1230 Exam 3: Psychotherapeutics

Pharmacokinetics

-studies what the body does to a drug - movement of the drug through the body *Phases* - absorption - distribution - metabolism - excretion

The nurse is providing care for a neonate diagnosed with apnea of prematurity. The prescription by the health care provider is for caffeine citrate intravenously 5 mg/kg once daily. The infant's weight is 5.4 lb. What is the correct dosage to administer to the patient?

12.3 mg

hydroxyzine

1st gen antihistamine

It may take 3-4 weeks before my mood is elevated

A patient w depression has been prescribed fluoxetine(Prozac) Which statement by pt. indicates an understanding of the medication teaching? a. Disorientation/hallucinations are common b. the drug may enhance my interest in sex c. it may take 3-4 weeks before my mood is elevated d. I can stop this medication when I feel less depressed

I will reduce my salt intake while taking this medication

A patient with BPD is prescribed lithium. Which statement, if made by the patient, indicates the need for further teaching? a. i can take the medication with milk or a snack b. i will call my doctor if i feel hyperactive c. i should drink at least 8-10 glasses of water every day d. i will reduce my salt intake while taking this medication

Factors affecting enteral absorption

Gastric contents acidity motility blood flow absorptive surfaces

MAOI tyramine crisis treatment

IV vasodilator sodium nitroprusside phentolamine labetulol

polydipsia, slurred speech, fine hand tremors

Pt. dxnsed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the pt for which s/s? a. insomnia, increased appetite, abdominal distention b. dry cough, hyperactive reflexes, hypertension c. polydipsia, slurred speech, fine hand tremors d. constipation, asterixis, generalized edema

bananas,smoked fish,cheese

Pt. is presvribed isocarboxazid(marplan) for treatment of depression. Which foods should pt. be taught to avoid? a. broccoli, shrimp, yogurt b. tomatoes, chicken, milk c. bananas, smoked fish, cheese d. apples, steak, cottage cheese

Diphenhydramine (Benedryl)

Pt. prescribed doxepin (sinequan) for depression. Which over-the-counter med should nurse teach patient to avoid? a. glucosamine sulfate b. omeprazole (prilosec) c. fish oil (omega3) d. diphenhydramine (benedryl)

Factors affecting the rate of absorption

Route of administration dosage formulation solubility pH- acid contents of stomach GI motility- peristaltic movement status of absorptive surfaces- mucosa blood flow- lack of blood flow decreases absorption presence of food/ fluids ingested with drug

amitriptyline (elavil)

TCA

furosemid (lasix)

The nurse cares for a patient who is receiving lithium. Which medication, if prescribed by the healthcare provider, should the nurse question? a. levothyroxine (synthroid) b. sulindac (clinoril) c. furosemid (lasix) d. propranolol (inderal)

Cyproheptadine

Treatment for serotonin syndrome

medication holiday switch class ex: Buspirone

Treatment for sexual dysfunction when taking SSRI

The nurse explains to a patient that using caffeine may exacerbate which health condition? a. Cardiac dysrhythmias b. Constipation c. Heart block d. Myelin degeneration

a

A patient with narcolepsy is prescribed methylphenidate (Ritalin). Which adverse effects should the nurse include in the teaching of this drug? (Select all that apply.) a. Insomnia b. Headache c. Weight Loss d. Decreased blood pressure e. Increased appetite

a b c

flumazenil (romazicon)

a pt is brought to the emergencry department for the treatment of an overdose of alpraxolam (xanax) which medication should the nurse prepare to administer to this patient? a. protamine sulfate b. acetylcysteine (acetadote) c. naloxone (narcan) d. flumazenil (romazicon)

The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder

a. Anxiety disorder

A patient who has received lithium for 3 weeks to control acute mania has the following symptoms: coarse hand tremor, diarrhea, vomiting, lethargy, and mild confusion. The priority nursing action should be to: a. Administer prn Cogentin to relieve the symptoms. b. Provide reassurance that the symptoms are transient. c. Obtain a stat lithium level; hold lithium pending results. d. Assist the patient to decrease the sodium in their daily diet.

c. Obtain a stat lithium level; hold lithium pending results.

A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the nurse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance? a. Methylphenidate (Concerta) b. Atomoxetine (Strattera) c. Amphetamine aspartate (Adderall) d. Dextroamphetamine sulfate (Dexedrine)

b

A nurse working with patients who are diagnosed with ADHD is aware that such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified? a. Schedule IV b. Schedule II c. Schedule I d. Schedule III

b

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c. "It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does."

Which statement made by a patient who will be maintained on lithium following discharge will require further instruction by the nurse? a. "I will have my blood work done regularly." b. "When I get home, I may go on a salt-free diet." c. "I have learned not to restrict my intake of water." d. "I understand some people gain weight on lithium."

b. "When I get home, I may go on a salt-free diet."

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

b. Anticoagulants

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

b. Decreased paranoia and delusions

A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group? a. Psychostimulants c. Anticholinergics b. Mood stabilizers d. Antidepressants

b. Mood stabilizers

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

b. Self-injury or suicidal tendencies

A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. cardiac dysrhythmia b. hypertensive crisis. c. hypotensive shock. d. hypoglycemia.

b. hypertensive crisis.

gabapentin

best med for neuropathic pain

propanolol

beta blocker used for hyperthyroidism

A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants? a. CNS stimulants activate cyclic adenosine monophosphate. b. CNS stimulants block or reduce the activity of inhibitory neurons. c. CNS stimulants increase release of and block reuptake of neurotransmitters. d. CNS stimulants decrease the production of excitatory neurotransmitters.

c

Ergot alkaloids exert their therapeutic effect by which action? a. Simulation of the alpha receptors. b. Vasodilation. c. Vasoconstriction. d. Blockade of the beta2 receptors.

c

Which instructions should the nurse discuss to reduce the gastrointestinal (GI) adverse effects of orlistat (Xenical)? a. Advise to take vitamin C supplement. b. Take the medication with an antacid. c. Limit dietary intake of fat. d. Increase fluid and fiber in the diet.

c

Which patient complaint should receive priority from a patient who is taking the MAOI tranylcypromine (Parnate)? a. "I haven't had a bowel movement in 2 days." b. "Will you take my temperature? I feel too warm." c. "I get a headache when I drank several cups of coffee." d. "My legs get stiff when I sit in the chair for any length of time."

c. "I get a headache when I drank several cups of coffee."

A patient taking SSRIs mentions to the nurse that his current medication causes fewer side effects than the tricyclic antidepressant he took several years earlier. The nurse understands that SSRIs advantage is due to: a. Inhibiting both serotonin and norepinephrine uptake b. Selectively inhibiting dopamine uptake c. Blocking only serotonin reuptake d. Making more GABA available

c. Blocking only serotonin reuptake

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

c. Cardiac dysrhythmias

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

c. Salami and Swiss cheese sandwich

Which patient outcomes would be most applicable for the patient who has been taking benzodiazepines? Patient will state: a. That there are specific foods to avoid while on this medication b. An understanding of how to increase medication dosage c. That alcohol is a substance to avoid while on the medication d. An understanding that he or she can return to work while on this medication

c. That alcohol is a substance to avoid while on the medication

aspirin

med associated with Reye's Syndrome

levothuroxine

medication for HYPOthyroidism

First-pass effect

medications absorbed through digestive system are transported to the liver via the hepatic- portal vein the liver inactivates a portion of the medication before releasing it back into systemic circulation this decreases bioavailability of the medication increased FPE= drug calculated to compensate

fludrocortisone

mineralcorticoid

Parent Drug>

original drug administered, when not active= prodrug *Prodrug*- metabolized to pharmacologically active metabolite *inactive metabolite*= drug waste products

2nd gen antiphyschotic

risperidone

Topical routes

skin- including transdermal patches) eyes ears nose lungs (inhalation) rectum vagina

Dissolution of oral medications

solid medications must be dissolved in fluid in order for absorption to occur additives/coatings enteric-coated time-released

fentanyl

strongest oipoid

pharmacognosy

the branch of knowledge concerned with medicinal drugs obtained from plants or other natural sources.

Toxicology

the branch of science concerned with the nature, effects, and detection of poisons.

clonazepam (klonopin)

the nurse is caring for a patient with social anxiety disorder. The pt is currently experiencing intense anxiety. The nurse should prepare to administer which medication for the immediate relief of anxiety? a. fluvoxamine (luvox) b. paroxetine (paxil) c. sertraline (zoloft) d. clonazepam (klonopin)

urinary creatinine clearance

the nurse prepares to administer lithium to a patient. which laboratory result should first be assessed? a. urinary creatinine clearance b. serum toponin I and T levels c. fasting blood glucose level d. serum lipid profile

the drug may leave a bitter taste in my mouth

the nurse teaches a pt about eszopiclone (lunesta) which statement by pt indicates that the teaching has been effective? a. i should take the drug 1 hour before bedtime b. the drug may leave a bitter taste in my mouth c. i may experience amnesia with prolonged use d. my body may build up a tolerance to this drug

aspirin

which med has antipyretic, anti-inflammatory, and analgesic properties

An agitated patient is to receive an intravenous dose of diazepam (Valium). The order reads, "Give diazepam, 2 mg, IV push, now. Repeat in 15 minutes if needed." Identify how many milliliters will the nurse administer for this dose. The medication vial contains 5 mg/mL. _______

ANS: 0.4 mL

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a. "I will take this medication regularly to prevent a migraine headache from occurring." b. "I will take this medication when I feel a migraine headache starting." c. "This medication does not reduce the number of migraines I will have." d. "I will keep a journal to record the headaches I have and how the injections are working."

ANS: A Although they may be taken during aura symptoms by patients who have auras with their headaches, these drugs are not indicated for preventive migraine therapy. The medication is intended to relieve the migraine and not to prevent it or to reduce the number of attacks. The triptans do not reduce the number of migraines a person will have. Journal recordings of headaches and the patient's responses to the medication are helpful.

A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation? a. Diazepam (Valium) b. Zolpidem (Ambien) c. Phenobarbital d. Cyclobenzaprine (Flexeril)

ANS: A Benzodiazepines such as diazepam are used as anxiolytics, or sedatives. Zolpidem is used as a hypnotic for sleep. Phenobarbital is not used as an anxiolytic but is used for seizure control. Cyclobenzaprine is a muscle relaxant and is not used to reduce anxiety. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 191 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder? a. Anxiety disorder b. Depression c. Schizophrenia d. Bipolar disorder

ANS: A Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.

The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation

ANS: A Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 197 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him? a. Risk for injury related to decreased sensorium b. Risk for addiction related to psychologic dependency c. Decreased fluid volume related to potential adverse effects d. Disturbed sleep pattern related to the drug's interference with REM sleep

ANS: A Musculoskeletal relaxants have a depressant effect on the CNS; thus, the patient needs to be taught the importance of taking measures to minimize self-injury and falls related to decreased sensorium. "Risk for addiction" is not a NANDA nursing diagnosis. The other nursing diagnoses are not appropriate for this situation. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 198 TOP: NURSING PROCESS: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient is taking flurazepam (Dalmane) three to four nights a week for sleeplessness. She is concerned that she cannot get to sleep without taking the medication. What nonpharmacologic measures should the nurse suggest to promote sleep for this patient? a. Providing a quiet environment b. Exercising before bedtime to become tired c. Consuming heavy meals in the evening to promote sleepiness d. Drinking hot tea or coffee just before bedtime

ANS: A Nonpharmacologic approaches to induce sleep include providing a quiet environment, avoiding heavy exercise before bedtime, avoiding heavy meals late in the evening, and drinking warm decaffeinated drinks, such as warm milk, before bedtime. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 201 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

A patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present? a. A history of peptic ulcers b. Migraine headaches c. Asthma d. A history of kidney stones

ANS: A Caffeine should be used with caution by patients who have histories of peptic ulcers or cardiac dysrhythmias or who have recently had myocardial infarctions. The other conditions are not contraindications to the use of caffeine

A patient with a history of anxiety attacks is given a medication for these episodes. Which medication is appropriate for this problem? Question 7 options: a) midazolam (Versed) b) phenobarbital c) bupropion (Wellbutrin) d) buspirone (BuSpar)

ANSWER D

The barbiturate phenobarbital is prescribed for a patient with epilepsy. While assessing the patient's current medications, the nurse recognizes that interactions may occur with which drugs? (Select all that apply.) a. Antihistamines b. Opioids c. Diuretics d. Anticoagulants e. Oral contraceptives f. Insulin

ANS: A, B, D, E The co-administration of barbiturates and alcohol, antihistamines, benzodiazepines, opioids, and tranquilizers may result in additive CNS depression. Co-administration of anticoagulants and barbiturates can result in decreased anticoagulation response and possible clot formation. Co-administration of barbiturates and oral contraceptives can result in accelerated metabolism of the contraceptive drug and possible unintended pregnancy. There are no interactions with diuretics and insulin. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 195 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome? (Select all that apply.) a. Agitation b. Drowsiness c. Tremors d. Bradycardia e. Sweating f. Constipation

ANS: A, C, E Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others. See Box 16-1 for a full list of symptoms.

The nurse is reviewing the use of central nervous system stimulants. Which of these are indications for this class of drugs? (Select all that apply.) a. Narcolepsy b. Depression c. Panic attacks d. Neonatal apnea e. Attention deficit hyperactivity disorder (ADHD) f. Appetite suppression

ANS: A, D, E, F Central nervous system stimulants can be used for narcolepsy, neonatal apnea, ADHD, and appetite suppression in the treatment of obesity. They are not used for depression and panic attacks

A 50-year-old man who has been taking phenobarbital for 1 week is found very lethargic and unable to walk after eating out for dinner. His wife states that he has no other prescriptions and that he did not take an overdose—the correct number of pills is in the bottle. The nurse suspects that which of these may have happened? a. He took a multivitamin. b. He drank a glass of wine. c. He took a dose of aspirin. d. He developed an allergy to the drug.

ANS: B Alcohol has an additive effect when combined with barbiturates and causes central nervous system (CNS) depression. Multivitamins and aspirin do not interact with barbiturates, and this situation does not illustrate an allergic reaction. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 195 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A 10-year-old patient will be started on methylphenidate hydrochloride (Ritalin) therapy. The nurse will perform which essential baseline assessment before this drug is started a. Eye examination b. Height and weight c. Liver studies d. Hearing test

ANS: B Assessment of baseline height and weight is important before beginning Ritalin therapy because it may cause a temporary slowing of growth in prepubertal children. The other studies are not as essential at this time.

A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect? a. Drowsiness b. Palpitations and anxiety c. Dry mouth d. Constipation

ANS: B Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng.

While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy? a. Hypertensive crisis b. Self-injury or suicidal tendencies c. Extrapyramidal symptoms d. Loss of appetite

ANS: B In 2005, the U.S. Food and Drug Administration (FDA) issued special black-box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect.

11. The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression, and there's no change! What's wrong with him?" What is the nurse's best response? a. "The medication may not be effective for him. He may need to try another type." b. "It may take up to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." c. "It sounds like the dose is not high enough. I'll check about increasing the dosage." d. "Some patients never recover from depression. He may not respond to this therapy."

ANS: B Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect.

Chlorpromazine (Thorazine) is prescribed for a patient, and the nurse provides instructions to the patient about the medication. The nurse includes which information? a. The patient needs to avoid caffeine while on this drug. b. The patient needs to wear sunscreen while outside because of photosensitivity. c. Long-term therapy may result in nervousness and excitability. d. The medication may be taken with an antacid to reduce gastrointestinal upset.

ANS: B Sun exposure and tanning booths need to be avoided with conventional antipsychotics because of the adverse effect of photosensitivity. Instruct the patient to apply sunscreen liberally and to wear sun-protective clothing and hats.

When a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect? a. Fewer panic attacks b. Decreased paranoia and delusions c. Decreased feeling of hopelessness d. Improved tardive dyskinesia

ANS: B The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect.

Phases of Pharmcokinetics

Absorption distribution metabolism excretion

Before beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class? a. Aspirin b. Anticoagulants c. Diuretics d. Nonsteroidal anti-inflammatory drugs

ANS: B Use of selective serotonin reuptake inhibitor (SSRI) antidepressants with warfarin results in an increased anticoagulant effect. SSRI antidepressants do not interact with the other drugs or drug classes listed. See Table 16-6 for important drug interactions with SSRIs.

A patient has a new prescription for phentermine (Ionamin) as part of the treatment for weight loss. Which information will the nurse include when teaching this patient about a stimulant such as phentermine? (Select all that apply.) a. Take this medication after meals. b. Take this medication in the morning. c. This drug is taken along with supervised exercise and suitable diet. d. Use mouth rinses, sugarless gum, or hard candies to minimize dry mouth. e. Avoid foods that contain caffeine, such as coffee, tea, and colas

ANS: B, C, D, E This drug should be taken in the morning to avoid interference with sleep, and the patient should also be on a supervised exercise and dietary regime. Caffeine-containing products should be avoided because of possible additional stimulation. Dry mouth can be minimized by the use of mouth rinses, sugarless gum, or hard candy. The other option is incorrect.

The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Gout b. Pregnancy c. Epilepsy d. Severe chronic obstructive pulmonary disease e. Severe liver disease f. Diabetes mellitus

ANS: B, D, E Contraindications to barbiturates include pregnancy, significant respiratory difficulties, and severe liver disease. The other disorders are not contraindications. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 194 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor ( MAOI). Which food choice would indicate the need for additional teaching? a. Orange juice b. Fried eggs over-easy c. Salami and Swiss cheese sandwich d. Biscuits and honey

ANS: C Aged cheeses, such a Swiss or cheddar cheese, and Salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. Orange juice, eggs, biscuits, and honey do not contain tyramine.

A patient has been taking temazepam (Restoril) for intermittent insomnia. She calls the nurse to say that when she takes it, she sleeps well, but the next day she feels "so tired." Which explanation by the nurse is correct? a. "Long-term use of this drug results in a sedative effect." b. "If you take the drug every night, this hangover effect will be reduced." c. "These drugs affect the sleep cycle, resulting in daytime sleepiness." d. "These drugs increase the activity of the central nervous system, making you tired the next day."

ANS: C Benzodiazepines suppress REM sleep to a degree (although not as much as barbiturates) and, thus, result in daytime sleepiness (a hangover effect). The other statements are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 191 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants? a. SSRIs have fewer sexual side effects. b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

ANS: C Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

ANS: C Extrapyramidal symptoms are manifested by tremors and muscle twitching, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.

Ramelteon (Rozerem) is prescribed for a patient with insomnia. The nurse checks the patient's medical history, knowing that this medication is contraindicated in which disorder? a. Coronary artery disease b. Renal insufficiency c. Liver disease d. Anemia

ANS: C Ramelteon is contraindicated in cases of severe liver dysfunction. The other conditions are not contraindications. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 193 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is brought to the emergency department for treatment of a suspected overdose. The patient was found with an empty prescription bottle of a barbiturate by his bedside. He is lethargic and barely breathing. The nurse would expect which immediate intervention? a. Starting an intravenous infusion of diluted bicarbonate solution b. Administering medications to increase blood pressure c. Implementing measures to maintain the airway and support respirations d. Administrating naloxone (Narcan) as an antagonist

ANS: C There are no antagonists/antidotes for barbiturates. Treatment supports respirations and maintains the airway. The other interventions are not appropriate. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 195 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern? a. Hypertension b. Renal failure c. Cardiac dysrhythmias d. Gastrointestinal bleeding

ANS: C Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.

An ergot alkaloid is prescribed for a patient who is having frequent migraine headaches. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which problem occurs? a. Nervousness b. Dizziness c. Chest pain d. Nausea and vomiting

ANS: C Nervousness, dizziness, and nausea and vomiting are expected adverse effects of ergot alkaloids. However, if chest pain occurs, the prescriber should be contacted immediately, or the patient should seek emergency care

When evaluating a patient who is taking orlistat (Xenical), which is an intended therapeutic effect? a. Increased wakefulness b. Increased appetite c. Decreased weight d. Decreased hyperactivity

ANS: C Orlistat (Xenical) is a nonstimulant drug that is used as part of a weight loss program. The other options are incorrect

A 22-year-old nursing student has been taking NoDoz (caffeine) tablets for the past few weeks to "make it through" the end of the semester and exam week. She is in the university clinic today because she is "exhausted." What nursing diagnosis may be appropriate for her? a. Noncompliance b. Impaired physical mobility c. Sleep deprivation d. Imbalanced nutrition: less than body requirements

ANS: C The main ingredient in NoDoz, caffeine, is a central nervous system stimulant that can be used to increase mental alertness. Restlessness, anxiety, and insomnia are common adverse effects. Thus, sleep deprivation is the most appropriate nursing diagnosis of those listed.

Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)? (Select all that apply.) a. Avoid foods and beverages that contain tyramine. b. Monitor the patient for extrapyramidal symptoms. c. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started. d. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication. e. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision. f. Cogentin is often also prescribed to reduce the adverse effects that may occur.

ANS: C, D During SSRI medication, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs.

A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem? a. These are adverse effects that usually subside after a few weeks. b. The drug must be stopped immediately because of possible adverse effects. c. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness. d. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.

ANS: D Barbiturates such as phenobarbital deprive people of REM sleep, which can result in agitation and the inability to deal with normal stress. A rebound phenomenon occurs when the drug is stopped (not during therapy), and the proportion of REM sleep increases, sometimes resulting in nightmares. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 194 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

A patient has experienced insomnia for months, and the physician has prescribed a medication to help with this problem. The nurse expects which drug to be used for long-term treatment of insomnia? a. Secobarbital (Seconal), a barbiturate b. Diazepam (Valium), a benzodiazepine c. Midazolam (Versed), a benzodiazepine d. Eszopiclone (Lunesta), a nonbenzodiazepine sleep aid

ANS: D Eszopiclone (Lunesta) is one of the newest prescription hypnotics to be approved for long-term use in treatment of insomnia. Barbiturates and benzodiazepines are not appropriate for long-term treatment of insomnia; midazolam is used for procedural (moderate) sedation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 193 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

ANS: D Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect.

A patient tells the nurse that he likes to drink kava herbal tea to help him relax. Which statement by the patient indicates that additional teaching about this herbal product is needed? a. "I will not drink wine with the kava tea." b. "If I notice my skin turning yellow, I will stop taking the tea." c. "I will not take sleeping pills if I have this tea in the evening." d. "I will be able to drive my car after drinking this tea."

ANS: D Patients should not drive after drinking this tea because it may cause sedation. Kava tea may cause skin discoloration (with long-term use). In addition, it must not be taken with alcohol, barbiturates, and psychoactive drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 192 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. "I can't sleep at night." b. "I feel hungry all the time." c. "Look at how red my hands are." d. "My mouth has been so dry lately."

ANS: D Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation.

A 44-year-old patient has been taking sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI) for 4 months. She tells the nurse she has been interested in natural health products and wants to start taking St. John's wort. Which statement below is an appropriate response for the nurse? Question 4 options: a) "That should be no problem." b) "Soon you'll be able to stop taking the Zoloft!" c) "Be sure to stop taking the herb if you notice a change in adverse effects." d) "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

ANSWER D

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

ANS: D The herbal product St. John's wort must not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors. The other responses by the nurse are inappropriate.

A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions a. She is giving him the medication dosage appropriately. b. The medication should not be taken until he is at school. c. The medication should be taken with meals for optimal absorption. d. The medication should be given 4 to 6 hours before bedtime to diminish insomnia

ANS: D Central nervous system stimulants should be taken 4 to 6 hours before bedtime to decrease insomnia. Generally speaking, once-a-day dosing is used with extended-release or long-acting preparations. These formulations eliminate the need to take this medication at school.

A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation a. These are expected adverse effects that will eventually diminish. b. The patient will need to stop this drug immediately if these adverse effects are occurring. c. The patient will need to increase her fat intake to prevent these adverse effects. d. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects

ANS: D Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects, which include oily spotting, flatulence, and fecal incontinence. The other options are incorrect

Before a patient receives triptans for the treatment of migraines, the nurse will assess for the presence of which condition, which is a contraindication if present? a. Hypotension b. Renal disease c. Liver damage d. Cardiovascular disease

ANS: D Triptans are contraindicated in patients with serious cardiovascular disease because of the vasoconstrictive potential of these medications. The other options are incorrect

A nurse is monitoring a patient with depression who has just started antidepressant therapy. During which time period does the patient have the highest potential for self-injury and suicide? Question 5 options: a) At the beginning, before drug therapy is started b) The time period between the start of therapy and symptomatic improvement c) Between 1 and 4 weeks of drug therapy d) After 6 months of drug therapy

ANSWER B

A patient is prescribed ibuprofen 200 mg PO q4H PRN for pain. The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. what will the nurse do? a) crush the tablets and mix them with apple sauce or pudding b) call the pharmacy and ask for the liquid form of the medication C) Call the pharmacy and ask for the intravenous (IV) form of medication D) Encourage the patient to try to swallow it

ANSWER B

Tardive dyskinesia is a adverse reaction to what type of psychotherapeutic medication? Question 10 options: a) Antianxiety b) Antipsychotics c) Antidepressants d) All Psychotherapeutic medications

ANSWER B

The wife of a patient who has been diagnosed with depression calls the office and says, "It's been an entire week since he started that new medicine for his depression and there's no change! What's wrong with him?" Which of the following statements is the best response by the nurse? Question 6 options: "The medication may not be effective for him. He may need to try another type." "It may take up to 4 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does." "It sounds like he is tolerant to the drug. I'll check about increasing the dosage." "Some patients never recover from depression. He may not respond to this therapy."

ANSWER B

A patient has been taking haloperidol for 3 months for a psychotic disorder. Because the nurse is concerned about the development of extrapyramidal symptoms (EPS), the patient will be monitored for which of the following? Question 2 options: a) Cogwheel rigidity and blurred vision b) Drowsiness and dizziness c) Tremors and muscle twitching d) Dry mouth and constipation

ANSWER C

When the nurse is teaching the patient about tricyclic antidepressants, which of the following is important to emphasize? Question 1 options: a) Serum blood levels should be drawn every 2 weeks. b) If drowsiness occurs, stop the medication immediately c) Drowsiness should decrease after the first few weeks of therapy d) Foods high in tyramine, such as cheese, beer, and wine, must be avoided

ANSWER C

Which of the following breakfast choices by a patient taking a monoamine oxidase inhibitor (MAOI) indicates the need for additional teaching? Question 8 options: Orange juice Fried eggs Cheddar cheese omlette French toast

ANSWER C

Which of the following is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than are tricyclic antidepressants (TCAs)? Question 9 options: a) SSRIs have fewer sexual adverse effects b) Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c) Tricyclic antidepressants can cause serious cardiac toxicities if an overdose occurs. d) SSRIs cause a therapeutic response faster than tricyclic antidepressants.

ANSWER C

A 22-year-old female has been taking lithium (Carbolith) for 6 months. She has blood work every month, and the nurse assesses her for signs of toxicity. What are indications of toxicity? Question 3 options: Serum lithium level 0.8 mEq/L and excitability Serum lithium level 1.0 mEq/L and palpitations Serum lithium level 1.5 mEq/L and hypertension Serum lithium level 2.5 mEq/L and cardiac dysrhythmias

ANSWER D

Pharmcology

Broadest term for the study or science of drugs

Time released products

CR- controlled/continuous release CRT- controlled release tablet LA- long acting SR- sustained release/slow release TR- time release TD- time delay SA- sustained-action ER/XL/XR- extended release MR- modified release

narcan

antidote for opioid OD

treatment for neuroleptic malignant syndrome

Dantrolene bromocriptine

Pharmaceutics

how different dosage forms influence how the body metabolizes a drug and how it affects the body different properties influenced by injection, tablet, capsule, extended, release, intravenous dosage forms determine the rate of dissolution and absorption

Absorption

Movement of a drug from site of administration to blood stream

I had a serious head injury 3 years ago

Nurse teaches a pt about bupropion (wellbutrin) which statement by patient indicates that more teaching is indicated? a. i can take the drug w food to reduce nausea b. drug will increase my interest in sex c. i may experience decreased appetite and weigh loss d. i had a serious head injury 3 years ago

Bioavailability

Portion of drug that reaches the systemic circulation... available to act on body cells

Sertraline (Zoloft) has been prescribed for a patient with symptoms of a major depression. Which factor was probably most important in the physician's decision to use an SSRI? a. Good side-effect profile b. Less expense for the patient c. Increase in medication compliance d. Rapid rate of absorption from the GI tract

a. Good side-effect profile

To educate a patient regarding what to expect following the administration of a benzodiazepine, the nurse must understand that benzodiazepines: a. Have a rapid onset of peak action b. Reduce availability of GABA c. Generally diminish the activity of GABA d. Interact with serotonin to increase availability

a. Have a rapid onset of peak action

An individual with poststroke depression is receiving an SSRI. What is the rationale for giving the medication at breakfast and again at midday? a. Prevent insomnia b. Prevent toxic reactions c. Decrease afternoon sleepiness d. Give an opportunity to monitor behavior closely

a. Prevent insomnia

Which person with mania is the least likely candidate to receive lithium? The patient who is: a. Six weeks pregnant b. Recovering from a hysterectomy c. Taking hormone replacement therapy d. Displaying symptoms of postpartum depression

a. Six weeks pregnant

A 22-year-old patient has been taking lithium for 1 year, and the most recent lithium level is 0.9 mEq/L. Which statement about the laboratory result is correct? a. The lithium level is therapeutic. b. The lithium level is too low. c. The lithium level is too high. d. Lithium is not usually monitored with blood levels.

a. The lithium level is therapeutic.

Route of Administration

affects the rate and extent of absorption *route*- Enteral route- GI (Sublingual- oral, gastric mucosa- buccal, rectal- ***********) Parenteral route: intradermally, subcutaneously, intravenously, intramuscularly, intrathecally (spinal tract), intraarticularly, intra-articularily (chronic joint pain)

beta 2 agonist

albuterol drug class

ipratropium

an anticholinergic drug used to treat bronchoconstriction

Mucomyst (acetylcysteine)

antidote for acetaminophin overdose

flumazenil

antidote for benzo OD

A patient has been taking haloperidol (Haldol) for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects? a. Increased paranoia b. Drowsiness and dizziness c. Tremors and muscle twitching d. Dry mouth and constipation

c. Tremors and muscle twitching

A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) is complaining of "feeling so badly" when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome?(Select all that apply. ) a. SSRIs have fewer sexual side effects b. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions. c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs. d. SSRIs cause a therapeutic response faster than tricyclic antidepressants.

c. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.

A nurse caring for a patient taking a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to: a. coherent thought processes. b. reduced levels of motor activity. c. improvement in depression. d. decreased extrapyramidal symptoms.

c. improvement in depression.

Which of these statements made by a patient taking the MAOI phenelzine (Nardil) would warrant further instruction? a. "I often forget to wear sunscreen when I go outside." b. "I need to restrict the amount of sodium in my diet." c. "I should not use over-the-counter cold medications." d. "I usually order liver and onions when my wife and I eat out."

d. "I usually order liver and onions when my wife and I eat out."

A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines? a. "I can't sleep at night." b. "I feel hungry all the time." c. "Look at how red my hands are." d. "My mouth has been so dry lately."

d. "My mouth has been so dry lately."

A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline (Zoloft) for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate? a. "That should be no problem." b. "Good idea! Hopefully you'll be able to stop taking the Zoloft." c. "Be sure to stop taking the herb if you notice a change in side effects." d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

d. "Taking St. John's wort with Zoloft may cause severe interactions and is not recommended."

A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil) for 6 months. The patient wants to go to a party and asks the nurse, "Will just one beer be a problem?" Which advice from the nurse is correct? a. "You can drink beer as long as you have a designated driver." b. "Now that you've had the last dose of that medication, there will be no further dietary restrictions." c. "If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking." d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

d. "You need to avoid all foods that contain tyramine, including beer, while taking this medication."

A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group? a. Tricyclic antidepressants c. Antimanic drugs b. Antipsychotic drugs d. Benzodiazepines

d. Benzodiazepines

Pharmacodynamics

investigates what the drug does to the body through specific receptors *Receptors*- special protein molecules embedded in the outer surfaces or inside where the drug binds to take effect

Pharmacogenomics (pharmacogenetics)

is the study of the role of the genome in drug response.

When following up on SSRI medication side effects, the nurse will need to make specific inquiries about: a. Anticholinergic symptoms b. Alpha-adrenergic blockade c. GI tract symptoms d. Sexual dysfunction

d. Sexual dysfunction

pharmacoeconims

defined as the branch of economics that uses cost-benefit, cost-effectiveness, cost-minimization, cost-of-illness and cost-utility analyses to compare pharmaceutical products and treatment strategies.

Pharmacotherapeutics

defined by Merriam-Webster as "the study of the therapeutic uses and effects of drugs" this is a study of beneficial and adverse effects of drugs.

mood stabilizer

drug class for lithium

bronchodilators

drug class that should NOT be used for allergic rhinitis

beclomethasone (qvar)

first line management therapy for asthma

TCA toxicity treatment

gastric lavage activated charcoal IV Na+ bicarb

1st gen antipsychotic

haloperidol class