Question 1

A nurse observes a patient diagnosed with schizophrenia tapping both feet,smacking both lips,and making contorted faces while speaking to another patient.These behaviors prompt the nurse to suspect the patient is experiencing:

Accepted Answer

Tardive dyskinesia usually occurs with long-term conventional antipsychotic agent treatment and is evidenced by stereotypical involuntary movements (e.g.,tongue protrusion,lip smacking,chewing,blinking,grimacing,choreiform movements of the limbs and trunk,foot tapping).

Question 2

Which assessment data would indicate to the nurse that the patient who is prescribed a benzodiazepine is experiencing a medication side effect?

Accepted Answer

A common side effect of benzodiazepine therapy is dizziness.Two options indicate that the patient is actually obtaining relief from the benzodiazepine,and physiological dependency is unlikely,whereas psychological dependency can occur if the patient is not taught effective ways to manage anxiety aside from taking a pill.

Question 3

What will a health care provider include in medication teaching for a patient who will be starting a monoamine oxidase inhibitor (MAOI) medication after ending treatment with sertraline hydrochloride (Zoloft)?

Accepted Answer

The psychiatrist or advanced practice nurse (psychiatric clinical specialist) will wait 2 weeks before changing from a selective serotonin reuptake inhibitor (SSRI) to a monoamine oxidase inhibitor (MAOI).The SSRI should not be administered concomitantly with an MAOI.Foods that contain tyramine (e.g.,Chianti,nuts,figs,cheese),a pressor amine,are avoided to prevent hypertensive crisis.

Question 4

A patient taking medication for depression states,"I need to stop taking my medication because it blurs my vision,and I'm making mistakes when I paint jewelry by hand." Which response by a nurse would be most therapeutic?

Accepted Answer

Blurred vision,an anticholinergic side effect of antidepressant and antipsychotic medications,will usually resolve within 1 to 2 weeks.The most therapeutic intervention is the one that assesses the patient's recall of medication teaching.Moreover,it offers a strategy to assist the patient to cope during work time.The nurse must apply knowledge of the anticholinergic side effects of antidepressants and antipsychotics to select the appropriate nursing intervention for the patient's problem.Although ECT may be offered when patients are unable to take medication,it is premature to suggest ECT or other medications,and these suggestions reflect a knowledge deficit.It is considered best to encourage patients to maintain activities of daily living and work,if possible.

Question 5

Which medication would the nurse expect to administer when observing that a patient being treated for schizophrenia is fidgety,demonstrates motor restlessness,and jiggles both legs when asked to sit down?

Accepted Answer

By blocking dopamine,antipsychotic medications produce extrapyramidal side effects.Akathisia is internal or external restless fidgeting or pacing.Patients with akathisia demonstrate motoric restlessness and complain of feeling their muscles quiver.When this condition has advanced,the patient will say that he or she is not able to sit still or lie down quietly.The nurse will want to observe whether the patient's legs are shaking.If the patient's feet are not shaking,the nurse will observe that his or her arms will start to shake.The therapeutic treatment is the administration of anticholinergic agents,such as benztropine (Cogentin),trihexyphenidyl (Artane),or procyclidine (Kemadrin).Diphenhydramine (Benadryl),an antihistamine,also may be administered.The other three medication selections are antipsychotic agents: Zyprexa,an atypical antipsychotic; Moban,an antipsychotic (dihydroindolone); and Mellaril (phenothiazine),a typical antipsychotic.

Question 6

When a patient requires an ever-increasing dose of a medication to achieve the same therapeutic effect,the nurse must assess the patient for:

Accepted Answer

Some patients become less responsive to the same dose of a particular drug over time,which is called tolerance,requiring that higher doses of the drug be given over time to obtain the same therapeutic effect.

Question 7

During a home visit with a patient diagnosed with schizophrenia the patient tells the nurse,"I'm going to stop going to the clinic for my fluphenazine decanoate (Prolixin) shots because I think I'm okay now." Which statement represents the best understanding of the effect of the patient's decision on the prognosis?

Accepted Answer

Nonadherence or noncompliance with medication is usually lessened with the decanoate preparation of the antipsychotic medication.The most therapeutic communication is usually the one that helps the patient to share thoughts and feelings.By restating and seeking clarification,the nurse can assist the patient in looking at what he or she is saying.If the nurse focuses,the patient will be able to help with the thinking-through process,which is to communicate that the Prolixin injections are received only 12 to 14 times annually and that they will keep the patient's thoughts clear.

Question 8

In order to accurately predict how the body absorbs,distributes,metabolizes,and eliminates psychotropic medications the nurse must be familiar with a medication's:

Accepted Answer

Pharmacokinetics is the study of how the body affects a drug.It answers the question: how does the body get drugs to and from their intended target? Body functions such as absorption,distribution,metabolism,and elimination all are pharmacokinetics.

Question 9

A nurse is assessing a patient who was recently prescribed an antipsychotic medication.Which side effects could the nurse expect to observe?

Accepted Answer

The most common side effects of antipsychotic medications include the following: dry mouth,blurred vision,nasal stuffiness,weight gain,difficulty urinating,infection,decreased sweating,increased sensitivity to sunlight,yellowing of the eyes (especially the whites of the eyes),breast enlargement/lactation,skin rash,anhedonia,itchy skin,and constipation.

Question 10

A patient who has been treated with clozapine (Clozaril) for 9 months calls to cancel a clinic appointment because of flulike symptoms,including a sore throat,fever,and tiredness.The nurse demonstrates the best understanding on the management of these symptoms when responding:

Accepted Answer

Although agranulocytosis occurs in only about 1% to 2% of patients,this is a risk 10 to 20 times greater than the risk with standard antipsychotic agents.In addition,even though the risk for this adverse effect decreases substantially after 5 months of taking these drugs,the risk always remains and requires vigilant monitoring.After the first 6 months,blood counts are drawn biweekly,so the nurse in the above situation would want to obtain one today to determine whether the patient is experiencing agranulocytosis or flu.Although this is a serious adverse effect,the nurse will provide specific instructions but endeavor not to alarm the patient.In addition,the fact that this patient is female and of an older age places her at increased risk for agranulocytosis.

Question 11

A patient who has been taking an antidepressant for 2 months shares with the nurse,"Since my depression is over,I've stopped the Prozac and I won't need to see you any longer." Which response by a nurse would be most therapeutic?

Accepted Answer

Most patients who respond initially to antidepressant therapy require at least 1 year of therapy and may take medication on a lifetime basis.This is similar to patients who take antihypertensives or insulin.The patient's statement alerts the nurse to set clear therapy goals that extend beyond medication assessment.Prozac takes 2 to 4 weeks to reach a steady state and is maintained in the body for several weeks after it is discontinued,but the nurse's suggestion of tapering off the medication is a wise intervention for this patient,who seems impulsive about medication adherence.A patient with a knowledge deficit and nonadherence potential requires communication that recalls prior teaching and that builds on the knowledge he or she already has.Reminding the patient of the time it takes to become depressed provides anticipatory guidance about the possibility of needing medication on a lifetime basis.Sarcastic humor is usually a poor response that demeans the patient and may reflect the nurse's impatience and a judgmental attitude toward the patient,and a laissez-faire response does not reflect a caring attitude.Withdrawal usually is not a problem for medications with a long half-life.

Question 12

A patient being treated for depression reports experiencing nausea,palpitations,and "a terrible headache." When the physical examination determines the patient is diaphoresic and hypertensive,the nurse should ask:

Accepted Answer

This question requires analytical decision making to identify hypertensive crises and data for the evaluation process.Knowing when the last dose of the monoamine oxidase inhibitor (MAOI) was taken helps determine immediate treatment.Although the ingestion of alcohol is pertinent to determining what tyramine-containing foods the patient may have had,it is not as crucial as knowing when the last dose of MAOI was consumed.Although natural foods may produce similar bioactivity and other antidepressants should not be taken along with an MAOI,these answers do not reflect medication assessment and evaluation.The patient is experiencing the clinical manifestation of hypertensive crisis.The classic symptoms of this condition are severe occipital headache,dilated pupils,hypertension,and palpitations or arrhythmias.This syndrome can be caused when the patient who is taking an MAOI ingests food containing tyramine,an amino acid released from foods that undergo hydrolysis (e.g.,fermentation,aging,pickling,smoking,spoilage).This inhibits the monoamine oxidase and allows tyramine to reach the adrenergic nerve endings and cause the release of excess norepinephrine,which causes hypertensive crisis.To confirm the physical syndrome,first determine whether the patient is taking an MAOI.Knowing when the last dose was ingested provides a window for the duration of hypertension and therapeutic nursing interventions.

Question 13

A patient taking a benzodiazepine says to the nurse,"I really like this pill because if I just take an extra one when I get very anxious,I always feel a lot better." What is the nurse's best response?

Accepted Answer

The patient seems to be using the medication first rather than trying more holistic ways of controlling the anxiety.It is the nurse's responsibility to teach complementary and alternative ways to cope with anxiety and stress as a lifetime measure rather than simply using a pill every time the patient identifies anxiety.Mild anxiety may help the individual adapt.

Question 14

Which set of instructions is most appropriate when preparing the patient for collection of a 24-hour creatinine clearance for a prelithium workup?

Accepted Answer

No consent form is required for this 24-hour urine and serum collection.Blood may be drawn at any time during the collection.In the morning the first voiding is discarded,and then the collection is timed and urine is collected for 24 hours.All urine is stored in a clean,3-L plastic container that is refrigerated when not in use and then delivered to the lab.Teaching the patient the procedure for a 24-hour creatinine clearance as part of a prelithium workup (urinalysis,BUN,TSH,T? and T?,FBS,and a complete physical examination with history and workup for family history of renal disease,diabetes mellitus,hypertension,diuretic use,and analgesic abuse) is required.

Question 15

A patient will be starting on fluoxetine hydrochloride (Prozac) therapy and taking 20 mg PO every morning.Which information should the nurse provide to the patient?

Accepted Answer

This question requires the application of knowledge about selective serotonin reuptake inhibitors (SSRIs) to a specific plan for medication education.To reduce nausea,the patient should be advised to take the medicine with meals.When teaching patients who are taking tricyclic antidepressants (TCAs),one must emphasize that patients should dangle their legs over the bed and change positions slowly to prevent postural hypotension.It is also advisable for patients to increase fluids,exercise,and roughage intake to prevent the anticholinergic effects of antidepressants.Foods that contain tyramine (e.g.,Chianti,nuts,cheese) are prohibited when patients are taking monoamine oxidase inhibitors (MAOIs).The primary synaptic activity for SSRIs is to inhibit the reuptake of 5-HT.The possible clinical effects of 5-HT include the following: gastrointestinal (GI) disturbances and sexual dysfunction.Fluoxetine hydrochloride (Prozac),an SSRI that is usually administered in the morning to reduce the potential of a side-effect profile that is 2+ for insomnia/agitation,also demonstrates a 3+ for GI disturbances.

Question 16

A patient who is taking lithium shares with the nurse,"I'm planning to breast-feed my baby who is due to be born in 2 months." Which statement shows the best understanding of the effect of lithium on breast-feeding?

Accepted Answer

Lithium crosses the placental barrier and is excreted in the breast milk,so breast-feeding is not an option.Lithium should only be taken by pregnant women when it is an absolute necessity.

Question 17

When assessing a patient who has been prescribed an antipsychotic medication,which statement would indicate a need for further patient education?

Accepted Answer

Increased sensitivity to sunlight is one of the most common side effects of antipsychotic agents.The patient will need to be instructed about the importance of using a sunscreen at all times when in the sun.

Question 18

A patient who is taking psychotropic medication is experiencing constipation.Which intervention would the nurse plan for the patient?

Accepted Answer

Constipation,an anticholinergic side effect,is alleviated by drinking six to eight glasses of water and eating bran and green vegetables daily.Prunes and raisins are especially helpful.If the side effect continues,the patient should notify the health care provider and use a laxative only when medically advised to do so.

Question 19

A patient who is prescribed an antidepressant medication says,"I've been getting dizzy in the morning when I wake up ever since I started this drug.Do you think I should stop taking it?" Which communication would reflect the most therapeutic nursing intervention on the basis of the patient's problem?

Accepted Answer

Antidepressant medications can cause orthostatic or postural hypotension,and the nurse will teach the patient the following: lie down,rest as able,and change positions slowly.Dangle at the side of the bed for 30 seconds or so.Operate heavy equipment and drive a car only with caution.Check and record your blood pressure,both sitting and standing,twice each day.

Question 20

Which statement represents the most appropriate instructions for a patient with a past suicide attempt who is prescribed amitriptyline (Elavil),150 mg PO at bedtime?

Accepted Answer

Amitriptyline (Elavil) is a tricyclic antidepressant (TCA) medication (tertiary amine).The TCAs are very toxic when ingested at levels of 1000 to 3000 mg,and overdosage and suicide attempts with this medication are extremely dangerous and often require emergency medical attention.Because an overdose often requires only a 1-week supply of medication,it is the nurse's responsibility to suggest that the prescription be dispensed in weekly doses.In the above situation,the patient has a history of self-directed lethality,and prudence is the best approach.By asking the patient to help the nurse determine the easiest method of dispensing medication,the nurse allows the patient control and offers respect and mutuality.

Quiz 26: Psychopharmacology