Psych Meds
*Possible Exam Question* The nurse is providing medication teaching to a patient who is prescribed an MAOI. Which instruction should the nurse emphasize when teaching the patient about this medication? A) "Take it at bedtime if sedation occurs." B) "Don't change the diet or decrease fluid intake." C) "Avoid foods containing tyramine." D) "Take in the morning with food to avoid GI upset and insomnia."
C) "Avoid foods containing tyramine." Rationale: Foods containing tyramine should be avoided when taking a monoamine oxidase inhibitor. Tricyclic antidepressants should be taken at bedtime if sedation occurs. The patient should not alter the diet or fluid intake if lithium is prescribed. Selective serotonin reuptake inhibitors should be taken in the morning or with food to prevent GI upset and insomnia. Foods with Tyramine: Certain cheeses, cured meats
A patient has been diagnosed with depression. The nurse is discussing complementary health approaches to treating depression. Which treatment is show to enhance the therapeutic response of SSRIs? A) Exercise B) Acupuncture C) Cognitive Behavioral Therapy D) Electroconvulsive Therapy (ECT)
B) Acupuncture Rationale: Clinical trials indicate that acupuncture, when used with SSRI antidepressants, enhances the therapeutic response, has an early onset of action, and is well tolerated compared to the use of SSRIs alone. Exercise has not shown in clinical trials to improve depression on its own. Therapy and ECT have not shown to improve SSRI medications.
A patient with a history of Alzheimer Disease (AD) is admitted for GI bleeding. Which medication in the patient's profile would the nurse expect the healthcare provider to discontinue? A) Antipsychotic B) Antidepressant C) Acetylcholinesterase inhibitor D) NMDA receptor antagonist
C) Acetylcholinesterase Inhibitor Rationale: The acetylcholinesterase inhibitors have a major adverse effect of gastrointestinal bleeding. Therefore, the nurse would expect the healthcare provider to discontinue the medication. The antipsychotic, antidepressant, and the NMDA receptor antagonist do not have this side effect.
A nurse provides instructions to a client taking fluoxetine (Prozac) an SSRI antidepressant. The nurse tells the client to take the medication: A) Early in the morning B) During lunch C) At snack time D) At bedtime
A) Early in the morning Rationale: Fluoxetine is used to treat major depressive disorder, bulimia nervosa obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). It is taken early in the morning to prevent interference with sleep.
An older client is beginning lithium therapy for newly diagnosed bipolar disorder. For which medical condition should the nurse review the chart before administering the prescribed medication? A) Anemia B) Kidney insufficiency C) Infection D) Liver failure
B) Kidney insufficiency Rationale: The older adult with bipolar disorder is at risk of lithium toxicity in the setting of renal disease. The client with anemia, infection, or liver issues is not at increased risk for lithium toxicity.
The nurse is caring for a patient with bipolar disorder undergoing long-term lithium carbonate therapy. The nurse should assess the patient for which clinical manifestations related to lithium toxicity? A) Energetic behavior B) Elevated muscle function C) Hypertension D) Edema
D) Edema Rationale: Assess for and identify signs and symptoms of lithium toxicity, which include diarrhea, lethargy, slurred speech, muscle weakness, ataxia, seizures, edema, hypotension, and circulatory collapse. Hypertension, energetic behavior, and elevated muscle response are not signs of lithium poisoning.
A patient has been instructed to stop taking MAOIs 4 days ago. the patient is happy and states, "I'm happy as I can now eat whatever I want." Which response by the nurse is correct? A) "Even though you have stopped the medication, you still need to wait 10 days before the dietary restrictions are lifted." B) "The dietary changes that were made need to be a permanent dietary change because you still have a diagnosis of depression." C) "Even though you've stopped the mediation, you still need to wait 4 days before the dietary restrictions are lifted." D) "Even though you've stopped the mediation you still need to wait 6 days before the dietary restrictions are lifted."
A) "Even though you have stopped the medication, you still need to wait 10 days before the dietary restrictions are lifted." Rationale: Monoamine oxidase inhibitors (MAOIs) require at least a 14-day interval between the use of MAOIs and other drugs and food restrictions. As the patient last took the drug 4 days ago, they need to wait 10 more days. Dietary changes are not due to diagnosis, but the specific class of medication chosen.
A patient is being started on lithium for mood stabilization and the last dose was administered at 0800. The nurse notes a lithium level needs to be drawn. Which time on the same day should the level be drawn? A) 1600 B) 1300 C) 1000 D) 1100
A) 1600 Rationale: The level should be obtained at 1600, because lithium levels should be drawn at least 8 hours after the last dose was given. Serum lithium levels should be ordered every 1-3 days when therapy is initiated and periodically thereafter because of the narrow therapeutic window between toxicity and effectiveness. The other times during the day are too soon.
A patient who is newly diagnosed with delirium has been prescribed an SSRI. Which condition should the nurse suspect is related to the patient's delirium? A) A mood disorder B) A psychotic disorder C) A medication reaction D) A heart condition
A) A mood disorder Rationale: To minimize delirium related to depression, which is a mood disorder, SSRIs or other antidepressants are often prescribed. Antipsychotics are prescribed for delirium related to an underlying psychotic disorder. Delirium related to a medication reaction would be treated by discontinuation of all medications. Heart conditions are not treated with SSRIs.
A nurse at a psychiatrist's office is reviewing the medication prescribed to several new clients for mood disorders. Which order would the nurse question? A) A prescription for paroxetine for a 15-year-old boy with depression B) A prescription for fluoxetine for a 14-year-old girl with depression C) A prescription for sertraline for a 10-year-old boy with obsessive-compulsive disorder D) A prescription for sertraline for an 11-year-old girl with depression
A) A prescription for paroxetine for a 15-year-old boy with depression Rationale: The FDA does not recommend paroxetine to treat depression in children and adolescents because of an increased risk in suicidal thinking and behavior during initial treatment. All other prescriptions are appropriate for the age and disorder.
Which medication should the nurse expect to administer to the client with bipolar disorder for immediate treatment of the clinical manifestations of mania? A) An anti-psychotic mood stabilizer, olanzaprine B) An antidepressant medication, paroxetine C) Anti-manic medication, lithium carbonate D) Anticholinergic medication, diphenhydramine
A) An anti-psychotic mood stabilizer, olanzaprine Rationale: Nausea, vomiting, and diarrhea, not constipation, are symptoms of lithium toxicity. Lithium carbonate needs to be closely monitored in pregnant clients. Anticonvulsants used as mood stabilizers are often used in treating bipolar disorder along with lithium or antipsychotic medications. Lab work is needed to monitor the therapeutic level of this medication.
A client prescribed an antidepressant tells the nurse that the pill causes dizziness upon standing or changing position too quickly. this is a common side effect of which antidepressant medication? A) Atypical antidepressant B) MAOI C) SSRI D) Lithium
A) Atypical antidepressant (Wellbutrin, Trazadone) Rationale: One side effect of atypical antidepressants is orthostatic hypotension, so clients should be instructed to change positions slowly, especially when moving from a lying to a sitting position or a sitting to a standing position. Orthostatic hypotension is not a common side effect of MAOIs or SSRIs. Lithium is used to treat bipolar disorder, not depression.
A patient with AD was started on an NMDA receptor antagonist for the treatment of moderate AD. The patient returns 3 months later for a follow-up appointment. Which assessment finding indicates a need for immediate healthcare provider notification? A) BP 180/90 mmHg B) Bowel movements 3-4 days a week C) Stomach upset with medication D) Occasional fatigue
A) BP 180/90 mmHg Rationale: NMDA receptor antagonists can cause increased blood pressure. Therefore, the BP reading of 180/90 mmHg indicates a high reading and the healthcare provider should be notified immediately. Bowel movements three to four times a week may be normal for this patient. The nurse would need to gather more information first. If the patient has stomach upset with the medication, it can be taken with food. Occasional fatigue is normal and does not warrant immediate healthcare provider notification.
*Possible Exam Question* The nurse in a long-term care facility is providing care for a patient who is receiving an acetylcholinesterase inhibitor for Alzheimer Disease (AD) Which adverse reaction to the medication should the nurse report to the healthcare provider? A) Guaiac postive stool B) Decreased appetite C) Tachycardia D) Hypertension
A) Guaiac positive stool Acetylcholinesterase inhibitors are associated with gastrointestinal bleeding. Blood in the stool would require notification to the healthcare provider. Tachycardia is a sign of early compensation for a decrease in intravascular fluid and could result from gastrointestinal bleeding; however, bradycardia is an adverse effect of acetylcholinesterase inhibitors and should be reported. Hypotension also could indicate a loss of intravascular fluid. A decrease in appetite is a mild side effect of the medication and would likely not be reported unless it worsened.
A client with depression who has been taking amitriptyline for three months returns to the clinic for a follow-up. The nurse observes the client in which of the following symptoms? A) Suicidal thoughts B) Lack of energy C) Loss of interest in personal appearance D) Neglect of responsibilities
A) Suicidal thoughts Rationale: Clients may have thoughts about suicide when taking an antidepressant such as amitriptyline, especially clients younger than 24 years old. Options B, C, and D are signs of depressions but are most likely improved as the treatment goes on.
Which collaborative process of initial monitoring should the nurse implement for a client who has been prescribed lithium? A) Testing lithium serum levels every 1-3 days B) Testing sodium levels every 1-3 days C) Arranging for BUN and creatnine levels every 1-3 days D) Arranging for therapy sessions every 1-3 days
A) Testing lithium sodium levels every 1-3 days Rationale: The window between lithium toxicity and therapy is short, and close monitoring is required. Sodium, blood urea nitrogen (BUN), and creatinine would not be a priority for initial monitoring of lithium.
The nurse is caring for the client prescribed thorazine. Which assessment findings alert the nurse to the possibility that the client has developed tardive dyskinesia? SATA A) Wormlike motions of the tongue B) Lip smacking C) Unusual facial movements D) Muscle spasms of the neck E) Shuffling gait
A, B, C Rationale: Tardive dyskinesia is characterized by unusual tongue and face movements such as lip smacking and wormlike motions of the tongue. Severe muscle spasms of the back, neck, and tongue are known as acute dystonia, not tardive dyskinesia.
A client arrives in the emergency room with a tricyclic antidepressant overdose. Which of the following measures should the nurse expect to do? SATA A) Maintain patent airway B) Administer sodium bicarbonate C) Gastric lavage with activated charcoal D) Obtain an ECG E) Administer an antipyretic
A, B, C, D Rationale: One of the signs and symptoms of a tricyclic antidepressant overdose is hypothermia, so an administration of an antipyretic will not help in the treatment. Option A: Maintain a patent airway by providing measures such as oxygen. Option B: Sodium bicarbonate resolves metabolic acidosis and cardiovascular complications. Option C: Gastric lavage with activated charcoal is done for GI decontamination. Option D: An ECG is done to check for dysrhythmias.
A nurse is providing information about acetylcholinesterase inhibitors for the spouse of a client diagnosed with AD. Which item will the nurse include in the teaching session? SATA A) Observe the client for improvement in manifestations B) Notify the healthcare provider if manifestations worsen C) The medication must be administered 1 hr before meals D) Don't stop the medication without consulting the healthcare provider E) Cholinesterase inhibitors will stop the progression of Alzheimer Disease
A, B, D Rationale: Appropriate teaching points to include are to not stop the medication without consulting with the healthcare provider, to observe for improvement, and to notify the healthcare provider if conditions worsen. The medication does not need to be administered 1 hour before a meal. The nurse would not include the teaching point that the medication will stop the progression of AD.
The healthcare provider has prescribed lithium for a client diagnosed with bipolar disorder. Which information should the nurse include in the client teaching? SATA A) "Monitor for nausea and vomiting, as this could indicate lithium toxicity." B) "Monitor for constipation, as this could indicate lithium toxicity." C) "Lab work will be needed to monitor the therapeutic level of this medication." D) "This medication may be used with an anticonvulsant used as a mood stabilizer." E) "This medication needs to be closely monitored by a healthcare provider if you suspect that you may be pregnant."
A, C, D, E Rationale: Nausea, vomiting, and diarrhea, not constipation, are symptoms of lithium toxicity. Lithium carbonate needs to be closely monitored in pregnant clients. Anticonvulsants used as mood stabilizers are often used in treating bipolar disorder along with lithium or antipsychotic medications. Lab work is needed to monitor the therapeutic level of this medication.
The client states to the nurse, "I take citalopram (Celexa, an SSRI) 40 mg every day, and I have also been taking St. John's wort 750 mg daily for the past 2 weeks." Which manifestation should lead the nurse to suspect that the client is developing serotonin syndrome? SATA A) Headache B) Constipation C) Diaphoresis D) Confusion E) Ataxia
A, C, D, E Rationale: Serotonin syndrome can occur if a selective serotonin reuptake inhibitor is combined with a monoamine oxidase inhibitor, a tryptophan-serotonin precursor, or St. John's wort. Signs and symptoms of serotonin syndrome include restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps, and hyperreflexia. Constipation is not associated with serotonin syndrome.
A patient is beginning medication with SSRIs as treatment for depression. Which assessment is most important as the patient begins to recover? A) Assess baseline weight to monitor for weight gain due to medications B) Assess for suicidal ideation and behaviors C) Assess the patient for agitation D) Assess the patient for nausea and vomiting
B) Assess for suicidal ideation and behaviors Rationale: As a depressed patient begins treatment with SSRIs, the nurse needs to monitor for suicidal ideation and behaviors throughout treatment. As patients begin to recover, energy levels rise, which may increase suicide risk. Weight gain, nausea and vomiting, and agitation need to be monitored also, but safety of the patient takes priority.
A nurse is giving instructions to a client taking risperidone (Risperdal). The nurse advises the client to which of the following? A) Take it on an empty stomach B) Change position slowly C) Get a daily source of sunlight D) Discontinue medication once the symptoms go away
B) Change position slowly Rationale: Risperidone (Risperdal) can cause orthostatic hypotension so instruct the client to change positions slowly to avoid it.
A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed below. WHich medication would cause the nurse to express concern and therefore initiate further teaching? A) Acetaminophen (Tylenol) B) Diphenhydramine (Benadryl) C) Furosemide (Lasix) D) Isosorbide dinitrate (Isordil)
B) Diphenhydramine (Benadryl) Rationale: Over-the-counter medications used for allergies and cold symptoms are contraindicated because they will increase the sympathomimetic effects of MAOIs, possibly causing a hypertensive crisis. None of the remaining medications will increase the sympathomimetic response and, therefore, are not contraindicated.
A client in the manic phase of bipolar disorder is prescribed lithium and has a current lithium blood level of 0.4 mEq/L. Which clinical manifestation does the nurse anticipate when assessing this client? A) A decrease in manic behavior B) Hyperactivity and pressured speech C) A return to baseline behavior, calm and rational D) Signs and symptoms of depression
B) Hyperactivity and pressured speech Rationale: A therapeutic lithium level is 0.8-1.2 mEq/L. Because this client's level is low, behaviors will indicate mania, that is, hyperactivity and pressured speech, because the client is in a manic phase. The client will not display a decrease in manic behaviors or a return to baseline behavior. The low lithium levels will not prevent the client from cycling to a depressive phase, but currently the client is in a manic phase, not a depressive phase, so the client will not display signs and symptoms of depression.
The risk of experiencing serotonin symptom increases when SSRIs are given with MAOIs. Serotonin system is best characterized in which of the following? A) Hypotension and urinary retention B) Muscle rigidity and high fever C) A productive cough and vomiting D) Tea colored urine and constipation
B) Muscle rigidity and high fever Rationale: Serotonin syndrome symptoms include high body temperature, agitation, muscle rigidity, tremor, sweating, dilated pupils, and diarrhea.
The healthcare provider has determined that a patient's delirium is being caused by severe depression. The patients s family asks the nurse, "Is there a medication that can help our parent?" A) Antipsychotics B) SSRIs C) Beta blockers D) Proton PUmp Inhibitors
B) SSRIs Rationale: To minimize delirium related to depression, healthcare officials often prescribe SSRIs or other antidepressants. Antipsychotics are prescribed for delirium related to other underlying psychotic disorders. Beta blockers are used to treat cardiac problems and hypertension. Proton pump inhibitors are used to decrease stomach acid in gastric reflux conditions. All medications are discontinued if the delirium is drug related.
*Possible Exam Question* The nurse is learning about classes of medications. Which classification is prescribed for mood disorders? SATA A) Benzodiazepines B) MAOIs C) Tricyclic antidepressants D) Carbonic anhydrase inhibitors E) SSRIs
B, C, E MAOIs, Tricyclic's, SSRIs Rationale: Medication classifications prescribed for mood disorders include tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors. Benzodiazepines are used for a variety of anxiety disorders. Carbonic anhydrase inhibitors are diuretics used to treat glaucoma.
The nurse is about to administer a mood stabilizer, antipsychotic, and antidepressant to a patient with schizophrenia. Which action should the nurse takin in administering the medications? A) Notify the healthcare provider immediately because this combination of meds shouldn't be given at the same time B) Administer the antipsychotic before administering the antidepressant and mood stabilizer C) Administer the medications because schizophrenia is usually treated with multiple medications and non-pharmacologic therapies D) Realize that the patient may refuse all medications based on paranoid delusions and lack of understanding of their purpose
C) Administer the medications because schizophrenia is usually treated with multiple medications and non-pharmacologic therapies Rationale: Patients with schizophrenia are often placed on a treatment plan that includes multiple medications and nonpharmacologic treatment plans. Schizophrenia treatment is very complex, with other mental health comorbidities being treated as well, and the nurse should anticipate administering numerous types of medications. The combination of medications may be questioned if there is any concern about the patient receiving medications. The order of medications delivered is not usually a concern with schizophrenic patients. A patient with schizophrenia may develop delusions or paranoia related to their medications, but this should not be the primary consideration, unless the nurse directly experiences this.
A client has been diagnosed with depression after loss of a spouse. The client has begun treatment with SSRIs and has started to feel better. Which is a priority nursing action while caring for the client? A)Assess for side effects of medications B) Assess for response to treatment C) Assess for risk of suicide D) Assess for client's feelings about the treatment plan
C) Assess for risk of suicide Rationale: The risk of suicide increases with initiation of SSRI therapy as clients in the severest stage of depression begin to improve. They have sufficient energy and cognitive ability to plan and successfully implement a suicide plan. While all assessments are appropriate for the client, suicide risk is a priority.
A nurse is giving discharge instructions to a client who is prescribed an MAOI. The nurse will tell the client to anticipate which of the following side effects of this med? A) Weight loss B) Dry skin C) Dizziness D) Fever
C) Dizziness Rationale: Dizziness, drowsiness, tiredness, weakness, problems sleeping, constipation, and dry mouth may occur while taking an MAOI. Options A, B, and D are not side effects related to the medication.
Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should: A) Assess the skin color and sclera B) Asses the radial pulse C) Take the client's BP D) Ask the client to void
C) Take the client's BP Rationale: Because chlorpromazine (Thorazine) can cause a significant hypotensive effect (and possible client injury), the nurse must assess the client's blood pressure (lying, sitting, and standing) before administering this drug. If the client had taken the drug previously, the nurse would also need to assess the skin color and sclera for signs of jaundice, a possible drug side affect; however, based on the information given here, there is no evidence that the client has received chlorpromazine before. Although the drug can cause urine retention, asking the client to avoid will not alter this anticholinergic effect.
The nurse is discussing the care of a client with Alzheimer disease (AD) with the family. The family reports the client has frequent mood swings and becomes combative. Which intervention should the nurse expect the healthcare provider to prescribe? A) Implement behavioral interventions B) Utilize physical and chemical restraints C) Increase acetylcholinesterase inhibitor use D) Administer SSRI antidepressants
D) Administer SSRI antidepressants Rationale: Clients with AD will experience frequent mood swings and may become combative. Research shows success in decreasing mood swings with the use of SSRI antidepressants. Increasing the acetylcholinesterase inhibitor dose will not change the client's mood. Behavioral interventions may be effective, but do not last long. Physical and chemical restraints should be a last resort.
Which of the following medications to treat Alzheimer's disease causes bradycardia and syncope? A) Tacrine (Cognex) B) Galantamine (Razadyne) C) Donepezil (Aricept) D) All of the above
D) All of the above Rationale: Tacrine (Cognex), Galantamine (Razadyne), and Donepezil (Aricept) are anti-Alzheimer drugs known to provoke slower heart rates and fainting episodes.
A patient diagnosed with bipolar disorder is on a low-salt diet. Which medication is best avoided by this patient? A) SSRI (paroxetine) B) Anti-seizure agent (carbamazepine) C) Atypical antipsychotic (olanzapine) D) Antimanic agent (lithium)
D) Anti-manic agent (lithium) Rationale: Lithium is a salt and should not be given to a patient on a low-sodium diet. It can worsen the patient's underlying medical condition. Paroxetine is a selective serotonin reuptake inhibitor (SSRI) often used to treat postpartum depression, olanzapine is an atypical antipsychotic that is approved for bipolar mania, and carbamazepine is an antiseizure medication. Carbamazepine is contraindicated in pregnancy, but none of the three are known to be contraindicated in patients with low-sodium diets.
Which of the following symptoms is classified as a mild lithium toxicity? A) Confusion and ataxia B) Muscle fasciculations and oliguria C) Tinnitus and blurred vision D) Apathy and lethargy
D) Apathy and lethargy Rationale: Mild toxicity has a lithium serum level of 1.5 mEq/L. Symptoms include apathy, lethargy, coarse hand tremors and slight muscle weakness. Options A and C are classified under moderate lithium toxicity. Option B is classified under severe lithium toxicity.
A client is prescribed with sertraline (Zoloft). To guarantee a safe administration of the medication, a nurse would administer the dose: A) As needed only for depression B) Early in the morning C) On an empty stomach D) At bedtime
D) At bedtime Rationale: Sertraline (Zoloft) is an antidepressant. It may be administered in the morning or evening, but giving it in the evening is more favored since drowsiness is one of the side effects.
Which instruction should the nurse provide to the patient who has been prescribed lithium for bipolar disorder? A) "It takes 8 weeks for lithium to be effective." B) "Lithium is effective immediately." C) "The effects of lithium starts after the fourth week." D) "Lithium takes 1-3 weeks for it to be effective."
D) Lithium takes 1-3 weeks for it to be effective."
A client with bipolar disorder has only been prescribed an antidepressive medication. Which risk factor should the nurse consider to be the highest? A) Increased anxiety B) Compulsive behaviors C) No change D) Manic episode
D) Manic episode Rationale: A client with bipolar disorder (BPD) who is prescribed antidepressive medication has a high risk of having a manic episode in response to the antidepressant; to avoid this possibility, most clients with BPD who need an antidepressant will also take mood stabilizers. Compulsive behaviors and increased anxiety are not directly related to antidepressive medications.
The nurse is discussing complementary health approaches with a patient for treatment. The patient has chosen acupuncture. Which class of medications would be recommended to also be part of the treatment plan? A) Atypical antidepressants (Including SNRIs) B) Tryicyclic antidepressants C) MAOIs D) SSRIs
D) SSRIs Rationale: Clinical trials indicate that acupuncture, when used with SSRI antidepressants, enhances the therapeutic response, has an early onset of action, and is well tolerated compared to the use of SSRIs alone. The other classes of antidepressants have not been shown to work with acupuncture.
A newly admitted client has started taking buproprion (Wellbutrin). The nurse monitors for which of the following side effects that could indicate an overdose of the medication? A) Headache B) Dizziness C) Constipation D) Seizures
D) Seizures Rationale: Wellbutrin (bupropion) is an antidepressant medication used to treat major depressive disorder and seasonal affective disorder. Overdose symptoms may include seizure, muscle stiffness, hallucinations, fast or uneven heartbeat, shallow breathing, or fainting. Options A, B, and C are the common side effects of the medication
A client with depression is taking an MAOI. The nurse advises the client to avoid consuming which foods while taking the medication? A) Crackers B) Vegetable salad C) Oatmeal D) Yogurt
D) Yogurt Rationale: The client should avoid eating tyramine-rich foods such as chocolate, alcoholic beverages, aged cheese, yogurt, processed meats, and fruits such as raisins, avocados, bananas, or figs.
