Deck 25: Psychopharmacology

Question 1

A patient has been taking chlorpromazine (Thorazine)for the past 2 weeks.He drools,has hand tremors,and walks with a shuffling gait.The nurse would correctly attribute these behaviors to:

A) Akinesia
B) Tardive dyskinesia
C) Pseudoparkinsonism
D) Neuroleptic malignant syndrome

Answer 1

Pseudoparkinsonism

Question 2

Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)?

A) Grimacing and lip smacking
B) Falling asleep in the chair and refusing to eat lunch
C) Experiencing muscle rigidity and tremors
D) Having excessive salivation and drooling

Answer 2

Grimacing and lip smacking

Question 3

Which patient outcomes would be most applicable for the patient who has been taking benzodiazepines? Patient will state:

A) That there are specific foods to avoid while on this medication
B) An understanding of how to increase medication dosage
C) That alcohol is a substance to avoid while on the medication
D) An understanding that he or she can return to work while on this medication

Answer 3

That alcohol is a substance to avoid while on the medication

Question 4

A patient with rapid cycling bipolar disorder is not responding well to lithium.The patient tells the nurse,"It feels as though I'll never get well.I get better,and then I get worse." The reply that is based on knowledge of current therapy would be:

A) "You're feeling very discouraged aren't you?"
B) "It's not all bad, is it? Sometimes you like being high."
C) "Another drug, valproic acid, is proving effective for rapid cycling."
D) "If your kidneys hold out, the lithium will eventually control the symptoms."

Question 5

A patient prescribed alprazolam (Xanax)for symptoms of anxiety shares with the nurse that,"I'm concerned about getting off this medication." Upon which fact will the nurse base the response to the patient's concern?

A) Long elimination half-life will result in a manageable withdrawal treatment plan.
B) Rapid absorption and distribution to brain cells make withdrawal more difficult to manage.
C) Sensitivity of the mesencephalic reticular activating system makes addiction unlikely.
D) The combination of medication with an antidepressant often positively impacts withdrawal.

Question 6

A patient who has received lithium for 3 weeks to control acute mania has the following symptoms: coarse hand tremor,diarrhea,vomiting,lethargy,and mild confusion.The priority nursing action should be to:

A) Administer prn Cogentin to relieve the symptoms.
B) Provide reassurance that the symptoms are transient.
C) Obtain a stat lithium level; hold lithium pending results.
D) Assist the patient to decrease the sodium in their daily diet.

Question 7

Which of these statements made by a patient taking the MAOI phenelzine (Nardil)would warrant further instruction?

A) "I often forget to wear sunscreen when I go outside."
B) "I need to restrict the amount of sodium in my diet."
C) "I should not use over-the-counter cold medications."
D) "I usually order liver and onions when my wife and I eat out."

Question 8

An individual with poststroke depression is receiving an SSRI.What is the rationale for giving the medication at breakfast and again at midday?

A) Prevent insomnia
B) Prevent toxic reactions
C) Decrease afternoon sleepiness
D) Give an opportunity to monitor behavior closely

Question 9

Which patient complaint should receive priority from a patient who is taking the MAOI tranylcypromine (Parnate)?

A) "I haven't had a bowel movement in 2 days."
B) "Will you take my temperature? I feel too warm."
C) "I get a headache when I drank several cups of coffee."
D) "My legs get stiff when I sit in the chair for any length of time."

Question 10

A severely depressed patient has been prescribed clomipramine (Anafranil).For which medication side effects should the patient be monitored?

A) Excess salivation and drooling
B) Muscle rigidity and restlessness
C) Polyuria and coarse hand tremors
D) Orthostatic hypotension and constipation

Question 11

When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed oral haloperidol (Haldol),which intervention would promote medication compliance?

A) Instructing the patient to have friends monitor his medications
B) Beginning administration of haloperidol (Haldol) decanoate
C) Writing instructions in detail for the patient to follow
D) Changing haloperidol to an atypical antipsychotic

Question 12

The nurse would assess for neuroleptic malignant syndrome (NMS)if a patient on haloperidol (Haldol)develops a:

A) 30 mm Hg decrease in blood pressure reading
B) Respiratory rate of 24 respirations per minute
C) Temperature reading of 104° F
D) Pulse rate of 70 beats per minute

Question 13

A patient taking fluphenazine (Prolixin)complains of dry mouth and blurred vision.What would the nurse assess as the likely cause of these symptoms?

A) Decreased dopamine at receptor sites
B) Blockade of histamine
C) Cholinergic blockade
D) Adrenergic blocking

Question 14

Sertraline (Zoloft)has been prescribed for a patient with symptoms of a major depression.Which factor was probably most important in the physician's decision to use an SSRI?

A) Good side-effect profile
B) Less expense for the patient
C) Increase in medication compliance
D) Rapid rate of absorption from the GI tract

Question 15

To educate a patient regarding what to expect following the administration of a benzodiazepine,the nurse must understand that benzodiazepines:

A) Have a rapid onset of peak action
B) Reduce availability of GABA
C) Generally diminish the activity of GABA
D) Interact with serotonin to increase availability

Question 16

Which statement made by a patient who will be maintained on lithium following discharge will require further instruction by the nurse?

A) "I will have my blood work done regularly."
B) "When I get home, I may go on a salt-free diet."
C) "I have learned not to restrict my intake of water."
D) "I understand some people gain weight on lithium."

Question 17

Which person with mania is the least likely candidate to receive lithium? The patient who is:

A) Six weeks pregnant
B) Recovering from a hysterectomy
C) Taking hormone replacement therapy
D) Displaying symptoms of postpartum depression

Question 18

When asked how tricyclic antidepressants affect neurotransmitter activity,the nurse should respond that they:

A) Decrease available dopamine.
B) Increase availability of norepinephrine and serotonin.
C) Make available increased amounts of monoamine oxidase.
D) Increase the effects of the chemical gamma-aminobutyric acid.

Question 19

The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics.The nurse correctly states that atypical antipsychotics:

A) Remain in the system longer
B) Act more quickly to reduce delusions
C) Produce fewer extrapyramidal effects
D) Are risk free for neuroleptic malignant syndrome (NMS)

Question 20

Which statement by a patient with generalized anxiety disorder for whom lorazepam (Ativan)is prescribed as needed (prn)suggests the patient understands the purpose of the medication?

A) "I can talk with my therapist more easily after my medication takes effect."
B) "I wonder if I will have to take this medication for the rest of my entire life."
C) "I'm embarrassed and don't want anyone to know I'm on this kind of medication."
D) "I'm going to ask for my prn dose so I can sleep instead of worrying about my kids."

Question 21

A patient with schizophrenia is seen in the ED in an acutely agitated state resulting from threatening auditory hallucinations.The patient's medical record indicates he has had severe dystonic reactions to parenteral administration of typical antipsychotic medication.The nurse can anticipate that the physician will order:

A) Ziprasidone (Geodon)
B) Fluphenazine (Prolixin) decanoate
C) Clozapine (Clozaril)
D) Paroxetine (Paxil)

Question 22

When reviewing the medications being taken by an elderly patient diagnosed with Alzheimer's disease,the nurse should consult with the patient's physician when noting a prescription for:

A) Risperidone (Risperdal)
B) Fluphenazine (Prolixin)
C) Lorazepam (Ativan)
D) Sertraline (Zoloft)

Question 23

A patient receiving haloperidol urgently calls to the nurse and reports that his eyes have rolled upward and he cannot redirect his gaze.The nurse contacts the physician to seek an order for:

A) Fluphenazine (Prolixin)
B) Citalopram (Celexa)
C) Benztropine (Cogentin)
D) Risperidone (Risperdal)

Question 24

What intervention will the nurse request for a patient reporting gastrointestinal side effects related to valproate therapy?

A) Mild laxative
B) Low-fat diet
C) Oral antacid
D) Histamine-2 antagonist

Question 25

A patient who began haloperidol (Haldol)therapy 24 hours ago tells the nurse that he feels jittery and unable to sit or stand still.The nurse can hypothesize that this report is related to:

A) Dystonia
B) Akathisia
C) Serotonin syndrome
D) Neuroleptic malignant syndrome

Question 26

When following up on SSRI medication side effects,the nurse will need to make specific inquiries about:

A) Anticholinergic symptoms
B) Alpha-adrenergic blockade
C) GI tract symptoms
D) Sexual dysfunction

Question 27

An atypical antipsychotic has been prescribed for an elderly patient.The nurse developing the patient's care plan includes:

A) Scheduling weekly WBC counts
B) Teaching about a tyramine-free diet
C) Requesting that a daily laxative be included
D) Teaching fall prevention strategies to both the patient and family

Question 28

To evaluate outcomes for a patient with schizophrenia receiving typical antipsychotic drug therapy,the nurse would look for improvement in:

A) Affective mobility
B) Positive symptoms
C) Self-care activities
D) Cognitive functioning

Question 29

A patient taking SSRIs mentions to the nurse that his current medication causes fewer side effects than the tricyclic antidepressant he took several years earlier.The nurse understands that SSRIs advantage is due to:

A) Inhibiting both serotonin and norepinephrine uptake
B) Selectively inhibiting dopamine uptake
C) Blocking only serotonin reuptake
D) Making more GABA available

Question 30

The nurse must notify the physician of the need to suspend treatment for a patient receiving clozapine (Clozaril)when the weekly WBC monitoring shows:

A) WBCs below 2000/mm3 and absolute neutrophils below 1000/mm3
B) WBCs below 2500/mm3 and absolute neutrophils below 1500/mm3
C) WBCs below 3000/mm3 and absolute neutrophils below 2000/mm3
D) WBCs below 3500/mm3 and absolute neutrophils below 2500/mm3

Question 31

A patient's serum lithium level is reported as 1.9 mEq/L.The nurse should immediately:

A) Restrict sodium and fluid intake.
B) Assess for signs and symptoms of toxicity.
C) Seek to have the patient transferred to ICU.
D) Notify the patient's physician immediately.

Question 32

The nurse notes that a patient who has been receiving paroxetine (Paxil)for symptoms of major depression begins to behave in a confused and elated manner with the presence of restlessness,muscle jerking,and diaphoresis.The nurse should assess these symptoms as probable:

A) Neuroleptic malignant syndrome
B) Anticholinergic blockade
C) Serotonin syndrome
D) Dystonia

Question 33

A patient whose schizophrenia has been refractory to treatment with other medications has been placed on clozapine (Clozaril).The priority discharge teaching should include:

A) Keep salt intake the same from day to day.
B) Maintain a strict tyramine-free daily diet.
C) Report for weekly blood tests for CBC level.
D) Use sunblocking agents when out of doors.

Question 34

When a patient for whom haloperidol has been prescribed tells the nurse,"I'm burning up and my muscles are stiff and sore," the nurse suspects neuromuscular malignant syndrome and recognizes the possibility that the physician may order:

A) Olanzapine (Zyprexa)
B) Benztropine (Cogentin)
C) Venlafaxine (Effexor)
D) Dantrolene (Dantrium)

Question 35

During a psychiatric emergency,IM ziprasidone (Geodon)is administered to an assaultive patient.During the next 2 hours,it is of primary importance that the nurse assess for:

A) Tardive dyskinesia
B) Anticholinergic effects
C) Orthostatic hypotension
D) Pseudoparkinsonism

Question 36

An appropriate outcome for trihexyphenidyl (Artane)therapy used in conjunction with high potency typical antipsychotic medication therapy is that the patient will:

A) Demonstrate a brighter mood
B) Be less sedated and drowsy
C) Display fewer movement disorder symptoms
D) Display decreased anticholinergic symptoms