Question 1

A nurse is performing an admission assessment. The client reports taking larger and larger doses of medication to get the desired effect. Based on this information, the nurse interprets this as suggesting what possible outcome?

Accepted Answer

Tolerance is a gradual decrease in the action of a drug at a given dose or concentration in the blood. This decrease may take days or weeks to develop and results in a loss of the therapeutic effect of a drug, necessitating an increase in medication to achieve the desired effect. Desensitization is a rapid decrease in drug effects that may develop within a few minutes of exposure to a drug. Toxicity generally refers to the point at which concentrations of the drug in the bloodstream are high enough to become harmful or poisonous to the body. Individuals vary widely in their responses to medications. Some clients experience adverse reactions more easily than others. The therapeutic index is the ratio of the maximum nontoxic dose to the minimum effective dose. A high therapeutic index means that there is a large range between the dose at which the drug begins to take effect and a dose that would be toxic to the body.

Question 2

An older adult reports anxiety and is prescribed diazepam by a primary care provider. The office nurse is asked to explain to the client the problematic side effects of this medication. Which instruction about this drug would be most important for the nurse to emphasize?

Accepted Answer

Diazepam is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client as the dizziness is directly related to a risk for physical injury.

Question 3

A nurse is caring for a psychiatric client who is prescribed an antipsychotic agent. The client is also receiving an antacid that contains aluminum salts. Which action by the nurse would be most appropriate?

Accepted Answer

Antacids containing aluminum salts decrease the absorption of most antipsychotic drugs; thus, antacids must be given at least 1 hour before administration or 2 hours afterward.

Question 4

A client is prescribed medication for a psychiatric disorder. After 3 days, the client reports being constipated. Which instruction would the nurse give the client?

Accepted Answer

The nurse should instruct the client to increase fiber and fluid intake. A mild laxative, exercise, and fiber supplement also may help the client's constipation. High-protein foods would have no effect on constipation. Stool softeners may be appropriate if an increase in fiber and fluids is ineffective. The side effect will not necessarily disappear.

Question 5

A nurse is caring for a psychiatric client age 70 years who has been prescribed a number of medications. When educating the client on the medications, which explanation would be most appropriate?

Accepted Answer

The activity of hepatic enzymes slows with age. As a result, the ability of the liver to metabolize medications may slow to as much as a fourfold decrease between the ages of 20 and 70 years. Thus, the client is at increased risk for toxicity. Gastric pH increases, and gastric emptying and motility decrease, which can influence absorption.

Question 6

A client has been prescribed clozapine for treatment of schizophrenia. Which would the nurse include in the education plan for this client and family?

Accepted Answer

Weight gain is a common side effect of the atypical antipsychotics, particularly clozapine and olanzapine, which can cause a weight gain of up to 20 pounds within 1 year. Orthostatic hypotension may occur with this drug. Breast engorgement would be more likely with typical antipsychotics. Photosensitivity, not dermatitis, is associated with antipsychotic use.

Question 7

A client who has been taking clozapine for 6 weeks visits the clinic reporting fever, sore throat, and mouth sores. The nurse notifies the client's physician because the nurse suspects what possible side effect of the medication?

Accepted Answer

High fever, sore throat, and mouth sores are indicative of infection secondary to agranulocytosis, which has been associated with clozapine. The medication can suppress the bone marrow and cause a significant decrease in white blood cells. The client's signs and symptoms do not suggest anemia, neuroleptic malignant syndrome, or encephalitis.

Question 8

A hospitalized client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. The client tells the nurse, "I cannot sit still." The nurse documents this finding using what term?

Accepted Answer

The client's inability to "sit still" and the client's frequent pacing are termed akathisia, an extrapyramidal effect of the antipsychotic medication. Akinesia is slowed movements. Dystonia involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles. Pseudoparkinsonism includes rigidity, slowed movements, and tremor.

Question 9

A nurse observes an older adult client who has been taking antipsychotic medications for 4 years. The nurse sees the client's lips smacking and eyes blinking rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?

Accepted Answer

The nurse should document the symptoms of tardive dyskinesia, a chronic syndrome caused by long-term use. Asking whether the client has been experiencing side effects would be inappropriate because the client is already exhibiting signs. Contacting the physician for a different medication implies that these effects can be reversed. Tardive dyskinesia is typically irreversible. It is not within the nurse's scope of practice to instruct the client to begin to taper the drug.

Question 10

A nurse is working as part of a team involved with the testing of a new psychiatric medication. The drug is currently being used in multiple clinical trials at various different sites. The nurse is engaged in which phase of testing?

Accepted Answer

Phase III of new drug testing involves extensive clinical trials conducted at multiple sites throughout the country with large numbers of clients. This phase concludes with a new drug application being submitted to the U.S. Food and Drug Administration (FDA). Phase I testing defines the range of dosages tolerated in healthy individuals. Phase II testing studies the effects of the drug in a limited number of persons with the disorder and defines a range of clinically effective dosages. Phase IV involves drug studies that continue after FDA approval to detect new or rare adverse reactions and potentially new indications.

Question 11

A psychiatric-mental health nurse practitioner is conducting a class on the pharmacodynamics of psychiatric medications for a group of psychiatric-mental health nurses. The nurse practitioner determines that additional education is needed when the group identifies which as a site of action?

Accepted Answer

Psychiatric medications primarily target the central nervous system at the cellular synaptic level at four sites: receptors, ion channels, enzymes, and carrier proteins. Receptors respond to neurotransmitters, but neurotransmitters are not a site of action of medications.

Question 12

A nurse is reviewing information about a psychiatric medication that describes the amount of the drug that actually reaches systemic circulation unchanged. The nurse identifies this using what term?

Accepted Answer

Bioavailability describes the amount of a drug that actually reaches the systemic circulation unchanged. First-pass effect refers to the metabolism that a drug undergoes within the gastrointestinal wall or liver before reaching the rest of the body. Solubility refers to the ability of a medication to cross a membrane. Biotransformation or metabolism is the process by which a drug is altered and broken down into small substances known as metabolites.

Question 13

A client receiving an antipsychotic agent develops acute extrapyramidal symptoms. Which response by the nurse would be most appropriate?

Accepted Answer

Individuals with acute extrapyramidal symptoms need frequent reassurance that these are not a worsening of their psychiatric condition but instead are treatable side effects of the medication. They also need validation that what they are experiencing is real and that the nurse is concerned and will be responsive to changes in these symptoms. Extrapyramidal symptoms are not indicative of an allergy. Photosensitivity occurs with antipsychotic agents and sunlight.

Question 14

A nurse administers a prescribed dose of lithium at 8 p.m. The nurse would schedule a specimen to be obtained for a blood concentration at which time?

Accepted Answer

Blood concentrations should be monitored 12 hours after the last dose of medication.

Question 15

A client is brought to the emergency department by a sibling, who reports that the client became very agitated and "started hallucinating." Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The sibling states that the client is taking paroxetine for depression. Which would the nurse most likely suspect?

Accepted Answer

The client's symptoms, along with the use of paroxetine (a selective serotonin reuptake inhibitor [SSRI]) suggest serotonin syndrome. Neuroleptic malignant syndrome and acute dystonic reaction would occur with antipsychotic uses. Hypothyroidism may result from lithium use.

Question 16

After teaching a client who is prescribed imipramine about the drug, the nurse determines that the education was effective when the client makes which statement?

Accepted Answer

Imipramine is a tricyclic antidepressant and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent rinsing of the mouth are helpful to combat dry mouth. A high fiber intake would be appropriate to decrease possible constipation.

Question 17

A client diagnosed with depression asks a nurse about possible herbal supplements. Which supplement would the nurse identify as being commonly used?

Accepted Answer

St. John's wort is an herbal supplement commonly used for depression. Valerian is a common ingredient in products promoted for insomnia and nervousness. Kava is used to reduce anxiety. Melatonin is used to treat insomnia and prevent jet lag.

Question 18

A nurse is reviewing the medical records of several clients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a client at greater risk for tardive dyskinesia?

Accepted Answer

Risk factors for tardive dyskinesia include age older than 50 years, female gender, affective disorders (particularly depression), brain damage or dysfunction, increased duration of treatment, standard antipsychotic medication, and, possibly, higher doses of antipsychotic agents.

Question 19

After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid consuming which food or beverage?

Accepted Answer

Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine, such as tap beers, matured and aged cheeses, dried aged and fermented meats, broad bean pods, concentrated yeast extract, sauerkraut, and soy sauce.

Question 20

During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate?

Accepted Answer

During stabilization, the medication dosage is adjusted or titrated to achieve the maximum amount of improvement with a minimum of side effects. Psychiatric-mental health nurses assess target symptoms, looking for changes or improvements and side effects. Education about relapse prevention and target symptoms and assessing whether the medication is losing its effect occur during the maintenance phase. Tapering occurs during the discontinuation phase.

Quiz 12: Psychopharmacology, Dietary Supplements, and Biologic Interventions