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Pharm Midterm 46-90

Terms in this set (45)

46. A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do?

a. Ask her to complete the Edinburgh Postnatal Depression Scale.
b. Reassure her that the "baby blues" are normal after childbirth.
c. Suggest that she get more sleep and try to increase her activity.
d. Suggest that she talk to her provider about using an SSRI.
a. Ask her to complete the Edinburgh Postnatal Depression Scale.

Women who experience depressive symptoms after childbirth can be screened using a quick test: the Edinburgh Postnatal Depression Scale, which may be administered 6 to 8 weeks after delivery. Reassuring her that her feelings are normal does not acknowledge her concerns; also, without objective screening, this reassurance may not be warranted. Increased sleep and activity may help, but screening is necessary to determine the severity of the depression. Until the patient is diagnosed as having postpartum depression, an SSRI is not indicated.
47. A patient is brought to the emergency department after taking a handful of TCA pills. The nurse will expect to provide what when caring for this patient? (Select all that apply.)

a. Cardiac monitoring
b. Cholinesterase inhibitors
c. Gastric lavage and activated charcoal
d. Sedative medications
e. Procainamide
a. Cardiac monitoring
b. Cholinesterase inhibitors
c. Gastric lavage and activated charcoal

Patients who overdose with a TCA should have cardiac monitoring, because cardiac side effects can occur. Cholinesterase inhibitors are given to counteract anticholinergic side effects. Gastric lavage followed by activated charcoal can reduce absorption of the TCA. Sedative drugs would only increase the sedative effects of the TCA. Procainamide causes cardiac depression and is not recommended to treat TCA dysrhythmias.
48. Which patients are candidates for MAOIs? (Select all that apply.)

a. Patients who have not responded to SSRIs and TCAs
b. Patients with atypical depression
c. Patients with bulimia nervosa
d. Patients with hypotension
e. Patients with postpartum depression
a. Patients who have not responded to SSRIs and TCAs
b. Patients with atypical depression
c. Patients with bulimia nervosa

Patients who have not responded to SSRIs or TCAs, patients with atypical depression, and patients with bulimia nervosa are candidates for MAOIs. MAOIs contribute to hypotension and therefore are contraindicated in patients with hypotension. MAOIs are not recommended for the treatment of postpartum depression.
49. A patient with schizophrenia has been taking an antipsychotic drug for several days. The nurse enters the patient's room to administer a dose of haloperidol (Haldol) and finds the patient having facial spasms. The patient's head is thrust back, and the patient is unable to speak. What will the nurse do?

a. Administer the haloperidol as ordered.
b. Discuss increasing the haloperidol dose with the provider.
c. Request an order to give diphenhydramine.
d. Request an order to give levodopa.
c. Request an order to give diphenhydramine.

An early reaction to antipsychotic drugs is acute dystonia. Initial treatment consists of an anticholinergic medication, such as diphenhydramine. Administering more antipsychotic medication would increase the symptoms and could be life threatening. Levodopa is not given for extrapyramidal symptoms, because it could counteract the beneficial effects of antipsychotic treatment.
50. A patient who is taking an antipsychotic drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and tremors and is drooling. The nurse will ask the patient's provider about which course of action?

a. Administering a direct dopamine antagonist
b. Giving an anticholinergic medication
c. Increasing the dose of the antipsychotic drug
d. Stopping the antipsychotic drug
b. Giving an anticholinergic medication

The patient is showing signs of parkinsonism, an extrapyramidal effect associated with antipsychotic medications. Anticholinergic medications are indicated. A direct dopamine antagonist would counter the effects of the antipsychotic and remove any beneficial effect it has. Increasing the dose of the antipsychotic medication would only worsen the extrapyramidal symptoms. Stopping the antipsychotic medication would cause the symptoms of schizophrenia to worsen.
51. A patient taking a first-generation antipsychotic (FGA) medication develops severe parkinsonism and is treated with amantadine (Symmetrel). The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to:

a. give anticholinergic medications.
b. make a diagnosis of idiopathic parkinsonism.
c. resume the amantadine indefinitely.
d. try a second-generation antipsychotic (SGA).
d. try a second-generation antipsychotic (SGA).

Neuroleptic-induced parkinsonism is treated with some of the same drugs used for idiopathic parkinsonism, such as amantadine. If parkinsonism is severe, switching to an SGA may help, because the risk of parkinsonism is much lower with these drugs. An anticholinergic medication may be used initially. A recurrence of parkinsonism when the drug is withdrawn does not indicate idiopathic parkinsonism. These drugs should not be used indefinitely
52. A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education?

a. "Anticholinergic medications may help control these symptoms."
b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA."
c. "The provider may try a low-potency FGA instead of the high-potency FGA."
d. "This patient may need to take a benzodiazepine or a beta blocker."
b. "Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA."

The patient is showing signs of akathisia, which can resemble an exacerbation of psychosis. If the two are confused and the provider orders more of the FGA, the symptoms may actually increase. Anticholinergic medications may be used, a low-potency FGA may be ordered, or a benzodiazepine or beta blocker may be prescribed.
53. A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient's tongue. The nurse recognizes which adverse effect in this patient?

a. Acute dystonia
b. Akathisia
c. Parkinsonism
d. Tardive dyskinesia
d. Tardive dyskinesia

Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This patient shows signs of this adverse effect. Acute dystonia is characterized by severe spasm of muscles in the face, tongue, neck, or back and by opisthotonus. Akathisia is characterized by constant motion. Parkinsonism is characterized by bradykinesia, drooling, tremor, rigidity, and a shuffling gait.
54. A nurse provides teaching for a patient about to begin taking a first-generation antipsychotic drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs?

a. "Anticholinergic effects are uncommon 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."
a. "Anticholinergic effects are uncommon with this medication."

Anticholinergic effects are common with FGAs, so this statement indicates a need for further teaching. Neuroendocrine effects, orthostatic hypertension, and sedation can occur with FGAs.
55. A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine (Clozaril). The nurse 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 ANC is less than 3000, the drug will be discontinued permanently."
d. "Use of this drug requires weekly evaluation of blood work."
c. "If the ANC is less than 3000, the drug will be discontinued permanently."

Clozapine can cause agranulocytosis. If the absolute neutrophil count (ANC) drops below 1000/mcL, the drug must be discontinued permanently. Blood counts must be evaluated weekly, and this evaluation should be continued for several weeks after withdrawal of the drug. Fever, sore throat, and mouth ulcers are symptoms of agranulocytosis and should be reported immediately.
56. A patient with schizophrenia receives a dose of risperidone (Risperdal Consta) IM. The nurse teaching this patient about this medication will make which statement?

a. "You will experience therapeutic levels of this drug in 1 to 2 weeks."
b. "You will need injections of this drug every 6 weeks."
c. "You will need to take an oral antipsychotic drug for 3 weeks."
d. "You probably will not have extrapyramidal symptoms with this drug."
c. "You will need to take an oral antipsychotic drug for 3 weeks."

Risperidone given intramuscularly is a depot preparation used for long-term therapy. Significant release of the drug does not occur until 2 to 3 weeks after injection; therefore, patients must take an oral antipsychotic medication until drug levels are raised. Therapeutic levels are reached 4 to 6 weeks after injection. Patients need injections every 2 weeks. With IM dosing, the incidence of extrapyramidal symptoms is substantial.
57. A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient's family reports a decrease in the person's hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?

a. An increased dose of the drug may be needed.
b. Intramuscular dosing may be needed.
c. Some symptoms take months to improve.
d. The entire dose may be taken at bedtime.
c. Some symptoms take months to improve.

When patients begin therapy with antipsychotic medications, some symptoms resolve sooner than others. During the first week, agitation, hostility, anxiety, and tension may resolve, but other symptoms may take several months to improve. It is not necessary to increase the dose in the first week. IM dosing is indicated for patients with severe, acute schizophrenia and for long-term maintenance. Sedation is normal, and once an effective dose has been determined, the entire dose can be taken at bedtime, but not in the initial days of therapy.
58. A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence?

a. Encourage the patient to take responsibility for medication management.
b. Teach the patient about drug side effects and how to manage them.
c. Tell the patient that an abstinence syndrome will occur if the drug is stopped.
d. Tell the patient that the drug may be taken as needed to control symptoms.
b. Teach the patient about drug side effects and how to manage them.

One way to promote adherence to a medication regimen is to teach patients about drug side effects and how to minimize undesired responses. Family members should be encouraged to oversee medication management for outpatients, because patients themselves may fail to appreciate the need for therapy or may be unwilling to take prescribed medications. It is not true that an abstinence syndrome occurs when these drugs are withdrawn. These drugs are not used PRN; they must be given on a regular basis.
59. A nurse in a mental health hospital finds a patient with schizophrenia who takes haloperidol (Haldol) lying rigid in bed with a temperature of 41.3° C. A cardiac monitor shows cardiac dysrhythmias. What will be included in the treatment of this patient? (Select all that apply.)

a. Anticholinergic medications
b. Beta blockers
c. Dantrolene
d. Intravenous fluids
e. Withdrawal of haloperidol
c. Dantrolene
d. Intravenous fluids
e. Withdrawal of haloperidol

Neuroleptic malignant syndrome is characterized by "lead pipe" rigidity, sudden high fever, and autonomic instability. Treatment requires supportive measures, drug therapy, and immediate withdrawal of the antipsychotic medication. Dantrolene is used to relax muscles and reduce heat production. Intravenous fluids are used to maintain hydration. Anticholinergic medications and beta blockers are not helpful.
60. Which side effects are more common in second-generation antipsychotic medications than in first-generation antipsychotic medications? (Select all that apply.)

a. Agranulocytosis
b. Anticholinergic effects
c. Extrapyramidal symptoms
d. Metabolism by CYP3A4
e. Prolactin elevation
a. Agranulocytosis
b. Anticholinergic effects
d. Metabolism by CYP3A4

SGAs are more likely than FGAs to cause agranulocytosis and anticholinergic effects and are metabolized by CYP3A4 enzymes. They are not more likely to cause extrapyramidal effects or prolactin elevation.
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