Psychotropic Drugs

Question 1

1. A patient asks, “What are neurotransmitters? The doctor said mine are imbalanced.” Select the nurse’s best response.
   a.“How do you feel about having imbalanced neurotransmitters?”
   b.“Neurotransmitters protect us from harmful effects of free radicals.”
   c.“Neurotransmitters are substances we consume that influence memory and mood.”
   d.“Neurotransmitters are natural chemicals that pass messages between brain cells.”

Answer 1

ANS: D
The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the patient’s question or provide untrue, misleading information.

Question 2

2. The parent of an adolescent diagnosed with schizophrenia asks the nurse, “My child’s doctor ordered a PET. What kind of test is that?” Select the nurse’s best reply.

a.“This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants?”
b.“PET means positron emission tomography. It is a special type of scan that shows blood flow and activity in the brain.”
c.“A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures.”
d.“It’s a special X-ray that shows structures of the brain and whether there has ever been a brain injury.”

Answer 2

ANS: B
The parent is seeking information about PET scans. It is important to use terms the parent can understand, so the nurse should identify what the initials mean. The correct response is the only option that provides information relevant to PET scans. The distracters describe MRI, CT scans, and EEG.

Question 3

3. A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer’s disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first?

a.Skull X-rays
b.Computed tomography (CT) scan
c.Positron emission tomography (PET)
d.Single-photon emission computed tomography (SPECT)

Answer 3

ANS: B
A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarct, information that would be helpful to the health care provider. PET and SPECT show brain activity rather than structure and may occur later. See relationship to audience response question.

Question 4

4. A patient’s history shows drinking 4 to 6 litres of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient?

a.Amygdala
b.Parietal lobe
c.Hippocampus
d.Hypothalamus

Answer 4

ANS: D
The hypothalamus, a small area in the ventral superior portion of the brain stem, plays a vital role in such basic drives as hunger, thirst, and sex.

Question 5

5. The nurse prepares to assess a patient diagnosed with major depression for disturbances in circadian rhythms. Which question should the nurse ask this patient?

a.“Have you ever seen or heard things that others do not?”
b.“What are your worst and best times of the day?”
c.“How would you describe your thinking?”
d.“Do you think your memory is failing?”

Answer 5

ANS: B
Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep pattern are also relevant to circadian rhythms. The distracters apply to assessment for illusions and hallucinations, thought processes, and memory.

Question 6

6. The nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which effect would be expected?
   a.Reduced anxiety
   b.Improved memory
   c.More organized thinking
   d.Fewer sensory perceptual alterations

Answer 6

ANS: A
Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations. See relationship to audience response question.

Question 7

7. A nurse would anticipate that treatment for a patient with memory difficulties might include medications designed to have which of the following effects?

a.Inhibit gamma-aminobutyric acid (GABA)
b.Prevent destruction of acetylcholine
c.Reduce serotonin metabolism
d.Increase dopamine activity

Answer 7

ANS: B
Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory. GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with Parkinson’s disease rather than improving memory.

Question 8

8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show dysfunction in which part of the brain?

a.Hippocampus
b.Frontal lobe
c.Cerebellum
d.Brain stem

Answer 8

ANS: B
The frontal lobe is responsible for intellectual functioning. The hippocampus is involved in emotions and learning. The cerebellum regulates skeletal muscle coordination and equilibrium. The brain stem regulates internal organs.

Question 9

9. The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of which of the following?

a.Parasympathetic nervous system
b.Sympathetic nervous system
c.Reticular activating system
d.Medulla oblongata

Answer 9

ANS: A
Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.

Question 10

10. The therapeutic action of neurotransmitter inhibitors that block reuptake cause which of the following effects?

a.Decreased concentration of the blocked neurotransmitter in the central nervous system
b.Increased concentration of the blocked neurotransmitter in the synaptic gap
c.Destruction of receptor sites specific to the blocked neurotransmitter
d.Limbic system stimulation

Answer 10

ANS: B
If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.

Question 11

11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop?
    a.Anticholinergic effects
    b.Dopamine-blocking effects
    c.Endocrine-stimulating effects
    d.Ability to stimulate spinal nerves

Answer 11

ANS: B
Medication that blocks dopamine often produces disturbances of movement, such as akathisia, because dopamine affects neurons involved in both thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.

Question 12

12. A patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter?

a.Gamma-aminobutyric acid (GABA)
b.Norepinephrine
c.Acetylcholine
d.Histamine

Answer 12

ANS: B
Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for “fight or flight.” GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation.

Question 13

13. A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group?
    a.Tricyclic antidepressants
    b.Antipsychotic drugs
    c.Antimanic drugs
    d.Benzodiazepines

Answer 13

ANS: D
Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Antimanic drugs are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis.

Question 14

14. A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about which of the following?

a.Chlordiazepoxide (Librium)
b.Clozapine (Clozaril)
c.Sertraline (Zoloft)
d.Tacrine (Cognex)

Answer 14

ANS: C
Sertraline (Zoloft) is an SSRI. This antidepressant blocks the reuptake of serotonin, with few anticholinergic and sedating adverse effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimer’s disease.

Question 15

15. A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group?

a.Psychostimulants
b.Mood stabilizers
c.Anticholinergics
d.Antidepressants

Answer 15

ANS: B
The symptoms describe mania, which is effectively treated by mood stabilizers, such as lithium, and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are not effective in the treatment of mania.

Question 16

16. A drug causes muscarinic receptor blockade. The nurse will assess the patient for which of the following?

a.Dry mouth
b.Gynecomastia
c.Pseudoparkinsonism
d.Orthostatic hypotension

Answer 16

ANS: A
Muscarinic receptor blockade includes atropine-like adverse effects, such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with α1 antagonism.

Question 17

17. A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drug’s strong dopaminergic effect?

a.Chew sugarless gum.
b.Increase dietary fiber.
c.Arise slowly from bed.
d.Report changes in muscle movement.

Answer 17

ANS: D
Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Movement disorders and motor abnormalities (extrapyramidal side effects), such as parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia, are likely to occur early in the course of treatment. They are often heralded by sensations of muscle stiffness. Early intervention with antiparkinsonism medication can increase the patient’s comfort and prevent dystonic reactions. The distracters are related to anticholinergic effects.

Question 18

18. A patient tells the nurse, “My doctor prescribed Paxil (paroxetine) for my depression. I assume I’ll have side effects like I had when I was taking Tofranil (imipramine).” The nurse’s reply should be based on what information about the drug?
    a.Paroxetine is a selective norepinephrine reuptake inhibitor.
    b.Paroxetine is a tricyclic antidepressant.
    c.Paroxetine is an MAO inhibitor.
    d.Paroxetine is an SSRI.

Answer 18

ANS: D
Paroxetine is an SSRI and will not produce the same adverse effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic hypotension.

Question 19

19. A nurse can anticipate anticholinergic adverse effects are likely when a patient takes which of the following:

a.Lithium carbonate (Carbolith)
b.Buspirone hydrochloride (Bustab)
c.Imipramine hydrochloride (Impril)
d.Risperidone (Risperdal)

Answer 19

ANS: C
Imipramine hydrochloride (Impril) is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major adverse effects.

Question 20

20. Which instruction has priority when teaching a patient about clozapine (Clozaril)?

a.“Avoid unprotected sex.”
b.“Report sore throat and fever immediately.”
c.“Reduce foods high in polyunsaturated fats.”
d.“Use over-the-counter preparations for rashes.”

Answer 20

ANS: B
Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly. The other options are not relevant to clozapine.

Question 21

21. A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Oleptro), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes which of the following?

a.Carbamazepine
b.Haloperidol
c.Phenelzine
d.Trazodone

Answer 21

ANS: C
Patients taking phenelzine, an MAO inhibitor, must be on a low tyramine diet to prevent hypertensive crisis. There are no specific dietary precautions associated with carbamazepine, haloperidol or trazodone.

Question 22

22. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of which of the following?

a.Cardiac dysrhythmia
b.Hypotensive shock
c.Hypertensive crisis
d.Hypoglycemia

Answer 22

ANS: C
Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.

Question 23

23. A nurse caring for a patient taking a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to which of the following?

a.Coherent thought processes
b.Improvement in depression
c.Reduced levels of motor activity
d.Decreased extrapyramidal symptoms

Answer 23

ANS: B
SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not reduce extrapyramidal symptoms.

Question 24

24. By which mechanism do selective serotonin reuptake inhibitors (SSRI) improve depression?

a.Destroying increased amounts of serotonin
b.Making more serotonin available at the synaptic gap
c.Increasing production of acetylcholine and dopamine
d.Blocking muscarinic and α1 norepinephrine receptors

Answer 24

ANS: B
Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or α1 norepinephrine blockade.

Question 25

25. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurse’s best action.

a.Report the results to the health care provider immediately.
b.Administer the next dose as prescribed.
c.Give aspirin and force fluids.
d.Repeat the laboratory test.

Answer 25

ANS: A
These laboratory values indicate the possibility of agranulocytosis, a serious adverse effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld. Caution: This question requires students to apply previous learning regarding normal and abnormal values of white blood cell counts.

Question 26

26. A drug blocks the attachment of norepinephrine to α1 receptors. The patient may experience which of the following?

a.Hypertensive crisis
b.Orthostatic hypotension
c.Severe appetite disturbance
d.An increase in psychotic symptoms

Answer 26

ANS: B
Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of α1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Nurses should teach patients ways of minimizing this phenomenon.

Question 27

27. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. The nurse should be most alert for problems associated with fluid and electrolyte imbalance with the patient receiving which drug?

a.Lithium
b.Clozapine (Clozaril)
c.Fluoxetine (Prozac)
d.Venlafaxine (Effexor)

Answer 27

ANS: A
Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, edema, and other symptoms of imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety.

Question 28

28. An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain?
    a.H1
    b.5 HT2
    c.Acetylcholine
    d.Gamma-aminobutyric acid (GABA)

Answer 28

ANS: A
H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patient’s weight.

Question 29

29. An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individual’s vital signs is most likely?

a.Pulse rate changes from 90 to 72.
b.Respiratory rate changes from 22 to 18.
c.Complaints of intestinal cramping begin.
d.Blood pressure changes from 114/62 to 136/78.

Answer 29

ANS: D
This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system.

Question 30

30. Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group?

a.Galantamine hydrobromide (Reminyl)
b.Valproate (Depakene)
c.Buspirone hydrochloride (Bustab)
d.Rivastigmine hydrogen tartrate (Exelon)

Answer 30

ANS: B
The medications listed in the question are mood stabilizers, anticonvulsant types. Valproate (Depakene) is also a member of this group. The distracters are drugs for treatment of Alzheimer’s disease and anxiety.

Question 31

31. A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient
    remembers the appointment?
    a.Write the appointment day, time, and location on a piece of paper and give it to the player.
    b.Log the appointment day, time, and location into the player’s cell phone calendar feature.
    c.Ask the health care provider to admit the patient to the hospital overnight.
    d.Verbally inform the patient of the appointment day, time, and location.

Answer 31

ANS: B
This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has a significant role in maintaining memory. Logging the appointment into the player’s cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the patient is unlikely to remember verbal instruction. Hospitalization is unnecessary.

Question 32

1. A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? Select all that apply.

a.Parkinson’s disease
b.Grave’s disease
c.Hyperlipidemia
d.Osteoarthritis
e.Diabetes

Answer 32

ANS: A, C, E
Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes, and increase serum triglycerides, which would complicate care of a patient with hyperlipidemia. Parkinson’s disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient. Osteoarthritis and Grave’s disease should have no synergistic effect with this medication.

Question 33

2. Questions the nurse could ask that would be nonjudgemental when obtaining information about patient use of herbal remedies include which of the following? (select all that apply)

a.“You don’t regularly take herbal remedies, do you?”
b.“What herbal medicines have you used to relieve your symptoms?”
c.“What over-the-counter medicines and nutritional supplements do you use?”
d.“What differences in your symptoms do you notice when you take herbal supplements?”
e.“Have you experienced problems from using herbal and prescription drugs at the same time?”

Answer 33

ANS: B, C, D, E
The correct responses are neutral in tone and do not express bias for or against the use of herbal medicines. The distracter, worded in a negative way, makes the nurse’s bias evident.

Question 34

3. An individual is experiencing problems with memory. Which of these structures are most likely to be involved in this deficit? Select all that apply.
   a.Amygdala
   b.Hippocampus
   c.Occipital lobe
   d.Reticular activating system (RAS)
   e.Basal ganglia

Answer 34

ANS: A, B
The amygdala and hippocampus play roles in memory. The occipital lobe is predominantly involved with vision. The reticular activating system (RAS) regulates the sleep–wake cycle. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions.

Question 35

4. A patient’s sibling says, “My brother has a mental illness, but the doctor ordered a functional magnetic resonance image (fMRI) test. That seems unnecessary and wasteful.” Select the nurse’s best responses. Select all that apply.

a.“Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation.”
b.“Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother.”
c.“Tell me more about what is concerning you about the testing.”
d.“It sounds like you do not truly believe your brother had a mental illness.”
e.“It would be better for you to discuss your concerns with the doctor.”

Answer 35

ANS: A, B, C
The correct responses provide information to the sibling. Modern imaging techniques are important tools in assessing molecular changes in mental disease and marking the receptor sites of drug action, which can help in treatment planning. Psychiatric symptoms can be caused by anatomical or physiologic abnormalities. There is no evidence of denial in the sibling’s comment. The nurse can answer this question rather than referring it to the physician. It would be inappropriate to discuss finances with the patient’s sibling.