NUR 316- Chap 22 Prep U PSychotherapuetic
Which instruction should a nurse give to a patient who is being administered lithium? Consume 2,000 mL/day of water. Limit consumption of alcohol. Take frequent sips of water. Take diuretics regularly.
Take frequent sips of water. Explanation: The nurse should instruct the patient to take frequent sips of water. The patient should consume 3,000 mL of water every day, not 2,000 mL. The consumption of alcohol should be strictly avoided. Diuretics will aggravate fluid loss and should be avoided.
The classification of central nervous system (CNS) stimulants frequently prescribed for exogenous obesity is: Analeptics Amphetamines Anorexiants Antropines
Amphetamines Explanation: The CNS stimulant group prescribed for exogenous obesity is amphetamines. The anorexiants are prescribed for general obesity.
Which drug would be indicated for the treatment of narcolepsy? Atomoxetine Dexmethylphenidate Lisdexamfetamine Modafinil
Modafinil Explanation: Modafinil would be indicated for the treatment of narcolepsy. Atomoxetine, dexmethylphenidate, and lisdexamfetamine are indicated for the treatment of attention deficit disorders.
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 nurse works at a weight management clinic. To which overweight patients could the nurse safely administer dextroamphetamine? A 38-year-old Caucasian woman with glaucoma A 60-year-old African-American man who experiences angina A 48-year-old Caucasian man who has adult-onset diabetes A 28-year-old African-American woman with hyperthyroidism
A 48-year-old Caucasian man who has adult-onset diabetes Explanation: Dextroamphetamine is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the patients at risk for hypertension and increased intraocular pressure. The only patient that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes.
A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine (Zyprexa). Which client likely has the highest susceptibility to the adverse effects of olanzapine? A client who is morbidly obese and who has a sedentary lifestyle A client who has type 1 diabetes and who practices poor glycemic control A client who has a body mass index of 16.5 (underweight) and who smokes one pack of cigarettes daily A client who was recently treated with intravenous antibiotics because of cellulitis in his lower leg
A client who has type 1 diabetes and who practices poor glycemic control Explanation: 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.
During an intake assessment, the nurse notes that the client cannot sit still and continually stands up and walks around the room. The nurse knows that the term for this behavior is: akathisia. anhedonia. avolution. dystonia.
akathisia. Explanation: Akathisia is defined as extreme restlessness and increased motor activity. Anhedonia is lack of joy or pleasurable feelings. Avolution is the inability to determine and initiate goals and activities. Dystonia is prolonged muscle contractions.
What represents the parts of the central nervous system (CNS)? Brain Spinal cord Afferent nerves Efferent nerves Autonomic nerves
Brain Spinal cord Explanation: The CNS is composed of the brain and spinal cord.
What should the nurse's pre-administration assessment of a client receiving a CNS stimulant for attention deficit hyperactivity disorder include? (Select all that apply.) Blood pressure Pulse Respiratory rate Behavior pattern Review recent lab work
Blood pressure Pulse Respiratory rate Behavior pattern Explanation: The nurse's pre-administration assessment of a client receiving a CNS stimulant for attention deficit hyperactivity disorder should include blood pressure, respiratory rate, and behavior pattern.
The use of CNS stimulants is contraindicated in clients with which conditions? (Select all that apply.) Epilepsy COPD Glaucoma Diabetes GERD
Epilepsy COPD Glaucoma Explanation: The use of CNS stimulants is contraindicated in clients with known hypersensitivity, epilepsy, COPD, and glaucoma.
The nurse should take care not to administer CNS stimulants to clients with which medical conditions? (Select all that apply.) Severe hypotension Hyperthyroidism Diabetes Cardiac disease Seasonal allergies
Hyperthyroidism Cardiac disease Explanation: The nurse should not administer CNS stimulants to clients with cardiac disease, severe hypertension, or hyperthyroidism.
A nurse caring for a client with narcolepsy may administer which CNS stimulants? (Select all that apply.) Methylphenidate (Concerta) Phenteramine (Adipex-P) Modafinil (Provigil) Armodafinil (Nuvigil) Dextroamphetamine (Dexedrine)
Methylphenidate (Concerta) Modafinil (Provigil) Armodafinil (Nuvigil) Dextroamphetamine (Dexedrine) Explanation: A nurse caring for a client with narcolepsy may administer methylphenidate, modafinil, armodafinil, and dextroamphetamine.
While caring for a client receiving antipsychotic therapy, the nurse observes cogwheel rigidity, tremors, and drooling. The nurse interprets this as: pseudoparkinsonism. tardive dyskinesia. akathisia. dystonia.
pseudoparkinsonism. Explanation: Pseudoparkinsonism is manifested by muscle tremors, cogwheel rigidity, drooling, shuffling gait, and slow movements. Tardive dyskinesia involves abnormal muscle movements such as lip smacking, tongue darting, chewing movements, and slow aimless arm and leg movements. Akathisia is manifested by continued restlessness and an inability to sit still. Dystonia is manifested by spasms of the tongues, neck, back, and legs.
A client is being treated with clozapine. What should the nurse monitor most closely? White blood cell count Urine quantity and quality Cardiac enzymes AST, ALT and bilirubin
White blood cell count Explanation: 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.
The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response? "ADHD usually starts in childhood and resolves by adolescence." "ADHD usually starts in childhood and resolves by adulthood." "ADHD usually starts in childhood and resolves before adolescence." "ADHD usually starts in childhood and may persist through adulthood."
"ADHD usually starts in childhood and may persist through adulthood." Explanation: ADHD usually starts in childhood and may persist through adulthood.
Typical antipsychotic medications are thought to exert their effects in which way? Inhibiting the release of dopamine in the brain Stimulating the release of dopamine in the brain Inhibiting the release of serotonin in the brain Stimulating GABA receptors in the brain
Inhibiting the release of dopamine in the brain Explanation: Antipsychotic medications are thought to act by inhibiting the release of dopamine in the brain and possibly increasing the firing of nerve cells in certain areas of the brain.
A male client is diagnosed with narcolepsy by his physician. He asks the physician to prescribe modafinil, because it works so well for his friend. The physician will not prescribe the medication because of what aspect of the client's history? Gout and a history of tophi Ischemic changes on his electrocardiograms Cirrhosis of the liver Pancreatitis
Ischemic changes on his electrocardiograms Explanation: Modafinil is not recommended for clients with a history of left ventricular hypertrophy or ischemic changes on electrocardiograms. Reference:
The nurse is aware that drug therapy is prescribed for children with ADHD under which circumstances? (Select all that apply.) Symptoms are mild to moderate. Symptoms are moderate to severe. Symptoms are identified by the parents and teacher. Symptoms are present for several months. Symptoms interfere in social, academic, or behavioral functioning.
Symptoms are moderate to severe. Symptoms are present for several months. Symptoms interfere in social, academic, or behavioral functioning. Explanation: Drug therapy is indicated when symptoms are moderate to severe; are present for several months; and interfere in social, academic, or behavioral functioning.
A 10-year-old child is being administered CNS stimulants for ADHD. What should the nurse instruct the parents to record periodically? Social interaction Weight and growth Voiding pattern Sleeping pattern
Weight and growth Explanation: The nurse should instruct the parents to monitor the weight and growth patterns of the child. Child's social interaction or sleeping pattern need not be recorded unless specified by the primary-care provider. Since the drugs administered for ADHD do not cause urinary retention, there is no need to monitor urinary patterns.
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 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse's priority assessment would be 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 patient. 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. 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.
A psychiatric nurse is reviewing various antipsychotic agents. The nurse should identify what drug as having the highest potency? Fluphenazine Prochlorperazine Thioridazine Chlorpromazine
Fluphenazine Explanation: Fluphenazine is considered a highly potent antipsychotic. Prochlorperazine , thioridazine and chlorpromazine are considered low-potency antipsychotics.
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather's antidepressant to improve his mood. After immediately phoning the boy's stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem? Cardiac dysrhythmia Hypertensive crisis Nephrotoxicity Hypokalemia
Hypertensive crisis Explanation: Because of its pressor effects, dextroamphetamine is contraindicated during the first 14 days after discontinuing monoamine oxidase inhibitor (MAOI) therapy, because MAOI therapy itself may predispose the patient toward elevated blood pressure. Therefore, this 14-day washout period for MAOIs must be observed to prevent hypertensive crisis. This particular combination of drugs does not constitute a risk for dysrhythmias, kidney damage, or electrolyte imbalances.
A patient suffering from schizophrenia is likely to have which pathophysiologic effects? Increased dopamine Increased potassium Decreased glutamate receptors Decreased interaction with GABA
Increased dopamine Explanation: The patient suffering from schizophrenia has increased dopamine activity in the brain. The amount of potassium would cause other physiological symptoms, but not affect schizophrenic symptoms. The patient with schizophrenia will have widespread glutamate receptors, not decreased glutamate receptors. In addition, the glutamatergic system interacts with the dopaminergic and gamma-aminobutyric acid systems and possibly other neurotransmission systems.
Aripiprazole (Abilify) is thought to exert its effect on which receptor in the brain? (Select all that apply.) Serotonin Dopamine Norepinephrine Muscarinic Nicotinic
Serotonin Dopamine Explanation: Atypical antipsychotic drugs like aripiprazole (Abilify) are thought to act on serotonin and dopamine receptors in the brain.
A patient with obesity comes to the clinic and informs the primary care provider (PCP) that he wants to have bypass surgery to lose 50 pounds. The patient does not have diabetes or high blood pressure, so the PCP informs the patient that as a first step, he wants the patient to try to diet and lose weight. Which medication would the PCP then most likely order? Dopram Didrex Provigil Nuvigil
Didrex Explanation: Didrex, an anorexiant, depresses appetite. Dopram is an analeptic used for respiratory depression. Both provigil and nuvigil are also analeptics but are most commonly used for narcolepsy and sleep apnea.
While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as: tardive dyskinesia. akathisia. pseudoparkinsonism. dystonia.
tardive dyskinesia. Explanation: Tardive dyskinesia involves abnormal muscle movements such as lip smacking and tongue darting, slow and aimless arm and leg movements, and chewing movements. Akathisia is manifested by continued restlessness and an inability to sit still. Pseudoparkinsonism is manifested by muscle tremors, cogwheel rigidity, drooling, shuffling gait, and slow movements. Dystonia is manifested by spasms of the tongues, neck, back, and legs
The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention? Restoring Deteriorating Improving Contravening
Improving Explanation: CNS stimulants improve behavior and attention in clients with ADHD.
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 prevent adverse reactions To serve as a study aid To have clients use the drugs appropriately To prevent side effects
To have clients use the drugs appropriately Explanation: 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.
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. Reference:
The main goal of therapy when using CNS stimulants is to: increase the ability to study for long periods of time. use the drugs as they are ordered. relieve the symptoms for which they were prescribed. increase productivity and work longer hours.
relieve the symptoms for which they were prescribed. Explanation: 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. These drugs are dangerous for drivers and those involved in similar activities and have no legitimate use in athletics.
Children taking CNS stimulants for the long-term treatment of ADHD should be monitored closely for: weight loss. growth. hyperglycemia. hypotension. respiratory depression.
weight loss. growth. Explanation: Children taking CNS stimulants for the long-term treatment of ADHD should be monitored closely for weight loss and growth patterns.
A bipolar client is being discharged home in 48 hours. What statement by the client indicates an understanding of treatment with lithium? "I will increase my salt intake." "I will increase my fluid intake." "I will decrease my salt intake." "I will decrease my fluid intake."
"I will increase my fluid intake." Explanation: In order to maintain a therapeutic lithium level the client must increase fluids. A decrease in fluids can lead to toxicity. An increase in salt intake can lead to lithium excretion and a decrease in effectiveness. A decrease in salt intake can cause fluid retention, also leading to toxicity. Maintaining salt intake is necessary to keep serum levels in therapeutic range.
A female client is diagnosed with Alzheimer-type dementia. She resides in a long-term care facility. The client's daughter asks the physician to prescribe an antipsychotic to control her mother's outbursts of anger and depression. The physician orders a psychiatric consultation for the client. The client's daughter asks, "Why doesn't the doctor 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 client who is being treated with a typical antipsychotic reports frequent nasal congestion are urinary hesitation. To what should the nurse most likely attribute these symptoms? Anticholinergic effects Laryngospasm Neuroleptic malignant syndrome Extrapyramidal symptoms
Anticholinergic effects Explanation: Nasal congestion and urinary hesitation are manifestations of anticholinergic effects. Neuroleptic malignant syndrome primarily affects the CNS. Tardive dyskinesia involves involuntary movements. Extrapyramidal symptoms are movement-related.
A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation? Antidepressant Antibiotic Antipsychotic Narcotic
Antipsychotic Explanation: Antipsychotic medications are used to treat agitation in clients with dementia. Antidepressant, antibiotic, and narcotic medications are not used to treat agitation in clients with dementia.
A nurse caring for an elderly client should monitor the client for what as older clients are more sensitive to the side effects of CNS depressants? (Select all that apply.) Confusion Anxiety Hypotension Insomnia Bradycardia
Anxiety Insomnia Confusion Explanation: A nurse caring for an elderly client should monitor the client for anxiety, nervousness, insomnia, and mental confusion as older clients are more sensitive to the side effects of CNS depressants.
Which would a nurse identify as being used as treatment for mania as well as schizophrenia? Lithium Risperidone Lamotrigine Aripiprazole
Aripiprazole Explanation: Aripiprazole is indicated for the treatment of mania and schizophrenia. Lithium and lamotrigine are indicated only for the treatment of mania. Risperidone is indicated only for the treatment of schizophrenia.
he nurse is caring for a client who is prescribed haloperidol long term. What assessment should the nurse prioritize? Assessment for involuntary movements Monitoring the client's white cell differential Assessment of the client's skin integrity Monitoring the client's CD4 T-cell count
Assessment for involuntary movements Explanation: Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Leukopenia is less common and there is no obvious threat to skin integrity. The client's T-cell levels will not be affected. Reference:
A patient is being prescribed a central nervous system stimulant. Which will have the lowest risk of abuse and dependence? Amphetamine Atomoxetine (Strattera) Dexmethylphenidate (Focalin) Adderall
Atomoxetine (Strattera) Explanation: Atomoxetine (Strattera) is administered for ADHD and has a lower abuse and dependence capability. Amphetamines have a strong potential for abuse and dependency. Dexmethylphenidate has a strong potential for abuse and dependence. Adderall has a strong potential for abuse and dependency.
A nurse should be able to differentiate between the typical and atypical antipsychotics. Which are classified as typical antipsychotics? (Select all that apply.) Lithium (Eskalith) Aripiprazole (Abilify) Chlorpromazine (Thorazine) Haloperidol (Haldol) Fluphenazine (Prolixin)
Chlorpromazine (Thorazine) Haloperidol (Haldol) Fluphenazine (Prolixin) Explanation: Chlorpromazine, haloperidol, and fluphenazine are classified as typical antipsychotics
The nurse expects to monitor a client's white blood count weekly when the client is prescribed: Aripiprazole Olanzapine Clozapine Quetiapine
Clozapine Explanation: 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.
After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent? Haloperidol Loxapine Clozapine Pimozide
Clozapine Explanation: Clozapine is classified as an atypical antipsychotic. Haloperidol, loxapine, and pimozide are considered typical antipsychotics.
Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication? Dexmethylphenidate will increase Scott's ability to understand information better. Dexmethylphenidate will stabilize Scott's mood so that he can concentrate. Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Dexmethylphenidate will improve Scott's memory.
Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Explanation: Dexmethylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. This activity results in improved attention spans, decreased distractibility, and increased ability to follow directions or complete tasks, and decreased impulsivity and aggression in patients with ADHD. Although dexmethylphenidate does not produce a physical dependence, it may induce tolerance or psychic dependence.
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.
The nurse is teaching a client who is prescribed fluphenazine about the drug. Which client statement indicates that the client has understood the instructions? "I shouldn't be alarmed if my urine turns pink or reddish brown." "I should call my doctor if I notice any heart irregularities." "I might get a severely runny nose with this drug." "I might develop diabetes if I take this drug, but I'll be monitored closely."
I shouldn't be alarmed if my urine turns pink or reddish brown." Explanation: Phenothiazines, such as fluphenazine, can turn the urine pink or reddish-brown. Arrhythmias are not associated with fluphenazine. Nasal congestion, not a runny nose, is a possible adverse effect of fluphenazine. The development of diabetes is associated with atypical antipsychotics; fluphenazine is a typical antipsychotic.
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 nurse caring for a client with attention deficit hyperactivity disorder (ADHD) may administer which CNS stimulants? (Select all that apply.) Methylphenidate (Concerta) Phenteramine (Adipex-P) Modafinil (Provigil) Doxapram (Dopram) Dextroamphetamine (Dexedrine)
Methylphenidate (Concerta) Dextroamphetamine (Dexedrine) Explanation: Methylphenidate (Concerta) and Dextroamphetamine (Dexedrine) are CNS stimulants used in the treatment of ADHD.
Ms. James is started on olanzapine for the treatment of psychotic symptoms associated with schizophrenia. What is part of the routine monitoring for patients on olanzapine? Monitoring for signs of diabetes, including elevated blood glucose levels Monitoring of blood pressure to prevent early onset of hypertension Monitoring of level of consciousness because of the CNS effects of the drug Monitoring of bowel function due to the cholinergic effects of the drug
Monitoring for signs of diabetes, including elevated blood glucose levels Explanation: Precautions should be taken if the patient has diabetes, because all use of atypical antipsychotics is associated with substantially elevated blood glucose levels. Patients who are not diagnosed with diabetes at the start of therapy still remain at risk for developing significant hyperglycemia while taking olanzapine or any other atypical antipsychotic. Patients without a history of diabetes are at risk for developing diabetes from therapy; the more diabetic risk factors present, the more likely hyperglycemia may develop. In addition to elevated glucose levels, patients may gain weight (a significant number of patients gain more than 7% of their baseline weight), have decreased insulin sensitivity, have lipid elevations, and develop metabolic syndrome (increased visceral fat, as measured by waist circumference; hyperglycemia; hypertension; and dyslipidemia), putting them at increased risk for cardiovascular problems.
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.
A nurse is explaining to a friend why CNS medications are addictive. What is one 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.
The nurse is caring for a client with bipolar disorder whose medication regimen includes lithium and who will soon be discharged. What health education should the nurse prioritize? Strategies for managing anticholinergic effects The need to avoid driving or operating machinery during therapy The need to have follow-up blood samples drawn on schedule The need to avoid high-potassium foods and salt substitutes
The need to have follow-up blood samples drawn on schedule Explanation: Serum levels of lithium must be carefully monitored to ensure effectiveness and prevent toxicity. The need for bloodwork is consequently a priority. The client does not necessarily have to avoid driving and there is no need to strictly avoid potassium. Lithium does not cause anticholinergic effects.
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.
The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose? To determine parent and child compliance with the medication regimen To determine medication blood levels in order to modify the dose To assess the education plan and modify the plan to meet the client's needs To assess beneficial and adverse effects
To assess beneficial and adverse effects Explanation: 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.
Typical antipsychotics block dopamine receptors. True False
True Explanation: The antipsychotic drugs, which are essentially dopamine receptor blockers, are used to treat disorders that involve thought processes.
Which test should be scheduled every week for a patient taking clozapine? Serum lithium WBC count Blood glucose pH level
WBC count Explanation: Use of the drug clozapine has been associated with severe agranulocytosis, (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an electrocardiogram (ECG). electromyelogram (EMG). electroencephalogram (EEG). electrophysiologic study (EPS).
electrocardiogram (ECG). Explanation: In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may: have undiagnosed diabetes. have the flu. have a urinary tract infection. be making up the symptoms simply to get attention.
have undiagnosed diabetes. Explanation: Schizophrenic clients have a higher than normal incidence of diabetes. The flu usually has a fever along with respiratory symptoms. A urinary tract infection may cause burning and frequent urination, but thirst is not normally a symptom. Also, UTIs are not more common in schizophrenics. A client could be making up symptoms, but the nurse should first consider other options that could be causing the symptoms.
A client's current drug regimen include modafinil (Provigil). When planning this client's care, the nurse should prioritize the client's risk for: injury. hopelessness. acute confusion. hallucinations.
injury. Explanation: Modafinil is indicated for the treatment of narcolepsy, a disorder which creates a significant risk for injury. Neither narcolepsy nor modafinil are directly associated with hopelessness, confusion or hallucinations.
A 72-year-old man is taking Adderall XR for the treatment of narcolepsy. He is currently having problems with not being able to swallow large tablets or capsules. The man also wears dentures, which makes it even more difficult for him to swallow medication. He is in the clinic to talk to the nurse about his problem. The nurse will instruct him to swallow the capsule with 8 ounces of water. ask his physician to prescribe an alternative drug. open the capsule and sprinkle the beads in applesauce. open the capsule and crush the beads.
open the capsule and sprinkle the beads in applesauce. Explanation: The benefits of Adderall XR are its once-daily dosing, its longer duration of action, and its potential for sprinkle administration. For patients with difficulty swallowing, Adderall XR's capsule may be opened and the beads sprinkled in applesauce. It is not advisable to suggest the use of an alternative drug. Patients should be told not to crush the beads after opening the capsule because this would alter drug absorption. Ingesting the capsule with 8 ounces of water will not solve the patient's difficulty with swallowing.
Which statement should be included in the teaching plan for a patient receiving methylphenidate (Ritalin)? "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 patient 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: "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 asks the nurse dopamine is. What is a correct response by the nurse? "Dopamine is an enzyme that regulates your temperature." "Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." "Dopamine is a medication that is given to fight infections and help with pain." "Dopamine is a part of the brain that controls your impulses and thoughts.
"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." Explanation: 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 parents of a child on methylphenidate (Ritalin) 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 regime. Withholding the medication will not assist in stabilizing cardiac function. Withholding the medication will not assist in a better drug response.
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 asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be: "You have to come in at least every month to have blood work done." "You will speak with her health care provider about getting her a new prescription." "It is important that you take the largest dose possible to keep the condition under control." "The prescription dose is always started as low as possible and the refills are monitored to prevent abuse."
"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse." 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).
An African American male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the physician's office with signs of tardive dyskinesia, and his physician 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? "The signs of tardive dyskinesia will diminish over time." "African Americans always experience tardive dyskinesia with antipsychotics." "When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in African Americans." "The olanzapine does not produce side effects in African American males."
"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in African Americans." Explanation: African Americans tend to respond more rapidly; experience a higher incidence of adverse effects, including tardive dyskinesia; and metabolize antipsychotic drugs more slowly than whites. When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in African Americans.
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 patient asks the nurse how much caffeine is safe to consume per day. What is the recommended amount of caffeine for a nonpregnant woman? 125 mg of caffeine 250 mg of caffeine 500 mg of caffeine 1 gram of caffeine
250 mg of caffeine Explanation: Some authorities recommend that normal, healthy, nonpregnant adults consume not more than 250 mg of caffeine daily. 125 mg of caffeine is lower than the recommended safe amount of consumption. 500 mg to 1 gram is more than the recommended daily consumption of caffeine.
The nurse in the emergency department admits a client who is experiencing seizures and is hypotensive. The client's family reports that the client takes lithium every day for bipolar disorder. What does the nurse anticipate this client's lithium level will be? 0.7 mEq/L 1.7 mEq/L 2.8 mEq/L 3.1 mEq/L
3.1 mEq/L Explanation: A normal lithium level is 0.6 mEq/L to 1.5 mEq/L. Symptoms associated with lithium levels between 1.5 mEq/L to 2 mEq/L are diarrhea, vomiting, nausea, drowsiness, muscular weakness and lack of coordination. Symptoms of toxicity for lithium levels between 2-3 mEq/L include giddiness, ataxia, blurred vision, tinnitus, vertigo, increasing confusion, slurred speech, blackouts, myoclonic twitching, urinary and fecal incontinence, agitation, hypertonia, and dysarthria. Levels of more than 3 mEq/L involve multiple organs and include seizures, arrhythmias, hypotension, peripheral vascular collapse, stupor, muscle group twitching, spasticity, and coma.
A male client comes into the emergency department and is agitated, swiping his arms at "the bugs" and screaming that Harry Potter sent the bugs to take him away. After two security officers help to restrain the client, the doctor orders 5 mg of Haldol STAT. How would the nurse administer this drug? two 2.5 mg tablets rectally 5 mg IM in the client's left hand 5 mg IM in the client's gluteus maximus 5 mg IV after calming the client down and placing an IV
5 mg IM in the client's gluteus maximus Explanation: In an emergency setting, Haldol is given IM in a large muscle, such as the gluteus maximus. IM shots are not given in the hand. It is unlikely a disoriented client will swallow pills, plus the Haldol would take a long time to work PO. Placing an IV in an agitated, disoriented, hallucinating client is nearly impossible.
The nurse practitioner knows not to prescribe an anorexiant for weight loss to which patient? A patient with diabetes who takes insulin A patient with depression who takes an antidepressant A patient with a history of kidney stones A patient with diverticulosis who takes a fiber supplement
A patient with depression who takes an antidepressant Explanation: Amphetamines and amorexiants should not be taken concurrently or within 14 days of antidepressant medications. There is no indication that they should not be taken by a patient who has a history of diabetes, kidney stones, or diverticulitis.
A patient has been prescribed lithium. Which intervention should the nurse perform while caring for the client? (Select all that apply.) Administer lithium with food Administer antacids if gastric upset occurs Continually monitor patient for drowsiness Increase fluid intake to about 3,000 mL/day Obtain blood sample immediately after dose
Administer lithium with food Continually monitor patient for drowsiness Increase fluid intake to about 3,000 mL/day Explanation: The nurse should administer lithium with food, continually monitor patient for drowsiness, and increase fluid intake to about 3,000 mL/day. Antacids should not be administered because they reduce the potency of the lithium. Blood sample should be obtained immediately before, not after, the dose.
A nurse is caring for a schizophrenic client who is taking clozapine, and sees that the granulocyte count on his CBC is low. The nurse knows that this is called what? Hypogranulocytosis Septicemia Polycythemia Agranulocytosis
Agranulocytosis Explanation: Agranulocytosis is a low granulocyte count. Polycythemia is a high red blood cell count. Septicemia is when an infection is found within the blood. Hypogranulocytosis is not a word.
A client calls the psychiatric clinic and tells the nurse he is stopping his antipsychotic medication. He states that it doesn't work and he has taken it for a week. What is the nurse's best response? "That's strange, most clients see a change after a dose or two." "Antipsychotic medications take six to 10 weeks to demonstrate an effect on the disorder." "Go ahead and stop the medication and I'll tell the doctor about your decision." "Antipsychotic medications take two to three weeks to demonstrate an effect on the disorder."
Antipsychotic medications take six to 10 weeks to demonstrate an effect on the disorder." Explanation: A client would not normally see an effect of the antipsychotic for six to 10 weeks. This should be explained to the client. No effect is expected after one to two doses. Telling the client to stop the medication without educating him about normal response time is incorrect. Two to three weeks is not long enough to demonstrate an effect. Reference:
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.
What should the nurse's ongoing assessment of a client receiving a CNS stimulant for respiratory depression include? (Select all that apply.) Blood pressure Pulse Respiratory rate Respiratory pattern Level of consciousness
Blood pressure Pulse Respiratory rate Respiratory pattern Level of consciousness Explanation: The nurse's ongoing assessment of a client receiving a CNS stimulant for respiratory depression should include blood pressure, pulse, respiratory rate, depth, and pattern, and level of consciousness.
What would the nurse's pre-administration assessment of a client receiving a CNS stimulant for the treatment of obesity include? (Select all that apply.) Blood pressure Pulse Weight Respiratory rate Review recent lab work
Blood pressure Pulse Weight Respiratory rate Explanation: The nurse's pre-administration assessment of a client receiving a CNS stimulant for the treatment of obesity should include blood pressure, pulse, respiratory rate, and weight.
A 3-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 15 minutes and he is doing something else. He often throws his toys and yells loudly." The child is diagnosed with attention deficit hyperactivity disorder. Which medications will be administered in conjunction with treatment? Ace inhibitors Central nervous system depressants Central nervous system stimulants MAO inhibitor
Central nervous system stimulants Explanation: ADHD is characterized by persistent hyperactivity, short attention span, difficulty completing task, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. Ace inhibitors lower blood pressure by specific inhibition of the angiotensin converting enzyme. Central nervous system depressants are contraindicated in patients with attention deficit disorder. MAO inhibitors are used as antipsychotic agents.
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.
The nursing instructor is discussing psychosis with the nursing students. According to the instructor, what behaviors are exhibited by people with psychosis? Disorganized and often bizarre thinking Slowed reaction time and poor coordination Short manic episodes followed by long depressive episodes Short- and long-term memory deficits
Disorganized and often bizarre thinking Explanation: Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia.
A nurse caring for a client taking a CNS stimulant should monitor the client for which side effects? (Select all that apply.) Disorientation Dyspnea Bradycardia Urinary retention Headache
Disorientation Dyspnea Urinary retention Headache Explanation: A nurse should monitor a client taking a CNS stimulant for the following side effects: headache, dizziness, apprehension, disorientation, hyperactivity, nausea, vomiting, cough, dyspnea, urinary retention, tachycardia, and palpatations.
A patient is undergoing lithium therapy at a health care facility. The patient informs the nurse that he is taking antacids for heartburn. Which is a possible effect of the interaction of lithium with antacids? Decreased effectiveness of lithium Increased risk of lithium toxicity Increased risk for bipolar disorder Increased psychotic symptoms
Decreased effectiveness of lithium Explanation: Combining lithium with antacids may result in decreased effectiveness of lithium. Increased risk of lithium toxicity, increased risk for bipolar disorder, and increased psychotic symptoms are not possible effects of combining lithium and antacids.
A patient is prescribed olanzapine (Zyprexa) for the treatment of acute bipolar disorder. The patient tells the nurse he is voiding three times at night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed? A urinary tract infection Diabetes mellitus Renal calculi Hyperthyroidism
Diabetes mellitus Explanation: The development of polyuria and polydipsia is indicative of diabetes mellitus. Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Urinary tract infection is not considered an adverse effect with olanzapine. Renal calculus is not an adverse effect of olanzapine. Hyperthyroidism is not an adverse effect of olanzapine.
The nurse should suspect lithium toxicity in a client that experiences which symptoms? (Select all that apply.) Diarrhea Lack of coordination Hypertensive crisis Muscle weakness Decreased urine output
Diarrhea Lack of coordination Muscle weakness Explanation: Signs of lithium toxicity include diarrhea, vomiting, nausea, drowsiness, muscular weakness, and lack of coordination.
Moderate CNS depression is characterized by: Wakefulness, mental alertness, and decreased fatigue. Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold. Increasing hyperactivity, excessive talking, nervousness, and insomnia. A lack of interest in surroundings and inability to focus on a topic.
Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold. Explanation: Signs of excessive CNS stimulation include: agitation, confusion, hyperactivity, difficulty concentrating on tasks, hyperactivity, nervousness, restlessness and sympathetic nervous system stimulation (eg, increased heart rate and blood pressure, pupil dilation, slowed gastrointestinal motility, and other symptoms). Signs of moderate CNS depression include drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.
The nurse is aware that medication dosage for a child with ADHD is stopped occasionally for what reason? Onset of puberty Evaluation of treatment regimen Brain growth Musculoskeletal growth
Evaluation of treatment regimen Explanation: 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? Sedation Anticholinergic Extrapyramidal Hypotension
Extrapyramidal Explanation: 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.
A 28-year-old woman has been diagnosed with schizophrenia. The physician has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects? Neuroleptic malignant syndrome Agranulocytosis Extrapyramidal symptoms Gastrointestinal problems
Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol. The cause of these symptoms is the relative lack of dopamine stimulation (i.e., excess dopamine blockade) and relative excess of cholinergic stimulation. Neuroleptic malignant syndrome and agranulocytosis are relatively rare, although potentially fatal adverse effects. Gastrointestinal problems are considered uncommon adverse effects of the drug.
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? Decreased libido Increased blood glucose Dry eyes Jittery feeling
Increased blood glucose Explanation: 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 male client tells the nurse he is going to stop taking his medication because he is always having fine tremors and slurred speech. These reactions are preventing him from teaching art classes like he used to do. The nurse knows that what action could help him? He could talk with his doctor and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic. He could stop taking his medication and see if he still has schizophrenia. He could learn to teach other classes via online education so that he wouldn't have to talk out loud. He could tell his doctor that the antipsychotics are not working and he needs a larger dose, or another medication added.
He could talk with his doctor and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic. Explanation: Fine tremors and slurred speech are common symptoms of extrapyramidal syndrome. Symptoms may decrease if the amount of the medication is decreased or if the client is changed to a second-generation antipsychotic medication. A large dose of medication or adding another first-generation antipsychotic medication would increase the symptoms. Changing his profession may be necessary, but getting on the correct drug and dosage is of primary concern. Schizophrenia is not cured by the antipsychotic medications. The symptoms are managed, so by stopping the drug the client is at risk of showing all the symptoms of schizophrenia.
When writing a plan of care for a patient beginning drug therapy for treatment of schizophrenia, which might be an appropriate nursing diagnosis? Self-Care Deficit related to hyperactivity Risk for Injury related to hyperactivity Impaired Physical Mobility related to sedation Altered Tissue Perfusion related to hypertension
Impaired Physical Mobility related to sedation Explanation: Of the four options, Impaired Physical Mobility related to sedation is the most likely nursing diagnosis for a patient receiving drug therapy for schizophrenia. Other possibilities include Risk for Injury related to sedation (rather than to hyperactivity), Altered Tissue Perfusion related to hypotension (rather than to hypertension), and Self-Care Deficit related to the disease process or drug-induced sedation (rather than to hyperactivity).
The use of what would a nurse identify as placing a client receiving lithium therapy at increased risk for toxicity? Tromethamine Thiazide diuretic Psyllium Antacids
Thiazide diuretic Explanation: 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.
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.
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia? Lip smacking Disorientation Abnormal eye movements Urinary incontinence
Lip smacking Explanation: Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.
A patient is to be started on amphetamine therapy for attention deficit hyperactivity disorder. Which medication has less physical dependence and abuse than other amphetamines? Amphetamine Dextroamphetamine (Dexedrine) Methamphetamine (Desoxyn) Lisdexamfetamine (Vyvanse)
Lisdexamfetamine (Vyvanse) Explanation: Lisdexamfetamine (Vyvanse) is approved for treatment of ADHD. The drug reportedly delays the stimulation associated with other amphetamines and may be less prone to abuse. Amphetamine, dextroamphetamine, and methamphetamine are prone to abuse.
A male client's physician 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 female client 70 years of age is receiving lithium. Which nursing intervention is appropriate for this client? Instruct the client to use barrier contraceptives. Check blood glucose levels every six hours. Monitor fluid and sodium intake every 12 hours. Encourage the client to check daily for weight loss.
Monitor fluid and sodium intake every 12 hours. Explanation: Older clients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly. A client age 70 years would not be concerned about the use of contraceptives. These drugs alone do not affect glucose levels. Weight loss is usually not associated with lithium use.
For which patient are CNS stimulants contraindicated? Patients with Parkinson's disease Patients with severe hypertension Patients younger than 20 Patients with renal dysfunction
Patients with severe hypertension Explanation: CNS stimulants are contraindicated for patients with severe hypertension. CNS stimulants are not contraindicated in patients younger than 20 or patients with Parkinson's disease. Even though CNS stimulants are not contraindicated in patients with renal dysfunction, they need to be administered with extreme caution.
Which medication is used to treat narcolepsy and does not cause cardiac and other systemic stimulatory effects like other CNS stimulants? Provigil Caffeine Dopram Focalin
Provigil Explanation: Provigil is used to treat narcolepsy and does not cause cardiac and other systemic stimulatory effects like other CNS stimulants.
A patient has been administered an antipsychotic. Which reaction should be reported immediately? Orthostatic hypotension Dry mouth Rigidity Drowsiness
Rigidity Explanation: The nurse should immediately report to the primary health care provider if the patient displays signs of rigidity. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.
The parents of a male child with attention deficit-hyperactivity disorder (ADHD) bring the child to the physician's office for a follow-up visit. During the visit, the parents tell the nurse that the child receives his first dose of Ritalin at 7:30 every morning. The child's teacher and school nurse have reported that his ADHD symptoms return just before his second daily dose, which coincides with the lunch period at noon. Which might the nurse suggest to help better control the child's symptoms during school hours? Delaying the first dose until the child arrives at school Talking to the physician about switching to a longer acting preparation Splitting the first dose so that half is taken before leaving for school and half is taken upon arriving at school Asking the teacher to allow the child to attend a different lunch period so that he can take his second dose earlier in the day
Talking to the physician about switching to a longer acting preparation Explanation: Immediate release preparations of methylphenidate, such as Ritalin, are typically taken twice daily, before breakfast and lunch. Delaying the child's first dose until after his arrival at school might result in ADHD symptoms being poorly controlled at the start of the school day. Extended release preparations, such as Ritalin SR, are taken less frequently but are intended to control symptoms for longer periods. The physician can substitute extended release methylphenidate once the daily dose is titrated with an immediate release version.
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? Hypertension Tardive dyskinesia Central nervous system agitation Urinary frequency
Tardive dyskinesia Explanation: A patient who has taken chlorpromazine (Thorazine) 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.
The nurse is caring for a client who takes clozapine. The nurse would be most concerned if this client displays what symptom? Temperature of 102°F Blood sugar of 108 Weight gain of 1 lb in the last week Blood pressure of 98/64
Temperature of 102°F Explanation: The nurse would be most concerned about a client's temperature of 102 because clozapine can cause agranulocytosis.
For clients taking clozapine (Clozaril), 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.
A pediatric patient has been admitted to the floor and began on ritalin therapy for AHDH. The nurse knows that an important daily intervention for this patient would be to: weigh the patient daily. record a daily summary of child's behavior. perform ROM exercises daily. suction the patient daily.
record a daily summary of child's behavior. Explanation: When a patient is started on an amphetamine for any reason the nurse weighs the patient and should take the blood pressure, pulse, and respiratory rate before starting therapy. The nurse records a daily summary of the child's behavior on the chart if the patient is hospitalized.
