CHAPTER 22 - PSYCHOTHERAPEUTIC AGENTS - PrepU Practice Questions

Which statement should be included in the teaching plan for a patient receiving methylphenidate (Ritalin)? "Adverse effects include hypertension and nervousness." "There is no risk of dependence." "The medication is usually taken just before bedtime." "The drug may cause weight gain."

"Adverse effects include hypertension and nervousness." p. 384 Rationale: 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.

A patient expresses that being diagnosed with narcolepsy has been devastating for him. Which statement by the patient should the nurse focus on initially during the assessment? "I hate being so dependent. I have to have somebody drive me everytwhere I go." "I don't like the way the stimulant medication makes me feel." "I have had to change my job. I now work from home." "I sometimes wonder if it is worth living a life that has so many restrictions."

"I sometimes wonder if it is worth living a life that has so many restrictions." p. 385 Rationale: Narcolepsy affects almost every aspect of daily life, including professional performance, ability to drive and operate machinery, and social interactions. Although all the patient's statements should be addressed, the suggestion that life may not be worth living should take priority.

The patient is ordered didrex 25 mg PO BID. The drug comes in 50-mg tablets. How much should the nurse administer to the patient at each dose? - 2 tablets - 3/4 tablet - 1/2 tablet - 1 tablet

- 1/2 tablet Rationale: The nurse should give 1/2 tablet at each dose. The drug comes in 50-mg tablets, and the patient is to receive 1/2 (25-mg) at each dose. The other options would be a medication error if administered.

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: - perform ROM exercises daily. - suction the patient daily. - weigh the patient daily. - record a daily summary of child's behavior.

- record a daily summary of child's behavior. Rationale: 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.

The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention? Deteriorating Restoring Improving Contravening

Improving p. 371, 383 Rationale: CNS stimulants improve behavior and attention in clients with ADHD.

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 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.

Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. p. 373, 384 Rationale: 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.

Typical antipsychotics block dopamine receptors. True False

True p. 371 Rationale: The antipsychotic drugs, which are essentially dopamine receptor blockers, are used to treat disorders that involve thought processes.

For clients taking clozapine (Clozaril), it is necessary to monitor what lab test for the first 6 months? White blood cells PT/PTT Liver enzymes Hemoglobin

White blood cells p. 373 Rationale: 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 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): - high drug efficacy of haloperidol. - decreased risk for toxic effects of haloperidol therapy. - decreased risk for muscular contractions and spasms. - increased risk for toxic effects of haloperidol therapy.

increased risk for toxic effects of haloperidol therapy. Rationale: 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.

A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation? Antibiotic Narcotic Antipsychotic Antidepressant

Antipsychotic p. 375 Rationale: 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.