Exam #1

Question 1

A client with bipolar disorder I is experiencing a depressive episode. What would the nurse expect to be prescribe?

Answer 1

Lamotrigine

Question 2

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client?

Answer 2

Orthostatic hypotension and urinary retention

Question 3

Which medication classification has most commonly been used to treat social phobia?

Answer 3

SSRIs

Question 4

prazosin in PTSD

Answer 4

Used to treat nightmares in PTSD

Question 5

A client with posttraumatic stress disorder (PTSD) tells the nurse that he often feels like he has left his body and is looking at things from a distance. The nurse interprets this as what?

Answer 5

Dissociation

Question 6

derealization

Answer 6

sensing that things are not real

Question 7

expansive mood

Answer 7

lack of restraint in expressing feelings, overvalued self importance, constant enthusiasm for interactions

Question 8

cyclothymic disorder

Answer 8

periods of hypomanic episodes and depressive episodes that do not meet the full criteria for a major depressive episode

Question 9

rapid cycling

Answer 9

four or more mood episodes that meet criteria for manic, mixed, hypomanic, or depressive episodes during the previous 12 months

Question 10

mean age of onset of bipolar disorder

Answer 10

21-30 years

Question 11

relationship of lithium with salt levels

Answer 11

higher sodium levels = lower lithium levels

Question 12

symptoms of lithium toxicity

Answer 12

arrythmas, blackouts, tremors, seizures, metallic taste, diarrhea, twitching, slurred speech, tinnitus

Question 13

divalproex sodium (Depakote)

Answer 13

anticonvulsant used as a mood stabilizer in bipolar patients
liver function tests and CBC with platelets should be obtained before starting therapy
drug levels tested weekly until pt is stable, then tested every 6 months

Question 14

Carbamazepine

Answer 14

anticonvulsant
levels measured monthly until the patient is on a stable dosage
SJS possibility

Question 15

Lamotrigine

Answer 15

mood stabilizer; requires dose titration
particularly effective for rapid cycling and depressed phase of BPD
Risk of SJS rash— report any rash with Lamotrigine

Question 16

GAD comorbities

Answer 16

3/4 of GAD pts have another psych diagnosis

Question 17

buspirone

Answer 17

anxiolytic
inhibits spontaneous firing of serotonergic neurons in the dorsal raphe
must be taken for 3-4 weeks before effects are felt

Question 18

antidepressants approved for anxiety treatment

Answer 18

venlafaxine (SNRI), paroxetine (SSRI), imipramine (TCA)

Question 19

treatment of choice for phobias

Answer 19

exposure therapy

Question 20

Average age of onset of OCG

Answer 20

19 (may occur in 20s and 30s)

Question 21

pharmacologic interventions for OCD

Answer 21

SSRIs, TCAs (clomipramine)

sertraline, fluvoxamine, paroxetine, fluoxetine

Question 22

response prevention

Answer 22

patient with OCD put in situations that induce anxiety but asked to refrain from performing rituals

Question 23

thought stopping

Answer 23

patient taught to interrupt obsessional thoughts

Question 24

cognitive restructuring in OCD

Answer 24

therapy helps patient understand that feared event is unlikely to happen if rituals arne’t performed.

Question 25

TCA level monitoring

Answer 25

TCAs have levels that should be monitored

Levels taken 12 hours after last dose

Question 26

MAOI side effects

Answer 26

headache, drowsiness, dry mouth and throat, constipation, blurred vision, orthostatic hypotension

Question 27

clomipramine

Answer 27

TCA

Question 28

TCA overdose symptoms

Answer 28

Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention.

Central nervous system suppression (ranging from drowsiness to coma) or an agitated delirium may occur.

Question 29

serotonin syndrome symptoms

Answer 29

mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.