Lithium
What is the primary therapeutic use of Lithium?
Bipolar disorder, treatment of acute mania, and maintenance therapy to prevent manic and depressive episodes.
What is the primary clinical indication for prescribing clozapine?
Treatment-resistant schizophrenia (typically after failure of at least two adequate trials of other antipsychotic medications)
Which of the following medications are available as long-acting injectable (LAI) antipsychotics?
A. Aripiprazole
B. Paliperidone
C. Risperidone
D. Haloperidol
E. All of the above
E. All of the above
What is the primary indication for methadone?
Treatment of opioid use disorder and chronic pain
What is the primary therapeutic effect of benzodiazepines?
Reduce anxiety and produce sedation
Why are regular blood tests required for patients taking Lithium, and
What laboratory values should be monitored?
Narrow therapeutic index
serum lithium levels, renal function (creatinine/eGFR), thyroid function (TSH), and electrolytes.
Why are regular blood tests required for patients taking clozapine, and
What serious adverse effects are they intended to detect?
Regular blood tests monitor the white blood cell count and absolute neutrophil count (ANC) to detect agranulocytosis or severe neutropenia, which can be life-threatening.
A nurse is preparing to administer an LAI antipsychotic.
Which nursing action is most appropriate to reduce the risk of medication leakage and improve intramuscular delivery?
A. Massage the injection site vigorously after administration.
B. Use the Z-track technique when indicated according to institutional policy.
C. Aspirate for 30 seconds before injection.
D. Inject rapidly to reduce discomfort.
B. Use the Z-track technique when indicated.
Before administering a scheduled dose of methadone, which nursing assessment is the highest priority?
Respiratory rate and level of sedation
Before administering a PRN benzodiazepine for agitation, which nursing assessment is the highest priority?
Respiratory rate and level of consciousness
A patient on Lithium says they plan to start a low-sodium diet and increase their exercise routine. What education would you provide, and why?
Importance of maintaining consistent salt and fluid intake,
risk of dehydration,
effects on lithium levels,
when to seek medical advice.
A patient taking clozapine reports excessive drooling at night, constipation, and feeling sleepy during the day.
Which of these side effects requires the most urgent nursing assessment, and why?
Constipation requires the most urgent assessment because clozapine-induced gastrointestinal hypomotility can progress to bowel obstruction, ileus, bowel perforation, sepsis, and death if not recognized and treated promptly.
How long to shake invega sustenna before administration?
Shake the syringe vigorously for at least 10 seconds to ensure a homogeneous suspension.
Which statement about methadone is TRUE?
A. It reaches its peak effect within 15 minutes.
B. It has a long and variable half-life, increasing the risk of accumulation.
C. It does not interact with other medications.
D. Missing one dose usually causes severe withdrawal immediately.
B. It has a long and variable half-life, increasing the risk of accumulation.
often 24–55 hours or longer
What is the antidote to benzodiazepines?
Flumazenil
A patient taking Lithium presents with nausea, coarse tremor, slurred speech, and unsteady gait.
What is your priority nursing assessment and immediate action?
Recognize possible lithium toxicity,
Assess vital signs and neurological status,
Hold lithium,
Notify MRP,
Obtain urgent lithium level,
Monitor hydration.
A patient who started clozapine three weeks ago develops a temperature of 38.8°C, sore throat, and flu-like symptoms.
What are the nurse's immediate priorities?
A nurse is educating a newly hired colleague about LAI antipsychotics. Which statement is correct?
A. All LAIs require refrigeration before administration.
B. Invega Sustenna requires oral overlap after the loading regimen has been completed in appropriately established patients.
C. Abilify Maintena may require oral overlap when initiating treatment, depending on the prescribing regimen.
D. Haloperidol Decanoate is administered subcutaneously.
C. Abilify Maintena may require oral overlap when initiating treatment, depending on the prescribing regimen.
A patient presents for their scheduled methadone dose. The nurse observes that the patient is difficult to arouse, has slurred speech, and has a respiratory rate of 8 breaths/min.
What is the nurse's best action?
Withhold the methadone dose, assess the patient, and notify the MRP immediately.
Why not administer intramuscular (IM) olanzapine and IM benzodiazepines at the same time?
because of the risk of cardiorespiratory depression and excessive sedation.
If both medications are clinically necessary, separate their administration by at least 1 hour and monitor the patient closely. RR, SpO2, BP, HR, LOC
A patient who has been stable on Lithium develops gastroenteritis with persistent vomiting and diarrhea.
Explain how this illness can affect lithium levels and describe your nursing management.
Dehydration increases lithium concentration,
Risk of toxicity,
Encourage medical review,
Temporary withholding as directed by the prescriber,
Monitor hydration, serum lithium level, renal function,
Patient education.
A patient who has been stable on clozapine for several months has not taken the medication for 24-48 hours.
The patient is now willing to take the dose. How should the nurse respond?
The previous maintenance dose should not be restarted immediately.
After an interruption of more than 48 hours, clozapine generally requires re-titration from a low starting dose due to the risk of severe hypotension, bradycardia, syncope, and cardiac or respiratory complications.
The MRP/on-call MD should be contacted before administering the medication.
A patient is scheduled for their Invega Sustenna injection. During assessment, the nurse notes a temperature of 38.9°C, severe muscle rigidity, diaphoresis, confusion, and fluctuating blood pressure. What is the nurse's priority action?
A. Administer the injection because it is overdue.
B. Administer acetaminophen and reassess in one hour.
C. Withhold the injection, suspect Neuroleptic Malignant Syndrome (NMS), initiate emergency assessment, and notify the prescriber immediately.
D. Encourage oral fluids and discharge the client.
C. Withhold the injection, suspect Neuroleptic Malignant Syndrome (NMS), initiate emergency assessment, and notify the prescriber immediately.
A patient receiving methadone reports taking several doses of a prescribed benzodiazepine earlier in the day for anxiety.
What is the nurse's priority concern?
Increased risk of respiratory depression and overdose
A patient receiving lorazepam for alcohol withdrawal has the following assessments: What is the nurse's priority action?
Administer the prescribed lorazepam according to the CIWA protocol and continue close monitoring.