Psych/Mental Health Pharm

A patient with depression has been prescribed fluoxetine [Prozac] (SSRI). Which statement made by the patient indicates an understanding of medication teaching? - "Disorientation and hallucinations are common." - "The drug may enhance my interest in sex." - "It may take 3 to 4 weeks until my mood is elevated". - "I can stop this medication when I feel less depressed."

"It may take 3 to 4 weeks until my mood is elevated".

Mary Thomas is to begin treatment with an antidepressant drug. She asks how long it will take before she feels better. The BEST response by the nurse would be:

"It will take three to four weeks before a full therapeutic effect is reached."

A patient has been prescribed venlafaxine [Effexor XR] and requests information about the medication. Which response by the nurse is most appropriate? - "Venlafaxine [Effexor XR] is used to treat anxiety and depression." - "Call your pharmacist because he or she will know the most about this drug." - "You will need to talk with the doctor about that." - "I will get you a pamphlet so that you can read about the drug."

"Venlafaxine [Effexor XR] is used to treat anxiety and depression."

Main Categories of Anxiolytics

- Antidepressants - Benzodiazepines - Atypical Anxiolytic Medications (Buspirone HCI - Buspar) - Other Medications (Propanolol HCI - Beta Blocker & Hydroxyzine - Vistaril, Atarax - Antihistamine

Main Categories of Sedative-Hypnotics

- Benzodiazepine - Barbiturates - Non-barbiturate Hypnotics

Main Categories of medications used to treat Bipolar

- Lithium Carbonate - Anticonvulsants (certain antiepileptic meds used) - Atypical Antipsychotics (many atypicals have mood-stabilizing properties)

Anticonvulsants used for Mood Stabilization

- carbamazepine (Tegretol) - valproic Acid; divalproex sodium (Depakote) - lamotrigine (Lamictal) topiramate (Topamax)

The provider ordered lorazepam [Ativan] 0.5 mg IV every 6 hours for anxiety. The medication available is lorazepam [Ativan] 2 mg/mL. How many mL will the nurse administer?

0.25 mL

Four milligrams of haloperidol [Haldol] (antipsychotic) are ordered for your patient. The pharmacy has available 2mL ampules that contain 5 mg/mL. How many mL's will you give?

0.8 mL

Tyramine-Containing Foods

Aged Wines (Chianti, Port, Sherry) Aged Cheeses (Blue, Brie, Cheddar, Swiss) Beer Dried or Overripe Fruit (Figs, Prunes, Raisins) Liver Sauerkraut Sourdough Soy Products (Soybeans, Tofu, Teriyaki) Yeast and Yeast Extracts (Brewer's Yeast, Marmite)

What term should the nurse use to document a client who is taking antipsychotic medications, pacing the hallway, unable to remain still, and reports feeling nervous? - Dystonia - Akathisia - Tardive dyskinesia - Akinesia

Akathisia

movement disorder characterized by severe restlessness

Akathisia

avoid with antipsychotics

Alcohol

Which of the following statements BEST explains the therapeutic effect of the antidepressants? In general, the antidepressant drugs:

Allow for more serotonin to remain in the synapses between brain neurons

A client with significant anxiety is prescribed an antianxiety medication. Which of the following is an example of a benzodiazepine medication? - Buspirone - Alprazolam (Xanax) - Lithium - Valproic acid (Depakote)

Alprazolam (Xanax)

All of the following statements about antianxiety drugs are correct EXCEPT: - Substances such as caffeine, cold medications, and appetite suppressants should be avoided when taking antianxiety drugs. - Antianxiety drugs can help to cure or solve underlying problems contributing to anxiety. - Relaxation therapy, meditation, and physical exercise should be encouraged along with medication. - Factors that trigger or exacerbate stress need to be identified.

Antianxiety drugs can help to cure or solve underlying problems contributing to anxiety.

common side effects with tricyclic antidepressants and other medications

Anticholinergic

A patient has decreased circulating levels of GABA. Which health problem is this most likely to suggest? - Alzheimer's disease - Parkinson's disease - Anxiety disorders - Insomnia

Anxiety disorders

Maria Diaz, diagnosed with major depression, has not responded to an SSRI medication. Her physician has now prescribed Parnate (tranylcypromine sulfate), an MAO inhibitor. Which of the following should now be included in Maria's teaching plan?

Avoid foods that contain tyramine

A nurse is giving discharge instructions to a client who will be taking phenobarbital [Luminal] (barbiturate). The nurse would educate the client in which of the following that directly correlates with the safety of the client? - Take the medication at the same time each day. - Take the medication with meals only. - Decrease the dosage once with symptoms of dizziness and lightheadedness. - Avoid using sleep aids while taking this medication.

Avoid using sleep aids while taking this medication.

A patient has been prescribed isocarboxazid [Marplan] (MAOI) for the treatment of depression. Which foods should the patient be taught to avoid? - Broccoli, shrimp, and yogurt. - Bananas, smoked fish, and cheese. - Apples, steak, and cottage cheese. - Tomatoes, chicken, and milk.

Bananas, smoked fish, and cheese.

warning that occurs with all antidepressants (2 words)

Black Box Warning

Monica has a history of alcohol dependence. Which antianxiety medication is most appropriate for Monica? - Buspirone - Alprazolam (Xanax) - Oxazepam - Diazepam (Valium)

Buspirone

Ruby Hart, diagnosed with acute anxiety, is prescribed buspirone to help control her symptoms. Which of the following statements regarding this medication is true? - Buspirone is the best choice for quick relief of her symptoms. - Buspirone has a lower potential for abuse than other antianxiety drugs. - Buspirone produces slightly more sedation than other antianxiety drugs. - Buspirone, taken with alcohol, increases CNS depression.

Buspirone has a lower potential for abuse than other antianxiety drugs.

It is important to warn a client against combining alcohol with an antidepressant drug because this combination may result in:

CNS Depression

an anticonvulsant used for mood stabilization (generic name)

Carbamazepine

The first anticonvulsant drug identified as a mood stabilizer for the treatment of bipolar disorder is:

Carbamazepine (Tegretol)

An anticonvulsant and a benzodiazepine that is used to treat panic disorder and bipolar disorder is:

Clonazepam (Klonopin)

Charles Downey has started to respond to antidepressant therapy. He suddenly becomes calm and peaceful and no longer verbalizes thoughts about dying. He does state to the nurse, "Things will be better soon." It is important that the nurse now engages in which of the following nursing interventions?

Complete a suicide assessment

Lithium toxicity Advanced Indications

Confusion, poor coordination, coarse tremors, GI distress, EKG Changes

Which symptoms would the nurse expect to assess in a client experiencing serotonin syndrome? - Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis - Orthostatic hypotension, urinary retention, constipation, and blurred vision - Dizziness, lethargy, headache, nausea - Hypomania, akathisia, cardiac arrhythmias, and panic attacks

Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis

The inpatient mental health client is being treated for major depressive disorder. The client has psychomotor retardation, speaks very little, and is extremely inactive physically. The client takes an antidepressant that causes anticholinergic side effects. The nurse should conclude that this client is at particular risk for developing which of the following? Select all that apply. - Constipation - Dry mouth - Weight loss - Diarrhea - Vomiting

Constipation Dry mouth

Helen suffers from schizophrenia. She has paranoid delusions and at times becomes violent towards others. Helen also talks about killing herself. She also has great difficulty bathing and dressing herself and is reluctant to eat. Which of the following interventions is of the HIGHEST priority? - Encourage compliance with drug regimen. - Create an environment that reduces the risk of self-harm. - Establish an open, trusting relationship with Helen. - Develop coping strategies for stress reduction.

Create an environment that reduces the risk of self-harm.

David is teaching Mr. Manning's wife and daughter about his antianxiety medication. All of the following actions are appropriate EXCEPT: - David explains the potential side effects of the medication. - David discusses how to evaluate the effectiveness of the medication's ability to reduce Mr. Manning's signs and symptoms. - David asks the family members to demonstrate correct administration of Mr. Manning's medication. - David explains that Mr. Manning does not need to consult his doctor about continuing to take weight loss products since these products will not affect his antianxiety medications.

David explains that Mr. Manning does not need to consult his doctor about continuing to take weight loss products since these products will not affect his antianxiety medications.

Lithium Toxicity Early Indications

Diarrhea, Nausea, vomiting, thirst, polyuria, muscle weakness, fine tremors, slurred speech

Contraindications with buspirone include all of the following EXCEPT: - Avoid giving them with MAOIs. - Do not take with grapefruit juice. - Clients with renal impairment should not take this drug. - Do not give with sedatives because of CNS depression increase.

Do not give with sedatives because of CNS depression increase.

When taking lithium for bipolar disorder, it is important to monitor urinary output because:

Fluid Volume deficits may occur as a result of polyuria

given for benzodiazepine overdose

Flumazenil

It is important that nurses know both the generic and trade names of a drug. Which of the following is the generic name for the popular antidepressant Prozac?

Fluoxetine

commonly given for anxiety with a history of substance abuse

Fluvoxamine

Symptoms of anxiety and panic are associated with a low level of which neurotransmitter? - Cortisol - Gamma-aminobutyric acid (GABA) - Glutamate - Dopamine

Gamma-aminobutyric acid (GABA)

1. Roberta is a nurse who works in a busy outpatient mental health clinic. One of her clients is a 35-year-old woman with obsessive-compulsive disorder. The client believes strongly in the power of herbal medicines. The client is evasive when asked if she is taking any herbal supplements. Based on this information, which of the following is an appropriate comment for Roberta to make when she is implementing patient education? - You can't lie to me about taking herbs! - Your problems will get worse and your insurance company will not pay for treatment if you don't do as I say. - Herbs can interact with your medication and cause harmful side effects. - Herbs usually don't interact with psychotherapeutic drugs.

Herbs can interact with your medication and cause harmful side effects.

occurs with tyramine and MAOIs (2 words)

Hypertensive Crisis

Because some of the SSRIs have a stimulating effect, these drugs should be administered

In the morning

Alan suffers from chronic depression. He has been taking antidepressants for about three months and is feeling considerable relief from the depression that has interfered with his life. Prior to taking the antidepressants, he refused to participate in social functions, and he and his wife experienced severe marital difficulties. Based on this scenario, all of the following are high-priority client goals for Alan EXCEPT: - Initiates self-care activities. - Maintains compliance with drug regimen. - Participates in sexual counseling. - Creates an environment that facilitates the improvement of interpersonal relationships.

Initiates self-care activities.

Jeffrey is diagnosed with bipolar disorder. He is in the midst of the depressive phase of the disorder. Jeffrey's psychiatrist prescribes an antidepressant. The nurse practitioner sits down with Jeffrey before he leaves the office in order to provide important client education. Jeffrey tells the nurse practitioner, "I can't wait to start this medication and feel better right away." Which of the following is the MOST critical part of planning Jeffrey's client education? - Jeffrey will discuss the action (including length of time it takes for therapeutic effects to occur), dose, and side effects of prescribed medication. - Jeffrey identifies of signs and symptoms of his disorder. - Jeffrey will maintain significant interpersonal relationships. - Jeffrey plans coping strategies for stressful situations.

Jeffrey will discuss the action (including length of time it takes for therapeutic effects to occur), dose, and side effects of prescribed medication.

Which of the following stimulant medications are prescribed in the treatment of ADHD? Select all that apply. - Lisdexamfetamine (Vyvanse) - Clonidine (Catapres) - Amphetamine/ dextroamphetamine (Adderall) - Methylphenidate (Concerta) - Guanfacine (Intuniv) PreviousNext

Lisdexamfetamine (Vyvanse) Amphetamine/dextroamphetamine (Adderall) Methylphenidate (Concerta)

primary medication used in the treatment of bipolar disorder, monitor sodium level

Lithium

A nurse is counseling a client about the drug lithium, which was prescribed to treat bipolar disorder. The nurse will tell the client all of the following EXCEPT

Lithium's action peaks in 2-3 days

group of antidepressants with diet restrictions (plural)

MAOIs

All of the following nursing actions are appropriate when a client is taking lithium. Which one is the MOST critical to take?

Monitor serum drug levels

Lithium Toxicity Extreme Indications

Multiple organ toxicity, Rapid progression of symptoms leading to coma and death

sudden high fever, labile BP, tachycardia, stupor, coma (medical abbreviation)

NMS

given for opiate overdose (generic name)

Naloxone

Valproic acid (Depakote) can cause a number of side effects. All of the statements about such side effects are true EXCEPT:

One of the long-term effects of Depakote is significant weight loss

Which of the following drugs is classified as a monoamine oxidase inhibitor (MAOIs)?

Phenelzine

A patient who is diagnosed with bipolar disorder (BPD) is prescribed lithium. To monitor for lithium toxicity, the nurse should observe the patient for which signs and symptoms? - Constipation, asterixis, and generalized edema - Dry cough, hyperactive reflexes, and hypertension - Insomnia, increased appetite, and abdominal distention - Polydipsia, slurred speech, and fine hand tremors

Polydipsia, slurred speech, and fine hand tremors

Lithium toxicity Severe Indications

Polyuria, diluted urine, tinnitus, blurred vision, ataxia, seizures, severe hypotension leading to coma, death from respiratory complications

A nurse has explained the use of naltrexone to a client. The nurse should interpret that teaching was effective when the client identifies which purpose of naltrexone? - Prevent withdrawal symptoms - Manage heightened anxiety - Reduce number of blackouts - Reduce craving for alcohol

Reduce craving for alcohol

A client receiving the drug Tofranil (imipramine) reports dizziness when getting out of bed in the morning. To decrease the effects of orthostatic hypotension, what should the nurse tell the patient?

Rise gradually from a supine position

Because they are considered to have fewer side effects, are safer for clients at risk for suicide, and are more specific in treating the symptoms of depression, the MOST frequently prescribed antidepressants today are the:

Selective Serotonin Reuptake Inhibitors (SSRIs)

Mark is taking an antidepressant. He is experiencing a loss of interest in his sexual relationship with his wife that is attributed to medication side effects. His wife is quite upset and has begun to drink large amounts of alcohol. Mark and his wife often quarrel and he has threatened to hit her on several occasions. Based on this information, all of the following nursing diagnoses are made EXCEPT: - Sexuality patterns, altered - Self-care deficit - Family coping, ineffective - Violence, at risk for

Self-care deficit

Mike is a 16-year-old who is suffering from major depression. He complains of lack of energy and says, "sometimes I wish I were dead." His physician prescribes an antidepressant. Mike has been taking the medication for about three weeks and tells his parents that he feels as though his energy is "coming back." Based on this information, Mike's nurse should alert his parents to assess Mike for signs and symptoms of which of the following? - Self-injury - Self-care deficit - Inappropriate social interactions - Manic behavior

Self-injury

confusion, fever, labile BP, tremors (2 words)

Serotonin Syndrome

one type of extrapyramidal symptom, administer benztropine (2 words)

Tardive Dyskinesia

A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue. The nurse determines the client is experiencing? - Hypertensive crisis - Parkinsonism - Tardive dyskinesia - Neuroleptic malignant syndrome

Tardive dyskinesia

A client has just been prescribed lithium for bipolar disorder treatment. The client works long hours and often drinks 10-12 cups of coffee a day to stay awake. How does this behavior affect the drug's effectiveness?

The caffeine in coffee may reduce the effectiveness of lithium

The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine (Clozaril), an atypical antipsychotic. Which laboratory data should the nurse evaluate? - The client's white blood cell count. - The client's red blood cell count. - The client's clozapine therapeutic level. - The client's arterial blood gases.

The client's white blood cell count.

A patient has been taking escitalopram [Lexapro] (SSRI)10 mg daily for four weeks. Initially, the patient reported depression and suicidal thoughts. The patient's sleep, appetite, energy, and appearance have now begun to improve. Which statement applies to this patient? - The medication should be increased. - The medication should be discontinued. - The patient's suicide potential is increased. - The patient's risk for suicide is not a concern.

The patient's suicide potential is increased.

given for Wernicke's and Korsakoff'

Thiamine

The delayed release form of valproic acid is used:

To control manic episodes in bipolar disorder

A client has severe asthma. Which of the following antianxiety drugs is LEAST appropriate for this client? - Diazepam (Valium) - Lorazepam (Ativan) - Triazolam (Halcion)

Triazolam (Halcion)

an amino acid to avoid if taking MAOIs

Tyramine

A client is prescribed valproic acid (Depakote). It is important that the nurse teaches the client that:

Valproic acid must be avoided by anyone with liver disease (hepatic disease) or poor liver function

A child takes Adderall XR (amphetamine/dextroamphetamine mixture) for ADHD. The nurse should assess the child for which adverse effects? - Hypotension, bradycardia, and a heart murmur - Fatigue, depression, and dry mouth - Weight loss, restlessness, and chest pain - Blurred vision, tinnitus, and muscle spasms

Weight loss, restlessness, and chest pain

A client's lithium blood level during maintenance therapy is 0.7 mEq/L. This result is:

Within Normal Limits

Although seizures are a relatively uncommon side effect, about five percent of clients taking the drug _________ experience seizures. a. Clozapine b. Risperidone c. Lurasidone (Latuda) d. Fluphenazine

a. Clozapine

A client is on maintenance therapy for schizophrenia. Which of the following maintenance drugs' effects last from two to four weeks? a. Fluphenazine b. Risperidone c. Olanzapine d. Aripiprazole

a. Fluphenazine

The newer, atypical antipsychotic drugs have which of the following actions in the brain? a. Inhibit the reception of dopamine and serotonin at specific postsynaptic sites. b. Prevent the reuptake of serotonin and norepinephrine at the presynaptic neuron. c. Potentiate the inhibitory neurotransmitter GABA. d. Correct an ion exchange abnormality.

a. Inhibit the reception of dopamine and serotonin at specific postsynaptic sites.

A nurse observes a client becoming more restless. He cannot sit still in group therapy and is pacing the hallway. The nurse recognizes that he is demonstrating which of the following extrapyramidal symptoms? a. akathisia b. oculogyric crisis c. dyskinesia d. akinesia

a. akathisia

Antipsychotic medications are most frequently used in the management of: a. delusions and hallucinations. b. severe depressive episodes. c. panic levels of anxiety. d. obsessive-compulsive disorders.

a. delusions and hallucinations.

Which of the following symptoms would lead the nurse to suspect that a client is having the adverse effect of pseudoparkinsonism from an antipsychotic drug? a. shuffling gait b. sucking and smacking movements of the lips c. restless pacing d. muscle spasms of the face and neck

a. shuffling gait

When a client is ordered Alprazolam (Xanax), the nurse should ESPECIALLY assess the client for which of the following concurrent illnesses? - epilepsy - acute angle closure glaucoma - cardiac arrhythmias - pulmonary disease

acute angle closure glaucoma

A client is experiencing both positive and negative symptoms of schizophrenia. Which of the following drugs is appropriate for this client? a. Loxapine b. Quetiapine c. Haloperidol d. Perphenazine

b. Quetiapine

A schizophrenic client will be discharged on an antipsychotic medication. The nurse should include all of the following in the teaching plan EXCEPT: a. avoid excessive exposure to sunlight. b. eliminate cheese and chocolate from the diet. c. immediately report chills and sore throat. d. continue the medication exactly as prescribed.

b. eliminate cheese and chocolate from the diet.

The irreversible antipsychotic effect that includes facial grimacing, lip smacking, and tongue protrusion is called: a. neuroleptic malignant syndrome. b. tardive dyskinesia. c. Parkinson's syndrome. d. extrapyramidal symptoms.

b. tardive dyskinesia.

A client is experiencing side effects consisting of frightening and painful spasms of specific muscle groups. These side effects are referred to as: a. Pseudoparkinsonism b. Akathisia c. Dystonic reactions d. NMS

c. Dystonic reactions

Which of the following statements about the safety alert pertaining to antipsychotics and older adults is true? a. Antipsychotics are contraindicated for older adults. b. Antipsychotics are used to treat Alzheimer's Disease. c. Black Box Warnings have been eliminated from information about antipsychotics. d. Antipsychotics may be prescribed to treat behavior disorders in older clients with dementia-related psychosis.

d. Antipsychotics may be prescribed to treat behavior disorders in older clients with dementia-related psychosis.

The nurse must teach clients and their families to monitor for an often-fatal side effect of antipsychotic medications characterized by muscular rigidity, high fever, leukocytosis, and increased production of muscle enzymes. This side effect is: a. Tardive dyskinesia b. Extrapyramidal side effects c. Akathisia d. Neuroleptic malignant syndrome (NMS)

d. Neuroleptic malignant syndrome (NMS)

Which anticonvulsant medication might be prescribed for a patient with bipolar disorder? - olanzapine (Zyprexa) - clonazepam (Klonopin) - divalproex sodium (Depakote) - lithium (Lithobid)

divalproex sodium (Depakote)

Susan has been diagnosed with GAD. She has been prescribed a benzodiazepine. These types of drugs help to relieve anxiety by: - inhibiting the action of the enzyme that dissolves the neurotransmitters. - selectively blocking the reuptake of serotonin by the presynaptic neurons. - enhancing the effectiveness of the neurotransmitter GABA. - blocking dopamine receptors.

enhancing the effectiveness of the neurotransmitter GABA.

A patient is brought to the emergency department for the treatment of an overdose of alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient? - naloxone (Narcan) - protamine sulfate - flumazenil [Romazicon] - acetylcysteine (Acetadote)

flumazenil [Romazicon]

Mildred suffers from schizophrenia. She believes that aliens from another planet are trying to kidnap her. Mildred has a history of violence against others when she fears that other people are trying to harm her. Which of the following is the most critical part of the nursing assessment process for Mildred? - vital signs, especially blood pressure - her ability to perform activities of daily living - her ingestion of herbal supplements - her current level of danger to herself and others

her current level of danger to herself and others

Client education in relationship to the psychotherapeutic drugs has been found to: - decrease the need for drug therapy. - result in early discontinuance of the drugs. - increase the side effects a client experiences. - increase the client's compliance with the drug regimen.

increase the client's compliance with the drug regimen.

Patient teaching for the benzodiazepine drugs should include all of the following EXCEPT: - do not discontinue the drug abruptly. - do not mix benzodiazepines with alcohol. This combination can be lethal. - long-term use can result in physical tolerance and dependence. - persons with sleep apnea may safely take benzodiazepines.

persons with sleep apnea may safely take benzodiazepines.

The long- term use of benzodiazepine is discouraged because it may result in: - physical and psychological dependence. - lowered mental capabilities. - Alzheimer's disease. - chronic severe depression

physical and psychological dependence.

Monica suffers from obsessive-compulsive disorder and her physician recently prescribed anti-anxiety agents. Her symptoms involve repeated hand-washing to the point that her skin is raw and open areas are beginning to appear. Some of these areas are infected. This hand-washing behavior is Monica's attempt to cope with the stress of her obsessions. Based on this information, which of the following is a priority for Monica? - sexuality counseling - reduce/eliminate the potential for violence - maintain social relationships - reduce/eliminate the potential for self-injury

reduce/eliminate the potential for self-injury

Benzodiazepines include:

◦Alprazolam (Xanax) ◦Chlordiazepoxide (Librium) ◦Clonazepam (Klonopin) ◦Chlorazepate (Tranxene) ◦Diazepam (Valium) ◦Lorazepam (Ativan)

Benzodiazepines used as Anxiolytic-Hypnotics

◦Alprazolam (Xanax) ◦Lorazepam (Ativan) ◦Midazolam (Versed) ◦Temazepam (Restoril) ◦Triazolam (Halcion)

Barbiturates

◦Amobarbital ◦Butabarbital ◦Pentobarbital ◦Phenobarbital ◦Secobarbital

Nonbarbiturates/Benzodiazepine-like Medications

◦Zaleplon ◦Zolpidem ◦Eszopiclone

CNS Stimulans used to treat ADHD

◦methylphenidate (Ritalin) ◦dexmethylphenidate (Focalin) ◦dextroamphetamine (Dexadin) ◦amphetamine Mixture (Adderall) ◦lisdexamfetamine dimesylate (Vyvanse)

Lithium Carbonate

- Alters sodium transport in nerve and muscle cells - Lithium (Lithobid, Eskalith, Lithonate, Lithotabs)

adverse effect with clozapine

Agranulocytosis

specific group of side effects with antipsychotics (2 words)

Extrapyramidal Symptoms