Nursing Considerations and Side Effects
When administering Lithium for bipolar disorder, nurses should monitor for toxicity and ensure patients maintain adequate hydration. What physiological factor increases Lithium retention and places patients at higher risk for toxicity?
sodium depletion
For patients receiving Lithium carbonate, which has a therapeutic range of 0.6–1.2 mEq/L, which clinical manifestation would most likely suggest Lithium toxicity if serum levels are above 1.5 mEq/L?
confusion and tremors
A patient on Haloperidol develops involuntary, sustained muscle contractions causing neck stiffness and difficulty swallowing. Which EPS is this, and what is the first-line treatment for this condition?
What is dystonia, and the treatment is benzotropine (Cogentin) or diphenhydramine (Benadryl)?
Lithium is commonly used for bipolar disorder to treat mania and hypomania. What is the most common adverse effect of Lithium, especially during the initial treatment phase?
What is polyuria and polydipsia?
Unlike benzodiazepines, Buspirone (Buspar) does not cause sedation or dependence. What is the critical patient teaching point regarding how long it takes for Buspirone to reach full therapeutic effect?
What is 2 to 4 weeks?
Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia, but it carries the risk of agranulocytosis. Which blood cell count must be checked weekly for the first 6 months to monitor for this serious side effect?
absolute neutrophil count (ANC)
(CBC)
Venlafaxine (Effexor), an SNRI, is prescribed for major depressive disorder and generalized anxiety disorder. When monitoring blood pressure during therapy, what is a serious side effect that may occur at higher doses, especially with long-term use?
hypertension
Tardive Dyskinesia (TD), an irreversible extrapyramidal side effect, causes repetitive, involuntary movements. What is the best intervention to prevent the development of TD in patients on long-term first-generation antipsychotics?
early detection and switching to a second-generation antipsychotic
Duloxetine (Cymbalta) is an SNRI prescribed for major depressive disorder and generalized anxiety disorder. What serious side effect requires close monitoring due to the risk of serotonin syndrome?
What is hypertension and serotonin syndrome (especially at higher doses)?
Benzodiazepines like Lorazepam are effective for acute anxiety, but pose significant risks with long-term use. What is the priority nursing intervention when discontinuing benzodiazepines after long-term use?
What is to taper the dose gradually to prevent withdrawal seizures?
Patients on First-Generation Antipsychotics (e.g., Haloperidol) are at high risk for extrapyramidal symptoms (EPS). Which EPS symptom manifests as a slow, shuffling gait, rigidity, and resting tremors in patients with Parkinsonism?
pseudo-parkinsonism
Clozapine requires frequent blood monitoring for agranulocytosis. What specific laboratory test is used to monitor the absolute neutrophil count (ANC), and at what threshold should Clozapine be discontinued due to the risk of fatal infection?
ANC < 1000
WBC <2000
A patient on antipsychotics reports experiencing restlessness, pacing, and difficulty sitting still. What EPS does this describe, and what medication can be given to treat this side effect?
What is akathisia, and the treatment is propranolol (Inderal) or benzodiazepines?
In treating bipolar disorder, which mood stabilizer has a narrow therapeutic window and requires frequent monitoring for serum levels, with toxicity potentially leading to neurological damage and renal failure?
What is Lithium?
This class of anti-anxiety medications is associated with anticholinergic effects like dry mouth, blurred vision, constipation, and urinary retention, and is generally avoided in older adults due to risk of confusion and falls.
What are benzodiazepines?
Buspirone (Buspar) is prescribed for Generalized Anxiety Disorder (GAD), and it does not cause sedation. What key nursing consideration must be avoided when taking Buspirone, which could alter its metabolism and lead to toxicity?
grapefruit juice
When administering first-generation antipsychotics like Chlorpromazine (Thorazine), the nurse should monitor for anticholinergic toxicity. Which common side effect of anticholinergic toxicity requires immediate intervention to prevent life-threatening complications?
urinary retention
A nurse notices muscle rigidity, hyperthermia, and altered mental status in a patient receiving Haloperidol. The patient is showing signs of Neuroleptic Malignant Syndrome (NMS). What is the first-line nursing intervention to manage NMS?
What is immediate discontinuation of the antipsychotic medication and supportive care, including hydration and cooling measures?
Which atypical antipsychotic used for bipolar disorder requires weekly monitoring of white blood cell count due to the risk of agranulocytosis, a potentially fatal side effect?
What is Clozapine?
SSRIs such as Paroxetine (Paxil) are often used as first-line treatments for Generalized Anxiety Disorder (GAD). What common initial side effect may paradoxically worsen anxiety before improvement is seen?
What is increased anxiety or agitation during the first few weeks of treatment?
Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal side effect of antipsychotic medications. When a patient presents with fever, muscle rigidity, and autonomic dysfunction, what is the initial priority intervention that the nurse must perform?
immediate discontinuation of the antipsychotic medication
The therapeutic level for Lithium is 0.6–1.2 mEq/L, but the nurse observes that the patient’s serum level is 1.8 mEq/L. What is the priority nursing action based on the symptoms of Lithium toxicity (e.g., confusion, tremor, GI distress)?
withholding the next dose of Lithium and consulting the healthcare provider immediately for potential treatment adjustments
A patient on first-generation antipsychotics presents with fever, autonomic dysregulation, and lead-pipe rigidity. What is the definitive treatment for Neuroleptic Malignant Syndrome (NMS) caused by dopamine antagonists?
What is dantrolene (a muscle relaxant), bromocriptine (a dopamine agonist), and supportive care?
Benzodiazepines (e.g., Lorazepam) are prescribed for acute anxiety. What nursing consideration is critical to prevent dependency or withdrawal symptoms with long-term use?
What is limiting use to short-term and tapering gradually when discontinuing?
A patient is prescribed Propranolol, a beta-blocker, for performance anxiety. What vital sign must the nurse always assess before administration, especially in patients with cardiac history?
What is the apical heart rate and blood pressure?