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A client is being treated with clozapine. What should the nurse monitor most closely?
White blood cell count Clozapine is associated with significant leukopenia. Subsequently, it is available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. The drug is not associated with changes in sliver function, cardiac enzymes, or urine output.
A client reports insomnia during a routine visit. What should the nurse assess first regarding the most likely cause?
Daily intake of caffeine-containing products The daily intake of caffeine should be assessed to determine if the intake is sufficient to disturb sleep. The amount of exercise the client engages in is important but not as critical as caffeine consumption. The family history of insomnia and sleep is not critical to assess. Amphetamines also have the potential to disrupt sleep, but caffeine use is far more prevalent.
A parenteral form of an antipsychotic is prescribed for a client who has become aggressive. When administering the drug, which site would be most appropriate for the nurse to use?
Gluteus When giving an antipsychotic parenterally, the drug should be given IM in a large muscle mass such as the gluteus muscle. The deltoid muscle is not a large muscle. The vastus lateralis and the ventrogluteal are not large muscles When a client is aggressive, the larger the muscle the better, thus gluteus is the best choice.
Monitoring of patients taking lithium includes periodically obtaining a serum lithium level; at what level may toxic reactions occur?
Greater than 1.5 mEq/mL toxic reaction may occur when serum lithium levels are greater than 1.5 mEq/mL
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?
Lip smacking Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.
Which drug would be indicated for the treatment of narcolepsy?
Modafinil Modafinil would be indicated for the treatment of narcolepsy. Atomoxetine, dexmethylphenidate, and lisdexamfetamine are indicated for the treatment of attention deficit disorders.
The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy?
relieve the symptoms for which they were prescribed. The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately. Stimulants are often misused and abused by people who want to combat fatigue and delay sleep, such as long-distance drivers, students, and athletes. College students reportedly use stimulants as study aids. Use of stimulants for these purposes is not justified.
A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?
"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." Dopamine is a neurotransmitter in the sympathetic nervous system that deals with pleasure and reward in the brain. Dopamine is not an enzyme or a part of the brain. Dopamine is a medication, but it does not fight infection or help with pain.
The nurse is reviewing the care plan for a client who has been prescribed a central nervous system (CNS) stimulant. What nursing assessment question addresses the main goal of therapy?
"Has your quality of life improved since being prescribed this medication?" The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given thus improving quality of life. A secondary goal is to have clients use the drugs appropriately. CNS stimulants should not be taken to affect quality of sleep or concentration
A black, male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the health care provider's (HCP's) office with signs of tardive dyskinesia, and his HCP modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?
"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients." Black clients tend to respond more rapidly; experience a higher incidence of adverse effects, including tardive dyskinesia; and metabolize antipsychotic drugs more slowly than white clients. When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients.
A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine. Which client likely has the highest susceptibility to the adverse effects of olanzapine?
A client who has type 1 diabetes and who practices poor glycemic control The use of olanzapine creates a significant risk of hyperglycemia. This is of particular concern in patients and clients who have diabetes mellitus. Smoking affects the pharmacodynamics of olanzapine, but this is less likely to result in serious adverse effects. Obesity, low BMI, and recent antibiotic use are not associated with a significantly increased risk of adverse effects.
The nurse working with the family of a child prescribed methylphenidate should implement what strategy to address possible adverse effects?
A plan to address the child's loss of appetite Like dextroamphetamine, methylphenidate often causes loss of appetite. Plans to address this should be in place at the beginning of therapy. Frequent blood glucose monitoring and actions to maintain bladder function are not likely necessary. Self-esteem should likely be addressed during treatment, but reduced self-esteem is not an adverse effect of methylphenidate.
What should the nurse's pre-administration assessment of a client receiving a CNS stimulant for respiratory depression include? (Select all that apply.)
Blood pressure Pulse Respiratory rate Respiratory pattern Review recent lab work The nurse's pre-administration assessment of a client receiving a CNS stimulant for respiratory depression should include blood pressure, pulse, respiratory rate, depth, and pattern, review of recent lab work, and identification of drugs that may have caused the respiratory depression.
A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain?
It needs to be determined if the child still has symptoms that require treatment. Periodically the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which if they do occur, indicates the need for continued treatment. This is not done because the plan is to switch drugs if the current drug is effective or because of an increased risk. The absence of medicine will determine if he no longer needs the medication.
A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?
It reduces the likelihood of drug dependence or diversion. When a CNS stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose (i.e., decreased symptoms) or the maximum daily dose is reached. In addition, the number of doses that can be obtained with one prescription should be limited. This action reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed).
Which drug shares the abuse potential of amphetamines and is a Drug Enforcement Administration (DEA) schedule II controlled substance?
Methylphenidate, a centrally acting CNS stimulant Methylphenidate is an orally administered CNS stimulant that is chemically and pharmacologically similar to the amphetamines. The CNS actions of methylphenidate are milder than those of the amphetamines and have more noticeable effects on mental activities than on motor activities. Adderall, dexmethylphenidate, and pemoline do not share the abuse potential of the amphetamines.
In light of current treatment modalities, the nurse should anticipate that the client newly diagnosed with schizophrenia will most likely be prescribed what drug?
Olanzapine The "atypical" antipsychotics, such as olanzapine, are the drugs of choice, especially for clients who are newly diagnosed with schizophrenia. The other drugs are all "typical" (first-generation) antipsychotics.
The nurse understands that the main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. What is a secondary goal for their use?
To have clients use the drugs appropriately the main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately.
The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?
"Adverse effects include hypertension and nervousness." Adverse effects of methylphenidate include hypertension, tachycardia, nervousness, and appetite suppression with resulting weight loss. The drug has a high potential for abuse and dependence. The last dose of any CNS stimulant is usually taken at least 6 hours before bedtime to prevent interference with sleep.
The wife of a client who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be which?
"Continue the prescribed dose. It may take several days to work." The nurse should instruct the wife to continue offering her husband the drug and that it will probably take several days to reach its full therapeutic effect. The dosage would not be increased, decreased, or discontinued.
A nurse works at a weight management clinic. To which overweight client could the nurse safely administer dextroamphetamine?
A 48-year-old Caucasian man who has adult-onset diabetes Dextroamphetamine is contraindicated in clients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the clients at risk for hypertension and increased intraocular pressure. The only client that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes.
What client is being treated with a typical antipsychotic?
An agitated client who was given haloperidol during acute psychosis Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics
A high-school-age client, brought to the emergency department (ED) by friends after taking a "whole handful of dextroamphetamine," is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose?
Cardiac monitoring Dextroamphetamine misuse may cause sudden death or serious cardiovascular events. It is essential to obtain a baseline electrocardiogram (ECG) and blood pressure reading. These assessments are priorities over blood glucose monitoring, respiratory assessment, and cognitive assessment.
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
Clozapine Clozapine is associated with significant leukopenia. Subsequently, is it available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. Aripiprazole, olanzapine, and quetiapine are not associated with leukopenia.
The nurse is assessing a client who has just received haloperidol for an acute psychotic episode. For what therapeutic effect should the nurse initially assess following administration?
Decreased agitation and combativeness When haloperidol is given for acute psychotic episodes, the nurse initially observes for sedation as well as decreased agitation, combativeness, and psychomotor activity. Increased insight, increased sophistication of thinking, and decreased CNS stimulation are not considered immediate priorities during an acute psychotic episode.
A teenage client, treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years, is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions?
Discontinue the dextroamphetamine. Dextroamphetamine, an amphetamine, is contraindicated upon the development of hyperthyroidism. The client will require a higher-calorie count, not a discontinuation of a high-calorie count. The client will not require an assessment for pulmonary edema. The client will only require a proton pump inhibitor if gastric hyperacidity occurs.
The nurse is aware that medication dosage for a child with ADHD is stopped occasionally for what reason?
Evaluation of treatment regimen A drug holiday (i.e., stopping drug therapy) is recommended at least annually to evaluate the child's treatment regimen. Dosage adjustments are usually needed as the child grows and hepatic metabolism slows. Also, drug holidays decrease weight loss and growth suppression.
A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?
Extrapyramidal Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Sedation, anticholinergic effects, and hypotension can occur, but the risk for these is much less when compared with the risk for extrapyramidal effects.
The school nurse is conducting a screening of kindergarten students. The nurse will assess the children for what characteristics of ADHD? (Select all that apply.)
Hyperactivity Impulsivity Short attention span ADHD is characterized by hyperactivity, impulsivity, and a short attention span. Most often, they do not get along well with other children because of their impulsivity and difficulty maintaining control.
A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?
Increased blood glucose All of the patient's adverse effects should be addressed by the nurse. However, the most critical effect that needs immediate attention would be the increased blood glucose. Drug therapy for the increased blood glucose may need to be altered. The patient should monitor blood glucose levels carefully and report abnormal findings as soon as possible. Medication can help his dry eyes, and a dose adjustment with the dextroamphetamine may be necessary if the jitteriness is profound and does not subside. Sympathomimetic action of the dextroamphetamine may lead to an inability to ejaculate and either increased or decreased libido. The patient may need to seek counseling for this concern.
A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action?
Inform the prescriber and monitor for GI and CNS effects Therapeutic serum lithium levels range from 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic, but would be unlikely to warrant admission to intensive care. The nurse should report the finding and assess for common adverse effects of toxicity, which include GI and CNS effects more often than respiratory effects.
An adolescent client has been taking dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) for 3 years, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy?
Measurement of height and body weight Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.
What is the central nervous system stimulant of choice to treat narcolepsy?
Modafinil Modafinil is used to treat narcolepsy. Atomoxetine is administered for attention deficit hyperactivity disorder (ADHD). Guarana is an herbal supplement high in caffeine; it is not administered for narcolepsy. Caffeine is not administered for narcolepsy.
A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenager who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite?
Reduced adverse effects Atypical antipsychotics may be more effective in relieving some symptoms than typical antipsychotics, and they usually produce milder adverse effects. A major drawback is the high cost of these drugs. All antipsychotics are available for the oral route. There are several black box warnings relating to atypical antipsychotics.
The nurse observes that a client with a long history of chlorpromazine therapy demonstrates lip smacking and appears to be chewing continually. The nurse should recognize that this client is likely experiencing what adverse effect of the medication?
Tardive dyskinesia Tardive dyskinesia occurs as the result of long-term use of chlorpromazine. Clients may experience lip smacking, tongue protrusion, and facial grimaces and may have choreic movements of the trunk and limbs. Akathisia is a form of restlessness, and dystonias are uncoordinated movements. Neuroleptic malignant syndrome is an acute complication.
The nurse on the unit has several clients taking clozapine. For which client is clozapine, an antipsychotic, contraindicated?
The 45-year-old with bone marrow depression Contraindications to antipsychotic drugs include bone marrow depression, liver damage, coronary artery disease, coma, and severe hypotension or hypertension. The use of clozapine is not contraindicated in clients with upper respiratory infection, diabetes insipidus or osteoarthritis.
The nurse admits a client newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason why the nurse includes the family when collecting the nursing history?
The client may not be able to provide a sufficient history Schizophrenia, the most common psychosis, is characterized by delusions, hallucinations, and inappropriate responses to stimuli. As a result, the client may be unable to provide a coherent history and may be unaware of their behaviors considered dysfunctional. There is no reason to suspect the client's level of consciousness is impaired, and reducing anxiety is not the priority rationale for including family. While family is included in treatment, the goal is to treat the client and not make the family feel better.
A nurse is teaching the client about CNS medications and how they are addictive. What is primary reason CNS medications are addictive?
The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine. CNS medications have a high degree of addiction potential because they stimulate the brain's pleasure centers with enhanced neurotransmission of dopamine. CNS stimulants do not promote sleep. CNS stimulants do not change visual acuity. Decreased dopamine does not produce feelings of euphoria.
The use of what would a nurse identify as placing a client receiving lithium therapy at increased risk for toxicity?
Thiazide diuretic A thiazide diuretic-lithium combination increases the risk of lithium toxicity because sodium is lost and lithium is retained. Lithium effectiveness is decreased with tromethamine and antacids. Psyllium interferes with the absorption of lithium, leading to nontherapeutic levels.
Which would be important for a nurse to include in the teaching plan for a client taking fluphenazine?
Urine turning pink to reddish-brown Phenothiazines such as fluphenazine often turn the urine pink to reddish-brown as a result of excretion. Fatal arrhythmias are associated with thioridazine, mesoridazine, and ziprasidone. Nasal congestion, not rhinorrhea, is a possible adverse effect. The risk for developing diabetes is associated with atypical antipsychotics. Fluphenazine is a typical antipsychotic.
The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment?
central nervous system (CNS) stimulants Attention deficit hyperactivity disorder (ADHD) is characterized by persistent hyperactivity, short attention span, and difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used; they do not affect CNS stimulation.
A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling?
dopamine Stimulants enhance dopamine transmission to areas of the brain that interpret well-being. To maintain pleasurable feelings, people continue the use of stimulants, which leads to their abuse and the potential for addiction. Low serotonin levels are believed to cause depression and anxiety. Epinephrine is a hormone that increases cardiac output. Low levels of norepinephrine are believed to lead to ADHD and depression.
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which
height and weight. The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric client. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.
Antipsychotic drugs are contraindicated in clients with:
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.
The nurse is participating in a family meeting with the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed dextroamphetamine. The nurse should discuss what black box warning associated with this medication?
potential for abuse A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Anticholinergic effects, stroke, and hyperglycemia are not addressed in a black box warning for this drug.
A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?
Antipsychotics do not improve memory loss and may further impair cognitive functioning. If antipsychotic drugs are used to control acute agitation in older adults, they should be used in the lowest effective dose for the shortest effective duration. If the drugs are used to treat dementia, they may relieve some symptoms (e.g., agitation, hallucinations, hostility, suspiciousness, uncooperativeness), but they do not improve memory loss and may further impair cognitive functioning.
A nurse is administering a CNS stimulant to a client with narcolepsy. The nurse understands that this drug does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Which drug is the nurse most likely administering?
Modafinil Modafinil is used to treat narcolepsy and does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Caffeine is a CNS stimulant and can cause increased heart rate. Doxapram is a respiratory stimulant that increases respiratory rate and tidal volume. Dexmethylphenidate is a CNS stimulant used to treat ADHD and narcolepsy; it is highly addictive and can be psychologically dependent.
A female client relates that she is taking diazepam for a muscle relaxant and modafinil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of client education, the nurse would include:
Modafinil may decrease the effects of her contraceptive, and she may need to use other protection. Modafinil may increase the effects of citalopram, clomipramine, diazepam, phenytoin, propranolol, sertraline, tricyclic antidepressants, and warfarin. It may decrease the effects of cyclosporine and oral contraceptives.
A nurse is providing care for a client diagnosed with attention deficit hyperactivity disorder (ADHD) who has been taking methylphenidate for several months. When monitoring for potential adverse effects, the nurse should include what assessments?
sleep patterns Because methylphenidate is a central nervous system (CNS) stimulant, it carries the potential to disturb sleep patterns. The client's pupillary response, orientation, and sexual function are less likely to be affected.
A female client is diagnosed with Alzheimer-type dementia. She resides in a long-term care facility. The client's daughter asks the health care provider to prescribe an antipsychotic to control her mother's outbursts of anger and depression. The provider orders a psychiatric consultation for the client. The client's daughter asks, "Why doesn't the provider just order an antipsychotic?" What is the nurse's best response to this family member?
"Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems." Clients with dementia may become agitated because of environmental or medical problems. Alleviating such causes, when possible, is safer and more effective than administering antipsychotic drugs. Inappropriate use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems.
A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to leave work for clinic appointments. How should the nurse respond to that request to best assure client safety?
"The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." When a central nervous system stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose or the maximum daily dose is reached. The number of doses that can be obtained with one prescription should be limited; this reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed). None of the other options effectively address this risk for injury.
A client with schizophrenia has been taking haloperidol for several years. The care team and the client have collaborated and chosen to transition the client to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the client's risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsychotic, the care team should implement which intervention?
Gradually taper the dose of haloperidol When discontinuing haloperidol, it is essential to taper the dosage to prevent extrapyramidal symptoms. If the medication is abruptly discontinued, the client is at risk for this condition. A drug holiday would exacerbate symptoms, and ECT is not indicated. Concurrent administration of two drugs has the potential to exacerbate adverse effects.
A mother is concerned about recent behaviors by her young-adult son, and asks the nurse about what behaviors characterize schizophrenia. The nurse knows that the characteristics of schizophrenia include what actions? (Select all that apply.)
Disordered thinking Abnormal behavior Impaired socialization Schizophrenia is characterized by disordered thinking, abnormal behavior, and impaired socialization. Sexual promiscuity and repetitive actions are not common characteristics of schizophrenia.
The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis?
Disorganized and often bizarre thinking Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia. Psychosis is not characterized by slow reaction time and poor coordination, short manic episodes followed by depression or short/long-term memory deficits.
A client, prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD) has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement?
Increase fiber intake. Constipation is a common adverse effect of dextroamphetamine. A client who is experiencing constipation should be instructed to increase fiber in the diet. The client should not take a laxative before attempting to manage the problem with dietary modifications. The client should not be instructed to take diphenoxylate hydrochloride because it is an antidiarrheal agent. The client should not be given metronidazole since it is an anti-infective agent.
A male client's health care provider orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.
A client visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. These behaviors support which medical diagnosis?
Narcolepsy Narcolepsy is characterized by daytime sleep attacks in which the person goes to sleep at any place or at any time. Sleep apnea is episodes of apnea, temporary cessation of breathing, during sleep. Insomnia is the inability to sleep. This client is not exhibiting signs and symptoms consistent with substance abuse.
The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose?
To assess beneficial and adverse effects Methylphenidate is commonly prescribed and is usually given daily for the first 3 to 4 weeks of treatment to allow caregivers to assess beneficial and adverse effects.
The client has been taking chlorpromazine for more than 40 years. What adverse effect will the client most likely be experiencing?
extrapyramidal effects A client who has taken chlorpromazine on a long-term basis will be at risk for late extrapyramidal effects. Hypertension is not an adverse effect of chlorpromazine, but hypotension is an adverse effect. Central nervous system agitation is not an adverse effect of chlorpromazine, but central nervous system depression is an adverse effect. Urinary frequency is not an adverse effect of chlorpromazine, but urinary retention is an adverse effect.
The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?
the importance of adherence to prescribed treatment The success or failure of treatment is largely dependent on the client's adherence to treatment. For most clients, this supersedes the immediate significance of nutrition or teaching about therapeutic effects. There is no need for weekly coagulation tests.