Ch. (53-57)
A patient is experiencing an episode of psychosis. He is belligerent, loud, and abusive when you enter the room. What is the best response by the nurse during future interactions? A. Respond to him in an assertive tone. B. Delegate care to the technician. C. Use a calm, soft voice. D. Place him in the quiet room.
Use a calm, soft voice
A woman has a history of long periods of depression interspersed with hypomanic episodes. What mood disorder is the patient most likely suffering from? A. Coping disorder B. Bipolar disorder type II C. Situational depression D. Bipolar disorder type I
Bipolar disorder type II
A patient treated for bipolar disorder with lithium carbonate (Eskalith) is scheduled for a lithium blood level. What is the therapeutic serum lithium level? A. 1.5 to 2.0 mEq/L B. 0.5 to 1.2 mEq/L C. 2.7 to 2.9 mEq/L D. 2.75 to 3.25 mEq/L
0.5 to 1.2 mEq/L
A neonate is suffering from apnea. Which of the following medications may be administered as a respiratory stimulant? A. Caffeine and Mefoxitin B. Caffeine and sodium bicarbonate C. Caffeine and methylphenidate D. Caffeine and sodium benzoate
Caffeine and sodium benzoate
Methylphenidate will be used to treat a 9-year-old boy's ADHD. In light of this drug's most common adverse effects, the nurse who is working with the family should implement what strategy? A. A plan to address the boy's loss of appetite B. A plan to enhance the boy's self-esteem C. A strategy to ensure that the boy maintains normal bladder function D. A strategy to regularly monitor the boy's blood glucose levels
A plan to address the boy's loss of appetite
A 40-year-old man has been prescribed fluoxetine (Prozac). The patient states he has not continued the prescribed therapy even though his depression improved. What assessment is most important for the nurse to make? A. Assess for pain and discomfort. B. Assess for sexual dysfunction. C. Assess for hypotension. D. Assess for cardiac dysrhythmia.
Assess for sexual dysfunction.
A 34-year-old man was diagnosed with depression several weeks ago and began taking citalopram (Celexa) 10 days ago. He has now scheduled an appointment at the clinic and has told the nurse that he intends to stop taking the drug, stating, "I don't feel any less depressed than I did before I started taking these pills." How should the nurse best respond to the patient's statement? A. "People who take this drug often think they don't feel better because the changes in mood are incremental and subtle." B. "I'll pass that information along to your care provider; a different drug might be more appropriate for you." C. "It could be that one of the other medications or supplements you're taking is negating the effects of Celexa." D. "I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."
"I'd encourage you to continue with the drug; it can take several weeks before it improves your mood."
A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The patient asks the nurse what likely prompted his care provider to change his medication. What is the nurse's best response? A. "Long-term use of benzodiazepines can result in dependency." B. "Long-term use of benzodiazepines can cause insomnia." C. "Your doctor may have been concerned about causing depression." D. "Your doctor may have been worried about the possibility of convulsions."
"Long-term use of benzodiazepines can result in dependency."
A nurse is providing health education for the family of a patient who has a substance use disorder. How should the nurse best explain the etiology of this disorder? A. "Substance abuse is a complex phenomenon, and science has not yet begun to truly understand the phenomenon." B. "Substance abuse is multifactorial and involves genetics, personality, and culture." C. "Many different factors contribute to substance abuse, but the primary ones are lack of willpower and impaired coping." D. "Substance abuse is considered to be primarily a cultural concept, since definitions vary widely across time and place."
"Substance abuse is multifactorial and involves genetics, personality, and culture."
After experiencing two workplace accidents in which he fell asleep, a 30-year-old construction worker has been diagnosed with narcolepsy. The patient admits that he is embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the patient by explaining what aspect of the etiology? A. "This is the result of neurological factors over which you have no direct control." B. "This usually stems from suppressed emotions, so counseling usually helps greatly." C. "This is something that runs in certain families, and it's not your fault that this has happened." D. "In a lot of cases, making improvements to your sleep habits can resolve narcolepsy."
"This is the result of neurological factors over which you have no direct control."
A patient has been achieving an acceptable reduction in his positive and negative signs of schizophrenia after several weeks of treatment with clozapine. The patient has asked the nurse if it is acceptable for him to have "a few drinks from time to time." How should the nurse best respond to the patient's inquiry? A. "If you notice that your symptoms are worsening when you drink, you should stop doing it." B. "When you're taking clozapine, it's best to avoid drinking alcohol altogether." C. "That's okay in most cases, but it's advisable to limit it to beer and wine and to avoid spirits." D. "That shouldn't present a problem, provided you make sure that you're safe when you do it."
"When you're taking clozapine, it's best to avoid drinking alcohol altogether."
A patient has a long history of heavy alcohol use and has been admitted to the hospital for traumatic injuries after a motor vehicle accident. How should the nurse best assess the patient for physical dependence on alcohol? A. Assess the patient for signs and symptoms of alcohol withdrawal. B. Assess the patient's typical alcohol intake. C. Assess the patient's perceptions of his coping strategies. D. Assess whether the patient ever feels guilty about his drinking.
Assess the patient for signs and symptoms of alcohol withdrawal.
A 12-year-old girl has undergone an extensive diagnostic workup that has resulted in a diagnosis of ADHD. The prescriber has reviewed the benefits and risks of dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take her dextroamphetamine at what times? A. 09:00, 14:00, and 19:00 B. 07:30, 11:30, 16:30, and 20:00 C. 08:00 and 20:00 D. 07:00 and 11:30
07:00 and 11:30
A 13-year-old child is started on atomoxetine (Strattera) for ADHD. The patient and his family should be taught about the peak plasma levels of the medication. He takes his medication at 07:00 AM. When will this medication reach its peak plasma level? A. 10:30 to 11:45 AM B. 13:00 to 14:00 PM C. 08:00 to 09:00 AM D. 09:45 to 10:30 AM
08:00-09:00 am
A patient is having seizure activity, and the physician has ordered diazepam (Valium) to be given parenterally. If this medication is administered intravenously, when will its onset of action be observed? A. More than 10 minutes B. 1 to 5 minutes C. 7 to 10 minutes D. Less than 1 minute
1 to 5 minutes
A female patient asks the nurse how much caffeine is safe to consume per day. What is the recommended amount of caffeine for a nonpregnant woman? A. 250 mg of caffeine B. 1 g of caffeine C. 500 mg of caffeine D. 125 mg of caffeine
250 mg of caffeine
A patient is admitted to the hospital for treatment of a stasis ulcer of the right leg. The patient's history indicates he has abused alcohol in the past, and he typically consumes at least eight alcoholic beverages daily. What symptoms should the nurse assess the patient for? A. Confusion, hallucination, agitation, tremors B. Denial, manipulation, combativeness C. Suspicion, mania, stubbornness, fear D. Depression, remorse, withdrawal from reality
A. Confusion, hallucination, agitation, tremors
A patient with a well-known history of heroin use has begun addiction treatment. The nurse had administered the patient's daily dose of methadone. The nurses should know that this medication aids in treating opioid addiction because it does which of the following? A. Acts as an opioid antagonist and causes unpleasant symptoms if the patient uses opioids B. Acts as an agonist at opioid receptors and prevents withdrawal symptoms C. Acts on the limbic system and the reticular system to suppress brain activity associated with addiction D. Depresses the CNS to a similar degree as opioids, aiding in detoxification
Acts as an agonist at opioid receptors and prevents withdrawal symptoms
A psychiatric nurse is providing care for a female patient with schizophrenia whose medication regimen includes oral chlorpromazine. When administering this medication, the nurse should do which of the following? A. Have the patient hold the drug under her tongue for at least 30 seconds. B. Administer the drug 1 to 2 hours before bedtime. C. Instruct the patient to avoid dairy products for 1 hour before and 2 hours after administration. D. Administer the drug on alternating days.
Administer the drug 1 to 2 hours before bedtime.
A patient has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which of the following foods should the patient avoid eating? A. Tortellini in cream sauce B. Aged Swiss cheese and bratwurst C. Mashed potatoes and roast beef D. Anise cookies and milk
Aged Swiss cheese and bratwurst
A patient is being observed for acute benzodiazepine withdrawal symptoms. Which of the following symptoms is characteristic of this problem? A. Bradycardia B. Agitation C. Lethargy D. Diaphoresis
Agitation
A patient who suffers from alcoholism is prescribed disulfiram (Antabuse). How does this medication assist the patient in refraining from ingestion of alcohol? A. Increases the level of serotonin B. Decreases stimulation of the CNS C. Increases the level of acetylcholine D. Allows the accumulation of acetaldehyde
Allows the accumulation of acetaldehyde
A patient is given midazolam (Versed) in combination with an opioid in the preoperative phase before a laparoscopic cholecystectomy. What does the administration of midazolam (Versed) assist in minimizing? A. Oral secretions B. Anxiety C. Muscle tone D. Hypotension
Anxiety
A 77-year-old patient is admitted for the treatment of a fracture, and the nurse has identified that the patient has a history of heavy alcohol use. At what point should the care team administer pharmacologic treatments for alcohol withdrawal? A. After cognitive behavioral therapy has begun B. After skeletal muscle relaxants have taken effect C. As soon as the patient shows signs of withdrawal D. After treatment for the patient's acute injuries has been completed
As soon as the patient shows signs of withdrawal
A high school-aged girl has been suffering from major depression for several months, and she has begun treatment with an SSRI. In light of the black box warning accompanying SSRIs, the nurse should prioritize which of the following assessments? A. Assessment of cardiac rate and rhythm B. Assessment for hypomanic state C. Assessment for venous thromboembolism (VTE) D. Assessment for suicidal ideation
Assessment for suicidal ideation
A patient suffers from narcolepsy. Which of the following aspects of patient teaching should be provided? A. Take 250 mg of caffeine daily. B. Avoid working shifts. C. Increase the Ritalin dose as needed. D. Take a lengthy nap every afternoon.
Avoid working shifts.
A patient is admitted for assessment because of his history of inappropriately flamboyant and extroverted behavior coupled with risk-taking behaviors. The wife states he has also had periods of major depression but refuses to seek help. From what mood disorder is the patient most likely suffering? A. Bipolar disorder type I B. Depression C. Schizophrenia D. Bipolar disorder type II
Bipolar disorder type I
A high school boy has been brought to the emergency department (ED) by his friends who state that he has taken a "whole handful of Dex" and is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose? A. Cognitive assessment B. Lung function testing C. Blood glucose monitoring D. Cardiac monitoring
Cardiac monitoring
A patient has been brought to the emergency department by paramedics. The patient's known history and highly agitated state are suggestive of cocaine-induced psychosis. What assessment should the nurse prioritize prior to administering pharmacologic treatments? A. Lung auscultation B. Assessment of blood glucose levels C. Cardiovascular assessment D. Assessment of cranial nerve function
Cardiovascular assessment
A 4-year-old child is brought to the pediatric clinic by his mother. She states, "I don't know what to do with him. He is in constant motion. He won't sit for more than a few seconds and he is doing something else. He often throws his toys and yells loudly, even compared with other kids his age." The child is diagnosed with attention deficit hyperactivity disorder. Which of the following medications will most likely be administered in conjunction with treatment? A. ACE inhibitors B. MAO inhibitors C. Central nervous system stimulants D. SSRIs
Central nervous system stimulants
A patient has been prescribed mirtazapine (Remeron). How will it decrease migraine headaches and depression? A. It blocks the presynaptic alpha2-adrenergic receptors. B. It acts on the dopamine only receptors in the brain. C. It inhibits norepinephrine and serotonin reuptake. D. It increases concentration of endogenous epinephrine.
It blocks the presynaptic alpha2-adrenergic receptors.
A patient is admitted to the inpatient alcohol rehabilitation program. What medication will the patient most likely be prescribed to treat alcohol withdrawal syndromes? A. Clonidine (Catapres) B. Atenolol (Tenormin) C. Methyldopa (Aldomet) D. Chlordiazepoxide (Librium)
Chlordiazepoxide (Librium)
An elderly patient with a long-standing history of schizophrenia has been admitted to the hospital for treatment of hyponatremia. The nurse reviews the patient's medical chart and reads that the patient was previously treated with phenothiazine antipsychotics. What medication may this patient have been treated with? A. Acetylsalicylic acid (aspirin) B. Chlorpromazine (Thorazine) C. Aminophylline (Theophylline) D. Dantrolene sodium (Dantrium)
Chlorpromazine (Thorazine)
A patient is seen in the ambulatory care clinic with a complaint of insomnia. What should the nurse assess in regard to the complaint of insomnia? A. Possible use of amphetamines B. The family history of insomnia and sleep C. The amount of exercise in which the patient engages D. Daily intake of caffeine-containing products
Daily intake of caffeine-containing products
Parenteral haloperidol has been ordered for a patient who is experiencing an acute psychotic episode. The nurse should recognize what primary goal of treatment? A. Decreased CNS stimulation B. Increased sophistication of thinking C. Decreased agitation and combativeness D. Increased insight into delusional thinking
Decreased agitation and combativeness
A patient is administered a benzodiazepine for anxiety. Which of the following will place the patient at risk for benzodiazepine toxicity? A. Decreased potassium B. Increased calcium C. Low bicarbonate D. Decreased albumin
Decreased albumin
A patient is admitted to the intensive care unit with a diagnosis of septicemia. In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill patient? A. Increased diffusion and perfusion B. Decreased cardiac workload C. Increased level of consciousness D. Decreased blood pH
Decreased cardiac workload
A patient is admitted to the hospital for cardiac surgery and has just come up to the postsurgical unit from the recovery room. He develops unprecedented confusion and states, "I see bugs up and down the walls. They are going to get me." The nurse suspects the patient is suffering from what symptom? A. Delusions B. Schizophrenia C. Depression D. Delirium
Delirium
A patient was admitted to the emergency room with acute alcohol intoxication and has been diagnosed with alcohol abuse after subsequent assessment and treatment. What are the goals of long-term treatment of this patient's substance abuse disorder? A. Detoxification, abstinence, and prevention of relapse B. Withdrawal, abstinence, and accountability C. Assessment, planning, and intervention D. Withdrawal, reeducation, and compliance
Detoxification, abstinence, and prevention of relapse
A patient is prescribed olanzapine (Zyprexa) for the treatment of schizophrenia. The patient tells the nurse he is voiding three times each night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed? A. Hyperthyroidism B. Diabetes mellitus C. Urinary tract infection D. Renal calculi
Diabetes mellitus
A nurse has noted that a newly admitted patient has been taking ramelteon (Rozerem) for the past several weeks. The nurse is justified in suspecting that this patient was experiencing what problem prior to starting this drug? A. Somnambulism (sleepwalking) B. Difficulty falling asleep at night C. Frequent nighttime awakenings D. Early morning waking
Difficulty falling asleep at night
A patient has been treated with dextroamphetamine for ADHD. At the age of 16 years, she is diagnosed with hyperthyroidism. What intervention should be implemented with this patient? A. Discontinue the amphetamines. B. Assess the patient for pulmonary edema. C. Administer a proton pump inhibitor. D. Discontinue the high-calorie diet.
Discontinue the amphetamines.
A patient's severe family tragedy 1 year ago resulted in depression and insomnia. Which of the following hypnotics may be safely taken for longer-term treatment of insomnia? A. Oxazepam (Serax) B. Eszopiclone (Lunesta) C. Lorazepam (Ativan) D. Chloral hydrate
Eszopiclone (Lunesta)
A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience? A. Hypertension B. Central nervous system agitation C. Urinary frequency D. Extrapyramidal effects
Extrapyramidal effects
An older adult patient suffers from generalized anxiety disorder. The use of benzodiazepines in this patient population creates a risk for what adverse effect? A. Sexual dysfunction B. Dysrhythmias C. Seizures D. Falls
Falls
A 22-year-old male is brought to the emergency room due to an overdose of diazepam (Valium). What drug will be administered in the emergency room to treat the overdose? A. Methadone (Dolophine) B. Naloxone (Narcan) C. Disulfiram (Antabuse) D. Flumazenil (Romazicon)
Flumazenil (Romazicon)
A patient has developed excessive sedation and respiratory depression. The patient has been taking a benzodiazepine and has diminished liver function. Which of the following medications will reduce the effects of sedation and respiratory depression in this patient? A. Olmesartan medoxomil (Benicar) B. Pancrelipase (Pancrease) C. Flumazenil (Romazicon) D. Pamidronate disodium (Aredia)
Flumazenil (Romazicon)
A patient with schizophrenia has been taking haloperidol for several years. The care team and the patient have collaborated and chosen to transition the patient to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the patient's risk of extrapyramidal effects during this transition, the care team should do which of the following? A. Arrange for weekly electroconvulsive therapy during the time of transition. B. Have a 2- to 3-week "drug holiday" between stopping the haloperidol and starting the atypical antipsychotic. C. Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks. D. Gradually taper the dose of haloperidol.
Gradually taper the dose of haloperidol.
An 8-year-old child is being seen in the clinic. The mother states he suffers from bed-wetting at least four times per week. What medication is effective in treating enuresis in children? A. Imipramine (Tofranil) B. Venlafaxine (Effexor) C. Duloxetine (Cymbalta) D. Amitriptyline (Elavil)
Imipramine (Tofranil)
A child is prescribed an amphetamine for attention deficit hyperactivity disorder. Which of the following effects provide evidence that the medications are working? A. Improved grades B. Increased sleep quality C. Polyphagia D. Lethargy
Improved grades
A 22-year-old man's increasingly bizarre behavior has culminated in a diagnosis of schizophrenia. In light of current treatment modalities for schizophrenia, the nurse should anticipate that the patient is most likely to be prescribed what drug? A. Chlorpromazine (Thorazine) B. Haloperidol (Haldol) C. Olanzapine (Zyprexa) D. Prochlorperazine (Compazine)
Olanzapine (Zyprexa)
A patient is taking dextroamphetamine for ADHD. He has developed constipation since beginning therapy. Which of the following should the patient be taught? A. Take diphenoxylate hydrochloride (Lomotil). B. Take an OTC laxative daily. C. Take metronidazole (Flagyl). D. Increase fiber intake.
Increase fiber intake.
Duloxetine (Cymbalta) is being considered in the treatment of a patient's depression. Which of the following laboratory values would prevent the patient from being treated with this medication? A. Decreased potassium level B. Decreased hemoglobin level C. Increased erythrocyte sedimentation rate D. Increased ALT
Increased ALT
A middle-aged woman has become increasingly debilitated by anxiety, to the extent that she has sought medical help. After a thorough assessment, her care provider has diagnosed her with an anxiety disorder. The etiology of anxiety involves which of the following physiological processes? A. Stimulation of the parasympathetic nervous system B. Adrenocortical suppression C. Increased activation of the autonomic nervous system D. Stimulating effects of somatotropin
Increased activation of the autonomic nervous system
A patient who has a diagnosis of schizophrenia is likely to have which of the following pathophysiologic effects? A. Increased serum potassium B. Decreased numbers of glutamate receptors C. Decreased interaction with GABA D. Increased dopamine
Increased dopamine
A patient is being treated for bipolar disorder with lithium carbonate (Eskalith). He also suffers from congestive heart failure and hypertension. The patient has an increased fluid volume and has recently had difficulty breathing. What laboratory value will most affect the action of the patient's lithium carbonate? A. Increased potassium level B. Increased sodium level C. Increased white blood cell count D. Increased hematocrit
Increased sodium level
A patient with a diagnosis of major depression has failed to respond to treatment with SSRIs, and the use of venlafaxine is being considered. The psychiatric nurse would recognize that this drug may have a therapeutic effect by which of the following means? A. Slowing the reuptake of acetylcholine in brain synapses B. Increasing levels of serotonin and norepinephrine C. Stimulating synthesis and potentiating the action of dopamine D. Slowing the reuptake of endorphins in the CNS
Increasing levels of serotonin and norepinephrine
A 77-year-old patient is suffering from insomnia. Which of the following medications can be most safely administered to this patient to induce sleep? A. Temazepam (Restoril) B. Alprazolam (Xanax) C. Diazepam (Valium) D. Clonazepam (Klonopin)
Temazepam (Restoril)
When administering benzodiazepines, which of the following medications should be considered the drug of first choice? A. Lorazepam (Ativan) B. Temazepam (Restoril) C. Estazolam (Prosom) D. Triazolam (Halcion)
Lorazepam (Ativan)
A patient has been taking lithium carbonate (Eskalith) for many years to treat bipolar disorder. Which of the following diets will require the dose of lithium carbonate (Eskalith) be reduced? A. Low sodium B. Low carbohydrate C. Low calorie D. Low residue
Low sodium
A patient diagnosed with schizophrenia is being seen by the home care nurse. What is the most important aspect of patient teaching with this patient? A. Report signs of neuralgia. B. Maintain the medication regimen. C. Limit alcohol intake to two drinks per day. D. Stop medications if weight gain occurs.
Maintain the medication regimen.
A 13-year-old boy has been taking dextroamphetamine for the treatment of ADHD since he was 10, achieving significant improvements in behavior and mood. When assessing the boy during a scheduled follow-up appointment, the nurse should prioritize what physical assessment? A. Abdominal girth and assessment for peripheral edema B. Measurement of height and body weight C. Visual acuity and hearing ability D. Assessment of deep tendon reflexes and peripheral pulses
Measurement of height and body weight
A patient is being treated for opioid abuse after many years of cocaine and heroin use. The nurse should anticipate that this patient will be treated with what drug? A. Naloxone (Narcan) B. Methadone (Dolophine) C. Flumazenil (Romazicon) D. Disulfiram (Antabuse)
Methadone (Dolophine)
A patient is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? A. Triazolam (Halcion) B. Chlordiazepoxide (Librium) C. Oxazepam (Serax) D. Midazolam (Versed)
Midazolam (Versed)
A patient with narcolepsy is placed on a central nervous system stimulant. What is the central nervous system stimulant of choice to treat narcolepsy? A. Atomoxetine (Strattera) B. Guarana C. Caffeine D. Modafinil (Provigil)
Modafinil (Provigil)
A 33-year-old patient with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an inpatient basis. When a nurse is administering this medication, he or she should do which of the following actions? A. Administer the oral form of the medication if the patient is combative B. Promptly stop administering the medication once status improvements are noted C. Monitor the patient's vital signs closely during IV administration D. Assess the patient's cardiac status prior to administering each dose
Monitor the patient's vital signs closely during IV administration
A patient 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. From what disease process does the occupational health nurse suspect the patient is suffering? A. Insomnia B. Narcolepsy C. Sleep apnea D. Substance abuse
Narcolepsy
A 15-year-old boy with a complex psychosocial history is being treated for inhalant abuse. When providing health education to this boy, the nurse should cite which of the following risks associated with inhalant abuse? A. Hyperactivity B. Psychological dependence C. Physiological dependence D. Organ damage
Organ damage
An elderly patient is admitted to the medical unit after a fall. At home he is taking amitriptyline (Elavil) 20 mg three times per day. What adverse effect could be related to the patient's fall? A. Orthostatic hypotension B. Urinary retention C. Urinary frequency D. Visual disturbances
Orthostatic hypotension
A patient who has long abused alcohol is being treated with disulfiram (Antabuse). The patient currently takes phenytoin (Dilantin) for an underlying seizure disorder. Based on the interaction of these two medications, what will need to be adjusted in the medication administration? A. The patient will require phenytoin (Dilantin) to be administered twice daily. B. The patient will require a larger dose of disulfiram (Antabuse). C. The patient will require a reduced dose of phenytoin (Dilantin). D. The patient will require more frequent administration of disulfiram (Antabuse).
The patient will require a reduced dose of phenytoin (Dilantin).
A patient suffers from insomnia and is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which of the following contributes to the long half-life of this medication and other benzodiazepines? A. Metabolism by cytochrome P450 B. Movement of calcium in the cell C. Excretion by the renal system D. Presence of active metabolites
Presence of active metabolites
A person is seen wandering the streets and talking in an animated way to people who are not there. From what disorder do you suspect the person is suffering? A. Delusions B. Depression C. Psychosis D. Confusion
Psychosis
A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenage girl who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite? A. Lower cost B. The possibility of oral administration C. Reduced adverse effects D. Absence of black box warnings
Reduced adverse effects
A patient is prescribed clozapine (Clozaril). The patient and family should be instructed on the adverse effects of this medication. What laboratory test is most important in the first months of the medication regime? A. Regular complete blood counts B. Daily INR C. Monthly creatinine levels D. Weekly liver enzymes
Regular complete blood counts
An elderly woman tells the nurse that she was successfully treated with phenelzine (Nardil) during a bout of severe depression in the 1970s. Her mood has been worsening in recent years as she has dealt with the death of her husband and functional declines. As a result, she has asked the nurse if her care provider is likely to prescribe this same drug. What fact should underlie the nurse's response to the patient? A. In most situations, MAO inhibitors have been largely superseded by tricyclic antidepressants. B. Cognitive behavioral therapy has been found to be more effective than MAO inhibitors, so they are rarely prescribed. C. MAO inhibitors are rarely used because serum levels must be monitored with blood work every 2 weeks. D. The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used.
The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used.
A patient with a history of alcoholism is being treated in the intensive care unit for multiple trauma following a motor vehicle accident. The patient is currently being treated with lorazepam (Ativan) to treat signs of alcohol withdrawal as well as hydromorphone (Dilaudid) for the pain of injuries. The intensive care nurse should prioritize what assessments? A. Arterial blood gases B. Deep tendon reflexes and pupillary response C. Cardiac rate and rhythm D. Respiratory rate and oxygen saturation
Respiratory rate and oxygen saturation
A boy has been diagnosed with ADHD and has been prescribed Ritalin. The boy's mother tells the nurse that she does not understand why a stimulant would help him, stating, "If anything, he's completely overstimulated, not understimulated!" What should the nurse explain to the mother about the therapeutic use of Ritalin? A. Ritalin enhances the function of dopamine, which regulates cognition. B. Ritalin stimulates the limbic system, which regulates control over behavior and affect. C. Ritalin stimulates the parasympathetic nervous system, resulting in increased control of behavior. D. Ritalin helps with the symptoms of ADHD, but the reasons for this are not well understood.
Ritalin helps with the symptoms of ADHD, but the reasons for this are not well understood.
A patient with a diagnosis of endocarditis has been admitted, and the care team is aware that IV opioid use is the origin of the patient's infection. The patient is open to the idea of treatment for her substance abuse disorder. When planning this aspect of the patient's care, what goal should the nurse first address? A. Compliance with treatment B. Taking ownership of the problem C. Safe detoxification D. Adequate stimulation of the CNS
Safe detoxification
A teenage boy has begun to exhibit the characteristic signs and symptoms of schizophrenia. During his mother's pregnancy, during what time in development could she have experienced an intrauterine insult? A. First trimester B. Conception C. Third trimester D. Second trimester
Second trimester
A patient is admitted to the emergency room suffering from symptoms of alcohol withdrawal. The nurse should plan care with the goal of preventing which of the following? A. Seizures B. Hypotension C. Gastrointestinal bleeding D. Bradycardia
Seizures
A patient has been taking a selective serotonin reuptake inhibitor for the treatment of depression. Which of the following represents the action of the medication? A. Selective serotonin reuptake inhibitors increase the number of serotonin binding sites. B. Selective serotonin reuptake inhibitors block GABA. C. Selective serotonin reuptake inhibitors increase serotonin synthesis. D. Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed.
Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed.
A patient suffers from depression and states feelings of gloom and inability to perform the activities of daily living. The normal function of which neurotransmitter is most likely impaired? A. Serotonin B. Insulin C. Acetylcholine D. Epinephrine
Serotonin
A patient in her 60s has been living with schizophrenia since she was a young woman and was treated with chlorpromazine for many years. The nurse who is meeting the patient for the first time observes that the patient continually smacks her lips and appears to be chewing. The nurse should recognize that this patient is likely experiencing what problem? A. Dystonias B. Tardive dyskinesia C. Akathisia D. Neuroleptic malignant syndrome
Tardive dyskinesia
A 77-year-old woman who experiences significant anxiety has been taking diazepam for several months. She was brought to the clinical earlier this week by her daughter, who stated that her mother had been behaving in an uncharacteristically confused manner. The clinician discontinued the patient's diazepam. Three days later, the daughter states that her mother has still been having problems with impaired memory and confusion. The nurse should consider what possible explanation for the patient's current status? A. Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B. The patient may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. C. The adverse effects of benzodiazepines can persist for several days after stopping the drug. D. The patient may have decreased liver function.
The adverse effects of benzodiazepines can persist for several days after stopping the drug.
A child with night terrors is administered a benzodiazepine agent. Why must the nurse follow the child's health status closely? A. The child is more vulnerable to adverse effects. B. The child is more likely to develop insomnia. C. The child is more vulnerable to hepatotoxicity. D. The child is more likely to develop dependence.
The child is more vulnerable to adverse effects.
A patient's current medical status includes multiple comorbidities. In recent months, the patient has been complaining of insomnia that has begun to have a significant impact on his quality of life. What aspect of this patient's health is most likely to cause insomnia? A. The patient has type 2 diabetes. B. The patient is morbidly obese. C. The patient has chronic pain. D. The patient has hypothyroidism.
The patient has chronic pain.
A man has asked the care team to consider the use of benzodiazepines to treat his wife's severe alcoholism. The use of benzodiazepines for this purpose may be contraindicated in what circumstances? A. The patient is also addicted to nicotine. B. The patient has previously been treated with benzodiazepines. C. The patient is acutely intoxicated. D. The patient denies the severity of her addiction.
The patient is acutely intoxicated.
A patient is being treated for addiction to cocaine and heroin and will begin treatment with naltrexone (ReVia). If the patient uses an opioid after taking this drug, the nurse should expect what effect? A. The patient will experience a decline in neurological function. B. The patient will experience visual disturbances and unpleasant hallucinations. C. The patient will not experience the usual physiological effects of opioids. D. The patient will experience a sudden onset of nausea and vomiting.
The patient will not experience the usual physiological effects of opioids.
A patient has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which of the following goals of care is the priority? A. The patient will participate in activities of daily living. B. The patient will demonstrate independent health maintenance. C. The patient will interact therapeutically with peers. D. The patient will remain safe.
The patient will remain safe.
A teenage boy is on amphetamine therapy for attention deficit hyperactivity disorder. The care provider has suggested a "drug holiday" for July and August. What is the purpose of this drug holiday? A. To prevent hyperthyroidism B. To minimize weight loss C. To allow electrolyte imbalances to resolve D. To slow bone resorption
To minimize weight loss
A child suffers from tics and verbal outbursts in the classroom and while he is awake. The patient is prescribed haloperidol (Haldol). What disease process is haloperidol (Haldol) used to treat? A. Tourette's syndrome B. Early-onset dementia C. Myasthenia gravis D. Muscular dystrophy
Tourette's syndrome
A patient suffers from insomnia secondary to temporomandibular joint pain. Which of the following selective serotonin reuptake inhibitors is most effective for treating insomnia? A. Trazodone (Desyrel) B. Citalopram hydrobromide (Celexa) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)
Trazodone (Desyrel)
A patient is taking disulfiram (Antabuse) and later consumes several shots of vodka. What effect will be produced from the combination of alcohol and disulfiram? A. Hyperalertness B. Hypertension C. Oral bleeding D. Vomiting
Vomiting
A patient is to be switched from fluoxetine (Prozac) to isocarboxazid (Marplan). What patient education is most important when changing from fluoxetine (Prozac)? A. Wait 1 week before starting isocarboxazid (Marplan). B. Wait 5 weeks before starting isocarboxazid (Marplan). C. Wait 2 weeks before starting isocarboxazid (Marplan). D. Wait 5 days before starting isocarboxazid (Marplan).
Wait 5 weeks before starting isocarboxazid (Marplan).
A patient who suffers from asthma is given theophylline. Theophylline will have an increased effect if taken with A. modafinil (Provigil). B. caffeine. C. atomoxetine (Strattera). D. Ritalin.
caffeine.
A patient with a diagnosis of depression states to the nurse that she has started taking St. John's wort to help her feel better and tolerate the demands of parenting. The patient has been taking an SSRI for the past several months. The nurse should teach that patient that this combination may result in A. worsened symptoms of depression. B. dangerous drug interactions. C. blood dyscrasias. D. hemostatic instability.
dangerous drug interactions.
A patient's medication administration record orders the IM administration of chlorpromazine. When administering this drug, the nurse should A. have the patient massage the injection site for 1 to 2 minutes after the injection. B. administer the drug into the deltoid muscle with a 1 1/2-inch needle. C. have the patient lie down for 30 to 60 minutes after the injection. D. observe the patient while he or she self-administers the drug.
have the patient lie down for 30 to 60 minutes after the injection.
A patient was admitted with a diagnosis of a gastrointestinal bleed, the latest of several hospital admissions that have been attributed to his alcohol abuse. The addictions medicine specialist has prescribed disulfiram, which will A. prevent the patient from experiencing euphoria if he drinks alcohol. B. intensify the patient's CNS depression if he drinks alcohol. C. result in a depressed mood if he drinks alcohol. D. produce unpleasant reactions if the patient drinks alcohol.
produce unpleasant reactions if the patient drinks alcohol.
In the 18 months following the death of his wife, a middle-aged man has been taking benzodiazepines on a daily basis. He has expressed to the nurse his desire to stop taking these medications. In order to minimize the chances of withdrawal symptoms, the nurse knows that the patient will likely be advised to A. taper down his dose of benzodiazepines over a prolonged period of time. B. replace the immediate-acting form of the drug with a long-acting form. C. replace the benzodiazepine with a herbal supplement in anticipation of stopping the medication. D. replace the benzodiazepine with an anticonvulsant.
taper down his dose of benzodiazepines over a prolonged period of time.
A patient is being prescribed dextroamphetamine for the treatment of ADHD. During health education, the nurse should make the patient aware of the black box warning relating to A. the risks of kidney failure. B. the potential for abuse. C. the potential for unstable blood glucose levels. D. the risk of stroke with excessive doses.
the potential for abuse.
