1230 Exam 3: Psychotherapeutics (Tier)

A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine? "Amantadine was developed as an antiviral agent but is now used for treatment of PD." "Amantadine works slowly over time but can lose its effectiveness in 3 to 6 months." "Amantadine works rapidly and does not lose its effectiveness." "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."

"Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications." Amantadine was developed as an antiviral agent, but this response is not helpful to explain the use of the medication to the family member. Medication effects develop rapidly—often within 2 to 3 days—but are much less profound than with levodopa or the dopamine agonists. Furthermore, effects may begin to diminish within 3 to 6 months. Amantadine is not considered a first-line agent. However, the drug may be helpful for managing dyskinesias caused by levodopa.

A patient with Parkinson's disease who takes levodopa/carbidopa [Sinemet] comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? "Have you noticed any swelling in your feet?" "Are you having vivid dreams or hallucinations?" "Have you noticed any changes in your stool?" "Have you had your flu vaccine?"

"Are you having vivid dreams or hallucinations?" Patients taking levodopa/carbidopa [Sinemet] are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.

The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? "Have you noticed dry mouth or blurred vision?" "Have you had any changes in your urine function?" "When was your last bowel movement?" "Have you had any changes in your mood or anxiety level?"

"Have you had any changes in your mood or anxiety level?" In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention.

Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse? "The medication should not make me feel sleepy." "I should take the medication on an empty stomach." "I'll need to discuss a reliable form of birth control with my gynecologist." "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."

"I should take the medication on an empty stomach." Gastrointestinal side effects, such as nausea, vomiting, and indigestion, can occur when valproic acid is taken on an empty stomach; this statement indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.

The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? "With proper treatment, we can completely eliminate your seizures." "Our goal is to reduce your seizures to an extent that helps you live a normal life." "Epilepsy medication does not reduce seizures in most patients." "These drugs will help control your seizures until you have surgery."

"Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in most patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.

A patient has elected to use rasagiline as a monotherapy treatment for PD. Which teaching statement by the nurse is incorrect? "Rasagiline may cause insomnia, so monitor your sleeping habits." "It is important to avoid tyramine-containing foods." "You may be at increased risk for malignant melanoma, so have regular skin checks." "You may experience side effects, such as headache, arthralgia, dyspepsia, depression, and flu-like symptoms."

"Rasagiline may cause insomnia, so monitor your sleeping habits." Unlike selegiline, rasagiline does not cause insomnia. Rasagiline may pose a risk of hypertensive crisis and hence patients should be instructed to avoid tyramine-containing foods. Rasagiline may increase the risk of malignant melanoma, a potentially deadly cancer of the skin. Periodic monitoring of the skin is recommended. Side effects are headache, arthralgia, dyspepsia, depression, and flu-like symptoms.

Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? "Take the medication with a glass of grapefruit juice each morning." "Notify the physician if you are gaining weight or your legs are swollen." "Nausea, vomiting, and indigestion are common side effects of carbamazepine." "Have liver function tests performed on a routine basis."

"Take the medication with a glass of grapefruit juice each morning." Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.

A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? "You have apparently developed resistance to your current medication and will have to change to another drug." "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." "You should try to keep taking your medication at the current dose. These effects will go away with time."

"This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon.

The healthcare provider orders amantadine 100 mg PO daily. Available is amantadine 10 mg/mL syrup. How many mL will the nurse administer? 1 mL 10 mL 100 mL 0.1 mL

10 mL The available concentration of amantadine is 10 mg/mL. The ordered dose of 100 mg would equal 10 mL of syrup. 100 mg/10 = 10 mL.

ID: 3772720636 The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount? 800 mg 1400 mg 1600 mg 3200 mg

1600 24 hours divided by every-6-hour doses equals 4 doses of 400 mg. 400 mg times 4 doses equals 1600 mg.

The healthcare provider ordered lithium 250 mg PO every 8 hours for a patient experiencing acute mania. What will the patient's total dose be in 24 hours? 250 mg 500 mg 750 mg 1000 mg

750 The patient taking a medication every 8 hours will take it three times in a 24-hour period: 250 mg times 3 equals 750 mg for a 24-hour period.

The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg

A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems.

The nurse is caring for a patient who is starting clozapine (Clozaril). Which nursing intervention is a priority for this patient? A. Assess baseline white blood cell count and absolute neutrophil count. B. Evaluate suicidal tendencies. C. Take a baseline EEG. D. Evaluate creatinine clearance.

A. Assess baseline white blood cell count and absolute neutrophil count. Patients taking clozapine (Clozaril) must be monitored for the life-threatening side effect of agranulocytosis. A baseline white blood cell count and absolute neutrophil count must be taken. Patients started on this medication are chronically and severely ill. Evaluation of suicidal tendencies would not need to happen before the patient started the medication. Patients on this medication may have an increased risk of seizures; however, a baseline EEG will not assist in predicting or preventing this side effect. This medication is metabolized before excretion. Evaluation of creatinine clearance is not a priority for the patient starting on the medication.

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia

A. Auditory hallucunations C. Delusions of grandeur D. Severe agitation Positive symptoms of schizophrenia, such as auditory hallucinations, are effectively treated with first-generation antipsychotics. Positive symptoms of schizophrenia, such as delusions of grandeur, are effectively treated with first-generation antipsychotics. Positive symptoms of schizophrenia, such as severe agitation, are effectively treated with first-generation antipsychotics.

A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine for the treatment of schizophrenia. The nurse shoudl expect to find the greatest improvement in which of the following manifestations? (Select all that apply.) A. Disorganized speech B. Bizarre behavior C. Impaired social interactions D. Hallucinations E. Decreased motivation

A. Disorganized speech B. Bizarre behavior D. Hallucinations A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior. A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations.

The patient has been ordered a medication regimen that includes loxitane (Loxapine). During instructional sessions regarding the medication, the nurse should emphasize which information? (Select all that apply.) A. Sedation can occur. B. Hypotension is likely. C. Extrapyramidal symptoms can occur. D. Nausea reduction will occur.

A. Sedation can occur. B. Hypotension is likely. C. Extrapyramidal symptoms can occur. Loxitane (Loxapine) is known to cause sedation, hypotension, and extrapyramidal symptoms. Nausea may result as a side effect of loxitane.

Which statement is true concerning the use of antipsychotic medications during pregnancy? A.Their use should be monitored closely by the mother's healthcare provider. B. Such medication poses severe risks when used during pregnancy. C. Medications in this class do not cross the placental barrier. D. There is no record of side effects in newborns exposed to such medications.

A. Their use should be monitored closely by the mother's healthcare provider. While antipsychotics do pose some risks to the pregnant woman, these risks are not generally considered severe; nonetheless, their use should be carefully monitored by the woman's healthcare provider. These drugs do pass the placental barrier and can cause EPSEs in some newborns but the risks of such exposure is small and levels are carefully monitored when a pregnant woman is prescribed this classification of medications in order to minimize the risk

A therapeutic benefit of fluphenazine decanoate (Prolixin Decanoate) is that the individual: A. does not have to remember to take medication daily. B. will not experience extrapyramidal side effects (EPSEs). C. may have daily doses titrated up or down. D. will experience a reduction in both negative and positive symptoms.

A. does not have to remember to take medication daily. This medication is not given daily but rather by injection every 2 to 3 weeks and does not require titration. Fluphenazine, a traditional first-generation antipsychotic drug, targets only positive symptoms of schizophrenia.

The nurse is working with a group of patients receiving drugs that work in the central nervous system (CNS). Nursing care of these patients is based on which facts? (Select all that apply.) a. Overall knowledge of the workings of CNS agents is limited. b. The CNS has many more neurotransmitters than the periphery. c. Animal studies in progress will greatly enhance knowledge of CNS medications. d. When CNS drugs are taken long term, their effects differ from initial use. e. The blood-brain barrier is permeable to water-soluble drugs.

A. overall knowledge of the workings of CNS agents is limited. b. The CNS has many more neurotransmitters than the periphery. d. When CNS drugs are taken long term, their effects differ from initial use. Even though CNS medications are widely used, much about them remains unclear. The CNS is known to have many more active neurotransmitters than the peripheral nervous system. Animal studies are not particularly helpful in studying CNS drugs, because adequate animal models of mental illness are lacking. Adaptive changes occur in the brain when CNS agents are taken over time. This can increase the therapeutic effects, decrease the side effects, and contribute to tolerance and physical dependence. The blood-brain barrier is permeable to lipid-soluble agents.

The nurse is caring for a patient whose seizures are characterized by a 10- to 30-second loss of consciousness and mild, symmetric eye blinking. Which seizure type does this most closely illustrate? Tonic-clonic Absence Atonic Myoclonic

Absence. This scenario accurately describes absence seizures. Tonic-clonic seizures present with convulsions and muscle rigidity followed by muscle jerks. Patients may experience urinary incontinence and loss of consciousness. Atonic seizures cause sudden loss of muscle tone. Myoclonic seizures present with sudden muscle contractions that last but a second.

The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? Increased risk of infection Reddened, swollen gums Nausea, vomiting, and indigestion Central nervous system depression

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

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

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

The nurse prepares to administer lithium to a patient. The nurse should assess what before administration of the medication? Urinary creatinine clearance Serum troponin I and T Fasting blood glucose Serum lipid profile

Answer: A Rationale: Renal function (e.g., serum creatinine, creatinine clearance, urinalysis) should be evaluated before administration of lithium; patients with reduced renal function are at risk for lithium toxicity. Serum lithium levels should be monitored every 2 to 3 days during initial therapy, and every 3 to 6 months during maintenance. Other parameters that should be evaluated at least once a year include complete blood count with differential, serum electrolytes, renal function, and thyroid function.

Which individual would be more sensitive to the effects of central nervous system drugs? 2-week-old infant who has pyloric stenosis 16-year-old adolescent who has a spinal cord injury 58-year-old adult who has venous insufficiency 74-year-old adult who has Parkinson's disease

Answer: A Rationale: The blood-brain barrier is not fully developed at birth. Accordingly, infants are much more sensitive to central nervous system drugs than are older children and adults.

A patient with obsessive-compulsive disorder is prescribed sertraline. The nurse should intervene if the patient makes which statement? A. "I may develop headaches and trouble sleeping." B. "I will feel better in approximately 3 weeks." C. "I need to take this medication for at least a year." D. "I should watch my diet so that I don't gain weight."

Answer: B Rationale: Beneficial effects of sertraline develop slowly over several months to become maximal. Common side effects include nausea, headache, insomnia, and sexual dysfunction. Weight gain can also occur. Treatment lasts for at least a year, and a trial discontinuation is conducted.

A patient taking levodopa/carbidopa for Parkinson's disease experiences frequent "on-off" episodes (or abrupt loss of effect). Which action by the nurse is best? A. Administer the medication on an empty stomach. B. Instruct the patient to avoid high-protein foods. C. Have the patient increase intake of vitamin B6. D. Discontinue the drug for 10 days (for a "drug holiday").

Answer: B Rationale: Meals high in protein can reduce therapeutic responses to levodopa and may trigger an abrupt loss of effect.

The nurse cares for a patient receiving pramipexole. The nurse is most concerned if the patient makes which statement? "I now use a patch instead of taking birth control pills." "Sometimes I just fall asleep without warning." "The pills make me sleepy, so I take a nap in the afternoon." "I have noticed that this medicine makes me constipated."

Answer: B Rationale: Pramipexole may cause sleep attacks; patients should inform the prescriber and should avoid potentially hazardous activities.

The nurse cares for a patient receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question? Levothyroxine Sulindac Furosemide Propranolol

Answer: C Rationale: Diuretics (e.g., furosemide) promote sodium loss. If sodium is low, renal excretion of lithium is reduced; lithium levels are increased, which may result in toxicity. No steroidal anti-inflammatory drugs (NSAIDs) can increase lithium levels by suppressing prostaglandin synthesis in the kidney and increasing renal reabsorption of lithium. NSAIDs known to increase lithium levels include ibuprofen, naproxen, piroxicam, indomethacin, and celecoxib. However, sulindac does not increase lithium levels. Anticholinergics can cause urinary hesitancy; lithium-induced polyuria may result in considerable discomfort. Patients should avoid drugs with prominent anticholinergic actions (e.g., antihistamines, phenothiazine antipsychotics, tricyclic antidepressants). Levothyroxine is safe to administer with lithium; lithium may cause hypothyroidism. Propranolol should be administered with caution because lithium toxicity can cause hypotension; propranolol may also cause hypotension.

A patient is prescribed isocarboxazid for treatment of depression. Which foods should the patient be taught to avoid? A. Broccoli, shrimp, and yogurt B. Tomatoes, chicken, and milk C. Bananas, smoked fish, and cheese D. Apples, steak, and cottage cheese

Answer: C Rationale: Foods high in tyramine should be avoided if a patient is taking monoamine oxidase inhibitors (MAOIs) such as isocarboxazid. Dietary tyramine promotes the release of accumulated norepinephrine, causing massive vasoconstriction and excessive stimulation of the heart. A hypertensive crisis may occur. Foods to avoid include yeast extracts, most cheeses, fermented sausages, and aged fish or meat.

An elderly patient with skin cancer and hypertension is prescribed levodopa/carbidopa to treat Parkinson's disease. Which action by the nurse is best? Give the medication if the blood pressure is normal. Administer the medication as prescribed. Ask the patient about the type of skin cancer. Hold the medication if the patient is older than 65 years.

Answer: C Rationale: Levodopa can activate malignant melanoma and consequently should be avoided in patients with undiagnosed skin lesions.

The nurse instructs a patient taking paroxetine for post-traumatic stress disorder (PTSD). Which statement, if made by the patient to the nurse, indicates understanding about the instructions? "This drug is effective only if PTSD is related to combat." "The drug must be effective because it is approved for PTSD." "It is not clear whether this drug is an effective treatment for PTSD." "This drug is more effective than any other type of therapy."

Answer: C Rationale: Optimal treatment for post-traumatic stress disorder (PTSD) with psychotherapy and/or drugs has not been established. Exposure therapy is a type of psychotherapy that has sufficient proof of efficacy to recommend its use. Regarding drugs used for PTSD, there is no proof that any of them help, including paroxetine and sertraline, the only agents approved for PTSD by the Food and Drug Administration (FDA). Events that can lead to PTSD include physical or sexual assault, rape, torture, combat, industrial explosions, serious accidents, natural disasters, being taken hostage, displacement as a refugee, and terrorist attacks. Combat carries a high risk of PTSD, but the use of paroxetine is not limited to combat-related PTSD.

A patient who is diagnosed with bipolar disorder is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms? A. Insomnia, increased appetite, and abdominal distention B. Dry cough, hyperactive reflexes, and hypertension C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, asterixis, and generalized edema

Answer: C Rationale: Signs and symptoms of lithium toxicity include polydipsia, slurred speech, and fine hand tremors. They also include nausea, vomiting, persistent GI upset, diarrhea, clonic movements, hyperirritability of muscles, muscle weakness, and hypotension.

A patient with depression is prescribed fluoxetine. Which statement made by the patient indicates an understanding of the medication teaching? A. "Disorientation and hallucinations are common." B. "The drug may enhance my interest in sex." C. "It may take 3 to 4 weeks before my mood is elevated." D. "I can stop this medication when I feel less depressed."

Answer: C Rationale: The half-life is prolonged; therefore approximately 4 weeks is required to produce steady-state plasma drug levels. Antidepressants do not relieve symptoms immediately. Initial responses develop in 1 to 3 weeks. Maximal responses develop over 1 to 2 months. Adverse effects of fluoxetine include sexual dysfunction (impotence, delayed or absent orgasm, delayed or absent ejaculation, decreased sexual interest), weight gain, serotonin syndrome, and withdrawal syndrome. Serotonin syndrome (disorientation and hallucinations) is uncommon unless the patient is taking a monoamine oxidase inhibitor (MAOI) or ritonavir. Abrupt discontinuation of fluoxetine can cause withdrawal syndrome (dizziness, headache, nausea, tremor, anxiety, and dysphoria).

A patient is prescribed venlafaxine and requests information about the medication. Which response by the nurse is most appropriate? A. Ask the patient to talk to the prescribing healthcare provider. B. Refer the patient to the pharmacist for detailed instructions. C. Tell the patient the medication treats anxiety and depression. D. Give the patient a pamphlet about drugs used to treat anxiety.

Answer: C Rationale: The nurse should respond to the patient's concerns or questions honestly. Venlafaxine treats both anxiety and depression.

The nurse receives a phone call from a patient who has been taking a central nervous system drug for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best? "Nausea is not a common side effect of this drug." "You should stop the medication immediately." "The nausea will most likely decrease over time." "Try taking the medication on an empty stomach."

Answer: C Rationale: When central nervous system drugs are taken on a long-term basis, the intensity of side effects may decrease (while therapeutic effects remain undiminished). Adaptations within the brain are believed to underlie these phenomena.

The nurse cares for a patient with social anxiety disorder. The patient is currently experiencing intense anxiety. Which medication should the nurse administer to provide immediate relief of anxiety? Fluvoxamine Paroxetine Sertraline Clonazepam

Answer: D Rationale: Benzodiazepines (e.g., clonazepam, alprazolam) provide immediate relief of anxiety and can be used as needed for intense anxiety. Selective serotonin reuptake inhibitors (SSRIs) are first-line drugs for most patients with social anxiety disorder and are especially well suited for patients who fear multiple situations and are obliged to face those situations on a regular basis. Currently, only three SSRIs (fluvoxamine, paroxetine, and sertraline) are approved for social anxiety disorder. Initial effects take about 4 weeks to develop; optimal effects are seen in 8 to 12 weeks.

The nurse teaches a patient about bupropion. Which statement by the patient requires an intervention by the nurse? "I can take the drug with food to reduce nausea." "This drug will increase my interest in sex." "I may experience decreased appetite and weight loss." "I had a serious head injury 3 years ago."

Answer: D Rationale: Bupropion is generally well tolerated but can cause seizures; bupropion should be avoided in patients with past head trauma because their risk for seizures is increased. Bupropion does not cause weight gain or sexual dysfunction; it appears to increase sexual desire and pleasure. Bupropion is administered orally and may be taken with food to decrease gastrointestinal upset.

A patient is prescribed a dopamine agonist, pramipexole. Which statement made by the patient indicates a need for further teaching? A. "The drug should be taken with food to prevent nausea." B. "I may experience hallucinations while taking this drug." C. "I should rise slowly to prevent dizziness and fainting." D. "This drug will stop the progression of Parkinson's disease."

Answer: D Rationale: Dopamine agonists will improve patients' abilities to complete activities of daily living but are not a cure and will not delay progression of Parkinson's disease.

A patient is brought to the emergency department for treatment of an overdose of alprazolam. Which medication should the nurse prepare to administer to this patient? Protamine sulfate Acetylcysteine Naloxone Flumazenil

Answer: D Rationale: Flumazenil, a benzodiazepine receptor antagonist, can be used to treat benzodiazepine overdose. Protamine sulfate is the antidote for heparin overdose, acetylcysteine is the antidote for acetaminophen overdose, and naloxone is the antidote for an opioid overdose.

A patient with bipolar disorder is prescribed lithium. Which statement if made by the patient indicates a need for further teaching? A. "I can take the medication with milk or a snack." B. "I will call my doctor if I feel hyperactive." C. "I should drink at least 8 to 10 glasses of water every day." D. "I will reduce my salt intake while taking this medication."

Answer: D Rationale: Lithium may be taken with milk or food to decrease gastric upset. Feelings of mania should be reported promptly; patients may need a mood stabilizer in addition to lithium. Patients taking lithium often experience polyuria and should drink 8 to 10 glasses of water each day. Lithium will accumulate if sodium is restricted in the diet.

A patient has been taking a medication for 2 months. Which statement, if made by the patient, would indicate to the nurse that drug tolerance is occurring? A. "The medication seems to be working better than at first." B. "I feel really sick if I do not take the medication every day." C. "The side effects are not bothering me anymore." D. "The medication does not seem to be working as well."

Answer: D Rationale: Tolerance is defined as a decreased response occurring in the course of prolonged drug use.

The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Ibuprofen [Motrin] for muscle pain Hydrochlorothiazide (HCTZ) for edema Aspirin (ASA) for mild headache Diphenhydramine [Benadryl] for cold symptoms

Aspirin Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has anticholinergic properties and can aggravate lithium-induced polyuria by causing urinary hesitancy.

A nurse is providing teaching for a male client who has schizophrenia and is taking risperidone. Which of the following instructions should the nurse include in the teaching? A. "Add extra snacks to your diet to prevent weight loss." B. "Notify the provider if you develop breast enlargement." C. "You may begin to have mild seizures while taking this medication." D. "This medication is likely to increase your libido."

B. "Notify the provider if you develop breast enlargement." Gynecomasia (breast enlargement) and galactorrhea can occur due to an increase in prolactin levels while taking risperidone. The client should inform the provider is theses manifestations occur.

The nurse is preparing to give ethosuximide [Zarontin]. The nurse understands that this drug is only indicated for which seizure type? Tonic-clonic Absence Simple partial Complex partial

B. Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.

The nurse is assessing a patient taking antipsychotics and notes that he has difficulty sitting still. The patient states that he is feeling "restless," as he paces the floor. What is the nurse's primary intervention? A. Stop the medication immediately and notify the health care provider. B. Administer the prescribed benzodiazepine. C. Administer benztropine (Cogentin) as ordered. D. Stay with the patient and offer reassurance.

B. Administer the prescribed benzodiazepine. Akathisia presents with restlessness and trouble standing still. This side effect is best treated with a benzodiazepine such as lorazepam. The medication is not stopped if a patient exhibits this type of effect. Cogentin is administered for Parkinson-like side effects, which this patient is not exhibiting. The symptoms displayed are most likely not just typical nervousness. Staying with the patient will not change the symptoms.

When an older adult is prescribed an antipsychotic medication, which intervention has priority regarding the patient's safety? A. Wearing sunglasses when outdoors B. Changing from a sitting to standing position slowly C. Being frequently monitored for suicidal ideations D. Avoiding foods with high fat content

B. Changing from a sitting to standing position slowly Hypotension is the major antiadrenergic effect of antipsychotic drugs. Hypotension occurs most often in older adults and when the individual stands or changes positions suddenly (orthostatic hypotension); thus, precautions against falls must be instituted. Frequent monitoring for suicidal ideation is appropriate for antidepressant medications. While wearing sunglasses and avoiding high-fat foods are appropriate health habits, they are not associated directly with antipsychotic medication therapy.

A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects? A. Take the medication in the morning to prevent insomnia. B. Chew sugarless gum to moisten the mouth. C. Use cooling measure to decrease fever. D. Take an antacid to relieve nausea.

B. Chew sugarless gum to moisten the mouth. Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic effect of fluphenazine.

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing

B. Drooling C. Involuntary arm movements E. Continual pacing Drooling is an indication of pseudoparkinsonism, which is an EPS. Incoluntary arm movements are an indication of tardive dyskinesia, which is an EPS. Continual pacing is an indication of akathesia, which is an EPS.

The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the health care provider will prescribe which medication? A. Lorazepam (Ativan) B. Flumazenil (Romazicon) C. Oxazepam (Serax) D. Buspirone HCl (BuSpar)

B. Flumazenil (Romazicon) Of the medications listed, flumazenil (Romazicon) is the only one that would be effective as a benzodiazepine antagonist.

A nurse is assessing a male client who recently began taking haloperidol. Which of the following findings is the highest priority to report to the provider? A. Shuffling gait B. Neck spasms C. Drowsiness D. Impotence

B. Neck spasms Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment. This is the greatest risk to the client and is therefore the priority finding.

The nurse will hold the next dose of antipsychotic medication for which patients? (Select all that apply.) A. The patient with a sitting blood pressure of 130/90 mm Hg and 100/80 mm Hg when standing B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips C. The patient who has pill-rolling motions of the hand D. The patient who has a sudden high fever

B. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips D. The patient who has a sudden high fever The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate Parkinson-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.

Which instruction does the nurse include when teaching a patient about phenelzine [Nardil] therapy? (Select all that apply.) a. "Take the medication as needed when you are feeling depressed." b. "If you experience a severe headache, inform your healthcare provider." c. "Profuse sweating is an expected side effect of this medication and will diminish with time." d. "Ginseng can be used to treat headache, which patients often experience when they first take phenelzine." e. "Avoid eating avocados when taking this drug."

B. severe headache - inform E. Avoid avocado Patients should be instructed to take MAOIs every day as prescribed—not PRN. They should be warned not to discontinue treatment once mood has improved, because doing so may result in relapse. Patients should be informed of the symptoms of hypertensive crisis--severe headache, tachycardia, hypertension, nausea, vomiting, confusion, and profuse sweating—and instructed to seek immediate medical attention if these develop. Patients should be forewarned of the hazard of hypertensive crisis and the need to avoid tyramine-rich foods, such as aged cheese, Chianti, and avocados. (Patients on low-dose transdermal selegiline need not avoid foods containing tyramine.) Patients taking MAOIs should not take ginseng, because headache, tremulousness, and manic-like reactions have occurred.

A patient has an infection affecting a central nervous system (CNS) component. Which structure makes the delivery of antibiotic therapy more difficult? Blood-brain barrier Chemotherapeutic trigger zone Neuropeptide receptors Thalamic synapses

Blood brain barrier The blood-brain barrier normally is protective, but it can also interfere with the delivery of some therapeutic agents. This is one reason CNS infections are critical.

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "Iwill be able to stop taking this meciation as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while I am taking this medication." D. "This medication is highly addictive and must be withdrawal slowly.

C. "I will be careful not to gain too much weight while I am taking this medication." Antipsychotic medications, such as iloperidone, have a high risk for significant weight gain.

A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine B. Quetiapine C. Aripiprazole D. Clozapine E. Asenapine

C. Aripiprazole D. Clozapine E. Asenapine Aripiprazole is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. Clozapine is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. Asenapine is available in a sublingual tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection.

What nutritional education should a nurse provide when managing the care of a patient who has been prescribed a newer antipsychotic medication? A. Limit protein intake. B. Increase fluid intake by 200 ml daily. C. Prepare to cope with a craving for carbohydrates. D. Increase calories to manage an expected weight loss.

C. Prepare to cope with a craving for carbohydrates. Carbohydrate craving is a common feature of this type of medication therapy. Weight gain can be significant, particularly for patients taking the newer agents. There is no need to limit protein or to increase fluid intake above normal consumption.

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticiptae a prescription of which of the following? A. Chlorpromazine B. Thiothixene C. Risperdone D. Haloperidol

C. Risperdone Second-generation antipsychotics, such as risperidone, are effective in treating negative symptoms of schizophrenia, such as lack of grooming and flat affect.

The multidisciplinary team discusses the patient's negative symptoms of schizophrenia. The nurse expects which medication to be ordered? A. Prolixin (fluphenazine) B. Haldol (haloperidol) C. Seroquel (quetiapine) D. Thorazine (chlorpromazine)

C. Seroquel (quetiapine) Quetiapine, an atypical second-generation antipsychotic drug, targets both the positive and negative symptoms of schizophrenia. Fluphenazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Haloperidol predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Chlorpromazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication.

Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? Take the medication on a full stomach. Change positions slowly. The drug may cause the urine to be very dilute. Carbidopa has many adverse effects.

Change positions slowly Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.

The nurse receives a laboratory report indicating that the phenytoin [Dilantin] level for the patient seen in the clinic yesterday is 16 mcg/mL. Which intervention is most appropriate? Continue as planned, because the level is within normal limits. Tell the patient to hold today's dose and return to the clinic. Consult the prescriber to recommend an increased dose. Have the patient call 911 and meet the patient in the emergency department.

Continue as planned, because the level is within normal limits The therapeutic range for phenytoin is 10 to 20 mcg/mL. Because this level is within normal limits, the nurse would continue with the routine plan of care.

A family member of a patient who is experiencing a severe manic episode asks the nurse why the patient is receiving an antipsychotic medication. The nurse informs the family member that antipsychotics are used in the treatment of severe manic episodes to do what? Help control symptoms during the severe manic episode Elevate mood during the severe manic episode Produce sedating effects during the severe manic episode Reduce the amount of physical pain the patient experiences during the severe manic episode

Control symptoms Antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. Benzodiazepines are given for their sedating effects. Antidepressants help elevate mood during manic episodes.

A preceptor is working with a new RN. The preceptor will note understanding of Clozaril (clozapine) by the new RN when he or she says: A. "I need to carefully assess each patient for EPSEs, since it is a major risk factor with clozapine." B. "The team decided to offer clozapine to the patient who was newly admitted and diagnosed with schizophrenia. I will discuss it with his family today." C. "I gave the first dose of clozapine this morning. He is experiencing no abnormal motor movements so far." D. "The patient's WBC and ANC meet the criteria to start clozapine."

D. "The patient's WBC and ANC meet the criteria to start clozapine." The new RN demonstrates knowledge of clozapine with establishing a baseline for the white blood cell count (WBC)/absolute neutrophil count ANC with the potential risk of agranulocytosis in mind. EPSE liability is lower with clozapine rather than higher. Clozapine is not the first-line treatment for schizophrenia because of the expense and dedication necessary to monitor bone marrow health and WBC. Abnormal motor movements are not expected following a first dose of clozapine.

A nurse is providing discharge teaching to a client who has a new prescription for clozapine. Which of the following statements should the nurse include in the teaching? A. "You should have a high-carbohydrate snack between meals and at bedtime." B. "You are likely to develop hand tremors if you take this medication for a long period of time." C. "You may experience temporary numbness of your mouth after each dose." D. "You should have your white blood cell count monitored every week."

D. "You should have your white blood cell count monitored every week." Due to the risk for fatal agranulocytosis weekly monitoring of the client's WBC count is recommended while taking clozapine.

There is an anticholinergic effect on the peripheral nervous system resulting from the effects of some antipsychotic medication. Tachycardia, constipation, and urinary hesitation are the result of this effect on which cranial nerve (CN)? A. CN III B. CN VII C. CN IX D. CN X

D. CN X The anticholinergic effects on CN X, the vagus nerve, would include tachycardia, constipation, and urinary hesitation. Anticholinergic effects on CN IX, the glossopharyngeal nerve, include dry mouth and dry nasal passages, while effects on CN VII, the facial nerve, result in dry mouth, decreased tearing, and dry nasal passages. An anticholinergic effect on CN III, the oculomotor nerve, would bring about dilated pupils, impaired accommodation, and blurred vision.

What aspect of traditional antipsychotic medication therapy is most responsible for a patient's medication nonadherence and resulting rehospitalization? A. The cost of the medication B. The need for frequent blood tests C. The biases against such medications D. The occurrence of EPSEs.

D. The occurrence of EPSEs. EPSEs → nonadherence → relapse → rehospitalization. It has been estimated that most patients who receive antipsychotic medications have EPSEs and, in turn, EPSEs account for many readmissions. High-potency traditional antipsychotics are most likely and atypical antipsychotics are least likely to cause EPSEs. While the cost of medication, the need for monitoring, and biases against medication can all be factors, the greatest impact on nonadherence is the development of EPSEs.

Which medication can cause this acid-base disturbance: pH 7.32, paCO2 33, HCO3 20? Primidone [Mysoline] Lamotrigine [Lamictal] Lacosamide [Vimpat] Topiramate [Topamax]

D. Topiramate The arterial blood gas results reflect metabolic acidosis with partial respiratory compensation. Topiramate can cause metabolic acidosis, because it inhibits carbonic anhydrase; this increases renal excretion of bicarbonate, causing the plasma pH to fall. Hyperventilation is the most characteristic symptom. Primidone, lamotrigine, and lacosamide do not cause metabolic acidosis.

Prior to administering Clozaril (clozapine) and at regular intervals during treatment, the nurse will evaluate the patient's: A. electroencephalogram (EEG). B. electrocardiogram (ECG). C. lipids. D. complete blood count (CBC).

D. complete blood count (CBC). Related to the risk for agranulocytosis from bone marrow suppression, monitoring of the WBC count by the prescriber, nurse, and/or pharmacist is required. This medication does not require monitoring of EEG, ECG, or serum lipids.

A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with his levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? Diarrhea Dyskinesia Wheezing Headache

Dyskinesia When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.

A female patient who is originally from Thailand is seen in the clinic for seizure control. She receives a new prescription for carbamazepine [Tegretol]. Before the patient takes the drug, which is the most appropriate initial nursing intervention? Warn her not to withdraw this drug abruptly. Recommend that she take this medication at bedtime with meals. Teach her family to assist with maintaining a seizure frequency chart. Ensure that genetic testing for HLA-B*1502 is performed.

Ensure genetic testing - Although all these interventions are appropriate for this patient, the initial nursing intervention would be to ensure that genetic testing is performed. Carbamazepine is associated with several dermatologic effects, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Patients of Asian descent are at higher risk for serious dermatologic reactions with this drug because of a genetic variation known as HLA-B*1502. The FDA now recommends that before taking carbamazepine, patients of Asian descent undergo genetic testing.

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

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

A nurse teaches a patient who takes an MAOI about important dietary restrictions. Which foods will the nurse caution the patient to avoid? Aged cheese and sherry Grapefruit and other citrus juices Coffee, colas, and tea Potato and corn chips

Foods that contain tyramine can produce a hypertensive crisis in individuals taking MAOI antidepressants. Many aged foods contain tyramines.

The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? It increases the risk of suicide in the early phase. It is less effective than the tricyclic antidepressants. It increases the risk of psychoses and parkinsonism. It has more side effects and drug interactions.

It has more side effects and drug interactions. Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine. Also, an increased incidence of drug-drug interactions is seen with phenelzine. Phenelzine does not pose an increased risk for suicide, psychoses, or parkinsonism, and it is as effective as the tricyclic and SSRI antidepressants.

Which drug should be used with caution in a patient with first-degree atrioventricular (AV) heart block? Lacosamide [Vimpat] Felbamate [Felbatol] Tiagabine [Gabitril] Levetiracetam [Keppra]

Lacosamide can prolong the PR interval and should be used with caution in patients with cardiac conduction problems and in those taking other drugs that prolong the PR interval, such as calcium channel and beta blockers. Felbamate, tiagabine, and levetiracetam do not affect the PR interval.

Which characteristic improves a drug's ability to reach the central nervous system (CNS)? Protein binding Lipid solubility Electrical charge Ionization

Lipid solubility Because drugs must cross the blood-brain barrier to enter the CNS, only lipid-soluble agents and those that have a specialized transport system are able to cross. Protein binding and ionization (electrical charge) reduce a drug's ability to cross the blood-brain barrier.

A nurse assesses a patient who takes a maintenance dose of lithium carbonate [Lithobid] for bipolar disorder. The patient complains of hand tremor, nausea, vomiting, and diarrhea. The patient's gait is unsteady. The patient most likely has done what? Consumed some foods high in tyramine Not taken the lithium as directed Developed tolerance to the lithium Developed lithium toxicity

Lithium toxicity Early lithium toxicity is evidenced by diarrhea, anorexia, muscle weakness, nausea, vomiting, tremors, slurred speech, and drowsiness. Later signs include blurred vision, seizures, trembling, confusion, and ataxia.

The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) Lithium Risperidone Divalproex sodium [Depakote] Carbamazepine Venlafaxine [Effexor]

Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder.

Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? Phenytoin [Dilantin] 200 mg IV over 4 minutes Phenobarbital 30 mg IM Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes

Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min. Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.

A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? Decaffeinated tea, gelatin cubes, and ginger ale when alert Docusate 100 mg orally daily Meperidine 50 mg IM every 4 hours as needed for pain Acetaminophen 650 mg every 6 hours as needed for temperature

Meperidine 50 mg IM every 4 hours as needed for pain. Selegiline can have a dangerous interaction with meperidine, leading to stupor, rigidity, agitation, and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication to the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.

Which statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.) a. Mood stabilizers are used to prevent recurrent manic-depressive episodes. b. Antipsychotics are used to treat depressive episodes. c. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. d. Lithium and valproate are the preferred mood stabilizers for BPD. e. A lithium level of 2.0 mEq/L is considered therapeutic.

Mood stabilizers prevent recurrent manic depressive episodes antidepressants should be used w. mood stabilizer for bipolar pt's Lithium and valproate are preferred for BPD The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index.

Which neurotransmitter is active in both the peripheral and central nervous systems (CNS)? Norepinephrine Serotonin Substance P Dynorphins

Norepi All of these agents are active in the CNS. The only known neurotransmitters in the peripheral nervous system are acetylcholine, epinephrine, and norepinephrine.

The nurse identifies which most common serious adverse effect of TCA therapy? Excitation Orthostatic hypotension Skin rash Sexual dysfunction

Ortho hypo - Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy.

The nurse is preparing a discharge teaching plan for a patient prescribed phenobarbital to control seizures. Which side effect is expected to occur during initiation of phenobarbital drug therapy but decline once dosage is achieved to control seizures? Nausea Sedation Fatigue Dry mouth

Sedation - Side effects of phenobarbital include sedation during the initial phase of therapy; however, with continued treatment, sedation declines while full protection from seizures is retained. This is thought to be related to adaptive change within the brain during prolonged phenobarbital drug exposure.

The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? Blood pressure of 160/90 mm Hg Insomnia and diarrhea Sedation and dry mouth Tachypnea and wheezing

Sedation and dry mouth Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs.

The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? Depressive psychosis Serotonin syndrome Escitalopram overdose Cholinergic crisis

Serotonin syndrome Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

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

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

The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? Sodium level of 128 mEq/L Prothrombin time of 8 seconds Blood urea nitrogen level of 25 mg/dL Potassium level of 5.6 mEq/L

Sodium 128 The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.

The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of BPD. The nurse anticipates which dosing schedule? Starting at a high dose to quickly control mania Starting at a low dose and titrating up Starting at a high dose and titrating down Starting with a loading dose and then a low maintenance dose

Start low- titrate up Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of BPD. The goal is to prevent affective relapses into mania or depression. To minimize the risk of serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased.

The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) Swollen, tender gums Measles-like rash Productive cough Unusual hair growth Nausea and vomiting

Swollen, tender gums Measles-like rash Unusual hair growth Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.

What is the goal of pharmacologic therapy in the treatment of Parkinson's disease? a. To increase the amount of acetylcholine at the presynaptic neurons b. To reduce the amount of dopamine available in the substantia nigra c. To balance cholinergic and dopaminergic activity in the brain d. To block dopamine receptors in presynaptic and postsynaptic neurons

To balance cholinergic and dopaminergic activity in the brain. Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.

The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? To reduce the risk of suicide with overdose To avoid weight gain and other gastrointestinal (GI) effects To help prevent sexual dysfunction To prevent the risk of serotonin syndrome

To reduce the risk of suicide with overdose The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome.

The nurse knows that which statements about postpartum depression are true? (Select all that apply.) a. About 80% of women experience depressive symptoms after giving birth. b. Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. c. Monoamine oxidase inhibitors are the first-line agents of choice for the treatment of postpartum depression. d. Once a woman has had postpartum depression, it will not recur with future deliveries. e. Sertraline [Zoloft] is the drug of choice for treating postpartum depression in breast-feeding mothers.

a. About 80% of women experience depressive symptoms after giving birth. b. Thyroid insufficiency as contributing factor in postpartum depression. e. Sertraline drug of choice for treating postpartum depression in breast-feeding mothers. The drug of choice for postpartum depression is an SSRI, such as sertraline [Zoloft], because these drugs are effective, well tolerated, and present little risk of toxicity if taken in overdose. If a woman has responded to another antidepressant in the past, that drug should be used first. The risk of relapse is high, as is the risk of postpartum depression with subsequent pregnancies. The statements in options C and D are false.

A patient asks the nurse to explain how antipsychotic drugs work to make him feel better. The nurse understands that antipsychotics act in which way? a. Blocking actions of dopamine b. Blocking actions of epinephrine c. Promoting prostaglandin synthesis d. Enhancing the action of gamma-aminobutyric acid

a. Blocking actions of dopamine

A patient appears to have had an overdose of phenothiazines. The nurse anticipates that which intervention(s) may be used to treat phenothiazine overdose? (Select all that apply.) a. Gastric lavage b. Adequate hydration c. Maintaining an airway d. Fluphenazine (Prolixin) e. Risperidone (Risperdal) f. Activated charcoal administration

a. Gastric lavage b. Adequate hydration c. Maintaining an airway f. Activated charcoal administration

The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) a. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." b. "You may have some mild sedation. Do not drive until you know how this drug will affect you." c. "This drug may cause easy bruising. If you notice this, call the clinic immediately." d. "It is very important to have good oral hygiene and to visit your dentist regularly." e. "You may continue to have wine with your evening meals, but only in moderation."

a. call the clinic if increased anxiety or agitation." b. mild sedation. Do not drive d. good oral hygiene and visit dentist Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.

An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications includes which drugs? (Select all that apply.) a. clozapine (Clozaril) b. fluphenazine (Prolixin) c. haloperidol (Haldol) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

a. clozapine (Clozaril) d. olanzapine (Zyprexa) e. aripiprazole (Abilify)

The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statement is appropriate to include in the teaching plan? (Select all that apply.) a. "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." b. "When you stop taking this medication, you should not withdraw it abruptly." c. "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." d. "This medication often causes drowsiness. You should take it at bedtime." e. "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety."

a. may cause some sexual side effects. b. Dp not withdraw it abruptly e. worsening mood, agitation, or increased anxiety Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk.

Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders? (Select all that apply.) Alcoholism Bulimia Schizophrenia Hypertension Glucocorticoid-induced psychosis

alcohol - bulimia - schizophrenia - glucocorticoid Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid-induced psychosis. Nonpsychiatric uses include hyperthyroidism, cluster headache, and migraine. In addition, lithium can raise neutrophil counts in children with chronic neutropenia and in patients receiving anticancer drugs or zidovudine (AZT).

The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face may have which condition? a. Akathisia b. Acute dystonia c. Tardive dyskinesia d. Pseudoparkinsonism

b. Acute dystonia

The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) a. The patient complains of excessive facial hair growth. b. The patient is walking with a staggering gait. c. The patient's gums are swollen, tender, and bleed easily. d. The patient complains of double vision. e. The nurse observes rapid back-and-forth movement of the patient's eyes.

b. The patient is walking with a staggering gait. d. The patient complains of double vision. e. rapid back-and-forth movement of eyes. Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.

An antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication? a. quetiapine (Seroquel) b. aripiprazole (Abilify) c. benztropine (Cogentin) d. chlorpromazine (Thorazine)

c. benztropine (Cogentin)