NCLEX Pharm: Psychiatric Medications

The nurse reviews an elderly client's medication administration record and identifies which prescriptions as having the potential for injury in the elderly?

1) Lorazepam 2) Amitriptyline 3) Chlorpheniramine

The nurse is caring for a client admitted with serotonin syndrome after taking citalopram and tramadol. Which assessment findings does the nurse expect to find?

1) Muscle rigidity 2) Tachycardia 3) Restlessness and agitation

A nurse on the behavioral health unit is reviewing medication prescriptions for 4 clients. Which combination of medications does the nurse question?

A patient with depression who is prescribed escitalopram and selegiline - Monoamine oxidase inhibitors (MAOIs) (eg, selegiline [Emsam]) interact with many medications, including many antidepressants. MAOIs and selective serotonin reuptake inhibitors should not be given within 2 weeks of each other to prevent adverse reactions (eg, serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis).

What are the symptoms of lithium toxicity?

Blurred vision, ataxia, tinnitus, persistent n/v/d, excessive urination, increased tremors, confusion, psychomotor retardation, nystagmus, impaired consciousness, seizures, coma, arrythmias, MI, cardiovascular collapse

A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question?

Continue prescribed home dose of lithium 300 mg PO Q8hrs - This patient is at risk for lithium toxicity. Clients with conditions that increase serum lithium levels (eg, dehydration, hyponatremia, severe renal dysfunction) are at increased risk for toxicity (>1.5 mEq/L [1.5 mmol/L]).

A nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder. Which statement by the client indicates a need for further teaching?

I should use ibuprofen for pain relief - NSAIDS and thiazide diuretics can cause a decrease in renal blood flow

The nurse has provided education for a client newly prescribed alprazolam for generalized anxiety disorder. Which client statement indicates that teaching has been effective?

I will take my daily dose at bedtime - Benzodiazepines have a sedative effect and should be administered at bedtime when possible.

The nurse prepares to administer clozapine to a client with schizophrenia. Which client statement would require priority investigation before administering the medication?

I've had a sore throat for 3 days and feel feverish today - Clozapine may cause agranulocytosis, which increases the risk of life-threatening infection. Clients receiving clozapine should be monitored for signs of infection (eg, fever, flulike symptoms).

The clinic nurse evaluates a client who was prescribed lithium therapy a month ago for bipolar disorder. Which client statement would cause the most concern?

I've had the stomach flu for the past couple of days - Dehydration and sodium loss from vomiting and diarrhea can lead to toxic lithium levels in clients receiving lithium therapy.

What effect does Chlorpheniramine have that makes it dangerous for the elderly?

Increased central nervous system effects (eg, drowsiness, dizziness) may occur due to its reduced clearance in the elderly

The nurse reinforces teaching for a client newly prescribed buspirone for generalized anxiety disorder. Which client statement indicates that teaching has been effective?

It will take 2-4 weeks for this drug to be effective

What risk does ziprasidone have?

Its use carries a risk for QT prolongation leading to torsade de pointes. A baseline electrocardiogram and potassium are usually checked. At a minimum, the client should be placed on a cardiac monitor.

What is Escitalopram (Lexapro)?

Levo-enantiomer of citalopram (both SSRIs) - more expensive but possibly with fewer side effects

The nurse provides discharge teaching for the parent of a child newly prescribed methylphenidate for attention-deficit hyperactivity disorder (ADHD). The nurse advises the parent that the child might experience which side effects?

Loss of appetite and restlessness

What type of drug is selegiline?

MAOI - it cannot be given within 2 weeks of SSRI to prevent neuroleptic malignant syndrome

What is Isocarboxazid?

MAOI - Used for resistant depression only

The client is brought to the emergency department in handcuffs by the police. Witnesses said that the client became violent and confused after consuming large amounts of alcohol at a party. The client is placed in 4-point restraints, and ziprasidone hydrochloride is administered. The client is sleeping 30 minutes later. What is a priority action for the nurse at this time?

Monitor for widened QT intervals and hypotension Also monitor for seizures - After ziprasidone hydrochloride administration, clients should be monitored for cardiac effects (including prolonged QT interval), hypotension, and/or seizure activity. Alcohol interacts with ziprasidone and increases the potential for an adverse effect from the drug.

The nurse reviews a client's medical record and notes the following PRN medication prescriptions: acetaminophen, haloperidol, and benztropine. The nurse would administer a dose of benztropine on assessing which client behavior?

Muscle rigidity and shuffling gate - an anticholinergic medication used to treat some extrapyramidal symptoms, which are side effects of some antipsychotic medications. -

What is NMS characterized by?

NMS is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction (eg, sweating, hypertension, tachycardia).

What is neuroleptic malignant syndrome most commonly associated with?

NMS is most often seen with the "typical" antipsychotics (eg, haloperidol, fluphenazine). However, even the newer "atypical" antipsychotic drugs (eg, clozapine, risperidone, olanzapine) can cause the syndrome.

The nurse completes the following drug administrations. Which would require an incident report?

Patient with depression was given escitalopram this morning after stopping phenelzine yesterday MAOIs must be stopped for at least 14 days before starting an SSRI

What are more examples of MAOI's?

phenelzine, and tranylcypromine

How is lithium cleared?

renally

A nurse is discharging a client who is receiving lithium for treatment of a bipolar disorder. It is most important for the nurse to provide which instruction to the client?

report excessive urination and increased thirst

What is the therapeutic level for lithium?

0.6-1.2 mEq/L (0.6-1.2 mmol/L). Levels >1.5 mEq/L (1.5 mmol/L) are considered toxic.

What are the major problems with stimulants like Methylphenidate (Ritalin) and amphetamines (eg, dextroamphetamine, lisdexamfetamine)?

1) Decreased appetite and weight loss - can lead to growth delays 2) Cardiovascular effects - hypertension and tachycardia (particularly in adults) 3) Appearance of new or exacerbation of vocal/motor tics 4) Excess brain stimulation - restlessness, insomnia 5) Abuse potential - misuse, diversion, addiction

What are the causes of lithium toxicity?

1) Dehydration 2) Decreased renal function (eg, elderly clients) 3) Diet low in sodium 4) Drug-drug interactions (nonsteroidal anti-inflammatory drugs [NSAIDs] and thiazide diuretics)

A client at 9 weeks gestation arrives at the clinic for an initial obstetric appointment. The nurse reviews the client's medical history and obtains a list of current medications. The nurse recognizes that which of the following medications should be clarified with the health care provider immediately?

1) Lisinopril (ACE inhibitors are contraindicated in pregnancy) 2) Doxycycline 3) Isotretinoin

What is Buspirone used for?

Acts on serotonin receptors - effective in treating anxiety but does not have sedative effects. - has low abuse potential - anxiolytic medication

What are the s/s of serotonin syndrome?

Clinical manifestations of serotonin syndrome include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysregulation (eg, hyperthermia, diaphoresis, tachycardia/hypertension), and neuromuscular hyperactivity (eg, tremor, muscle rigidity, clonus, hyperreflexia).

What is clozapine and what is it used for?

Clozapine, an atypical antipsychotic, is used to manage schizophrenia in clients who have not improved with other medications.

What is the treatment for NMS?

Discontinue antipsychotic Expect order for: Dantrolene / Dantrium and/or Bromocriptine / Parlodel Aimed at reducing muscle rigidity

A client with seizure disorder is prescribed a moderately high dose of phenytoin. Which teaching topic should the nurse discuss with this client?

Good oral care and dental follow up - this prevents gingival hyperplasia

What is Chlorpheniramine?

H1 antihistaminic receptor blocker. decreases allergic response

A child with attention-deficit hyperactivity disorder (ADHD) has been taking methylphenidate for a year. What are the priority nursing assessments when the client comes to the clinic for a well-child visit?

Hight/weight and BP - Side effects of methylphenidate therapy that require on-going monitoring are delayed growth and development and increased blood pressure.

The nurse working on the inpatient psychiatric unit is preparing to administer 9:00 AM medications to a client. The medication administration record is shown in the exhibit. On assessment, the client is tremulous, exhibits muscle rigidity, and has a temperature of 101.1 F (38.4 C). Which action should the nurse take?

Hold the haloperidol and notify the HCP right away - This indicates neuroleptic malignant syndrome

A behavioral health clinic nurse assesses a 23-year-old client who started taking paroxetine 3 weeks ago. Which statement made by the client is most important for the nurse to investigate?

I have more energy but I feel just as depressed - A client reporting increased energy with little or no reduction of depression needs immediate assessment for suicide risk. (this drug works in 1-4 weeks)

What is the beers criteria?

Provides a list that classifies potentially harmful drugs to avoid or administer with caution in the elderly due to the high incidence of adverse effects and potential for injury.

The nurse develops a teaching care plan for the client with a prescription to change antidepressant medications from imipramine to phenelzine. Which instruction is appropriate to include in the teaching?

Taper down imipramine, then discontinue for 2 weeks before starting phenelzine - Caution must be taken when a client switches from a tricyclic antidepressant to a monoamine oxidase inhibitor to avoid adverse reactions (eg, hypertensive crisis, discontinuation syndrome).

How fast does the body clear alcohol from the system?

The body normally clears alcohol at a rate of 25-50 mg/dL per hour.

What drugs does the beers criteria include?

The list includes antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales.

What are side effects of phenytoin?

The other major side effects of phenytoin use are an increase in body hair, rash, folic acid depletion, and decreased bone density (osteoporosis).

Can Benzodiazepines be stopped abruptly?

They should never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more.

The parent of a child diagnosed with attention-deficit hyperactivity disorder (ADHD), predominantly inattentive type, says to the nurse, "I hate the idea of my child taking a drug that's a stimulant. How will I know that the methylphenidate is even working?" Which is the best response by the nurse?

Your child should be more easily able to complete school assignments and other tasks

What is ziprasidone?

Ziprasidone hydrochloride (Geodon) is an atypical antipsychotic drug that is used for acute bipolar mania, acute psychosis, and agitation.