Pharmacology Psych Quiz
Your patient is taking the antipsychotic medications clozapine and divalproex sodium (Depakote), both of which cause weight gain. What should this patient be carefully monitored for? A: Decreased serum calcium. B: Urine nitrates. C: Decreased blood pressure D: Increased blood glucose.
D. Increased blood glucose
lithium uses
Mood stabilizer for bipolar disorder; blocks relapse and acute manic events. Also SIADH.
lithium MOA
may alter Na and K transportation across the cell
Lithium
psychotropic agent
Clozaril (clozapine) use
schizophrenia pts who other anti-psychotics have failed, recurrent suicidal behavior
Risperdal (risperidone) use
schizophrenia, bipolar/mania, irritability associated with autistic disorder
Depakote (divalproex sodium/valproic acid) uses
seizures, bipolar, schizo adjunct
lithium therapeutic levels <0.4-1
side effect signs of toxicity : mild nausea, weight gain, mild thirst, fine hand tremors
1. A 9-year-old child has been prescribed with lithium as a mood stabilizer. His lab results shows his lithium level of 1.5 mmol/L. The priority nursing diagnosis for this child should be: A. Activity Intolerance B. Risk for Aspiration C. Ineffective Therapeutic Regimen Management D. Disturbed Thought Process
Answer: B Children who develop lithium toxicity are prone to seizures and coma. Due to the seizures that can occur the child is at risk for aspiration during seizure. This can also occur if the child is comatose. Based on Maslow's hierarchy of needs, maintaining a paten airway is the priority nursing diagnosis.
20. A man is prescribed with lithium to manage bipolar disorder. The nurse is most concerned about lithium toxicity when he notices which of these assessment findings? A. Manic episodes a week ago B. Having diarrhea every day C. Client has rashy pruritis on his arms and legs D. The client presents as severely depressed
Answer: B Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity. Rashy pruritis is not a symptoms of lithium toxicity. Having a depressive or manic episodes is not an indication of lithium toxicity—these findings indicates that the lithium is not effective or is not at a therapeutic level.
8. A female client was prescribed with lithium carbonate 600 mg p.o t.i.d to manage her bipolar disorder. The nurse would be aware that the teaching given to the client with regards to the medication side effects was understood when the client make which of the following statement? "I will call my doctor immediately once I notice any: A. Sensitivity to bright light or sun B. Fine hand tremors or slurred speech C. Sexual dysfunction or breast enlargement D. Inability to urinate or difficulty when urinating
Answer: B These are the common adverse effects of lithium carbonate
24. A physician prescribes lithium for a client diagnosed with bipolar disorder. The nurse needs to provide appropriate education for the client on this drug. Which topic should the nurse cover? Select all that apply. A. The potential for addiction B. Signs and symptoms of drug toxicity C. The potential for tardive dyskinesia D. A low-tyramine diet E. The need for consistently monitor blood levels F. Changes in his mood that may take 7 to 21 days
Answer: B, E, F Client education should cover the signs and symptoms of drug toxicity as well as the need to report them to the physician. The client should be instructed to monitor his lithium levels on regular basis to avoid toxicity. The nurse should explain that 7 to 21 days may pass before the client notes a change in his mood. Lithium does not have addictive properties. Tyramine is a potential concern to clients taking monoamine-oxidase inhibitors.
21. In giving discharge teaching to a client with a home med lithium carbonate. Which of the following should be included: A. Advising the client to watch the diet carefully B. Suggesting that the client take the pills with milk C. Reminding the client that a CBC must be done once a month D. Encouraging the client to have blood levels checked as ordered
Answer: C Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.
2. A client receiving lithium therapy for the treatment of his bipolar disorder has a lithium level of 0.85 mEq/L. The appropriate nursing action is: A. Notify the physician immediately B. Observe the client for signs of toxicity C. Record the laboratory result in the client's chart D. Hold the next dose of lithium
Answer: C The client's laboratory result of lithium is within the therapeutic rage 0.4 - 1 mEq/L.
17. A client came to the psychiatric unit 2 days ago. She has a history of bipolar disorder, is in the manic phase, and stopped taking lithium (Eskalith) 2 weeks ago. Which finding would the nurse be least likely to see? A. Flight of ideas B. Delusions of grandeur C. Increased appetite D. Restlessness
Answer: C The manic client is usually unwilling or unable to slow down enough to eat. Flight of ideas, delusions of grandeur and restlessness are associated with the manic phase.
12. A client under your care as a nurse was newly prescribed with lithium carbonate. To prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches B. Decrease fluid intake to less than 1,500 mL daily C. Restrict intake of foods rich in sodium D. Limit aerobic activity in hot weather
Answer: D Activities that could cause sodium/water depletion should be avoided in order to prevent lithium carbonate toxicity. Acetaminophen, rather than NSAIDs such as ibuprofen, should be used for headaches because NSAIDs interact with lithium and could cause increased blood levels of lithium. The client should make sure to take in enough sodium and increase, rather than decrease fluid intake to prevent toxicity
10. A client under lithium medication suffered from diarrhea and vomiting. Which of the following nursing intervention should the nurse in charge do first? A. Recognize this as a drug interaction B. Give the client Cogentin C. Reassure the client that these are common side effects of lithium therapy D. Hold the next dose and obtain an order for a stat serum lithium level
Answer: D Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extrapyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.
23. A client on lithium has suffered from diarrhea and vomiting. Which of the following is the priority nursing intervention of the nurse in-charge? A. Reassure the client that these are common side effects of lithium therapy B. Recognized this as a drug interaction C. Give the client Cogentin D. Hold the next dose and obtain an order for a stat serum lithium level
Answer: D Diarrhea and vomiting are manifestations of lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. These manifestations are not due to drug interaction. Cogentin is used to manage extrapyramidal symptom side effects of antipsychotics. The common side effects of lithium are fine hand tremors, nausea, polyuria and polydipsia.
5. A client who has been taking lithium medication for the past few years, recently got pregnant, and she is so concerned of the effects of the medication to her child. Which of the following statement is true that would address the client's concern? A. Lithium does not cross the placental barrier and poses no risk for the fetus B. Pregnant woman with diagnosed with bipolar disorder should not take lithium meds C. Oral contraceptive and lithium medication may result to a false-positive pregnancy test. D. Lithium should be avoided during the latter part of the first trimester if possible.
Answer: D Lithium crosses placental barrier and poses the risk for developing birth defects to a fetus. To minimize any risk to the fetus, lithium should be avoided in the latter part of the first trimester if possible. Option B is incorrect because it can help control the mother's manic symptoms with little risk to the fetus in the second and third trimester. Option C is also incorrect because it is only true with carbamazepine (Tegretol).
19. The client taking lithium carbonate (Eskalith) is having difficulty time walking, is confused, agitated and is complaining of blurred vision. The nurse checks the lithium level drawn earlier in the day, expecting the level to be within which of the following ranges? A. 0.5 to .8 mEq/L B. 1.2 to 1.5 mEq/L C. 1.5 to 1.8 mEq/L D. 2.0 to 3.0 mEq/L
Answer: D The symptoms listed are those of lithium toxicity, and are seen when the serum level is 2 to 3 mEq/L.
A nurse provides discharge teaching to a client who has a new prescription of olanzapine (Zyprexa) for the management of schizophrenia. The nurse should know this medication increases the risk of which of the following? A. Leukocytosis B. Hyperglycemia C. Ventricular tachycardia D. Secondary hypertension
B. Hyperglycemia Clients taking olanzapine have an increased risk of developing hyperglycemia. Olanzapine is an antipsychotic second-generation (atypical) medication. Serious adverse effects also include new onset of diabetes mellitus, weight gain, and dyslipidemia.
Zyprexa (olanzipine) MOA
antagonizes alpha adrenergic, dopamine, histamine, muscarinic, and serotonin receptors
Lithium nursing considerations
lithium toxicity - diarrhea, vomiting, tremors, twitching serum levels 2x/wk until stabilized, then q2months daily weights - check for edema sodium intake must be adequate toxicity = >1.5 mEq/L therapeutic = 0.5-1.5 mEq/L
Depakote (divalproex sodium/valproic acid) nursing considerations
may cause hepatotoxicity - monitor LFTs (especially in children under 2) blood dyscrasias - do not use in pts with bleeding abnormalities lower dose for elderly do not take w/ carbonated drinks take with food
11. A client's latest lab result shows her plasma lithium level is 0.2 mEq/L. The nurse can expect to implement which of the following nursing interventions? A. Administer an additional oral dose of lithium B. Infuse 1 L of 0.9% sodium chloride over 4 hr C. Prepare to give emergency resuscitation D. Prepare the client immediate for another laboratory draw
Answer: A This plasma level is subtherapeutic and the client should be given an additional dose. Emergency resuscitation may be indicated if the client's laboratory value indicates toxicity. There is no indication that the client need supplemental fluids. There is no reason to question the laboratory results.
16. A client with bipolar disorder has been receiving lithium (Eskalith) for 2 weeks. She also has been taking chemotherapeutic drugs that cause her to feel nauseated and anorexic, making it difficult to distinguish early signs of lithium toxicity. Which of the following signs would indicate lithium toxicity at serum drug levels below 1.5 mEq/L? A. Hyperpyrexia B. Marked analgesics and lethargy C. Hypotonic reflexes with muscle weakness D. Oliguria
Answer: C Lithium alters sodium transport in nerve and muscle cells, slowing the speed of impulse transmission, so look for hypotonic reflexes and muscle weakness. Lithium has no known effect on body temperature nor on the transmission of pain impulses. The drug doesn't cause lethargy. Oliguria and other signs of renal failure occur late in sever lithium toxicity.
15. What information is important to include in the nutritional counseling of a family with a member who has bipolar disorder? A. If sufficient roughage isn't eaten while taking lithium, bowel problems will occur. B. If the intake of carbohydrate increases, the lithium level will increase C. If the intake of calories is reduced, the lithium level will increase D. If the intake of sodium increases, the lithium level will decrease.
Answer: D Any time the level of sodium increases, such as with a change in dietary intake, the level of lithium will decrease. The intake of roughage and carbohydrates in the diet isn't related to metabolism of lithium. Reducing the number of calories the client eats don't affect the lithium level in the body.
14. A client has been taking lithium carbonate for the management of bipolar disorder. Which of the following adverse reaction does the client need to report? A. Black tongue B. Increased lacrimation C. Periods of disorientation D. Persistent GI upset
Answer: D Persistent GI upset indicates a mild-to-moderate toxic reaction. Black tongue is an adverse reaction of mirtazapine (Remeron), not lithium. Increased lacrimation isn't an adverse effect of lithium. Periods of disorientation don't tend to occur with the use of lithium.
Depakote Divalproex sodium / Valproic Acid
Anticonvulsant/Mood Stabilizer
Zyprexa (olanzipine) use
diminishes manifestations of psychotic symptoms, stabilizes moods.
Clozaril (clozapine) MOA
interferes with dopamine receptor binding w/ lack of EPS. Also acts as an adrenergic/cholinergic/histaminergic/serotonin agonist
The home care nurse is visiting a client discharged yesterday from an inpatient unit with a prescription for a 10 day supply of olanzipine 10 mg daily. The client states a prescription refill is needed because the prescription provided yesterday is all gone. The nurse should assess the client for which signs? SATA 1. Psychosis 2. Diarrhea 3. Nervousness 4. Hypoglycemia 5. Dizziness upon standing
3,5 The nurse expects the primary possible side effects of nervousness, somnolence, dizziness, or insomnia, to be compounded with excessive indigestion.
The nurse caring for a client prescribed risperidone observes the client carefully for which possible side effects? A. Daytime sleepiness B. Reports of heartburn C. A rapid heartbeat D. Sexual dysfunction E. A weight gain
A, D, E Daytime sleepiness Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication. Reports of heartburn Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication. A rapid heartbeat Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication. Sexual dysfunction Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication. A weight gain Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication.
4. A client diagnosed with bipolar disorder has been prescribed with lithium (carbonate) by his physician. Which question will help the nurse identify signs of early lithium toxicity? A. Have you been experiencing any nausea, vomiting or diarrhea? B. Do you have frequent headache? C. Have you been urinating excessively/frequently? D. Do you experience leg aches over the past few days?
Answer: A The most common early signs of lithium toxicity is gastrointestinal (GI) disturbance including nausea,vomiting, or diarrhea. B, C, D assessment question is unrelated to lithium toxicity.
9. A client receiving lithium carbonate has a lithium level of 2.3 mEq/L. The nurse will immediately assess the client for which of the following symptoms? A. Weakness B. Diarrhea C. Blurred Vision D. Fecal incontinence
Answer: C At lithium levels of 2 -2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2 mEq/L the client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.
A 49-year-old patient diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this patient? A. Monitoring blood levels to avoid toxicity B. Monitoring for abnormal involuntary movements C. Observing for secondary mania D. Observing for memory changes
B. Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.
Zyprexa (olanzipine) nursing considerations
increased risk of hyperglycemia agranulcytosis run LFT, BS, hemodynamic tests injectable may cause post injection delerium syndrome - must give in a facility and be monitored for 3 hrs
Risperdal (risperidone) nursing considerations
increased risk of hyperglycemia - use w/ caution in diabetic pts, take BS reduce dose for renal impairment drowsiness or dizziness may occur, will decrease over time do not give w/ caffeinated beverages Do not admin via IV
severe lithium toxicity >2.0
signs and symptoms: ataxia, serial EEG changes blurred vision, seizures, stupor, large output of diluted urine , coma
moderate lithium toxicity 1.5-2.0
signs and symptoms: coarse hand tremors, persistent GI upset, confusion, muscle hyperirritability, sedation, EEG changes.
mild lithium toxicity 1.0-1.5
signs and symptoms: nausea, vomiting,diarrhea, thirst, polyuria, lethargy, slurred speech, fine hand tremors
A client prescribed lithium carbonate (Lithium) 300mg qam and 600mg qhs presents to the ED with impaired consciousness, nystagmus, arrhythmias, and history of recent seizures. which serum lithium would the nurse expect to assess? A. 3.7 mEq/L B. 3.0 mEq/L C. 2.5 mEq/L D. 1.9 mEq/L
Correct Answer: A clients with a serum level greater than 3.5 mEq/L may show signs such as impaired consciousness, Nystagmus, seizures, coma, Oliguria/ anuria, arrhythmias, myocardial infarction, or cardiovascular collapse
Risperdal (risperidone) MOA
antagonizes dopamine and serotonin receptors
Clozaril (clozapine)
atypical antipsychotic
Risperdal (risperidone)
atypical antipsychotic
Zyprexa (olanzapine)
atypical antipsychotic
Depakote (divalproex sodium/valproic acid) MOA
directly increases concentration of inhibitory nerotransmitter y-aminobutyric acid (GABA)
6. A client newly diagnosed with bipolar disorder was prescribed with lithium meds. While giving the health teaching the client keeps asking about why there is a need for frequent blood works. Which of the following statement of the nurse addressing the client's question is true: A. "It will help determine if the medication dosage is still within the therapeutic level" B. "Frequent blood works is unnecessary once medication is taken as ordered" C. "It will help identify if the liver has been working properly" D. "It will monitor if the medication already pass the blood brain barrier"
Answer: A Lithium levels determine whether an effective dose of lithium is being given to maintain a therapeutic level of the drug. Lithium blood work aren't drawn for the reason of figuring out whether the drug pass through the blood brain barrier or if the liver is working properly. Taking the medication as ordered doesn't kill the requirement for blood work.
25. A client with bipolar disorder was prescribed with lithium (Eskalith). Upon giving teaching, the nurse instructed the client to report severe signs of toxicity? Select all that apply. A. Seizures B. Blurred vision C. Slurred speech D. Ataxia E. Tinnitus
Answer: A, B, D, E Slurred speech can be seen as early signs of toxicity
18. Which discharge instructions is most important for a client taking lithium (Eskalith)? A. Limit fluid to 1,500 ml daily B. Maintain a high fluid intake C. Take advantage of the warm weather by exercising outside whenever possible D. When feeling a cold coming, it's okay to take over-the-counter (OTC) remedies
Answer: B Client taking lithium need to maintain a high fluid intake. Exercising outside may not be safe; photosensitivity occurs with lithium use, and activity in warm weather could increase sodium loss, predisposing the client to lithium toxicity. The client shouldn't take OTC drugs without the physician's approval.
3. A nurse was giving health teaching to a client newly prescribed with lithium medication. Which of the following statement of the client indicates understanding about the medication? A. "When my mood fluctuates, I can increase the dosage of the medication" B. "I can still eat my favorite salty food" C. "I can crush an extended-release tablet, if ever it will be difficult for me to take it whole by mouth" D. "Drinking too much cranberry juice will help maintain a desirable lithium level"
Answer: B Clients under lithium therapy don't need to limit their sodium intake, instead it is recommended to keep salt intake the same as before prescription of the lithium medication. Increasing the dose of lithium without evaluating the client's lab works can cause lithium toxicity, overdose, and renal failure. Extended-releasetablet should be taken whole, it is uniquely made to release the medication slowly in the body, breaking the pill would cause the drug to be release at one time. Watermelon, cantaloupe, grapefruit juice, and cranberry juice will not therapeutically help in maintaining desirable lithium level because of its diuretic effect.
13. Which of the following is an adverse effect of lithium carbonate taken by a client with bipolar disorder. A. Alopecia B. Tremors C. Urinary retention D. Constipation
Answer: B Fine hand tremors are a common adverse effect in clients who take lithium. Alopecia is not an adverse effect of lithium. Diarrhea and polyuria are side effects of lithium.
22. A female client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering the medication? A. Calcium B. Sodium C. Chloride D. Potassium
Answer: B Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn'trestrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes are important for normal body functions but sodium is most important to the absorption of lithium.
7. A client under lithium medication reduce his dietary salt intake. Which of the following is expected to show in his blood work? A. Decreased lithium level B. Increased lithium level C. Increased then decrease in the next result of the lithium blood work D. No significant changes
Answer: B There is a direct relationship between the amount of salt and the plasma levels of lithium. Lithium plasma levels increase when there is a decrease in dietary salt. Increase in dietary salt causes the opposite effect of decreasing lithium plasma. That's why it is important that the nurse monitor dietary sodium intake.
Clozaril (clozapine) nursing considerations
agranulcytosis - monitor WBC neuroleptic malignant syndrome seizures w/ higher doses taper to discontinue do not use with geriatric pts = death hypotension/bradycardia/syncope teach pt signs of agranulcytosis take extra precautions to stay cool = heat stroke
A Client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of diluted urine, tremors, and muscular irritability. these symptoms would lead the nurse to expect to assess which serum lithium level? A. 0.6 mEq/L B. 1.5 mEq/L C. 2.6 mEq/L D. 3.5mEq/L
correct answer:C Rational: A client with serum level 2.6 mEq/L may experience excessive diluted urine, tremors, muscular irritability, psychomotor retardation, and mental confusion. the client's symptoms described in the question supports a serial level of 2.6 mEq/L.
The nurse is administering valproic acid (Depakote) to a patient. The nurse checks the laboratory values and finds a serum range for valproic acid of 200 mcg/ml. What should the nurse do? a. Increase the daily dose to get the patient's level to a therapeutic range. b. Hold the morning dose but give the other scheduled dosages for the day. c. Ask the patient if he is having any adverse effects from the medication. d. Hold the medication and notify the health care provider.
d
