Psych Pharm

Which adverse effect is least likely to occur in a client who is prescribed clozapine? 1 Seizures 2 Sedation 3 Akathisia 4 Myocarditis

4: Myocarditis Clozapine is a second gen antipsychotic. Seizures, sedation, and akathisia (restlessness) are common side effects.

Naltrexone is used to treat clients with substance abuse problems. In which situation does the nurse anticipate that naltrexone will be administered? 1 To treat opioid overdose 2 To block the systemic effects of cocaine 3To decrease the recovering alcoholic's desire to drink alcohol 4 To prevent severe withdrawal symptoms from antianxiety agents

3 Naltrexone is effective in reducing the risk of relapse among recovering alcoholics in conjunction with other types of therapy. Naloxone, not naltrexone, is used for opioid overdose. Naltrexone is not used to treat the effects of cocaine. Naltrexone is an opioid antagonist. It is not used for antianxiety agent withdrawal.

Why does the nurse question a prescription for a benzodiazepine for an individual experiencing acute grief? 1 The depression is magnified, and the risk of suicide increases. 2 Brain activity is suppressed, and the risk of depression increases. 3 Lethargy results, and it prevents the return to interpersonal activity. 4 The period of denial is extended, and the grieving process is suppressed.

4 Benzodiazepines are sedative; the client does not face the reality of a situation and merely delays the onset of acceptance. Most of the support that a person will obtain after a death is immediately after; this drug does not allow the client to use these support systems.

Side Effects of First Gen Antipsychotics

EPS (dystonia, akathisia, & akinesia), TD, NMS; confusion, HA, dry mouth, amenorrhea, gynecomastia, visual disturbances, hyperpyrexia, edema, weight gain, urinary retention

A primary healthcare provider prescribes 0.25 mg of alprazolam by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. For what most common side effect of this drug will the nurse monitor the client? 1 Drowsiness 2 Bradycardia 3 Agranulocytosis 4 Tardive dyskinesia

1 Alprazolam, a benzodiazepine, potentiates the actions of gamma-aminobutyric acid, enhances presympathetic inhibition, and inhibits spinal polysynaptic afferent pathways. Drowsiness, dizziness, and blurred vision are common side effects. Alprazolam may cause tachycardia, not bradycardia. Agranulocytosis is usually a side effect of the antipsychotics in the phenothiazine, not the benzodiazepine, group. Tardive dyskinesia occurs after prolonged therapy with antipsychotic medications; alprazolam is an antianxiety medication, not an antipsychotic.

A client with schizophrenia, undifferentiated type, is receiving a typical antipsychotic/neuroleptic. The nurse will assess for which extrapyramidal effects? 1 Shuffling gait, tremors, and restlessness 2Nausea, vomiting, and muscle cramps 3 Drowsiness, disorientation, and slurred speech 4 Tachycardia, urine retention, and constipation

1 Shuffling gait, tremors, and restlessness are common extrapyramidal signs (pseudoparkinsonism) that occur as side effects of neuroleptics; they are usually controlled with antiparkinsonian drugs. Nausea, vomiting, and muscle cramps are signs of lithium toxicity. Drowsiness, disorientation, and slurred speech are common side effects that occur with central nervous system depressants. Tachycardia, urine retention, and constipation are common side effects that occur with antidepressants.

A client has a bipolar disorder for which the primary healthcare provider prescribes a mood-stabilizing medication. The nurse completes a teaching session with the client concerning the medical regimen. Which client comment indicates to the nurse that further teaching is needed? 1 "I know I won't have to stay on this medication for too long." 2 "I understand that I'll need to keep in touch with my primary healthcare provider." 3 "Taking medication without using other forms of therapy may not be as effective." 4 "Taking the medication is better than experiencing the highs and lows I've been having."

1 The comment "I know I won't have to stay on this medication for too long" reveals that the client does not understand that the medication is necessary to prevent mood swings; *long-term adherence* to the pharmacologic regimen is important in managing bipolar disorder Regular medical visits are needed to ensure the best management of the illness. Various cognitive and behavioral therapies provide support in coping with life's stressors. Adherence to the medication regimen should eliminate mood swings for most people with bipolar disorder.

A client with the diagnosis of schizophrenia, paranoid type, has been receiving a phenothiazine drug. When the psychiatric daycare center plans a fishing trip, it will be important for the nurse to take which action? 1 Provide the client with sunscreen. 2 Caution the client to limit exertion during the trip. 3 Give the client an extra dose of medication to take after lunch. 4 Take the client's blood pressure before allowing participation in the outing.

1 Provide the client with sunscreen Phenothiazines commonly cause a photosensitivity that can be controlled with sunscreen. Limiting activity is not a necessary precaution when phenothiazines are prescribed. The medication must be administered as prescribed. Participating in the outing should not negatively affect the client's blood pressure.

Which antidepressant drug is a selective monoamine oxidase-B inhibitor? 1 Selegiline 2 Phenelzine 3 Isocarboxazid 4 Tranylcypromine

1 Selegiline Selegiline is a selective monoamine oxidase-B inhibitor. Phenelzine, isocarboxazid, and tranylcypromine are nonselective monoamine oxidase-A and monoamine oxidase-B inhibitors

Which drug would the nurse administer transdermally to treat a client with major depression? 1 Selegiline 2 Phenelzine 3 Isocarboxazid 4 Tranylcypromine

1 Selegiline (MAOI) tx depression and parkinsons Phenelzine (maoi) last line depression Isocarboxazid [Marplan] (maoi) antidepressant Tranylcypromine [Parnate] (maoi) second line MDD

A client receiving the medication buspirone is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies that the client's sclerae look yellow. What will be the nurse's initial action? 1 Withhold the medication. 2 Give the buspirone with milk. 3 Reduce the dosage of the medication. 4 Ensure that the medication can be given parenterally.

1 Withhold the medication Jaundice indicated possible liver damage; this prolongs elimination of the drug and increases the risk of toxicity.

During an interview and assessment, a 60-year-old client reports to the nurse, "I've been using St. John's wort to try to feel more like myself again. I'm not sure whether it's going to work." The nurse will pursue an assessment related to the client's report of which symptom? 1 Depression 2 Sleep disturbances 3 Diminished cognitive ability 4 Sensory-perceptual disturbances

1 depression

Which drugs can be used as preanesthetic agents? Select all that apply. 1 Barbiturates 2 Benzodiazepines 3 Antiepileptic agents 4 Atypical antipsychotics 5 Mood stabilizing agents

1, 2 Barbiturates and benzodiazepines are sedative-hypnotics that may also be used to decrease effects of anxiety in presurgical clients. Antiepileptic agents are used to treat seizure activity and manage bipolar disorder. Atypical antipsychotics are mainly used to treat bipolar disorder and psychosis. Mood stabilizing agents are used to treat bipolar disorder.

A registered nurse provides dietary instructions to a client who is prescribed isocarboxazid for depression. Which statements made by the client indicates a need for further education? Select all that apply. 1 "I will limit my intake of fish." 2 "I will limit my intake of yogurt." 3 "I will limit my intake of bananas." 4 "I will limit my intake of beer." 5 "I will limit my intake of chocolate."

1, 2, 4 If a client is unresponsive to other antipsychotic drugs, isocarboxazid (maoi) is used to treat depression. Clients taking isocarboxazid should avoid foods high in tyramine and should limit the intake of foods that contain a moderate amount of tyramine content because these foods may cause a hypertensive crisis. F ish, yogurt, and major domestic beers are low in tyramine content and should not be avoided as they generally do not cause hypertensive crisis. Large amounts of bananas or chocolate should be avoided as they can cause a reaction.

A client is diagnosed with neuroleptic malignant syndrome (NMS) as an adverse effect of high-potency antipsychotic use. Which actions by the nurse indicate understanding of the management of this syndrome? Select all that apply. 1 Providing the clients with cooling blankets 2 Administering a fast acting benzodiazepine 3 Increasing the client's fluid intake 4 Withdrawing the neuroleptic drug immediately 5 Switching to another first-generation antipsychotic

1, 3, 4 Neuroleptic malignant syndrome (NMS) is a rare reaction that carries a 4 percent risk of death. Symptoms include fluctuations in blood pressure, fever, sweating, rigidity, and dysrhythmias. Supportive treatment includes giving the client cooling blankets to decrease high body temperatures. Rehydrating the client by increasing the fluid intake is also indicated. The nurse should also administer a muscle relaxant such as dantrolene and immediately withdraw the neuroleptic. Research has shown that administration of a fast-acting benzodiazepine can also help with symptom management. The primary healthcare provider should switch the client to a second-generation antipsychotic if a second episode occurs.

Which drug is contraindicated in clients with eating and seizure disorders? 1 Bupropion 2 Trazodone 3 Amitriptyline 4 Lithium citrate

1: Bupropion [BuSpar]: anxiolytic; contraindicated in pts with eating and seizure disorders 2: Trazodone: SSRI; contraindicated in clients with known allergic reaction to the drug 3: Amitriptyline [Elavil]: TCA; contraindicated in pregnant women 4: Lithium citrate: mood stabilizer; contraindicated in clients with renal or CV disease.

A client with schizophrenia is given an antipsychotic drug. The nurse recalls all the extrapyramidal effects associated with this type of medication and anticipates that the drug will be discontinued if which occurs? 1 Akathisia 2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction

2 Tardive dyskinesia TD: protrusion and vermicular movements of the tongue, chewing and puckering movements of the mouth, and a puffing of the cheeks; may be irreversible Akathisia (restlessness), parkinsonian syndrome, and acute dystonia can be treated with antiparkinsonsian/anticholinergic drugs.

In addition to hydration during alcohol withdrawal delirium, parenteral administration of lorazepam is prescribed for a client. The nurse knows that this drug is given during detoxification primarily for what purpose? 1 To prevent injury when seizures occur 2 To enable the client to sleep better during periods of agitation 3 To reduce the anxiety tremor state and prevent more serious withdrawal symptoms 4 To quiet the client and encourage cooperation by promoting acceptance of the treatment plan

3 Lorazepam potentiates the actions of gamma-aminobutyric acid, which reduces the anxiety and irritability associated with withdrawal. This drug helps reduce the risk of seizures but does not prevent physical injury if a seizure occurs. Although the drug may enable the client to sleep better during periods of agitation, this is not the primary objective of using the drug. The ability of the client to accept treatment depends on readiness to accept the reality of the problem.

A nurse teaches a client about the side effects and precautions associated with the antipsychotic haloperidol. The nurse concludes that the teaching has been understood when the client makes which statement? 1 "I'll call my primary healthcare provider right away if I have any diarrhea or vomiting." 2 "I won't eat anything containing tyramine while I'm taking this drug." 3 "I'll avoid direct sunlight and make sure to use sunscreen when I go outside." 4"I'll be sure to drink enough fluids, because the drug may make me urinate more than usual."

3 Photosensitivity is a side effect of many antipsychotic medications. Diarrhea and vomiting are side effects of lithium, not haloperidol. Avoiding tyramine-containing foods is a precaution associated with monoamine oxidase inhibitors, not haloperidol. Adequate fluid intake is a precaution associated with lithium, not haloperidol.

Which condition is contraindicated for St. John's wort herbal therapy? 1 Anxiety 2 Seizures 3 Dementia 4 Cardiac disease

3 Dementia Dementia is contraindicated for St. John's wort herbal therapy; this herbal therapy is used to treat anxiety. Seizures are contraindicated for bupropion therapy. Cardiac disease is contraindicated for valerian (Valeriana Officinalis).

Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? 1 Trazodone 2 Bupropion 3 Duloxetine 4 Mirtazapine

3 Duloxetine [Cymbalta] (ssnri) Trazodone (sari's) antidepressant Bupropion [Wellbutrin] antidepressant Mirtazapine [Remeron] antidepressant Duloxetine can worsen uncontrolled angle-closure glaucoma. Trazodone is contraindicated in clients with a known drug allergy. Bupropion is contraindicated for clients with seizures. Mirtazapine is contraindicated in cases of known drug allergy and concurrent use of monoamine oxidase inhibitors.

A nurse is administering medications to clients on a psychiatric unit. What does the nurse identify as the reason that so many psychiatric clients are given the drug benztropine or trihexyphenidyl in conjunction with the phenothiazine-derivative neuroleptic medications? 1 They reduce postural hypotension. 2 They potentiate the effects of the neuroleptic drug. 3 They combat the extrapyramidal side effects of the neuroleptic drug. 4 They ameliorate the depression that may accompany schizophrenia.

3 They combat the extrapyramidal side effects of the neuroleptic drug. Benztropine and trihexyphenidyl control EPS manifestations (antiparkinsonian drugs).

A client is hospitalized with social anxiety disorder. The client has a history of exhibiting intense, irrational fear of being scrutinized by others. Which primary anxiolytic medications would be prescribed to the client? Select all that apply. 1 Sertraline 2 Paroxetine 3 Alprazolam 4 Venlafaxine 5 Clonazepam

3, 5 Manifestations of social anxiety disorder include stuttering, sweating, palpitations, dry throat, and muscle tension. Clients with this disorder exhibit intense, irrational fear of being scrutinized by others. Alprazolam and clonazepam are benzodiazepines that are well tolerated in clients, and the benefits are immediate. Sertraline and paroxetine are selective serotonin reuptake inhibitors that are also used in the treatment of social anxiety disorder, but they do not act quickly. Venlafaxine is used to treat posttraumatic stress disorder.

Which drug is used to treat both generalized anxiety disorder and depression? 1 Fluoxetine 2 Bupropion 3 Duloxetine 4 Mirtazapine

3: Duloxetine [Cymbalta]: SSNRI; GAD & MDD 1 Fluoxetine [Prozac]: SSRI; depression 2 Bupropion [Wellbutrin]: antidepressant; smoking cessation and depression 4 Mitrazapine [Remeron]: antidepressant; depression & reduces adverse sexual s/e of male client on SSRI therapy

Lithium is prescribed for a client with bipolar disorder experiencing a manic episode. When teaching the client about this medication, the nurse will emphasize which fact about lithium? 1 Cannot be taken safely with any other antipsychotic medications 2 Can be taken safely with diuretics if the potassium level is maintained 3 Should be discontinued and the primary healthcare provider notified if depression occurs 4 Should temporarily be stopped and the primary healthcare provider notified if diarrhea results

4 A decrease in serum sodium because of diarrhea decreases the excretion of lithium, which can result in a toxic level in the blood. In addition, diarrhea is a sign of lithium toxicity. It is safe to take lithium with other antipsychotics, because the client's behavior may require combination pharmacotherapy. Lithium should not be taken with diuretics, regardless of the potassium level, because diuretics decrease the sodium level, and lithium is not excreted when the sodium level is decreased. Lithium is useful in both the manic and depressive phases of a bipolar disorder.

A client with newly diagnosed rapid-cycling bipolar disorder will be meeting with the nurse for an educational session about the pharmacological approach that is planned. Which classification of medication does the nurse expect to discuss? 1 Antianxiety medication 2 Antiparkinson medication 3 Antidepressant medication 4 Anticonvulsant medication

4 Anticonvulsant medications are therapeutic for clients with rapid-cycling bipolar disorder. Antianxiety medications are not primarily used for rapid-cycling bipolar disorder. Antianxiety medications may be helpful for clients with treatment-resistant mania. Antiparkinson medications are not used for rapid-cycling bipolar disorder. An antidepressant medication is not used unless the client also is taking an antipsychotic medication.

A nurse is teaching clients in a medication education group about side effects of medications. Which drug will cause a heightened skin reaction to sunlight? 1 Lithium 2 Sertraline 3 Methylphenidate 4 Chlorpromazine

4 Clients taking chlorpromazine should be instructed to stay out of the sun. Photosensitivity makes the skin more susceptible to burning. Photosensitivity is not a side effect of lithium, sertraline, or methylphenidate. Lithium (mood stabilizer) tx BiPo/Mania Sertraline [Zoloft] (ssri) Methylphenidate [Ritalin] (stimulant) ADHD & narcolepsy

What is the best drug of choice for treating obsessive-compulsive disorder? 1 Imipramine 2 Lithium salts 3 Amitriptyline 4 Clomipramine

4 Clomipramine [Anafranil] is a tricyclic antidepressant drug prescribed for treating of obsessive-compulsive disorder. Childhood enuresis necessitates the administration of imipramine. Lithium salt is prescribed to treat bipolar disorders. Dysthymias can be treated by the administration of antidepressant drugs such as amitriptyline.

A healthcare provider prescribes disulfiram for a client who abuses alcohol. The nurse teaches the client that disulfiram will have which action? 1 Affect short-term memory 2 Permit a healthier lifestyle 3 Allow the client to tolerate small amounts of alcohol 4 Cause a severe adverse reaction if alcohol is consumed

4 Disulfiram is an aversion therapy; a person who consumes alcohol while taking disulfiram will experience a severe reaction consisting of nausea, vomiting, hypotension, headache, tachycardia, tachypnea, and flushing. The drug does not affect short-term memory. Use of disulfiram may or may not foster a healthier lifestyle, and if it does occur, this is the result of multiple factors, not just disulfiram therapy. When taking disulfiram the client cannot tolerate any alcohol.

Which statement about psychotherapeutic drugs in elderly clients requires correction? 1 Tricyclic antidepressants may increase anxiety in elderly clients. 2 Normal dosage of lithium may result in lithium toxicity in elderly clients. 3 Elderly clients on antipsychotic drugs are susceptible to orthostatic hypotension. 4 Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs.

4 High serum levels are recorded in elderly clients on psychotherapeutic drugs. Instead of decreasing the anxiety, tricyclic antidepressant drugs may increase the anxiety in older adults. Normal dosage of lithium may result in lithium toxicity in elderly clients, thus necessitating the need to administer low doses of the drug. Orthostatic hypotension, anticholinergic adverse effects, sedation, and extrapyramidal symptoms are more common in elderly clients taking psychotherapeutic drugs.

A primary healthcare provider prescribes oxazepam for a client who is beginning to experience withdrawal symptoms while undergoing detoxification. What are the primary reasons that oxazepam is given during detoxification? 1 Prevents injury and protects the client when seizures occur 2 Enables the client to sleep and eat better during periods of agitation 3 Encourages the client to cooperate with and accept treatment for alcoholism 4 Reduces the anxiety-tremor state and prevents more serious withdrawal symptoms

4 Oxazepam (benzo) potentiates the actions of gamma-aminobutyric acid, especially in the limbic system and reticular formation and thus minimizes withdrawal symptoms. This drug helps reduce the risk for seizures but does not prevent injury or protect the client during a seizure. Enabling the client to sleep and eat better during periods of agitation is not the purpose of the drug. The ability of the client to accept treatment depends on the client's readiness to accept the reality of the problem.

A client is to be discharged on a regimen of lithium carbonate. What will the nurse include in the discharge teaching plan? 1 Advising the client to restrict the intake of gluten 2 Instructing the client to take the medication with milk 3 Reminding the client to have a complete blood count once a month 4 Encouraging the client to have the lithium blood level tested regularly

4 The blood level must be checked monthly or bimonthly when the client is undergoing maintenance therapy, because there is only a small difference between the therapeutic and toxic ranges. A regular diet should be encouraged if the client does not have gluten enteropathy. There is no need to take lithium carbonate with milk, because it does not cause gastrointestinal problems. Lithium carbonate does not affect the blood cells.

A 45-year-old client who recently completed alcohol detoxification reports plans to begin using disulfiram (Antabuse) as part of the alcoholism treatment regimen. What important client teaching does the nurse share regarding this drug? 1 Voluntary compliance with the disulfiram regimen is very high. 2 A single dose of oral disulfiram will be effective for up to 72 hours. 3 Disulfiram may be taken intramuscularly and will be effective for as long as 7 days. 4 Foods, medications, and any topical preparation containing alcohol should be avoided.

4 Avoid alcohol Disulfiram causes unpleasant physical effects when mixed with alcohol. Any substance that contains alcohol may trigger an adverse reaction. Voluntary compliance with the use of disulfiram is often very low because of the negative physical effects experienced by the individual if alcohol is ingested. For disulfiram to be effective, it must be taken orally every day. Disulfiram is not administered intramuscularly.

Which client condition is contraindicated for prescribing clozapine? 1 Seizures 2 Glaucoma 3 Dysrhythmias 4 Bone marrow depression

4 Bone Marrow Depression Clozapine [Clozaril] is 2G antipsychotic. contraindicated in clients with bone marrow depression; one of the main s/e is agranulocytosis (leukopenia} Clozapine should be used with caution in clients with seizures. 1G antipsychotics should be used in caution with clients with glaucoma. Ziprasidone [Geodon] is contraindicated in clients with dysrhythmias

Imipramine, 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered? 1 Telling the client that barbiturates and steroids will not be prescribed 2 Warning the client not to eat cheese, fermented products, and chicken liver 3 Monitoring the client for increased tolerance and reporting when the dosage is no longer effective 4 Having the client checked for increased intraocular pressure and teaching about glaucoma symptoms

4 Having the client checked for increased intraocular pressure and teaching about glaucoma symptoms Imipramine [Tofranil] (tca) tolerance is not an issue with tca's (1) and (2) are true for maoi's.

Which drugs are considered typical antipsychotics? Select all that apply. 1 Asenapine 2 Lurasidone 3 Aripiprazole 4 Thioridazine 5 Chlorpromazine

4, 5 1G antipsychotic drugs are also known as typical/ conventional antipsychotics. Thioridazine and chlorpromazine are typical antipsychotics. Asenapine, lurasidone, and aripiprazole are atypical antipsychotics, AKA 2G antipsychotics.

Side effects of Second Gen Antipsychotics

Metabolic syndrome, weight gain, tachycardia, akathisia (restlessness), agitation, asthenia (physical weakness), ataxia (lack of voluntary movement), seizures, dyskinesia (involuntary muscle movements), dizziness, drowsiness, headaches, insomnia, dry mouth, dyspepsia (indigestion), anxiety, increased appetite

A nurse is counseling a client who abuses cocaine. The nurse recognizes that this drug is representative of which drug category? 1 An opioid 2 A stimulant 3 A barbiturate 4 A hallucinogen

b Stimulant Cocaine is classified as a stimulant. It is inhaled in its powdered form or smoked as crack; its use creates experiences similar to but more intense than those experienced with the amphetamines, and its withdrawal results in a deeper crash. Opioids and barbiturates are central nervous system depressants. Hallucinogens produce cerebral excitation that can yield a state similar to psychosis.

Four clients are admitted to a hospital with different symptoms associated with depression. Which client would benefit from mirtazapine? 1. Client 1 with Fatigue 2 Client 2 with Insomnia 3 Client 3 with Chronic Pain 4 Client 4 with Sexual dysfunction

2 Mirtazapine [Remeron] (atypical antidepressant) s/e sedation Client 1 requires CNS stimulatn {eg Fluoxetine} Client 3 would benefit from Duloxetine Client 4 would benefit from bupropion

A client is receiving doxepin. For which most dangerous side effect of tricyclic antidepressants will a nurse monitor the client? 1 Mydriasis 2 Dry mouth 3 Constipation 4 Breast hypertrophy

1 Mydriatic action causes dilated pupils, which can precipitate an acute attack of glaucoma, resulting in blindness. Although dry mouth, constipation, and breast hypertrophy are all side effects, none is as serious as mydriasis.

A monoamine oxidase inhibitor (MAOI) is prescribed, and the nurse is formulating a teaching plan. What will the nurse instruct the client to avoid while taking this drug? 1 Fermented foods 2 Prolonged sun exposure 3 Strenuous physical exercise 4 Over-the-counter antihistamine drugs

1 An MAOI can cause hypertensive crisis if food or beverages that are high in tyramine, such as fermented foods, are ingested. Prolonged exposure to the sun is hazardous for clients taking one of the phenothiazines. Strenuous physical exercise is not contraindicated. Antihistamines are not prohibited with MAOI medications.

An older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. What is the most appropriate nursing intervention? 1 Withholding the next dose of lithium and drawing blood to test it for toxicity 2 Obtaining a prescription for the antidote to lithium and administering it immediately 3 Suggesting that the primary healthcare provider replace the lithium for an antiepileptic that will control the mania 4 Assessing the client for coarse hand tremor and, if it is present, giving the daily dose of lithium with a bit of water

1 The client is displaying signs and symptoms of early lithium toxicity; older clients should be monitored carefully and given smaller doses of lithium, because its excretion from the kidneys is slower than that in younger adults. There is no antidote to lithium. Coarse hand tremor is an indication of advanced lithium toxicity; the lithium should be withheld. Although antiepileptics are effective in 25% to 50% of clients with treatment-resistant bipolar disorder, this is not the appropriate treatment for lithium toxicity.

When lithium therapy is instituted, the nurse will teach the client to maintain an adequate daily intake of which mineral? 1 Iron 2 Sodium 3 Potassium 4 Magnesium

2 Decreased sodium intake can accelerate lithium retention, resulting in toxicity. Iron, potassium, and magnesium intake are unrelated to the administration of lithium.

A primary healthcare provider plans to have a client with the diagnosis of bipolar disorder continue taking lithium after discharge. The nurse confirms that the teaching about the medication plan is understood when the client makes which statement? 1 "I know that I should stop the medication if I think I'm getting sick." 2 "I know that I may need to take the medication for the rest of my life." 3 "I know that this drug causes no serious side effects when it's taken correctly." 4 "I know that I'll have to increase the dosage at the beginning of a manic episode."

2 In clients with bipolar disorders, it has been shown that long-term lithium therapy flattens the highs of the euphoric episodes and minimizes the lows of the depressed episodes. The primary healthcare provider should be notified before the medication is stopped. The therapeutic level and the toxic level are very close, and serious side effects may occur. Clients should never adjust their own dosages.

After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client? 1 Caffeine 2 Modafinil 3 Atomoxetine 4 Methylphenidate

2 Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).

A client has been prescribed lithium. What important nursing intervention must be implemented while this medication is being administered? 1 Restricting the client's daily sodium intake 2 Testing the client's urine specific gravity weekly 3 Regularly testing the level of the drug in the client's blood 4 Withholding the client's other medications for several days

3 Regularly testing the level of the drug in the client's blood. Lithium alters sodium transport in nerve and muscle cells and causes a shift toward intraneuronal metabolism of catecholamines. Because the range between therapeutic and toxic levels is very slim, the client's serum lithium level should be monitored closely. Sodium restriction may cause electrolyte imbalance and lithium toxicity. Testing the client's urine specific gravity weekly is not necessary or useful. Withholding the client's other medications for several days may or may not be necessary; it depends on what the client is receiving; also, it requires a primary healthcare provider's prescription.

Which drugs may cause an increase in the serum clozapine level? Select all that apply. 1 Rifampin 2 Phenytoin 3 Ketoconazole 4 Erythromycin 5 Bromocriptine

3, 4 Ketoconazole and erythromycin increase clozapine levels in the blood by inhibiting P450 isoenzymes. Rifampin and phenytoin reduce clozapine levels in the blood by inducing cytochrome P450 isoenzymes. Bromocriptine is a direct dopamine receptor agonist that activates dopamine receptors. 1 Rifampin tx TB 2 Phenytoin [Dilantin] anticonvulsant 3 Ketoconazole [antifungal] 4 Erythromycin [antibiotic] 5 Bromocriptine [Parlodel] tx hyperprolactinema, parkinsons symptoms

A client is receiving a monoamine oxidase inhibitor (MAOI). What does the nurse teach the client? 1 It is necessary to avoid the sun. 2 Drowsiness is an expected side effect of this medication. 3 The therapeutic and toxic levels of the drug are very close. 4 Many prescribed and over-the-counter drugs cannot be taken with this medication.

4 MAOIs interact with many other medications to produce harmful side effects. Clients must be taught to check with the prescribing primary healthcare provider before taking any new medications. Photosensitivity has not been reported in clients who are taking MAOIs. Drowsiness is not an expected side effect, but it may occur as an adverse reaction. The therapeutic and toxic levels of the drug are not close for these medications.

Which drug is contraindicated in clients with blood dyscrasias? 1 Duloxetine 2 Bupropion 3 Mirtazapine 4 Chlorpromazine

4 Chlorpromazine [Thorazine]-first gen antipsychotic; contraindicated in pts with blood dyscrasias (more than one blood component gets impaired) 1 Duloxetine [Cymbalta]: SSNRI; antidepressant contrindicated in clients with uncontrolled angle-closed glaucoma 2 Bupropion [Wellbutrin]: antidepressant; contraindicated in clients with anorexia nervosa 3 Mirtazapine [Remeron]: Antidepressant; contraindicated-allergic rxns & concurrent used of MAOIS

Which atypical antipsychotics are approved for long-term use to prevent the recurrence of mood episodes in clients with bipolar disease? Select all that apply. A. Olanzapine B. Quetiapine C. Ziprasidone D. Risperidone E. Aripiprazole

a Olanzapine (Zyprexa), c Ziprasidone (Geodon), e Aripiprazole (Abilify) each is 2nd gen antipsychotic; approved for long term use to prevent recurrence of mood episodes. quetiapine (seroquel) and risperidone (risperdal) are second gen antipsychotics that are approved for use in BiPo, but not for long-term used to prevent recurrence of mood disorders.

Which monoamine oxidase inhibitor is used to treat Parkinson disease? 1 Selegiline 2 Phenelzine 3 Isocarboxazid 4 Tranylcypromine

1 Selegiline is a monoamine oxidase-B inhibitor used to treat Parkinson disease. Phenelzine, isocarboxazid, and tranylcypromine are nonselective inhibitors of both type A and B used in the treatment of depression.

A healthcare provider diagnoses attention deficit hyperactivity disorder (ADHD) in a 7-year-old child and prescribes methylphenidate. The nurse discusses the child's treatment with the parents. What does the nurse emphasize as important for the parents to do? 1 Monitor the effect of the medication on their child's behavior. 2 Increase or decrease the dosage, depending on the child's behavior. 3 Avoid imposing too many rules, because this will frustrate the child. 4 Point out to their child that behavior can be controlled.

1 ::HCP can determine effectiveness of the medication.

Which food should be avoided by a client who is prescribed monoamine oxidase inhibitors (MAOIs)? 1 Bologna 2 Potatoes 3 Citrus fruit 4 Grapefruit juice

1 Bologna Bologna has a high tyramine content; tyramine should not be consumed by clients taking monoamine oxidase inhibitors (MAOIs) because the drug interaction may cause severe hypertension. Potatoes and citrus fruits do not contain tyramine. Grapefruit juice may cause a negative drug interaction in clients taking buspirone.

A client on antidepressant therapy develops hyponatremia. Which drug may be responsible for the client's electrolyte imbalance? 1 Phenelzine 2 Paroxetine 3 Imipramine 4 Amitriptyline

2 Paroxetine is a selective serotonin reuptake inhibitor; side effects include hyponatremia. Phenelzine is a monoamine oxidase inhibitor; side effects include orthostatic hypotension. Imipramine and amitriptyline are tricyclic antidepressants; side effects associated with these drugs include dry mouth and blurred vision.

The primary healthcare provider prescribes a neuroleptic drug to a client diagnosed with schizophrenia. On what basis would the primary healthcare provider choose the drug? 1 Symptoms 2 Side effects 3 Therapeutic effects 4 Underlying pathology

2 Side effects First-generation antipsychotic drugs are also known as neuroleptics. The selection of these drugs is primarily based on side effects rather than therapeutic effects. Because all symptoms respond equally to antipsychotic drugs, the drug selection may not be based on symptoms. Because these drugs do not alter the underlying pathology, the selection may not be based on underlying pathology.

A client is to take an antipsychotic drug twice a day. Two-thirds of the daily dose is given in the evening and one-third in the morning. What will the nurse tell the client is the rationale for this schedule? 1 To facilitate dreaming 2 To maintain the daily sleep rhythm 3 To reduce sedation during the daytime 4 To decrease assaultiveness in the evening

3 Antipsychotic drugs tend to make the client listless or drowsy and can interfere with the ability to participate in the therapeutic regimen. Antipsychotic drugs do not induce rapid eye movement sleep, which is when most dreams occur. Antipsychotic drugs do not appreciably affect diurnal rhythms. Assaultiveness is associated with increased anxiety and is unrelated to the time of day.

The nurse is teaching a client who is receiving a monoamine oxidase inhibitor about dietary restrictions. The nurse plans to caution the client to avoid which foods? 1 Pork, spinach, and fresh oysters 2 Milk, grapes, and meat tenderizers 3 Cheese, beer, and products with chocolate 4 Leafy green vegetables, fresh apples, and ice cream

3 Cheese, beer, and products with chocolate are high in tyramine, which in the presence of a monoamine oxidase inhibitor can cause an excessive epinephrine-type response that can result in a hypertensive crisis.

A primary healthcare provider prescribes antipsychotic medication, and the nurse teaches the client about the possible side effects of the drug. The nurse concludes that the client needs further teaching about these side effects when the client reports plans to call the clinic if which problem occurs? 1 Tremors 2 Constipation 3 Blurred vision 4 Ringing in the ears

4 Otototoxicity is not side effect of antipsychotics. Signs of pseudoparkinsonism (e.g., tremors, rigidity, and bradykinesia) are common side effects of antipsychotics. The anticholinergic effect of antipsychotic medications can cause constipation, and it is a common gastrointestinal side effect. Vision changes and photosensitivity are common side effects of antipsychotic medications.

Which statement is true regarding antipsychotic drugs? 1 All first- and second-generation antipsychotics are equally effective. 2 Second-generation antipsychotics pose a risk of extrapyramidal symptoms. 3 First-generation antipsychotics pose a significant risk of metabolic side effects. 4 Clozapine is more effective than other second-generation antipsychotics.

4 Clozapine is more effective than other 2G antipsychotics. Clozapine is a second-generation antipsychotic drug that is more effective than other second-generation antipsychotics. Most (but not all) first- and second-generation antipsychotics are equally effective. Second-generation antipsychotics may cause metabolic side effects such as diabetes and dyslipidemia. First-generation antipsychotics may cause extrapyramidal side effects.

Which is the adverse effect of haloperidol? 1 Ataxia 2 Asthenia 3 Insomnia 4 Gynecomastia

4 Gynecomastia (increase in breast tissue in males) Haloperidol: first gen antipsychotic S/E EPS (dystonia, akathisia, & akinesia), TD, NMS; confusion, HA, dry mouth, amenorrhea, gynecomastia, visual disturbances, hyperpyrexia, edema, weight gain, urinary retention Asthenia: physical weakness Ataxia: lack of voluntary movement.

Which condition contraindicates the use of ginseng herbal therapy? 1Pregnancy 2Schizophrenia 3Bipolar depression 4Alzheimer disease

1 Pregnancy Ginseng: improvement of physical endurance, concentration, and stress reduction; s/e inc BP, CP, anxiety, insomnia, headache, NVD Contraindications: children and pregnant women Schizophrenia, bipolar depression, and Alzheimer disease are contraindicated for St. John's Wort herbal therapy

A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The primary healthcare provider prescribes the anticholinergic medication benztropine, 2 mg daily. What will the nurse assess the client for daily when administering these medications together? 1 Constipation 2 Hypertension 3 Increased salivation 4 Excessive perspiration

1 Constipation The anticholinergic activity of each drug is magnified, and adverse effects such as paralytic ileus may occur. Hypotension, dry mouth, and decreased perspiration occur with anticholinergic medications.

What drug does a nurse anticipate that the primary healthcare provider will prescribe for a client demonstrating clinical manifestations associated with an opioid overdose? 1Naloxone 2Methadone 3Epinephrine 4Amphetamine

1 Naloxone Naloxone is a narcotic antagonist that displaces opioids from receptors in the brain, thereby reversing respiratory depression. Methadone is a synthetic opioid that causes central nervous system depression; it will add to the problem of overdose. Epinephrine and amphetamine will have no effect on respiratory depression related to opioid overdose.

Which medications are used over the long-term to treat generalized anxiety disorder (GAD)? Select all that apply. 1 Duloxetine 2 Venlafaxine 3 Clonazepam 4 Escitalopram 5 Clomipramine

1, 2, 4 Duloxetine [Cymbalta] (ssnri), venlafaxine [Effexor] (ssnri), and escitalopram [Lexapro] (ssri) are antidepressants approved for the long-term treatment of generalized anxiety disorder (GAD). Clonazepam [Klonopin] is a benzodiazepine used for short-term relief of anxiety; it also induces sedation and can be used to treat panic disorders and anxiety-related depression. Benzodiazepines can be used for short-term management of GAD but are not recommended for long-term therapy. Clomipramine [Anafranil] is a tricyclic antidepressant and is used to manage panic disorder and obsessive-compulsive disorder (OCD).

Which antipsychotic drugs have the higher risk of causing tardive dyskinesia? Select all that apply 1 Loxapine 2 Quetiapine 3 Haloperidol 4 Ziprasidone 5 Olanzapine

1, 3 *First-generation antipsychotic* drugs such as loxapine and haloperidol may cause *tardive dyskinesia*, an extrapyramidal reaction. *Second-generation antipsychotic* drugs such as quetiapine, ziprasidone, and olanzapine have a lower risk of causing extrapyramidal reactions.

A client has been receiving fluphenazine for several months. The nurse will assess the client for which side effects? Select all that apply. 1 Tremors 2 Excess salivation 3 Rambling speech 4 Reluctance to converse 5 Uncoordinated movement of extremities

1, 5 Fluphenazine (Prolixin) is a 1G antipsychotic=high risk for EPS/TD/NMS. tremors and uncoordinated movements of the extremeties are s/s of acute dystonia, which are part of EPS

A client who has been taking the prescribed dose of zolpidem for 5 days returns to the clinic for a follow-up visit. When interviewing the client, the nurse identifies that the medication has been effective when the client makes which statement? 1 "I have less pain." 2 "I have been sleeping better." 3 "My blood glucose is under control." 4 "My blood pressure is coming down."

2 "I have been sleeping better." Zolpidem [Ambien] is a benzodiazepine-like drug; it is a sedative-hypnotic that produces CNS depression in the limbic, thalamic, and hypothalamic areas of the brain.

Nortriptyline three times a day is prescribed for a depressed client. When does the nurse expect a therapeutic response? 1 1 to 3 days 2 2 to 3 weeks 3 12 to 24 hours 4 30 minutes to 2 hours

2 2 to 3 weeks nortriptyline [Pamelor] is a TCA; therapeutic effects take 2-3 weeks

Which statement about primary anxiolytic drugs requires correction? 1 Benzodiazepines are indicated for ethanol withdrawal. 2 Benzodiazepines block gamma-aminobutyric acid receptors. 3 Benzodiazepines are first-line drugs used in chronic anxiety disorders. 4 Benzodiazepines act by depressing activity in the region of the brainstem.

2 Benzodiazepines block gamma-aminobutyric acid receptors. Benzodiazepines stimulate gamma-aminobutyric acid receptors, which reduces neuron excitability and produces an overall inhibitory effect. Apart from its indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the drug of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and limbic system.

A client with schizophrenia is started on a regimen of chlorpromazine. After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate 2 mg by mouth daily is prescribed. What does the nurse remember when administering these medications together? 1 Both medications are cholinesterase inhibitors. 2 Both medications have a cholinergic-blocking action. 3 The antipsychotic effects of chlorpromazine will be decreased. 4 The synergistic effect of these medications will cause drooling

2 Both medications have a cholinergic-blocking action. Both medications block central acetylcholine receptors. Neither medication inhibits cholinesterase; neostigmine (Prostigmin) acts in this manner. Although benztropine mesylate can cause mental confusion when given in large doses, it does not reduce the antipsychotic effect of chlorpromazine. Both medications cause dry mouth.

Which drug worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? 1 Buspirone 2 Duloxetine 3 Chlorpromazine 4 Lithium carbonate

2 Duloxetine [Cymbalta]: antidepressant used to treat GAD; can worsen uncontrolled angle-closure glaucoma 1 Buspirone [BuSpar]: antidepressant 3 Chlorpromazine [Remeron]: 1G antipsychotic; contraindicated-blood dyscrasias 4 Lithium Carbonate: treat manic episodes; contraindicated-renal disease

Which drug most commonly causes extrapyramidal side effects (EPS)? 1 Clozapine 2 Haloperidol 3 Risperidone 4 Aripiprazole

2 Haloperidol: 1G Antipsychotic Haloperidol is a typical antipsychotic that commonly causes extrapyramidal side effects. Clozapine is an atypical antipsychotic that has a low risk of causing extrapyramidal side effects. Risperidone and aripiprazole have a low risk of causing extrapyramidal side effects.

A client is started on chlorpromazine. To prevent life-threatening complications from the administration of this medication to an anxious, restless client, it is important that the nurse take which action? 1 Provide adequate restraint. 2 Monitor the client's vital signs. 3 Protect against exposure to direct sunlight. 4 Watch the client for extrapyramidal side effects

2 Monitor the client's vital signs. Chlorpromazine [Thorazine] (1G antipsychotic) Tachycardia, hyperpyrexia, and tachypnea are indications of *neuroleptic malignant syndrome*, which is a life-threatening complication. Restraint of any type may worsen the client's anxiety and result in struggling and increased agitation. Photosensitivity occurs most commonly when clients are taking large doses and are spending time outdoors in the sun, but it is not life threatening. Tardive dyskinesia results from prolonged large doses of phenothiazines in susceptible clients, but it is not life threatening.

A nurse notes that haloperidol is most effective for clients who exhibit which type of behavior? 1 Depressed 2 Overactive 3 Withdrawn 4 Manipulative

2 Overactive Haloperidol (1G antipyschotic) reduces emotional tension, excessive psychomotor activity, panic, and fear. It is used for clients with thought disorders and hyperactivity. Clients exhibiting excited-depressed behavior do not respond well to haloperidol, because it tends to worsen the depression. Haloperidol appears to have few stimulating effects for a withdrawn client and, in fact, increases feelings of lassitude and fatigue. Haloperidol does not decrease manipulative behavior. Clients who are capable of manipulation usually do not exhibit behavior that involves overactivity, fear, and panic.

Which drug is contraindicated in a pregnant client diagnosed with bipolar disorder? 1 Sertraline 2 Paroxetine 3 Venlafaxine 4 Despramine

2 Paroxetine [Paxil] (SSRI) may cause birth defects. Setraline [Zoloft] (ssri), Venlafaxine [Effexor] (ssnri), and Desipramine [Normramin] (tca) are all safe for pregnant women. They are all antidepressants

A client has been taking 3 mg of risperidone twice a day for the past 8 days. At the follow-up appointment, the client reports tremors, shortness of breath, a fever, and sweating. What will the nurse do? 1 Call 911 and have the client transported to the nearest psychiatric unit. 2 Take the client's vital signs and arrange for immediate transfer to a hospital. 3 Check the number of risperidone tablets left in the prescription bottle to see whether there was an overdose. 4 Request a prescription for 2 mg of intramuscular benztropine stat and assess the client in 10 to 15 minutes for symptom relief.

2 Take the client's vital signs and arrange for immediate transfer to a hospital. *NMS* cardinal sign is high body temperature. These clinical manifestations signal the presence of neuroleptic malignant syndrome; the cardinal sign of this condition is a high body temperature. Therefore the nurse first should document the hyperthermia and then arrange for immediate hospitalization. Unless the client is experiencing impaired ventilation, it is important to complete a focused assessment before transfer. The care needed can be provided in an emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant syndrome may occur without an overdose; this syndrome can occur when a high-potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after initiation of the medication. Benztropine will have little or no effect on neuroleptic malignant syndrome.

A client is diagnosed with acute mania. The primary healthcare provider plans to prescribe lithium therapy to the client. After assessing the client's condition, the primary healthcare provider changes the therapy. Which client conditions would cause the provider to change course? Select all that apply. 1 Glaucoma 2 Pregnancy 3 Atherosclerosis 4 Renal insufficiency 5 Severe dehydration

2, 3, 4, 5 Lithium therapy has been widely used to treat bipolar disorders and maniac episodes; cardiovascular diseases increase lithium toxicity. Therefore, it is contraindicated in clients with atherosclerosis. Lithium therapy is also contraindicated in clients with kidney related problems such as renal insufficiency. Dehydration causes electrolyte imbalances, which increases the risk of lithium toxicity. Lithium also may harm a fetus and, whenever possible, is not given to women who are pregnant. Clients with narrow-angle glaucoma should not be prescribed benzodiazepines.

The provider orders olanzapine for a client who experienced agranulocytosis when taking clozapine. Which statements indicate that the nurse's teaching about olanzapine has been effective? Select all that apply. 1 "I've got to remember to take my benztropine." 2 "I need to be careful not to gain too much weight." 3 "I might feel restless while I'm taking this medication." 4 "I need to be careful so I don't nick myself when I shave." 5 "This medication should help me enjoy fun activities again."

2, 5 Weight gain is a common side effect of olanzapine. Being an atypical antipsychotic, olanzapine affects the negative symptoms of schizophrenia, one of which is lack of pleasure (anhedonia). As an atypical antipsychotic, olanzapine has a decreased chance of extrapyramidal side effects and akathisia. It has no significant effect on blood clotting time.

A client is prescribed the benzodiazepine alprazolam for the management of panic attacks. The nurse is confident that the medication information discussed has been understood when the client takes which action? 1 Removes the pepperoni from a pizza 2 Asks for an extra bottle of flavored water to drink with dinner 3 Requests a prescription for oral birth control before being discharged 4 States that chewable antacids may be taken to relieve heartburn

3 Benzodiazepines increase the risk of congenital anomalies and so should not be taken by pregnant women. Refraining from eating pepperoni is appropriate for people taking monoamine oxidase inhibitors because tyramine needs to be strictly avoided. Appropriate hydration is critical for those taking lithium. Antacids can affect both absorption and metabolism of benzodiazepines and should be avoided.

A client is receiving an antipsychotic medication. When assessing the client for signs and symptoms of pseudoparkinsonism, the nurse will be alert for which complication? 1 Drooling 2 Blurred vision 3 Muscle tremors 4 Photosensitivity

3 Drug-induced parkinsonism presents with the classic triad of adaptations associated with Parkinson disease: rigidity, slowed movement (bradykinesia), and tremors. The anticholinergic effects of antipsychotic medication cause dry mouth, not drooling. Neither dry mouth nor drooling is related to pseudoparkinsonism. Blurred vision and photosensitivity are side effects of anticholinergic, not antipsychotic, medications.

A client with mental health problems is given a prescription for fluphenazine. The nurse develops a teaching plan about the medication. What will the nurse caution the client to avoid? 1 Eating cheeses 2 Nighttime driving 3 Staying in the sun 4 Taking drugs containing aspirin

3 Fluphenazine [Prolixin] (1G antipsychotic) causes photosensitivity; severe sunburn may occur with exposure to the sun. T he client should avoid eating cheese if she is taking a monoamine oxidase inhibitor, not fluphenazine, which is a phenothiazine. There are no known side effects of fluphenazine that affect the ability to drive at night. Aspirin is not contraindicated for clients taking fluphenazine.

A depressed client is prescribed citalopram hydrobromide. Six days later the client tearfully says to the nurse, "I'm taking an antidepressant, but it's not working. I'm hopeless." What is the best response by the nurse? 1 "You feel hopeless." 2 "It's easy to get discouraged." 3 "It takes 2 or 3 weeks before it begins to relieve depression." 4 "Give it a little more time; it works more slowly in some people."

3 Informing the client about the expected response to the medication is factual information that may decrease the client's sense of hopelessness. Although empathic responses may be helpful, at this time the client needs information and reassurance based on fact. Citalopram hydrobromide does not work more slowly in some people.

A client has been receiving lithium for the past 2 weeks for the treatment of bipolar disorder, manic phase. What will the nurse include in the teaching plan for this client? 1 A diuretic is necessary for anyone taking lithium. 2 Lithium must be taken for the rest of the client's life. 3 The blood level of lithium must be checked every month. 4 A low-sodium diet must be followed while lithium is being taken.

3 Lithium's therapeutic window is very narrow, and a toxic level may accumulate in the body unless routine checks of the drug's concentration in the blood are performed. acute phase of mania: therapeutic blood level of lithium 1.0-1.5 mEq/L maintenance therapeutic blood level 0.5-1.2 mEq/L Diuretics reduce sodium and should be avoided; lithium is not excreted when the sodium level is decreased, resulting in toxicity. Lithium may or may not need to be taken for the rest of a client's life. A low-sodium diet can lead to hyponatremia, which must be avoided because it limits the excretion of lithium, resulting in toxicity.

A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client? 1 Constricted pupils 2 Intractable diarrhea 3 Increased heart rate 4 Decreased respirations

3 Increased Heart Rate Methamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system. The pupils will dilate because the sympathetic nervous system is activated. Clients withdrawing from opioids experience diarrhea. The respirations will be increased because of the activation of the sympathetic nervous system.

Which drug may lead to bruxism? 1 Vilazodone 2 Isocarboxazid 3 Clomipramine 4 Levomilnacipran

4 Levomilnacipran [Fetzima] (ssnri) treats depression Vilazodone [Viibryd] (ssri): tx depression Isocarboxazid [Marplan] (MAOI) tx depression Clomipramine [Anafranil] (tca) tx: depression OCD bruxism: grinding/gnashing of teeth

A client is receiving carbamazepine for the treatment of a manic episode of bipolar disorder. What does the nurse include when planning client teaching about this medication? Select all that apply. 1 "You have to eat a low-sodium diet every day." 2 "You'll have to take a diuretic with this medication." 3 "You'll have to take this medication for the rest of your life." 4 "You may want to suck on sugar-free hard candy when you get a dry mouth." 5 "We'll need to test your blood often during the first few weeks of therapy."

4, 5 Sucking on hard candy or frequent rinsing may relieve a dry mouth, a side effect of carbamazepine. Carbamazepine can cause severe bone marrow depression in the early phase of therapy. Also, the drug level needs to be checked frequently to ensure a therapeutic level. A low-sodium diet is not required; nor is a diuretic. The client may or may not have to take the medication for life.