Psych Pharm Exam 1 practice questions

19. Your patient with major depression tells you he suffers from urinary retention. Which medication would be most likely to cause this? A. Amitriptyline B. Duloxetine C. Carbamazepine D. Ritalin

A. Amitriptyline this is a TCA - known to cause anticholinergic effects

A young male patient taking an antipsychotic is experiencing an oculogyric crisis. The nurse prepares to administer: a. diphenhydramine. b. haloperidol. c. aripiprazole. d. risperidone

A. Diphenhydramine (Benedryl) Acute dystonic reactions may be controlled by intramuscular injections of diphenhydramine. Haloperidol, aripiprazole, and risperidone are not used for dystonic reactions.

After teaching a group of nursing students about the neurobiologic theories of depression, the instructor determines the need for additional teaching when the students identify which neurotransmitter as playing a role? A) Gamma-amino butyric acid (GABA) B) Norepinephrine C) Serotonin D) Dopamine

A. GABA

22. Which drug(s) interact(s) with SSRI agents? (Select all that apply.) a. Tranylcypromine (Parnate) b. Lithium (Eskalith) c. Warfarin (Coumadin) d. Furosemide (Lasix) e. Propranolol (Inderal)

A. Tranylcypromine (Parnate) B. Lithium (Eskalith) C. Warfarin (coumadin) E. propranolol (Inderal) A 14-day lapse is recommended between MAOIs, such as Parnate, and SSRI agents. The incidence of lithium toxicity is increased with SSRI agents. The anticoagulant effects of warfarin may be enhanced with SSRIs. The SSRIs fluvoxamine and citalopram inhibit the metabolism of beta adrenergic blocking agents such as propranolol. Lasix does not interact with SSRI agents.

The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the clients vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? A) A white blood cell count B) Liver function studies C) Serum potassium level D) Serum Sodium level

A. a white blood cell count

Which adverse effect(s) may occur as a result of antipsychotic drug therapy? (Select all that apply.) a. Acute dystonia b. Akathisia c. Weight loss d. Neuroleptic malignant syndrome e. Hypoglycemia f. Tardive dyskinesia

A. acute dystonia B. akathisia D. neuroleptic malignant syndrome F. tardive dyskinisia Antipsychotic drugs can cause neuroleptic malignant syndrome and motor dysfunctions such as dystonia, akathisia, and tardive dyskinesia. Antipsychotic drugs may cause weight gain and hyperglycemia.

The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests for the first 6 months of treatment to monitor for which potential complication? a. Agranulocytosis b. Vitamin deficiencies c. Clotting abnormalities d. Polycythemia

A. agranulocytosis The use of clozapine requires a baseline and weekly white blood cell (WBC) counts because of the high incidence of agranulocytosis. Clozapine does not cause vitamin deficiencies. Clozapine does not interfere with clotting abilities. Clozapine does not affect red blood cell volume.

The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinsons disease. Which agent would the nurse expect the physician to prescribe? A) Anticholinergic B) Anxiolytic C) Benzodiazepine D) Beta Blocker

A. anticholingergic

Which nursing action is most important when providing care to a patient diagnosed with a mood disorder? a. Assess the patient for thoughts of suicide. b. Provide supplemental feedings as needed. c. Assist with activities of daily living. d. Offer opportunities for interaction with other patients.

A. assess the patient for thoughts of suicide Determining if there is a risk for suicide, monitoring at specified intervals, and providing patient safety and supervision are the highest priorities with severe mood disorders. Providing supplemental feedings, assisting with activities of daily living, and offering opportunities for interaction with other patients are not priorities of care.

A patient admitted with the diagnosis of schizophreniform disorder R/O organic pathology. Based on this information, the nurse can expect that the patient will: a. Be scheduled for a magnetic resonance imaging (MRI) test b. See a mental health specialist for extensive psychological testing c. Have an immunologic assay performed within 2 days of the admission d. Participate in a dexamethasone suppression test (DST) administered by the staff

A. be scheduled for an MRI

19. Which food(s) containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy? (Select all that apply.) a. Beer b. Red meat c. Aged cheeses d. Green vegetables e. Bananas

A. beer C. aged cheeses E. bananas

The nurse is caring for a patient who is taking a newly prescribed drug, nefazodone, for treatment of depression. Which physical assessment finding is most important for the nurse to report to the health care provider immediately? a. Bradycardia b. Dizziness c. Drowsiness d. Urinary retention

A. bradycardia Bradycardia with a drop in 15 beats/min is to be reported to the health care provider immediately; withholding the dose is warranted until approved. Dizziness, drowsiness, and urinary retention are common adverse effects that would not need to be reported to the health care provider.

20. Which nursing assessment(s) is/are important before the initiation of antidepressant therapy?(Select all that apply.) a. Compliance with medication therapy within the last 2 months b. Nonverbal interactions among patient and significant others present c. Evaluation of the coherency, relevancy, and organization of thoughts in responses d. Appearance and posture e. Elimination pattern

A. compliance with medication therapy within the last 2 months B. nonverbal interactions among patient and significant others present C. evaluations of the coherency, relevancy, and organization of thoughts in responses D. appearance and posture Compliancy with prescribed medications over the last 2 months provides the health care provider with information regarding the patients state of mind and ability to follow through with medication administration independently. Patients with altered thought processes often display inconsistencies between statements of feelings and behavior norms in social settings. Coherency, relevancy, and organization of thoughts are often affected by thought disorders. This assessment also provides information regarding the accuracy of other information that the patient has offered. Note general appearance and appropriateness of attire and posture because these are often affected by mood disorders. Elimination pattern is not a priority premedication assessment.

A patient with bipolar disorder reveals to the clinic nurse that she may be 4 weeks pregnant. Which action will the nurse take? a. Confer with the physician about ordering a pregnancy test and discontinuing lithium. b. Educate the patient to the risk to the fetus as a result of exposure to the lithium in her blood. c. Suggest to the physician that the lithium dose should be increased for better symptom control. d. Remind the patient that barrier birth control methods should be used to prevent pregnancy during lithium therapy.

A. confer with the physician about ordering a pregnancy test and discontinuing lithium. The first need is to learn whether the patient is pregnant. Lithium ingestion by the mother can cause fetal damage. Lithium should be discontinued, not increased, if pregnancy is confirmed. It is premature to discuss fetal malformations before thepregnancy is confirmed. Options b and c are inappropriate and harmful. Birth control information has no value unless the pregnancy test is negative.

A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? A) Diphenhydramine (Benadryl) B) Propranolol (Inderal) C) Risperidone (Risperdal) D) Aripiprazole (Abilify)

A. diphenydramine (benedryl)

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? A) Dopamine B) Serotonin C) Norepinephrine D) Gamma-amino butyric acid (GABA)

A. dopamine

What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil)? (Select all that apply.) a. Dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem. b. Rise slowly from a supine or sitting position to avoid dizziness and orthostatic hypotension. c. Avoid alcohol and barbiturates. d. If adverse effects occur, discontinue the medication. e. An immediate elevation in mood will be noted.

A. dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem B. rise slowly from a supine or sitting position to avoid dizziness and orthostatic hypotension C. avoid alcohol and barbituates Common adverse effects associated with tricyclic antidepressants are dry mouth and orthostatic hypotension. Alcohol and barbiturates should be avoided while taking tricyclic antidepressants because they enhance sedation.Adverse effects are likely to occur, and the medication should not be discontinued without the direction of the health care provider. Tricyclic antidepressants typically take several weeks to produce a therapeutic effect

Which type of adverse effects is present when a patient displays prolonged tonic contractions of the tongue, oculogyric crisis, and torticollis? a. Dystonic reactions b. Pseudoparkinsonism c. Akathisia d. Tardive dyskinesia

A. dystonic reactions Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is taking antipsychotic agents. Dystonias are spasmodic movements of muscle groups such as tongue protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms (trismus), or neck torsion (torticollis). Pseudoparkinsonism is characterized by tremor and rigidity. Akathisia is characterized by subjective feelings of anxiety and restlessness, accompanied by pacing and the inability to remain in one place for extended periods. Tardive dyskinesia is characterized by persistent involuntary hyperkinetic movements.

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately? A) Elevated temperature B) Tremor C) Decreased blood pressure D) Weight gain

A. elevated temperature

Dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia are types of which effect? a. Extrapyramidal symptoms b. Allergic reactions c. Idiosyncratic reactions d. Therapeutic responses

A. extrapyramidal symptoms There are four categories of extrapyramidal symptoms: dystonic reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. These are not allergic reactions, idiosyncratic reactions, or therapeutic responses.

Which sign(s) and symptom(s) may occur in neuroleptic malignant syndrome? (Select all that apply.) a. Fever b. Hypertension c. Severe extrapyramidal symptoms d. Alterations in consciousness e. Bradycardia

A. fever B. hypertension C. severe extrapyramidal symptoms D. alterations in consciousness Fever, severe extrapyramidal symptoms, hypertension, and alterations in consciousness (such as stupor, mutism, and coma) are characteristic of neuroleptic malignant syndrome. Bradycardia is not a sign of neuroleptic malignant syndrome.

A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage? a. HydroDIURIL daily b. Navane bid c. Ativan at bedtime d. Cefobid daily

A. hydroDIURIL daily Diuretics alter fluid and electrolyte balance, increasing risk for lithium toxicity; therefore HydroDIURIL is correct. Antipsychotic medications are frequently prescribed concurrently with lithium to manage acute symptoms of mania, so no re- evaluation of lithium dose is necessary for Navane. Antianxiety drugs are not contraindicated with concurrent lithium use, so no lithium dose re-evaluation is necessary for Ativan. Antibiotics do not alter fluid and electrolyte balance, so readjustment of lithium dosage is not required for Cefobid.

Your patient takes tranylcypromine for depression. Which of the following is most likely to indicate dietary restrictions have not been followed? A. Hypertensive crisis B. Syncope C. Muscle spasms D. Increased depression

A. hypertensive crisis Tranylcypromine is a MAOI. eating restricted foods can trigger a hypertensive crisis

6. Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen? a. I will restrict my daily salt intake. b. I will take my medications with food. c. I will have my blood drawn on schedule. d. I will drink 8 to 12 glasses of liquids daily.

A. i willl restrict my daily salt intake Patients taking lithium must maintain a normal sodium intake or risk symptoms of lithium toxicity. The patient should have 2 to 3 liters of fluid daily. Taking lithium with food minimizes gastrointestinal side effects. Regular monitoring of lithium levels is important to prevent toxicityq

Which statement is most true about depression? A. It is more common in women than men. B. It is rare to have more than one episode of major depression in ones lifetime. C. Young children do not suffer from depression. D. As one ages, there is reduced risk of depression.

A. it is more common in women than men

Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith) who is being discharged? (Select all that apply.) a. Persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the health care provider immediately. b. It is important to comply with schedules for blood tests to assess therapeutic levels. c. You should avoid foods such as Chianti wine and aged cheeses. d. The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve. e. You will be gradually weaned off this medication. f. Take the medication with food or milk.

A. persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the health care provider immediately B. it is important to comply with schedules for blood tests to assess therapeutic levels D. The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve F. take the medication with food or milk

14. Which is/are extrapyramidal adverse effect(s) of antipsychotic agents? (Select all that apply.) a. Spasmodic movements of muscle groups b. Masklike expression c. Lip smacking d. Inability to sit in one place for an extended period e. Weight gain

A. spasmodic movements of muscle groups B. masklike expression C. lip smacking D. inability to sit in one place for an extended period Antipsychotic drug therapy often causes substantial weight gain, but this is not classified as a extrapyramidal adverse effect.

The nurse is caring for a client in the outpatient setting who has been diagnosed with a depressive disorder. Before the client is given a prescription for a tricyclic antidepressant, assessment for which of the following would be most important? A) Suicide B) Hypersomnia C) Cardiac arrhythmia D) Erectile dysfunction

A. suicide

Which outcomes would be appropriate to determine early favorable response to antidepressant medication? a. The patient will complete own self-care activities. b. The patient will demonstrate assertive communication skills. c. The patient will describe signs and symptoms of major depression. d. The patient will make plans to attend one community social activity a week.

A. the patient will complete own self-care activities

15 the nurse is developing a teaching plan for a client who is prescribed escitalopram. Which of the following side effects would the nurse include in this plan? Select all that apply. A) Weight gain B) Decreased sexual interest C) Sedation D) Blurred vision E) Urinary retention F) Dry mouth

A. weight gain B. decreased sexual interest

The nurse is teaching a patient about medication treatment for depression. The patient asks how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate? a. 3 days b. 1 week c. 4 weeks d. 2 months

B. 1 week. The physiological manifestations of depression (sleep disturbance, change in appetite, loss of energy, fatigue, palpitations) begin to be alleviated within the first week of therapy. It takes longer than 3 days for the symptoms to improve. Four weeks and 2 months are longer than it takes for the symptoms to improve

Helen, a 47-year-old client with a long history of severe depression, has not responded to antidepressant medications or psychotherapy. The nurse caring for the patient knows that the treatment of choice for depression unresponsive to conventional treatment would be: A. Lithium. B. Electroconvulsive therapy (ECT). C. Light therapy. D. Neurolinguistic programming.

B. ECT ECT is sometimes needed in cases of severe depression that are unresponsive to antidepressants

Your depressed patient is just started on duloxetine (Cymbalta). Which statement by the spouse tells you that family teaching has been effective? A. I cant wait for him to be back to his old self in the next day or so. B. I realize we cant expect big changes right away. C. I have to take him for weekly blood tests to monitor the drug dosage. D. I will make sure he doesnt eat any aged cheese for the next 2 months until the dose is stabilized.

B. I realize we cant expect big changes right away

Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin? a. Meperidine (Demerol) b. Morphine c. Ibuprofen (Advil) d. Acetaminophen (Tylenol)

B. Morphine Morphine is the narcotic analgesic of choice because it will not interact with the patients MAOI. Meperidine will interact with the patients medication. Ibuprofen and acetaminophen are not narcotic analgesics.

Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant drugs? (Select all that apply.) a. MAOIs block the effects of dopamine in the CNS. b. SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft. c. Tricyclic antidepressants block the action of norepinephrine and epinephrine in the SNS. d. Monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action. e. SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine.

B. SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft D. monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action E. SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine. SSRIs block the destruction and storage of serotonin at the synaptic cleft, therefore increasing the amount of serotonin available. Monocyclic antidepressants have an unknown mechanism of action. They are weaker inhibitors of the reuptake and inactivation of the neurotransmitters serotonin norepinephrine and dopamine. SNRIs act by inhibiting the reuptake and destruction of serotonin and norepinephrine and, to a lesser extent, dopamine, from the synaptic cleft, thereby prolonging the action of the neurotransmitters. MAOIs act by blocking the metabolic destruction of dopamine, so concentration is increased. Tricyclics block the reuptake of neurotransmitters, not their effects.

Which of the following drugs is a tricyclic antidepressant? A. Bupropion (Wellbutrin) B. Amitriptyline (Elavil) C. Fluoxetine (Prozac) D. Citalopram (Celexa)

B. amitriptyline (elavil)

The wife of a patient diagnosed with paranoid schizophrenia asks I've been told that my husband's illness is probably related to imbalanced brain chemicals. Can you be more specific? The response based on the dopamine hypothesis is: a. Breakdown of dopamine produces LSD, which in large amounts produces psychosis. b. An increase in the brain chemical dopamine explains the presence of delusions and hallucinations. c. Decreased amounts of the brain chemical dopamine explain the presence of delusions and hallucinations. d. An increase in the brain chemical dopamine explains the presence of lack of motivation and disordered affect

B. an increase in the brain chemical explains the presence of delusions and hallucinations

Some medications such as tricyclics cause blurred vision. What is the cause of this effect? A. Hyperglycemia B. Anticholinergic effect C. Hypoxia D. Hypertension

B. anticholinergic effect

Why is a combination of antipsychotic agents with benzodiazepines useful in initial treatment of the agitated patient? (Select all that apply.) a. Antipsychotics are not effective for 2 days. b. Benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high dose therapy. c. It assists in calming the psychotic patient. d. It allows for rapid increase in dosing of the antipsychotic agents to expedite treatment of hallucinations. e. It effectively treats extrapyramidal adverse effects associated with antipsychotic agents.

B. benzodiazepines allow for lower dosages of antipsychotic agents to be used, thereby decreasing serious adverse effects seen with high dose therapy. C. It assists in calming the psychotic patient The use of benzodiazepines allows lower dosages of antipsychotic agents to be used. Benzodiazepines assist in calming the agitated psychotic patient. Antipsychotic medications can be effective in a matter of minutes when injected. Benzodiazepines do not facilitate the increase of antipsychotic medications or treat extrapyramidal adverse effects associated with antipsychotic agents.

After assessing a client with schizophrenia, the nurse suspects that the client is experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply. A) Dilated reactive pupils B) Blurred vision C) Ataxia D) Coherent speech E) Facial pallor F) Disorientation

B. blurred vision C.ataxia F. disorientation

6. A client is prescribed phenelzine (Nardil) to treat her depression. She is at a local caf for lunch with a friend. Which of the following items on the menu would be least appropriate for the client to order? A) Roast beef, mashed potatoes, and gravy B) A Cobb salad with blue cheese and Roquefort salad dressing C) Scrambled eggs, toast, and grape jelly D) Medium-well steak, French fries, and broccoli

B. cobb salad with blue cheese and roquefort salad dressing

What is the basis for the reduction in disturbed thought processes when a patient is administered haloperidol (Haldol)? a. Reduction in the number of brain cells that crave dopamine b. Dopamine receptors are blocked, making dopamine less available c. Dopamine receptors are enhanced, making more dopamine available d. Medication causes an increased cellular production of dopamine

B. dopamine receptors are blocked, making dopamine less available

The nurse must be sure to instruct the patient about which potential adverse effect(s) of tricyclic antidepressants? (Select all that apply.) a. Diarrhea b. Dryness of mouth, nose, and throat c. Constipation d. Nocturia e. Urinary retention f. Blurred vision

B. dryness of mouth, nose, and throat C. constipation E. urinary retention F. blurred vision The patient may experience difficulty with dryness of the mouth, nose, and throat as well as smooth muscle contraction (resulting in constipation, urinary retention, and blurred vision). Diarrhea and nocturia are not adverse effects of tricyclic antidepressants.

12. What is the main difference between major depression and dysthymic depression? A. Dysthymia is a short-term depression and major depression lasts for years. B. Dysthymia is a chronic, low-level depression that lasts for years, while major depression is more severe. C. Dysthymia is more likely to be caused by psychological factors and major depression is caused by neurological dysfunction. D. Dysthymia is normally treated with psychotherapy only, while major depression is treated with antidepressants and psychotherapy.

B. dysthymia is a chronic, low-level depression that lasts for years, while major depression is more severe

13. Your depressed patient is starting a new medication called phenelzine (Nardil). Which teaching would be most important to emphasize? A. Educate the patient to take this medication ongoing, even as symptoms improve. B. Instruct the patient and family about the many food-drug interactions. C. Instruct the patient about interventions to relieve dry mouth. D. Inform the patient that this medication takes 4 to 6 weeks to take full effect.

B. instruct the patient and family about many food-drug interactions Nardil is an MAOI !!

Which of the following is an important intervention for a patient taking nortriptyline? A. Make sure that CBC is ordered to monitor blood counts. B. Monitor for anticholinergic side effects. C. Ensure that the patients diet is gluten free. D. Push fluids to prevent dehydration.

B. monitor for anticholinergic side effects

The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the clients eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? A) Akathisia B) Oculogyric crisis C) Retrocollis D) Tardive dyskinesia

B. oculogyric crisis

Which statement is true regarding the adverse effects associated with antipsychotic medications? a. Tardive dyskinesia is a common, reversible condition. b. Painful dystonic reactions can occur in the first 72 hours of initiation of therapy. c. Neuroleptic malignant syndrome (NMS) is a common adverse effect. d. Pseudoparkinsonian symptoms can cause Parkinsons disease.

B. painful dystonic reactions can occur in the first 72 hours of initiation of therapy Approximately 90% of all dystonic reactions occur in the first 72 hours of antipsychotic therapy. These symptoms are often frightening and painful. Tardive dyskinesia is present in 20% to 25% of patients and may become irreversible. NMS is not a common adverse effect. Pseudoparkinsonism is not related to Parkinsons disease

On what is the choice of tricyclic antidepressants based? a. The need to decrease the action of norepinephrine, dopamine, or serotonin b. Patient age and gender c. An absence of adverse effects, such as orthostatic hypotension d. The need for stimulation and increased mental alertness

B. patient age and gender The choice of tricyclic antidepressants is based on their individual therapeutic characteristics. Tricyclics prolong the action of norepinephrine, dopamine, and serotonin. All tricyclics produce orthostatic hypotension to some degree. All tricyclics produce sedation, not stimulation.

The psychiatric nurse is educating an elderly patient and family about antipsychotic drug therapy. When providing this education, the nurse will include which statement(s)? (Select all that apply.) a. Hallucinations may be reduced within 1 week of starting. b. Rapid increase in dosages will increase frequency of adverse effects. c. Older patients should be observed for hypertension. d. Tardive dyskinesia may be reversible in early stages e. Full therapeutic response may require 6 to 8 weeks to be achieved

B. rapid increases in dosage will increase the frequency of adverse effects D. Tardive dyskinesia may be reversible in early stages E. full therapeutic responses may require 6 to 8 weeks to be achieved. Rapid increases in dosages of antipsychotic medication will not reduce the antipsychotic response time but will increase the frequency of adverse effects. Tardive dyskinesia may be reversible in early stages, but it becomes irreversible with continued use of the antipsychotic medication. Reduction in hallucinations, delusions, and thought disorders often requires 6 to 8 weeks for a full therapeutic response to be achieved. Older patients should be observed for hypotension.

Biological theories of depressive disorders include all of the following except: A. Chemical imbalances are responsible. B. The patient experiences maladaptive thought processes. C. There are genetic tendencies that run in families. D. Hormonal factors make women more susceptible than men

B. the patient experiences maladaptive thought processes. ACD are all biological contributing factors to depression

What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy? a. Complying with this therapy will cure your depression. b. This medication is expected to improve brain chemical imbalance. c. Amitriptyline will help re-establish your ability to think clearly again. d. Elavil will be particularly effective at assisting you in regaining your independence.

B. this medication is expected to improve brain chemical balance

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following? A) He needs to have an electrocardiogram periodically when taking this drug. B) Well need to make sure that he has his blood count checked at least weekly. C) He might develop toxic levels of the drug if he smokes cigarettes. D) We need to watch to make sure that he doesnt lose too much weight.

B. we'll need to make that he has his blood count checked at least weekly

What is the most common cause of nonadherence to antipsychotic pharmacologic treatment? a. Expense b. Increased symptoms of chemical dependency c. Extrapyramidal effects d. Inability of the patient to understand the need to take medications

C. Extrapyramidal effects

What response would be anticipated when a patient who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia is switched to Seroquel (quetiapine)? a. Development of pseudoparkinsonism b. Development of dystonic reactions c. Improvement in tardive dyskinesia d. Worsening of anticholinergic symptoms

C. Improvement of tardve dyskinesia Atypical antipsychotics have been noted to block oral dyskinesia and improve tardive dyskinesia as well as improve both positive and negative symptoms of schizophrenia. Pseudoparkinsonism and dystonic reactions are associated with typical antipsychotic medication. Anticholinergic symptoms are not intense with the use of atypical antipsychotic medication.

Which is an appropriate nursing intervention for a patient who has recently been prescribed clozapine (Clozaril)? a. Assess for signs and symptoms of hypoglycemia. b. Encourage a low fiber diet. c. Measure the patients waist circumference. d. Monitor for insomnia.

C. Measure the patients waist circumference Waist circumference baseline measurement is appropriate because of the weight gain and onset of diabetes with use of these medications. Hypoglycemia and insomnia do not occur with this medication. A low fiber diet is not appropriate.

During a treatment team meeting, the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (5HT2) excess will suggest that the patient receive: a. Haloperidol (Haldol) b. Chlorpromazine (Thorazine) c. Olanzapine (Zyprexa) d. Phenelzine (Nardil)

C. Olanzapine (Zyprexa) Olanzapine is an atypical antipsychotic. Atypical antipsychotic medications are more effective than typical antipsychotics in blocking serotonin receptors and reducing the negative symptoms of schizophrenia. Haloperidol (Haldol) and chlorpromazine (Thorazine) are typical antipsychotic medications while phenelzine (Nardil) is an MAOI antidepressant.

After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a secondgeneration antipsychotic agent? A) Fluphenazine (Prolixin) B) Thiothixene (Navane) C) Quetiapine (Seroquel) D) Chlorpromazine (Thorazine)

C. Quetipaine (seroquel)

13. A client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. Johns wort to feel better. The nurse assesses the client for which of the following? A) Water intoxication B) Increased depressive symptoms C) Serotonin syndrome D) Hypertensive crisis

C. SEROTONIN SYNDROME

A patient with schizophrenia has been nonadherent with his home medication regimen. He requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic episodes. Which medication regimen would be appropriate for this patient? a. Daily home nursing visits to administer the prescribed oral medication b. Continuous inpatient hospitalization for medication therapy c. Administration of depot antipsychotic medication d. Subcutaneous medication administration

C. administration of depot antipsychotic medication Depot antipsychotic medications are long acting injections that may be used with noncompliant patients and may assist in avoiding repeated hospital admissions. Daily home nursing visits are not an efficient way to ensure medication compliance.

Lithium (Eskalith) is the drug of choice for which of the following disorders? a. Psychotic episodes b. Obsessive compulsive disorders (OCDs) c. Bipolar disorders d. Depressive disorders

C. bipolar disorders

What is the action of MAOIs on neurotransmitters? a. Blocking their reuptake b. Increasing their production c. Blocking their destruction d. Increasing their reuptake

C. blocking their destruction MAOIs act by blocking the metabolic destruction of epinephrine, norepinephrine, dopamine, and serotonin neurotransmitters by the enzyme monoamine oxidase in the presynaptic neurons of the brain. They prevent the degradation of these central nervous system (CNS) neurotransmitters so that their concentration is increased.

Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety? a. Excessive thirst b. Hand tremor c. Drowsiness d. Diarrhea

C. drowsiness Drowsiness is a common adverse effect, and people who work with machinery, drive a car, administer medicines, or perform other duties in which they must remain mentally alert should not take trazodone while working. Excessive thirst, hand tremors, and diarrhea are not an adverse effect associated with trazodone

A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is: a. nausea. b. imbalanced nutrition (less than body requirement) c. fluid volume deficit. d. altered peripheral tissue perfusion

C. fluid volume defecit

Which of the following meal choices indicates the patient understands the diet restrictions when taking an MAOI? A. Pepperoni pizza and beer B. Roast chicken, baked potato, and beer C. Fried fish, rice, and cola D. Pickled herring, eggs, and coffee

C. fried fish, rice, and cola`

The nurse is preparing 0800 medications for a patient with the medical diagnosis of end stage renal disease. When reviewing the medication administration record (MAR), the nurse notices the patient is scheduled to receive an MAOI drug. Which intervention(s) will the nurse perform before administering the drug? (Select all that apply.) a. Assess temperature. b. Provide an alternative drug. c. Hold the MAOI drug. d. Consult with the prescribing health care provider. e. Assess urine output prior to administration

C. hold the MAOI drug D. consult with the prescribing health-care provider If the patient prescribed an MAOI drug has a history of severe renal disease, the medication must not be given and the prescribing health care provider consulted. It is not necessary to assess temperature at this time. An alternative medication needs to be ordered by a health care provider licensed to prescribe. Assessing urine output does not apply to this situation

The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states: a. I can stop my lithium when I feel better. b. I can continue with my diuretic and cardiac medications. c. I will probably need to take the lithium for the rest of my life. d. I will taper my lithium when a therapeutic serum level is achieved.

C. i will probably need to take the lithium for the rest of my life Most patients with bipolar disorder require long-term maintenance on lithium or other antimanic medication. Patients should never stop medication without consulting the physician. When a therapeutic level is achieved, the patient will continue on maintenance doses of lithium. Diuretics are contraindicated for the patient on lithium.

The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation. Which statement by the patient would indicate the need for further teaching? a. My dose will increase after 3 days. b. I should swallow this medication whole. c. If I have the urge to smoke, I will take more medication. d. I do not need to taper my dose when the drug is discontinued

C. if i have the urge to smoke, i will take more medication Dosage will begin at 150 mg/day for the first 3 days and then, for most patients, be increased to 300 mg/day. The patient is maintained on doses of 300 mg/day for 7 to 12 weeks and dosage is not based on a desire to smoke. Bupropion should be swallowed whole, not crushed, divided, or chewed. Dose tapering is not required when discontinuing bupropion.

A patient is admitted to a long term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _________ the MAOI drug. a. immediately following the last dose of b. in 1 week following the last dose of c. in 14 days following the last dose of d. before discontinuing

C. in 14 days following the last dose of MAOIs and TCAs, especially imipramine and desipramine, should not be administered concurrently. It is recommended that at least 14 days lapse between discontinuing an MAOI and starting SSRI/SNRI therapy.

To what does potency of an antipsychotic medication refer? a. Severity of adverse effects associated with the drug b. Length of time that it takes to reach a therapeutic blood level of the drug c. Milligram doses used for the medication d. Effectiveness of the drug in alleviating psychotic behavior

C. milligram doses used for the medication Low and high potency refers only to the milligram doses used for the medications and does not suggest any difference in effectiveness. Potency is not related to severity of adverse effects or onset of action. Potency does not refer to effectiveness.

A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication? a. Constipation b. Hypotension c. Neck stiffness d. Urinary retention

C. neck stiffness

A nurse is preparing an in-service program for a group of psychiatricmental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse? A) Lack of family support B) Accessibility to community resources C) Non-adherence to prescribed medications D) Stigmatization of mental illness

C. non-adherence to prescribed medications

Which of the following antidepressants is a tricyclic? A. Bupropion (Wellbutrin) B. Sertraline (Zoloft) C. Nortripyline (Pamelor) D. Venlafaxine (Effexor)

C. notripyline

11. You are doing patient teaching for Margaret, who has been prescribed amitriptyline (Elavil) for treatment of depression. Which of the following statements suggests that Margaret needs further instruction? A. I know I might not start feeling better for a few weeks, but Ill keep taking the medication just as the doctor prescribed. B. Ill keep some hard candies in my purse in case my mouth gets dry from the medicine. C. Once I start feeling better, Im looking forward to cutting down on this medication. D. Im worried I may gain some weight, but thats a small price to pay for feeling better.

C. once i start feeling better, I'm looking forward to cutting down on this medication

What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy? a. They are less expensive than the other classes of antidepressants. b. They cure major depressive illnesses. c. They do not cause anticholinergic and cardiovascular adverse effects. d. Therapeutic relief is immediate.

C. they do not cause the anticholinergic and cardiovascular adverse effects SSRIs are the most widely used class of antidepressants. Although they are as effective in treating depression as the tricyclic antidepressants, they do not cause the anticholinergic and cardiovascular adverse effects that often limit the use of tricyclic antidepressants. SSRIs tend to be more expensive than other available antidepressants.

A client diagnosed with major depression was prescribed imipramine (Tofranil) and has been taking this medication for 1 week. The client took his last dose of imipramine (Tofranil) at 9:00 PM. The client is scheduled to have blood drawn to monitor the medication level the next morning. The nurse should instruct the client to have his blood drawn as close as possible to which time? A) 6:00 AM B) 7:00 AM C) 8:00 AM D) 9:00 AM

D. 0900 Am

When assessing a client for possible disordered water balance, the nurse checks the clients urine specific gravity. Which result would lead the nurse to suspect that the client is experiencing severe disordered water balance? A) 1.020 B) 1.011 C) 1.005 D) 1.002

D. 1.002

A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis? a. Uses a rhyming form of speech b. Refuses to eat any unwrapped foods c. Laughs when watching a sad movie d. Maintains an immobilized state for hours

D. Maintains an immobilized state for hours

Your patient has been taking a SSRI antidepressant for 6 weeks. On arrival at the clinic, which observation would indicate a positive outcome from the medication? A. Patient reports sleeping 12 hours a night. B. Patient reports sleeping 3 hours a night. C. Patient reports a weight loss of 10 pounds. D. Patient arrives neatly dressed.

D. Patient arrives early, neatly dressed

20 The nurse is reviewing the medical record of a client diagnosed with depression and notes that the client has been prescribed mirtazapine. The nurse interprets this information, identifying this agent as which type? A)Selective serotonin reuptake inhibitor B) Cyclic antidepressant C) Norepinephrine dopamine reuptake inhibitor D) Alpha-2 antagonist

D. alpha-2 antagonist

A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following? A) Weight loss B) Hypertension C) Diarrhea D) Diabetes

D. diabetes

Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts? a. Accept that delusion is illogical. b. Distinguish external boundaries. c. Explain the basis for the delusions. d. Engage in reality-oriented conversation.

D. engage in reality-oriented conversation

You are admitting a new patient who is depressed. Your initial contact should do what? A. Address why he is depressed B. Keep communication open C. Lift his spirits D. Establish trust

D. establish trust

A patient prescribed an antipsychotic medication develops a high fever, unstable blood pressure, and muscle rigidity. Her next dose of medication is due. The nurse should: a. Administer the medication and monitor the vital signs every 4 hours. b. Give a lower dose of the medication for 24 hours and monitor the blood pressure. c. Prepare to administer a prn dose of the anticholinergic drug benztropine (Cogentin). d. Hold the medication and immediately describe the patients symptoms to the doctor.

D. hold the medication and immediately describe the patient's symptoms to the doctor These symptoms could be related to a possibly fatal disorder called neuroleptic malignant syndrome (NMS), and the nurse should hold the medication and contact the doctor immediately. The other options are inappropriate in light of the seriousness of the situation.

6. Your depressed patient who is taking a tricyclic antidepressant is advised of possible anticholinergic side effects. Which of the following is NOT an anticholinergic side effect? A. Blurred vision B. Difficulty starting urine stream C. Dry mouth D. Muscle rigidity

D. muscle rigidity

5. Which psychological manifestation of depression will improve in response to antidepressant therapy? a. Loss of energy b. Palpitations c. Sleep disturbances d. Social withdrawal

D. social withdrawal Social withdrawal and lack of interest in surroundings are psychological responses that will improve within 2 to 4 weeks of the patient receiving an effective dosage of antidepressant therapy. An increase in energy, decreased palpitations, and improvement in sleep patterns are physiological responses.

The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following? A) Weight loss B) Torticollis C) Hypoglycemia D) Tardive dyskinesia

D. tardive dyskinesia

Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients a. Mood and affect b. Activity level c. Cognitive ability to understand information about the medication d. Support network and its members willingness to participate in treatment

c. cognitive ability to understand information about the medication

Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid? a. Anxiety b. Ineffective coping c. Risk for self-injury d. Chronic low self-esteem

c. risk for self-injury