Psychiatric Medications
A client who is severely depressed is being prescribed a tricyclic antidepressant. Which of the following teaching points should the nurse be sure to include when educating this client? Select all that apply. A. Use with caution if taking other medications that have a sedative effect B. Do not take this medication if taking an SSRI antidepressant C. Take steps to prevent constipation D. Take this medication in the morning E. Monitor for urinary retention
A, B, C, E - Tricyclic antidepressants (TCAs) cause sedation, so the client needs to be aware of this and take other sedatives with caution, or not at all. TCAs can cause urinary retention and constipation, so the client should be educated on ways to prevent this. Both TCAs and selective serotonin reuptake inhibitors increase the level of serotonin in the body. Taking these two medications concurrently increases the risk of serotonin syndrome, which is a medical emergency.
The nurse is caring for a client with Alzheimer's disease who is taking quetiapine. A family member asks the nurse, "What is the benefit to taking this drug?" Which of the following responses from the nurse is correct? Select all that apply. A. Quetiapine improves agitation associated with Alzheimer's B. Quetiapine lessens the discomfort of UTIs that lead to agitation C. Quetiapine helps the brain restore low levels of neurotransmitters D. Quetiapine restores a client's sleep routine by calming the brain in the evening E. Quetiapine helps prevent tardive dyskinesia associated with Alzheimer's
A, C - Quetiapine is an antipsychotic used for psychotic disorders, including Alzheimer's. This drug helps improve agitation associated with the disease. It works by restoring levels of certain natural neurotransmitters in the brain which are low in the client with Alzheimer's disease.
Which benzodiazepine is used primarily to treat anxiety? A. Lorazepam B. Estazolam C. Triazolam D. Flurazepam
A. Benzodiazepines used to treat anxiety include lorazepam, alprazolam, chlordiazepoxide hydrochloride, clonazepam, clorazepate dipotassium, diazepam, halazepam, and oxazepam.
Which food should the patient taking an MAO inhibitor avoid? A. Cheese B. Apples C. Carrots D. Beer
A. Certain foods can interact with MAO inhibitors and produce severe reactions. The most serious reactions involve tyramine-rich foods, such as red wine, aged cheese, smoked meats, and fava beans.
The nurse is caring for a client with dystonia. What is the priority nursing intervention for this client? A. Place client on fall precautions B. Give the client a face mask C. Get the client's pain under control D. Place client on seizure precautions
A. Dystonia is a muscle control disorder, so the client needs to be on fall precautions to avoid any falls.
A nurse is administering an antidepressant medication. The nurse teaches the client to avoid tyramine-containing foods with the medication. Which of the following types of antidepressant medication is the client taking? A. A monoamine oxidase inhibitor (MAOI) B. Tricyclics C. Heterocyclics D. A selective serotonin reuptake inhibitor (SSRI)
A. MAOIs block the monoamine oxidase enzyme in the body, which prevents the body from breaking down tyramine. Tyramine is an amino acid that helps regulate blood pressure. If a tyramine level becomes too high, a client can become extremely hypertensive and require emergency medical attention.
A client is diagnosed with neuroleptic malignant syndrome. Which of the following events has the client likely experienced? A. Antipsychotic medication prescription B. Frequent outdoor running C. Recent anesthesia D. Frequent opiate use
A. Neuroleptic malignant syndrome is caused by taking antipsychotic medication. The body reacts in this manner due to the dopamine receptor blockade. Neuroleptic malignant syndrome usually includes a very high fever (102 to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea), muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure.
A client taking lithium reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L (2.5 mmol/L). The nurse plans care based on which representation of this level? 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal
Answer: 1 Rationale: Maintenance serum levels of lithium are 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L). Symptoms of toxicity begin to appear at levels of 1.5 mEq/L (1.5 mmol/L). Lithium toxicity requires immediate medical attention and the primary health care provider is notified if symptoms of toxicity occur.
The nurse is describing the medication side and adverse effects to a client who is taking amitriptyline. Which information should the nurse incorporate in the discussion? 1. Consume a low-fiber diet. 2. Increase fluids and bulk in the diet. 3. Rest if the heart begins to beat rapidly. 4. Walk if you have difficulty urinating because this is a normal side effect.
Answer: 2 Rationale: Amitriptyline causes constipation, and the client is instructed to increase fluid intake and bulk (high fiber) in the diet. If the heart begins to beat fast, the primary health care provider (PHCP) is notified, because this could indicate an adverse effect. Difficulty urinating is an adverse effect and indicates urinary retention; this should also be reported.
A client who has been taking buspirone for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred? 1. Paranoid thought process 2. Rapid heartbeat or anxiety 3. Alcohol withdrawal symptoms 4. Thought broadcasting or delusions
Answer: 2 Rationale: Buspirone is not recommended for the treatment of paranoid thought disorders, drug or alcohol withdrawal, or schizophrenia. Buspirone most often is indicated for the treatment of anxiety.
A hospitalized client has begun taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect, indicating that the client is taking an excessive amount of medication? 1. Constipation 2. Seizure activity 3. Increased weight 4. Dizziness when getting upright
Answer: 2 Rationale: Seizure activity can occur in clients taking bupropion dosages greater than 450 mg daily. Weight gain is an occasional side effect, whereas constipation is a common side effect of this medication. This medication does not cause significant orthostatic blood pressure changes.
A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how should the nurse administer the dose? 1. On an empty stomach 2. At the same time each evening 3. Evenly spaced around the clock 4. As needed when the client complains of depression
Answer: 2 Rationale: Sertraline is classified as an antidepressant. Sertraline generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline is not prescribed for use as needed.
The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? 1. Parkinsonism 2. Tardive dyskinesia 3. Hypertensive crisis 4. Neuroleptic malignant syndrome
Answer: 2 Rationale: Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, mask-like facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of monoamine oxidase inhibitors and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.
The nurse is teaching a client who is being started on imipramine about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication? 1. In 2 months 2. In 2 to 3 weeks 3. During the first week 4. During the sixth week of administration
Answer: 2 Rationale: The maximum therapeutic effects of imipramine may not occur for 2 to 3 weeks after antidepressant therapy has been initiated. Options 1, 3, and 4 are incorrect time periods.
The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating
Answer: 2 Rationale: The most common side and adverse effects related to fluoxetine include central nervous system and gastrointestinal system dysfunction. Fluoxetine affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side and adverse effects associated with this medication.
A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1. Client reports not going to work for the past week. 2. Client complains of not being able to "do anything" anymore. 3. Client arrives at the clinic neat and appropriate in appearance. 4. Client reports sleeping 12 hours per night and 3 to 4 hours during the day.
Answer: 3 Rationale: Depressed individuals sleep for long periods, are unable to go to work, and feel as if they cannot "do anything." When these clients have had some therapeutic effect from their medication, they report resolution of many of these complaints and exhibit an improvement in their appearance. Options 1, 2, and 4 identify continued depression.
A hospitalized client is started on a monoamine oxidase inhibitor (MAOI) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply. 1. Figs 2. Yogurt 3. Crackers 4. Aged cheese 5. Tossed salad 6. Oatmeal raisin cookies
Answer: 3, 5 Rationale: With MAOIs, the client should avoid ingesting foods that are high in tyramine. Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt; aged cheeses; smoked or processed meats; red wines; and fruits such as avocados, raisins, or figs.
A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1. Platelet count 2. Blood glucose level 3. Liver function studies 4. White blood cell count
Answer: 4 Rationale: A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.
A client gives the home health nurse a bottle of clomipramine. The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication? 1. Complaints of insomnia 2. Complaints of hunger and fatigue 3. A pulse rate less than 60 beats per minute 4. Frequent hand washing with hot, soapy water
Answer: 4 Rationale: Clomipramine is a tricyclic antidepressant used to treat obsessive-compulsive disorder. Sedation sometimes occurs. Insomnia seldom is a side effect. Weight gain and tachycardia are side and adverse effects of this medication.
A client is scheduled for discharge and will be taking phenobarbital for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety? 1. Take the medication only with meals. 2. Take the medication at the same time each day. 3. Use a dose container to help prevent missed doses. 4. Avoid drinking alcohol while taking this medication.
Answer: 4 Rationale: Phenobarbital is an anticonvulsant and hypnotic agent. The client should avoid taking any other central nervous system depressants such as alcohol while taking this medication. The medication may be given without regard to meals. Taking the medication at the same time each day enhances compliance and maintains more stable blood levels of the medication. Using a dose container or "pillbox" may be helpful for some clients.
The nurse is administering risperidone to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? 1. Get adequate sunlight. 2. Continue driving as usual. 3. Avoid foods rich in potassium. 4. Get up slowly when changing positions.
Answer: 4 Rationale: Risperidone can cause orthostatic hypotension. Sunlight should be avoided by the client taking this medication. With any psychotropic medication, caution needs to be taken (such as with driving or other activities requiring alertness) until the individual can determine whether her or his level of alertness is affected. Food interaction is not a concern.
A nurse is caring for a client who is seeking care for symptoms of serotonin syndrome. The client has a prescription for citalopram. Which of the following substances, when combined with this medication, would most likely lead to serotonin syndrome? Select all that apply. A. Naproxen B. Oxycodone C. Bupropion D. Esomeprazole
B, C - Serotonin syndrome occurs when an antidepressant is taken in combination with certain other drugs including; antidepressants, opioids, and/or migraine medications. Serotonin syndrome occurs when drugs interact to cause excessive accumulation of serotonin in the body. This syndrome leads to symptoms of agitation, confusion, muscle rigidity, and headache.
A client is complaining that all their signs and symptoms started when they started to take their antidepressant. The nurse notes that the client is on a tricyclic antidepressant. Which of the following complaints would the nurse associate with this class of drugs? Select all that apply. A. Anxiety B. Sweating C. Dry mouth D. Blurred vision E. Tremors
B, C, D - Sweating, dry mouth, and blurred vision are side effects of TCAs. Some other side effects of TCAs include dizziness and other anticholinergic effects.
Which of the following medications would be classified as an antipsychotic medication? A. Alprazolam (Xanax) B. Haloperidol (Haldol) C. Secobarbital (Seconal) D. Methylphenidate (Concerta)
B. An antipsychotic medication is used in the treatment of some psychiatric disorders for control of thoughts and hallucinations. Antipsychotic medications affect dopamine receptors in the brain, which can improve the thought processes and behavior of the person with psychotic symptoms. An example of an antipsychotic medication is haloperidol.
A client with severe depression has been prescribed isocarboxazid, a monoamine oxidase inhibitor, for treatment of symptoms. Which of the following foods would the nurse counsel the client to avoid when taking this medication? A. Mayonnaise B. Sauerkraut C. Beets D. Pasta
B. Monoamine oxidase inhibitors (MAOIs) work by altering levels of neurotransmitters in the brain. However, they also affect the level of tyramine, which is an amino acid that regulates blood pressure. When monoamine oxidase is blocked, excess tyramine builds up and the patient can develop dangerously high blood pressure, so tyramine-containing foods must be avoided for clients taking MAOIs. Examples of tyramine-containing items include cured or pickled foods, such as sauerkraut, pickles, aged cheeses, wine, beer and cured meats.
A client is prescribed a selective serotonin re-uptake inhibitor and the nurse knows that a benefit of taking an SSRI over other anti-depressants is which of the following? A. An SSRI is the most effective anti-depressant available B. An SSRI affects only one neurotransmitter instead of several C. An SSRI is less expensive than MAOIs and tricyclic antidepressants D. An SSRI does not cause unwanted side effects
B. Tricyclic antidepressants affect norepinephrine and serotonin neurotransmitters. MAOIs affect norepinephrine, epinephrine, serotonin, and dopamine. SSRIs selectively affect the neurotransmitter serotonin, which means SSRIs have less side effects than MAOIs and tricyclic antidepressants.
The nurse is caring for a client who has been taking amitriptyline for two months. The client complains that the medication does not relieve symptoms. Which of the following is an accurate response from the nurse? A. "You can discuss switching to another medication with the healthcare provider, but you will have to overlap both medications for a few weeks while you taper amitriptyline" B. "You have not been on this medication long enough to see positive effects yet. You will have to give it six months" C. "It's appropriate for you to try another medication to relieve your symptoms, but you will have to stop taking amitriptyline for 3 weeks before starting another drug" D. "You should have no problem switching to another medication. Talk to the healthcare provider and you will likely get a new prescription to start taking today"
C. Amitriptyline is a tricyclic antidepressant. This drug must be given 2-3 weeks to clear the client's system before another type of antidepressant is started. If not, the client will have many adverse effects.
Which of the following medications would be classified as an antipsychotic medication? A. Alprazolam (Xanax) B. Methylphenidate (Concerta) C. Haloperidol (Haldol) D. Secobarbital (Seconal)
C. An antipsychotic medication is used in the treatment of some psychiatric disorders for control of thoughts and hallucinations. Antipsychotic medications affect dopamine receptors in the brain, which can improve the thought processes and behavior of the person with psychotic symptoms. An example of an antipsychotic medication is haloperidol.
A client is complaining of some symptoms that started when they began taking an antidepressant. The nurse notes that the client is on an SSRI. Which of the following side effects would the nurse associate with SSRIs? A. Blurred vision B. Increased heart rate C. Sexual dysfunction D. Confusion
C. Sexual dysfunction is the main complaint of clients taking SSRIs. Additional side effects include nausea, headache, anxiety, and weight loss (at first) but weight gain later.
A client is brought into the emergency room by a family member. The client states she is being followed by people who are trying to kill her. The nurse reviews the client's medications and notes that the client is likely to have schizophrenia based on which medication? A. Oxycodone B. Oxytocin C. Olanzapine D. Omeprazole
C. This is a mood stabilizing antipsychotic medication used for schizophrenia as well as depression and anorexia.
A 29-year-old client is being seen for a diagnosis of schizophrenia. The physician has ordered an atypical antipsychotic medication for disease management. Which best describes how this type of medication works? A. By enhancing activity of the peripheral nervous system B. By interrupting function of the nerve cells in the brain to alter perception of reality C. By increasing the effects of gamma-aminobutyric acid (GABA) D. By acting on dopamine receptors
D. An atypical antipsychotic medication may be prescribed for the treatment of some types of psychiatric disorders. The exact mechanism of action of atypical antipsychotics is unknown, but they have been found to be related to dopamine receptor blocking. Examples of atypical antipsychotics include aripiprazole (Abilify) and risperidone (Risperdal).
Which adverse reaction is common in the patient taking buspirone? A. Nausea B. Diarrhea C. Constipation D. Headache
D. Common reactions to buspirone include headache, dizziness, light-headedness, insomnia, rapid heart rate, and palpitations.
The nurse is caring for a client with dystonia. What is the priority nursing intervention for this client? A. Give the client a face mask B. Get the client's pain under control C. Place client on seizure precautions D. Place client on fall precautions
D. Dystonia is a muscle control disorder, so the client needs to be on fall precautions to avoid any falls.
The client is newly prescribed a selective serotonin reuptake inhibitor (SSRI) for depression and needs education on the medication. The nurse is educating the client on serotonin syndrome and knows that the client correctly understands serotonin syndrome when the client states which of the following? A. "When I begin to feel less depressed, I will be able to begin tapering the dose" B. "If I experience decreased libido or dizziness, I will discuss tapering the dose with the provider" C. "If I feel excessively depressed, I will contact my provider right away" D. "If I feel a rapid heartbeat and my muscles begin twitching, I will contact my provider immediately"
D. Serotonin syndrome is a serious condition caused by excess levels of serotonin. This usually occurs when a client is taking multiple antidepressants, such as an SSRI and MAOI together. While tremors, sweating, weight loss, anxiety, and diarrhea are side effects of SSRI's, if the client begins to feel these side effects along with a rapid heartbeat and jerking and twitching of muscles, they are experiencing serotonin syndrome and must get medical attention right away.
A client has been prescribed paroxetine (Paxil) while in the hospital. Several hours after receiving the first dose, the client becomes confused and agitated. He starts sweating and is having hallucinations. Which of the following best describes the most likely cause of this reaction? A. Infection B. Anaphylaxis C. Withdrawal syndrome D. Serotonin syndrome
D. Serotonin syndrome, or serotonin toxicity, is a potential complication of using medications that are selective serotonin reuptake inhibitors (SSRIs), and the risk increases if the client takes additional drugs that increase serotonin. Serotonin syndrome can develop within a couple of hours to three days after an initial dose of this type of medication, and it can be life-threatening. Symptoms include tachycardia, hallucinations, agitation, fever, sweating, and tremor.
A patient with Tourette's syndrome has been taking haloperidol and has developed tardive dyskinesia. Based on this development, which signs or symptoms would the nurse most likely see in this patient? A. Abdominal pain B. Headaches C. Vision loss D. Facial grimacing
D. TD symptoms are categorized as movement disorders, including facial grimacing, tongue thrusting and repetitive chewing. Tardive dyskinesia is a condition that develops as a side effect of neuroleptic medications. Some antipsychotic drugs, such as haloperidol may lead to these effects.