatic hypotension d. Confusion, central nervous system depression, and disorientation

ANS: A The paradoxical symptoms manifested by someone using benzodiazepines are insomnia, excitation, euphoria, and rage. Laryngeal edema, hypotension, and wheals are manifestations of anaphylaxis. Vasodilation, flushing, and orthostatic hypotension indicate an adverse reaction to the medication. Confusion, central nervous system depression, and disorientation may be manifestations of a benzodiazepine overdose.

A nurse is assessing a patient on benzodiazepines who exhibits drowsiness, lethargy, and confusion, and has respirations of 11/minute. The nurse recognizes these signs and symptoms and should prepare to administer which drugs ordered by the prescriber? a. Flumazenil (Romazicon) b. Naloxone (Narcan) c. Epinephrine (adrenaline) d. Atropine (AtroPEN)

ANS: A The patient exhibits signs and symptoms of benzodiazepine overdose, therefore the nurse should administer an antagonist such as flumazenil. Naloxone is indicated for narcotic overdose. Epinephrine is indicated for anaphylaxis. Atropine is indicated for cholinergic overdose.

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 nurse is providing patient education for a patient just starting therapy with an antipsychotic agent. The nurse teaches the patient about the extrapyramidal effects of antipsychotic drugs, and provides information about symptoms that may develop early in therapy. The patient demonstrates understanding when he identifies which of the following as early extrapyramidal symptoms? a. Mild spasms of the muscles of the tongue, face, neck, or back b. Pacing and squirming c. Involuntary upward deviation of the eyes d. Cramping that causes joint dislocation

ANS: B Akathisia is characterized by pacing and squirming, which are extrapyramidal symptoms brought on by an uncontrollable need to be in motion. Mild spasms of the muscles of the tongue, face, neck, and back are not associated with acute dystonia; the symptoms would be severe. Involuntary upward deviation of the eyes, also known as oculogyric crisis, is another symptom of acute dystonia, but it is not an early extrapyramidal symptom. Cramping that causes joint dislocation is associated with opisthotonus, which is consistent with acute dystonia but is not an early extrapyramidal symptom.

Since the initiation of an antipsychotic drug, a patient complains of light-headedness and dizziness upon standing. Select the most appropriate comment the nurse can offer the patient. a. "This is an unfortunate and permanent effect of this class of drugs." b. "Get up slowly. Tolerance to this effect should develop in 2 to 3 months." c. "The drug must be discontinued immediately to avoid injury." d. "We need to increase your fluid intake, which should fix the problem."

ANS: B Antipsychotic drugs promote orthostatic hypotension, which causes blood pressure to fall when the patient stands because of vasodilation; this results in light-headedness and dizziness. The effect is not permanent and subsides within 2 to 3 months as the patient develops tolerance. The effects described by the patient are not permanent, and the use of the words "this is an unfortunate..." is nontherapeutic. The drug does not need to be discontinued. Tolerance to the orthostatic hypotension should develop in 2 to 3 months. Increasing fluid intake may help, but the most appropriate response from the nurse provides the patient with better information on what to anticipate.

Two nursing students studying pharmacology are discussing the contraindications to the use of barbiturates. Which statement made by one of the students best demonstrates an understanding of the use of barbiturates? a. "Barbiturates should not be used in patients with a history of delirium." b. "Barbiturates should not be used in patients with suicidal tendencies." c. "Barbiturates should not be used in patients with an allergy to benzodiazepines." d. "Barbiturates should not be used in patients with a history of drowsiness with the use of these agents."

ANS: B Barbiturates have a low therapeutic index; overdose may rapidly lead to death. Because of their toxicity, barbiturates frequently are used as a means of suicide and should not be prescribed to patients with suicidal tendencies. Barbiturates may be used in patients with a history of delirium. Barbiturates may be used in patients with a history of allergy to benzodiazepines. Central nervous system depression and drowsiness may be side effects of barbiturates; therefore, if the drugs have been used previously, these would be expected findings.

A nurse is caring for a patient taking chlorpromazine (Thorazine) who is to be discharged from the hospital. What information about chlorpromazine (Thorazine) would be most important for the nurse to include in the discharge teaching? a. Do not drive for 6 months. b. Avoid excessive exposure to sunlight and wear sunscreen. c. This medication may actually enhance your libido. d. Monitor your blood pressure frequently to avoid hypertension.

ANS: B Drugs in the phenothiazine class, such as chlorpromazine, can sensitize the skin to ultraviolet light and increase the risk of severe sunburn. Patients should be instructed to avoid excessive exposure to sunlight, to apply sunscreen, and to wear protective clothing when outside. Chlorpromazine has no effect on a patient's ability to drive a car. Antipsychotic agents, such as chlorpromazine, can actually impair the libido, orgasm, and ejaculation. Orthostatic hypotension, not hypertension, is a side effect of antipsychotics such as chlorpromazine.

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 nurse is checking on her patients during the night shift. One of the patients admitted with major depression complains of insomnia. The nurse should notify the patient that she will discuss the insomnia with the prescriber, but she suspects that the prescriber may order which of the following drugs? a. Venlafaxine (Effexor) b. Mirtazapine (Remeron) c. Bupropion (Wellbutrin) d. Phenelzine (Nardil)

ANS: B Mirtazapine may cause somnolence and aid sleeping, because it has an increased release of serotonin. Venlafaxine may actually contribute to the patient's insomnia and therefore would not be recommended for this patient. Bupropion has the side effects of agitation, excitability, and insomnia and therefore would not be recommended for this patient. Phenelzine can cause insomnia as a side effect and therefore would not be recommended for this patient.

While providing patient education for a patient who has been prescribed modafinil (Provigil), the nurse should explain that this drug differs from the more traditional amphetamines in which of the following ways? a. Modafinil has a higher potential for abuse. b. Modafinil will not disrupt nighttime sleep. c. Modafinil is safer for patients with liver disease. d. Modafinil is approved for narcolepsy.

ANS: B Modafinil does not disrupt nighttime sleep, a side effect often seen with other amphetamines. Modafinil has a lower potential for abuse than traditional amphetamines. Modafinil is eliminated primarily by the liver, therefore it would not be safer for patients with liver disease. As can most amphetamines, modafinil can be prescribed for narcolepsy.

A patient is to continue taking sustained-released benzodiazepines at home. A nurse has provided patient education about the medication. Which statement made by the patient demonstrates the need for further teaching? a. "I can take my medicine with food to reduce stomach upset." b. "I should take two pills if I miss a dose." c. "I should not crush or chew my pills." d. "I should try not to drive if I am sleepy during the day."

ANS: B Patients should be warned not to increase the dose or discontinue treatment of benzodiazepines without consulting the prescriber. Benzodiazepines may be taken with food to reduce gastrointestinal or stomach upset. Benzodiazepines should not be crushed or chewed. Driving should be avoided when the patient is sleepy or has residual effects associated with benzodiazepines.

Clozapine (Clozaril) is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient? a. Strategies to manage breast enlargement and nipple discharge b. The importance of promptly reporting flulike symptoms c. Contraceptive measures and expected changes in menstruation d. Proper technique for measuring blood pressure

ANS: B Patients taking clozapine should be informed about the risk of agranulocytosis and must have a weekly blood test. They should be instructed to inform their primary health care provider immediately about any early signs of infection (e.g., fever, sore throat, fatigue, mucous membrane ulceration). Breast enlargement and nipple discharge are not adverse effects of clozapine. Changes in menstruation are important to include in patient education, but this is not the most important information. Changes in blood pressure are not adverse effects of clozapine.

A patient discloses feelings of helplessness and fear after being stranded on a rooftop for 3 days after a major hurricane. Which nursing diagnosis would be most appropriate for this patient? a. Ineffective coping related to generalized anxiety disorder b. Fear related to post-traumatic stress disorder c. Alteration in activities of daily living related to obsessive-compulsive disorder d. Fear secondary to panic disorder

ANS: B Post-traumatic stress disorder develops after a traumatic event that elicited an immediate reaction of fear, helplessness, or horror. This patient's fear is directly related to the traumatic event experienced. This patient is not experiencing generalized anxiety, therefore this is an inappropriate nursing diagnosis. This patient is not experiencing obsessive-compulsive disorder, therefore this is an inappropriate nursing diagnosis. Although the patient is experiencing panic and fear, the symptoms are directly related to post-traumatic stress disorder, therefore panic disorder is not an appropriate nursing diagnosis.

The nurse is providing patient education on quetiapine (Seroquel). The nurse correctly tells the patient that she should be closely monitored for the development of what health condition secondary to the use of quetiapine? a. Breast cancer b. Cataracts c. Hypertension d. Multiple sclerosis

ANS: B Quetiapine may pose a risk for the development of cataracts. The patient's eyes should be examined prior to the initiation of treatment and at least every 6 months during treatment. Quetiapine is not associated with the development of breast cancer. Quetiapine is not associated with hypertension; to the contrary, it causes orthostatic hypotension. Quetiapine is not associated with the development of multiple sclerosis.

A nurse is acting as a preceptor to a graduate nurse. They are discussing the differences between various medications. The nurses understand that, in contrast to the barbiturates, the benzodiazepines have which principal mechanism of action? a. They cannot pass the blood-brain barrier. b. They have limited central nervous system depression effects. c. They are not lipid soluble. d. They have more difficulty affecting the central nervous system.

ANS: B The ability of benzodiazepines to depress central nervous system function is low. Because of their high lipid solubility, benzodiazepines readily cross the blood-brain barrier to reach sites in the central nervous system. Benzodiazepines readily cross the blood-brain barrier. Benzodiazepines are highly lipid soluble. Benzodiazepines do not have more difficulty affecting the central nervous system than barbiturates do.

An adolescent has been prescribed atomoxetine (Strattera) for attention-deficit/hyperactivity disorder. During the health history, the parents state that they hope this medication will improve the girl's ability to make friends, because at times she seems so sad. In providing discharge instructions to the patient and family, what teaching would be most important for the nurse to include? a. Atomoxetine can cause nausea and vomiting. b. Atomoxetine can cause suicidal thinking. c. Atomoxetine can cause difficulty sleeping. d. Atomoxetine can cause euphoria.

ANS: B The adolescent patient should be monitored for suicidal thinking. Although the incidence is low, a social history should be obtained, and the patient should be closely monitored, because cases of suicide have been reported for adolescents take atomoxetine. Nausea, vomiting, and difficulty sleeping also can occur, but these are not the most important considerations for adolescents with an increased risk of suicidal ideation. Atomoxetine does not cause euphoria.

A nurse is reviewing a patient's antidepressant medications. The nurse understands that the monoamine oxidase inhibitor antidepressants are typically used for which patient? a. A patient who has just started on antidepressants b. A patient who has not responded to selective serotonin reuptake inhibitors and tricyclic antidepressants c. A patient who has developed serotonin syndrome d. A patient who has difficulty sleeping

ANS: B The monoamine oxidase inhibitors are the second or third choice of antidepressants for most patients, after selective serotonin reuptake inhibitors and tricyclic antidepressants. Monoamine oxidase inhibitors are not used as first-line agents for the treatment of depression. Monoamine oxidase inhibitors are not used in patients who have serotonin syndrome or difficulty sleeping.

A nurse is caring for a patient who just started on an antipsychotic drug and begins to complain of severe muscle spasms of the tongue, face, and back. Based on these manifestations, which class of drugs should the nurse anticipate that the prescriber will order? a. Narcotic antagonist b. Anticholinergic agent c. Neuroleptic agent d. Tricyclic agent

ANS: B The patient shows clear evidence of extrapyramidal symptoms involving acute dystonia, such as severe spasms of the muscles of the tongue, face, neck, and back. A narcotic antagonist is indicated only for a narcotic overdose. A neuroleptic agent is not indicated in this situation. A tricyclic antidepressant is not indicated in this situation.

A patient reports awakening at 1 AM after only 2 hours of sleep and is unable to return to sleep for several hours. The patient is becoming increasingly anxious and requests a sleeping medication that will not cause a "hangover." The nurse would anticipate the prescriber to order which one of the following drugs? a. Zolpidem (Ambien) b. Zaleplon (Sonata) c. Flurazepam (Dalmane) d. Trazodone (Desyrel)

ANS: B Zaleplon does not produce next day sedation or a "hangover" feeling and therefore would be the expected medication for the prescriber to order. Zolpidem, flurazepam, and trazodone may cause next day sedation and/or a "hangover" feeling and therefore would not be appropriate for this patient. DIF: Cognitive Level: Application REF: p. 373 TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

In a review class on medications, nurses are discussing the actions of zolpidem (Ambien) and benzodiazepines. A nurse correctly states that the actions of zolpidem (Ambien) do not produce which of the following effects that benzodiazepines do? a. Induce sleep. b. Reduce anxiety. c. Affect REM sleep. d. Prolong sleep duration.

ANS: B Zolpidem does not reduce anxiety, as the benzodiazepines do. Both zolpidem and benzodiazepines induce sleep, affect REM sleep, and prolong the duration of sleep. DIF: Cognitive Level: Application REF: p. 372 TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse recognizes that the actions of benzodiazepines include which of the following findings? (Select all that apply.) a. Sleep deprivation b. Relief of general anxiety c. Suppression of seizures and/or seizure activity d. Development of tardive dyskinesia e. Increase in muscle spasms

ANS: B, C Benzodiazepines are indicated to relieve the symptoms of general anxiety and to suppress the central nervous system, thereby suppressing seizures and/or seizure activity. Benzodiazepines cause sleepiness, not sleep deprivation. Benzodiazepines do not cause tardive dyskinesia. Benzodiazepines relax muscles, they do not increase muscle spasms.

A nurse assesses the patient for possible lithium toxicity when the serum lithium level reaches 2.5 mEq/L. Which clinical manifestations would the nurse anticipate with lithium toxicity? (Select all that apply.) a. Hyperactivity b. Slurred speech c. Constipation d. Muscle twitching e. Ataxia f. Hypertension

ANS: B, D, E A patient with lithium toxicity is hyponatremic, which may be manifested by slurred speech, muscle twitching, and mild to moderate ataxia. Hyperactivity, constipation, and hypertension are not manifestations associated with lithium toxicity.

A nurse is providing education to a group of patients regarding amphetamines. To evaluate the group's understanding, the nurse asks a participant what effects amphetamines would have on her. The participant shows that she understands the effects of these drugs if she gives which of the following answers? (Select all that apply.) a. Amphetamines increase fatigue. b. Amphetamines suppress the perception of pain. c. Amphetamines increase appetite. d. Amphetamines increase the heart rate. e. Amphetamines elevate mood.

ANS: B, D, E At customary doses, amphetamines increase wakefulness and alertness, reduce fatigue, elevate mood, and augment self-confidence and initiative. Amphetamines also suppress appetite and the perception of pain and increase the heart rate. Amphetamines do not increase fatigue or appetite.

A nurse is reviewing laboratory findings for a patient with bipolar disorder. The patient is to be started on carbamazepine (Tegretol). Which laboratory value should the nurse be prepared to obtain as a baseline level? a. Blood urea nitrogen b. Direct bilirubin c. Complete blood count d. Thyroid function studies

ANS: C A complete blood count should be obtained at baseline and periodically thereafter. Carbamazepine can cause changes in hematological laboratory values. Blood urea nitrogen, direct bilirubin, and thyroid function studies are not adversely effected by carbamazepine.

A patient with a history of bipolar disorder has been on lithium therapy for 3 years. The patient begins to develop hypertension. Which class of drugs, if given concurrently with lithium, would result in an adverse drug-to-drug interaction? a. ACE inhibitors b. Vasodilators c. Diuretics d. Calcium channel blockers

ANS: C Diuretics promote sodium loss and thereby can increase the risk of lithium toxicity. Toxicity occurs because in the presence of low sodium, renal excretion of lithium is reduced, which causes lithium levels to rise. There are no adverse drug-to-drug interactions between lithium and ACE inhibitors, vasodilators, and calcium channel blockers, therefore any of them can be given to treat the patient's hypertension.

A patient with bipolar disorder takes lamotrigine (Lamictal). Which statement made by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment? a. "I get a little dizzy sometimes." b. "I had a headache last week that lasted for about an hour." c. "I've broken out in a rash on my chest and back." d. "Last night I woke up twice with a bad dream."

ANS: C Evidence of a rash in a patient taking lamotrigine requires further assessment, because this may indicate the development of Stevens-Johnson syndrome. Although dizziness and headaches are side effects of lamotrigine, they are not potentially life-threatening. A bad dream is not necessarily related to the lamotrigine.

A patient taking an antipsychotic agent begins to drool and displays tremors, rigidity, and a shuffling gait. The nurse is correct to suspect that the patient is experiencing extrapyramidal symptoms that are consistent with assessment findings for which of the following disorders? a. Akathisia b. Tourette's syndrome c. Parkinsonism d. Tardive dyskinesia

ANS: C Extrapyramidal symptoms are movement disorders resulting from the effects of antipsychotic drugs on the extrapyramidal motor system. The patient's symptoms are consistent with parkinsonism, because they mirror the symptoms that patients with Parkinson's disease exhibit, such as tremors, rigidity, shuffling gait, and a masklike face. Akathisia is characterized by pacing and squirming. Tourette's syndrome is manifested by uncontrollable motor tics, barking cries, grunts, and outbursts of obscene language. Tardive dyskinesia is characterized by involuntary twisting, writhing, and wormlike movements.

A nurse is discussing lithium levels with another nurse. As they review the laboratory findings, they discover a lithium level of 0.6 mEq/L. Which statement made by one of the nurses best demonstrates an understanding of lithium levels? a. The patient's plasma level is below the toxic level of 3 mEq/L and is considered therapeutic. b. The patient's plasma level exceeds 0.5 mEq/L and is therefore toxic. c. The patient's plasma level is between 0.4 and 1 mEq/L and is considered therapeutic. d. The patient's plasma level is below the 2.5 mEq/L level that would indicate toxicity.

ANS: C For maintenance therapy, lithium levels should range from 0.4 to 1 mEq/L. Lithium toxicity is defined as a level above 1.5 mEq/L. A lithium level of 0.5 mEq/L is considered therapeutic. Lithium toxicity is defined as a level above 1.5 mEq/L.

Haloperidol (Haldol Decanoate) has been ordered for a patient admitted with schizophrenia. A nurse understands that this drug should be administered at what intervals? a. Twice per day b. Once per week c. Every 2 to 4 weeks d. As needed

ANS: C Haloperidol should be administered in a dosing interval of 2 to 4 weeks. These dosing intervals are incorrect.

A patient has been admitted to the hospital for complications associated with obesity. The nurse has received an order for the patient for dextroamphetamine sulfate 15 mg, given intravenously every 6 hours. Based on this situation, the nurse's next action would be which of the following interventions? a. Call the prescriber, because the medication is not indicated for obesity. b. Administer the medication as ordered. c. Call the prescriber and clarify the route of administration of the drug. d. Check the patient's vital signs prior to administration.

ANS: C In clinical practice, amphetamines are given orally. These drugs are not approved for intravenous administration. Amphetamines are indicated for obesity. The medication should not be administered as ordered. Obtaining vital signs is important, but not as important as questioning the route of administration ordered for the medication.

A nurse has just administered a barbiturate to an elderly debilitated patient. The nurse understands that the patient is likely to exhibit a. suicidal tendencies. b. hangover effects. c. paradoxical excitement. d. hyperalgesia.

ANS: C In some patients, including the elderly and debilitated individuals, barbiturates may cause excitation, a paradoxical response. Suicidal tendencies are not commonly associated with barbiturate use in the elderly. Hangover and hyperalgesia are not specific to the elderly debilitated patient as they relate to barbiturate use.

A nurse counsels an 8-year-old child and the parents about the methylphenidate (Concerta LD) that was just prescribed for attention-deficit/hyperactivity disorder. What information should the nurse provide regarding administration of the drug? a. "Chew one tablet twice daily." b. "Dissolve a tablet in juice or milk in the morning." c. "Do not crush or chew the medication." d. "Crush the medicine and mix it in apple sauce."

ANS: C Methylphenidate tablets must be swallowed whole. Methylphenidate tablets should not be crushed, chewed, or dissolved in liquids

A nurse is checking on his patients. He enters the room of a patient who takes an antipsychotic agent. The patient is confused, has a sudden fever, and develops "lead-pipe" rigidity. The nurse recognizes these symptoms as which of the following? a. Tardive dyskinesia b. Acute dystonia c. Neuroleptic malignant syndrome d. Parkinsonism

ANS: C Neuroleptic malignant syndrome is rare but serious. The primary symptoms are "lead-pipe" rigidity, sudden high fever, and confusion. Tardive dyskinesia is manifested by involuntary twisting, writhing, and wormlike movements. Acute dystonia is manifested by severe spasm of the muscles of the tongue, face, neck, and back. Other manifestations include oculogyric crisis and opisthotonus. Parkinsonism is manifested by tremors, rigidity, shuffling gait, and a masklike face.

A patient with major depression is started on sertraline (Zoloft). A nurse is providing patient education. Which statement by the patient best demonstrates understanding of the possible side effects of sertraline (Zoloft)? a. "I may have trouble with stiff muscles." b. "I need to have frequent, complete blood tests." c. "I may feel nervous and have trouble sleeping." d. "I should drink 8 to 10 glasses of water daily."

ANS: C The patient is correct to state that nervousness and insomnia may be experienced, because these are common side effects of sertraline. Stiff muscles are not a side effect of sertraline therapy. There is no need for the patient to have frequent complete blood tests. There is no need to increase fluid intake in a patient on sertraline therapy.

A patient diagnosed with panic disorder is placed on a tricyclic antidepressant. The patient asks a nurse when the medication will take full effect. The nurse's best response would be which of the following time frames? a. 3 to 7 days b. 1 to 3 weeks c. 1 to 2 months d. 6 months

ANS: C Tricyclic antidepressants, similar to other classes of antidepressants, have initial responses that develop in approximately 1 to 3 weeks. Maximal responses may take up to 1 to 2 months to develop. These time frames are incorrect.

A patient comes to the clinic complaining of insomnia. In his health history, the patient reveals that he works in a coffee shop, and as a snack he has been eating a cup of chocolate-covered coffee beans daily in the late afternoon. Based on the patient's statement, the nurse should assess for what other clinical manifestations? (Select all that apply.) a. Vasodilation of blood vessels in the central nervous system b. Elevated serum sodium levels c. Diuresis d. Bronchodilation e. Nervousness

ANS: C, D, E Caffeine, which the patient is ingesting from the coffee beans daily, causes relaxation of bronchial smooth muscle, which promotes bronchodilation, nervousness, and diuresis secondary to vasodilation of the blood vessels in the peripheral vascular system. Caffeine causes vasoconstriction of the blood vessels in the central nervous system. Caffeine does not elevate serum sodium levels.

A nurse assesses a patient receiving perphenazine (Trilafon), a traditional antipsychotic medication. The nurse notices that the patient is squirming and pacing. When composing his nurse's notes, the nurse would describe his assessment findings by which terminology? a. Dystonia b. Central nervous system effects c. Parkinsonism d. Akathisia

ANS: D Akathisia is characterized by pacing and squirming brought on by an uncontrollable need to be in motion. Dystonia is manifested by severe spasms of the muscles of the face, neck, tongue, or back. "Central nervous system effects" is a very vague description, because many types of effects can occur; therefore, this would not be appropriate in the nurse's notes. Parkinsonism is characterized by bradykinesia, a masklike face, drooling, tremor, and rigidity.

A nurse provides education for a patient who has just started taking buspirone (BuSpar). The patient asks the nurse, "When should I expect to see an effect from the medication?" The nurse's best response would be based on the understanding that the effects of buspirone begin in most patients during which time frame? a. 3 days b. 24 to 48 hours c. 1 day d. 4 to 6 weeks

ANS: D Although an initial response to buspirone may occur as early as 1 week, it may take up to 4 to 6 weeks for peak results of the medication to occur. One to 3 days is too short an interval to expect the effects of buspirone to develop.

A patient on triazolam (Halcion) begins to complain of forgetfulness. The nurse should consider the possibility that which of the following effects may be occurring? a. Retrograde amnesia b. Toxicity c. The expected effect d. Anterograde amnesia

ANS: D Anterograde amnesia has been assessed in patients taking triazolam. Triazolam does not cause retrograde amnesia. The patient shows no evidence of triazolam toxicity. Forgetfulness in not an expected effect of medications, including triazolam.

A nurse is providing nursing education about the use of atypical antipsychotic agents and their effects on the body. Which statement made by a nurse best demonstrates an accurate understanding of the effects of atypical antipsychotic agents? a. They cause a higher rate of relapse. b. They affect only the negative symptoms of schizophrenia. c. They cause more extrapyramidal symptoms. d. They pose a risk of weight gain and diabetes mellitus.

ANS: D Atypical antipsychotics pose a risk of weight gain and the development of diabetes mellitus. Atypical antipsychotics result in a lower rate of relapse. Atypical antipsychotic agents have the same effect as conventional antipsychotic agents on positive symptoms of schizophrenia, and they have a greater effect on negative symptoms and cognitive dysfunction. Atypical antipsychotics cause fewer extrapyramidal symptoms.

A patient who is also a nurse is being treated for anxiety with a selective serotonin reuptake inhibitor. She asks about the rationale for use of this agent rather than a benzodiazepine. Which of the following is the nurse's best response? a. "Selective serotonin reuptake inhibitors are better for the control of bodily symptoms than benzodiazepines." b. "Selective serotonin reuptake inhibitors provide a more rapid and durable response to the uncomfortable anxiety symptoms." c. "Benzodiazepines currently have no role in the treatment of anxiety." d. "Selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety than benzodiazepines."

ANS: D Compared with benzodiazepines, selective serotonin reuptake inhibitors are better for reducing the cognitive and psychic symptoms of anxiety, but not the somatic symptoms. Selective serotonin reuptake inhibitors are not better than benzodiazepines for reducing somatic symptoms of anxiety. Selective serotonin reuptake inhibitors have a delayed response to uncomfortable anxiety symptoms. Benzodiazepines are used in the treatment of anxiety.

A nurse is assessing a patient taking a monoamine oxidase inhibitor who complains of a headache, nausea, and vomiting. The patient's vital signs are pulse 128/minute, blood pressure 194/106, and, respiration 30/minute. The patient confesses to the nurse that she has been drinking a glass of red wine with dinner each night. The nurse would be correct to suspect the patient is experiencing which of the following health alterations? a. Allergic reaction b. Reflex tachycardia c. Rebound hypertension d. Hypertensive crisis

ANS: D Hypertensive crisis is characterized by hypertension, headache, tachycardia, nausea, and vomiting; it can be brought on if the patient eats foods rich in tyramine, such as aged cheese and wine, while taking a monoamine oxidase inhibitor to manage depression. The patient's cluster of symptoms is not indicative of an allergic reaction, reflex tachycardia, or rebound hypertension

A nurse understands that a central nervous system (CNS) stimulant would be indicated for a patient with which of the following health alterations? a. Depression b. Opiate overdose c. Poor appetite d. Narcolepsy

ANS: D Narcolepsy can be treated with a CNS stimulant, which can promote arousal and thereby relieve symptoms. Depression is not an indication for the use of CNS stimulants. Antidepressants are the drugs of choice for depression. CNS stimulants do not abate opiate overdoses. Narcan is the drug of choice for that purpose. CNS stimulants reduce appetite and therefore would not be recommended for a patient with a poor appetite.

Two nurses are debating the effects of olanzapine (Zyprexa) and clozapine (Clozaril). When comparing the effects of olanzapine with those of clozapine, which statement is correct? a. Olanzapine produces more tardive dyskinesia than clozapine. b. Olanzapine does not cause somnolence, as clozapine does. c. Clozapine has fewer serious side effects than olanzapine. d. Olanzapine has a higher risk of diabetes.

ANS: D Olanzapine increases the risk of the development of diabetes mellitus, which clozapine does not. Olanzapine and clozapine produce a similar number of tardive dyskinesia symptoms. Olanzapine and clozapine cause a similar degree of somnolence. Clozapine has more serious side effects than olanzapine, including agranulocytosis.

A drug representative is providing education on barbiturates to the nurses on a unit. The drug representative correctly explains that most barbiturates are considered nonselective central nervous system depressants, with the exception of a. thiopental. b. secobarbital (Seconal). c. butabarbital (Butisol). d. phenobarbital (Luminal).

ANS: D Phenobarbital is considered a selective central nervous system depressant. Thiopental, secobarbital, and butabarbital are considered nonselective central nervous system depressants.

A nurse prepares to collect a health history from a patient with narcolepsy. Which of the following is the most appropriate way for the nurse to facilitate acquisition of the health history from this patient? a. A structured form the patient can complete in writing b. Information from significant others rather than the patient c. The patient's past medical records d. Short, focused interview sessions that require the patient's active participation

ANS: D Short, focused interview sessions are the best means of obtaining an accurate health history from a patient with narcolepsy. The patient could stay awake for short intervals and hopefully be focused enough to get through them. The patient's focus is likely to be poor for a prolonged period, therefore use of a structured written form is not the best method. Patient information is privileged and cannot be obtained from another source, including family members, without the patient's written consent. Past medical records may not be available for this patient, or they may be outdated or not pertinent to this diagnosis.

A patient is brought to the emergency department in a state of extreme uncontrolled anxiety. The prescriber orders a benzodiazepine. A nurse understands that benzodiazepines are used in this clinical situation based on which of the following principles? a. Benzodiazepines have a very short half-life. b. There is no risk of physical dependence when taking benzodiazepines. c. Benzodiazepines are known to cure generalized anxiety. d. Benzodiazepines have a rapid onset of action.

ANS: D The patient is clearly in a state of extreme uncontrolled anxiety. Benzodiazepines are the drug of choice for acute episodes of anxiety because of their rapid onset of action. Benzodiazepines do not have a very short half-life. Benzodiazepines are associated with physical dependence. Benzodiazepines do not cure generalized anxiety, nor do any other drugs.

A patient taking amitriptyline (Elavil) complains of having blurred vision and dry mouth, and he states that he hasn't had a bowel movement in 3 days, whereas he normally has one daily. His vital signs are temperature 97.6° F, pulse 78/minute, blood pressure 130/79, and respirations 20/minutes. Based on this assessment, the nurse should suspect which of the following causes? a. Possible toxicity b. Cholinergic effects c. Dehydration d. Anticholinergic effects

ANS: D The signs and symptoms displayed by the patient are consistent with the anticholinergic effects common in patients taking amitriptyline. There is no evidence of amitriptyline toxicity. The patient is displaying anticholinergic, not cholinergic, signs and symptoms,. The patient's findings are not consistent with dehydration, because his pulse rate is within normal limits and he is not hypotensive.

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 patient comes to the clinic for a routine blood pressure check. After reviewing the patient's medications, a nurse recognizes that the patient is taking a monoamine oxidase inhibitor. The nurse provides patient education regarding diet. Which breakfast choice made by the patient would indicate the need for additional teaching? a. Orange juice b. Carbonated beverages c. Fried eggs d. Yogurt

ANS: D Yogurt, aged cheeses, chocolate, red wine, and other foods with tyramine are contraindicated in patients taking monoamine oxidase inhibitors, because they can precipitate a hypertensive crisis. Orange juice, carbonated beverages, and fried eggs are not contraindicated in patients taking monoamine oxidase inhibitors.

Monoamine oxidase inhibitor antidepressants are: 1. used first-line in the treatment of depression. 2. reserved for patients who have not responded to SSRIs and TCAs. 3. used in patients who have developed serotonergic syndrome. 4. indicated for patients who have difficulty sleeping.

2

Quetiapine (Seroquel) has been associated with the development of: 1. breast cancer. 2. cataracts. 3. ovarian hypertrophy. 4. multiple sclerosis.

2

A college student being treated for depression reports taking a 30-day supply of antidepressant drugs at one time. Which antidepressant is the most dangerous in overdose? 1. Venlafaxine 2. Fluoxetine 3. Paroxetine 4. Sertraline

1

Fluoxetine achieves its effects by: 1. selectively inhibiting serotonin reuptake. 2. blocking the uptake of monoamines. 3. inhibiting MAO-A in nerve terminals. 4. direct stimulation of serotonin receptors.

1

For how long after an acute episode of psychosis should a nurse expect a patient to take an antipsychotic medication? 1. At least 12 months 2. Life 3. 2 weeks 4. 6 months

1

The nurse assesses a patient who is actively hallucinating and delusional. Which term would most accurately document these findings? 1. Positive symptoms 2. Negative symptoms 3. Affective flattening 4. Attention impairment

1

The nurse cares for a patient on an antipsychotic drug who develops acute dystonia. Which drug will most likely be prescribed for this reaction? 1. 5-HT3 blocker 2. Anticholinergic 3. Neuroleptic 4. Tricyclic

2

Clozapine is prescribed for a patient with a schizophreniform disorder. Which information would be the most important to include in the teaching plan for this patient? 1. Strategies to manage breast enlargement and nipple discharge 2. The importance of promptly reporting flulike symptoms 3. Contraceptive measures and expected changes in menstruation 4. The meaning of various components of a white blood cell count

2

A patient complains of lightheadedness on standing since the initiation of an antipsychotic drug. Select the nurse's best response. 1. "This is an unfortunate and permanent effect of this class of drugs." 2. "Get up slowly. Tolerance to this effect should develop in 2 to 3 months." 3. "The drug must be discontinued immediately to avoid injury." 4. "This probably means that you are not getting enough of the drug."

2

An adult patient suddenly cries out. The nurse sees the patient's head twisted to the side, the back arched, and the eyes rolled up. The patient has been newly diagnosed with schizophrenia, and therapy with a traditional antipsychotic medication was started yesterday. Select the next nursing action. 1. Obtain the patient's vital signs and pulse oximetry. 2. Administer a PRN dose of diphenhydramine. 3. Administer a PRN dose of haloperidol. 4. Explore the patient's feelings about the new diagnosis.

2

When a patient is taught about the extrapyramidal effects of antipsychotic drugs, information about what symptoms that may develop early in therapy should be included? 1. Severe spasms of the muscles of the tongue, face, neck, or back 2. Pacing and squirming 3. Involuntary upward deviation of the eyes 4. Cramping causing joint dislocation

2

Which agent is a tricyclic antidepressant with weak anticholinergic properties? 1. Amitriptyline 2. Desipramine 3. Fluvoxamine 4. Citalopram

2

Which antidepressant would be the most useful for a depressed patient with insomnia? 1. Venlafaxine 2. Mirtazapine 3. Bupropion 4. Phenelzine

2

A patient diagnosed with panic disorder is placed on a tricyclic antidepressant. The nurse should counsel the patient to expect full benefit from the drug in: 1. 5-6 days. 2. 2-3 weeks. 3. 1-2 months. 4. 6 months.

3

A patient on an antipsychotic agent suddenly becomes febrile, develops "lead-pipe" rigidity, and appears confused. The nurse should suspect: 1. tardive dyskinesia. 2. acute dystonia. 3. neuroleptic malignant syndrome. 4. Parkinsonism.

3

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 nurse assesses a patient receiving perphenazine, a traditional antipsychotic medication. The nurse notices the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. Select the most accurate term for the documentation of these findings. 1. Dystonia 2. CNS effects 3. Alexithymia 4. Akathisia

4

A nurse wants to find a description of the diagnostic criteria for depressive disorders. Which resource would have the most complete information? 1. A psychiatric nursing textbook 2. Journal of Mental Health and Psychosocial Nursing 3. Taber's Cyclopedic Medical Dictionary 4. Diagnostic and Statistical Manual of Mental Disorders

4

A patient is being treated for muscle spasms. A nurse is preparing to administer a prn medication for this patient. The nurse is aware that the only benzodiazepine commonly used to relieve muscle spasm is which of the following? a. Diazepam (Valium) b. Lorazepam (Ativan) c. Estazolam (Prosom) d. Clonazepam (Klonopin)

ANS: A A benzodiazepine (diazepam) is used to relive muscle spasm and spasticity. Lorazepam's primary indication is as an antianxiety medication or to manage status epileptics. Estazolam is used primarily to manage sleep disturbances. Clonazepam is used primarily to manage panic disorders.

A patient who just returned from a war-torn country is admitted to the hospital with post-traumatic stress disorder. A nurse anticipates that the prescriber will order which of the following medications for the patient? a. Paroxetine (Paxil) b. Alprazolam (Xanax) c. Clomipramine (Anafranil) d. Venlafaxine (Effexor XR)

ANS: A Paroxetine is approved by the FDA for post-traumatic stress disorder. Alprazolam is used to treat anxiety. Clomipramine is used to treat obsessive-compulsive disorder. Venlafaxine is used to treat anxiety.

A college student is brought into the emergency department for treatment after friends say that she took at least 20 antidepressant pills all at once. A nurse should be most concerned that of all the antidepressants, which of the following could lead to the worst outcome for the patient? a. Venlafaxine (Effexor) b. Fluoxetine (Prozac) c. Paroxetine (Paxil) d. Sertraline (Zoloft)

ANS: A Venlafaxine can cause dose-related, sustained diastolic hypertension, a medical crisis for the patient. Fluoxetine, paroxetine, and sertraline, all selective serotonin reuptake inhibitors, may do harm to the patient when taken in such a large dose, but death by overdose is extremely rare.

An adult patient suddenly cries out. A nurse sees the patient's head twisted to the side, arched back, and the eyes rolled up. The patient has been newly diagnosed with schizophrenia, and therapy with a traditional antipsychotic medication was started yesterday. Based on the nurse's assessment, what would be the next nursing action? a. Obtain the patient's vital signs and pulse oximetry. b. Administer a PRN dose of diphenhydramine (Benadryl). c. Administer a PRN dose of haloperidol (Haldol). d. Obtain a serum drug level and reassure the patient.

ANS: B The patient is displaying symptoms of intense dystonia, a crisis that can occur after administration of an antipsychotic medication. The crisis should be managed with a dose of diphenhydramine. Vital signs may be obtained after the initial management of the physiological crisis. Haloperidol is not indicated for the treatment of acute dystonia; in fact, it is an adverse effect of haloperidol. Obtaining a serum drug level is not an immediate concern.

A nurse is reviewing a patient's laboratory findings prior to medication administration. The most recent serum lithium level is 2.2 mEq/L and was drawn yesterday. The patient takes 300 mg of lithium carbonate 4 times a day. Which of the following is the nurse's most appropriate action? a. Administer the drug as prescribed. b. Recognize that the dose is subtherapeutic. c. Administer half of the dose. d. Hold the next dose and notify the prescriber.

ANS: D The lithium level is toxic, therefore the dose should be held and the prescriber notified. The drug should not be administered as prescribed, because it will increase the toxicity. The dose is not subtherapeutic; rather, the patient's lithium level indicates toxicity. It is up to the prescriber to change the dosage ordered. Changing the dosage without discussing it with the prescriber is a violation of the Nurse Practice Act, because nurses do not prescribe.