Deck 7: Psychotherapeutic Drugs

Question 1

A patient taking fluoxetine reports decreased sexual interest. The prescriber orders a "drug holiday." What instructions will the provider give the patient to describe a drug holiday?

A) "Cut the tablet in half anytime to reduce the dosage."
B) "Discontinue the drug for 1 week."
C) "Don't take the medication on Friday and Saturday."
D) "Take the drug every other day."

Answer 1

"Don't take the medication on Friday and Saturday."

Question 2

A neonate is born to a mother who is prescribed venlafaxine. The provider orders the neonatal unit staff to report any signs of drug withdrawal seen in the infant. The staff will monitor for what signs of withdrawal?

A) Irritability, tremor, and respiratory distress
B) Poor appetite and disturbed sleeping patterns
C) Serotonin syndrome
D) Sustained mydriasis

Answer 2

Irritability, tremor, and respiratory distress

Question 3

A college track star with a history of seasonal allergies is diagnosed with bipolar disorder. After the prescriber teaches the patient about newly ordered lithium, which statement by the patient indicates the need for further teaching?

A) "I can continue to use ibuprofen as needed for muscle pain."
B) "I need to drink extra fluids before and during exercise."
C) "I should stop taking antihistamines while taking lithium."
D) "I should report muscle weakness and tremors to my provider."

Answer 3

"I can continue to use ibuprofen as needed for muscle pain."

Question 4

A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over 6 months. Which medication will the provider order for this patient?

A) Alprazolam
B) Amitriptyline
C) Buspirone
D) Paroxetine

Question 5

A patient who is admitted to a hospital for management of first-time symptoms of mania is exhibiting euphoric mania. Which medication will the provider order?

A) Lithium
B) Olanzapine
C) Risperidone
D) Divalproex sodium

Question 6

A patient is given intravenous diazepam for seizures. When the seizures stop, the patient is lethargic and confused with a respiratory rate of 10 breaths/minute. The provider will take what action immediately to address the patient's risk for injury?

A) Prescribe flumazenil.
B) Order a gastric lavage.
C) Institute respiratory support measures.
D) Order toxicology testing.

Question 7

A patient taking a monoamine oxidase inhibitor (MAOI) has a blood pressure of 198/102 mm Hg. What assessment question will the provider initially ask this patient?

A) "Are you taking any antihypertensive medications?"
B) "Do you drink grapefruit juice?"
C) "What foods have you eaten in the last 24 hours?"
D) "Are you taking any SSRIs in addition to the MAOI?"

Question 8

To manage a patient's panic attacks, the provider will first prescribe a drug in which drug class?

A) Benzodiazepines
B) Monoamine oxidase inhibitors
C) Selective serotonin reuptake inhibitors
D) Tricyclic antidepressants

Question 9

A patient with asthma is having difficulty at work because of anxiety and fear when making presentations at meetings three or four times each year. The patient reports when this occurs, the anxiety can stimulate an asthma attack. The provider will order which medication to be taken as needed?

A) Alprazolam
B) Albuterol
C) Paroxetine
D) Propranolol

Question 10

A patient prescribed a serotonin reuptake inhibitor (SSRI) for depression several months ago tells the provider that the medication has not helped with symptoms. The provider explains plans to switch to a monoamine oxidase inhibitor (MAOI). What must the provider do to address the patient's risk for injury?

A) Start taking the MAOI and stop the SSRI when symptoms improve.
B) Start taking the MAOI and then gradually withdraw the SSRI.
C) Gradually withdraw the SSRI while gradually increasing the MAOI dosage.
D) Stop taking the SSRI 2 weeks before starting the MAOI.

Question 11

A patient diagnosed with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone in addition to the lithium that the patient is already taking. The prescriber will tell the patient that the risperidone is used to achieve what outcome?

A) Elevation of mood during depressive episodes
B) Helping to control symptoms during manic episodes
C) Managing tremors associated with lithium use
D) Preventing recurrence of depressive episodes

Question 12

A provider orders thioridazine for a patient with diabetes mellitus who is diagnosed with schizophrenia. The patient requests olanzapine, which the patient has seen advertised on television. Which response will the provider give to address the primary reason the patient is not being prescribed olanzapine?

A) "Olanzapine is more expensive than thioridazine."
B) "Olanzapine causes more metabolic side effects than thioridazine."
C) "Thioridazine has fewer side effects than olanzapine."
D) "Thioridazine has a faster onset of action than olanzapine."

Question 13

A patient whose job requires often staying up late and then getting up early reports occasional instances of being unable to fall asleep. The provider will prescribe which medication for this patient?

A) Flurazepam
B) Trazodone
C) Zaleplon
D) Zolpidem

Question 14

A provider prescribes clozapine for a patient with schizophrenia who shows suicidal behaviors. After the provider teaches the family about the medication and its side effects, which statement by a family member indicates a need for further teaching about this drug?

A) "Blood counts are necessary for several weeks after discontinuation of the drug."
B) "Fever, sore throat, and sores in the mouth should be reported immediately."
C) "If the absolute neutrophil count is less than 3000, the drug will be discontinued permanently."
D) "Use of this drug requires weekly evaluation of blood work."

Question 15

A young adult patient, who has been taking an antidepressant medication for several weeks, reports having increased thoughts of suicide. The patient's history includes an attempted suicide more than once in the past. When questioned the patient identifies a concrete plan for committing suicide. The provider will take what action to best assure the patient's safety?

A) Changing the medication to another drug class
B) Discontinuing the current medication immediately
C) Hospitalizing the patient for closer monitoring
D) Requiring more frequent clinic visits for this patient

Question 16

A patient with bipolar disorder who has been taking lithium for several years has developed a goiter. When the serum tests reveal hypothyroidism what will the provider prescribe for this patient?

A) Levothyroxine therapy
B) Increasing the lithium dose
C) Iodine supplements daily
D) Propylthiouracil

Question 17

A patient prescribed a first-generation antipsychotic (FGA) has developed difficulty speaking and chewing and is observed having slow, wormlike movements of the tongue. The provider recognizes these symptoms and begins treatment for which adverse reaction?

A) Acute dystonia
B) Akathisia
C) Parkinsonism
D) Tardive dyskinesia

Question 18

A prescriber provides teaching for a patient about to begin taking a first-generation antipsychotic (FGA) drug. Which statement by the patient indicates a need for further teaching about side effects of these drugs?

A) "Increased salivation and diarrhea are common with this medication."
B) "I may experience gynecomastia and galactorrhea."
C) "I may feel lightheaded or dizzy and should sit or lie down if this occurs."
D) "Sedation may occur initially, but will subside in 1 to 2 weeks."

Question 19

A patient is prescribed a benzodiazepine for alcohol withdrawal. The provider understands that this drug is effective because of what associated action?

A) The alcohol does not interact with the benzodiazepine.
B) The benzodiazepine potentiates alcohol withdrawal symptoms.
C) The benzodiazepine relieves muscle spasms and spasticity.
D) The patient has a cross-dependence to the benzodiazepine.

Question 20

A patient who has major depression with severe symptoms begins taking an antidepressant medication. Three weeks later, the patient reports that the drug is not working. What action will the provider take to address the patient's concerns?

A) Add a second medication to complement this drug.
B) Change the medication to one in a different drug class.
C) Increase the dose of this medication.
D) Suggest nondrug therapies to augment the medication.

Question 21

A patient is brought to the emergency department after taking a handful of tricyclic antidepressant (TCA) tablets. What interventions will the provider order? (Select all that apply.)

A) Cardiac monitoring
B) Intravenous sodium bicarbonate
C) Gastric lavage and activated charcoal
D) Sedative medications
E) Procainamide

Question 22

Which patients will the provider consider as candidates for monoamine oxidase inhibitor (MAOI) therapy? (Select all that apply.)

A) Patients who have not responded to SSRIs and TCAs
B) Patients diagnosed with atypical depression
C) Patients with bulimia nervosa
D) Patients with hypotension
E) Patients with postpartum depression

Question 23

A patient who takes haloperidol for schizophrenia is found lying rigid in bed with a temperature of 41.3 $\degree$ C. A cardiac monitor shows cardiac dysrhythmias. What interventions will be ordered by the provider as the treatment of this patient? (Select all that apply.)

A) Anticholinergic medications
B) ( $\beta$ ) blockers
C) Dantrolene
D) Intravenous fluids
E) Withdrawal of haloperidol

Question 24

A child will begin taking methylphenidate for attention-deficit/hyperactivity disorder (ADHD). What important baseline information about this patient will the provider obtain before medication administration is started?

A) An electrocardiogram (ECG)
B) A family history of psychosis
C) Child's height and weight
D) Status of renal function