114- exam 2 pharmacology

Which information should the nurse discuss with the client diagnosed with schizophrenia who is prescribed an antipsychotic medication? 1. Drink decaffeinated coffee and tea 2. Decrease the dietary intake of salt 3. Eat six small, high-protein meals a day 4. Limit alcohol intake to one glass of wine a day

1 caffeine- containing substances will negate the effects of antipsychotic medication; therefore, the client should drink caffeine free beverages such as decaffeinated coffee and tea and caffeine free colas

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

1 tegretol is an anticonvulsasnt medication that is prescribed as a mood stabilizer. mood stabilizers are prescribed because they have the ability to moderate extreme shifts in emotions between mania and depression.

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

1 the nurse should ask if the client has a plan to commit suicide. as the client begins to recover from both psychological and physical depression, the clients energy level increases, making the client more prone to commit suicide during this time. it takes 2-6 weeks for therapeutic effects

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

1 2 lithium has a narrow therapeutic serum level. the level is monitored every 3-5 days initially and every 2-3 months thereafter. lithium is salt and may cause dehydration; therefore, the client should maintain an adequate fluid intake of at least 2000 ml or more a day

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

1 3 4 antidepressant medications may cause orthostatic hypotension, and the nurse should question administration if BP is less than 90/60. many antidepressants may cause hepatoxicity; therefore the nurse should monitor the clients liver function tests. the nurse should ensure the clients safety. many antidepressants may cause orthostatic hypotension and increase risk of falls and injuries

The nurse is preparing to administer lithium (Eskalith), an antimania medication, to a client diagnosed with bipolar disorder. The lithium level is 1.4 mEq/L. Which action should the nurse implement? 1. Administer the medication 2. Hold the medication 3. Notify the health-care provider 4. Verify the lithium level

1. Administer the medicationThe therapeutic serum level is 0.6 to 1.5 mEq/L. Because the lithium level is within those parameters, the nurse should administer the medication.

The client diagnosed with a general anxiety disorder is prescribed alprazolam (Xanax), a benzodiazepine. Which information should the clinic nurse discuss with the client? 1. Explain to the client that this medication is for short-term use. 2. Inform the client that rage and excitement are expected side effects 3. Tell the client to avoid foods that are high in vitamin K 4. Instruct the client to take the medication with at least 8 ounces of water

1. Explain to the client that this medication is for short-term useXanax has the potential for dependency, but that potential can be minimized by using the lowest effective dosage for the shortest time necessary.

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

1. The client reports a "2" on a 1-10 scale, with 10 being very depressedDepression is subjective and the nurse does not know this client; therefore, asking the client to rate the depression on a scale best indicates the effectiveness of the medication. Any subjective data can be put on a scale to make it objective

The 24-year-old female client with bipolar disorder is prescribed valproic acid (Depakote), an anticonvulsant medication. Which question should the nurse ask the client? 1. "Have you ever had a migraine headache?" 2. "Are you taking any type of birth control?" 3. "When was the last time you had a seizure?" 4. "How long since you have had a manic episode?"

2 depakote is a category d drug, which means it will cause harm to the fetus and should not be prescribed to a female of childbearing age who is not taking the birth control pill

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

2 playing soccer or any sport that includes running can lead to dehydration and the nurse must make sure the client understands the need to stay well hydrated during the activity. therefore this comment indicates the need for further clarification by the nurse

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

2 serotonin sydnrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temp) and ataxia. conservation tx includes stopping the SSRI and supportive treatment.

The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate?1. The client's clozapine therapeutic level2. The client's white blood cell count3. THe client's red blood cell count4. The client's arterial blood gases

2 weekly WBCs are taken because the client is at risk for fatal agranulocytosis. Initially the medication will not be administered if the WBC is not available

Which statement indicates the client diagnosed with bipolar disorder who is taking lithium (Eskalith), an anti mania medication, understands the medication teaching? 1. "I will monitor my daily lithium level." 2. "I will make sure I do not get dehydrated." 3. "I need to taper the dose if I quit taking it." 4. "I need to take the medication on an empty stomach."

2. "I will make sure I do not get dehydrated"Lithium acts like sodium in the body so dehydration can cause lithium toxicity; therefore, the client should not become dehydrated

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

2. "It is all right to take the medication at night. It may help you sleep at night"Antidepressants may cause central nervous depression, which causes drowsiness. Therefore, taking the medication at night may help the client sleep at night and relieve daytime sedation. This is the nurse's best response.

The client diagnosed with obsessive-compulsive disorder is prescribed the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft). Which statement indicates the client understands the medication teaching? 1. "If I get a headache or become nauseated, I will notify my HCP." 2. "It will take a couple of months before I see a change in my behavior." 3. "I need to be careful because SSRIs may cause physical addiction." 4. "I am glad I do not need to go to my psychologist's appointments."

2. "It will take a couple of months before I see a change in my behavior"The beneficial effects of SSRIs develop slowly, taking several months to become maximal when used to treat obsessive-compulsive disorder. The client understands this.

he client diagnosed with a major depressive disorder asks the nurse, "Why did my psychiatrist prescribe an SSRI medication rather than one of the other types of anti-depressants?" Which statement by the nurse would be most appropriate? 1. "Probably it is the medication that your insurance will pay for" 2. "You should ask your psychiatrist why the SSRI was ordered" 3. "SSRIs have fewer side effects than the other classifications" 4. "The SSRI medications work faster than the other medications"

3 SSRIs have the same efficiancy as MAO inhibitors and tricyclics but SSRIs are safet because they do not have the sympathomimetic effects and anticholinergic effects

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

3 haldol causes agranulocytosis, which diminishes the clients ability to fight infection but the medication does not cause the client to have increased susceptibility to colds and the flu. if the client has a fever or sore throat, the HCP should be notified, and if the wbc count is elevated the medication will be discontinued

The client with bipolar disorder who is taking lithium (Eskalith), an anti mania medication, has a lithium level of 3.1 mEq/L. Which treatment would the nurse expect the health-care provider to prescribe?1. No treatment because this is within the therapeutic range.2. Intravenous therapy with an 18-gauge angiocath3. Preparation for immediate hemodialysis4. The antidote for lithium toxicity

3 preparation for immediate hemodialysis extremely high toxic levels of lithium require hemodialysis and supportive care

The nurse is preparing to administer the benzodiazepine alprazolam (Xanax) to a client who has a generalized anxiety disorder. Which intervention should the nurse implement prior to administering the medication? 1. Assess the client's apical pulse 2. Assess the client's respiratory rate 3. Assess the client's anxiety level 4. Assess the client's blood pressure

3. Assess the client's anxiety levelThe nurse must assess the client's anxiety level on a scale of 1 to 10, with 10 being the most anxious, before administering the Xanax. If the nurse does not do this, there is no way to evaluate the effectiveness of the medication later

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

3. Ensure the client has no more than a 7-day supply of antidepressantsEnsuring the psychological and physical safety of the client is priority. As antidepressant medications become more effective, the client is at a higher risk for suicide. Therefore, the nurse should ensure that the client cannot take an overdose of medication

The elderly client diagnosed with a panic attack disorder is in the busy day room of a long-term care facility and appears anxious, is starting to hyperventilate, is trembling, and is sweating. Which action should the nurse implement first? 1. Administer the benzodiazepine alprazolam (Xanax) 2. Assess the client's vital signs 3. Remove the client from the day room 4. Administer the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft)

3. Remove the client from the day roomThis is the most appropriate intervention; the nurse should remove the client from the busy day room to help decrease the anxiety attack

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

3. The 42-year-old client taking a loop diuretic Diuretics increase the excretion of lithium from the kidneys; therefore, the nurse would question administering lithium to this client

Which assessment data indicates the atypical antipsychotic quetiapine (Seroquel) is effective for the client diagnosed with paranoid schizophrenia?1. The client does not exhibit any tremors or rigidity2. The client reports a "2" on an anxiety scale of 1-103. The family reports the client is sleeping all night4. The client denies having auditory hallucinations

4 antipsychotic medications are prescribed to decrease the signs or symptoms of schizophrenia. if the client denies auditory hallucinations, the medication is effective

The 43-year-old female client diagnosed with schizophrenia has been taking the conventional antipsychotic medication chlorpromazine (Thorazine) for 20 years. Which assessment data would warrant discontinuing the medication?1. The client has had menstrual irregularities for the last year2. The client has to get up very slowly from a sitting position3. The client complains of having a dry mouth and blurred vision4. The client has fine, wormlike movements of the tongue

4 exhibiting fine, wormlike movements of the tongue is a symptom of tardive dyskinesia, which is an adverse effect that may develop after months or years of continous therapy with a conventional antipsychotic medication. the med should be discontinued and a benzodiazepine should be administered

The client diagnosed with depression is prescribed phenelzine (Nardil), a monoamine oxidase (MAO) inhibitor. Which statement by the client indicates to the nurse the medication teaching is effective?1. "I am taking the herb ginseng to help my attention span"2. "I drink extra fluids, especially coffee and iced tea"3. "I am eating three well-balanced meals a day"4. "At a family cookout I had chicken instead of a hotdog"

4 taking MAOIs requires adherence to strict dietary restrictions concerning tyramine containing foods, such as processed meat (hot dogs, bologna, and salami) yeast products, beer, and red wines. eating these foods can cause a life threatening hypertensive crisis

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

4 the client should avoid driving and other hazardous activities until the effects of tegretol are known because this medication may cause sedation and drowsiness

the client who returned from the war 1 month ago is diagnosed with posttraumatic stress disorder (PTSD) and prescribed paroxetine (Paxil), an SSRI. The client asks the nurse, "Will this medication really help me? I don't like feeling this way." Which statement is the nurse's best response?1. "The medication will make you feel better within a couple of days."2. "Why do you think the medication won't help you feel better?"3. "Nothing really helps PTSD unless you go to counseling weekly."4. "Because the traumatic event was within 1 month, the Paxil should be helpful."

4. "Because the traumatic event was within 1 month, the Paxil should be helpful."SSRIs reduce the three core symptoms of PTSD: re-experiencing, avoidance/ emotional numbing, and hyperarousal. The medication is most effective if taken within 3 months of the traumatic event and may take up to 2 or 3 months for maximal response

The client prescribed an antidepressant 1 week ago tells the psychiatric clinic nurse, "I really don't think this medication is helping me." Which statement by the psychiatric nurse would be most appropriate? 1. "Why do you think the medication is not helping you?" 2. "You think your medication is not helping you?" 3. "You need to come to the clinic so we can discuss this." 4. "It takes about 3 weeks for your medication to work"

4. "It takes about 3 weeks for your medication to work"The client probably was told this information but may have forgotten it, or the client may not have been told, but the most appropriate response is to provide information so that the client realizes it takes 3 weeks for the medication to work and that he or she may not feel better until that time has elapsed.

the client with major depressive disorder has been taking amitriptyline (elavil), a tricyclic antidepressant, for more than one year. the client tells the psychiatric nurse that the client wants to quit taking the antidepressant. which intervention is most important for the nurse to discuss with the client. a. ask questions to determine if the client is still depressed b. ask the client why he or she wants to stop taking the medication c. tell the client to notify the HCP before stopping medication d. explain the importance of tapering off the medication

4. Explain the importance of tapering off the medicationThe client must first know the importance of needing to taper off the medication because rebound dysphoria, irritability, or sleepiness may occur if the medication is discontinued abruptly. Then the client should see the HCP to determine what action doesn't want to take the medication.

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

4. Teach the family member what to do in case the client has a seizureAntipsychotic medications lower the seizures threshold, even if the client does not have a seizure disorder. Therefore, the nurse should discuss what to do if the client has a seizure

To educate a patient regarding what to expect following the administration of a benzodiazepine, the nurse must understand that benzodiazepines: a. Have a rapid onset of peak action b. Reduce availability of GABA c. Generally diminish the activity of GABA d. Interact with serotonin to increase availability

ANS: A Benzodiazepines do have a more rapid onset. There is no effect on the availability or function of GABA. Benzodiazepines do not diminish GABA activity; they enhance it.

the nurse reads in the patients medication history that the patient is taking buspirone. The nurse interprets that the patient may have which disorder? a. anxiety disorder b. depression c. schizophrenia d. bipolar disorder

ANS: A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.

An individual with poststroke depression is receiving an SSRI. What is the rationale for giving the medication at breakfast and again at midday? a. Prevent insomnia b. Prevent toxic reactions c. Decrease afternoon sleepiness d. Give an opportunity to monitor behavior closely

ANS: A CNS stimulants may cause insomnia if given late in the day. Toxicity is a result of excessive medication in the system, not when it is administered. The drowsiness resulting from SSRI use would not be minimized if taken as described. There is no expectation that resulting behaviors will need to be so closely monitored.

. Sertraline (Zoloft) has been prescribed for a patient with symptoms of a major depression. Which factor was probably most important in the physicians decision to use an SSRI? a. Good side-effect profile b. Less expense for the patient c. Increase in medication compliance d. Rapid rate of absorption from the GI tract

ANS: A Compared to other antidepressant medication groups, SSRIs have the best side-effect profile. SSRIs are more costly. No studies have shown that SSRIs result in better compliance. These drugs are absorbed slowly from the GI tract.

The nurse must notify the physician of the need to suspend treatment for a patient receiving clozapine (Clozaril) when the weekly WBC monitoring shows: a. WBCs below 2000/mm3 and absolute neutrophils below 1000/mm3 b. WBCs below 2500/mm3 and absolute neutrophils below 1500/mm3 c. WBCs below 3000/mm3 and absolute neutrophils below 2000/mm3 d. WBCs below 3500/mm3 and absolute neutrophils below 2500/mm3

ANS: A Counts at this level indicate the presence of leukopenia. Agranulocytosis is a possible side effect of Clozaril therapy for which the patient is closely monitored. The other levels are high enough to be considered safe.

Which person with mania is the least likely candidate to receive lithium? The patient who is: a. Six weeks pregnant b. Recovering from a hysterectomy c. Taking hormone replacement therapy d. Displaying symptoms of postpartum depression

ANS: A Lithium is contraindicated during pregnancy because of teratogenic effects. The remaining options would not be contraindicative to lithium therapy.

A patients serum lithium level is reported as 1.9 mEq/L. The nurse should immediately: a. Restrict sodium and fluid intake. b. Assess for signs and symptoms of toxicity. c. Seek to have the patient transferred to ICU. d. Notify the patients physician immediately.

ANS: B A serum lithium level this high suggests that the patient may be experiencing symptoms of lithium toxicity. Clinical assessment is essential to determine what, if any, signs and symptoms are present. After the clinical assessment has been made, the nurse can provide the physician with a complete picture. Restricting sodium and fluids would raise the serum level. Transferring may not be necessary and would require a physicians order.

When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed oral haloperidol (Haldol), which intervention would promote medication compliance? a. Instructing the patient to have friends monitor his medications b. Beginning administration of haloperidol (Haldol) decanoate c. Writing instructions in detail for the patient to follow d. Changing haloperidol to an atypical antipsychotic

ANS: B Haloperidol decanoate is a depot medication, given intramuscularly every 2 to 4 weeks. It is unknown whether the patient has a support system. The patient probably received education, including written instructions prior to discharge. Changing to another classification of medication would not necessarily improve compliance.

A patient prescribed alprazolam (Xanax) for symptoms of anxiety shares with the nurse that, Im concerned about getting off this medication. Upon which fact will the nurse base the response to the patients concern? a. Long elimination half-life will result in a manageable withdrawal treatment plan. b. Rapid absorption and distribution to brain cells make withdrawal more difficult to manage. c. Sensitivity of the mesencephalic reticular activating system makes addiction unlikely. d. The combination of medication with an antidepressant often positively impacts withdrawal.

ANS: B In general, shorter-acting benzodiazepines are more difficult to taper and potentially cause more problems with withdrawal. The remaining options are neither true nor relevant.

Which statement made by a patient who will be maintained on lithium following discharge will require further instruction by the nurse? a. I will have my blood work done regularly. b. When I get home, I may go on a salt-free diet. c. I have learned not to restrict my intake of water. d. I understand some people gain weight on lithium.

ANS: B This statement shows that the patient does not understand the relationship between lithium and sodium. The patient must be taught that changing dietary salt intake will affect lithium levels. Adding salt can cause lower levels; reducing salt can result in toxicity. The remaining options reflect correct information regarding lithium therapy.

When asked how tricyclic antidepressants affect neurotransmitter activity, the nurse should respond that they: a. Decrease available dopamine. b. Increase availability of norepinephrine and serotonin. c. Make available increased amounts of monoamine oxidase. d. Increase the effects of the chemical gamma-aminobutyric acid.

ANS: B Tricyclic antidepressants block neurotransmitter uptake, increasing the amounts of norepinephrine and serotonin available. Decreasing dopamine is the action of typical antipsychotic medication. Increasing monoamine oxidase is not the action of tricyclics. Benzodiazepines, not tricyclics, increase the effects of GABA.

before beginning a patients therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medication class? a. aspirin b. anticoagulants c. diuretics d. NSAIDS

ANS: B Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs.

the nurse is reviewing the food choices of a patient who is taking a MAOI inhibitor. which food choices would indicate the need for additional teaching? a. orange juice b. fried eggs over easy c. salami and swiss cheese sandwich d. buscuits and honey

ANS: C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine.

The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics: a. Remain in the system longer b. Act more quickly to reduce delusions c. Produce fewer extrapyramidal effects d. Are risk free for neuroleptic malignant syndrome (NMS)

ANS: C Atypical antipsychotics produce less D2 blockade; thus movement disorders are less of a problem. No evidence suggests that the medication remains in the system longer nor that it acts more quickly to reduce delusions. The atypicals are not risk free for NMS.

hich patient complaint should receive priority from a patient who is taking the MAOI tranylcypromine (Parnate)? a. I havent had a bowel movement in 2 days. b. Will you take my temperature? I feel too warm. c. I get a headache when I drank several cups of coffee. d. My legs get stiff when I sit in the chair for any length of time.

ANS: C Hypertensive crisis may occur if a patient taking a MAOI ingests certain food containing tyramine or drugs that cause blood pressure (BP) elevation. Headache is a warning sign of hypertensive crisis. The nurse should assess BP and inquire about other symptoms of hypertensive crisis. Stiffness is not related to MAOI therapy. Elevated temperature is not an initial sign of hypertensive crisis. Constipation is not a sign of hypertensive crisis.

The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a: a. 30 mm Hg decrease in blood pressure reading b. Respiratory rate of 24 respirations per minute c. Temperature reading of 104 F d. Pulse rate of 70 beats per minute

ANS: C Increased temperature is the cardinal sign of NMS. This BP is not a significant feature of NMS. There are no significant findings to support the options related to respirations or pulse rate.

During a psychiatric emergency, IM ziprasidone (Geodon) is administered to an assaultive patient. During the next 2 hours, it is of primary importance that the nurse assess for: a. Tardive dyskinesia b. Anticholinergic effects c. Orthostatic hypotension d. Pseudoparkinsonism

ANS: C The side effect most likely to appear is orthostatic hypotension related to alpha1 receptor blockade preventing peripheral blood vessels from automatically responding to positional change. Anticholinergic effects are of lesser concern. The remaining options are less likely to occur at this point in therapy.

a patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertaline (zoloft) for about 6 months. at a recent visit she tells the nurse she has been interested in herbal therapies and wants to start taking st johns wort. which response by the nurse is appropriate a. that should be no problem b. good idea hopefully you will be able to stop taking the zoloft c. be sure to stop taking the herb if you notice a change in side effects d. taking st johns wort with zoloft may cause severe interactions and is not recommended

ANS: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate.

Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)? a. Grimacing and lip smacking b. Falling asleep in the chair and refusing to eat lunch c. Experiencing muscle rigidity and tremors d. Having excessive salivation and drooling

TD manifests as abnormal movements of voluntary muscle groups after a prolonged period of dopamine blockade. movements may affect any muscle groups but muscles of the face, mouth, tongue and digits are commonly affected. falling asleep is reflective of the sedative effect of these medicaions. muscle rigidity and drooling reflect eps caused from imbalance between dopamine and acetylcholine

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

a desirable long term maintenance lithium levels range between 0.6 and 1.2.

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

a c e common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shiv

to evaluate outcomes for a patient with schizophrenia receiving typical antipsychotic drug therapy, the nurse would look for improvement in: a. Affective mobility b. Positive symptoms c. Self-care activities d. Cognitive functioning

b Typical antipsychotic medications produce improvement in the positive symptoms of schizophrenia such as hallucinations and delusions. Negative symptoms and cognitive functioning tend to show less improvement.

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

b in 2005 the US food and Drug administration issued black box warnings regarding the use of all classes of antidepressants in both adult and pediatric populations. data from the FDA indicated a higher risk for suicide in patients receiving these medications. as a result current recommendations include regular monitoring for signs of worsening depressive symptoms

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c. "It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

b patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. the other answers are incorrect

Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a. The patient needs to avoid caffeine while on this drug. b. The patient needs to wear sunscreen while outside because of photosensitivity. c. Long-term therapy may result in nervousness and excitability. d. The medication may be taken with an antacid to reduce gastrointestinal upset.

b sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity . instruct the pt to apply sunscreen liberally and to s

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

b the therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). tardive dyskinesia is a potential adverse effect of these drugs

a patient wants to take a ginseng dietary supplement. the nurse instructs the patient to look for what potential adverse effect? a. drowsiness b. palpitations and anxiety c. dry mouth d. constipation

b. elevated blood pressure, chest pain, or palpitations, anxiety, insomnia, headache, nausea, vomiting and diarrhea are potential side effects of ginseng.

A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would the nurse assess as the likely cause of these symptoms? a. Decreased dopamine at receptor sites b. Blockade of histamine c. Cholinergic blockade d. Adrenergic blocking

c Fluphenazine administration produces blockade of cholinergic receptors giving rise to anticholinergic effects, such as dry mouth, blurred vision, and constipation.

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

c death from overdose of tricyclic antidepressants usually results from either seizures or dysrythmias. SSRIs are associated with significantly fewer and less severe adverse effects

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

c extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy

The nurse notes that a patient who has been receiving paroxetine (Paxil) for symptoms of major depression begins to behave in a confused and elated manner with the presence of restlessness, muscle jerking, and diaphoresis. The nurse should assess these symptoms as probable: a. Neuroleptic malignant syndrome b. Anticholinergic blockade c. Serotonin syndrome d. Dystonia

c restlessness, muscle jerking, and diaphoresis are symptoms of serotonin syndrome

A patient has been taking chlorpromazine (Thorazine) for the past 2 weeks. He drools, has hand tremors, and walks with a shuffling gait. The nurse would correctly attribute these behaviors to: a. Akinesia b. Tardive dyskinesia c. Pseudoparkinsonism d. Neuroleptic malignant syndrome

c these are symptoms of pseudoparkinsonism associated with dopamine bloackade. tardive dyskinesia occurs after long term therapy.

The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone (Risperdal), an atypical antipsychotic. Which intervention should the nurse implement? a. provide the client with a low tyramine diet b. assess the clients respirations for 1 full minute c. instruct the client to change positions slowly d. monitor the clients intake and output

c A side effect of all types of antipsychotics is orthostatic hypotension (lightheadedness, dizziness), which can be minimized by moving slowly when assuming an erect posture.

A patient who has received lithium for 3 weeks to control acute mania has the following symptoms: coarse hand tremor, diarrhea, vomiting, lethargy, and mild confusion. The priority nursing action should be to: a. Administer prn Cogentin to relieve the symptoms. b. Provide reassurance that the symptoms are transient. c. Obtain a stat lithium level; hold lithium pending results. d. Assist the patient to decrease the sodium in their daily diet.

c The symptoms the patient is experiencing are consistent with moderate lithium toxicity. The nurse should hold lithium, obtain a stat lithium level, and notify the physician. Cogentin is inappropriate; the symptoms are not EPS. The nurse may reassure the patient but cannot suggest that the symptoms will resolve over time. Minimizing salt would worsen lithium toxicity.

a patient has been admitted to the emergency dept with a suspected overdose of a tricyclic antidepressant. the nurse will prepare for what immediate concern a. hypertension b. renal failure c. cardiac dysrhythmias d. gastrointestinal bleeding

c tricyclic antidepressant overdoses are nortoriously lethal. the primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur.

c d during ssri medication therapeutic effects may not be seen for 4-6 weeks. to prevent the potentially fatal pharacodynamic interactions that can occur between the SSRIs and the MAOIs a 2-5 week washout period is recommended between uses of these two classes of medications.

Which of these statements made by a patient taking the MAOI phenelzine (Nardil) would warrant further instruction? a. I often forget to wear sunscreen when I go outside. b. I need to restrict the amount of sodium in my diet. c. I should not use over-the-counter cold medications. d. I usually order liver and onions when my wife and I eat out.

d MAOIs require pt to observe a tyramine free diet to prevent hypertensive crisis. liver is a food containing large amounts of tyramine

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

d foods containing tyramine, such as beer and aged cheeses, should be avoided while a pt is taking an MAOI. drinking bee while taking an MAOI may precipitate a dangerous hypertensive crisis.

What intervention will the nurse request for a patient reporting gastrointestinal side effects related to valproate therapy? a. Mild laxative b. Low-fat diet c. Oral antacid d. Histamine-2 antagonist

d indigestion, heartburn and nausea are common side effects. administration of a histamine 2 antagonist such as pepcid is sometimes helpful

a patient with the dx of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this pt indicates that he is experiencing a common adverse effect of phenothiazines a. i cant sleep at night b. i feel hungry all the time c. look at how red my hands are d. my mouth has been so dry lately

d phenothiazines produce anticholinergic like effects such as dry mouth, urinary hesitancy and constipation