Psych Pharmacology Questions

Which of the following clients would have to be monitored closely when prescribed triazolam (Halcion) 0.125 mg qhs? Select all that apply. 1. An 80 year-old man diagnosed with a depressive disorder. 2. A 45 year-old woman diagnosed with alcohol use disorder. 3. A 25 year-old woman admitted to the hospital after a suicide attempt. 4. A 60 year-old man admitted after a panic attack. 5. A 50 year-old man who has a diagnosis of Parkinson's disease.

1. An 80 year-old is at risk for injury, and giving this client a central nervous system (CNS) depressant can increase the risk for falls. This client needs to be monitored closely. 2. Benzodiazepines such as triazolam can be addictive. Individuals diagnosed with alcohol use disorder may have increased risk of abusing a benzodiazepine and would need to be monitored closely. Alcohol is a central nervous system (CNS) depressant and if taken with a benzodiazepine, the client could experience an additive CNS depressant effect. 3. CNS depressants such as triazolam increase depressive symptoms. It would be important that the nurse monitor this client closely for suicidal ideations. 5. A client who is diagnosed with Parkinson's disease is at increased risk for injury because of altered gait and poor balance and giving this client a CNS depressant can increase the risk for falls. This client needs to be monitored closely.

In which situation would the nurse expect an additive central nervous system depressant effect? 1. When the client is prescribed chloral hydrate (Noctec) and thioridazine (Mellaril). 2. When the client is prescribed temazepam (Restoril) and methylphenidate (Concerta). 3. When the client is prescribed zolpidem (Ambien) and buspirone (BuSpar). 4. When the client is prescribed zaleplon (Sonata) and verapamil (Calan).

1. Chloral hydrate is a sedative/hypnotic, and thioridazine is a phenothiazine. When they are given together, the nurse needs to watch for an additive CNS depressant effect.

A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications could be appropriately prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (Lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety.

A client prescribed lithium carbonate (Lithium) 300 mg qam and 600 mg qhs presents in the ED with impaired consciousness, nystagmus, arrhythmias, and a history of recent seizure. Which serum lithium level would the nurse expect to assess? 1. 3.7 mEq/L. 2. 3.0 mEq/L. 3. 2.5 mEq/L. 4. 1.9 mEq/L.

1. Clients with a serum lithium level greater than 3.5 mEq/L may show signs such as impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, or cardiovascular collapse

A client diagnosed with obsessive-compulsive personality disorder is admitted to a psychiatric unit in a highly agitated state. The physician prescribes a benzodiazepine. Which of the following medications should the nurse expect to administer? Select all that apply. 1. Clonazepam (Klonopin). 2. Lithium carbonate (Lithium). 3. Clozapine (Clozaril). 4. Olanzapine (Zyprexa). 5. Chlordiazepoxide (Librium).

1. Clonazepam (Klonopin) is a benzodiazepine medication 5. Chlordiazepoxide (Librium) is a benzodiazepine medication

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to: 1. Anxiety. 2. Depression. 3. Mania. 4. Catatonia.

1. Clonazepam (Klonopin) is a benzodiazepine that works quickly to relieve anxiety.

Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply. 1. Clonidine hydrochloride (Catapres). 2. Fluvoxamine maleate (Luvox). 3. Buspirone (BuSpar). 4. Alprazolam (Xanax). 5. Haloperidol (Haldol).

1. Clonidine hydrochloride (Catapres), an antihypertensive, is used in the treatment of panic disorders and generalized anxiety disorder. 2. Fluvoxamine maleate (Luvox), an antidepressant, is used in the treatment of obsessive-compulsive disorder. 3. Buspirone (BuSpar), an anxiolytic, is used in the treatment of panic disorders and generalized anxiety disorders. 4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxiety disorders.

Which symptoms would the nurse expect to assess in a client experiencing serotonin syndrome? 1. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis. 2. Hypomania, akathisia, cardiac arrhythmias, and panic attacks. 3. Dizziness, lethargy, headache, and nausea. 4. Orthostatic hypotension, urinary retention, constipation, and blurred vision.

1. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis all are symptoms of serotonin syndrome. Other symptoms include dilated pupils, loss of muscle coordination or twitching, diarrhea, headache, shivering and goose bumps. If this syndrome were suspected, the offending agent would be discontinued immediately

Which of the following medications may be administered before electroconvulsive therapy? Select all that apply. 1. Glycopyrrolate (Robinul). 2. Thiopental sodium (Pentothal). 3. Succinylcholine chloride (Anectine). 4. Lorazepam (Ativan). 5. Divalproex sodium (Depakote)

1. Glycopyrrolate (Robinul) is given to decrease secretions and counteract the effects of vagal stimulation induced by ECT. 2. Thiopental sodium (Pentothal) is a short acting anesthetic medication administered to produce loss of consciousness during ECT. 3. Succinylcholine chloride (Anectine) is a muscle relaxant administered to prevent severe muscle contractions during the seizure, reducing the risk for fractured or dislocated bones.

Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

1. Insomnia may be experienced if diazepam is abruptly stopped. 2. Tremor may be experienced if diazepam is abruptly stopped. 3. Delirium may be experienced if diazepam is abruptly stopped

A client is newly prescribed lithium carbonate (Lithium). Which teaching point by the nurse takes priority? 1. "Make sure your salt intake is consistent." 2. "Limit your fluid intake to 2000 mL/day." 3. "Monitor your caloric intake because of potential weight gain." 4. "Get yourself in a daily routine to assist in avoiding relapse."

1. Lithium is similar in chemical structure to sodium, behaving in the body in much the same manner and competing with sodium at various sites in the body. If sodium intake is reduced, or the body is depleted of its normal sodium, lithium is reabsorbed by the kidneys, and this increases the potential for toxicity

Which of the following medications would be given to a client, in an outpatient setting, diagnosed with schizophrenia experiencing nonadherence? Select all that apply. 1. Olanzapine IM (Zyprexa Relprevv). 2. Ziprasidone IM (Geodon IM). 3. Haloperidol Lactate (Haldol Lactate). 4. Aripiprazole IM (Abilify Maintena). 5. Paliperidone IM (Invega Trinza)

1. Olanzapine IM (Zyprexa Relprevv) is a long-acting antipsychotic injection that can be given every 4 weeks to assist with medication adherence for a client diagnosed with schizophrenia. 4. Aripiprazole IM (Abilify Maintena) is a long-acting antipsychotic injection given every 4 weeks in an outpatient setting to assist clients with medication adherence. 5. Paliperidone IM (Invega Trinza) is a long-acting antipsychotic injection given every 3 months in an outpatient setting to assist clients with medication adherence. Normally a client will be stabilized on paliperidone IM (Invega Sustenna) every 4 weeks for 6 months, 1 year before changing to the every 3-month Invega Trinza injection.

A client diagnosed with bipolar affective disorder is prescribed divalproex sodium (Depakote). Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply. 1. Platelet count. 2. Aspartate aminotransferase (AST). 3. Fasting blood sugar (FBS). 4. Alanine aminotransferase (ALT). 5. Serum divalproex sodium level.

1. Platelet counts need to be monitored before and during therapy with divalproex sodium because of the potential side effect of blood dyscrasias. 2. Aspartate aminotransferase (AST) is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium because of the potential side effect of liver toxicity 4. Alanine aminotransferase (ALT) is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium because of the potential side effect of liver toxicity. 5. Divalproex sodium levels need to be monitored to determine therapeutic levels and assess potential toxicity

A client asks the nurse about nonpharmacological treatments for depression. Which of the following information should the nurse include in client teaching? Select all that apply. 1. "Transcranial Magnetic Stimulation (TMS) is an FDA approved treatment for depression." 2. "Cognitive-behavioral therapy can help clients dealing with mild to moderate depression." 3. "Research has shown that light therapy can be used for the treatment of all types of depressive disorders." 4. "Vagus Nerve Stimulation has been shown to be effective for depressed clients who have poor response to medications." 5. "Electroconvulsive therapy affects brain chemistry and decreases depressive symptoms."

1. TMS is a procedure that does not require surgery or medications, is FDA approved, and has been shown to be safe and effective in the treatment of depression. 2. Cognitive-behavioral therapy (CBT) can help clients deal with symptoms associated with depression. 4. Vagus Nerve Stimulation (VNS) is a procedure where a surgically implanted pacemaker-like device sends electrical pulses to stimulate the vagal nerve. This treatment has been FDA approved for clients experiencing treatment resistant depression. 5. ECT is among the safest and most effective treatments available for depression. ECT causes a brief seizure in the brain and is one of the fastest ways to relieve symptoms in severely depressed or suicidal clients.

A client, admitted after experiencing suicidal ideations, is prescribed citalopram (Celexa). Four days later, the client has pressured speech and is noted wearing heavy makeup. What may be a potential reason for this client's behavior? 1. The client is in a manic episode caused by the citalopram (Celexa). 2. The client is showing improvement and is close to discharge. 3. The client is masking depression in an attempt to get out of the hospital. 4. The client has "cheeked" medications and taken them all in an attempt to overdose.

1. When an SSRI is prescribed for clients diagnosed with bipolar affective disorder, it can cause alterations in neurotransmitters and trigger a hypomanic or manic episode.

A client is prescribed olanzapine (Zyprexa Relprevv). Which of the following client statements indicate that teaching regarding this medication has been effective? Select all that apply. 1. "I must stay in the facility and be monitored for 3 hours after receiving the injection." 2. "I cannot drive for the remainder of the day." 3. "I must register paperwork with the drug company." 4. "I need to notify staff if I get overly tired or confused." 5. "After my first three injections, the risk of adverse reaction decreases.

1. The client stating that he or she needs to stay in the facility for 3 hours shows understanding of the need to be monitored during that time for any signs and symptoms of postinjection delirium/sedation syndrome. Highest risk occurs during the first hour after the injection but can occur 3 hours after. 2. The client stating that he or she will be unable to drive for the remainder of the day shows understanding of the need for the client to avoid activities that can cause danger to themselves or others if postinjection delirium/sedation syndrome occurs. 3. The client stating he or she needs to complete registration with the drug company shows understanding of the process to obtain Zyprexa Relprevv. Because of the risk of postinjection delirium/sedation syndrome, the facility, the nurse giving the injection, and the client must all be registered with Eli Lilly's Zyprexa Relprevv program. 4. The client stating he or she needs to notify staff immediately if sedation or confusion occur shows understanding of the recognition of early signs of postinjection delirium/sedation syndrome.

A client complains of poor sleep and loss of appetite. When prescribed trazodone (Desyrel) 50 mg qhs, the client states, "Why am I taking an antidepressant? I'm not depressed." Which nursing response is most appropriate? 1. "Sedation is a side effect of this low dose of trazodone. It will help you sleep." 2. "Trazodone is an appetite stimulant used to prevent weight loss." 3. "Trazodone is an antianxiety medication that decreases restlessness at bedtime." 4. "Trazodone is an antipsychotic medication used off label to treat insomnia."

1. Trazodone is an antidepressant and when prescribed at a low dose can be used to improve sleep.

Which of the following are examples of anticholinergic side effects from tricyclic antidepressants? Select all that apply. 1. Urinary hesitancy. 2. Constipation. 3. Blurred vision. 4. Sedation. 5. Weight gain.

1. Urinary hesitancy is an anticholinergic side effect of tricyclic antidepressant. 2. Constipation is an anticholinergic side effect of tricyclic antidepressant. 3. Blurred vision is an anticholinergic side effect of tricyclic antidepressant.

A client on an in-patient psychiatric unit is prescribed lamotrigine (Lamictal) 50 mg qd. After client teaching, which client statement reflects understanding of important information related to lamotrigine? 1. "I will call the doctor if I miss more than 5 days before restarting the medication." 2. "I will schedule an appointment for my blood to be drawn at the lab next week." 3. "I will call the doctor immediately if my temperature rises above 100°F." 4. "I will stop my medication if I start having muscle rigidity of my face or neck."

1. When lamotrigine is titrated incorrectly, the risk for Stevens-Johnson syndrome increases. Clients need to be taught the importance of taking the medication as prescribed and accurately reporting adherence.

An instructor is teaching students about psychiatric medications. Which of the following antipsychotic medications need to be given with food? Select all that apply. 1. Ziprasidone (Geodon). 2. Vilazodone (Viibryd). 3. Lurasidone (Latuda). 4. Aripiprazole (Abilify). 5. Asenapine (Saphris).

1. Ziprasidone (Geodon) is an antipsychotic medication that needs to be given with at least 350 calories to facilitate absorption. 3. Lurasidone (Latuda) is an antipsychotic medication that needs to be given with at least 350 calories to facilitate absorption.

A client has been prescribed ziprasidone (Geodon) 40 mg bid. Which of the following interventions are important related to this medication? Select all that apply. 1. Obtain a baseline EKG initially and periodically throughout treatment. 2. Teach the client to take the medication with meals. 3. Monitor the client's pulse because of the possibility of palpitations. 4. Institute seizure precautions and monitor closely. 5. Watch for signs and symptoms of a manic episode.

1. Ziprasidone has the potential, in rare cases, to elongate the QT interval; a baseline and periodic EKG would be necessary. 2. Ziprasidone needs to be taken with meals for it to be absorbed effectively. It is important for the nurse to teach the client the need to take ziprasidone with meals. 3. Palpitations can be a side effect of ziprasidone and would need to be monitored.

A client diagnosed with posttraumatic stress disorder is prescribed paroxetine (Paxil) 30 mg qhs. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.

1.5 tablets

A client thought to be cheeking medications is prescribed lithium syrup 900 mg bid. The syrup contains 300 mg of lithium per 5 mL. At 0800, how many milliliters would the nurse administer? _____ mL

15 mL

A client is prescribed risperidone (Risperdal) 4 mg bid. After the client is caught cheeking medications, liquid medication is prescribed. The label reads 0.5 mg/mL. How many milliliters would be administered daily? _____ mL.

16 mL

A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg prn q8h. The maximum daily dose of lorazepam should not exceed 4 mg qd. This client would be able to receive ______ prn doses as the maximum number of prn lorazepam doses.

2 prn doses

A client is prescribed estazolam (ProSom) 1 mg qhs. In which situation would the nurse clarify this order with the physician? 1. A client with a blood urea nitrogen (BUN) of 16 mg/dL and creatinine level of 1.0 mg/dL. 2. A client with an aspartate aminotransferase (AST) of 60 mcg/L and an alanine aminotransferase (ALT) of 70 U/L. 3. A client sleeping 2 to 3 hours per night. 4. A client rating anxiety level at night to be a 5 out of 10.

2. A nurse would be concerned if a client's aspartate aminotransferase (AST) is 60 mcg/L (normal range 16 to 40 mcg/L) and alanine aminotransferase (ALT) is 70 U/L (normal range 8 to 54 U/L). A client needs to have normal liver function to metabolize estazolam properly, and the nurse would need to check with the physician to clarify the safety of this order

A client is newly prescribed hydroxyzine (Atarax) 50 mg qhs and clozapine (Clozaril) 25 mg bid. Which is an appropriate nursing diagnosis for this client? 1. Risk for injury R/T serotonin syndrome. 2. Risk for injury R/T possible seizure. 3. Risk for injury R/T clozapine toxicity. 4. Risk for injury R/T depressed mood.

2. A side effect of clozapine is that it lowers the seizure threshold. The nurse would need to place the client taking clozapine on seizure precautions.

A client is diagnosed with intermittent explosive disorder. The clinic nurse should anticipate potentially teaching about which of the following medications? Select all that apply. 1. Sertraline (Zoloft). 2. Paliperidone (Invega). 3. Buspirone (BuSpar). 4. Phenelzine (Nardil). 5. Valproate sodium (Depakote).

2. An antipsychotic medication like paliperidone (Invega) can be prescribed for intermittent explosive disorder 5. A mood stabilizing medication like valproate sodium (Depakote) can be prescribed for intermittent explosive disorder.

A client diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize? 1. Remind the client that the medication takes 6 to 8 weeks to take full effect. 2. Instruct the client and family about the many food-drug and drug-drug interactions. 3. Teach the client about the possible sexual side effects and insomnia that can occur. 4. Educate the client about taking the medication prescribed even after symptoms improve.

2. Because there are numerous drug-food and drug-drug interactions that may precipitate a hypertensive crisis during treatment with MAOIs, it is critical that the nurse prioritize this teaching.

In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol induced withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol induced withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol use disorder, and bipolar affective disorder: manic episode.

2. Benzodiazepines are prescribed for short-term treatment of generalized anxiety disorder and alcohol induced withdrawal and can be prescribed during preoperative sedation

A client has been taking bupropion (Wellbutrin) for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the ED. For which reason would the nurse question the continued use of this medication? 1. The client may have a possible injury to the gastrointestinal system. 2. The client is at risk for seizures from a potential closed head injury. 3. The client is at increased risk of bleeding while taking bupropion. 4. The client may experience sedation from bupropion, making assessment difficult.

2. Bupropion lowers the seizure threshold. Bupropion is contraindicated for clients who have increased potential for seizures, such as a client with a closed head trauma injury.

A client diagnosed with major depressive disorder is prescribed vortioxetine (Trintellix). Which of the following teaching points would the nurse review with the client? Select all that apply. 1. Ask the client about suicidal ideations related to depressed mood. 2. Discuss the need to take medications, even when symptoms improve. 3. Instruct the client about the risks of abruptly stopping the medication. 4. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects. 5. Remind the client that the medication's full effect may not occur for 6 to 8 weeks.

2. Discussing the need for medication adherence, even when symptoms improve, is a teaching point that the nurse would need to review with a client who is prescribed vortioxetine. 3. Instructing the client about the risk for discontinuation syndrome is a teaching point that the nurse would need to review with a client prescribed vortioxetine. 4. Alerting the client to the risks of dry mouth, sedation, nausea, and sexual side effects is a teaching point that the nurse would need to review with a client prescribed vortioxetine. 5. Reminding the client that vortioxetine's full effect may not occur for 6 to 8 weeks is a teaching point that the nurse would need to review with a client prescribed vortioxetine.

Which of the following situations would place a client at high risk for a life-threatening hypertensive crisis? Select all that apply. 1. A client is prescribed tranylcypromine (Parnate) and eats chicken salad. 2. A client is prescribed isocarboxazid (Marplan) and drinks hot chocolate. 3. A client is prescribed venlafaxine (Effexor) and drinks wine. 4. A client is prescribed phenelzine (Nardil) and eats fresh roasted chicken. 5. A client is prescribed rasagiline (Azilect) and eats smoked pork.

2. Isocarboxazid (Marplan) is an MAOI, and the intake of chocolate would likely cause a life-threatening hypertensive crisis. 5. Rasagiline (Azilect) is an MAOI. Eating smoked pork while taking rasagiline would likely cause a life threatening hypertensive crisis

A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, tremor, and diarrhea. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movement

2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, tremor, and diarrhea

Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continuously as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine the need for additional buspirone (BuSpar) prn. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam (Klonopin), prescribed because of its quick onset of effect, until the buspirone begins working.

Which of the following medications must be taken with food? Select all that apply. 1. Levomilnacipran (Fetzima) 2. Lurasidone (Latuda) 3. Vilazodone (Viibryd) 4. Vortioxetine (Trintellix) 5. Risperidone (Risperdal)

2. Lurasidone (Latuda) is an atypical antipsychotic medication used in the treatment of psychosis and mood instability. Lurasidone must be taken with at least 350 calories in order to be effectively absorbed. 3. Vilazodone (Viibryd) is a selective serotonin reuptake inhibitor used in the treatment of depression and anxiety. Vilazodone must be taken with at least 350 calories in order to be effectively absorbed.

Which of the following oral antipsychotic medications could be administered on an inpatient psychiatric unit to prevent a client from cheeking, or hiding medication in the mouth? Select all that apply. 1. Mirtazapine (Remeron SolTab). 2. Olanzapine (Zyprexa Zydis). 3. Paliperidone (Invega Sustenna). 4. Aripiprazole (Abilify Discmelt). 5. Asenapine (Saphris).

2. Olanzapine (Zyprexa Zydis) is an atypical antipsychotic medication that will dissolve rapidly in saliva and would ensure medication adherence for those suspected of cheeking medications 4. Aripiprazole (Abilify Discmelt) is an atypical antipsychotic medication that will dissolve rapidly in saliva and would ensure medication adherence for those suspected of cheeking medications. 5. Asenapine (Saphris) is an atypical antipsychotic medication that will dissolve rapidly in saliva when administered sublingually and would ensure medication adherence for those suspected of cheeking medications

A client prescribed quetiapine (Seroquel) 50 mg bid has a nursing diagnosis of risk for injury R/T sedation. Which nursing intervention appropriately addresses this client's problem? 1. Assess for homicidal and suicidal ideations. 2. Remove clutter from the environment to prevent injury. 3. Monitor orthostatic changes in pulse or blood pressure. 4. Evaluate for auditory and visual hallucinations

2. Removing clutter from the client's environment would assist the client in avoiding injury due to tripping and falling. It is important for the nurse to ensure the environment is clutter-free, especially when the client may be experiencing sedation.

A client recently prescribed venlafaxine (Effexor) 37.5 mg bid complains of dry mouth, orthostatic hypotension, and blurred vision. Which nursing intervention is appropriate? 1. Hold the next dose and document symptoms immediately. 2. Reassure the client that side effects are transient and teach ways to deal with them. 3. Call the physician to receive an order for benztropine (Cogentin). 4. Notify dietary about food restrictions related to monoamine oxidase inhibitors.

2. The nurse needs to teach the client about acceptable side effects and what the client can do to deal with them. The nurse can suggest that the client use ice chips, sip small amounts of water, or chew sugar free gum or candy to moisten the dry mouth. For orthostatic hypotension, the nurse may encourage the client to change positions slowly. For blurred vision, the nurse may encourage the use of moisturizing eyedrops

A client is prescribed clozapine (Clozaril) 12.5 mg qam and 50 mg qhs. Clozapine is available in 25-mg tablets. How many tablets would be administered daily? _____ tablets.

2.5 tablets

A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect to assess which serum lithium level? 1. 0.6 mEq/L. 2. 1.5 mEq/L. 3. 2.6 mEq/L. 4. 3.5 mEq/L.

3. A client with a serum lithium level of 2.6 mEq/L may experience an excessive output of dilute urine, tremors, muscular irritability, psychomotor retardation, and mental confusion. The client's symptoms described in the question support a serum lithium level of 2.6 mEq/L.

A client diagnosed with schizophrenia takes clozapine (Clozaril) 200 mg qd. Lab results reveal RBC 4.7 million/mcL, ANC 800/mcL, and TSH 1.3 mIU/L. Which of the following would the nurse expect the physician to order? 1. "Levothyroxine sodium (Synthroid) 150 mcg qd." 2. "Ferrous sulfate (Feosol) 100 mg tid." 3. "Discontinue clozapine." 4. "Discontinue clozapine and start levothyroxine sodium 150 mcg qd."

3. A normal adult value of absolute neutrophil count (ANC) is >1500/mcL. This client's ANC is 800/mcL, indicating moderate neutropenia, which is a potentially fatal blood disorder. There is a significant risk for neutropenia with clozapine (Clozaril) therapy. The nurse would expect the physician to discontinue clozapine.

The nurse is discussing the side effects experienced by a female client taking antipsychotic medications. The client states, "I haven't had a period in 4 months." Which client teaching should the nurse include in the plan of care? 1. Antipsychotic medications can cause a decreased libido. 2. Antipsychotic medications can interfere with the effectiveness of birth control. 3. Antipsychotic medications can cause amenorrhea, but ovulation still occurs. 4. Antipsychotic medications can decrease red blood cells, leading to amenorrhea.

3. Antipsychotic medications can cause amenorrhea, but ovulation still occurs. If this client does not understand this, there is a potential for pregnancy. This is vital client teaching information that must be included in the plan of care.

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam is to be used for long-term therapy in conjunction with buspirone. 2. The client verbalizes that buspirone can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam is to be used short term until the buspirone takes full effect. 4. The client verbalizes that tolerance could result with the long-term use of buspirone.

3. Clonazepam would be used for short-term treatment while waiting for the buspirone to take effect, which can take 2 to 3 weeks

Lithium carbonate (Lithium) is to mania as clozapine (Clozaril) is to: 1. Anxiety. 2. Depression. 3. Psychosis. 4. Akathisia.

3. Clozapine (Clozaril), an atypical antipsychotic, is used to treat symptoms of schizophrenia spectrum disorders, such as, but not limited to, psychoses.

Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder? 1. Lithium carbonate (Lithium), loxapine (Loxitane), and carbamazepine (Tegretol). 2. Gabapentin (Neurontin), thiothixene (Navane), and clonazepam (Klonopin). 3. Divalproex sodium (Depakote), asenapine (Saphris), and olanzapine (Zyprexa). 4. Lamotrigine (Lamictal), risperidone (Risperdal), and benztropine (Cogentin).

3. Divalproex sodium (Depakote), an anticonvulsant, is used in long-term treatment of BPAD. Asenapine (Saphris) and olanzapine (Zyprexa), antipsychotic medications, have been approved by the FDA for the treatment of bipolar disorder.

A client is prescribed aripiprazole (Abilify) 10 mg qam. The client complains of sedation and dizziness. Vital signs reveal B/P 100/60 mm Hg, pulse 80, respiration rate 20, and temperature 97.4°F. Which nursing diagnosis takes priority? 1. Risk for nonadherence R/T irritating side effects. 2. Knowledge deficit R/T new medication prescribed. 3. Risk for injury R/T orthostatic hypotension. 4. Activity intolerance R/T dizziness and drowsiness.

3. Haloperidol, an antipsychotic, would decrease an individual's grandiosity, which is one of many symptoms of a schizophrenia spectrum disorder

A woman is prescribed risperidone (Risperdal) 1 mg bid. At her 3-month follow-up, the client states, "I knew it was a possible side effect, but I can't believe I am not getting my period anymore." Which is a priority teaching need? 1. "Sometimes amenorrhea is a temporary side effect of medications and should resolve itself." 2. "I am sure this was very scary for you. How long has it been since your last menstrual cycle?" 3. "Although your menstrual cycles have stopped, there is still a potential for you to become pregnant." 4. "Maybe the amenorrhea is not due to your medication. Have your menstrual cycles been regular in the past?"

3. It is important for nurses to teach clients taking antipsychotic medications about the potential for amenorrhea and that, even though they are not regularly having their menstrual cycle, ovulation still may occur

A client recently prescribed fluphenazine (Prolixin) complains to the nurse of severe muscle spasms. On examination, heart rate is 110, blood pressure is 160/92 mm Hg, and temperature is 101.5°F. Which nursing intervention takes priority? 1. Check the chart for a prn order of benztropine mesylate (Cogentin) because of increased extrapyramidal symptoms. 2. Hold the next dose of fluphenazine and call the physician immediately to report the findings. 3. Schedule an examination with the client's physician to evaluate cardiovascular function. 4. Ask the client about any recreational drug use, and ask the physician to order a drug screen

3. Risk for injury R/T orthostatic hypotension, which is a side effect of the aripiprazole, is a priority diagnosis. It is important for nurses to recognize when a client is at increased risk for injury because of side effects such as orthostatic hypotension.

A client diagnosed with paranoid personality disorder is prescribed risperidone (Risperdal). The client is noted to have restlessness and weakness in the lower extremities and is drooling. Which nursing intervention would be most important? 1. Hold the next dose of risperidone and document the findings. 2. Monitor vital signs and encourage the client to rest in his or her room. 3. Give the ordered prn dose of trihexyphenidyl (Artane). 4. Get a fasting blood sugar measurement because of potential hyperglycemia.

3. The symptoms noted are EPS caused by antipsychotic medications. These can be corrected by using anticholinergic medications, such as trihexyphenidyl (Artane), benztropine (Cogentin), or diphenhydramine (Benadryl).

A client diagnosed with dependent personality disorder has a nursing diagnosis of altered sleep pattern R/T impending divorce. The client is prescribed oxazepam (Serax) prn. Which is an appropriate correctly written outcome for this nursing diagnosis? 1. The client verbalizes a decrease in tension and racing thoughts. 2. The client expresses understanding about the medication side effects by day 2. 3. The client sleeps 4 to 6 hours a night by day 3. 4. The client notifies the nurse when the medication is needed.

3. This outcome relates directly to the stated nursing diagnosis (altered sleep pattern), is measurable (sleeps 4 to 6 hours a night), and has a time frame (by day 3).

A client diagnosed with bipolar affective disorder is prescribed carbamazepine (Tegretol). The client exhibits nausea, vomiting, and anorexia. Which is an appropriate nursing intervention at this time? 1. Stop the medication and notify the physician. 2. Hold the next dose until symptoms subside. 3. Administer the next dose with food. 4. Ask the physician for a stat carbamazepine level.

3. When clients prescribed carbamazepine experience nausea, vomiting, and anorexia, it is important for the nurse to administer the medication with food to decrease these uncomfortable, but acceptable, side effects. If these side effects do not abate, other interventions may be necessary

A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h prn for agitation. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ prn doses of alprazolam within a 24-hour period

4 prn doses

A client diagnosed with major depressive disorder and experiencing suicidal ideation is showing signs of anxiety. Alprazolam (Xanax) is prescribed. Which assessment should be prioritized? 1. Monitor for signs and symptoms of physical and psychological withdrawal. 2. Teach the client about side effects of the medication and how to handle these side effects. 3. Assess for nausea and give the medication with food if nausea occurs. 4. Ask the client to rate his or her mood on a mood scale and monitor for suicidal ideations.

4. Alprazolam is a central nervous system depressant, and it is important for the nurse in this situation to monitor for worsening depressive symptoms and possible worsening of suicidal ideations

A client has a history of schizophrenia, controlled by haloperidol (Haldol). During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect the physician to prescribe for this client? 1. Haloperidol (Haldol). 2. Fluphenazine decanoate (Prolixin Decanoate). 3. Clozapine (Clozaril). 4. Benztropine mesylate (Cogentin).

4. Benztropine mesylate (Cogentin) is an anticholinergic medication used for the treatment of extrapyramidal symptoms such as akathisia. The nurse would expect the physician to prescribe this drug for the client's symptoms of restlessness.

Which atypical antipsychotic medication has the highest potential for a client to experience serious side effects? 1. Haloperidol (Haldol). 2. Chlorpromazine (Thorazine). 3. Risperidone (Risperdal). 4. Clozapine (Clozaril).

4. Clozapine, an "atypical" antipsychotic, has side effects including sedation, weight gain, and hypersalivation. Because of these side effects and the life-threatening side effect of neutropenia, clozapine usually is used as a last resort after other failed medication trials. Diagnostic lab tests need to be performed weekly for 6 months, every other week for the next 6 months, and then monthly as long as the clozapine is prescribed.

The nurse documents that a client diagnosed with schizophrenia is experiencing anticholinergic side effects from long-term use of thioridazine (Mellaril). Which symptoms has the nurse noted? 1. Akinesia, dystonia, and pseudoparkinsonism. 2. Muscle rigidity, hyperpyrexia, and tachycardia. 3. Hyperglycemia and diabetes. 4. Dry mouth, constipation, and urinary retention.

4. Dry mouth, constipation, and urinary retention are anticholinergic side effects of antipsychotic medications such as thioridazine. Anticholinergic side effects are caused by agents that block parasympathetic nerve impulses. Thioridazine has a high incidence of anticholinergic side effects.

A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Vilazodone (Viibryd) is prescribed. Which nursing intervention takes priority? 1. Remind the client that medication effectiveness may take 2 to 3 weeks. 2. Teach the client to take the medication with food to avoid nausea. 3. Check the client's blood pressure every shift to monitor for hypertension. 4. Monitor closely for signs that the client might be "cheeking" medications.

4. If a client comes into the in-patient psychiatric unit with a plan to overdose, it is critical that the nurse monitor for checking and hoarding of medications. Clients may cheek and hoard medications to take, as an overdose, at another time.

Which of the following medications would be classified as tricyclic antidepressants? Select all that apply. 1. Bupropion (Wellbutrin). 2. Mirtazapine (Remeron). 3. Citalopram (Celexa). 4. Nortriptyline (Pamelor). 5. Doxepin (Sinequan).

4. Nortriptyline (Pamelor) is classified as a tricyclic antidepressant. Other tricyclic antidepressants include amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil). 5. Doxepin (Sinequan) is classified as a tricyclic antidepressant

A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms? 1 . Amitriptyline (Elavil) and divalproex sodium (Depakote). 2. Verapamil (Calan) and topiramate (Topamax). 3. Lithium carbonate (Eskalith) and clonazepam (Klonopin). 4. Risperidone (Risperdal) and lamotrigine (Lamictal).

4. Risperidone (Risperdal), an antipsychotic, directly addresses the auditory hallucinations experienced by the client. Lamotrigine (Lamictal), a mood stabilizer, would address the classic symptoms of bipolar I disorder.

A nurse is teaching a client about taking asenapine (Saphris) effectively. Which client statement indicates that learning has occurred? 1. "I must take the medicine with a meal to help with absorption." 2. "I must take the medicine in the morning to help with my depression." 3. "I must monitor for signs and symptoms of serotonin syndrome." 4. "I must place the medicine under my tongue."

4. The client prescribed asenapine would need to place the medication under the tongue to be absorbed through the mucus membrane. The nurse must teach the client to avoid eating or drinking for 10 minutes following administration.

A client has an order for "ziprasidone (Geodon) 20 mg IM q4h prn for agitation with a maximum daily dose of 40 mg/day." Administration times are documented in the medication record. Which times indicate safe medication administration? 1. "0800 and 1100". 2. "1200, 1700, and 2100". 3. "0900, 1200, and 2100". 4. "1300 and 1700".

4. The medication administration record documenting that ziprasidone was administered at 1300 and 1700 is 4 hours apart (q4h) and equals the maximum daily dose of 40 mg/day. This would be appropriate documentation of the order "ziprasidone (Geodon) 20 mg IM q4h for agitation with a maximum daily dose of 40 mg/day."

The nurse is evaluating lab test results for a client prescribed lithium carbonate (Lithium). The client's lithium level is 1.9 mEq/L. Which nursing intervention takes priority? 1. Give next dose because the lithium level is normal for acute mania. 2. Hold the next dose and continue the medication as prescribed the following day. 3. Give the next dose after assessing for signs and symptoms of lithium toxicity. 4. Immediately notify the physician and hold the dose until instructed further.

4. The nurse needs to notify the physician immediately of the serum lithium level, which is outside the therapeutic range, to avoid any risk for further toxicity.

For the past year, a client has received haloperidol (Haldol). The nurse administering the client's next dose notes a twitch on the right side of the client's face and tongue movements. Which nursing intervention takes priority? 1. Give haloperidol and benztropine (Cogentin) 1 mg IM prn per order. 2. Assess for other signs of hyperglycemia resulting from the use of the haloperidol. 3. Check the client's temperature and assess mental status. 4. Hold the haloperidol and call the physician.

4. The symptoms noted in the question reflect tardive dyskinesia, a potentially irreversible side effect of antipsychotic medications, and the nurse must hold the medications to avoid permanent damage and call the physician

A client is prescribed venlafaxine (Effexor) 75 mg qam and 150 mg qhs. Venlafaxine is supplied in a 37.5-mg tablet. How many tablets would the nurse administer a day? _____ tablets.

6 tablets in 1 day.