Psychotherapeutic (before midterm) Flashcards
When administering an intramuscular injection of risperidone (Risperdal Consta®), the nurse tells the patient that this medication dosage will be effective for how long?
a. 24 hours
b. 48 hours
c. 1 week
d. 2 weeks
ANS: D
The long-acting injectable form of risperidone Risperdal Consta®, and one intramuscular injection lasts approximately 2 weeks.
Before beginning therapy with fluoxetine (Prozac), the nurse should assess for concurrent use of which medication?
a. acetylsalicylic acid
b. warfarin sodium
c. Diuretics
d. Nonsteroidal anti-inflammatory drugs
ANS: B
The use of second-generation antidepressants (such as fluoxetine) with warfarin results in an increased anticoagulant effect.
When the nurse is teaching the patient about monoamine oxidase inhibitors (MAOIs), which is important to emphasize?
a. Serum blood levels should be drawn every 2 weeks.
b. If drowsiness occurs, stop the medication immediately.
c. Drowsiness should decrease after the first few weeks of therapy.
d. Foods high in tyramine—such as cheese, beer, and wine—must be avoided.
ANS: D
If a patient is taking an MAOI, caution the patient to avoid over-the-counter (OTC) cold and flu products. Foods or beverages high in tyramine must also be avoided.
A patient has been taking haloperidol for 3 months for a psychotic disorder. Because the nurse is concerned about the development of extrapyramidal symptoms, the patient will be monitored for which symptom?
a. Cogwheel rigidity and blurred vision
b. Drowsiness and dizziness
c. Motor restlessness and muscle spasms
d. Dry mouth and constipation
ANS: C
Extrapyramidal symptoms are involuntary motor symptoms similar to those associated with Parkinson’s disease. This drug-induced state is known as pseudoparkinsonism and is characterized by symptoms such as akathisia (distressing motor restlessness) and acute dystonia (painful muscle spasms).
A patient has been taking the MAOI phenelzine (Nardil®) for 6 months. The patient says he’s going out to the local bar to meet a few friends for a beer. What important information should the nurse tell this patient?
a. Drinking beer is permitted as long as there is a designated driver.
b. He has no further dietary restrictions because he has taken the last dosage.
c. If he begins to experience a throbbing headache, rapid pulse, or nausea, he should stop drinking.
d. He needs to avoid foods with tyramine while on this medication.
ANS: D
Patients taking an MAOI need to be cautioned about avoiding OTC cold and flu products as well as foods or beverages high in tyramine.
A 22-year-old female has been taking lithium (Carbolith®) for 6 months. She has blood work every month, and the nurse assesses her for signs of toxicity. What are the indications of toxicity?
a. Serum lithium level of 0.8 mmol/L and excitability
b. Serum lithium level of 1.0 mmol/L and palpitations
c. Serum lithium level of 1.3 mmol/L and hypertension
d. Serum lithium level of 2.3 mmol/L and cardiac dysrhythmias
ANS: D
Lithium levels exceeding 2.0 mmol/L produce moderate to severe toxicity, and cardiac dysrhythmias are possible adverse effects
A patient taking clozapine has shown marked improvement. Which statement by this patient indicates the experiencing of a common adverse effect of clozapine?
a. “I have been losing weight.”
b. “I don’t feel like eating at all.”
c. “Look at how red my hands are.”
d. “My mouth has been so dry lately.”
ANS: D
Adverse effects of clozapine include tachycardia, akathisia, agitation, asthenia, ataxia, seizures, dyskinesia, dizziness, drowsiness, headache, insomnia, dry mouth, dyspepsia, anxiety, increased appetite, and weight gain.
A 44-year-old patient has been taking sertraline (Zoloft®), a selective serotonin reuptake inhibitor (SSRI), for 4 months. The patient tells the nurse about having an interest in natural health products and wants to start taking St. John’s wort. Which statement to the patient is an appropriate response from the nurse?
a. “That should be no problem.”
b. “Soon you’ll be able to stop taking the Zoloft!”
c. “Be sure to stop taking the herb if you notice a change in adverse effects.”
d. “Taking St. John’s wort with Zoloft may cause severe interactions and is not
recommended.”
ANS: D
The herbal product St. John’s wort should not be used with SSRIs. Potential interactions include confusion, agitation, muscle spasms, twitching, and tremors.
Which ethnic group often requires lower doses of benzodiazepines and tricyclic antidepressants?
a. Indigenous peoples
b. Asians
c. Latin Americans
d. Somalis
ANS: B
Asians have a lower activity of drug metabolism and thus often require lower doses of benzodiazepines and tricyclic antidepressants than with White people require.
st. John’s wort is a natural health product that some people use for the treatment of mild to moderate symptoms of depression. Use of St. John’s wort is contraindicated in patients with which conditions?
a. Schizophrenia, Alzheimer’s disease
b. Benign prostatic hypertrophy, diabetes
c. Dementia, emphysema
d. Heart disease, schizophrenia
ANS: A
St. John’s Wort is contraindicated in patients with bipolar disorder, schizophrenia, Alzheimer’s disease, and other forms of dementia.
A nurse is monitoring a depressed patient who has just started antidepressant therapy. During which time period does the patient have the highest potential for self-injury and suicide?
a. At the beginning, before drug therapy is started
b. The period between the start of therapy and symptomatic improvement
c. Between 1 and 4 weeks of drug therapy
d. After 6 months of drug therapy
ANS: B
Several weeks may pass before the therapeutic effects of antidepressants are evident. After the start of therapy and before symptomatic improvement, careful monitoring of the patient (being readily available) and providing supportive care are critical to the therapeutic approach because during this time period, the patient may be at highest risk for self-harm and suicide.
Which is a reason that SSRIs are more widely prescribed today than are tricyclic antidepressants (TCAs)?
a. SSRIs have fewer sexual adverse effects.
b. Unlike TCAs, SSRIs do not have drug–food interactions.
c. TCAs can cause serious cardiac toxicities if an overdose occurs.
d. SSRIs therapeutically respond faster than tricyclic antidepressants.
ANS: C
These newer antidepressants offer several attractive advantages over the traditional TCAs and MAOIs. SSRIs are associated with significantly fewer and less-severe adverse effects and systemic adverse effects.
The wife of a patient who has been diagnosed with depression calls the office and says, “It’s been an entire week since he started that new medicine for his depression, and there’s no change! What’s wrong with him?” Which statement is the best response from the nurse?
a. “The medication may not be effective for him. He may need to try another type.”
b. “It may take up to 4 weeks to notice any therapeutic effects. Let’s wait a little longer to see how he does.”
c. “It sounds like he is tolerant to the drug. I’ll check about increasing the dosage.”
d. “Some patients never recover from depression. He may not respond to this
therapy.”
ANS: B
Patients should be told that antidepressant drugs commonly require several weeks before full therapeutic effects can be noted and that these drugs can take up to 6 weeks to reach their full therapeutic effect.
A patient with a history of anxiety attacks is given a medication for these episodes. Which medication is appropriate for this problem?
a. fluphenazine
b. phenobarbital
c. bupropion
d. buspirone hydrochloride
ANS: D
Buspirone hydrochloride is a nonbenzodiazepine that is indicated for treatment of anxiety.
Which breakfast choice by a patient taking an MAOI indicates the need for additional teaching?
a. Orange juice
b. Fried eggs
c. Cheddar cheese omelet
d. French toast
ANS: C
Aged cheeses, such a cheddar cheese, contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur.
