PSYCHOPHARM (for Bipolar, Schizophrenia, Anxiety, & Depression)
An individual with poststroke depression is receiving an SSRI. What is the rationale for giving the medication at breakfast and again at midday? a. Prevent insomnia b. Prevent toxic reactions c. Decrease afternoon sleepiness d. Give an opportunity to monitor behavior closely
a. Prevent insomnia CNS stimulants may cause insomnia if given late in the day. Toxicity is a result of excessive medication in the system, not when it is administered. The drowsiness resulting from SSRI use would not be minimized if taken as described. There is no expectation that resulting behaviors will need to be so closely monitored.
When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, I stopped taking those pills. They made me feel like a robot. What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose
a. Sedation and muscle stiffness Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a robot. The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient.
A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders? A. Sertraline (Zoloft) B. Valproic acid (Depakote) C. Trazodone (Desyrel) D. Paroxetine (Paxil)
b. Valproic acid (Depakote) Although lithium is a prototype drug in the treatment of bipolar disorders, anticonvulsants such as valproic acid also have demonstrated efficacy for mood stabilization.
The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a: a. 30 mm Hg decrease in blood pressure reading b. Respiratory rate of 24 respirations per minute c. Temperature reading of 104 F d. Pulse rate of 70 beats per minute
c. Temperature reading of 104 F Increased temperature is the cardinal sign of NMS. This BP is not a significant feature of NMS. There are no significant findings to support the options related to respirations or pulse rate.
When following up on SSRI medication side effects, the nurse will need to make specific inquiries about: a. Anticholinergic symptoms b. Alpha-adrenergic blockade c. GI tract symptoms d. Sexual dysfunction
d. Sexual dysfunction SSRIs often cause sexual dysfunction, a symptom patients may be reluctant to bring up voluntarily. Patients readily bring up the side effects mentioned in the other options.
A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? a. dry mouth b. blurred vision c. nasal congestion d. urinary retention
d. urinary retention All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues.
A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)
D. Fluoxetine (Prozac) Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.
A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? A. Symptoms indicate consumption of foods high in tyramine. B. Symptoms indicate lithium carbonate discontinuation syndrome. C. Symptoms indicate the development of lithium carbonate tolerance. D. Symptoms indicate lithium carbonate toxicity.
D. Symptoms indicate lithium carbonate toxicity. The nurse should interpret that the clients symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly during maintenance therapy to ensure proper dosage.
During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. On the basis of this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.
A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The clients spouse questions the Zyprexa order. Which is the appropriate nursing reply? A. Zyprexa in combination with Eskalith cures manic symptoms. B. Zyprexa prevents extrapyramidal side effects. C. Zyprexa ensures a good nights sleep. D. Zyprexa calms hyperactivity until the Eskalith takes effect.
D. Zyprexa calms hyperactivity until the Eskalith takes effect. The nurse should explain to the clients spouse that Zyprexa can calm hyperactivity until the Eskalith takes effect. Eskalith may take 1 to 3 weeks to begin to decrease hyperactivity. Zyprexa is classified as an antipsychotic and can be used to immediately to reduce hyperactive symptoms in acute manic episodes.
A patient admitted to the hospital with PTSD is ordered the following medications. Which of these medications has a direct use in treating symptoms that are common in PTSD? Select all that apply. A. Alprazolam B. Propanolol C. Colace D. Dulcolax
A, B Alprazolam is an antianxiety agent and anxiety symptoms are common in PTSD. Propanolol is an antihypertensive medication and evidence has demonstrated its effectiveness in treating symptoms of PTSD, including nightmares, intrusive recollections, and insomnia. The last two medications are used to treat constipation, and this symptom is not directly related to PTSD
Which of the following instructions regarding lithium therapy should be included in a nurses discharge teaching? Select all that apply. A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2,500 to 3,000 mL of fluid per day. D. Restrict sodium content. E. Restrict fluids to 1,500 mL per day.
A, B, C The nurse should instruct the client taking lithium to avoid excessive use of caffeine, maintain a consistent sodium intake, and consume at least 2,500 to 3,000 mL of fluid per day. The risk of developing lithium toxicity is high due to the narrow margin between therapeutic doses and toxic levels.
A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? Select all that apply. A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations
A, C, E (somatic delusions, gustatory hallucinations, clang associations) The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.
A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? A. I will need scheduled bloodwork in order to monitor for toxic levels of this drug. B. I wont stop taking this medication abruptly, because there could be serious complications. C. I will not drink alcohol while taking this medication. D. I wont take extra doses of this drug because I can become addicted.
A. I will need scheduled bloodwork in order to monitor for toxic levels of this drug. The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. No blood work is needed when taking a short-acting benzodiazepine. The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.
A client who has been diagnosed with bipolar I disorder states, God has taught me how to decode the Bible. A nurse should anticipate that which combination of medications would be ordered to address this clients symptoms? A. Lithium carbonate (Lithobid) and risperidone (Risperdal) B. Lithium carbonate (Lithobid) and carbamazepine (Tegretol) C. Valproic acid (Depakote) and sertraline (Zoloft) D. Valproic acid (Depakote) and lamotrigine (Lamictal)
A. Lithium carbonate (Lithobid) and risperidone (Risperdal) The patient who is experiencing psychosis (in this case, delusions of grandeur) may be benefited by the addition of an antipsychotic medication (risperidone) to the mood stabilizer (lithium). In addition, since lithium does not immediately reach therapeutic levels, the sedative properties of an antipsychotic may be useful in reducing agitation, hyperactivity, and/or insomnia.
A client who is admitted to the inpatient psychiatric unit and is taking Thorazine presents to the nurse with severe muscle rigidity, tachycardia, and a temperature of 105F (40.5C). The nurse identifies these symptoms as which of the following conditions? A. Neuroleptic malignant syndrome B. Tardive dyskinesia C. Acute dystonia D. Agranulocytosis
A. Neuroleptic malignant syndrome
A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention
A. Sore throat, fever, and malaise The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.
If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen
A. White blood cell count The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considered as a treatment option. Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur.
A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol dependence B. History of personality disorder C. History of schizophrenia D. History of hypertension
A. history of alcohol dependence The nurse should question a prescription of alprazolam (Xanax) for acute anxiety if the client has a history of alcohol dependence. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance abuse may be more likely to abuse other addictive substances and/or combine this drug with alcohol.
A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, I heard about something called a monoamine oxidase inhibitor (MAOI). Cant my doctor add that to my medications? Which is an appropriate nursing reply? A. This combination of drugs can lead to delirium tremens. B. A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis. C. Thats a good idea. There have been good results with the combination of these two drugs. D. The only disadvantage would be the exorbitant cost of the MAOI.
B. A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis. The nurse should explain to the client that combining an MAOI and Luvox can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread.
Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment? A. I will limit my intake of fluids daily. B. I will maintain normal salt intake. C. I will take Lithobid on an empty stomach. D. I will increase my caloric intake to prevent weight loss.
B. I will maintain normal salt intake. A client taking Lithobid should be taught not to skimp on dietary sodium intake. He or she should take Lithobid on a full stomach to avoid gastrointestinal upset and choose lower-calorie foods to prevent weight gain
After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of which client statement? A. I should expect to feel better in a couple of days. B. Ill call my doctor immediately if I experience any diarrhea or ringing in my ears. C. If I forget a dose, I can double the dose the next time I take this drug. D. I need to restrict my intake of any food containing salt.
B. Ill call my doctor immediately if I experience any diarrhea or ringing in my ears. The initial signs of lithium toxicity include ataxia, blurred vision, severe diarrhea, persistent nausea and vomiting, and tinnitus.
A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. I cannot drink any alcohol with this medication. B. It is going to take 2 to 3 weeks in order for me to begin to feel better. C. This drug causes physical dependence, and I need to strictly follow doctors orders. D. I cant take this medication with food. It needs to be taken on an empty stomach.
B. It is going to take 2 to 3 weeks in order for me to begin to feel better. BuSpar takes at least 2 to 3 weeks to be effective in controlling symptoms of anxiety. This is important to teach clients in order to prevent potential noncompliance due to the perception that the medication is ineffective.
A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300 mg daily, for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor reply is most accurate? A. High doses of tricyclic medications will be required for effective treatment of OCD. B. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. C. The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia. D. The dosage of Luvox is outside the therapeutic range and needs to be questioned.
B. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the U.S. Food and Drug Administration for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness.
A client is taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for drug overdose? A. When the client has a knowledge deficit related to the effects of the drug B. When the client combines the drug with alcohol C. When the client takes the drug on an empty stomach D. When the client fails to follow dietary restrictions
B. When the client combines the drug with alcohol Both Librium and alcohol are central nervous system depressants. In combination, these drugs have an additive effect and can suppress the respiratory system, leading to respiratory arrest and death.
Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? A. Long-term treatment with diazepam (Valium) B. Acute symptom control with citalopram (Celexa) C. Long-term treatment with buspirone (BuSpar) D. Acute symptom control with ziprasidone (Geodon)
C. Long-term treatment with buspirone (BuSpar) The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients with GAD. It takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.
A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom
C. Risperidone (Risperdal) to address the positive symptom The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).
A newly admitted client has taken thioridazine (Mellaril) for 2 years, with good symptom control. Symptoms exhibited on admission included paranoia and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.
C. The client has not taken the medication as prescribed. Altered thinking can affect a clients insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.
What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The clients understanding of the need for regular bloodwork B. The clients mood and affect score, according to the facilitys mood scale C. The clients cognitive ability to understand information about the medication D. The clients access to a support network willing to participate in treatment
C. The client's cognitive ability to understand information about the medication There are many dietary and medication restrictions when taking Nardil. A client must have the cognitive ability to understand information about the medication and which foods, beverages, and medications to eliminate when taking Nardil.
An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order? A. This dosage is within the recommended dosage range. B. This dosage is lower than the recommended dosage range. C. This dosage is more than twice the recommended dosage range. D. This dosage is four times higher than the recommended dosage range.
C. This dosage is more than twice the recommended dosage range. The recommended dose of lamotrigine for treatment of bipolar disorder in adult clients should not exceed 400 mg daily.
A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply? A. Thats strange. Weight loss is the typical pattern. B. What have you been eating? Weight gain is not usually associated with lithium. C. Weight gain is a common but troubling side effect. D. Weight gain occurs only during the first month of treatment with this drug.
C. Weight gain is a common but troubling side effect. The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication compliance and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication.
A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included? Select all that apply. a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach
a, c, d (caution in use of machinery, importance of caffeine restriction, avoidance of alcohol and other sedatives) Caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine - lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Benzodiazepines do not require a special diet. Food will reduce gastric irritation from the medication.
A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, I took a few extra tablets earlier today and now I feel bad. Which assessments are most critical? Select all that apply. a. Vital signs b. Urinary frequency c. Psychomotor retardation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness
a, d, e (vital signs, presence of abdominal pain & diarrhea, hyperactivity or feelings of restlessness) The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. The patient may have urinary retention, but frequency would not be expected.
A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patients head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. Acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d .Akathisia
a. Acute dystonic reaction Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia.
An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patients head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the PRN medication administration record.
a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record. Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine.
A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? A. Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder. B. Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder. C. Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks. D. Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks.
a. Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder. The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine that can be abused and lead to physical dependence and tolerance. It can be used on an as-needed basis to reduce anxiety and its related symptoms.
A patient with bipolar disorder reveals to the clinic nurse that she may be 4 weeks pregnant. Which action will the nurse take? a. Confer with the physician about ordering a pregnancy test and discontinuing lithium. b. Educate the patient to the risk to the fetus as a result of exposure to the lithium in her blood. c. Suggest to the physician that the lithium dose should be increased for better symptom control. d. Remind the patient that barrier birth control methods should be used to prevent pregnancy during lithium therapy.
a. Confer with the physician about ordering a pregnancy test and discontinuing lithium. The first need is to learn whether the patient is pregnant. Lithium ingestion by the mother can cause fetal damage. Lithium should be discontinued, not increased, if pregnancy is confirmed. It is premature to discuss fetal malformations before the pregnancy is confirmed. Options b and c are inappropriate and harmful. Birth control information has no value unless the pregnancy test is negative.
Sertraline (Zoloft) has been prescribed for a patient with symptoms of a major depression. Which factor was probably most important in the physicians decision to use an SSRI? a. Good side-effect profile b. Less expense for the patient c. Increase in medication compliance d. Rapid rate of absorption from the GI tract
a. Good side-effect profile Compared to other antidepressant medication groups, SSRIs have the best side-effect profile. SSRIs are more costly. No studies have shown that SSRIs result in better compliance. These drugs are absorbed slowly from the GI tract.
Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)? a. Grimacing and lip smacking b. Falling asleep in the chair and refusing to eat lunch c. Experiencing muscle rigidity and tremors d. Having excessive salivation and drooling
a. Grimacing and lip smacking TD manifests as abnormal movements of voluntary muscle groups after a prolonged period of dopamine blockade. Movements may affect any muscle group, but muscles of the face, mouth, tongue, and digits are commonly affected. Falling asleep is reflective of the sedative effect of these medications. Muscle rigidity and drooling reflect EPS caused from imbalance between dopamine and acetylcholine.
To educate a patient regarding what to expect following the administration of a benzodiazepine, the nurse must understand that benzodiazepines: a. Have a rapid onset of peak action b. Reduce availability of GABA c. Generally diminish the activity of GABA d. Interact with serotonin to increase availability
a. Have a rapid onset of peak action Benzodiazepines do have a more rapid onset. There is no effect on the availability or function of GABA. Benzodiazepines do not diminish GABA activity; they enhance it.
A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage? a. HydroDIURIL daily b. Navane bid c. Ativan at bedtime d. Cefobid daily
a. Hydrodiuril daily Diuretics alter fluid and electrolyte balance, increasing risk for lithium toxicity; therefore HydroDIURIL is correct. Antipsychotic medications are frequently prescribed concurrently with lithium to manage acute symptoms of mania, so no re-evaluation of lithium dose is necessary for Navane. Antianxiety drugs are not contraindicated with concurrent lithium use, so no lithium dose re-evaluation is necessary for Ativan. Antibiotics do not alter fluid and electrolyte balance, so readjustment of lithium dosage is not required for Cefobid.
Which statement by a patient with generalized anxiety disorder for whom lorazepam (Ativan) is prescribed as needed (prn) suggests the patient understands the purpose of the medication? a. I can talk with my therapist more easily after my medication takes effect. b. I wonder if I will have to take this medication for the rest of my entire life. c. Im embarrassed and dont want anyone to know Im on this kind of medication. d. Im going to ask for my prn dose so I can sleep instead of worrying about my kids.
a. I can talk with my therapist more easily after my medication takes effect. The patient recognizes the therapeutic effects of the medication in assisting her to work effectively with the therapist. The remaining options show questions and inappropriate use of the medication.
Which person with mania is the least likely candidate to receive lithium? The patient who is: a. Six weeks pregnant b. Recovering from a hysterectomy c. Taking hormone replacement therapy d. Displaying symptoms of postpartum depression
a. Six weeks pregnant Lithium is contraindicated during pregnancy because of teratogenic effects. The remaining options would not be contraindicative to lithium therapy.
The nurse must notify the physician of the need to suspend treatment for a patient receiving clozapine (Clozaril) when the weekly WBC monitoring shows: a. WBCs below 2000/mm3 and absolute neutrophils below 1000/mm3 b. WBCs below 2500/mm3 and absolute neutrophils below 1500/mm3 c. WBCs below 3000/mm3 and absolute neutrophils below 2000/mm3 d. WBCs below 3500/mm3 and absolute neutrophils below 2500/mm3
a. WBCs below 2000/mm3 and absolute neutrophils below 1000/mm3 Counts at this level indicate the presence of leukopenia. Agranulocytosis is a possible side effect of Clozaril therapy for which the patient is closely monitored. The other levels are high enough to be considered safe.
A patient with schizophrenia is seen in the ED in an acutely agitated state resulting from threatening auditory hallucinations. The patients medical record indicates he has had severe dystonic reactions to parenteral administration of typical antipsychotic medication. The nurse can anticipate that the physician will order: a. Ziprasidone (Geodon) b. Fluphenazine (Prolixin) decanoate c. Clozapine (Clozaril) d. Paroxetine (Paxil)
a. Ziprasidone (Geodon) This atypical antipsychotic comes in an injectable form and is effective in controlling agitated and assaultive behaviors. Fluphenazine (Prolixin) decanoate is a typical antipsychotic. Clozapine (Clozaril) is used only for refractory schizophrenia. Paroxetine (Paxil) is an SSRI.
A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola
a. pepperoni pizza and red wine The nurse should instruct the client to avoid pepperoni pizza and red wine. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread.
When reviewing the medications being taken by an elderly patient diagnosed with Alzheimers disease, the nurse should consult with the patients physician when noting a prescription for: a. Risperidone (Risperdal) b. Fluphenazine (Prolixin) c. Lorazepam (Ativan) d. Sertraline (Zoloft)
a. risperidone (Risperdal) Patients with dementia-related psychosis who were treated with atypical (second-generation) antipsychotics such as Risperdal were at an increased risk of death as compared with patient taking a placebo. The other medications are not currently known to have that risk.
The nurse receives a laboratory report indicating a patients serum level is 1 mEq/L. The patients last dose of lithium was 8 hours ago. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. invalid because of the time lapse since the last dose
a. within therapeutic limits Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.
A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level? A. 1.3 mEq/L B. 1.7 mEq/L C. 2.3 mEq/L D. 3.7 mEq/L
b. 1.7 mEq/L The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy. There is a narrow margin between the therapeutic and toxic levels. The symptoms presented in the question can be correlated with a lithium level of 1.7 mEq/L. Levels of 2.3 mEq/L and 3.7 mEq/L would produce more extreme symptoms of intensified toxicity, eventually leading to death.
A patient who began haloperidol (Haldol) therapy 24 hours ago tells the nurse that he feels jittery and unable to sit or stand still. The nurse can hypothesize that this report is related to: a. Dystonia b. Akathisia c. Serotonin syndrome d. Neuroleptic malignant syndrome
b. Akathisia Akathisia, an extrapyramidal side effect, is characterized by restlessness, inability to sit still, and the need to pace. It usually occurs early in the course of treatment with a typical antipsychotic drug. The symptomology is not related or seen in the other options.
A patients serum lithium level is reported as 1.9 mEq/L. The nurse should immediately: a. Restrict sodium and fluid intake. b. Assess for signs and symptoms of toxicity. c. Seek to have the patient transferred to ICU. d. Notify the patients physician immediately.
b. Assess for signs and symptoms of toxicity. A serum lithium level this high suggests that the patient may be experiencing symptoms of lithium toxicity. Clinical assessment is essential to determine what, if any, signs and symptoms are present. After the clinical assessment has been made, the nurse can provide the physician with a complete picture. Restricting sodium and fluids would raise the serum level. Transferring may not be necessary and would require a physicians order.
When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed oral haloperidol (Haldol), which intervention would promote medication compliance? a. Instructing the patient to have friends monitor his medications b. Beginning administration of haloperidol (Haldol) decanoate c. Writing instructions in detail for the patient to follow d. Changing haloperidol to an atypical antipsychotic
b. Beginning administration of haloperidol (Haldol) decanoate Haloperidol decanoate is a depot medication, given intramuscularly every 2 to 4 weeks. It is unknown whether the patient has a support system. The patient probably received education, including written instructions prior to discharge. Changing to another classification of medication would not necessarily improve compliance.
When asked how tricyclic antidepressants affect neurotransmitter activity, the nurse should respond that they: a. Decrease available dopamine. b. Increase availability of norepinephrine and serotonin. c. Make available increased amounts of monoamine oxidase. d. Increase the effects of the chemical gamma-aminobutyric acid.
b. Increase availability of norepinephrine and serotonin. Tricyclic antidepressants block neurotransmitter uptake, increasing the amounts of norepinephrine and serotonin available. Decreasing dopamine is the action of typical antipsychotic medication. Increasing monoamine oxidase is not the action of tricyclics. Benzodiazepines, not tricyclics, increase the effects of GABA.
A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve? a. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee b. Mashed potatoes, ground beef patty, corn, green beans, apple pie c. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
b. Mashed potatoes, ground beef patty, corn, green beans, apple pie The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine. Fresh ground beef and apple pie are safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages/hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate
A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol (Haldol) b. Olanzapine (Zyprexa) c. Chlorpromaine (Thorazine) d. Diphenhydramine (Benadryl)
b. Olanzapine (Zyprexa) Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine.
To evaluate outcomes for a patient with schizophrenia receiving typical antipsychotic drug therapy, the nurse would look for improvement in: a. Affective mobility b. Positive symptoms c. Self-care activities d. Cognitive functioning
b. Positive symptoms Typical antipsychotic medications produce improvement in the positive symptoms of schizophrenia such as hallucinations and delusions. Negative symptoms and cognitive functioning tend to show less improvement.
A patient prescribed alprazolam (Xanax) for symptoms of anxiety shares with the nurse that, Im concerned about getting off this medication. Upon which fact will the nurse base the response to the patients concern? a. Long elimination half-life will result in a manageable withdrawal treatment plan. b. Rapid absorption and distribution to brain cells make withdrawal more difficult to manage. c. Sensitivity of the mesencephalic reticular activating system makes addiction unlikely. d. The combination of medication with an antidepressant often positively impacts withdrawal.
b. Rapid absorption and distribution to brain cells make withdrawal more difficult to manage. In general, shorter-acting benzodiazepines are more difficult to taper and potentially cause more problems with withdrawal. The remaining options are neither true nor relevant.
A patient took trifluoperazine 30 mg po daily for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patients neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourettes syndrome d. Anticholinergic effects
b. Tardive dyskinesia Tardive dyskinesia is a neuroleptic-induced condition involving the face, trunk, and limbs. Involuntary movements, such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Agranulocytosis is a blood disorder. Tourettes syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.
What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy? a. Complying with this therapy will cure your depression. b. This medication is expected to improve brain chemical imbalance. c. Amitriptyline will help re-establish your ability to think clearly again. d. Elavil will be particularly effective at assisting you in regaining your independence.
b. This medication is expected to improve brain chemical imbalance. Antidepressant medication works by re-establishing the balance of neurotransmitters in the brain, particularly serotonin and norepinephrine. Antidepressants do not promise a cure for depression. Cognitive therapy, rather than antidepressants, addresses thinking issues. Learned helplessness is addressed by cognitive therapy.
A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCL (Latuda). The patient is 56 and currently weighs 204 lbs. Which topic is most important for the nurse to include in the teaching plan related to this medication? a. How to recognize tardive dyskinesia b. Weight management strategies c. Ways to manage constipation d. Sleep hygiene measures
b. Weight management strategies Lurasidone HCL (Latuda) is a second-generation antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with this medication. The patient is overweight now, so weight management will be especially important. The incidence of tardive dyskinesia is low with second-generation antipsychotic medications. Constipation may occur, but it is less important than weight management. This drug usually produces drowsiness.
Which statement made by a patient who will be maintained on lithium following discharge will require further instruction by the nurse? a. I will have my blood work done regularly. b. When I get home, I may go on a salt-free diet. c. I have learned not to restrict my intake of water. d. I understand some people gain weight on lithium.
b. When I get home, I may go on a salt-free diet. This statement shows that the patient does not understand the relationship between lithium and sodium. The patient must be taught that changing dietary salt intake will affect lithium levels. Adding salt can cause lower levels; reducing salt can result in toxicity. The remaining options reflect correct information regarding lithium therapy.
A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen? It will: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. be used for long-term control of hyperactivity.
b. bring hyperactivity under rapid control. Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithiums antimanic activity nor minimize the side effects. Lithium will be used for long-term control.
An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, Ive had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do? The nurse will advise the patient to: a. restrict food and fluids for 24 hours and stay in bed. b. have someone bring the patient to the clinic immediately. c. drink a large glass of water with 1 teaspoon of salt added. d. take one dose of an over-the-counter antidiarrheal medication now.
b. have someone bring the patient to the clinic immediately. The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment. Because neurological symptoms are present, the patient should not drive and should be accompanied by another person. The incorrect options will not ameliorate the patients symptoms.
A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. hypotensive shock b. hypertensive crisis c. cardiac dysrhythmias d. cardiogenic shock
b. hypertensive crisis Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.
A patient with rapid cycling bipolar disorder is not responding well to lithium. The patient tells the nurse, "It feels as though Ill never get well. I get better, and then I get worse." The reply that is based on knowledge of current therapy would be: a. Youre feeling very discouraged arent you? b. Its not all bad, is it? Sometimes you like being high. c. Another drug, valproic acid, is proving effective for rapid cycling. d. If your kidneys hold out, the lithium will eventually control the symptoms.
c. Another drug, valproic acid, is proving effective for rapid cycling. Valproic acid is a first-line agent for the treatment of bipolar disorder. It is particularly effective with rapid cycling. The other options are not responsive to the question stem, which asks for knowledge of current therapy.
A patient receiving haloperidol urgently calls to the nurse and reports that his eyes have rolled upward and he cannot redirect his gaze. The nurse contacts the physician to seek an order for: a. Fluphenazine (Prolixin) b. Citalopram (Celexa) c. Benztropine (Cogentin) d. Risperidone (Risperdal)
c. Benztropine (Cogentin) The nurse should recognize the patients problem as dystonia and know the treatment is IM administration of an antiparkinsonian drug, such as benztropine, or an antihistamine, such as diphenhydramine (Benadryl), for which a physicians order is necessary. Fluphenazine (Prolixin) would worsen the condition. The remaining options would not be useful.
A patient taking SSRIs mentions to the nurse that his current medication causes fewer side effects than the tricyclic antidepressant he took several years earlier. The nurse understands that SSRIs advantage is due to: a. Inhibiting both serotonin and norepinephrine uptake b. Selectively inhibiting dopamine uptake c. Blocking only serotonin reuptake d. Making more GABA available
c. Blocking only serotonin reuptake TCAs inhibit the reuptake of both norepinephrine and serotonin, producing more side effects than SSRIs that selectively block only serotonin reuptake. SSRIs do not affect dopamine or GABA availability.
A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would the nurse assess as the likely cause of these symptoms? a. Decreased dopamine at receptor sites b. Blockade of histamine c. Cholinergic blockade d. Adrenergic blocking
c. Cholinergic blockade Fluphenazine administration produces blockade of cholinergic receptors giving rise to anticholinergic effects, such as dry mouth, blurred vision, and constipation.
Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients: a. Mood and affect b. Activity level c. Cognitive ability to understand information about the medication d. Support network and its members willingness to participate in treatment
c. Cognitive ability to understand information about the medication Phenelzine (Nardil) administration requires strict adherence to a restricted diet. The patient must have the cognitive ability to understand the food and medication interactions that may cause a serious reaction.
An appropriate outcome for trihexyphenidyl (Artane) therapy used in conjunction with high potency typical antipsychotic medication therapy is that the patient will: a. Demonstrate a brighter mood b. Be less sedated and drowsy c. Display fewer movement disorder symptoms d. Display decreased anticholinergic symptoms
c. Display fewer movement disorder symptoms Trihexyphenidyl is used to treat extrapyramidal symptoms, such as pseudoparkinsonism. The other options are not expected outcomes of administration of this medication.
A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? a. Stop that! No one did anything to provoke an attack by you. b. If you do that one more time, you will be secluded immediately. c. Do not hit anyone. If you are unable to control yourself, we will help you. d. You know we will not let you hit anyone. Why do you continue this behavior?
c. Do not hit anyone. If you are unable to control yourself, we will help you. When the patient is unable to control his or her behavior and violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient, threaten the patient with seclusion as punishment, and ask a rhetorical question.
Which patient complaint should receive priority from a patient who is taking the MAOI tranylcypromine (Parnate)? a. I havent had a bowel movement in 2 days. b. Will you take my temperature? I feel too warm. c. I get a headache when I drank several cups of coffee. d. My legs get stiff when I sit in the chair for any length of time.
c. I get a headache when I drank several cups of coffee Hypertensive crisis may occur if a patient taking a MAOI ingests certain food containing tyramine or drugs that cause blood pressure (BP) elevation. Headache is a warning sign of hypertensive crisis. The nurse should assess BP and inquire about other symptoms of hypertensive crisis. Stiffness is not related to MAOI therapy. Elevated temperature is not an initial sign of hypertensive crisis. Constipation is not a sign of hypertensive crisis.
A patient who has received lithium for 3 weeks to control acute mania has the following symptoms: coarse hand tremor, diarrhea, vomiting, lethargy, and mild confusion. The priority nursing action should be to: a. Administer prn Cogentin to relieve the symptoms. b. Provide reassurance that the symptoms are transient. c. Obtain a stat lithium level; hold lithium pending results. d. Assist the patient to decrease the sodium in their daily diet.
c. Obtain a stat lithium level; hold lithium pending results. The symptoms the patient is experiencing are consistent with moderate lithium toxicity. The nurse should hold lithium, obtain a stat lithium level, and notify the physician. Cogentin is inappropriate; the symptoms are not EPS. The nurse may reassure the patient but cannot suggest that the symptoms will resolve over time. Minimizing salt would worsen lithium toxicity.
During a treatment team meeting, the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (5HT2) excess will suggest that the patient receive: a. Haloperidol (Haldol) b. Chlorpromazine (Thorazine) c. Olanzapine (Zyprexa) d. Phenelzine (Nardil)
c. Olanzapine (Zyprexa) Olanzapine is an atypical antipsychotic. Atypical antipsychotic medications are more effective than typical antipsychotics in blocking serotonin receptors and reducing the negative symptoms of schizophrenia. Haloperidol (Haldol) and chlorpromazine (Thorazine) are typical antipsychotic medications while phenelzine (Nardil) is an MAOI antidepressant.
During a psychiatric emergency, IM ziprasidone (Geodon) is administered to an assaultive patient. During the next 2 hours, it is of primary importance that the nurse assess for: a. Tardive dyskinesia b. Anticholinergic effects c. Orthostatic hypotension d. Pseudoparkinsonism
c. Orthostatic hypotension The side effect most likely to appear is orthostatic hypotension related to alpha1 receptor blockade preventing peripheral blood vessels from automatically responding to positional change. Anticholinergic effects are of lesser concern. The remaining options are less likely to occur at this point in therapy.
The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics: a. Remain in the system longer b. Act more quickly to reduce delusions c. Produce fewer extrapyramidal effects d. Are risk free for neuroleptic malignant syndrome (NMS)
c. Produce fewer extrapyramidal effects Atypical antipsychotics produce less D2 blockade; thus movement disorders are less of a problem. No evidence suggests that the medication remains in the system longer nor that it acts more quickly to reduce delusions. The atypicals are not risk free for NMS.
A patient has been taking chlorpromazine (Thorazine) for the past 2 weeks. He drools, has hand tremors, and walks with a shuffling gait. The nurse would correctly attribute these behaviors to: a. Akinesia b. Tardive dyskinesia c. Pseudoparkinsonism d. Neuroleptic malignant syndrome
c. Pseudoparkinsonism These are symptoms of pseudoparkinsonism associated with dopamine blockade. Tardive dyskinesia occurs after long-term therapy. The remaining options are not associated with the symptoms mentioned.
A patient whose schizophrenia has been refractory to treatment with other medications has been placed on clozapine (Clozaril). The priority discharge teaching should include: a. Keep salt intake the same from day to day. b. Maintain a strict tyramine-free daily diet. c. Report for weekly blood tests for CBC level. d. Use sunblocking agents when out of doors.
c. Report for weekly blood tests for CBC level. Clozaril has the potential to cause agranulocytosis; hence the need for weekly blood draws for CBCs for the first 6 months of therapy and every other week after that point. The other options are not relevant to Clozaril therapy. Salt intake refers to lithium therapy, tyramine to MAOI therapy, and sunblocking to phenothiazine therapy.
Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid? a. Anxiety b. Ineffective coping c. Risk for self-injury d. Chronic low self-esteem
c. Risk for self-injury Patients with depression are at increased risk for suicide when they have been on antidepressant medication for 2 weeks, because they are regaining some energy but may not have achieved full therapeutic effect with mood improvement. Poor coping is important but it is not the priority. Evidence of noncompliance is lacking. The medication is not prescribed for anxiety disorders.
The nurse notes that a patient who has been receiving paroxetine (Paxil) for symptoms of major depression begins to behave in a confused and elated manner with the presence of restlessness, muscle jerking, and diaphoresis. The nurse should assess these symptoms as probable: a. Neuroleptic malignant syndrome b. Anticholinergic blockade c. Serotonin syndrome d. Dystonia
c. Serotonin syndrome These are symptoms of serotonin syndrome, a condition that requires medical intervention. The other options are not associated with SSRI therapy.
A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse will advise the patient to: a. Go to the nearest emergency department immediately. b. Do not to be alarmed. Take two aspirin and drink plenty of fluids. c. Take a dose of your antidepressant now and come to the clinic to see the health care provider. d. Resume taking your antidepressants for 2 more weeks and then discontinue them again.
c. Take a dose of your antidepressant now and come to the clinic to see the health care provider. The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.
Which patient outcomes would be most applicable for the patient who has been taking benzodiazepines? Patient will state: a. That there are specific foods to avoid while on this medication b. An understanding of how to increase medication dosage c. That alcohol is a substance to avoid while on the medication d. An understanding that he or she can return to work while on this medication
c. That alcohol is a substance to avoid while on the medication Combining a benzodiazepine with alcohol or other CNS depressant is potentially fatal. No food restrictions exist. Dosage should not be changed without consultation with the physician. Patients may return to work unless experiencing sedation. In this case, they would be cautioned not to operate machinery.
When alprazolam (Xanax) is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to: a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.
c. avoid alcoholic beverages. Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Patients should be taught not to deviate from the prescribed dose and schedule for administration.
A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, This medicine isnt working. The nurses best intervention would be to: a. discuss with the health care provider the need to increase the dose. b. reassure the patient that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. d. critically assess the patient for symptoms of improvement.
c. explain the time lag before antidepressants relieve symptoms. Escitalopram is an SSRI antidepressant. One to three weeks of treatment is usually necessary before symptom relief occurs. This information is important to share with patients.
Consider these three anticonvulsant medications: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which medication also belongs to this classification? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (Lamictal) d. aripiprazole (Abilify)
c. lamotrigine (Lamictal) The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs.
A patient diagnosed with schizophrenia has taken fluphenazine (Prolixin) 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. neuroleptic malignant syndrome b. hepatocellular effects c. pseudoparkinsonism d. akathisia
c. psydoparkinsonism Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinsons disease. It frequently appears within the first month of treatment and is more common with first-generation antipsychotic drugs. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness.
A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about: a. restricting sodium intake to 1 gram daily. b. minimizing exposure to bright sunlight. c. reporting increased suicidal thoughts. d. maintaining a tyramine-free diet.
c. reporting increased suicidal thoughts. Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, I dont think I can keep taking these pills. They make me so dizzy, especially when I stand up. The nurse will: a. limit the patients activities to those that can be performed in a sitting position. b. withhold the drug, force oral fluids, and notify the health care provider. c. teach the patient strategies to manage postural hypotension. d. update the patients mental status examination.
c. teach the patient strategies to manage postural hypotension. Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing this information may convince the patient to continue the medication. Activity is an important aspect of the patients treatment plan and should not be limited to activities that can be done in a sitting position. Withholding the drug, forcing oral fluids, and notifying the health care provider are unnecessary actions. Independent nursing action is called for. Updating a mental status examination is unnecessary.
A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine (Clozaril) b. Ziprasidone (Geodon) c. Olanzapine (Zyprexa) d. Aripiprazole (Abilify)
d. Aripiprazole (Abilify) Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weigh gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.
A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patients behavior? a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. b. Continue to monitor and document the patients speech patterns and motor activity. c. Ask the health care provider to prescribe an increased dose and frequency of lithium. d. Consider the need to check the lithium level. The patient may not be swallowing medications.
d. Consider the need to check the lithium level. The patient may not be swallowing medications. The patient is continuing to exhibit manic symptoms. The lithium level may be low from cheeking (not swallowing) the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased. Monitoring the patient does not address the problem.
When a patient for whom haloperidol has been prescribed tells the nurse, Im burning up and my muscles are stiff and sore, the nurse suspects neuromuscular malignant syndrome and recognizes the possibility that the physician may order: a. Olanzapine (Zyprexa) b. Benztropine (Cogentin) c. Venlafaxine (Effexor) d. Dantrolene (Dantrium)
d. Dantrolene (Dantrium) Dantrolene, a direct-acting skeletal muscle relaxant, is a drug often used to treat NMS. The other drugs mentioned would have no therapeutic effect on NMS.
A newly diagnosed patient is prescribed lithium. Which information from the patients history indicates that monitoring of serum concentrations of the drug will be challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Heart Failure
d. Heart Failure The patient with congestive heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.
What intervention will the nurse request for a patient reporting gastrointestinal side effects related to valproate therapy? a. Mild laxative b. Low-fat diet c. Oral antacid d. Histamine-2 antagonist
d. Histamine-2 antagonist Indigestion, heartburn, and nausea are common side effects of valproate therapy. The administration of a histamine-2 antagonist such as famotidine (Pepcid) is sometimes helpful. The other options would have no impact on the complaint.
Which of these statements made by a patient taking the MAOI phenelzine (Nardil) would warrant further instruction? a. I often forget to wear sunscreen when I go outside. b. I need to restrict the amount of sodium in my diet. c. I should not use over-the-counter cold medications. d. I usually order liver and onions when my wife and I eat out.
d. I usually order liver and onions when my wife and I eat out. MAOIs require patients to observe a tyramine-free diet to prevent hypertensive crisis. Liver is a food that contains large amounts of tyramine. The remaining options have no relevance for MAOI therapy.
A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8 F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurses best analysis and action. a. Agranulocytosis; institute reverse isolation. b. Tardive dyskinesia; withhold the next dose of medication. c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome; notify health care provider stat.
d. Neuroleptic malignant syndrome; notify health care provider stat. Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in the scenario are not consistent with the medical problems listed in the incorrect options.
A severely depressed patient has been prescribed clomipramine (Anafranil). For which medication side effects should the patient be monitored? a. Excess salivation and drooling b. Muscle rigidity and restlessness c. Polyuria and coarse hand tremors d. Orthostatic hypotension and constipation
d. Orthostatic hypotension and constipation Alpha1 blockade produces orthostatic hypotension, and cholinergic blockade produces constipation. Mild tremors and urinary retention may occur. Drooling and excessive salvation may occur with SSRIs. Muscle rigidity and restlessness may occur with antipsychotics.
An atypical antipsychotic has been prescribed for an elderly patient. The nurse developing the patients care plan includes: a. Scheduling weekly WBC counts b. Teaching about a tyramine-free diet c. Requesting that a daily laxative be included d. Teaching fall prevention strategies to both the patient and family
d. Teaching fall prevention strategies to both the patient and family Orthostatic hypotension is a possible side effect due to alpha-adrenergic blockade. The nurse should teach the patient about changing position slowly and using handrails when walking to prevent falls. The remaining options are not related to antipsychotic medications.
A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin (Dilantin) b. clonidine (Catapres) c. risperidone (Risperdal) d. carbamazepine (Tegretol)
d. carbamazepine (Tegretol) Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine and valproate. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients. Phenytoin is also an anticonvulsant but not used for mood stabilization. Risperidone is not an anticonvulsant.
A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient: a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting. c. can identify foods with high selenium content that should be avoided. d. confers with a pharmacist when selecting over-the-counter medications.
d. confers with a pharmacist when selecting over-the-counter medications. Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.
A nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. imipramine (Tofranil) B. doxepine (Senequan) C. ziprasidone (Geodon) D. tranylcypromine (Parnate)
d. tranylcypromine (Parnate) tranylcypromine is an MAOI.
