You're screwed part 2 (Mental health)

Which drugs are used as the first-line treatment for posttraumatic stress disorder (PTSD)? Select all that apply. A. Sertraline B. Paroxetine C. Phenelzine D. Venlafaxine E. Amitriptyline

ANS: A, B Sertraline and paroxetine are SSRIs that are approved by the FDA as a first-line treatment for PTSD. If these drugs are ineffective, the use of phenelzine, venlafaxine, and amitriptyline is indicated.

The primary healthcare provider prescribes valproate and olanzapine to a client. Which clinical finding would support this intervention? A. Euphoric mania B. Dysphoric mania C. Rapid cycling mania D. Mania with psychosis

ANS: D Valproate is a mood stabilizer drug, and olanzapine is an antipsychotic. Clients experiencing mania with psychosis are generally prescribed with mood stabilizers and antipsychotics. Euphoric mania is treated with a mood stabilizer alone, preferably lithium. Dysphoric and rapid cycling mania is treated with a mood stabilizer alone, preferably valproate.

Which drug would be used to treat a client with severe motor tics, barking cries, and outbursts of obscene language? A. Loxapine B. Pimozide C. Thiothixene D. Thioridazine

ANS: B Severe motor tics, barking cries, and outbursts of obscene language are signs of Tourette syndrome. Pimozide is a high-potency drug used to treat this syndrome. Loxapine is a medium-potency agent indicated only for schizophrenia. Thiothixene is a high-potency agent indicated for schizophrenia. Thioridazine is a low-potency first-generation antipsychotic indicated for schizophrenia.

Which of the following drugs is commonly used as an adjunct during conscious sedation for minor surgeries? A. Diazepam B. Midazolam C. Lorazepam D. Clonazepam

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

The nurse noticed increased blood pressure in a client on treatment for depression. Which antidepressant drug does the nurse ask the primary healthcare provider to reconsider? A. Fluoxetine B. Bupropion C. Trazodone D. Mirtazapine

ANS: B Bupropion is the antidepressant drug used in the treatment of depression. The adverse effect of this drug is increased blood pressure. Fluoxetine's adverse side effects include anxiety and insomnia. Sedative effects are the adverse effects of trazodone. Drowsiness and abnormal dreams are the adverse effects of mirtazapine.

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

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

A client is receiving imipramine, a tricyclic antidepressant, for depression. The nurse assesses the client for side effects and adverse effects. Which adverse effect requires further assessment and possible medical intervention? A. Dry mouth B. Weight gain C. Blurred vision D. Urinary hesitancy

ANS: D Urinary hesitancy and retention are adverse effects of imipramine that may require immediate medical intervention. Dry mouth, weight gain related to increased appetite, and blurred vision may occur as side effects of imipramine; they usually decrease over time or can be managed through nursing interventions.

While caring for a client on antidepressant therapy, the nurse observes hyperthermia and seizures. Upon a further assessment, the nurse finds that the client's heart rate is 200 beats per minute. Which medication might be responsible for the condition? A. Sertraline B. Asenapine C. Risperidone D. Fluphenazine

ANS: A A heart rate of 200 BPM indicates cardiac dysrhythmias. Hyperthermia, seizures, and cardiac dysrhythmias in a client on antidepressant therapy indicate serotonin syndrome. Serotonin syndrome is an adverse effect of selective serotonin inhibitors such as sertraline. Asenapine, risperidone, and fluphenazine are antipsychotics that may cause drowsiness, neuroleptic malignant syndrome, extrapyramidal symptoms, and tardive dyskinesia as adverse effects.

A client is prescribed venlafaxine. Which disorders is this drug used to treat? Select all that apply. A. Panic disorder B. Bipolar disorder C. Social anxiety disorder D. Major depression E. Obsessive compulsive disorder

ANS: A, C D Panic disorders, social anxiety disorders, and major depression can be treated with venlafaxine.

A client is on antipsychotic therapy for schizophrenia. During a follow-up visit, the nurse suspects acute akathisia. Which symptoms in the client support the nurse's suspicion? Select all that apply. A. Rigidity B. Anxiety C. Agitation D. Stooped posture E. Restless movement

ANS: B, C, E Akathisia is an extrapyramidal effect of antipsychotic medications. Akathisia is characterized by anxiety, agitation, and restless movement. Rigidity and stooped posture are manifestations of Parkinsonism.

The nurse cares for a client with bipolar disorder who is receiving drug therapy. The laboratory report reveals that the client's serum sodium level is 132 mEq/L (132 mmol/L). Which drug might have led to this condition? A. Lithium B. Bupropion C. Fluoxetine D. Nortriptyline

ANS: C A serum sodium level of 132 mEq/L indicates hyponatremia. Fluoxetine is a serotonin reuptake inhibitor that may lead to hyponatremia.

A client is known to be on lithium therapy for the treatment of depression. What is the expected adverse effect of this drug? A. Ataxia B. Confusion C. Blurred vision D. Paradoxical anxiety

ANS: A Ataxia is the expected adverse effect in clients who are undergoing lithium therapy for the treatment of depression. Confusion is one of the adverse effects of diazepam. Blurred vision and paradoxical anxiety are the adverse effects of buspirone.

The nurse observed seizures in a client who is taking lithium for cycles of mania. Which laboratory parameters may lead to this condition? A. 1 mEq/L serum lithium levels B. 3 mEq/L serum lithium levels C. 135 mEq/L serum sodium levels D. 140 mEq/L serum sodium levels

ANS: B

After reviewing the data of a client who has been taking clozapine for two months, the primary healthcare provider instructs the client to discontinue the drug for a few weeks. Which laboratory parameter assessed by the primary healthcare provider would support the intervention? A. Hemoglobin of 12 g/dL B. White blood cell count of 2,000/mm^3 C. RBC count of 4.2 million/mm^3 D. Platelet count of 30,000/mm^3

ANS: B Because clozapine may cause agranulocytosis, the client's WBC count should be monitored weekly. The drug should be discontinued if the count falls below 3,000/mm^3.

The nurse cares for a client diagnosed with bipolar disorder who was prescribed drug therapy. Laboratory reports reveal that the client's thyroxine levels are low. Which drug might have led to this condition? A. Lithium B. Fluoxetine C. Risperidone D. Carbamazepine

ANS: A Lithium is used to treat bipolar disorder. Decreased levels of thyroxine and triiodothyronine may indicate hypothyroidism. Lithium may cause a goiter, which is associated with hypothyroidism. Fluoxetine is a selective reuptake inhibitor that may lead to hyponatremia. Risperidone is a second generation antipsychotic used to treat bipolar disorder that does not cause hypothyroidism. Carbamazepine is an antiepileptic drug used to treat bipolar disorder; this drug may cause leukopenia, anemia, and thrombocytopenia.

A 19-year-old adolescent is admitted to the emergency department with multiple fractures and potential internal injuries. The client's history reveals multiple drug abuse for the past 8 months. When caring for this client, the nurse determines that the most serious life-threatening responses usually result from withdrawal from which drug? A. Heroin B. Methadone C. Barbiturates D> Amphetamines

ANS: C Withdrawal from CNS depressants, such as barbiturates, is associated with more severe morbidity and mortality. Symptoms begin with anxiety, shakiness, and insomnia; within 24 hours convulsions, delirium, tachycardia, and death may occur.

Lithium therapy is initiated for a client diagnosed with manic episodes. Laboratory testing shows that the client's lithium level is 1.2 mEq/L (1.2 mmol/L). Why would the healthcare provider reduce the client's lithium dosage? A. To promote the drug excretion B. To reduce the risk of side effects C. To maintain the serum drug level D. To reduce the risk of drug accumulation

ANS: C Plasma lithium levels must be kept below 1.5 mEq/L to reduce the risk of toxicity. Normal lithium levels should range from 0.8 to 1.4 mEq/L. Once the desired therapeutic effect has been achieved, the dosage is reduced to produce maintenance levels ranging from 0.4 to 1 mEq/L.

A client is hospitalized with social anxiety disorder. The client has a history of exhibiting intense, irrational fear of being scrutinized by others. Which primary anxiolytic medications would be prescribed to the client? Select all that apply. A. Sertraline B. Paroxetine C. Alprazolam D. Venlafaxine E. Clonazepam

ANS: C, E Manifestations of social anxiety disorder include stuttering, sweating, palpitations, dry throat, and muscle tension. Clients with this disorder exhibit intense, irrational fear of being scrutinized by others.

A nurse is teaching clients in a medication education group about side effects of medications. Which drug will cause a heightened skin reaction to sunlight? A. Lithium B. Sertraline C. Methylphenidate D. Chlorpromazine

ANS: D Clients taking chlorpromazine should be instructed to stay out of the sun. Photosensitivity makes the sun more susceptible to burning.

A 55-year-old client who has a long history of drug and alcohol abuse mentions taking ginkgo biloba. The nurse knows that ginkgo biloba is taken to treat what condition? A. Insomnia B. Depression C. Memory impairment D. Anxiety and nervousness

ANS: C Ginkgo biloba is an herb used to treat age-related memory impairment and dementia.

A client with schizophrenia who has been taking clozapine is to be started on 10 mg of olanzapine instead. The nurse explains to the client, in terms that can be understood, that olanzapine is being substituted for clozapine because it does not produce which side effect? A. Hypotension B. Gastric upset C. Agranulocytoss D. Metabolic syndrome

ANS: C Although neutropenia may occur, agranulocytosis does not occur as a side effect of olanzapine. Cardiovascular responses, such as hypotension, are side effects of both medications. Dyspepsia, N/V, anorexia, and other GI disturbances occur with both medications. Metabolic syndrome may occur with olanzapine.

Considering the anticholinergic-like side effects of many of the psychotropic drugs, the nurse will encourage clients taking these drugs to take which action? A. Restrict their fluid intake. B. Eat a diet high in carbohydrates C. Suck on sugar-free hard candies. D. Avoid products that contain aspirin.

ANS: C Dry mouth increases the risk for cavities; candy with sugar adds to this risk.

Which sedative-hypnotics are used to treat insomnia effects associated with a panic disorder? Select all that apply. A. Phenelzine B. Paroxetine C. Alprazolam D. Imipramine E. Clonazepam

ANS: C, E Alprazolam and clonazepam are examples of benzodiazepams, a class of sedative-hypnotics used to treat clients with insomnia effects associated with panic disorders. Phenelzine is a MAOI used to treat panic disorders and promote sleep. Paroxetine is a SSRI used to treat panic disorders and promote sleep. Imipramine is a tricyclic antidepressant used to treat panic disorders and promote sleep.

The nurse suspects serotonin syndrome in a client prescribed second-generation antidepressants for depression. Which assessment findings observed by the nurse would be beneficial in diagnosing the severity of the syndrome? Select all that apply. A. Delirium B. Hyperreflexia C. Hyperthermia D. Muscle spasms E. Rhabdomyolysis

ANS: C, E Serotonin syndrome is a potentially hazardous adverse effect of second-generation antidepressants that are used to treat depression. Hyperthermia and rhabdomyolysis are symptoms observed in severe cases of sertonin syndrome.

The nurse teaches the client about foods to avoid while on phenelzine therapy. Which response given by the client indicates the need for further education? A. "I should avoid raisins in my diet." B. "I should avoid corned beef in my diet." C. "I should avoid burgundy and sherry in my diet." D. "I should avoid foods that are made of pepperoni."

ANS: A Most adverse effects of MOAIs are caused by their interactions with food and other medications. Therefore the client should avoid foods that contain high amounts of tyramine.

A pediatric client with a history of chickenpox is undergoing treatment for mental illness with psychotherapeutic drugs. Which is the expected adverse effect of the psychotherapeutic drug in the pediatric client? A. Reye's syndrome B. Serotonin syndrome C. Orthostatic hypotension D. Extrapyramidal symptoms

ANS: A Reye's syndrome is the adverse effect noticed in the pediatric client who has had chickenpox and on treatment for mental illness with psychotherapeutic drugs.

A client with schizophrenia, undifferentiated type, is receiving a typical antipsychotic/neuroleptic. The nurse will assess for which extrapyramidal effects? A. Shuffling gait, tremors, and restlessness B. Nausea, vomiting, and muscle cramps C. Drowsiness, disorientation, and slurred speech D. Tachycardia, urine retention, and constipation

ANS: A Shuffling gait, tremors, and restlessness are common extrapyramidal signs (pseudoparkinsonism) that occur as side effects of neuroleptics; they are usually controlled with antiparkinsonian drugs.

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

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

A client on bupropion therapy for depression experiences seizures. Which actions of the primary healthcare provider are used to reduce the risk for seizures? Select all that apply. A. Discouraging rapid dose titration B. Maintaining the dose at 550 mg/day C. Avoiding administration of the medication with paroxetine D. Avoiding concomitant use of fluoxetine with the medication. E. Administering the medication with small doses of fluoxetine

ANS: A, C, D Bupropion is an atypical antidepressant used to treat depression. Bupropion is associated with seizures. Paroxetine and fluoxetine are medications that inhibit CYP2B6; these drugs should be avoided in clients on bupropion because these medications elevated bupropion levels. Bupropion doses above 450 mg/day may cause seizure.

What are the adverse effects of mirtazapine? Select all that apply. A. Asthenia B. Dyskinesia C. Drowsiness D. Gynecomastia E. Abnormal dreams

ANS: A, C, E Mirtazapine is a second-generation antidepressant drug. Dyskinesia and gynecomastia are the side effects of first-generation antidepressant drugs.

A client reports to the primary healthcare provider with a complaint of becoming panicked and having irrational fear of public talking. Which drug does the nurse anticipate to be prescribed by the primary healthcare provider? A. Buspirone B. Alprazolam C. Diazepam D. Lorazepam

ANS: B Alprazolam (a benzodiazepine) is a short-acting anxiolytic drug used to treat those clients with panic disorders and the irrational fear of talking openly in public. Buspirone is always administered on a scheduled basis (not PRN) for the treatment of anxiety.

A client has been prescribed chlorpromazine for the management of positive symptoms of schizophrenia. What is the nurse's response when the client reports difficulty sustaining an erection? A. Reassuring the client that this side effect will resolve in a few weeks B. Consulting with the primary HCP regarding alternative medication therapies C. Explaining that all conventional antipsychotic medications cause impotence D. Providing additional medication education to explain this medication's side effect in detail

ANS: B Although erectile dysfunction can result from conventional antipsychotic medication therapy, the provider is often able to prescribe an alternative medication that will help manage the symptoms but is less likely to cause the dysfunction.

An 11-year-old client reports having the habit of bedwetting (enuresis). Which drug may be prescribed to this client? A. Alprazolam B. Imipramine C. Lithium salts D. Clomipramine

ANS: B Certain conditions of pediatric clients necessitate the usage of tricyclic antidepressant drugs as an adjuvant. Childhood enuresis is one such condition that necessitates the administration of imipramine.

A client with a history of smoking is suspected of having depression. The primary healthcare provider prescribes a drug that would be beneficial in treating depression and would aid in smoking cessation. Which adverse effects would the nurse suspect in this client? Select all that apply. A. Asthenia B. Confusion C. Tachycardia D. Constipation E. Increased appetite

ANS: B, C Bupropion is used to treat depression and aid in smoking cessation. Therefore, the nurse would suspect confusion and tachycardia in a client who is prescribed bupriopion. Mirtazapine is indicated for the treatment of depression. Asthenia, constipation, and increased appetite are adverse effects associated with mirtazapine.

Donepezil is prescribed for a senior client who has mild dementia of the Alzheimer type. What information does the nurse include when discussing this medication with the client and family? A. Fluids should be limited to four large glasses per day. B. Constipation should be reported to the primary HCP immediately. C. Blood tests that reflect liver function will be performed routinely. D. The client's medication dosage may be self-adjusted according to the client's response.

ANS: C Donepezil may affect the liver, because ALT is found predominantly in the liver; most ALT increases indicate hepatocellular disease. Clients taking this medication should have regular liver function tests and report light stools and jaundice to the primary HCP.

A primary healthcare provider diagnoses chronic low-grade depression in a client. Which drug may be prescribed for this client? A. Alprazolam B. Lithium salts C. Amitriptyline D. Clomipramine

ANS: C Dysthymia (chronic low-grade depression) can be treated by the administration of antidepressant drugs such as amitriptyline. Alprazolam is the drug of choice for treating anxiety disorders. Lithium salt is prescribed to treat bipolar disorder. Clomipramine is a tricyclic antidepressant drug prescribed for treating OCD.

Which client may benefit from the administration of the herbal preparation of Hypericum perforatum? A. Clients with dementia B. Client with schizophrenia C. Client with sleep disorder D. Client with Alzheimer disease

ANS: C Hypericum perforatum is an OTC herbal preparation sold as treatment for sleep disorders, depression, anxiety, and nervousness.

Naltrexone is used to treat clients with substance abuse problems. In which situation does the nurse anticipate that naltrexone will be administered? A. To treat opioid overdose B. To block the systemic effects of cocaine C. To decrease the recovering alcoholic's desire to drink alcohol D. To prevent severe withdrawal symptoms from antianxiety agents

ANS: C Naltrexone is effective in reducing the risk of relapse among recovering alcoholics in conjunction with other types of therapy.

A client's serum lithium level is 0.2 mEq/L (0.2 mmol/L). What is the nurse's interpretation of this finding? A. Within toxic range B. Borderline toxic range C. Below therapeutic range D. Borderline therapeutic range

ANS: C The therapeutic range of serum lithium is 0.5 to 1.5 mEq/L. The signs and symptoms of lithium toxicity usually occur when the serum lithium level exceeds 2.0 mEq/L.

A client with schizophrenia is started on an antipsychotic/neuroleptic medication. The nurse explains to a family member that this drug primarily is used to achieve what purpose? A. Keep the client quiet and relaxed. B. Control the client's behavior and reduce stress. C. Reduce the client's need for physical restraints. D. Make the client more receptive to psychotherapy.

ANS: D Antipsychotic/neuroleptic medications help control anxiety, improve cognition, and decrease acting-out behavior, rendering the client better able to participate in therapy.

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

ANS: D Many people with dementia experience physical problems such as UTI but cannot adequately verbalize what is happening. They may just become more restless and agitated. Because the client has been taking this dose for 3 months, the problems are probably not being caused by the medication.

A nurse administers an antipsychotic medication to a client. The nurse will assess the client for which common manageable side effect? A. Jaundice B. Melanocytosis C. Drooping eyelids D. Unintentional tremor

ANS: D Unintentional tremor is one of the extrapyramidal side effects of antipsychotic medications; it is considered common and manageable.