Chapter 22: Psychotherapeutic Agents
What client is being treated with a typical antipsychotic? An agitated client who was given haloperidol during acute psychosis A client with schizophrenia who received paliperidone 6 mg PO daily A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client who recently began taking ziprasidone
An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.
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 cause a gradual return of cognitive ability. Antipsychotics reduce memory loss. Antipsychotics increase the risk of long-term memory loss. Antipsychotics do not improve memory loss and may further impair cognitive functioning.
Antipsychotics do not improve memory loss and may further impair cognitive functioning. Explanation: 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 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? "It would be very costly to purchase a years' worth of medication at one time." "The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." "I understand the inconvenience, but you have to come in at least every month to have blood work done." "I will speak with your health care provider about increasing the size of each refill."
"The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." Explanation: 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.
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." "The medication is usually taken just before bedtime." "The drug may cause weight gain." "There is no risk of dependence."
"Adverse effects include hypertension and nervousness." Explanation: 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." "I'll ask the nurse practitioner if the dosage can be increased." "I'll ask the nurse practitioner if the haloperidol can be discontinued and another drug started." "I'll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol."
"Continue the prescribed dose. It may take several days to work." Explanation: 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 client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask the client to confirm why the medication was prescribed? "Do you have a history of depression?" "Have you ever been diagnosed with narcolepsy?" "Do you have a problem with sleepwalking?" "Do you have trouble falling asleep?"
"Have you ever been diagnosed with narcolepsy?" Explanation: Modafinil is used to treat narcolepsy and to improve wakefulness in other sleep disorders. It is not used to treat insomnia, somnambulism, or depression.
An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology? "This is the result of neurologic factors over which you have no direct control." "In a lot of cases, making improvements to your sleep habits can resolve narcolepsy." "This is something that runs in certain families, and it's not your fault that this has happened." "This usually stems from suppressed emotions, so counseling usually helps greatly."
"This is the result of neurologic factors over which you have no direct control." Explanation: Narcolepsy is a neurologic sleep disorder, not the result of mental illness or psychological problems. It is most likely due to several genetic abnormalities, but family history is not noted to be highly significant. Learning that improvement of sleeping habits is important, but it will not address embarrassment.
The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed? Theophylline Haloperidol Chlorpromazine Thiothixene
Chlorpromazine Explanation: Chlorpromazine is the prototype phenothiazine. Theophylline is a xanthine agent administered to treat some respiratory disorders. Haloperidol and thiothixene are nonphenothiazine antipsychotics.
Which antipsychotic medications have antiemetic effects? (Select all that apply.) Lithium (Eskalith) Aripiprazole (Abilify) Chlorpromazine (Thorazine) Prochlorperazine (Compazine) Clozapine (Clozaril)
Chlorpromazine (Thorazine) Prochlorperazine (Compazine) Explanation: Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are antipsychotic medications that have antiemetic effects.
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 high-calorie diet. Assess the client for pulmonary edema. Discontinue the dextroamphetamine. Administer a proton pump inhibitor.
Discontinue the dextroamphetamine. Explanation: 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.
During periods of dehydration, the client is at risk for lower serum lithium levels. True False
False Explanation: During periods of sodium depletion or dehydration, the kidney reabsorbs more lithium into the serum, often leading to toxic levels.
Parents bring a 15-year-old male into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What is an appropriate question to ask the parents? Which of your family members did not have schizophrenia? What symptoms should he have? What health care providers have you taken your son to? How long has your son been exhibiting symptoms?
How long has your son been exhibiting symptoms? Explanation: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality.
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 Inform the prescriber and perform a focused respiratory assessment Contact the prescriber and request a supplementary dose of lithium Facilitate a transfer to the intensive care unit
Inform the prescriber and monitor for GI and CNS effects Explanation: 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.
Many bipolar patients quit taking their medications. Research has now indicated that what may be effective in the long-term prevention of recurrent psychosis? Gene therapy Depot injections of anti-psychotic drugs Intense, one-on-one psychotherapy Lamictal 25 mg po q day
Lamictal 25 mg po q day Explanation: Several studies indicate that Lamictal 25 mg po q day is effective in long-term prevention of recurrent psychosis.
A client is to be started on amphetamine therapy for attention deficit hyperactivity disorder. Which medication has less physical dependence and abuse than other amphetamines? Dextroamphetamine and amphetamine Dextroamphetamine Methamphetamine Lisdexamfetamine
Lisdexamfetamine Explanation: Lisdexamfetamine is approved for treatment of ADHD. The drug reportedly delays the stimulation associated with other amphetamines and may be less prone to abuse. Dextroamphetamine and amphetamine, dextroamphetamine, and methamphetamine are prone to abuse.
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? Abdominal girth and assessment for peripheral edema Measurement of height and body weight Visual acuity and hearing ability Assessment of deep tendon reflexes and peripheral pulses
Measurement of height and body weight Explanation: 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.
Serotonin abnormalities are thought to be involved in the following disorders: Epilepsy and strokes. Attention deficit disorder. Mental depression and sleep disorders. Severe anxiety and hyperactivity.
Mental depression and sleep disorders. Explanation: Normal levels of serotonin in the brain produce mood elevation or euphoria, increasing mental alertness and capacity for work, decrease fatigue and drowsiness, and prolong wakefulness. Abnormalities alter these functions.
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 diazepam. Modafinil will not interfere with any of the medications she is taking. Modafinil may decrease the effects of her contraceptive, and she may need to use other protection. Modafinil should not be taken if the client is on a contraceptive.
Modafinil may decrease the effects of her contraceptive, and she may need to use other protection. Explanation: 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 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? Lower cost The possibility of oral administration Reduced adverse effects Absence of black box warnings
Reduced adverse effects Explanation: 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.
A client who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine. The client has been taking the medication for more than 40 years. What adverse effect will the client most likely experience? Hypertension Tardive dyskinesia Central nervous system agitation Urinary frequency
Tardive dyskinesia Explanation: A client who has taken chlorpromazine on a long-term basis will be at risk for late extrapyramidal effects, such as tardive dyskinesia. 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.
A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior? Stevens-Johnson syndrome Neuroleptic malignant syndrome Tardive dyskinesia Extrapyramidal syndrome
Tardive dyskinesia Explanation: Tardive dyskinesia is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw, and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome (EPS), neuroleptic malignant syndrome (NMS), and Stevens-Johnson syndrome do not cause rhythmic, involuntary, facial movements.
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 Akathisia Dystonia Neuroleptic malignant syndrome
Tardive dyskinesia Explanation: 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.
A 24-year-old client is being seen in the emergency department because of a high fever and cannot move the right arm. During the history-taking process, The nurse discovers the client is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client? The client may have influenza A and will need to be put into isolation. The client may have broken his arm and not remember what happened because of his schizophrenia. The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately. The client may have neuroleptic malignant syndrome, which will self-resolve in a few hours after rest and Tylenol.
The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately. Explanation: Neuroleptic malignant syndrome (NMS) is a rare reaction characterized by extrapyramidal effects, hyperthermia, and autonomic disturbance. NMS is potentially fatal and requires immediate treatment. NMS does not self-resolve. Influenza A is not characterized by having an immobile arm. Usually a schizophrenic client would be able to tell you how he had broken his arm.
The nurse is caring for a patient who is receiving drug therapy for a psychotic disorder. Which goals should the nurse include in a care plan for the patient following discharge from the hospital? The patient will return for follow-up appointments when the patient believes they are necessary. The patient will exhibit decreased symptoms of acute psychosis. The patient will take medications as prescribed. The patient will normalize sleeping and eating patterns.
The patient will take medications as prescribed. Explanation: Goals that relate to care following discharge may include ensuring that the patient takes medications as prescribed and returns for all scheduled follow-up appointments with health care providers. Normalizing sleep and eating patterns and decreasing symptoms are short-term (e.g., within the first week of treatment) goals of patients who experience acute psychotic episodes.
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 serotonin epinephrine norepinephrine
dopamine Explanation: 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. Vision. body temperature. blood pressure.
height and weight. Explanation: 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.
A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client? history of seizure disorder vegetarian eating plan treatment for rheumatoid arthritis remote work in customer service
history of seizure disorder Explanation: Clozapine is contraindicated for use in a client with a history of seizure disorders. The medication is not contraindicated for any specific eating plan. Treatment for rheumatoid arthritis is not a contraindication for this medication. The type of employment is not identified as a contraindication for this medication.
A nurse is caring for a patient who is taking haloperidol. The patient has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on a(n): decreased risk for toxic effects of haloperidol therapy. increased risk for toxic effects of haloperidol therapy. decreased risk for muscular contractions and spasms. high drug efficacy of haloperidol.
increased risk for toxic effects of haloperidol therapy. Explanation: Haloperidol is highly protein bound. Therefore, if it is administered along with another drug that is highly protein bound, it is likely to cause higher blood levels, leading to an increased risk for toxic effects. It does not decrease the risk for muscular contractions and spasms or increase drug efficacy.
Antipsychotic drugs are contraindicated in clients with: - liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. - kidney damage, chronic obstructive lung disease, mild hypotension, and chronic bone pain. - nausea, severe hypotension, or intractable hiccups. - peptic ulcer disease, mild hypertension, chronic joint pain, and kidney failure.
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Explanation: 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 providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus? maintenance of adequate nutrition potential therapeutic effects of medication the need for weekly blood coagulation testing the importance of adherence to prescribed treatment
the importance of adherence to prescribed treatment Explanation: 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.
A female client 25 years of age has begun taking lithium for treatment of bipolar disorder. Which statement indicates that the client needs further instruction? "I will need to come to the clinic regularly for blood tests." "I will need to stop taking my birth control pills while I take lithium." "My lithium dose may change depending on the results of my blood tests." "I will call the health care provider if I experience diarrhea."
"I will need to stop taking my birth control pills while I take lithium." Explanation: Women of childbearing age are often prescribed contraceptives during lithium therapy because lithium is a pregnancy category D and is contraindicated during pregnancy and lactation. The client understands the need to come in regularly for blood tests, and that the lithium level may need to be adjusted depending upon the blood work. Client also understands that diarrhea is one of the early signs of lithium toxicity.
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? "Clients with dementia routinely become agitated due to their disease process." "Clients with dementia respond poorly to antipsychotic medications." "Clients with dementia respond well to antipsychotic medications." "Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems."
"Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems." Explanation: 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 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? "Clients with dementia routinely become agitated due to their disease process." "Clients with dementia respond poorly to antipsychotic medications." "Clients with dementia respond well to antipsychotic medications." "Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems."
"Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems." Explanation: 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 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. The drug must be occasionally stopped to prevent anticholinergic effects The drug likely needs to be switched to another agent that is less toxic. The risk for cumulative adverse effects is greater if the child doesn't have a break.
It needs to be determined if the child still has symptoms that require treatment. Explanation: 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? The cost is prohibitive when prescribed in a large number. It reduces the likelihood of drug dependence or diversion. Changes in dosages are common. HMOs will not reimburse the cost for larger numbers.
It reduces the likelihood of drug dependence or diversion. Explanation: 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).
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 accelerated and drug elimination half-lives shortened, causing an increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives shortened, with resultant accumulation and increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Metabolism may be accelerated and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Explanation: 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 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 administering? Modafinil Caffeine Dopram Dexmethylphenidate
Modafinil Explanation: 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 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. The medication stimulates the brain's sleep centers, so the client can sleep more soundly. The medication stimulates the brain's visual centers, so the client sees everything more clearly. The medication decreases the amount of dopamine released into the body, causing feelings of euphoria.
The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine. Explanation: 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.
What disease process is haloperidol used to treat? muscular dystrophy early-onset dementia Tourette's syndrome myasthenia gravis
Tourette's syndrome Explanation: Haloperidol is used in treating Tourette's syndrome, which is a disorder characterized by involuntary movements and vocalizations. Muscular dystrophy, Alzheimer's disease, and myasthenia gravis are not treated with atypical antipsychotics.
The parents of a child on methylphenidate want to know why they need to withhold the medication during the summer months. What is the nurse's best response? "Withholding the medication will assist in evaluating psychotherapy." "Withholding the medication will allow for stabilized cardiac function." "Withholding the medication will decrease the growth suppression." "Withholding the medication will assist in better drug response."
"Withholding the medication will decrease the growth suppression." Explanation: Stopping drug therapy will decrease weight loss and growth suppression. Withholding the drug will not assist in evaluating psychotherapy; it will allow for evaluation of the treatment regimen. Withholding the medication will not assist in stabilizing cardiac function. Withholding the medication will not assist in a better drug response.
A nurse is reviewing a client's serum lithium level and determines that the level is therapeutic by which result? 0.2 mEq/L 0.8 mEq/L 1.4 mEq/L 2.0 mEq/L
0.8 mEq/L Explanation: Therapeutic serum lithium levels range from 0.6 mEq/L to 1.2 mEq/L, so a level of 0.8 mEq/L would be considered therapeutic. A level of 0.2 mEq/L would be nontherapeutic. Levels above 1.2 mEq/L would be considered toxic.
A nurse educating a client starting lithium should educate the client about which side effects? (Select all that apply.) Extrapyramidal symptoms Tremors Tardive dyskinesia Polyuria Dystonia
Tremors Polyuria Explanation: A nurse educating a client starting lithium should educate the client about these adverse reactions associated with lithium: headache, drowsiness, tremor, nausea, and polyuria.
For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months? Liver enzymes Hemoglobin White blood cells PT/PTT
White blood cells Explanation: Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. However, despite these advantages, it is a second-line drug, recommended only for clients who have not responded to treatment with at least two other antipsychotic drugs or who exhibit recurrent suicidal behavior. The reason for the second-line status of clozapine is its association with agranulocytosis, a life-threatening decrease in white blood cells (WBCs), which usually occurs during the first 3 months of therapy. A BLACK BOX WARNING alerts health practitioners to this dangerous side effect. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts are maintained, then WBC counts can be monitored every 2 weeks.
