Mental Health Disorders

1. 1. Confusion and restlessness would not indicate the flu. The elevated temperature should make the nurse suspect a possible serious complication of SSRIs. 2. Serotonin syndrome is a serious complication of SSRIs that produces mental changes (confusion, anxiety, and restlessness), hypertension, tremors, sweating, hyperpyrexia (elevated temperature), and ataxia. Conservative treatment includes stopping the SSRI and supportive treatment. If untreated, ESE can lead to death. 3. Taking the medication at night will not treat serotonin syndrome. 4. These are not expected side effects. They require nursing intervention.

1. The client with a major depressive disorder taking the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) reports feeling confused and restless and having an elevated temperature. Which intervention should the clinic psychiatric nurse implement? 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.

10. 1. The nurse should realize this medication takes at least 3 weeks to work; therefore, this question is not helpful to the client. 2. This is a therapeutic response to encourage the client to ventilate feelings, but the client needs factual information. 3. The nurse should realize this medication takes at least 3 weeks to become effective, and the client does not need to come into the clinic to be told that fact. 4. 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.

10. 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 is 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."

11. 1. The lithium level is monitored by a venipuncture serum level, which must be done by a laboratory; it is not a test to be done at home. 2. Lithium acts like sodium in the body so dehydration can cause lithium toxicity; therefore, the client should not become dehydrated. 3. Lithium should not be stopped because bipolar disorder is a chemical imbalance, and the client must continue taking this medication or manic behavior will return. 4. The client should take the medication with food to decrease gastrointestinal upset. 5. Foods high in tyramine should be avoided when taking MAO inhibitors, an antidepressant.

11. Which statements indicate the client diagnosed with bipolar disorder who is taking lithium (Eskalith), an antimania medication, understands the medication teaching? Select all that apply. 1. "I must 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 should take the medication with food." 5. "I will not eat foods high in tyramine."

12. 1. The 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. 2. This is within the therapeutic range; therefore, the nurse should not hold the medication but should administer it. 3. This is within the therapeutic range; therefore, the nurse should administer the medication. 4. There is no reason to verify the lithium level; therefore, the nurse should administer the medication. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

12. 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 intervention should the nurse implement? 1. Administer the medication. 2. Hold the medication. 3. Notify the health-care provider. 4. Verify the lithium level.

13. 1. The client taking lithium should have adequate sodium intake because a salt-free diet reduces lithium excretion and can lead to lithium toxicity. The nurse would not question administering the medication to this client. 2. Many clients with bipolar disorder are prescribed an antidepressant medication and an anti-mania drug to treat bipolar disorder; therefore, the nurse would not question administering this medication. 3. Diuretics increase the excretion of lithium from the kidneys; therefore, the nurse would question administering lithium to this client. 4. The nurse would not question administering lithium to a client who has an adequate urine output.

13. To which client should the nurse question administering lithium (Eskalith), 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.

14. 1. Depakote may be used to help prevent migraine headaches, but this is not an appropriate question to ask this client. 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. 3. Many times a classification of medications can be prescribed for another disease process. The nurse must know what the medication is prescribed for, as stated in the stem of the question. 4. Depakote takes 2-3 weeks to become therapeutic; therefore, this question is not pertinent. MEDICATION MEMORY JOGGER: Any time a female client of childbearing age is prescribed a routine medication the nurse should think about possible pregnancy.

14. 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?"

15. 1. Caffeine has a diuretic effect that can cause lithium sparing by the kidneys, which may cause lithium toxicity. This statement indicates the client understands the medication teaching. 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. 3. The client needs to maintain adequate fluid intake to prevent dehydration. This statement indicates the client understands the medication teaching. 4. Diarrhea is a sign of lithium toxicity, and the client should notify the health-care provider so that a serum lithium level can be evaluated. This statement indicates the client understands the medication teaching.

15. The client diagnosed with bipolar disorder is taking lithium (Eskalith), an antimania 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."

16. 1. This is an extremely high toxic level that requires immediate treatment. The therapeutic range is 0.6 to 1.5 mEq/L. 2. This is an extremely high toxic level that requires intravenous therapy. 3. Extremely high toxic levels of lithium require hemodialysis and supportive care. 4. There is no known antidote for lithium toxicity. 5. The nurse must monitor cardiac function to assess rhythm disturbances.

16. The client with bipolar disorder who is taking lithium (Eskalith), an antimania medication, has a lithium level of 3.1 mEq/L. Which treatments should the nurse expect the health-care provider to prescribe? Select all that apply. 1. No treatment because this is within the therapeutic range. 2. Initiate intravenous therapy with isotonic sodium chloride. 3. Prepare the client for immediate hemodialysis. 4. Administer the antidote for lithium toxicity. 5. Monitor the client's cardiac status on telemetry.

17. 1. Tegretol is an anticonvulsant 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. Therefore, this data indicates the medication is effective. 2. Serum drug levels determine if the medication is at a toxic level, but they do not indicate that the client's mania is controlled. Therefore, this does not indicate the medication is effective. 3. Tegretol is prescribed to treat the mania in bipolar disorder, not the depression. Therefore, a depression scale does not indicate anything about the effectiveness of the medication. 4. A client with bipolar disorder experiences a mood disorder, not a thought disorder such as schizophrenia. Therefore, this data does not indicate the medication is effective in treating the bipolar disorder. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

17. 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.

18. 1. This would be an appropriate intervention, but the client's physiological needs are priority. 2. The nurse must assess why the client is not compliant with medication, but in an acute manic state the client cannot answer this question. Therefore, it is not the first intervention. 3. This is the first intervention because the client is in an acute manic state and the client's physiological need is priority. 4. Lithium takes 2-3 weeks to become therapeutic; therefore, a stat dose of lithium orally will not help the manic state. Lithium is not available in intramuscular or intravenous route.

18. The client with bipolar disorder who is prescribed lithium (Eskalith), an antimania medication, is admitted to the psychiatric unit in an acute manic state. Which intervention should the nurse implement first? 1. Determine the client's serum lithium level. 2. Assess why the client quit taking the lithium. 3. Implement care for the client's physiological needs. 4. Administer a stat dose of lithium to the client.

19. 1. Recommending use of a soft-bristled toothbrush is specific for clients taking phenytoin (Dilantin), another anticonvulsant medication, but not for Tegretol. 2. Tegretol does not affect visual acuity; therefore, there is no reason to recommend this health promotion activity for this client. 3. Tegretol does not affect the blood pressure; therefore, there is no reason to recommend this health promotion activity for this client. 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. MEDICATION MEMORY JOGGER: The nurse should discuss information with the client that is specific to that medication. There are many health promotion activities that the nurse can discuss with the client, but the nurse should not overload the client with activities that are not specific to the medication prescribed for the client.

19. 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.

2. 1. The cost of the medication or the type of insurance should not be a reason one medication is prescribed over another. 2. This is passing the buck, and the psychiatric nurse should be knowledgeable about medications. 3. SSRIs have the same efficacy as MAO inhibitors and tricyclics, but SSRIs are safer because they do not have the sympathomimetic effects (tachycardia and hypertension) and anticholinergic effects (dry mouth, blurred vision, urinary retention, and constipation) of the MAO inhibitors and tricyclics. 4. All antidepressant medications take at least 14 to 21 days to become effective.

2. The 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 antidepressants?" Which statement by the nurse is 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."

20. 1. Lithium has a narrow therapeutic serum level. The level is monitored every 3-5 days initially and every 2-3 months thereafter. 2. Lithium is a salt and may cause dehydration; therefore, the client should maintain an adequate fluid intake of at least 2000 mL or more a day. 3. Insufficient dietary salt intake causes the kidneys to conserve lithium, which increases serum lithium levels; therefore, the client should have sufficient salt intake and not decrease the sodium intake. 4. The radial pulse is not evaluated before taking lithium, and the client should take the medication even if the pulse is less than 60. 5. Lithium does not cause orthostatic hypotension; therefore, the nurse does not need to discuss ways to prevent it.

20. 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.

21. 1. There is no such test as a therapeutic serum level for clozapine. 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. 3. The client's RBC count is not affected by clozapine. 4. The respiratory system is not affected by clozapine; therefore, ABGs do not have to be evaluated when taking this medication. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has flulike symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the white blood cell count, leaving the body defenseless against bacterial invasion.

21. 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 level. 2. The client's white blood cell count. 3. The client's red blood cell count. 4. The client's arterial blood gases.

22. 1. Atypical antipsychotics do not have any food interactions; a low-tyramine diet is prescribed for clients taking an MAO inhibitor, an antidepressant. 2. Respirations are not assessed to determine the effectiveness of the medication, nor are they used to determine when to question the medication; therefore, this is not an appropriate intervention for this medication. 3. A side effect of all types of antipsychotics is orthostatic hypotension (light-headedness, dizziness), which can be minimized by moving slowly when assuming an erect posture. 4. The client's renal system is not affected by Risperdal; therefore, it does not need to be monitored while taking this medication.

22. The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone (Risperdal), an atypical antipsychotic. Which intervention should the nurse implement? 1. Provide the client with a low tyramine diet. 2. Assess the client's respiration for 1 full minute. 3. Instruct the client to change positions slowly. 4. Monitor the client's intake and output.

23. 1. Atypical antipsychotic medications have a lower risk of sexual dysfunction than conventional antipsychotic medications; therefore, if the client experiences impotency, he should call his HCP. This statement does not indicate he understands the medication teaching. 2. Atypical antipsychotic medications do not cause photosensitivity (unlike conventional antipsychotic drugs). This statement does not indicate he understands the medication teaching. 3. Atypical antipsychotic medications do not cause gynecomastia (unlike conventional antipsychotic drugs). This statement indicates that the client does not understand the medication teaching. 4. Geodon is well tolerated, but the most common side effect is difficulty in sleeping, perhaps because of the histamine antagonist blockade effect of the drug. This comment indicates the client understands the teaching.

23. The male client diagnosed with schizophrenia is prescribed ziprasidone (Geodon), an atypical antipsychotic. Which statement to the nurse indicates the client understands the medication teaching? 1. "I need to keep taking this medication even if I become impotent." 2. "I should not go out in the sun without wearing protective clothing." 3. "This medication may cause my breast size to increase." 4. "I may have trouble sleeping when I take this medication."

24. 1. Clozaril can promote significant weight gain; therefore, the client should exercise regularly, monitor weight, and reduce caloric intake. 2. Clozaril promotes weight gain. 3. Clozaril does not cause gastrointestinal distress and can be taken with food or on an empty stomach. 4. Aspirins do not affect taking this medication. 5. Cigarette smoking may decrease the effectiveness of this medication.

24. The client diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which information should the nurse discuss with the client concerning this medication? Select all that apply. 1. Discuss the need for regular exercise. 2. Instruct the client to monitor for weight gain. 3. Tell the client to take the medication with food. 4. Explain to the client the need to stop taking aspirin. 5. Encourage the client to quit smoking cigarettes.

25. 1. Clients with schizophrenia do not have an anxiety disorder, and this medication does not help decrease anxiety. 2. Abilify affects the receptor sites for dopamine and does not increase the secretion of dopamine. 3. Like other antipsychotics, Abilify treats the positive and negative symptoms of schizophrenia—but it does so with fewer side effects than other antipsychotics. This medication does not cause significant weight gain, hypotension, or prolactin release, and it poses no risk of anticholinergic effects or dysrhythmias. 4. This medication does not block cholinergic receptors.

25. The client with paranoid schizophrenia is prescribed aripiprazole (Abilify), a dopamine system stabilizer (DDS). Which statement best describes the scientific rationale for administering this medication? 1. It decreases the anxiety associated with hallucinations and delusions. 2. It increases the dopamine secretion in the brain tissue to improve speech. 3. It reduces positive symptoms of schizophrenia and improves negative symptoms. 4. It blocks the cholinergic receptor sites in the diseased brain tissue.

26. 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. 2. Salt intake does not affect antipsychotic medication, nor does it affect schizophrenia. Therefore, the dietary intake of salt does not need to be decreased. 3. Small meals and protein do not affect antipsychotic medications, nor will they affect schizophrenia. Therefore, the client does not have to eat high-protein meals. 4. Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD) exhibited by muscle spasms and rigidity. 5. Atypical antipsychotics may increase the client's risk of developing diabetes and high cholesterol; therefore, the client's weight, glucose levels, and lipid levels should be monitored regularly.

26. Which information should the nurse discuss with the client diagnosed with schizophrenia who is prescribed an atypical antipsychotic medication? Select all that apply. 1. Drink decaffeinated coffee and tea. 2. Decrease the dietary intake of salt. 3. Eat six small, high-protein meals a day. 4. Report muscle spasms and rigidity. 5. Monitor glucose levels and lipid levels.

27. 1. The client should be responsible for taking his or her own medication and not rely on the family member to administer it. The nurse should encourage the family member not to make the client dependent on anyone. 2. There is no reason for the family member to learn CPR because antipsychotic medications do not cause death. 3. The nurse should encourage the family member to attend a support group for families of people with schizophrenia. If there are any groups available for people with schizophrenia, then the client should attend one. The nurse should encourage the family member to let the client take care of his or her own mental illness. 4. Antipsychotic medications lower the seizure 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.

27. 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 (CPR). 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.

28. 1. Tremors or rigidity indicate the client is having extrapyramidal side effects of antipsychotic medications; such activity does not indicate the medication is effective. 2. Antipsychotic medications are not prescribed for anxiety; therefore, anxiety cannot be evaluated to determine if the medication is effective. 3. Sleeping all night is a good sign for the client, but it does not determine if the medication is effective. 4. Antipsychotic medications are prescribed to decrease the signs or symptoms of schizophrenia. If the client denies auditory hallucinations, the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

28. 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 rigidity. 2. The client reports a 2 on an anxiety scale of 1-10. 3. The family reports the client is sleeping all night. 4. The client denies having auditory hallucinations.

29. 1. Rigidity and tremors are signs of extrapyramidal side effects and should be reported to the HCP. The client does not need additional teaching. 2. Haldol has anticholinergic effects, including constipation. Increasing fiber and fluid intake will help prevent constipation. This statement does not indicate that the client needs additional teaching. 3. Haldol causes agranulocytosis, which diminishes the client's ability to fight infection, but the medication (if the client does not develop the adverse effect of agranulocytosis) 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 white blood cell count is elevated, the medication will be discontinued. 4. This statement indicates the client understands why the medication is being taken; this indicates the medication teaching is effective. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has flulike symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the white blood cell count, leaving the body defenseless against bacterial invasion.

29. 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. 1. Depression 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. 2. This is a very vague statement and it is not objective; therefore, it is not the best indicator of effectiveness of the medication. 3. Completing ADLs indicates the client is not severely depressed, but it does not objectively support that the client's antidepressant medication is effective. 4. Consuming 90% of the food may indicate the client is not depressed, but the nurse does not know how the client eats when severely depressed. Therefore, it is not the best indicator of the medication's effectiveness. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

3. The client diagnosed with pneumonia is admitted to the medical unit. The nurse notes the client is taking an antidepressant medication. Which data best indicates 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.

30. 1. Menstrual irregularity is a common side effect of conventional antipsychotic medications like Thorazine and would not warrant discontinuing the medication. 2. Orthostatic hypotension is a common side effect of conventional antipsychotic medications and would not warrant discontinuing the medication. 3. Anticholinergic effects are common side effects of conventional antipsychotic medications and would not warrant discontinuing the medication. 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 continuous therapy with a conventional antipsychotic medication. The medication should be discontinued, and a benzodiazepine should be administered.

30. The 43-year-old female client diagnosed with schizophrenia has been taking the conventional antipsychotic medication chlorpromazine (Thorazine) for 20 years. Which assessment data warrants discontinuing the medication? 1. The client has had menstrual irregularities for the past year. 2. The client has to get up very slowly from a sitting position. 3. The client complains of having a dry mouth and blurred vision. 4. The client has fine, wormlike movements of the tongue.

31. 1. Xanax has the potential for dependency, but that potential can be minimized by using the lowest effective dosage for the shortest time necessary. 2. Rage, excitement, and heightened anxiety are signs of paradoxical reactions and should be reported to the HCP. The medication will be discontinued. 3. There is no contraindication to eating foods high in vitamin K and taking Xanax. 4. This medication can initially cause drowsiness, so the client should not drive automobiles or use machinery. 5. There is no reason for the client to take the medication with 8 ounces of water.

31. The client diagnosed with a general anxiety disorder is prescribed alprazolam (Xanax), a benzodiazepine. Which information should the clinic nurse discuss with the client? Select all that apply. 1. Explain to the client 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. Discuss the importance of not driving due to drowsiness. 5. Instruct the client to take the medication with at least 8 ounces of water.

32. 1. The client should inform the obstetrician of the panic attacks and the Ativan therapy, but this is not the nurse's first intervention. 2. The client must quit taking the medication because it has the potential to harm a fetus, but if the client has been on longterm therapy, the medication should be discontinued gradually to prevent withdrawal symptoms. 3. The nurse should first determine how long the client has been taking Ativan and what dosage (or how many pills) to determine if the medication can be discontinued abruptly or if it must be gradually decreased. 4. The nurse should encourage the client to stop taking the Ativan prior to getting pregnant, but the first intervention is to assess the client to determine how long she has been taking the medication. MEDICATION MEMORY JOGGER: The test taker should question administering any medication to a client who is pregnant or trying to become pregnant. Many medications cross the placental barrier and could affect the fetus.

32. The female client taking lorazepam (Ativan), a benzodiazepine, for panic attacks tells the clinic nurse that she is trying to get pregnant. Which intervention should the nurse implement first? 1. Tell the client to inform the obstetrician she is taking Ativan. 2. Instruct the client to quit taking the medication. 3. Determine how long the client has been taking the medication. 4. Encourage the client to stop taking Ativan prior to getting pregnant.

33. 1. The client's apical pulse would not be monitored prior to the nurse administering the Xanax. 2. The client's potassium level would not be monitored prior to the nurse administering the Xanax. 3. The 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. 4. The client's blood pressure would not be monitored prior to the nurse administering the Xanax.

33. 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 serum potassium level. 3. Assess the client's anxiety level. 4. Assess the client's blood pressure.

34. 1. Common side effects of SSRIs include nausea, headache, insomnia, and sexual dysfunction; if these side effects develop, the client would need to notify the HCP or he/she may stop taking the medication due to the side effect. The client does not understand the medication teaching. 2. The beneficial effects of SSRIs develop slowly, taking several months to become maximal when used to treat obsessive-compulsive disorder. The client understands this. 3. SSRIs are antidepressants used to treat obsessive-compulsive disorder. They do not have addictive properties. The client does not understand the medication teaching. 4. The client should continue to go to a counselor or psychologist to determine the cause of the anxiety so that the client can eventually discontinue the SSRI. The client does not understand the medication teaching.

34. 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 experience sexual dysfunction, I will not 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."

35. 1. This is not an accurate statement. Initial responses can be seen within 2 weeks but may take up to 2-3 months for maximal response. 2. The nurse should not ask the client "why." It is a confrontational question and does not answer the client's question. 3. The client should continue with cognitive therapy, but this is a very negative statement and is not the nurse's best response. 4. 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.

35. 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."

36. 1. This is an appropriate medication for an anxiety attack, but it will take at least 15-30 minutes for the medication to treat the physiological signs or symptoms. 2. The client is in distress. The nurse should not assess the client; the nurse needs to help the client. 3. This is the most appropriate intervention; the nurse should remove the client from the busy day room to help decrease the anxiety attack. 4. SSRIs can be used to treat panic attacks, but the medication takes weeks to work; therefore, it would not be helpful in an acute panic attack. MEDICATION MEMORY JOGGER: Remember that when a client is in distress, medication usually takes too long to work to immediately help the client. The nurse should always treat the client directly.

36. 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 intervention 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).

37. 1. Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypotension, which is a common side effect of antianxiety medications and is not a reason to quit taking the medication. 2. Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypotension, which is a common side effect of antianxiety medications and is not a reason for the client to come to the clinic. 3. Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypotension, which is a common side effect of antianxiety medications, and fluid intake would not affect the client's behavior. 4. Feeling dizzy and weak when getting out of a chair is indicative of orthostatic hypotension, which is a common side effect of antianxiety medications. The nurse should instruct the client to rise slowly from the sitting to standing position to avoid dizziness.

37. The client with an anxiety disorder is prescribed the anxiolytic alprazolam (Xanax). The client calls the clinic and reports a dizzy, weak feeling when getting out of the chair. Which intervention should the nurse implement? 1. Instruct the client to quit taking the medication. 2. Make an appointment for the client to come to the clinic. 3. Determine if the client is drinking enough fluids. 4. Discuss ways to prevent orthostatic hypotension.

38. 1. The first intervention in a case of Xanax overdose is to encourage vomiting—to remove the medication from the stomach before the medication is metabolized and absorbed into the system. Administering an emetic with activated charcoal would induce vomiting. 2. This is an appropriate intervention, but it is not the nurse's first intervention. 3. The antidote is usually not administered if the client is conscious; therefore, this is not the first intervention. 4. This is an appropriate intervention, but it is not the nurse's first intervention.

38. The conscious client was admitted to the emergency department with an overdose of the anxiolytic alprazolam (Xanax). Which intervention should the nurse implement first? 1. Prepare to administer an emetic with activated charcoal. 2. Request a mental health consultation for the client. 3. Prepare to administer the antidote flumazenil (Romazicon) IV. 4. Determine why the client chose to overdose on the medication.

39. 1. This is subjective and does not best indicate the medication's effectiveness. 2. The pulse rate is elevated in an acute anxiety attack, but pulse rate is not the best assessment data to indicate if the medication is effective. 3. The client hyperventilates in an acute anxiety attack; respiratory rate is not the best assessment data to indicate the medication is effective. 4. The best indicator of the medication's effectiveness is the client's objective report of his or her anxiety level.

39. The client is receiving the anxiolytic alprazolam (Xanax) for a generalized anxiety disorder. Which assessment data best indicates the medication is effective? 1. The client reports not feeling anxious. 2. The client's pulse is not greater than 100. 3. The client's respiratory rate is not greater than 22. 4. The client reports a 1 on a 1-10 anxiety scale.

4. 1. The client should use herbs cautiously because ginseng causes headaches, tremors, mania, insomnia, irritability, and visual hallucinations. 2. The client should refrain from drinking too many beverages containing caffeine. 3. Eating three balanced meals a day is not information that the nurse would teach about MAO inhibitors. 4. Taking MAO inhibitors 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. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.

4. 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."

40. 1. Valium is oil based and should not be diluted with normal saline. 2. The nurse should administer the Valium undiluted over 2-3 minutes in the IV port closest to the client's hand so the medication can get to the client's bloodstream faster. 3. The Valium should be administered as an IVP, not as an IV piggyback. 4. Valium can be administered safely via the intravenous route and is recommended for acute, severe anxiety attacks because it will be effective within 1-5 minutes.

40. The client is having a CT scan and starts having a severe anxiety attack. The HCP prescribed the anxiolytic diazepam (Valium), intravenous push. Which intervention should the nurse implement? 1. Dilute the Valium with normal saline and administer IVP. 2. Do not dilute the Valium and inject in a port closest to the client. 3. Inject the Valium into a 50-mL normal saline bag and infuse. 4. Question the order because Valium should not be administered IV.

41. 1. Weight gain would not warrant intervention; weight loss would be of concern to the nurse. 2. These vital signs are within normal limits for a10-year-old child. 3. The nurse should further investigate the cause of the bruises because this could be an adverse effect of the medication caused by leukopenia, anemia, or both; it could also be the result of child abuse. Either way, it warrants intervention by the nurse. 4. Sitting quietly in the examination room would indicate the medication is effective and would not warrant intervention by the nurse. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

41. The 10-year-old child diagnosed with attention deficit-hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin), a central nervous stimulant. Which assessment data warrants intervention from the pediatric clinic nurse? 1. The child has gained 3 kg in the last month. 2. The child's pulse is 98 and B/P is 100/70. 3. The child has multiple bruises on the arm. 4. The child sits quietly in the examination room.

42. 1. The medication should be taken with food to help decrease gastrointestinal upset and counteract anorexia. 2. The child's weight should be taken weekly and any significant weight loss should be reported. 3. The medication should be administered in the morning, and the last medication should be given no later than 1600 so that the child can sleep. This medication is a central nervous stimulant. 4. A behavior diary should be kept to chronicle symptoms and response to drug therapy. This diary should be brought to all follow-up visits with the health-care provider. 5. The medication is not affected by sunlight; therefore, this is not correct information.

42. The 7-year-old child newly diagnosed with attention deficit-hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which information should the nurse discuss with the parents? Select all that apply. 1. Take the medication with food. 2. Weigh your child weekly in the morning. 3. Administer the medication at night. 4. Keep a behavior diary on your child. 5. Protect the child from direct sunlight.

43. 1. Ritalin does not affect the glucose level; therefore, the nurse would not need to check this level. 2. The medication should be administered with food to decrease gastrointestinal upset, but it does not need to be given with a full glass of water. 3. Stimulation of the central nervous system induces the release of catecholamines with a subsequent increase in heart rate and blood pressure. Therefore, the nurse should assess the child's vital signs. 4. The nurse should assess the child's surgical wound, but it is not pertinent when administering Ritalin. The nurse must administer the Ritalin no matter what the wound looks like.

43. The 6-year-old child with attention deficit-hyperactivity disorder (ADHD) is admitted to the pediatric department after having an emergency appendectomy. Which intervention should the nurse implement when administering methylphenidate (Ritalin), a central nervous stimulant to the child? 1. Check the child's glucose level. 2. Administer with a full glass of water. 3. Monitor the child's vital signs. 4. Assess the child's incisional wound.

44. 1. Most schools have a "zero drug tolerance" policy and do not allow students to carry personal medication. The adolescent must keep the medication in the original prescription container. This statement indicates the student does not understand the medication teaching. 2. Ritalin has a high abuse potential and is often sold illegally on the street. This is the reason this medication is not allowed to be carried by students in the school. This statement indicates the adolescent understands the medication teaching—specifically, that the medication will be kept by the school nurse. 3. Ritalin must be taken daily, usually twice a day. It is not a PRN medication. The student does not understand the medication teaching. 4. The adolescent should not be giving prescription medication to another child. This statement does not support that the adolescent understands the medication teaching.

44. The 14-year-old adolescent with attention deficit-hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin), a central nervous stimulant. Which statement indicates to the nurse that the adolescent understands the medication teaching? 1. "I can carry my medication in a personal pill container with me at school." 2. "I hate that I have to go to the school nurse to take my medication." 3. "I just take my medication on days that I have important tests." 4. "A friend of mine has ADHD and I gave him one of my pills."

45. 1. This is a false statement. There are other medications that can be taken for ADHD. 2. The word "why" is considered argumentative, and the nurse should try to provide information to the mother. 3. Atomoxetine (Strattera) is a medication that has the same efficacy as Ritalin and is not a scheduled drug. Parents who are hesitant to administer stimulants to their child now have a reasonable alternative. The nurse should provide factual information. 4. The nurse can discuss medications with the mother. The mother would have to obtain a prescription for the medication, but the school nurse must be knowledgeable about medications.

45. The mother of a male child with attention deficit-hyperactivity disorder (ADHD) tells the school nurse she does not want her son to take Ritalin and wants to know if there is any other medication her son could take. Which statement is the nurse's best response? 1. "There are no other medications that work as well as Ritalin." 2. "Why are you worried about your child taking Ritalin?" 3. "There is a nonstimulant medication called Strattera that your child could take." 4. "I think that is something you should discuss with your child's doctor."

46. 1. Growth rate may stall in response to nutritional deficiency caused by anorexia. A 4-pound weight loss in 2 weeks is cause for investigation. The child needs to be seen by the HCP. 2. The medication should not be discontinued abruptly because rebound hyperactivity or withdrawal symptoms can occur. 3. This is not a normal response to Ritalin and the child should be seen by the HCP. 4. This may need to be done, but the child needs to see the HCP to determine why the child has lost 4 pounds in 2 weeks. This is not normal for a 7-year-old child.

46. The mother of a 7-year-old child taking methylphenidate (Ritalin), a central nervous stimulant, for attention deficit-hyperactivity disorder (ADHD) calls the pediatric clinic and tells the nurse her daughter has lost 4 pounds in the past 2 weeks. Which action should the nurse implement? 1. Make an appointment for the child to see the HCP. 2. Instruct the mother to discontinue the Ritalin. 3. Explain that this is normal response to the medication. 4. Tell the mother to increase the child's caloric intake.

47. 1. Inappropriate behavior at school would not indicate the child's medication is effective. 2. Ritalin is not administered to help the child sleep all the time; therefore, this medication is not effective and the child is receiving too much medication. 3. The child's ability to focus on a specific activity indicates the medication is effective. Inability to focus on one task at a time and jumping from one activity to another are signs of ADHD. 4. Difficulty in following verbal instruction is a symptom of ADHD; this indicates the medication is not effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

47. Which assessment data indicates the central nervous stimulant methylphenidate (Ritalin) has been effective for the 8-year-old child diagnosed with attention deficit-hyperactivity disorder (ADHD)? 1. The child has two notes from the school for inappropriate behavior in 1 week. 2. The child sleeps 8 hours a night and falls asleep during the day. 3. The child is able to sit and play a game for 30 minutes with a friend. 4. The child has difficulty following verbal instructions from the teacher.

48. 1. All medication must be kept in a safe place to prevent accidental poisoning of children. 2. Drug holidays may decrease the reduction in growth rate that is associated with this medication. The medication teaching has been effective. 3. Growth rate may be stalled in response to nutritional deficiency caused by anorexia, which often occurs when Ritalin is taken. 4. Insomnia is an adverse reaction to the medication; central nervous stimulants may disrupt normal sleep patterns. This statement indicates the medication teaching has not been effective.

48. The 8-year-old child newly diagnosed with attention deficit-hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which statement by the mother indicates the medication teaching has not been effective? 1. "I will keep the medication in a safe place." 2. "I will schedule regular drug holidays for my child." 3. "It may cause my child to have growth restriction." 4. "My child will probably experience insomnia."

49. 1. Ritalin is metabolized in the liver and excreted by the kidneys. Impaired organ function can increase serum drug levels. The medication may cause leukopenia, anemia, or both. The HCP would order a CBC, differential, and platelet count. 2. Potassium and sodium levels are not monitored for methylphenidate (Ritalin). 3. The growth rate may stall as a result of nutritional deficiency caused by anorexia, but the child's bone density is not affected; therefore, this diagnostic test is not monitored. 4. There is no serum drug level for methylphenidate (Ritalin). MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored while a client is taking long-term medication.

49. Which diagnostic test should the nurse expect the HCP to monitor for the child diagnosed with attention deficit-hyperactivity disorder (ADHD) who is prescribed methylphenidate (Ritalin), a central nervous stimulant? 1. Complete blood cell count (CBC). 2. Serum potassium and sodium levels. 3. An annual bone density test. 4. Serum methylphenidate level.

5. 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 client's energy level increases, making the client more prone to commit suicide during this time. It takes 2-6 weeks for therapeutic effects of tricyclic antidepressants to be effective. 2. As the depression gets better, the client will start sleeping better, which indicates the medication is effective, but this is not a priority intervention because the client is suicidal. 3. The family is an excellent resource to determine how the client is tolerating the medication and if it is effective, but the nurse should ask the client directly, not the family members, if he or she has thoughts of suicide. 4. If the client seriously wants to commit suicide, usually the client will not show objective signs of wanting to kill themselves. The nurse must directly ask the client if he or she has a plan to commit suicide.

5. 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.

50. 1. The epiphyseal plate of the bone determines if a person has completed growing, but this would not be assessed in an 8-year-old child. The epiphyseal plate is a thin layer of cartilage between the epiphysis, a secondary bone-forming center, and the bone shaft. 2. The child's baseline height and weight must be obtained because reduction in growth rate is associated with this medication. 3. The HCP would not order an EKG on an 8-year-old child. This medication does not affect the electrical conductivity of the heart. 4. The head circumference would not be measured on an 8-year-old child because the fontanels close at around 2 years old.

50. The 8-year-old child is newly diagnosed with attention deficit-hyperactivity disorder (ADHD) and is prescribed methylphenidate (Ritalin), a central nervous stimulant. Which assessment data should the nurse anticipate the HCP obtaining prior to the child starting the medication? 1. An x-ray of the epiphyseal plate. 2. The child's height and weight. 3. An electrocardiogram (EKG). 4. The child's head circumference.

51. 1. Valium can depress respirations, but this client has already been taking the medication. 2. Valium is administered to clients during a seizure to treat a seizure, but this client has informed the nurse that it is being taken for sleep. 3. The client has already told the nurse that the Valium is used to induce sleep. 4. Benzodiazepines should be tapered off when the client is trying to stop taking them. The nurse should request an order for the Valium.

51. The male client diagnosed with chronic obstructive pulmonary disease (COPD) is admitted to the medical unit. During the admission process the client tells the nurse that he cannot sleep without Valium, a benzodiazepine, every night. Which intervention should the nurse implement? 1. Inform the client that clients with COPD should not take Valium. 2. Ask the client when he last had any seizure activity. 3. Determine what effect the Valium has on the client when he takes it. 4. Ask the health-care provider for an order for Valium.

52. 1. The client is having abdominal surgery so the client will be NPO for a while. Xanax is only manufactured as an oral medication. Therefore, the client will need a similar medication postoperatively. The nurse should discuss this with the HCP. 2. The client will be NPO after a major abdominal surgery; Xanax only comes in an oral preparation. 3. If the client is going to stop taking Xanax, it should be tapered, but the stem does not indicate a need to discontinue the medication. 4. The Xanax is being taken PRN, not just for sleep but also for anxiety.

52. The elderly client being prepared for major abdominal surgery has been taking alprazolam (Xanax), a benzodiazepine, PRN, for many years for nerves. Which information should the nurse discuss with the HCP? 1. Discuss prescribing another benzodiazepine medication postoperatively. 2. Make sure that the alprazolam (Xanax) is ordered after surgery. 3. Taper the medication to prevent complications. 4. Change the alprazolam (Xanax) to a medication for sleep.

53. 1. ACE inhibitors are administered to treat hypertension or for prophylaxis in clients diagnosed with diabetes and would not interfere with a sleep study. 2. Antihistamines such as diphenhydramine (Benadryl) can cause drowsiness in many clients; the client should not take any medication that would interfere with the test being interpreted correctly. 3. Loop diuretics are administered early in the day to prevent nocturia, and the effects should have worn off before the sleep study begins. Sleep studies are conducted during the night. 4. Normal routine doses of thyroid medication would not interfere with a sleep study.

53. The client diagnosed with insomnia is scheduled for sleep studies. Which medication should the nurse instruct the client not to take? 1. The ACE inhibitor captopril. 2. The antihistamine diphenhydramine. 3. The loop diuretic furosemide. 4. The thyroid medication levothyroxine.

54. 1. The client should be instructed not to attempt to get pregnant while receiving chemotherapy or taking Ativan. Ativan is a pregnancy category D drug. Ativan is very useful in controlling chemotherapy-induced nausea and vomiting, so the HCP is attempting to achieve a dual use for the medication— improved sleep and relief of chemotherapy-induced nausea. 2. Ativan can interact with alcohol, increasing central nervous system depression. The client should not consume alcohol at all. 3. Exercise immediately before bedtime can increase the client's inability to sleep. Exercising a few hours prior to bedtime is suggested. 4. Clients taking benzodiazepines may become dependent on the medications, but they do not become addicted to them. The medications are tapered off if they are being discontinued.

54. The health-care provider has prescribed lorazepam (Ativan), a benzodiazepine, for a female client receiving chemotherapy who complains of inability to sleep. Which information should the nurse teach the client? 1. Do not attempt to become pregnant while taking Ativan. 2. Avoid consuming too much alcohol while taking Ativan. 3. Exercise prior to going to bed to help sleep restfully. 4. Do not take the medication too long to avoid addiction.

55. 1. This situation requires further evaluation by the nurse before notifying the HCP. 2. Safety is a priority. The client received a sedative medication and an anti-nausea medication within the past 10 hours. Elderly clients frequently require longer periods of time to clear medications from their systems. 3. The client is not in a code situation. The client is lethargic, probably from the medications. 4. The nurse should re-evaluate the client in 30-60 minutes, but safety in the meantime is the first intervention.

55. The day shift nurse finds an elderly client difficult to arouse during the initial morning shift assessment. The nurse reviews the client's medication record for the last 24 hours. Which intervention should the nurse implement first? 1. Notify the health-care provider of the client's current status. 2. Make sure the client has a call light within reach. 3. Call a code and initiate cardiopulmonary resuscitation. 4. Reassess the client's neurological status in 1 hour.

56. 1. There is only one reason to take Synthroid— thyroid replacement. The nurse should know this. 2. There is no indication that the client is vomiting. Prilosec is frequently taken for gastroesophageal reflux disease (GERD). 3. The blood pressure before beginning Capoten is not important. The current blood pressure and the amount of control the client achieves while taking Capoten are important. 4. Melatonin is an over-the-counter hormone that many people take to prevent jet lag or induce sleep.

56. The client John D. being admitted to the medical unit gives the nurse a list of medications being taken at home. Which question should the nurse ask the client? 1. "Why do you take the Synthroid?" 2. "Does your emesis have red or dark-brown flecks in it?" 3. "What was your blood pressure before starting taking Capoten?" 4. "Do you have difficulty sleeping at night?"

57. 1. Ritalin is a stimulant and should be taken early in the day to prevent insomnia at night. 2. Taking the medication at bedtime would prevent the client from sleeping. 3. Most clients do not have a locked cabinet in their home. The medication should be kept out of the reach of children, as should all medications. 4. This is an expected side effect of Ritalin; the client does not need to notify the HCP.

57. The client diagnosed with narcolepsy is prescribed methylphenidate (Ritalin), an amphetamine. Which information should the nurse teach the client? 1. Take the medication early in the day. 2. The medication should be taken at bedtime. 3. Keep the medication in a locked cabinet. 4. Notify the HCP if there is a decrease in appetite.

58. 1. Caffeine may help the client to achieve some measure of alertness, whereas products containing diphenhydramine can increase the client's problem because this medication is used in over-the-counter sleep aids. The client should be taught about both. 2. Flavored water will not have any effect on the narcolepsy, and beta carotene is a precursor to vitamin A and is often taken to treat degenerative eye diseases. 3. Milk with vitamin D is useful for clients with osteoporosis, and saw palmetto is used to treat benign prostatic hypertrophy. The question does not state that the client has either of these conditions. 4. Carbonated drinks should be avoided by clients who have gastroesophageal reflux disease, and black cohosh is used for menstrual irregularities and menopausal symptoms and as an antispasmodic. The question does not state that the client has either of these problems.

58. The male client is diagnosed with narcolepsy. Which over-the-counter preparations should the nurse teach the client about? 1. Caffeinated beverages and diphenhydramine (Benadryl). 2. Flavored water and beta carotene. 3. Milk with added vitamin D and saw palmetto. 4. Carbonated sodas and black cohosh.

59. 1. A mild sedative would increase the child's inability to awaken during the night if needed. There is no medication that is useful to treat sleepwalking. 2. This is a safety measure to keep the child from exiting the house during the night. 3. It is difficult to arouse a sleepwalker. The child should be guided back to the bed and allowed to remain asleep. 4. Guided imagery will not stop sleepwalking. 5. Strattera is administered for attention deficit-hyperactivity disorder (ADHD), not for sleepwalking. MEDICATION MEMORY JOGGER: In a "select all that apply" question, only one option may be correct, a few options may be correct, or all options may be correct.

59. The 10-year-old client has begun to sleepwalk, a parasomnia disorder. Which information should the nurse provide the parents of the child? Select all that apply. 1. Give the child a mild sedative 2 hours before bedtime. 2. Place a lock on the outer door out of the child's reach. 3. Make the child wake up when an episode occurs. 4. Have the child practice guided imagery before bedtime. 5. Administer atomoxetine (Strattera) every morning.

66. 1. The client must want to quit drinking alcohol. Nothing in the question indicates this, so it would not be appropriate to prescribe disulfiram for this client. 2. Disulfiram is only effective in highly motivated clients because the success of pharmacotherapy is entirely dependent on client compliance. This client is highly motivated to quit drinking alcohol. 3. Disulfiram inhibits acetaldehyde dehydrogenase, the enzyme that metabolizes alcohol; it is not used for amphetamine abuse. 4. Disulfiram inhibits acetaldehyde dehydrogenase, the enzyme that metabolizes alcohol; it is not used for heroin abuse.

66. Which client would it be most appropriate to prescribe disulfiram (Antabuse), an abstinence medication? 1. A client with chronic alcoholism admitted to the medical unit. 2. A highly motivated client who wants to quit drinking alcohol. 3. A client who has been taking amphetamines for more than 1 year. 4. A highly motivated client who wants to quit taking heroin.

6. 1. The nurse should discuss what behavior led to the client being prescribed antidepressants and determine if the client is still depressed, but the most important thing to discuss with the client is that the antidepressant medication should not be discontinued abruptly. 2. The nurse should discuss why the client wants to stop taking the medication, but the most important intervention is to teach the client that the medication must be tapered. The client could quit taking medication without telling an HCP; therefore, teaching safety is priority. 3. The client should notify the HCP before stopping the medication, but the most important intervention is to keep the client safe and inform the client to taper off the medication. 4. The 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 should be taken because the client doesn't want to take the medication.

6. The client with major depressive disorder has been taking amitriptyline (Elavil), a tricyclic antidepressant, for more than 1 year tells the psychiatric clinic nurse the client wants to quit taking the antidepressant. Which intervention is most important for the nurse to discuss with the client? 1. Ask questions to determine if the client is still depressed. 2. Ask the client why he or she wants to stop taking the medication. 3. Tell the client to notify the HCP before stopping medication. 4. Explain the importance of tapering off the medication.

60. 1. This is a situation in which caffeine will not be enough to allow the client to remain awake. NoDoz contains caffeine. 2. An inhaled steroid will not help the client to sleep at night. The client may be placed on a breathing treatment during the night to maintain respirations. 3. A central nervous system stimulant would be ordered to prevent somnolence. 4. Elavil can cause drowsiness and should not be administered to a client with a problem of falling asleep at inopportune times.

60. The client has pickwickian syndrome and falls asleep at inappropriate times. Which medication should the nurse prepare to administer? 1. Maximum Strength NoDoz, a caffeine drug. 2. An inhaled steroid in a bi-pap machine for night-time sleep. 3. Modafinil (Provigil), a central nervous system stimulant. 4. Amitriptyline (Elavil), a tricyclic antidepressant.

61. 1. Librium diminishes anxiety and has anticonvulsant qualities to provide safe withdrawal from alcohol. It may be ordered every 4 hours or PRN to manage adverse effects from withdrawal, after which the dose is tapered to zero. 2. Thiamine is a vitamin prescribed for clients with chronic alcoholism; it is prescribed to prevent Wernicke's encephalopathy, not to prevent delirium tremens. 3. Antabuse is used when a client wishes to quit drinking alcohol. It prevents the breakdown of alcohol and causes the client to vomit when alcohol is consumed. 4. Antidepressants are not used to prevent delirium tremens. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

61. The client who is a chronic alcoholic is admitted to the medical unit for pneumonia. Which medication should the nurse expect the health-care provider to prescribe to prevent delirium tremens? 1. Chlordiazepoxide (Librium), a benzodiazepine. 2. Thiamine (vitamin B1), a vitamin. 3. Disulfiram (Antabuse), an abstinence medication. 4. Fluoxetine (Prozac), an antidepressant.

62. 1. Methadone would not help a client addicted to cocaine. 2. Methadone blocks the craving for heroin. 3. Methadone would not help a client addicted to amphetamines. 4. Methadone would not help a client addicted to hallucinogens, such as lysergic acid diethylamide (LSD).

62. Which client should the nurse expect the health-care provider to prescribe methadone, an abstinence medication? 1. A client addicted to cocaine. 2. A client addicted to heroin. 3. A client addicted to amphetamines. 4. A client addicted to hallucinogens.

63. 1. A smoking cessation support group may be helpful, but nicotine withdrawal is a physical withdrawal, and medication should be used to help with the withdrawal symptoms. 2. Tapering the number of cigarettes daily is not the most successful method to quit smoking cigarettes. 3. Using a nicotine patch or chewing nicotine gum is the most successful way to help with the nicotine withdrawal symptoms. 4. Clonidine is used to help prevent delirium tremens in a client with alcohol dependence.

63. The client is discussing wanting to quit smoking cigarettes with the clinic nurse. Which intervention is most successful in helping the client to quit smoking cigarettes? 1. Encourage the client to attend a smoking cessation support group. 2. Discuss tapering the number of cigarettes smoked daily. 3. Instruct the client to use nicotine replacement therapy, such as a patch. 4. Explain that clonidine can be taken daily to help decrease withdrawal symptoms.

64. 1. Methadone causes gastrointestinal distress, which can be minimized by taking the medication with food. 2. Methadone causes constipation; therefore, the client should increase fiber intake to help prevent constipation. 3. Methadone does not affect the pulse; therefore, the pulse does not need to be monitored before taking the medication. 4. Methadone causes drowsiness, lightheadedness, dizziness, and a transient drop in blood pressure. Therefore, the nurse should discuss how to prevent orthostatic hypotension. Methadone is used to treat heroin withdrawal.

64. The client is prescribed methadone, an opiate agonist. Which intervention should the nurse discuss with the client? 1. Take the medication on an empty stomach. 2. Decrease the fiber in the diet while taking the medication. 3. Do not take methadone if the radial pulse is less than 60. 4. Learn how to prevent orthostatic hypotension.

65. 1. Nausea, vomiting, and agitation, along with tachycardia, diaphoresis, tremors, and marked insomnia, are adverse effects of central nervous system depressants, such as benzodiazepines. 2. Yawning, rhinorrhea, and cramps are signs of withdrawal from opiates, such as heroin, meperidine, morphine, and methadone. 3. Disorientation, lethargy, and craving are signs of withdrawal from a stimulant, such as crack cocaine and amphetamines. 4. Ataxia, hyperpyrexia, and respiratory distress are signs of an overdose of a stimulant, such as crack cocaine and amphetamines.

65. The client has been taking alprazolam (Xanax), a benzodiazepine, daily for the past 2 years. Which signs or symptoms would warrant intervention by the nurse? 1. Nausea, vomiting, and agitation. 2. Yawning, rhinorrhea, and cramps. 3. Disorientation, lethargy, and craving. 4. Ataxia, hyperpyrexia, and respiratory distress.

67. 1. The fact that the client has not had any food in 3 days may be a cause for the headache, but the nurse does not need to ask the client the last time he or she had any food because the nurse is aware of this information. The type of diet the client ate prior to being NPO for 3 days would not be an appropriate question in determining the cause of the client's headache. 2. Alcohol withdrawal does not cause a headache. 3. Taking sleeping pills regularly would not cause a headache. 4. A hallmark symptom of caffeine withdrawal is a headache, along with fatigue, depression, and impaired performance of daily activities. This question would be most appropriate for the nurse to ask the client.

67. A client in the medical unit has been NPO for 3 days and is complaining of a headache. Which question should the nurse ask the client in regard to determining the reason for the headache? 1. "Do you eat a diet high in glucose?" 2. "How often do you drink alcohol?" 3. "Do you take sleeping pills regularly?" 4. "How often do you drink caffeinated beverages?"

68. 1. The nurse should implement seizure precautions, but it is not the first intervention. 2. Immediately on arrival to a hospital the client should be rehydrated with large amounts of intravenous physiologic fluids. This is the first intervention. 3. After treating delirium tremens, it is essential the client undergo a course of withdrawal treatment in a therapeutic milieu, but it is not the first intervention in the emergency department. 4. Malnutrition is a serious complication of chronic alcoholism, especially thiamine deficiency, which can result in neurologic impairments; therefore, thiamine must be administered intravenously. This is not the first intervention.

68. The male client with chronic alcoholism comes to the emergency department (ED) reporting he has not had an alcoholic drink in more than 1 week. Which intervention should the ED nurse implement first? 1. Implement seizure precautions according to hospital policy. 2. Rehydrate the client with large amounts of intravenous fluids. 3. Discuss withdrawal treatment in a hospital environment. 4. Administer thiamine (vitamin B1) through an intravenous route.

69. 1. The nurse would not suspect alcohol overdose with these signs or symptoms. 2. The nurse would not suspect amphetamine overdose with these signs or symptoms. 3. The nurse would not suspect the client inhaling paint thinner with these signs or symptoms. 4. Respiratory distress, ataxia, hyperpyrexia, convulsions, coma, or stroke are signs and symptoms of cocaine overdose. This question would be most appropriate for the nurse to ask based on the client's signs and symptoms.

69. The client with a staggering gait is brought to the emergency department by a friend. The client is short of breath and has an oral temperature of 104°F. Which question should the nurse ask the client's friend? 1. "How many alcoholic drinks has your friend had today?" 2. "When was the last time your friend took amphetamines?" 3. "Has your friend been inhaling any type of paint thinner?" 4. "Through which route and at what time did your friend take cocaine?"

7. 1. This medication does not need to be taken in the morning to be more effective. 2. 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. 3. Antidepressants do not need to be taken with food because they do not cause gastrointestinal distress. 4. The nurse can provide factual information to the client without contacting the HCP. Taking antidepressants at night is not contraindicated; therefore, the nurse can share this information with the client.

7. The client with major depressive disorder is prescribed duloxetine (Cymbalta), an atypical antidepressant. The client tells the nurse, "I am going to take my medication at night instead of in the morning." Which statement is 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?"

70. 1. Marijuana is psychologically addicting, not physically addicting. There is no medication that can help the client to quit smoking marijuana. 2. Nicotine replacement therapy is used in clients who are trying to quit smoking cigarettes, not marijuana. 3. Antianxiety medications are not used to treat clients who want to quit smoking marijuana. 4. Marinol is a synthetic derivative of tetrahydrocannabinol (THC), the principal constituent of marijuana. It is prescribed to clients receiving chemotherapy to help treat nausea and vomiting.

70. Which pharmacologic intervention should the nurse discuss with the client who is requesting help to quit smoking marijuana? 1. Explain that there is no specific pharmacologic intervention. 2. Instruct the client to use a nicotine patch or chew nicotine gum. 3. Encourage the client to have the HCP prescribe an antianxiety medication. 4. Discuss tapering dronabinol (Marinol) over a 2-week period.

71. 1. Antipsychotic drugs produce varying degrees of muscarinic cholinergic blockade, including dry mouth, blurred vision, and photophobia. Chewing sugarless gum may help dry mouth. 2. Antipsychotic medications promote orthostatic hypotension by blocking alpha-adrenergic receptors on blood vessels. Therefore, the nurse should teach the client about orthostatic hypotension. 3. The sedative effects of the antipsychotic medications should have subsided by the time the client is discharged. Therefore, this is not an appropriate teaching for discharge. Sedation is common during the early days of treatment, but it subsides within a week or so. 4. Antipsychotics can cause sexual dysfunction in women and men, so this should be discussed by the nurse. 5. Flulike symptoms are a sign of agranulocytosis, which is a rare but serious reaction to antipsychotic medications. In agranulocytosis, the body loses its ability to fight infection.

71. The nurse is leading a medication group in a psychiatric unit. Which information should the nurse discuss with the clients concerning antipsychotic medications after discharge? Select all that apply. 1. Chew sugarless gum to help dry mouth. 2. Teach the client about orthostatic hypotension. 3. Explain that the medication may cause drowsiness. 4. Discuss that these medications may cause sexual dysfunction. 5. Instruct the client to call the HCP if flulike symptoms occur.

72. 1. The client eating 90% of the meal does not indicate the client has gained weight. 2. The medication is effective if the client gains weight, and 2.2 pounds is an excellent weight gain for a client with anorexia. 3. The antihistamine would be effective if the client had no signs of hay fever, but this is not why this medication is being administered. 4. The client can say anything, but weight gain indicates the medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

72. The female client diagnosed with anorexia nervosa is in the inpatient psychiatric unit receiving amitriptyline (Elavil), an antidepressant, and cyproheptadine (Periactin), an antihistamine. Which data suggests the medications are effective? 1. The client eats at least 90% of the meal. 2. The client has a weight gain of 1 kg. 3. The client has no symptoms of hay fever. 4. The client states she will eat all her meals.

73. 1. The Asian culture does not acknowledge mental illness as a problem, and the client may not believe in taking antidepressant medications. The Asian male may see taking medications as a weakness; therefore, the nurse must determine if the client will take the medications. 2. Clients who have difficulty in procuring medications will usually inform the nurse. It is not a question the nurse should ask. Culturally speaking, an Asian male may find this question offensive. 3. Aged cheese and wine contain tyramine, which should be avoided when taking an MAO inhibitor, not an SSRI. 4. Some beta blockers may interact with an SSRI, but ACE inhibitors do not.

73. The Asian male client is prescribed fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI), for clinical depression after the death of his wife. Which question should the nurse ask the client when discussing this medication? 1. "How do you feel about taking this medication?" 2. "Do you have insurance to pay for the medications?" 3. "Does your diet include a lot of aged cheese and wine?" 4. "Are you currently taking any ACE inhibitors?"

74. 1. Sleeping most of the day does not indicate the medication is effective; this may indicate the client is very depressed or is taking too much medication. 2. Weight loss or gain may indicate the client is depressed. 3. Verbalizing remorse does not indicate the medication is effective. 4. Setting new goals and priorities such as getting a job indicates the client may no longer be depressed and the medication is effective.

74. The clinic nurse is assessing a client 3 weeks after a suicide attempt. The client was prescribed sertraline (Zoloft), an SSRI. Which behavior indicates the medication is effective? 1. The client sleeps 14-16 hours a day. 2. The client has lost 3 pounds. 3. The client regrets the suicide attempt. 4. The client has started a new job.

75. 1. Clients taking this medication must not eat foods high in tyramine because it causes a life-threatening complication. This statement does not warrant intervention. 2. Dextromethorphan (Robitussin) interacts with MAOIs to produce hypertension, fever, and coma. This statement warrants intervention. 3. Tylenol does not interact with MAOIs; therefore, this statement does not warrant intervention. 4. Caffeine should be limited when taking MAOIs, but it may be consumed in moderation. This statement does not warrant intervention. MEDICATION MEMORY JOGGER: Some classes of medications are notorious for adverse reactions, and MAO inhibitors, which are prescribed rarely for depression, are among the worst.

75. The client diagnosed with panic disorder is taking a phenelzine (Nardil), an MAO inhibitor. Which statement by the client warrants immediate intervention? 1. "I am very careful about what I eat." 2. "I have been taking Robitussin for my cough." 3. "I took two Tylenol for my headache." 4. "I only drink one cup of coffee a day."

76. 1. This client is stable and has a diagnosis of panic attack; administering Xanax would be an appropriate task to assign to an LCP. 2. Tardive dyskinesia is a life-threatening complication of antipsychotic medication, and the nurse should not delegate care of a client who is unstable. 3. This lithium level is toxic, and the client should not receive any lithium. 4. The client should receive intravenous, not oral, thiamine medication. The client is not stable and the nurse should not delegate this medication administration.

76. Which task is most appropriate for the nurse to assign to the licensed practical nurse (LPN) working in the psychiatric department? 1. Administer alprazolam (Xanax), a benzodiazepine, to a client diagnosed with a panic disorder. 2. Administer haloperidol (Haldol), an antipsychotic, to a client experiencing tardive dyskinesia. 3. Administer lithium (Lithobid) to a client diagnosed with bipolar disease who has a lithium level of 2.0 mEq/L. 4. Administer oral thiamine (B1), a vitamin, to a client diagnosed with chronic alcoholism who is experiencing delirium tremens.

77. 1. This is the scientific rationale for administering donepezil (Aricept) to a client with Alzheimer's disease. 2. This is the scientific rationale for administering lithium to a client with bipolar disorder. 3. Strattera is prescribed for ADHD because it is not a CNS stimulant or controlled substance. It acts to increase norepinephrine and regulate impulse control, organizes thoughts, and focuses attention. It does not decrease appetite, and the child does not need to take drug holidays. 4. This is the scientific rationale for administering methylphenidate (Ritalin) to children with ADHD.

77. Which statement is the scientific rationale for prescribing atomoxetine (Strattera), a norepinephrine reuptake inhibitor, for a child diagnosed with attention deficit- hyperactivity disorder (ADHD)? 1. It increases acetylcholine levels and the brain's cholinergic function. 2. This medication normalizes the reuptake of certain neurotransmitters. 3. This medication is a nonstimulant, nonnarcotic that regulates impulse control. 4. It results in mild central nervous stimulation to control the child's behavior.

78. 1. The glucose level is not monitored when taking Cylert. 2. The child should test positive for amphetamine because amphetamines are the prototype for Cylert. But this test is not monitored because the drug's effectiveness is determined by the client's behavior. 3. Melatonin is a hormone produced by the body that regulates sleep patterns. Cylert can cause insomnia, but it does not interfere with melatonin levels. 4. Cylert, as with most medications, is metabolized by the liver and can cause liver dysfunction or liver failure if taken over a long period. Therefore, liver function tests should be monitored. MEDICATION MEMORY JOGGER: The kidneys and the liver are responsible for metabolizing and excreting all medications.

78. The child diagnosed with ADHD has been taking pemoline (Cylert) for an extended period of time. Which laboratory test should the nurse monitor? 1. Serum glucose levels. 2. Amphetamine levels. 3. Serum melatonin levels. 4. Liver function tests.

79. 1. Some OTC medications are as effective as prescription medications; therefore, this is a false statement. 2. Tylenol PM is a combination of acetaminophen and Benadryl, and it is not addictive. 3. The client did not verbalize this concern. The client needs factual information, not a therapeutic response. 4. This medication allows the client to fall asleep and stay asleep, which is why it is prescribed for clients with insomnia. Short-term use does not result in an addiction to this medication.

79. The client diagnosed with insomnia asks the nurse, "Why did my HCP prescribe Ambien CR and tell me to quit taking Tylenol PM?" Which response by the nurse is most appropriate? 1. "Over-the-counter medications are not as good as prescriptions." 2. "Tylenol PM is addicting and you should not take it nightly." 3. "You are concerned your HCP gave you a prescription drug." 4. "Ambien CR will help you get to sleep and stay asleep through the night."

8. 1. Antidepressant medications may cause orthostatic hypotension, and the nurse should question administering the medication if the blood pressure is less than 90/60. 2. Antidepressant medications do not have a therapeutic blood level; the effectiveness and side effects of the medication are determined by the client's behavior. 3. Many antidepressants may cause hepatotoxicity; therefore, the nurse should monitor the client's liver function tests. 4. The nurse should ensure the client's safety. Many antidepressants may cause orthostatic hypotension and increase the risk for dizziness, falls, and injuries. 5. Antidepressant medications take at least 3 weeks to become effective; therefore, when the client is first admitted to the psychiatric department and prescribed an antidepressant, evaluating for the effectiveness of the medication is not an appropriate intervention.

8. 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.

80. 1. Librium is used to prevent delirium tremens; therefore, the nurse would not question this medication. 2. Haldol is prescribed for psychosis; therefore, the nurse would not question this medication. 3. Clonidine is administered primarily to treat hypertension, but it is also used to reduce the symptoms of withdrawal from opioids, nicotine, and alcohol. The nurse would question administering this medication because of the client's low blood pressure no matter why it is being prescribed. 4. Thiamine is used to diminish Wernicke- Korsakoff encephalopathy, which is characterized by confusion, memory loss, and loss of cranial nerve function resulting from chronic alcohol abuse.

80. The nurse on the substance abuse unit is administering medications. Which medication should the nurse question administering? 1. Chlordiazepoxide (Librium), a benzodiazepine, to a client admitted for alcohol detoxification. 2. Haloperidol (Haldol), an antipsychotic, to a client diagnosed with phencyclidine (PCP) psychosis. 3. Clonidine (Catapres), an alpha-adrenergic agonist, to client with a blood pressure of 88/60. 4. Thiamine (B1), a vitamin, intravenously to a client diagnosed with Wernicke- Korsakoff syndrome.

81. 1. Cannabis is marijuana and results in a lack of sense of time, apathy, and increased appetite, not the signs and symptoms the client is experiencing. 2. Heroin abuse results in slurred speech, sedated appearance, apathy, and decreased emotional pain, not hypervigilance and insomnia. 3. Hypervigilance, insomnia, dilated pupils, and a runny nose are the signs or symptoms of cocaine abuse. 4. Alcohol abuse results in lack of control, hostility, rationalization, grandiosity, confusion, and blackouts, not the signs and symptoms this client has. MEDICATION MEMORY JOGGER: Many of the illegal substances that are abused by clients may produce the same symptoms, so the test taker must focus on symptoms that are different, such as "runny nose" for cocaine.

81. The client is brought to the emergency department by a friend. The client is hypervigilant, has not slept in 3 days, has dilated pupils, has an apical pulse of 118, and has a runny nose. Which substance should the nurse suspect the client is abusing? 1. Cannabis. 2. Heroin. 3. Cocaine. 4. Alcohol.

82. 1. The nurse cannot delegate evaluation of assessment data. The unlicensed assistive personnel (UAP) can obtain the intake and output but not evaluate it. 2. The UAP can obtain the client's weight. This does not require judgment. 3. The UAP should not be manipulating the IV, the IV pump, or the IV tubing. TPN is a medication, and the nurse cannot delegate the administration of medications. 4. The client is anorexic, and any food intake should be evaluated by the nurse. Having the UAP go to the cafeteria removes the employee from the unit for an extended period; therefore, this is not an appropriate task to delegate. 5. The TPN is high in glucose and the client's glucose level should be monitored every 6 hours; the UAP can perform this skill.

82. The client diagnosed with anorexia nervosa is admitted to the medical department for total parenteral nutrition (TPN) because of her emaciated condition. Which task can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply. 1. Evaluate the client's intake and output. 2. Obtain the client's daily weight. 3. Change the TPN tubing during the bath. 4. Escort the client to the hospital cafeteria. 5. Perform a glucometer check every 6 hours.

83. 1. Substance abuse, whether involving legal or illegal substances, is still abuse, and the client needs psychological intervention to help with the abuse. The pharmacologic intervention helps with the physiologic withdrawal, with the scientific rationale being to help the client not take any type of medication, legal or illegal. 2. The two main purposes for prescribing medication for clients who are addicted to alcohol, sedative/hypnotics, and benzodiazepines are to permit safe withdrawal from the substance and to prevent relapse into addiction again. 3. No medications used in substance abuse detoxification can prevent all side effects. 4. This statement is not true.

83. Which statement best supports the scientific rationale for pharmacologic treatment in clients diagnosed with substance abuse? 1. Medications allow the clients to take a medication legally for their problem. 2. Medications permit safe withdrawal and help prevent relapse. 3. Medications will prevent all side effects of substance abuse withdrawal. 4. Medications allow the client to have a psychological reason to quit the substance abuse.

84. 1. This is within the therapeutic range of 0.6 to 1.2 mEq/L. Therefore, the nurse should take no action, except to make sure the client has a follow-up appointment. 2. This would be appropriate if the client's lithium level was elevated, which it is not. 3. This would be appropriate if the client's lithium level was elevated, which it is not. 4. The lithium level is therapeutic; therefore, the client does not need to adjust his or her salt intake. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

84. The client diagnosed with bipolar disorder is taking lithium (Lithobid) and has a lithium level of 1.0 mEq/L. Which intervention should the psychiatric clinic nurse implement based on this laboratory result? 1. Schedule the client's next clinic appointment. 2. Call the client and have him or her come to the clinic. 3. Instruct the client to hold the medication for 2 days. 4. Tell the client to increase daily salt intake.

85. 1. The nicotine patch and nicotine gum are both nicotine replacement products, and if one doesn't work, neither will the other one. 2. The nicotine patch is an over-the-counter medication, so this recommendation is not helpful to the client. 3. Nicotine lowers vitamin C levels in the body, so it will not help the client with withdrawal symptoms from nicotine. 4. Bupropion (Wellbutrin) is an antidepressant that has been proved to be an adjunct to smoking cessation.

85. The client wants to quit smoking cigarettes. The client has been to a smoking cessation support group and has used nicotine patches but has not been successful. Which recommendation should the nurse give the client? 1. "Chew nicotine gum instead of using the patch." 2. "Try an over-the-counter medication to help quit smoking." 3. "Take 500 mg of vitamin C twice a day." 4. "Ask your HCP for a prescription for Wellbutrin, an antidepressant."

86. 1. This is the correct amount of medication to administer to the client; 100 divided by 50 is 0.5 mL. 2. This would be a medication error and would be administering 100 mg of medication, or twice the dose prescribed. 3. This would be a medication error and would be administering 150 mg of medication, or three times the dose prescribed. 4. This would be a medication error and would be administering 200 mg of medication, or four times the dose prescribed. MEDICATION MEMORY JOGGER: Most pharmaceutical companies package the medication in amounts that are usually prescribed by the HCP. If the nurse uses more than one vial to administer a medication, then the nurse should seek clarification of the prescription.

86. The client diagnosed with schizophrenia is hallucinating and attacking other clients in the psychiatric unit. The client has a PRN order for 50 mg of chlorpromazine (Thorazine) IM. The medication comes in a vial with 100 mg per mL. How many milliliters should the nurse administer? Designate the spot on the syringe. 1. A. 2. B. 3. C. 4. D.

87. 1. The multivitamins in the IV solution cause the IV solution to be yellow; therefore, there is no reason to notify the HCP. 2. This IV does not need to be protected from light. The yellow color is normal for this IV therapy. 3. This IV therapy is commonly known as a "banana boat" because of the yellow color of the IV solution. The nurse should administer the medication as prescribed. 4. This is not cost effective because the yellow color is normal for this medication.

87. The client diagnosed with chronic alcoholism is prescribed multivitamins via intravenous route because of malnutrition. The intravenous solution turns yellow after injecting the multivitamin. Which intervention should the nurse implement? 1. Notify the pharmacist about the discoloration of the IV. 2. Cover the IV bag and tubing with light-resistant material. 3. Administer the medication as prescribed and take no action. 4. Discard the intravenous bag and obtain another vial of medication.

88. 1. Involuntary movements of the tongue and lips are signs and symptoms of tardive dyskinesia, which is an adverse reaction to first-generation antipsychotic medications such as Thorazine. 2. Antianxiety medications, such as Ativan, do not cause tardive dyskinesia. 3. Antibiotics, such as Zinacef, do not cause tardive dyskinesia. 4. The client has signs and symptoms of tardive dyskinesia, which is an adverse reaction to a first-generation antipsychotic medication such as Thorazine. The nurse must intervene when assessing these signs and symptoms.

88. The client diagnosed with schizophrenia is admitted to the medical department for pneumonia and is exhibiting involuntary movements of the tongue and lips. Which medication should the nurse question administering? 1. Chlorpromazine (Thorazine). 2. Lorazepam (Ativan). 3. Cefuroxime (Zinacef). 4. The nurse should not question administering any of these medications.

89. 1. Risperdal is the drug of choice for an adolescent diagnosed with bipolar disorder. 2. Tagamet may reduce the effects of antipsychotic medications and lead to medication failure. The client diagnosed with schizophrenia would be taking an antipsychotic medication, so the nurse should discuss an alternate medication to decrease the client's gastric acidity. 3. The client receiving antituberculin medications must receive them to prevent resistant strains of TB and protect the community. 4. Elavil has shown efficacy in promoting weight gain in clients with anorexia nervosa. Therefore, the nurse would not need to discuss this medication with the HCP.

89. The nurse is administering medications on a psychiatric unit. Which client should the nurse discuss with the health-care provider? 1. The 17-year-old client diagnosed with bipolar disorder who is receiving risperidone (Risperdal), an antipsychotic. 2. The client diagnosed with schizophrenia who is receiving cimetidine (Tagamet), a histamine blocker. 3. The client with a heroin dependency who is receiving rifampin (Rifadin), an antituberculin. 4. The 16-year-old client diagnosed with anorexia nervosa who is receiving amitriptyline (Elavil), a tricyclic antidepressant.

9. 1. Providing phone numbers for the client and family is an intervention that the nurse could implement, but it is not priority over the psychological and physical safety of the client. 2. Follow-up appointments are important for the client after being discharged from a psychiatric facility, but it is not priority over the psychological and physical safety of the client. 3. Ensuring 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. 4. This is an appropriate intervention, but it is not priority over the psychological and physical safety of the client.

9. 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.

90. 1. The antidepressant is administered to improve the mood; therefore, this indicates the medication is effective. 2. Arguing with the parents will not determine the effectiveness of the medication. 3. Verbalizing future goals will not determine the effectiveness of the medication. 4. Being preoccupied with the shape and weight is a symptom of anorexia and indicates the medication is not effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

90. The 17-year-old adolescent female diagnosed with anorexia is prescribed desipramine (Norpramin), a tricyclic antidepressant. Which data indicates the medication is not effective? 1. The client's mood has improved. 2. The client does not fight with her parents. 3. The client is verbalizing wanting to go college. 4. The client is preoccupied with shape and weight.