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Chapter 11: Psychopharmacology, Dietary Supplements & Biologic Foundations - Mental health Nursing
Terms in this set (80)
A client with schizophrenia is brought to the community mental health center by a family member for a follow-up visit. The client was started on antipsychotic drug therapy six weeks ago with an atypical antipsychotic agent. During this visit, the nurse assesses the client for possible side effects. Which assessment would be most important for the nurse to make? Select all that apply.
fasting blood glucose level
An adult client has been taking citalopram for 4 months and notices a change in mood that is "better than it's been for years." The client has told the nurse, "I'm going to stop taking it, because I just don't think I need medication anymore." What is the nurse's best response?
It's excellent that you're feeling better, but that's not a good idea because the drug is likely responsible for your improvement in mood."
The nurse has been asked to explain electroconvulsive therapy to a client and his family. Which of the following statements made by the nurse would be correct?
A tapering schedule may be used to end your treatments to try to prevent rehospitalization."
The most common therapy for seasonal affective disorder includes which of the following?
Which of the following is the most effective treatment available for refractory major depression?
Electroconvulsive therapy (ECT)
St. John's wort is an herbal product for ..
Extrapyramidal side effects are characterized by a triad of symptoms, including what?
Dystonia, akathisia, and pseudoparkinsonism
A client who has been admitted to the hospital after a suicide attempt has been diagnosed with major depression and the client's care team has recommended ECT. Which of the following teaching points should the nurse include in client education before the procedure?
You might feel a bit confused or disoriented after your treatment, but this will pass."
During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate?
Assessing the client for target symptoms and side effects
A psychiatric-mental health nurse is reviewing the medication history of a client with depression who is receiving bupropion. When teaching the client about this medication, the nurse would integrate information about which neurotransmitter as being affected by this medication? Select all that apply.
The effective minimization of the clinical symptoms of depression as a result of electroconvulsive therapy (ECT) has been proven to be a result of
Electrode placement and the form and dosage of the electrical stimulus
When responsible for the recovery care of a client receiving electroconvulsive therapy (ECT), the psychiatric nurse provides care until the client is ...
Oriented to person, place, and time
Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?
The nurse knows that the client understands the rationale for dietary restrictions when taking a monoamine oxidase inhibitor (MAOI) when the client makes which statement?
"I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels."
When teaching a client about restrictions for tranylcypromine, the nurse will tell the client to avoid which food?
An alternate somatic therapy approved for the treatment of both epileptic seizures and depression is ...
Vagus nerve stimulation (VNS)
Harry has noticed that in the fall and winter months he has a loss of energy, difficulty sleeping, and sadness. After seeking treatment, Harry is diagnosed with seasonal affective disorder. Which of the following treatments is effective for this condition?
Which reason do clients cite most frequently as the cause for self-discontinuation of medication?
Intolerable side effects
A client with a diagnosis of depression has not seen her mood and affect improve with the use of antidepressants, and the worsening of her symptoms has prompted her physician to order ECT. Which of the nurse's following teaching points about the procedure is most accurate?
"Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective."
Which electrode placement during electroconvulsive therapy (ECT) is associated with the best outcomes?
Bilateral electrode placement on the client's temporal areas
In providing post-op care for the client who has just undergone ECT, which of the following findings would indicate that ECT has been effective and the client is displaying normal sequelae of this procedure?
The client cannot remember to which inpatient unit he or she is returning.
Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply.
A client is being seen in the mental health clinic. The client has been on haloperidol for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. A nurse would document this chronic syndrome as:
A nurse is leading a medication education group for clients with depression. A client states he has read that herbal treatments are just as effective as prescription medications. The best response is
"We need to look at the research very closely to see how reliable the studies are."
A client is receiving ziprasidone as part of the treatment plan. On a return visit to the clinic, the client reports some anticholinergic side effects. When teaching the client about ways to minimize these effects, which statement would be most appropriate for the nurse to make? Select all that apply
"Try sucking on some sugarless candies."
"Make sure to include high fiber foods in your diet."
A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?
A client is undergoing ECT. The nurse would be correct to inform the client of which aspect prior to the ECT?
NPO will be employed 8 hours prior to the procedure.
A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?
Make sure that you don't drink any alcohol when you're taking this medication."
What is the difference between traditional and atypical antipsychotics?
Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade.
Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug?
Its ability to block the reuptake of serotonin
The psychiatric-mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply.
Indications for use
Food and drug interactions
Which are examples of monoamine oxidase inhibitors (MAOIs)? Select all that apply.
The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?
The foods contain tyramine, which may provoke hypertensive crisis.
In the discharge instructions for a client who is taking alprazolam, the nurse should include what?
Sudden cessation of alprazolam can cause rebound insomnia and nightmares.
Dietary modifications are most likely necessary when a client is being treated with which antidepressant?
Monoamine oxidase inhibitors (MAOIs)
Mrs. Taylor's psychiatrist has explained the potential benefits of ECT in the treatment of her depression. Which of the following nursing diagnoses is most likely to apply to a client who is scheduled to soon begin ECT?
Risk for anxiety
A client has begun taking 1 mg of eszopiclone at bedtime, a dose which is considered to be equivalent to a 3.75-mg dose of her previous hypnotic, zopiclone. This comparison of the relative dosages of these two drugs is referred to as what?
Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)?
Atypical antipsychotics block both serotonin and dopaminergic receptors.
When explaining the term "pharmacokinetics" to a client who is being educated on a newly prescribed medication, it would be appropriate to define it as
The way the body handles the medication
A drug that is an antagonist functions to do what?
Prevent natural or other substances from activating cell function
A psychiatric-mental health nurse is conducting a teaching session for clients who are prescribed antianxiety agents. Which information about this group of drugs would the nurse integrate into the teaching?
A hangover effect may occur when benzodiazepines are used for sleep.
The nurse is caring for a client who suffers from anxiety. The client informs the nurse that he has been taking the herb kava. What should the nurse be aware that kava is associated with?
Benzodiazepines work by the following mechanism of action
They act directly on GABA receptors and are thought to increase the amount of GABA available.
A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?
Call the client's psychiatrist because her symptoms are indicative of moderate toxicity
A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment?
Ensuring the client's blood levels reach a therapeutic and safe dose
When referring to the pharmacodynamics of a medication, what is the result of an agonistic effect?
The target receptors are stimulated
A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?
Which client is most likely to benefit from treatment with an antiparkinsonism agent?
A client who has a medication-induced movement disorder
A nurse is administering an MAOI to a client with depression. Which information would the nurse most likely include in the teaching plan? Select all that apply.
--Hypertensive crisis if food with tyramines are ingested
-- Interaction with other MAOI's and antidepressants
--Risk for decreased libido and impotence
When discussing the effects of a newly prescribed psychotropic drug with the client, the nurse explains the process of clearance as
How much of the drug is excreted out of the body in a specific period of time.
A client receiving antipsychotic therapy develops an acute dystonic reaction. Which medication would the nurse most likely expect the health care provider to prescribe as treatment?
After being presented with the potential benefits of ECT, a client has replied, "I've seen enough movies to know there's no way I'm going to have any shock therapy." Which response by the nurse would be most appropriate to address the client's concerns?
"The movies often exaggerate things. ECT has been shown to be safe and very effective."
A psychiatric-mental health nurse is providing care to several clients receiving antipsychotic medications. Which client would the nurse identify as being at greatest risk for the development of pseudoparkinsonism?
74-year-old male who started therapy about 3 weeks ago
A client comes to the clinic for an evaluation. During the interview, the client describes the frequent travel required by the job and feelings of being jet lagged all the time. The client asks, "Is there any supplement that I could use that might be helpful? Which suggestion would the nurse most likely include in the response?
A client who is taking lithium is scheduled to come to the community mental health center to have a blood level obtained. The client takes the last dose of lithium each day at 10 p.m. The nurse tells the client to hold the morning dose. At which time would the nurse tell the client to come to the center to have the specimen drawn?
A client is prescribed the long-acting form of risperidone by intramuscular injection. When administering this medication, which action by the nurse would be most appropriate?
Assessing the site for possible soreness
An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply.
The client makes repetitive movements with the fingers
The client often smacks lips when at rest
The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?
White blood cell count
A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?
A 36-year-old client has been receiving a selective serotonin reuptake inhibitor for treatment of depression. The client is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which symptom of this syndrome?
Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of:
cardiac or seizure disorders.
vcardiac or seizure disorders.
During which phase of drug treatment does the prescriber adjust or titrate the medication dosage to achieve the maximum amount of improvement with a minimum of side effects
A client with a history of depression has been receiving outpatient treatment for several months but the client's partner has now brought the client to the emergency department. The partner states that the client had visual hallucinations earlier in the day. The client has an unstable gait and vomited on the way to the hospital. In addition to monitoring the client's vital signs, the care team should prioritize what action?
Discontinuing the client's SSRI
A client begins taking 40 mg of fluoxetine daily. The next day the client calls complaining of restlessness. Which interventions should the nurse advocate for to the client's prescribing physician first?
Decrease the dosage of the medication.
A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The nurse is teaching about effective administration of methylphenidate to the parents. What education given by the nurse is appropriate?
"Administer the drug early in the morning."
The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?
White blood cell count
A 52-year-old woman is seeing a nurse therapist for moderate depression. The client has been taking fluoxetine (Prozac) for 3 weeks, but her mood has not improved. She states, "I need more than this to get better. I'm taking St. John's wort, too." Why does the nurse tell the client to immediately stop taking St. John's wort?
St. John's wort with fluoxetine may lead to serotonin syndrome.
Benzodiazepines and buspirone are included in which therapeutic category?
The prescription of clozapine requires weekly blood samples for which time frame?
A mental health nurse is teaching a client with depression about ECT. The nurse understands that treatments are typically given how often?
Twice a week
When a client who is considering electroconvulsive therapy (ECT) asks the nurse how this treatment will improve his depression, the most appropriate response is ...
"Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours."
A client is experiencing acute mania and started on lithium therapy. After several doses, the client has a serum lithium level drawn. Which result would the nurse identify as being outside the therapeutic range?
A nurse is talking with a group of parents who have children diagnosed attention deficit-hyperactivity disorder (ADHD). The children are receiving psychostimulant therapy as part of the treatment plan. During the discussion, each of the child's parents reports side effects. Which statement about side effects would the nurse expect to hear?
Our child just doesn't seem to have any appetite.
A client is admitted to the psychiatric unit with a diagnosis of major depression with psychotic features. When the client does not respond to antidepressant medications, ECT is ordered. What is the mechanism of action of this therapy?
The mechanism of action of ECT remains unknown.
A client with depression has a history of discontinuing medications and relapsing, often using alcohol and other substances to self-medicate. A new nurse case manager is evaluating the treatment plan developed to enhance the client's ability to manage the medication regimen. The case manager determines that the plan has been effective when the client makes which statement?
"The medicine doesn't seem to be working. I called my therapist and made an appointment to discuss other medications. In the meantime, I'm still taking this medication."
A client is experiencing hallucinations and delusions. The nurse would expect the physician to order which class of drug?
A client is prescribed a monoamine oxidase inhibitor (MAOI) as part of the treatment plan for depression. When disussing the medication with the client, the client tells the nurse that the client applies the medication as a patch on the skin. The nurse interprets the client's statement as indicating which medication?
A client is prescribed antidepressant therapy and is being discharged. When conducting discharge teaching with the client and family, the nurse would emphasize the need to be especially alert for:
suicide by overdose
A client is receiving amitriptyline as part of the treatment plan for depression. The health care provider orders a drug plasma level. Which result would the nurse identify as being therapeutic?
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