Evolve EAQ: Psych - Psych/HM Drugs

A recently married 22-year-old woman is brought to the trauma center by the police. She has been robbed, beaten, and sexually assaulted. The client, although anxious and tearful, appears to be in control. The primary healthcare provider prescribes 0.25 mg of alprazolam for agitation. The nurse will administer this medication when what event occurs? A. The client's crying increases B. The client requests something to calm her C. The nurse determines a need to reduce her anxiety D. The primary healthcare provider is getting ready to perform a vaginal examination

B. The client requests something to calm her Because a sexual assault is a threat to the sense of control over one's life, some control should be given back to the client as soon as possible. Crying is a typical way to express emotions; the client should be told that medication is available if desired. The nurse determining a need to reduce the client's anxiety or administering the medication when the primary healthcare provider is getting ready to do a vaginal examination takes control away from the client; the client may view these actions as an additional assault on the body, which increases feelings of vulnerability and anxiety and does not restore control.

Which antipsychotic drugs have a higher risk of causing tardive dyskinesia? Select all that apply. A. Loxapine B. Quetiapine C. Haloperidol D. Ziprasidone E. Olanzapine

A. Loxapine C. Haloperidol First-generation antipsychotic drugs such as loxapine and haloperidol may cause tardive dyskinesia, an extrapyramidal reaction. Second-generation antipsychotic drugs such as quetiapine, ziprasidone, and olanzapine have a lower risk of causing extrapyramidal reactions.

A client has been receiving fluphenazine for several months. The nurse will assess the client for which side effects? Select all that apply. A. Tremors B. Excess salivation C. Rambling speech D. Reluctance to converse E. Uncoordinated movement of extremities

A. Tremors E. Uncoordinated movement of extremities Acute dystonic reactions such as tremors, dyskinesia, and akathisia are observable side effects of fluphenazine therapy. There is a decrease, not an increase, in salivation with fluphenazine therapy. Rambling speech is not a side effect of this drug; nor is reluctance to converse.

The primary healthcare provider prescribes a neuroleptic drug to a client diagnosed with schizophrenia. On what basis would the primary healthcare provider choose the drug? A. Symptoms B. Side effects C. Therapeutic effects D. Underlying pathology

B. Side effects First-generation antipsychotic drugs are also known as neuroleptics. The selection of these drugs is primarily based on side effects rather than therapeutic effects. Because all symptoms respond equally to antipsychotic drugs, the drug selection may not be based on symptoms. Because these drugs do not alter the underlying pathology, the selection may not be based on underlying pathology.

A client with a diagnosis of dementia of the Alzheimer type has been taking donepezil 10 mg/day for 3 months. The client's partner calls the clinic and reports that the client has increasing restlessness and agitation accompanied by nausea. What does the nurse advise the partner to do? A. Give the medication with food B. Administer the medication to the partner at bedtime C. Omit one dose today and start with a lower dose tomorrow D. Bring the partner to the clinic for testing and a physical examination

D. Bring the partner to the clinic for testing and a physical examination Many people with dementia experience physical problems such as urinary tract infections but cannot adequately verbalize what is happening. They may just become more restless and agitated. Because the client has been taking this dose for 3 months, the problems are probably not being caused by the medication. The client should be brought in for an evaluation. Taking the medication with meals is recommended to decrease gastrointestinal side effects, but this client is experiencing more than gastrointestinal effects. Donepezil (Aricept) can cause insomnia. The client is already restless and agitated. Taking the medication at bedtime will not help. The nurse should not advise a modification of the dosage without consulting the healthcare provider.

What is the best drug of choice for treating obsessive-compulsive disorder? A. Imipramine B. Lithium salts C. Amitriptyline D. Clomipramine

D. Clomipramine Clomipramine is a tricyclic antidepressant drug prescribed for treating of obsessive-compulsive disorder. Childhood enuresis necessitates the administration of imipramine. Lithium salt is prescribed to treat bipolar disorders. Dysthymias can be treated by the administration of antidepressant drugs such as amitriptyline.

Which food should be avoided by a client who is prescribed monoamine oxidase inhibitors (MAOIs)? A. Bologna B. Potatoes C. Citrus fruit D. Grapefruit juice

A. Bologna Bologna has a high tyramine content; tyramine should not be consumed by clients taking monoamine oxidase inhibitors (MAOIs) because the drug interaction may cause severe hypertension. Potatoes and citrus fruits do not contain tyramine. Grapefruit juice may cause a negative drug interaction in clients taking buspirone.

Which drug does the nurse recognize as an effective mood-stabilizing drug used in clients with bipolar disorder and in the acute treatment of mania and prevention of recurrent mania and depressive episodes? A. Doxepin B. Clozapine C. Amitriptyline D. Lithium carbonate

D. Lithium carbonate Lithium carbonate is often the first choice of treatment, once primary acute mania has been diagnosed, to calm acute manic symptoms and relieve recurrent mania. Doxepin and amitriptyline are antidepressants used to treat depression but not mania. Clozapine is an antipsychotic medication used to control hallucinations and delusions in clients with psychosis but is not a first-line drug because of its side effects, which include seizures and significant weight gain.

An antidepressant is prescribed for a depressed older client. After 1 week the client's son expresses concern that there does not seem to be much improvement. How does the nurse respond? A. "Antidepressant therapy requires several weeks before it becomes effective." B. "Antidepressant therapy will be more effective as the physical condition improves." C. "Additional medications may be required before behavioral changes will be observed." D. "Additional time is needed for the medication to become effective because of the prolonged depression."

A. "Antidepressant therapy requires several weeks before it becomes effective." The effects of antidepressants are cumulative; it may take 3 to 4 weeks before improvement is identified. Antidepressants do not become more effective as a client's physical condition improves. It is too early to come to this conclusion. Antidepressants become effective after 3 or 4 weeks, regardless of the duration of the depression.

Which drug is contraindicated in clients with eating and seizure disorders? A. Bupropion B. Trazodone C. Amitriptyline D. Lithium citrate

A. Bupropion (Wellbutrin) Bupropion is contraindicated in clients with eating and seizure disorders. Trazodone is contraindicated in clients with a known allergic reaction to this drug. Amitriptyline is contraindicated in clients who are pregnant and have known allergic reactions to this drug. Lithium citrate is contraindicated in clients with renal or cardiovascular disease.

An older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. What is the most appropriate nursing intervention? A. Withholding the next dose of lithium and drawing blood to test it for toxicity B. Obtaining a prescription for the antidote to lithium and administering it immediately C. Suggesting that the primary healthcare provider replace the lithium for an anti epileptic that will control the mania D. Assessing the client for coarse hand tremor and, if it is present, giving the daily dose of lithium with a bit of water

A. Withholding the next dose of lithium and drawing blood to test it for toxicity The client is displaying signs and symptoms of early lithium toxicity; older clients should be monitored carefully and given smaller doses of lithium, because its excretion from the kidneys is slower than that in younger adults. There is no antidote to lithium. Coarse hand tremor is an indication of advanced lithium toxicity; the lithium should be withheld. Although antiepileptics are effective in 25% to 50% of clients with treatment-resistant bipolar disorder, this is not the appropriate treatment for lithium toxicity.

What is the planned effect of naloxone when it is administered for a heroin overdose? A. To compete with opioids for occupancy of opioid receptors B. To prevent excessive withdrawal symptoms as heroin wears off C. To accelerate metabolism of heroin and stimulate respiratory centers D. To stimulate cortical sites that control consciousness and cardiovascular function

A. to compete with opioids for occupancy of opioid receptors Naloxone is used to treat opioid-induced apnea. It competes with the opioid for central nervous system receptor sites and thus acts as an opioid antagonist. Preventing excessive withdrawal symptoms as heroin wears off is not the specific action of this drug. Naloxone does not accelerate the metabolism of heroin. Stimulating cortical sites that control consciousness and cardiovascular function is not the action of naloxone. One adverse reaction of naloxone is cardiovascular irritability.

In preparation for medication administration, the nurse is reviewing the results of diagnostic laboratory tests on a newly admitted client. In light of this information, what is the initial nursing intervention? A. Checking the client's temperature every 4 hours B. Holding the morning dose of clozapine C. Educating the client on the need for additional iron in the diet D. Assessing the client for the presence of diarrhea or constipation

B. Holding the morning dose of clozapine This client's white blood cell (WBC) count is very depressed; a count this low indicates the need to hold the clozapine and have the client evaluated for agranulocytosis. Agranulocytosis is a significant side effect of clozapine. Although it is appropriate for the client's temperature to be monitored, none of these diagnostic findings warrants taking the client's temperature every 4 hours. Although the client's red blood cell (RBC) count and hematocrit and hemoglobin values are moderately decreased, adjusting the client's diet is not the priority at this time. It is true that diarrhea and constipation are side effects of alendronate, but this assessment finding is not the priority at this time.

Which clients with schizophrenia should not be prescribed chlorpromazine? Select all that apply. A. Clients with glaucoma B. Client with dynamic ileum C. Clients with Parkinson disease D. Client's with severe hypertension E. Client's with prostatic hypertrophy

C. Clients with Parkinson disease D. Clients with severe hypertension Chlorpromazine is a first-generation antipsychotic drug that should be avoided in clients with a history of Parkinson disease or severe hypertension. Clients with a history of glaucoma, dynamic ileus, or prostatic hypertrophy should be prescribed chlorpromazine with caution.

Which drug is a high-potency medication used to treat schizophrenia? A. Loxapine B. Thioridazine C. Fluphanazine D. Perphenazine

C. Fluphanazine Fluphenazine is a high-potency medication used for schizophrenia. Loxapine and perphenazine are medium-potency medications used to treat schizophrenia. Thioridazine is a low-potency medication used to treat schizophrenia.

A healthcare provider prescribes disulfiram for a client who abuses alcohol. The nurse teaches the client that disulfiram will have which action? A. Affect short-term memory B. Permit a healthier lifestyle C. Allow the client to tolerate small amounts of alcohol D. Cause a severe adverse reaction if alcohol is consumed

D. Cause a severe adverse reaction if alcohol is consumed Disulfiram is an aversion therapy; a person who consumes alcohol while taking disulfiram will experience a severe reaction consisting of nausea, vomiting, hypotension, headache, tachycardia, tachypnea, and flushing. The drug does not affect short-term memory. Use of disulfiram may or may not foster a healthier lifestyle, and if it does occur, this is the result of multiple factors, not just disulfiram therapy. When taking disulfiram the client cannot tolerate any alcohol.

Which drug is contraindicated in clients with blood dyscrasias? A. Duloxetine B. Bupropion C. Mirtazapine D. Chlorpromazine

D. Chlorpromazine Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias. Duloxetine is an antidepressant drug contraindicated in clients with uncontrolled angle-closed glaucoma. Bupropion is an antidepressant drug contraindicated in clients with anorexia nervosa. Mirtazapine is an antidepressant drug contraindicated in clients who have allergic reactions due to drugs and concurrent use of monoamine oxidase inhibitors.

A client is to be discharged on a regimen of lithium carbonate. What will the nurse include in the discharge teaching plan? A. Advising the client to restrict the intake of gluten B. Instructing the client to take the medication with milk C. Reminding the client to have a complete blood count once a month D. Encouraging the client to have the lithium blood level tested regularly

D. Encouraging the client to have the lithium blood level tested regularly The blood level must be checked monthly or bimonthly when the client is undergoing maintenance therapy, because there is only a small difference between the therapeutic and toxic ranges. A regular diet should be encouraged if the client does not have gluten enteropathy. There is no need to take lithium carbonate with milk, because it does not cause gastrointestinal problems. Lithium carbonate does not affect the blood cells.

During an interview and assessment, a 60-year-old client reports to the nurse, "I've been using St. John's wort to try to feel more like myself again. I'm not sure whether it's going to work." The nurse will pursue an assessment related to the client's report of which symptom? A. Depression B. Sleep Disturbances C. Diminished cognitive ability D. Sensory-perceptual disturbances

A. Depression St John's wort is an herb that is marketed as a natural way to improve mood and ease feelings of depression. Because St. John's wort is considered a dietary supplement, it is not regulated by the Food and Drug Administration as drugs are. It has not been shown to exert positive effects in people with sleep disturbances, diminished cognitive abilities, or sensory-perceptual disturbances.

Which medications are used over the long-term to treat generalized anxiety disorder (GAD)? Select all that apply. A. Duloxetine B. Venlafaxine C. Clonazepam D. Escitalopram E. Clompiramine

A. Duloxetine B. Venlafaxine D. Escitalopram Duloxetine, venlafaxine, and escitalopram are antidepressants approved for the long-term treatment of generalized anxiety disorder (GAD). Clonazepam is a benzodiazepine used for short-term relief of anxiety; it also induces sedation and can be used to treat panic disorders and anxiety-related depression. Benzodiazepines can be used for short-term management of GAD but are not recommended for long-term therapy. Clomipramine is a tricyclic antidepressant and is used to manage panic disorder and obsessive-compulsive disorder (OCD).

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. Monitor the effect of the medication on their child's behavior 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.

Which atypical antipsychotics are approved for long-term use to prevent the recurrence of mood episodes in clients with bipolar disease? Select all that apply. A. Olanzapine B. Quetiapine C. Ziprasidone D. Risperidone E. Aripiprazole

A. Olanzapine C. Ziprasidone E. Aripiprazole Olanzapine, ziprasidone, and aripiprazole are atypical antipsychotics approved for long-term use to prevent recurrence of mood episodes. Quetiapine and risperidone are atypical antipsychotics approved for use in bipolar disease but are not approved for long-term use to prevent the recurrence of mood episodes.

A client receiving the medication buspirone is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies that the client's sclerae look yellow. What will be the nurse's initial action? A. Withhold the medication B. Give the buspirone with milk C. Reduce the dosage of the medication D. Ensure that the medication can be give parenterally

A. Withhold the medication The medication should be stopped immediately, because jaundice indicates possible liver damage, which prolongs elimination of the drug and may result in toxic accumulation. Milk does not change the effect of the drug. The drug must be stopped, not reduced. The drug is available only in an oral form; in addition, the route of administration will not influence the occurrence of toxic accumulation.

After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client? A. Caffeine B. Modafinil C. Atomoxetine D. Methylphenidate

B. Modafinil Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).

A client is started on chlorpromazine. To prevent life-threatening complications from the administration of this medication to an anxious, restless client, it is important that the nurse take which action? A. Provide adequate restraint B. Monitor the client's vital signs C. Protect against exposure to direct sunlight D. Watch the client for extrapyramidal side effects

B. Monitor the client's vital signs Tachycardia, hyperpyrexia, and tachypnea are indications of neuroleptic malignant syndrome, which is a life-threatening complication. Restraint of any type may worsen the client's anxiety and result in struggling and increased agitation. Photosensitivity occurs most commonly when clients are taking large doses and are spending time outdoors in the sun, but it is not life threatening. Tardive dyskinesia results from prolonged large doses of phenothiazines in susceptible clients, but it is not life threatening.

A nurse notes that haloperidol is most effective for clients who exhibit which type of behavior? A. Depressed B. Overactive C. Withdrawn D. Manipulative

B. Overactive Haloperidol reduces emotional tension, excessive psychomotor activity, panic, and fear. It is used for clients with thought disorders and hyperactivity. Clients exhibiting excited-depressed behavior do not respond well to haloperidol, because it tends to worsen the depression. Haloperidol appears to have few stimulating effects for a withdrawn client and, in fact, increases feelings of lassitude and fatigue. Haloperidol does not decrease manipulative behavior. Clients who are capable of manipulation usually do not exhibit behavior that involves overactivity, fear, and panic.

A client with schizophrenia is given an antipsychotic drug. The nurse recalls all the extrapyramidal effects associated with this type of medication and anticipates that the drug will be discontinued if which occurs? A. Akathisia B. Tardive dyskinesia C. Parkinsonian syndrome D. Acute dystonic reaction

B. Tardive dyskinesia Tardive dyskinesia is characterized by protrusion and vermicular movements of the tongue, chewing and puckering movements of the mouth, and a puffing of the cheeks. These adverse effects may or may not be reversible when the antipsychotic medication is withdrawn. Motor restlessness (akathisia), parkinsonian symptoms, or an acute dystonic reaction can be treated with an antiparkinsonian or anticholinergic drug while the antipsychotic medication is continued.

A client on a psychiatric unit who has been hearing voices is receiving a neuroleptic medication for the first time. The client takes the cup of water and the pill and stares at them. What is the most therapeutic statement the nurse can make? A. "You have to take your medicine." B. "This is the medication that your healthcare provider ordered." C. "This will help you not to hear the voices. It will only work if you take it." D. "There must be a reason that you don't want to take your medicine."

C. "This will help you not to hear the voices. It will only work if you take it." Telling the client that the provider wants him or her to take the medication and instructing him or her to do so presents reality and simply states the expected behavior. Explaining what the medication will do for the client is an appropriate nursing intervention. Telling the client that he or she has to take the medication is an authoritarian, not a therapeutic, statement. The client has the right to refuse medication. Telling the client that the medication has been prescribed for him or her does not tell the client what behavior is expected. Noting that there must be a reason that the client doesn't want to take the medication assumes that the client does not want to take medication, even though the client may simply not understand what to do.

Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? A. Trazodone B. Bupropion C. Duloxetine D. Mirtazapine

C. Duloxetine Duloxetine can worsen uncontrolled angle-closure glaucoma. Trazodone is contraindicated in clients with a known drug allergy. Bupropion is contraindicated for clients with seizures. Mirtazapine is contraindicated in cases of known drug allergy and concurrent use of monoamine oxidase inhibitors.

Lithium carbonate, 600 mg by mouth three times a day, is prescribed for a client. The nurse concludes that the teaching about its side effects is understood when the client says that the primary healthcare provider will be notified immediately if what condition occurs? A. Difficulty urinating B. Sensitivity to bright light or sun C. Fine hand tremor or slurred speech D. Sexual dysfunction or breast enlargement

C. Fine hand tremor or slurred speech Fine hand tremor or slurred speech in a person taking lithium may signal the development of toxicity; signs of toxicity include marked tremors, lack of coordination, sluggishness, and confusion. Lithium carbonate can cause polyuria and incontinence, not urine retention. Sensitivity to bright light or sun is a side effect of the phenothiazine group of medications. Neither sexual dysfunction nor breast enlargement is associated with lithium carbonate intake.

A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client? A. Constricted pupils B. Intractable diarrhea C. Increased heart rate D. Decreased respirations

C. Increased heart rate Methamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system. The pupils will dilate, not constrict, because the sympathetic nervous system is activated. Clients withdrawing from opioids, not methamphetamine, experience diarrhea. The respirations will be increased, not decreased, because of the activation of the sympathetic nervous system.

Which drugs may cause an increase in the serum clozapine level? Select all that apply. A. Rifampin B. Phenytoin C. Ketoconazole D. Erythromycin E. Bromocriptine

C. Ketoconazole D. Erythromycin Ketoconazole and erythromycin increase clozapine levels in the blood by inhibiting P450 isoenzymes. Rifampin and phenytoin reduce clozapine levels in the blood by inducing cytochrome P450 isoenzymes. Bromocriptine is a direct dopamine receptor agonist that activates dopamine receptors.

An 80-year-old client with depression requires the prescription of antidepressant drugs. Which tricyclic antidepressant drug is appropriate? A. Doxepin B. Amoxapine C. Nortriptyline D. Trimipramine

C. Nortriptyline Nortriptyline and desipramine are preferred for use in the elderly as these antidepressant drugs have less anticholinergic activity. Doxepin, amoxapine, and trimipramine have more cholinergic activity than nortriptyline and are not the preferred drugs for elderly clients.

A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks? A. Lithium B. diazepam C. Fluvoxamine D. Fluphenazine

D. Fluphenazine Fluphenazine can be given intramuscularly every 2 to 3 weeks to clients who are unreliable about taking oral medications; it allows them to live in the community while keeping the disorder under control. Lithium is a mood-stabilizing medication that is given to clients with bipolar disorder. This drug is not given for schizophrenia. Diazepam is an antianxiety/anticonvulsant/skeletal muscle relaxant that is not given for schizophrenia. Fluvoxamine is a selective serotonin reuptake inhibitor; it is administered for depression, not schizophrenia.

An antianxiety medication is prescribed for an extremely anxious client. The client says, "I'm afraid to take this medication because I heard they're addictive." The nurse teaches the client that antianxiety medications have what properties? A. Rarely cause dependence when the dosage is controlled B. May require increases in dosage but really cause dependence C. Usually result in psychological but not physiologic dependence D. Have the potential for physiologic and psychological dependence

D. Have the potential for physiologic and psychological dependence Antianxiety medications have the potential for physiologic and psychological dependence; the nurse should teach the client about both the advantages and disadvantages of taking this drug. Physiologic or psychological dependence may develop, even when the dosage is controlled. Tolerance does develop and can lead to dependence.

Which statement about psychotherapeutic drugs in elderly clients requires correction? A. Tricyclic antidepressants may increase anxiety in elderly clients B. Normal dosage of lithium may result in lithium toxicity in elderly clients C. Elderly clients on antipsychotic drugs are susceptible to orthostatic hypotension D. Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs

D. Low serum levels of the drug are reported in elderly clients on psychotherapeutic drugs High serum levels are recorded in elderly clients on psychotherapeutic drugs. Instead of decreasing the anxiety, tricyclic antidepressant drugs may increase the anxiety in older adults. Normal dosage of lithium may result in lithium toxicity in elderly clients, thus necessitating the need to administer low doses of the drug. Orthostatic hypotension, anticholinergic adverse effects, sedation, and extrapyramidal symptoms are more common in elderly clients taking psychotherapeutic drugs.