ELSEVIER: Psych & Seizure Drugs
A client who is on haloperidol therapy has developed akathisia and acute dystonia. Which drugs would be used to manage extrapyramidal effects? Select all that apply. a. Bupropion b. Duloxetine c. Benztropine d. Amitriptyline e. Trihexyphenidyl
C &E: Haloperidol is an antipsychotic drug which may cause extrapyramidal effects such as akathisia and acute dystonia. Benztropine and trihexyphenidyl are anticholinergic drugs used to treat extrapyramidal symptoms. Bupropion, duloxetine, and amitriptyline are used to treat depression.
An agitated, acting-out, delusional client is receiving large doses of haloperidol, and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations will alert the nurse to stop the drug immediately? Select all that apply. a. Jaundice b. Dizziness c. Tachycardia d. Lethargic behavior e. Extrapyramidal symptoms
A & C: Jaundice signifies liver function interference and requires that the medication be stopped. Tachycardia, QT-interval prolongation, and cardiac arrest are life-threatening cardiovascular effects of haloperidol (Haldol). Dizziness due to orthostatic hypotension usually subsides after several weeks of treatment. Lethargy and drowsiness usually subside after several weeks of treatment. Extrapyramidal symptoms usually require that the dose be reduced or can be treated with other medications; if symptoms do not subside, then the drug is stopped.
The registered nurse is teaching about tricyclic antidepressant drugs to a nursing student. Which statement made by the nursing student indicates the need for further teaching? Select all that apply. a. Nortriptyline is contraindicated in older clients. b. Desipramine is preferred for use in elderly clients. c. Imipramine is used as an adjunct in the treatment of childhood enuresis. d. Tricyclic antidepressant drugs are prescribed for clients with seizure disorders. e. Tricyclic antidepressant drugs are contraindicated in clients with a history of seizures.
A & D: Nortriptyline is a preferred tricyclic antidepressant drug that can be safely administered in elderly clients. Antiepileptic drugs are prescribed to clients with seizures. Desipramine and nortriptyline are preferred tricyclic antidepressant drugs for use in elderly clients. Childhood enuresis necessitates the administration of imipramine. Clients with epilepsy should not be prescribed tricyclic antidepressant drugs, to avoid the risk of medical complications.
A healthcare provider diagnoses attention deficit hyperactivity disorder (ADHD) in a 7-year-old child and prescribes methylphenidate. The nurse discusses the child's treatment with the parents. What does the nurse emphasize as important for the parents to do? a. Monitor the effect of the medication on their child's behavior. b. Increase or decrease the dosage, depending on the child's behavior. c. Avoid imposing too many rules, because this will frustrate the child. d. Point out to their child that behavior can be controlled.
A - By monitoring and reporting changes in the child's behavior, the healthcare provider can determine the effectiveness of the medication. Dosage changes are the responsibility of the healthcare provider. Children need structure and rules; they provide a sense of security. Behavior is not deliberate or controllable; this statement may diminish the child's self-esteem if he or she cannot exert control.
A client is admitted to the emergency department in the midst of persistent tonic-clonic seizures (status epilepticus). Diazepam is to be administered immediately. In addition to decreasing central neuronal activity, what other effect does the nurse anticipate? a. Relaxing peripheral muscles b. Slowing cardiac contractions c. Dilating tracheobronchial structures d. Providing amnesia of the convulsive episode
A - Diazepam is a tranquilizer and anticonvulsant used to relax skeletal muscles during continuous seizures. Diazepam does not slow cardiac contractions. Diazepam does not dilate the tracheobronchial structures. Diazepam does not provide amnesia of the convulsive episode.
An 18-month-old toddler who stepped on a rusty nail 4 days ago shows signs of generalized tetanus, including neck and jaw stiffness and facial muscle spasms. The toddler is receiving intravenous diazepam as a muscle relaxant every 4 hours. What response to the medication does the nurse anticipate? a. Control of hypertonicity and prevention of seizures b. Control of laryngospasms and neck and jaw rigidity c. Prevention of excess oxygen and caloric expenditure d. Prevention of restlessness and resistance to assisted ventilation
A - Diazepam is commonly used to manage generalized muscular spasms. Laryngospasm and nuchal rigidity are responses to the exotoxin and are treated with tetanus immune globulin. Diazepam is not administered to decrease the metabolic rate. Pancuronium bromide, an acetylcholine antagonist, is given to children who do not respond to sedatives and muscle relaxants and therefore resist ventilatory assistance.
A nurse is providing instructions for a client who is receiving phenytoin but has limited access to health care. What side effect is the basis for the nurse's emphasis on meticulous oral hygiene? a. Hyperplasia of the gums b. Alkalinity of the oral secretions c. Irritation of the gingiva and destruction of tooth enamel d. Promotion of plaque and bacterial growth at the gum line
A - Gingival hyperplasia is an adverse effect of long-term phenytoin therapy; incidence can be decreased by maintaining therapeutic blood levels and meticulous oral hygiene. Alkalinity is not related to phenytoin or to gingival hyperplasia caused by phenytoin. Irritation of the gingiva and destruction of tooth enamel are not direct effects of phenytoin. Plaque and bacterial growth at the gum line are unrelated to phenytoin or to hyperplasia caused by it.
A client who is receiving phenytoin asks why folic acid (Folate) was prescribed. What is the best explanation by the nurse? a. Absorption of folate from foods is inhibited. b. The action of phenytoin is potentiated. c. Absorption of iron from foods is improved. d. Neuropathy caused by phenytoin is prevented.
A - Phenytoin inhibits folic acid absorption and potentiates the effects of folic acid antagonists. Folic acid is helpful in correcting certain anemias that can result from administration of phenytoin. The dosage must be carefully adjusted because folic acid diminishes the effects of phenytoin. Absorption of iron from foods and prevention of neuropathy caused by phenytoin are not effects of folic acid.
A client who has just started on a regimen of haloperidol is observed pacing and shifting weight from one foot to the other. What side effect does the nurse document in the client's chart? a. Akathisia b. Parkinsonism c. Tardive dyskinesia d. Acute dystonic reaction
A - Restlessness or the desire to keep moving (akathisia) can occur within 6 hours of the first dose of haloperidol; this side effect is associated with most neuroleptics. Parkinsonian side effects include masklike facies, tremors, and shuffling gait. Tardive dyskinesia is a severe, largely irreversible, extrapyramidal side effect occurring after prolonged treatment with phenothiazines. Acute dystonic reaction is characterized by severe, bizarre muscle contractions.
A client receiving risperidone plans to spend a day at the beach with family members. It is important that the nurse take which action? a. Encourage the client to use sunscreen. b. Caution the client to avoid excessive activity. c. Advise the client to bring an additional dose of medication to take after lunch. d. Have the client take a blood pressure reading before leaving for the outing.
A - Risperidone causes photosensitivity, which can be controlled with the use of sunscreens and protective clothing. Cautioning the client to avoid excessive activity is not a necessary precaution with this atypical antipsychotic drug; the client should be allowed to participate fully. The medication should be administered as prescribed; additional doses should not be administered. Participating in an outing should not affect the client's blood pressure.
A client who is taking haloperidol has developed tardive dyskinesia. Which therapy is beneficial for the client? a. Administering benzodiazepines b. Providing anticholinergics therapy c. Administering nonsteroidal antiinflammatory drugs d. Switching to other first-generation antipsychotic drugs
A - The long-term usage of first-generation antipsychotics such as haloperidol increases the risk of tardive dyskinesia. The client should be treated with benzodiazepines. Any anticholinergics drugs should be discontinued in the client. Nonsteroidal antiinflammatory drugs may not be beneficial for the client. The client should not switch to another first-generation antipsychotic because the risk of tardive dyskinesia still remains.
The nurse assesses a client with bipolar disorder. While reviewing the laboratory reports, the nurse finds the client's lithium levels are 1.3 mEq/L (1.3 mmol/L). Which nursing intervention would be appropriate in this client? a. Continuing to administer the drug b. Administering phenothiazine antipsychotics along with lithium c. Notifying the primary healthcare provider of the lithium levels d. Withdrawing the drug by consulting primary healthcare provider
A - The normal range of lithium is below 1.5 mEq/L (1.5 mmol/L). Because the serum lithium level is 1.3 mEq/L (1.3 mmol/L), the nurse should continue administering the drug. Administration of phenothiazine antipsychotics should be avoided because they may cause anticholinergic effects when used with lithium. The primary healthcare provider does not need to be consulted, and the drug should not be withdrawn.
A depressed client takes 50 mg of sertraline at bedtime. For which drug-related side effects will the nurse monitor the client? Select all that apply. a. Dry mouth b. Weight gain c. Constipation d. Photosensitivity e. Projectile vomiting
ABC - Dry mouth is a common side effect of sertraline that should be shared with the client because measures can be taken to relieve discomfort; this side effect should subside within 2 to 3 weeks after therapy begins. Constipation is also a common side effect of sertraline; an increase in fluids and bulk in the diet may minimize this effect. While there may be some initial weight loss with sertraline because of the side effects of anorexia, dry mouth, indigestion, and nausea, over time most patients who remain on the drug will have a noticeable increase in body mass, so the nurse would monitor for weight gain. Photosensitivity is not a side effect of this medication. Although nausea and vomiting may occur, the vomiting is not projectile vomiting.
A client with depression has not responded to a tricyclic antidepressant and outpatient electroconvulsive therapy (ECT). The healthcare provider prescribes selegiline, and the nurse teaches the client about food to be avoided while taking this medication. Which foods identified by the client allow the nurse to conclude that the instructions have been understood? Select all that apply. a. Fresh fish b. Beer c. Fried chicken d. Licorice e. Leafy vegetables
B &D - Selegiline is a monoamine oxidase inhibitor (MAOI), so the client must avoid foods containing tyramine because they can cause a hypertensive crisis. These foods include pickled herring, beer, wine, chicken livers, aged or natural cheese, overripe fruits, caffeine, cola, licorice, avocados, bananas, and bologna. There is no need to limit the intake of fish, chicken, or leafy vegetables while taking an MAOI.
A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin. What instructions will the nurse give to the client? a. Take the medication on an empty stomach. b. Brush the teeth and gums three times daily. c. Stop taking the drug if abdominal pain occurs. d. Note any change in pulse and respiratory rates.
B - Adequate dental hygiene is essential to control or prevent the common side effect of hypertrophy of the gums. The medication should be taken with food or milk to decrease gastrointestinal side effects. The healthcare provider should be consulted before the drug is discontinued or the dosage is adjusted; usually in this situation, a gradual dosage reduction is prescribed. Changes in pulse and respiratory rates are unrelated to phenytoin therapy.
A client's antidepressant medication therapy has recently been modified to substitute a tricyclic antidepressant for the monoamine oxidase inhibitor (MAOI) prescribed 2 years ago. In light of this assessment data collected during the follow-up appointment, what will the nurse do first? a. Retake the individual's blood pressure. b. Determine exactly when the client began taking the amitriptyline (Elavil). c. Ask how the client is managing the stress related to the new job and pregnancy. d. Identify what measures the client has implemented to help manage the recurrent headaches.
B - Improper weaning from an MAOI can result in the development of hypertensive crisis. The client's increased blood pressure and chronic headache are possible early warning signs of this serious side effect. Determining exactly when the client began taking the newly prescribed tricyclic medication will help the nurse determine whether the MAOI had sufficient time to be excreted from the body. Reassessing the client's blood pressure, though not inappropriate, does not have the same priority as does gathering new information that could help identify the root of the hypertension and headaches. Stress can be a factor in increased blood pressure and headaches, but in this situation a more serious potential complication must be explored. Identifying the self-treatment the client has implemented for the reported headaches, though appropriate, does not take priority over determining the possible cause of the increased blood pressure and headaches.
A depressed client has been prescribed a tricyclic antidepressant. How long does the nurse inform the client that it usually takes before clients notices a significant change in the depression? a. 4 to 6 days b. 2 to 4 weeks c. 5 to 6 weeks d. 12 to 16 hours
B - It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level. Time spans of 4 to 6 days and 12 to 16 hours are both too short for a therapeutic blood level of the drug to be achieved. Improvement in depression should be demonstrated sooner than 5 to 6 weeks.
Methylphenidate is prescribed for a 6-year-old boy with the diagnosis of attention deficit-hyperactivity disorder (ADHD). The nurse teaches the father about safe medication administration and concludes that the instructions have been understood when the father says that he should administer it at which time? a. At bedtime b. After breakfast c. When the child gets hungry d. When the child's behavior is out of control
B - Methylphenidate (Ritalin SR) may cause nausea, anorexia, and dry mouth, which interfere with appetite and adequate food intake; therefore it should be administered after the child has eaten breakfast. Methylphenidate is a cerebral stimulant that can interfere with sleep; it should not be administered within 6 hours of bedtime. It should be taken exactly as prescribed, not on an as-needed basis.
A nurse is teaching the parents of a child with attention deficit hyperactivity disorder (ADHD) about the prescribed medication methylphenidate. When will the daily dose be administered? a. Before breakfast b. Just after breakfast c. Immediately before lunch d. As soon as the child awakens
B - Methylphenidate is an appetite suppressant; it should be given after meals. Methylphenidate given before a meal or as soon as the child awakens may suppress the child's appetite.
A client is prescribed sertraline, an antidepressant. What does the nurse include when preparing a teaching plan about the side effects of this drug? a. Seizures b. Agitation c. Tachycardia d. Agranulocytosis
B - Sertraline, a selective serotonin reuptake inhibitor (SSRI), inhibits neuronal uptake of serotonin in the central nervous system, thus potentiating the activity of serotonin. Central nervous system side effects of this drug include agitation, anxiety, confusion, dizziness, drowsiness, and headache. Seizures are a side effect of clozapine, an antipsychotic, not sertraline, which is an antidepressant. Tachycardia is a side effect of tricyclic antidepressants, not sertraline, which is an SSRI antidepressant. A decrease in the production of granulocytes (agranulocytosis) causing a pronounced neutropenia is a side effect of clozapine, not sertraline.
A client has been taking 3 mg of risperidone twice a day for the past 8 days. At the follow-up appointment, the client reports tremors, shortness of breath, a fever, and sweating. What will the nurse do? a. Call 911 and have the client transported to the nearest psychiatric unit. b. Take the client's vital signs and arrange for immediate transfer to a hospital. c. Check the number of risperidone tablets left in the prescription bottle to see whether there was an overdose. d. Request a prescription for 2 mg of intramuscular benztropine stat and assess the client in 10 to 15 minutes for symptom relief.
B - These clinical manifestations signal the presence of neuroleptic malignant syndrome; the cardinal sign of this condition is a high body temperature. Therefore the nurse first should document the hyperthermia and then arrange for immediate hospitalization. Unless the client is experiencing impaired ventilation, it is important to complete a focused assessment before transfer. The care needed can be provided in an emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant syndrome may occur without an overdose; this syndrome can occur when a high-potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after initiation of the medication. Benztropine will have little or no effect on neuroleptic malignant syndrome.
A client is lonely and extremely depressed, and the healthcare provider prescribes a tricyclic antidepressant. The client asks the nurse what the medication will do. What is the best response by the nurse? a. "This drug will help you forget why you're lonely and depressed." b. "The medication will increase your appetite and make you feel better." c. "You'll start to feel much better after taking this medication for 2 or 3 days." d. "You'll feel less depressed when you take this with the monoamine oxidase inhibitor."
B - Tricyclic antidepressants create a general sense of well-being, increase appetite, and help lift depression. The client might not know the reason for depression, and the drug does not cause amnesia. Symptomatic relief usually begins after 2 to 3 weeks of therapy. Concomitant use of monoamine oxidase inhibitors and tricyclic antidepressants is contraindicated.
Which teratogenic effect is seen due to lithium? a. Stillbirth b. Shortened limbs c. Ebstein anomaly d. Neural tube defects
C - Ebstein anomaly (cardiac defects) in the newborn occurs due to taking lithium during pregnancy. Stillbirth may occur due to alcohol use. Shortened limbs may occur due to thalidomide. Neural tube defects are due to antiseizure drugs.
What will the nurse do when determining whether a client is experiencing adverse effects of risperidone? a. Monitor for episodes of diarrhea. b. Test sensation of lower extremities. c. Question if dizziness is experienced. d. Auscultate breath sounds to detect wheezing.
C - Hypotension and dizziness are adverse effects of risperidone. Risperidone may cause constipation, not diarrhea. It does not affect the neuromuscular or cardiovascular function of the legs; numbness and coldness of the feet do not occur. Risperidone does not cause wheezing or shortness of breath.
Methylphenidate is prescribed to treat a 7-year-old child's attention deficit-hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of this disorder in children because it has what effect? a. Diuretic effect b. Synergistic effect c. Paradoxical effect d. Hypotensive effect
C - Methylphenidate, a stimulant, has an opposite effect on hyperactive children; the reason for this action is as yet totally unexplained. Although methylphenidate has a hypotensive effect, this is not why it is given to hyperactive children. Methylphenidate does not induce diuretic or synergistic effects.
Lithium therapy is initiated for a client diagnosed with manic episodes. Laboratory testing shows that the client's lithium level is 1.2 mEq/L (1.2 mmol/L). Why would the healthcare provider reduce the client's lithium dosage? a. To promote the drug excretion b. To reduce the risk of side effects c. To maintain the serum drug level d. To reduce the risk of drug accumulation
C - Plasma lithium levels must be kept below 1.5 mEq/L (1.5 mmol/L) to reduce the risk of toxicity. Normal lithium levels should range from 0.8 to 1.4 mEq/L (0.8-1.4 mmol/L). Once the desired therapeutic effect has been achieved, the dosage is reduced to produce maintenance levels ranging from 0.4 to 1 mEq/L (0.4-1 mmol/L). The client's serum lithium level of 1.2 mEq/L (1.2 mmol/L) indicates that the client is at an effective therapeutic level; therefore, the primary healthcare provider should reduce the dose to maintain the serum levels to reduce the risk of toxicity. Reducing the client's lithium dosage will not promote the drug's excretion, reduce the risk of side effects, or reduce the risk of drug accumulation. The client's lithium dosage is decreased to reduce the risk of drug toxicity.
A client who is going to be discharged has been receiving 3 mg of risperidone three times a day. What will the nurse teach the client about the medication? a. May be reduced if the client feels better at home b. May be discontinued after the client is discharged c. May cause sedation if taken concurrently with alcohol d. Should be taken early in the day to be sure that it is not forgotten
C - Risperidone potentiates the action of alcohol and can cause oversedation if the drug and alcohol are taken together. This medication should be taken consistently to prevent recurrence of symptoms and maintain a therapeutic blood drug level. Medications should be taken as prescribed; taking them all at one time may interrupt the maintenance of a constant therapeutic blood level.
A client has been hospitalized for 3 weeks while receiving a tricyclic medication for severe depression. One day the client says to the nurse, "I'm really feeling better; my energy level is up." After the encounter an aide tells the nurse that the client has given away a favorite jacket. What should the nurse conclude that the client's statement indicates? a. Improved mood b. Improved socialization c. Increased risk for suicide d. Heightened need for independence
C - When the energy level improves in the depressed client, the risk for suicide increases; also, the client has given away a personal belonging, which may indicate a plan to commit suicide. Elevated mood may be true, but the gift of a cherished personal belonging decreases the possibility that the client's statement simply reflects an improvement in mood. The client's socialization may be improved, but the gift of a valuable personal belonging decreases the possibility that the act simply reflects an improved level of socialization. Giving something away is unrelated to independence.
A client is treated with lorazepam for status epilepticus. What effect of lorazepam does the nurse consider therapeutic? a. Slows cardiac contractions b. Dilates tracheobronchial structures c. Depresses the central nervous system (CNS) d. Provides amnesia for the convulsive episode
C -Lorazepam, an anxiolytic and sedative, is used to treat status epilepticus because it depresses the CNS. Slower cardiac contractions are not an effect of lorazepam. Dilating tracheobronchial structures is not an effect of lorazepam. Providing amnesia for the convulsive episode is not an effect of lorazepam.
In addition to hydration during alcohol withdrawal delirium, parenteral administration of lorazepam is prescribed for a client. The nurse knows that this drug is given during detoxification primarily for what purpose? a. To prevent injury when seizures occur b. To enable the client to sleep better during periods of agitation c. To reduce the anxiety tremor state and prevent more serious withdrawal symptoms d. To quiet the client and encourage cooperation by promoting acceptance of the treatment plan
C: Lorazepam potentiates the actions of gamma-aminobutyric acid, which reduces the anxiety and irritability associated with withdrawal. This drug helps reduce the risk of seizures but does not prevent physical injury if a seizure occurs. Although the drug may enable the client to sleep better during periods of agitation, this is not the primary objective of using the drug. The ability of the client to accept treatment depends on readiness to accept the reality of the problem.
A nurse teaches the parents of a 7-year-old girl who has been prescribed long-term phenytoin therapy about care pertinent to this medication. Which statement indicates that the teaching has been effective? a. "We give the medication between meals." b. "We'll call the clinic if her urine turns pink." c. "She's eating high-calorie foods, and we encourage fluids, too." d. "We'll have her massage her gums and floss her teeth frequently."
D - A common side effect of phenytoin is gingival hyperplasia. Meticulous oral hygiene may reduce the risk of this side effect. Phenytoin is strongly alkaline and should be administered with meals to help prevent gastric irritation. Pink urine may be observed during drug excretion; it is expected and does not require treatment. Avoidance of overeating and overhydration may result in better seizure control.
A 7-year-old boy with a diagnosis of attention deficit-hyperactivity disorder (ADHD) is receiving methylphenidate. His mother asks about its action and side effects. What is the nurse's initial response? a. "This medicine increases the appetite." b. "This medicine must be continued until adulthood." c. "It is a short-acting medicine that must be given with each meal." d. "It is a stimulant that has a calming effect on children with your son's disorder."
D - Although the exact mechanism is unknown, clinical improvements have been reported with sympathomimetic amines such as methylphenidate. After the purpose and action of the drug are explained, the nurse should review side effects with the parent. The appetite of a child taking methylphenidate usually diminishes. The child should be medicated for as short a period as possible. Each child is evaluated individually. The duration of methylphenidate is 3 to 6 hours, or 8 hours with the extended-release form.
Bupropion has a unique side effect not shared by most other drugs of its class. The nurse will assess the client for which unique possible side effect of this drug? a. Heart failure b. Breast tumors c. Tardive dyskinesia d. Generalized seizures
D - Bupropion inhibits the reuptake of dopamine, serotonin, and norepinephrine and may cause seizures that can be life threatening; also, it may cause headaches, agitation, sedation, tremors, and confusion. Heart failure is not a side effect of bupropion. Bupropion does not cause breast tumors. Tardive dyskinesia can occur with the use of neuroleptics.
Which is the adverse effect of haloperidol? a. Ataxia b. Asthenia c. Insomnia d. Gynecomastia
D - Haloperidol is an antipsychotic drug used in the long-term treatment of psychosis. Gynecomastia is one of the adverse effects of this drug. Ataxia, asthenia, and insomnia are the adverse effects of clozapine.
Sertraline is prescribed for a depressed client. What information does the nurse include when teaching the client about this drug? a. The drug can cause a hypertensive crisis. b. The drug interferes with the reuptake of norepinephrine. c. Specific foods should be avoided when one is taking the drug. d. Several weeks may pass before the effects of the drug become evident.
D- It may take several weeks to achieve a therapeutic level with this selective serotonin reuptake inhibitor. Hypertensive crises do not occur with this drug. This drug inhibits serotonin uptake but has little effect on norepinephrine receptors. No food restrictions are placed on clients who take this drug.
An older client with depression is prescribed a tricyclic antidepressant. What is the priority nursing intervention in this situation? a. Providing psychotherapy to the client b. Teaching strategies to overcome depression c. Encouraging the client to walk for 30 minutes d. Requesting that the physician change the drug
D: Tricyclic antidepressants have anticholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence in older adults. Therefore the priority nursing care for an older client who is prescribed a tricyclic antidepressant is to request that the physician change the drug. Providing psychotherapy is an alternate treatment, which is of medium priority. Teaching strategies to overcome depression is of low priority. Encouraging the client to walk for 30 minutes overcomes the feelings of depression, but it is not the priority.
