Psychiatric medications

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NCLEX-PN
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1

A nurse has administered a dose of diazepam (Valium) to the client. The nurse would take which most important action before leaving the client's room?
1. Drawing the shades or blinds closed
2. Putting up the side rails on the bed
3. Giving the client a bedpan
4. Turning down the volume on the television

2- Diazepam is a sedative-hypnotic w/anticonvulsant & skeletal muscle relaxant properties. The nurse should institute safety measure before leaving the client's room to ensure that the client does not injure themselves.
* The most frequent side effects of this medication are: dizziness, drowsiness & lethargy.

2

A nurse provides medication instructions to a client who is taking lithium carbonate (Eskalith). The nurse determines that the client needs additional instructions if the client states that the or she will:
1. Monitor lithium blood levels very closely
2. Contact the physician if excessive diarrhea, vomiting, or diaphoresis occurs
3. Take the lithium w/meals
4. Decrease fluid intake while taking the lithium

4- Because therapeutic & toxic dosage ranges are so close, lithium blood levels must be monitored very closely, more frequently at first and then once every several months.
- The client should be instructed to call the doctor if excessive diarrhea, vomiting, or diaphoresis occurs.
-Lithium is irritating to the gastric mucosa; therefore, lithium should be taken w/meals. A normal diet & normal salt & fluid intake (1500 to 3000 mL/day) should be maintained, because lithium decreases sodium reabsorption by the renal tubules, which could cause sodium depletion.
- A low sodium intake causes lithium retention & could lead to toxicity.

3

A client w/a psychotic disorder is being treated w/haloperidol (Haldol). Which of the following would indicate the presence of a toxic effect of this medication?
1. Hypotension
2. Nausea
3. Excessive salivation
4. Blurred vision

3- Toxic effects include extrapyramidal symptoms noted as marked drowsiness & lethargy, EXCESSIVE SALIVATION, and a fixed stare. * Akathisia ,(state of agitation, distress, and restlessness) acute dystonia (state of abnormal muscle tone resulting in muscular spasm and abnormal posture) are also signs of toxicity.

4

Buspirone hydrochloride (BuSpar) is prescribed for a client w/an anxiety disorder. The nurse instructs the client regarding the medication & informs the client that which of the following is a characteristic of this medication?
1. The medication can produce a sedating effect
2. Tolerance can occur w/the medication
3. The medication is addicting
4. Dizziness & headaches may occur

4- Buspirone hydrochloride is used in the management of anxiety disorders. The advantages of this medication are that it is not sedating, tolerance does not develop & it is not addicting.

5

Neuroleptic malignant syndrome is suspected in a client who is taking chlorpromazine (Thorazine). Which medication would the nurse prepare in anticipation of being ordered to treat this adverse effect related to the use of chlorpromazine?

2- Bromocriptine is an antiparkinsonian prolactin inhibitor used in the treatment of neuroleptic malignant syndrome.

6

A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication?
1. White blood cell count
2. Platelet count
3. Cholesterol level
4. Blood urea nitrogen level

1- Hematological reactions can occur in the client taking clozapine & include agranulocytosis & mild leukopenia. The white blood cell count should not be checked before initiating treatment & should be monitored closely during use of this medication. The pt. should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise and fever.

7

Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. The nurse is collecting data on the client & is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication?
1. When the last alcoholic drink was consumed
2. A history of diabetes insipidus
3. A history of hyperthyroidism
4. When the last full meal was consumed

1- Disulfiram is used as an adjunct treatment for selective clients w/chronic alcoholism who want to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for a least 12hrs before the initial dose of the medication is administered. THE MOST IMPORTANT DATA IS TO DETERMINE WHEN THE LAST ALCOHOLIC DRINK WAS CONSUMED.

8

A nurse is collecting data from a client & the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication?
1. Dementia
2. Obsessive-compulsive disorder
3. Seizure disorder
4. Schizophrenia

1- Donepezil hydrochloride is a cholinergic agent used in treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine.

9

Fluoxetine hydrochloride (Prozac) is prescribed for the client. The nurse provides instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication?
1. "I should take the medication right before bedtime snack."
2. "I should take the medication w/my evening meal."
3. "I should take the medication at noon with an antacid."
4. "I should take the medication in the morning when I first arise."

4- Fluoxetine hydrochloride is administered in the early morning without consideration to meals.

10

A nursing student is assigned to care for a client w/a diagnosis of schizophrenia. Haloperidol (Haldol) is prescribed for the client. The nursing instructor asks the student to describe the action of the medication. Which statement by the nursing student indicates an understanding of the action of this medication?
1. It blocks the uptake of norepinephrine & serotonin
2. It blocks the binding of dopamine to the postsynaptic dopamine receptors in the brain
3. It is a serotonin reuptake blocker
4. It inhibits the breakdown of released acetycholine

2- Haloperidol acts by blocking the binding of dopamine to the post synaptic dopamine receptors in the brain. Imipramine hydrochloride (Tofranil) blocks the reuptake of norepinephrine & serotonin. Donepezil hydrochloride (Aricept) inhibits the breakdown of released acetylcholine. Fluoxetine hydrochloride (Prozac) is a potent serotonin reuptake blocker.

11

A client receiving lithium carbonate (Eskalith) complains of loose, watery stools & difficulty walking. The nurse would expect the serum lithium level to be which of the following?
1. 0.7 mEq/L
2. 1.0 mEq/L
3. 1.2 mEq/L
4. 1.7 mEq/L

4- The therapeutic serum level of lithium ranges from 0.6-1.2mEq/L. Serum lithium levels above the therapeutic level will produce signs of toxicity.

12

When teaching a client who is being started on imipramine hydrochloride (Tofranil), the nurse would inform the client that the described effects of the medication may:
1. Start during the first week of administration
2. Start during the second week of administration
3. Not occur for 2 to 3 weeks of administration
4. Not occur until after a month of administration

3- The therapeutic effects of administration of imipramine hydrochloride (Tofranil may not occur for 2-3 weeks after the antidepressant therapy has been initiated.

13

A client receiving Thioridazine (Mellaril)complains that he feels very "faint" when he tries to get out of bed in the morning, the nurse recognizes this complaint as a symptom of:
1. Psychosomatic symptoms
2. Cardiac dysrhythmias
3. Respiratory insufficiency
4. Postural hypotension

4- Thioridazine can cause postural hypotension. The client needs to be taught to get out of bed slowly and to rise from a sitting position slowly because of the adverse effect related to the medication.

14

A client who is taking lithium carbonate (Eskalith) is scheduled for surgery. The nurse informs the client that:
1. The medication will be discontinued several days before surgery & resumed by injection in the immediate postoperative period.
2. The medication is to be taken until the day of surgery & resumed by injection immediately postoperatively
3. The medication will be discontinued 1-2 days before surgery & resumed as soon as full oral intake is allowed.
4. The medication will be discontinued a week before the surgery & resumed 1 week postoperatively

3- The client who is on lithium carbonate must be off the medication for 1-2 days before a scheduled surgical procedure & can resume the medication when full oral intake is ordered after the surgery.

15

A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan?
1. Reports sleeping 12hrs per night & 3 to 4 hours during the day
2. Arrives at the clinic neat & appropriate in appearance
3. Reports not going to work for this past week
4. Complains of not being able to "do anything" anymore

2- Depressed individuals will sleep for long periods, are not able to go to work, and feel as if they cannot "do anything." Once they have had some therapeutic effect from their medication, they will report resolution of many of these complaints as well as demonstrate an improvement in their appearance.

16

A nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (Prozac). What information would be important for the nurse to gather regarding the adverse effects related to the medication?
1. Problems w/excessive sweating
2. Gastrointestinal dysfunctions
3. Cardiovascular symptoms
4. Problems w/mouth dryness

2-The most common adverse effects related to fluoxetine include central nervous system (CNS) & gastrointestinal system dysfunction. This medication affects the GI system by causing nausea & vomiting, cramping & diarrhea.

17

A client taking Buspirone hydrochloride (BuSpar) for 1 month returns to the clinic for a follow-up visit. Which of the following would indicate mediation effectiveness?
1. No reports of alcohol withdrawal symptoms
2. No paranoid thought processes
3. No rapid heartbeats or anxiety
4. No thought broadcasting or delusions

3- Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal, paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspirone hydrochloride is most often indicated for treatment of anxiety & aggression.

18

A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus & tremors. The lithium levis is checked as a part of the routine follow-up & the level is 3.0 mEq/L. The nurse knows that this level is:
1. Normal
2. Slightly above normal
3. Excessively below normal
4. Toxic

4- The therapeutic serum level of lithium is 0.6-1.2 mEq/L. A level of 3 mEq/L indicates toxicity.

19

A client is placed on chloral hydrate (Aquachloral) for short-term treatment. Which nursing action indicates an understanding of the major side effect of this medication?
1. Monitoring neurological signs every 2 hours
2. Monitoring the blood pressure every 4 hours
3. Instructing the client to call for ambulation assistance
4. Lowering the bed & clearing a path to the bathroom at bedtime

3- Chloral hydrate causes sedation & impairment of motor coordination; therefore, safety measures need to be implemented. Instruct client to call to prevent a fall, opt 4 is safe, but if client gets out of bed on their own, they can fall.

20

A client admitted to the hospital gives the nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client 2 months. What behaviors observed in the client would validate noncompliance w/this medication?
1. Frequent hand washing w/hot soapy water
2. Complaints of hunger
3. A pulse rate below 60 beats per min
4. Complaints of insomnia

1- Comipramine is commonly used in tx of obsessive-compulsive disorder.

21

A client in a mental health unit is administered haloperidol (Haldol) intramuscularly. The nurse would check which of the following to determine medication effectiveness?
1. The client's vital signs
2. The physical safety of other unit clients
3. The client's nutritional intake
4. The client's orientation & delusional status

4 Haloperidol is used to treat clients exhibiting psychotic features. Therefore, to determine medication effectiveness, the nurse would check the client's orientation & delusional status.

22

Diphenhydramine hydrochloride (Benadryl) is used in the treatment of allergic rhinitis for hospitalized clients w/chronic psychotic disorder. The client asks the nurse why the medication is being discontinued before hospital discharge. The nurse responds, knowing that:
1. Allergic symptoms are short term in duration
2. Poor compliance causes this medication to fail to reach its therapeutic blood level
3. Addictive properties are enhanced in the presence of psychotropic medications
4. This medication promotes long-term extrapyramidal symptoms

3- Addictive properties are enhanced in the presence of psychotropic medications.
**Opt 4 is incorrect because Diphenhydramine hydrochloride (Benadryl) may be used for extrapyramidal symptoms & mild medication-induced movement disorders.

23

A client arrives at the health care clinic & tells the nurse that he has been doubling his daily dosage of bupropion (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following?
1. Orthostatic hypotension
2. Seizure activity
3. Weight gain
4. Insomnia

2- Seizure activity is common in dosages greater than 450mg daily & insomnia is a side effect.

24

Immediately after taking a routine evening dose of alprazolam (Xanax), a client says "I'm not sure I should have taken that stuff." The nurse makes which appropriate statement to the client?
1. "You are afraid of the media claims about this medication?"
2. "Your depression will fade once the medication begins to work."
3. "Anxiety is expected w/any new experience."
4. "Let's talk about how you feel about Xanax for a while."

4- The nurse should focus on determining the reason for the client's concern.

25

A hospitalized client is started on Phenelzine sulfate (Nardil) for the treatment of depression. At lunch time, a tray is delivered to the client. Which food item, if on the client's lunch tray, will the nurse removed?
1. Yogurt
2. Tossed salad
3. Crackers
4. Oatmeal cookies

1- Phenelzine sulfate is a monoamine oxidase inhibitor (MAOI). The client should avoid taking in foods that are high in tyramines. These foods could trigger a potentially fatal hypertensive crisis. * FOODS TO AVOID: yogurt, aged cheese, smoked or processed meats, red wines & fruits such as avocados, raisin, or figs.

26

A client is scheduled for discharge & will be taking phenobarbital sodium (Luminal) for an extended period. The nurse would place highest priority on teaching the client which of the following points that directly relates to client safety?
1. Avoid drinking alcohol while taking this medication
2. Take the medication only with meals
3. Take medication at the same time each day
4. Always use a dose container to help prevent missed doses

1-Phenobarbital sodium is an anticonvulsant & and a hypnotic agent.
**The client should avoid taking any other central nervous system depressants (such as alcohol) while taking this med. You can take this med without regard to meals & taking it a the same time each day enhances compliance and maintains more stable blood levels of the medication.

27

Fluphenazine (Prolixin)is administered to a client daily. The nurse plans to monitor for the common side effects of the medication & includes which of the following in the plan of care?
1. Monitor the blood pressure every 2 hours
2. Review the white blood cell count results daily
3. Offer a nutritious snack between meals
4. Offer hard candy or gum periodically

4- Dry mouth is a common side effect of this medication. Frequent mouth rinsing w/water, sucking on hard candy & chewing gum will alleviate this common side effect. Hypo/hyper tension are rare side effects of Fluphenazine. Leukopenia is common but not viewed as a serious health threat, and the WBC count would not be obtained on a daily basis. *Weight gain is a common side effect & frequent meals would aggravate this problem.

28

A depressed client who is on tranylcypromine sulfate (Parnate) has been instructed on diet. The nurse feels confident that the client understands the diet when given a choice of restaurant foods if the client selects:
1. Pepperoni pizza, salad, and cola
2. Roasted chicken, roasted potatoes, and beer
3. Pickled herring, French fries, and milk
4. Fried haddock, baked potato, and cola

4- Tranylcypromine sulfate is a monoamine oxidase inhibitor (MAOI)used to treat depression. A tyramines restricted diet is required while on this med to avoid hypertensive crisis. FOODS TO BE AVOIDED: are meats prepared w/tenderizer, smoke or pickled fish, beef or chicken liver, and dry sausage (salami, pepperoni & bologna). In addition, figs, bananas, aged cheese, yogurt, sour cream, beer, red wine, alcoholic beverages, soy sauce, yeast extract, chocolate, caffeine and aged, pickled and fermented smoked foods NEED TO BE AVOIDED. Many OTC meds have tyramines too

29

A client is being treated for depression w/amitriptyline hydrochloride (Elavil). During the initial phases of treatment, the most important nursing intervention is:
1. Ordering the client an tyramines-free diet
2. Monitoring blood levels frequently, because there is narrow range between therapeutic & toxic blood levels of this medication
3. Getting baseline postural blood pressures on the client before administering the medication and each time the medication is dispensed to the client, especially during the initial days of treatment
4. Checking the client for anticholinergic effects

3- Amitriptyline hydrochloride is a tricyclic antidepressant often used to depression; it causes orthostatic changes & can produce hypotension & tachycardia. This is frightening and dangerous to the client, they can become dizzy and fall.
* Instruct client to move slowly from a lying to a sitting to a standing position to avoid injury.
* The client may also experience sedation, dry mouth, constipation, blurred vision, and other anticholinergic effects, but these are transient & will diminish w/time.

30

A client who is on lithium carbonate (Eskalith) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that is most important to:
1. Avoid soy sauce, wine & aged cheese
2. Take medication only as prescribed because it can become addicting
3. Check w/the psychiatrist before using any over-the-counter medications or prescription medications
4. Have the lithium level checked every week

3- Lithium is the medication of choice to treat manic-depressive illness. Many OTC meds interact w/lithium & the client is instructed to avoid OTC medications while taking lithium, although lithium levels need to be monitored, it is not necessary to check these levels every week. A tyramine-free diet is associated w/ MAOIs