Mental Health (Pharmacology)

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?

"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.

A registered nurse teaches a client about precautions to be taken before initiating lithium therapy. Which statements made by the client indicates effective learning? Select all that apply.

"I will take the medication with meals or milk." "I will maintain normal sodium intake levels in my diet." "I will swallow slow release tablets intact without crushing or chewing them." The client should take lithium with meals or milk to decrease gastric upset. A sodium deficiency can cause lithium to accumulate; therefore, the client should maintain normal levels of sodium intake in their diet. Slow release tablets should be swallowed intact. Diarrhea can cause significant sodium loss, which may cause an accumulation of lithium. A client experiencing diarrhea should make dietary changes to reduce the risk of toxicity instead of discontinuation or termination of drug therapy. If any signs of toxicity develop, the client should immediately terminate therapy and notify the prescriber.

Clozapine, an atypical antipsychotic, is prescribed for a client with psychosis. It is important for client to have frequent blood tests for which possible complication?

Agranulocytosis Although the complication is rare, clients taking clozapine are at increased risk of agranulocytosis, a marked decrease in granulated white blood cells. All clients taking clozapine require frequent blood testing during the therapy and for as long as 4 weeks after the medication is discontinued. Clozapine does not cause anemia or thrombocytopenia. Hemophilia is a genetic deficiency of certain proteins needed to help blood to clot.

A client is anxious, and the healthcare provider prescribes alprazolam 5 mg by mouth three times a day. What will the nurse do before administering this prescription?

Clarify the prescription with the healthcare provider The prescribed dosage is excessive, and it must be questioned before its administration. Ventilation of feelings does not affect the need to question the prescription. Therapeutic dosages of alprazolam range from 0.75 mg to 4 mg daily; the maximal daily dose for panic attacks is 8 mg.

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?

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.

A young adult being treated for substance abuse asks the nurse about methadone. The nurse responds that methadone is useful in the treatment of opioid addiction because it has what characteristic?

Has an effect of longer duration The duration of effect of methadone is 12 to 24 hours, compared with other opioids, which have a 3- to 6-hour duration of effect. It is just as addictive but controls the addiction and keeps the client out of the illicit drug market. Methadone does produce a cumulative effect. Physical as well as psychological dependence is possible, just as with other opioids.

A primary healthcare provider prescribes divalproex. What does the nurse consider an appropriate indication for the use of this drug?

Management of manic episodes of bipolar disorder Although divalproex is an antiepileptic, it is used to control the manic phase of bipolar disorder. Divalproex is not the drug of choice for schizophrenia; nor is it used for agitated paranoid states. Divalproex is not used for major depression, except with a history of at least one manic episode or a family history of manic disorders.

Which of the following drugs is commonly used as an adjunct during conscious sedation for minor surgeries?

Midazolam When used in conjunction with an opioid analgesic, midazolam causes conscious sedation, which is a semiconscious state suitable for minor surgeries and endoscopic procedures. Diazepam and lorazepam are used for anesthetic induction, preanesthetic medication, and the production of conscious sedation when used in conjunction with opioid analgesics. Clonazepam is used to treat seizures and anxiety.

A nurse on a mental health unit administers a variety of antipsychotic medications. The nurse concludes that olanzapine has a distinct advantage over other antipsychotics for what reason?

Tablets disintegrate immediately in the mouth, preventing tablet "cheeking." Olanzapine is an oral disintegrating tablet that dissolves on contact with moisture. Extrapyramidal effects are possible side effects of this medication. This medication must be administered daily. Olanzapine's action is unknown; it is believed to be a dopamine and serotonin type 2 antagonist. Increased dopamine at receptor sites increases psychotic behavior.

Which statements regarding the use of selegiline to treat depression are true? Select all that apply.

Oxcarbazepine significantly raises the level of selegiline. The most common adverse reaction of selegiline is a localized rash. Transdermal selegiline is the only transdermal treatment for major depression. Oxcarbazepine significantly raises the level of selegiline and is contraindicated. The most common adverse reaction of selegiline is a localized rash. Transdermal selegiline is the first and only transdermal treatment for major depression. Carbamazepine raises the level of selegiline. Oral forms of selegiline are approved to treat symptoms of Parkinson disease.

A client who is diagnosed with schizophrenia was prescribed antipsychotic drugs. During a follow-up visit, the client had developed extrapyramidal symptoms. Which drugs might be responsible for these symptoms? Select all that apply.

Perphenazine, Fluphenazine, and Trifluoperazine Perphenazine, fluphenazine, and trifluoperazine are first-generation antipsychotic drugs that have a high risk of causing extrapyramidal symptoms. Second-generation antipsychotic drugs such as clozapine and olanzapine have a lower risk of extrapyramidal symptoms.

The primary healthcare provider prescribed selective serotonin reuptake inhibitor therapy for a client who survived a bomb blast. During a follow-up visit, the nurse finds that the symptoms did not subside. Which other medications would be beneficial for the client? Select all that apply.

Phenelzine, Mirtazapine, and Imipramine A client who survived a bomb blast would have posttraumatic stress disorder (PTSD). Selective serotonin reuptake inhibitors (SSRIs) are first-line agents used to treat PTSD. If SSRIs are not effective, then monoamine oxidase inhibitors (such as phenelzine or mirtazapine) or a tricyclic antidepressant (such as imipramine) may be effective in treating PTSD. Buspirone and trazodone are not used to treat PTSD.

What will the nurse do when determining whether a client is experiencing adverse effects of risperidone?

Question if dizziness is experienced. 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.

The primary healthcare provider prescribes an atypical antipsychotic drug to a client and asks the nurse to set up an appointment for the client to see an ophthalmologist. Which drug was prescribed to the client?

Quetiapine Quetiapine is a second-generation antipsychotic drug that may pose a risk of cataracts. Therefore, the prescriber would refer the client to an ophthalmologist for an examination of the lenses. Clozapine is a second-generation antipsychotic drug that does not have any risk of causing cataracts. Ziprasidone may cause alterations in the QT intervals. Chlorpromazine is a first-generation antipsychotic drug that does not cause cataracts.

The mother of a client reports, "My son is afraid of every small thing and has a fear of dying." Upon assessment, the nurse finds palpitations, racing heartbeat, and sweating. Which first-line medications would be beneficial for the client? Select all that apply.

Sertraline, and Fluoxetine A fear of every small thing, fear of dying, palpitations, racing heartbeat, and sweating are manifestations of a panic disorder. Selective serotonin reuptake inhibitors such as sertraline and fluoxetine are first-line agents used to treat panic disorders. Phenelzine is a monoamine inhibitor (MAOI) that is a last-line treatment in a panic disorder. Alprazolam is a benzodiazepine and a second-line treatment for a panic disorder. Imipramine is a tricyclic antidepressant used as a second-line treatment for a panic disorder.

What is the planned effect of naloxone when it is administered for a heroin overdose?

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.

The nurse cares for a client who has schizophrenia and is taking chlorpromazine. The nurse instructs the family members to inform the nurse if any adverse effects develop. Which side effects are considered late extrapyramidal side effects?

Worm-like tongue movements Chlorpromazine is a first-generation antipsychotic drug that may cause extrapyramidal side effects. Late extrapyramidal side effects include fine, worm-like tongue movements. Tremors, restless movements, and muscle spasms of the neck, back, tongue, or face are early extrapyramidal side effects.

Which assessment finding alerts the nurse to stop administering haloperidol to a client until further laboratory work is done?

Yellow sclerae Yellow sclerae is a sign of jaundice, indicating an increase of liver enzymes, which may be irreversible even if drug therapy is discontinued. Although grimacing may be a sign of a serious side effect, it may also just be a behavioral response of the disorder; the nurse should notify the primary healthcare provider rather than withhold the drug. Shuffling gait is a parkinsonian symptom that can be reversed with treatment; continuation of the medication is permitted. Photosensitivity is not a problem as long as the client is cautioned to stay out of the sun.

anosognosia

inability to recognize one's own illness