Anti-depressants
A patient has been taking an antidepressant for two weeks and is requesting a new medication because the one they are taking is "not working." What is the best response to the patient?
A. "I can talk to the doctor about increasing your dose."
B. "Most antidepressants take between 4-8 weeks until peak efficacy is shown."
C. "You will not feel better until you are on the medications for at least 6 months."
D. "We could try a different medication if this one is not working."
ANS: B
Most antidepressants have a delayed onset and should not be measured for efficacy until 4-8 weeks on the medication.
A nurse is preparing to administer haloperidol (Haldol) intramuscularly to a client with acute psychosis. Which nursing action is most appropriate?
A. Place the client on seizure precautions after administration
B. Monitor blood glucose closely due to risk of hyperglycemia
C. Ensure telemetry monitoring is in place after administration
D. Restrict fluids to reduce the risk of hyponatremia
ANS: C
Haloperidol can prolong the QT interval, especially when given IM or IV in high doses, increasing the risk for cardiac arrhythmias. Telemetry monitoring is recommended.
A nurse is providing discharge teaching to a client prescribed phenytoin (Dilantin) for seizure control. Which statement by the client indicates a need for further teaching?
A. "I will have my blood levels checked regularly while taking this medication."
B. "If I miss a dose, I can double up the next one to catch up."
C. "I should report any unusual bleeding or gum changes to my provider."
D. "I will avoid alcohol while on this medication."
ANS: B
Phenytoin has a narrow therapeutic index, and doubling doses can result in toxicity.
A client taking lithium for bipolar disorder reports fatigue and polyuria at a follow-up appointment. What is the nurse’s best response?
A. "These symptoms suggest toxicity, and you should stop taking lithium immediately."
B. "These are expected side effects at therapeutic levels; continue your medication as prescribed."
C. "You should increase your dose to help reduce these symptoms."
D. "You may be allergic to lithium; report to the ER right away."
ANS: B
Fatigue and polyuria are common adverse effects at therapeutic levels of lithium and do not necessarily indicate toxicity. These should be monitored, but stopping the medication abruptly or increasing the dose would be inappropriate.
A school-age child is prescribed methylphenidate (Ritalin) for ADHD. Which finding, if observed by the parent, should be reported to the healthcare provider?
A. Decreased appetite and trouble falling asleep
B. Mild headaches in the afternoon
C. Weight loss and elevated blood pressure
D. Increased focus and improved grades
ANS: C
Methylphenidate is a stimulant and can cause weight loss, appetite suppression, and hypertension. These are significant adverse effects that need monitoring. Mild insomnia and improved academic performance are expected.
A nurse is caring for a 19-year-old client recently prescribed fluoxetine for generalized anxiety disorder. Which nursing intervention is the priority during the first few weeks of treatment?
A. Monitor for signs of weight gain and sexual dysfunction
B. Educate the client on avoiding abrupt discontinuation of the medication
C. Assess the client for new or increased suicidal thoughts or behaviors
D. Encourage the client to take the medication at bedtime to reduce nausea
ANS: C
SSRIs like fluoxetine increase serotonin to help regulate mood, sleep, and attention, but in young adults under age 25, they carry a black box warning for increased risk of suicidal ideation, especially during the first few weeks of therapy. Monitoring for mood changes and suicidal thoughts is the highest priority.
A client receiving oral haloperidol reports lip-smacking, facial grimacing, and tongue protrusion. What should the nurse do first?
A. Educate the client that these symptoms are harmless and will go away
B. Document the findings as expected long-term effects of the medication
C. Notify the provider of possible tardive dyskinesia
D. Hold the medication and reassess in one hour
ANS: C
These are signs of tardive dyskinesia, a serious form of extrapyramidal symptoms (EPS). The nurse must notify the provider for possible medication change or dose adjustment.
A nurse is monitoring a client taking valproic acid (Depakote) for generalized seizures. Which lab result would require immediate notification of the healthcare provider?
A. ALT 96 U/L (elevated)
B. WBC 8,000/mm³
C. Platelets 230,000/mm³
D. Sodium 139 mEq/L
ANS: A
Valproic acid is associated with hepatotoxicity. Elevated liver enzymes (like ALT) (should be between 7-56) indicate possible liver damage and require provider notification.
WBC, platelets, and sodium values are within normal limits.
Which symptom reported by a client on lithium therapy requires immediate provider notification?
A. Mild nausea and headache
B. Polyuria and dry mouth
C. Fine hand tremor and increased thirst
D. Tinnitus and new onset of confusion
ANS: D
Tinnitus and confusion are symptoms of lithium toxicity, which may progress to seizures or coma. These findings require immediate evaluation. The other options reflect common side effects or expected reactions.
The nurse is caring for an adolescent starting amphetamine/dextroamphetamine (Adderall). Which assessment is most important before initiating therapy?
A. Serum electrolytes
B. Visual acuity
C. Height, weight, and blood pressure
D. Serum creatinine and BUN
ANS: C
Stimulant medications may suppress growth and increase blood pressure. Baseline height, weight, and BP should be recorded before therapy and monitored regularly.
The nurse is teaching a client who has been prescribed amitriptyline for insomnia and fibromyalgia. Which statement by the client indicates a correct understanding of the teaching?
A. "I’ll take this medication first thing in the morning so I don’t forget."
B. "It’s okay to stop this medication abruptly if I feel too drowsy."
C. "I should drink extra fluids and increase fiber to help with constipation."
D. "If I feel dizzy when standing up, I’ll just ignore it since that’s expected."
ANS: C
TCAs cause anticholinergic effects, including constipation, so increasing fluids and fiber is appropriate client self-care. Since TCAs are sedating you would want to take them at bedtime, not in the morning. You should not discontinue TCAs abruptly. Orthostatic hypotension needs to be reported and managed, not ignored.
A nurse is reviewing medications for a hospitalized client receiving quetiapine (Seroquel) at bedtime. The client has no psychiatric diagnosis. Which explanation by the nurse is most appropriate?
A. “This medication is used to manage blood pressure during the night.”
B. “It helps regulate sleep and prevent hospital-related confusion or delirium.”
C. “This medication is used to stimulate appetite overnight.”
D. “You are receiving this medication to prevent anxiety-related nightmares.”
ANS: B
Quetiapine is often used off-label in hospital settings to promote a normal sleep-wake cycle and prevent delirium, especially in elderly or critically ill patients.
A client prescribed phenobarbital for seizure control reports extreme drowsiness and difficulty staying awake during the day. What is the nurse’s best response?
A. "You should stop taking the medication until you see your provider."
B. "This medication may be causing central nervous system depression; let me notify the provider."
C. "Try drinking coffee or other caffeinated drinks during the day."
D. "This is expected. It will go away in a few weeks."
ANS: B
Phenobarbital is a CNS depressant and can cause sedation, especially when initiated or adjusted. The provider may need to adjust the dose. Never advise a client to stop antiseizure meds abruptly.
A nurse is reviewing a client’s medication list. Which of the following prescribed medications would prompt the nurse to question continued lithium use?
A. Lisinopril
B. Acetaminophen
C. Levothyroxine
D. Omeprazole
ANS: A
ACE inhibitors like lisinopril can interact with lithium and increase the risk of toxicity. Lithium should be used cautiously or avoided with ACE inhibitors. The others do not commonly interact with lithium.
Which statement by a parent of a child taking lisdexamfetamine (Vyvanse) indicates a need for further teaching?
A. "I will give the medication early in the day to avoid sleep problems."
B. "I can mix the capsule contents with water or juice if swallowing is a problem."
C. "This medication may cause my child to feel sleepy or sluggish during the day."
D. "I will notify the provider if my child stops gaining weight."
ANS: C
Lisdexamfetamine is a stimulant, not a sedative. It may cause insomnia, restlessness, or appetite suppression—not sleepiness. The other statements are correct regarding administration and monitoring.
A client has been taking sertraline (Zoloft) for 10 months and reports feeling emotionally stable, has resumed social activities, and is sleeping and eating well. The client asks the nurse if it's okay to stop taking the medication. What is the nurse's best response?
A. "Yes, if you're feeling better, it's safe to stop the medication now."
B. "You should continue the medication indefinitely to prevent future depression."
C. "Let’s talk to your provider about gradually tapering off the medication."
D. "Take a break from the medication for a few weeks and see how you feel."
ANS: C
Abrupt discontinuation of selective serotonin reuptake inhibitors (SSRIs) can cause withdrawal syndrome, so these drugs should be withdrawn gradually. After symptoms are in remission, treatment should continue for 4 to 9 months to prevent relapse; these drugs are not taken indefinitely. It is incorrect to counsel the patient to stop taking the drug without tapering it.
A client with schizophrenia has a history of nonadherence to antipsychotic medications. The nurse is developing a plan of care to support the client’s medication compliance. Which intervention is most effective?
A. Educate the client on potential side effects and strategies to manage them
B. Explain that missing doses may result in dangerous withdrawal symptoms
C. Encourage the client to self-monitor and adjust the dosage as needed
D. Remind the client that the medication can be taken only when symptoms are severe
ANS: A
Teaching the client about side effects and how to manage them empowers the patient and promotes long-term adherence to treatment.
The nurse is caring for a child actively seizing in the emergency department. Which medication should the nurse expect to administer?
A. Phenytoin PO
B. Diazepam IV
C. Gabapentin PO
D. Levetiracetam PO
ANS: B
IV diazepam (Valium) is used for status epilepticus or acute seizures because of its rapid onset. PO medications are not effective during active seizures.
A client taking olanzapine (Zyprexa) for bipolar disorder has a fasting blood glucose of 146 mg/dL and has gained 10 pounds in 2 months. What is the nurse’s best action?
A. Reassure the client that weight gain is temporary.
B. Document findings and continue routine monitoring.
C. Notify the provider; these may indicate adverse metabolic effects.
D. Educate the client to increase carbohydrate intake to boost energy.
ANS: C
Olanzapine is associated with metabolic syndrome, including weight gain, hyperglycemia, and dyslipidemia. A fasting glucose of 146 mg/dL is elevated and, combined with weight gain, warrants provider notification for possible medication adjustment or monitoring.
A parent of a child newly prescribed a stimulant for ADHD asks about safety. Which statement by the nurse is most appropriate?
A. "Stimulants are habit-forming and should only be used in emergencies."
B. "These medications must be taken with high-fat meals to improve absorption."
C. "It's important to store the medication safely to prevent misuse or abuse."
D. "If side effects occur, double the dose the next day to build tolerance."
ANS: C
Stimulants like methylphenidate and amphetamine-based meds are Schedule II controlled substances with abuse potential. Safe storage is essential. They do not require high-fat meals and doses should never be doubled.
A client newly prescribed duloxetine (Cymbalta) for generalized anxiety disorder reports experiencing headaches and difficulty sleeping. During the assessment, the nurse notes a blood pressure of 154/92 mmHg. What is the nurse’s best action?
A. Reassure the client that these are expected side effects and require no intervention
B. Instruct the client to stop taking the medication immediately and call the provider
C. Notify the healthcare provider about the elevated blood pressure reading
D. Encourage the client to take the medication at night to reduce insomnia and headaches
ANS: C
Duloxetine, an SNRI, increases norepinephrine, which can activate the sympathetic nervous system, potentially causing hypertension. An elevated BP like 154/92 mmHg warrants provider notification.
Which statement by a client taking clozapine (Clozaril) indicates the need for further teaching?
A. “I know I’ll need frequent blood tests while on this medication.”
B. “This drug may cause weight gain and raise my blood sugar.”
C. “I’ll stop the medication if I start to feel really tired.”
D. “This medication helps control symptoms of schizophrenia.”
ANS: C
Abruptly stopping clozapine can lead to psychotic relapse. The client should never stop the drug without medical supervision. Fatigue may be a side effect, but discontinuation must be discussed with the provider.
A client is prescribed divalproex sodium (Depakote) for seizure prevention. Which lab tests should the nurse expect to monitor? Select all that apply.
A. Platelet count
B. Liver enzymes (ALT, AST)
C. Serum sodium
D. Serum drug levels
E. BUN and creatinine
ANS: A, B, D
Divalproex (valproate) can cause thrombocytopenia and hepatotoxicity, so platelets and liver function should be monitored. Drug levels should be monitored to maintain therapeutic range.
Lurasidone is indicated for the following (SATA)
A. Anxiety
B. Schizophrenia
C. Bipolar I disorder
D. OCD
ANS: B, C
Lurasidone is indicated for the treatment of schizophrenia in adults and adolescents and bipolar I disorder in adult and pediatric patients
The nurse is educating the parent of a child starting guanfacine (Intuniv) for ADHD. Which side effect should the nurse instruct the parent to monitor most closely?
A. Insomnia and weight loss
B. Drowsiness and low blood pressure
C. Hyperactivity and agitation
D. Dry mouth and rapid speech
ANS: B
Guanfacine is a non-stimulant alpha-2 agonist that may cause sedation, fatigue, and hypotension, especially at the start of therapy or with dose increases. It's not associated with stimulant effects like insomnia or hyperactivity.