Antidepressants
A patient with reactive depression is ordered to receive fluoxetine. Which information will the nurse include when teaching this patient?
A.The medication takes effect in 1 to 2 days.
B.The medication increases libido.
C.The medication should be taken with grapefruit juice.
D.The medication may cause headaches and insomnia.
ANS: D
Side effects include headache, nervousness, restlessness, insomnia, blurred vision, tremors, GI distress, and sexual dysfunction. The drug takes about 2 to 4 weeks for onset, decreases libido, and has no interaction with grapefruit juice.
A client who has been taking buspirone (BuSpar) for two months returns to the clinic for a follow-up. The nurse determines that the medication is effective if there is an absent display of?
A) Feelings of panic, fear, and uneasiness.
B) Thought broadcasting or delusions.
C) Paranoid and suicidal thought process.
D) Alcohol withdrawal symptoms.
A) Feelings of panic, fear, and uneasiness.
Buspirone (BuSpar) is used to treat symptoms of anxiety, such as fear, tension, irritability, dizziness, pounding heartbeat, and other physical symptoms.
Which statement by a patient indicates that more teaching on phenothiazine therapy for the treatment of psychosis is needed?
A.“It might take 6 weeks or more for the drug to take effect.”
B.“I will get up slowly from a seated position.”
C.“When I start to feel better, I will cut the dose of my medication in half.”
D.“I will avoid exposure to direct sunlight.”
ANS: C
The drug should be taken exactly as ordered. Antipsychotics do not cure the mental illness but do alleviate symptoms. Compliance with drug regimen is extremely important.
A client is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include:
A) Advising the client to watch the diet carefully
B) Suggesting that the client take the pills with milk
C) Reminding the client that a CBC must be done once a month.
D) Encouraging the client to have blood levels checked as ordered.
Option D: Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.
A patient has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do?
A) Withhold the drug.
B) Record the client’s response.
C) Encourage the client to tell the doctor.
D) Suggest that it takes a while before seeing the results.
Option D: The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached.
A patient with major depression has been
prescribed fluoxetine. What nursing diagnosis would be most appropriate?
A.Social Isolation
B.Mobility, Impaired Physical
C.Urinary Elimination, Impaired
D.Sensory Perception, Disturbed
ANS: A
The most appropriate nursing diagnosis for the patient taking fluoxetine is social isolation. Impaired physical mobility, impaired urinary elimination, and disturbed sensory perception are not associated with fluoxetine.
The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam states
A.“I must stop drinking coffee and colas.”
B.“I can stop this drug after 3 weeks if I feel better.”
C.“I must stop drinking alcoholic beverages.”
D.“I should not become pregnant while taking this drug.”
ANS: B
Lorazepam should not be discontinued abruptly, but gradually, over a period of several days. Caffeine and alcohol should be avoided when taking lorazepam, a benzodiazepine. This drug should not be taken during pregnancy because of possible teratogenic effects.
A patient on risperidone may be at increased risk for injury due to
A.increased potential for aspiration due to sedation.
B.increased risk for falls due to orthostatic hypotension.
C.increased risk for infection due to neutropenia.
D.increased risk for suicide due to changes in thought processes.
ANS: B
Orthostatic hypotension is the most common adverse reaction seen in patients treated with risperidone (Risperdal).
A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as:
A) Normal level.
B) Toxic level.
C) Below normal level.
D) Above normal level.
Answer: B, toxic level
The therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L. OR 1.0 mEq/L to 1.5 mEq/L
Assessment findings for a patient with neuroleptic malignant syndrome (NMS) include
A.bradycardia.
B.hypothermia.
C.muscle weakness.
D.rhabdomyolysis.
ANS: D
NMS symptoms include muscle rigidity, sudden high fever, altered mental status, blood pressure fluctuations, tachycardia, dysrhythmias, seizures, rhabdomyolysis, acute renal failure, respiratory failure, and coma.
Before administering an monoamine oxidase inhibitor, it is most important for the nurse to assess the patient’s
•
A.sexual history.
B.socioeconomic status.
C.dietary intake.
D.hydration status.
ANS: C
Certain drug and food interactions with MAO inhibitors can be fatal. Foods that contain tyramine have sympathomimetic-like effects and can cause a hypertensive crisis. These types of food must be avoided by MAOI users.
A nurse caring for a patient in an outpatient setting notes that the patient is currently taking lorazepam for anxiety and her breath smells of alcohol. The nurse reports this to the health care provider because
A.taking alcohol with Ativan can be fatal.
B.taking alcohol with Ativan may increase sedative effects.
C.all patients using alcohol should be referred for assistance.
D.Ativan and alcohol antagonize one another.
ANS: B
Alcohol and other CNS depressants should not be taken with benzodiazepines because respiratory depression could result.
A young woman is being treated for psychosis with fluphenazine. Which sign would indicate the need to add an anticholinergic to the patient’s medication regimen?
A.A decrease in pulse and respiratory rate
B.Facial grimacing and tongue spasms
C.An increase in hallucinations
A decrease in the patient’s level of orientation
ANS: B
Pseudoparkinsonism, which resembles symptoms of Parkinson’s disease, is a major side effect of typical antipsychotic drugs such as fluphenazine (Prolixin). Anticholinergic medications may be used to control this side effect.
Which laboratory test is most important for the nurse to monitor when a patient is receiving lithium?
A.Urinalysis
B.Serum glucose
C.Serum electrolytes
D.Complete blood count
ANS: C
Serum sodium levels need to be monitored in patients taking lithium. Lithium tends to deplete sodium. Lithium must be used with caution, if at all, by patients taking diuretics.
Earlier in the day a client refuses his evening dose of Haloperidol (Haldol), then becomes extremely agitated in the dayroom while other clients are watching television. He begins cursing and throwing furniture. This nurse's first action is to:
A) Check the client’s medical record for an order for an as-needed I.M. dose of medication for agitation.
B) Place the client in full leather restraints.
C) Call the attending physician and report the behavior.
D) Remove all other clients from the dayroom.
D) Remove all other clients from the dayroom.
Option D: The nurse’s first priority is to consider the safety of the clients in the therapeutic setting. Options A, B, and C: The other actions are appropriate responses after ensuring the safety of other clients.
Which advice will the nurse include when teaching the patient about lithium therapy?
A.Take the drug on an empty stomach.
B.Eliminate all sodium from your diet.
C.Stop taking the lithium when you feel better.
D.It may take 1 to 2 weeks before you have any benefits from taking the medication.
ANS: D
The effectiveness of lithium may not be evident until 1 to 2 weeks after the start of therapy. The patient should be taught to maintain adequate sodium intake and to avoid crash diets that affect physical and mental health. Lithium levels are maintained by taking the drug on a daily basis. The patient should be taught to take lithium with meals to decrease gastric irritation.
A patient has been newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following?
A) warning about the drugs delayed therapeutic effect, which is from 14 to 30 days.
B) A warning about the incidence of neuroleptic malignant syndrome (NMS).
C) A reminder of the need to schedule blood work in 1 week to check blood levels of the drug.
D) A warning that immediate sedation can occur with a resultant drop in pulse.
Option A: The client should be informed that the drug’s therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Option B: NMS hasn’t been reported with this drug, but tachycardia is frequently reported. Option C: Blood level checks aren’t necessary.
a psychiatric client is to be discharged with orders for haloperidol (haldol) therapy. When developing a teaching plan for discharge, the nurse should include cautioning the client against:
A) Driving at night
B) Staying in the sun
C) Ingesting wines and cheeses
D) Taking medications containing aspirin
Option B: Haldol causes photosensitivity. Severe sunburn can occur on exposure to the sun.
The psychiatrist orders lithium carbonate 600 mg p.o t.i.d for a female client. The nurse would be aware that the teaching about the side effects of this drug were understood when the client state, “I will call my doctor immediately if I notice any:
A) Sensitivity to bright light or sun
B) Fine hand tremors or slurred speech
C) Sexual dysfunction or breast enlargement
D) Inability to urinate or difficulty when urinating
Option B: Although a fine hand tremor can be a common side effect of lithium carbonate, it may indicate toxicity. Slurred speech is also indicative of LiCo3 toxicity
The Nurse knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD):
A) benztropine (Cogentin) and diphenhydramine (Benadryl).
B) chlordiazepoxide (Librium) and diazepam (Valium)
C) fluvoxamine (Luvox) and clomipramine (Anafranil)
D)divalproex (Depakote) and lithium (Lithobid)
Option C: The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Option B: Librium and Valium may be helpful in treating anxiety related to OCD but aren’t drugs of choice to treat the illness. Options A and D: The other medications mentioned aren’t effective in the treatment of OCD
Which statement about amitriptyline does the nurse identify as being true?
A.The drug is administered first thing in the morning.
B.The drug should be discontinued slowly.
C.The onset of antidepressant effect is 48 hours.
Hypertension is a frequent side effect of this drug.
ANS: B
When discontinuing TCAs such as amitriptyline (Elavil), the drug should be gradually decreased to avoid withdrawal symptoms such as nausea, vomiting, anxiety, and akathisia. TCAs are given at night to minimize problems caused by their sedative action. The onset of the antidepressant effect of amitriptyline is 1 to 4 weeks. Orthostatic hypotension is a common side effect of amitriptyline (Elavil).
The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent?
A) Combativeness, sweating, and confusion
B) Agitation, hyperactivity, and grandiose ideation
C) Emotional lability, euphoria, and impaired memory
D) Suspiciousness, dilated pupils, and increased blood pressure
Option C: Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory. Option A: Phencyclidine overdose can cause combativeness, sweating, and confusion. Option B: Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation. Option D: Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure.
A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient?
•
A.Dantrolene
B.Tetrabenazine
C.Propranolol
D.Lorazepam
ANS: A
Treatment of NMS involves immediate withdrawal of antipsychotics, adequate hydration, hypothermic blankets, and administration of antipyretics, benzodiazepines, and muscle relaxants such as dantrolene (Dantrium). Tetrabenazine (Xenazine), used to improve symptoms of Huntington’s disease, seems to be effective in treating tardive dyskinesia. Propanolol (Inderal) has been found to be effective in the treatment of akathisia. Acute dystonia may be treated with lorazepam (Ativan).
Nurse Maureen knows that the non-antipsychotic medication used to treat some clients with schizoaffective disorder is:
A) phenelzine (Nardil)
B) chlordiazepoxide (Librium)
C) lithium carbonate (Lithane)
D) imipramine (Tofranil)
Option C: Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder. Option A: Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don’t respond to other antidepressant drugs such as imipramine. Option B: Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. Option D: Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and that undergoing cocaine detoxification.
Nurse Krina recognizes that the suicidal risk for depressed client is greatest:
A
A) As their depression begins to improve
B) When their depression is most severe
C) Before any type of treatment is started
D) As they lose interest in the environment
Option A: At this point, the client may have enough energy to plan and execute an attempt. This is why it is imperative to assess clients that have recently started medications to treat their depression for suicidal ideations (SI)