Week 7: Chapter 27 and Chapter 28

Question 1

How do tricyclic antidepressants (TCAs) work in the treatment of depression?

Answer 1

TCAs drugs inhibit the reuptake of neurotransmitters

Question 2

Why are SSRI drugs prescribed more often than TCA drugs for the treatment of depression?

Answer 2

SSRI drugs have fewer side effects than TCA drugs

Question 3

Which class of drugs is most likely to lead to dependence when prescribed?

Answer 3

Benzodiazepines

Question 4

A patient is prescribed olanzapine (Zyprexa) for treatment of psychosis. What information from the patient must you report to the prescriber?

Answer 4

The patient tells you that he smokes cigarettes

Question 5

How do selective serotonin reuptake inhibitors (SSRIs) work to treat depression?

Answer 5

By increasing the amount of the neurotransmitter serotonin in the brain

Question 6

A pt. who has been taking amitriptyline (Elavil) to treat depression has developed dizziness with a blood pressure of 94/60. The patient tells the unlicensed assistive personnel (UAP) that he needs to get up and use the bathroom. What are your best instructions for the UAP?

Answer 6

Have the pt get up slowly and sit on the side of the bed before standing

Question 7

A pt prescribed the SSRI paroxetine (Paxil) 4 weeks ago tells you that it is not working and askes if she can have diazepam (Valium) instead? What is your best response?

Answer 7

Paroxetine can take from 1 - 8 weeks for symptoms of depression to improve

Question 8

Which antidepressant drug may cause unusual excitement, irritability, and trouble sleeping when prescribed to children?

Answer 8

fluoxetine (Prozac)

Question 9

The pt prescribed chlorpromazine (Thorazine) is at risk for constipation. What is your best action?

Answer 9

Instruct the patient to drink extra fluids everyday

Question 10

The patient prescribed a benzodiazepine drug tells you that he is considering suicide. What must you do?

Answer 10

1. Notify the prescriber
2. Initiate suicide precautions
3. Ask the patient if he/she has a suicide plan

Question 11

After giving a pt risperidone (Risperal) she tells you that she feels nauseated. What is your best action?

Answer 11

Provide the patient with food when giving this drug

Question 12

The pt prescribed chlorpromazine (Thorazine) tells you that he is very active and spends a lot of time outdoors. What best advice do you teach the patient?

Answer 12

Be sure to wear protective clothing when you are outside

Question 13

What precautions will you teach an older adult who is prescribed chlorpromazine (Thorazine)?

Answer 13

Chlorpromazine (Thorazine) can cause dizziness, so be sure to change positions slowly.

Question 14

With which drug for insomnia should you warn the patient about the side effect of sleepwalking, sleep eating or sleep driving?

Answer 14

eszopiclone (Lunesta)

Question 15

What should you instruct the patient to do immediately after taking a benzodiazepine receptor agonist?

Answer 15

Go to bed within 5-10 minutes after taking the drug

Question 16

Which drugs belong to the benzodiazepine receptor agonist class?

Answer 16

1. eszopiclone (Lunesta)
2. zaleplon (Sonata)
3. zolpidem (Ambien)

Question 17

Which drug for insomnia is rarely uses now because it is a Schedule II drug with a high potential for abuse and dependence?

Answer 17

pentobarbital (Nembutal)

Question 18

Why should a pt taking CNS depressant avoid drinking alcohol?

Answer 18

Alcohol can potentiate the sedating effect of these drugs

Question 19

What is the reversal agent for benzodiazepine receptor agonist overdose?

Answer 19

flumazenil (Romazicon)

Question 20

Which statement made by a person prescribed to tak zolpidem (Ambien) indicates a need for more teaching?

Answer 20

I am so glad that this drug is so safe and has no potential for dependence

Question 21

A pediatric nurse is caring for a child with a history of depression. The nurse knows that what life span consideration applies to the use of antidepressants in children?

Answer 21

Antidepressants may increase the risk of suicide in children and adolescents

Question 22

A patient with anxiety asks why benzodiazepines cannot be stopped suddenly, especially if they are more addictive. What is your best response?

Answer 22

The withdrawal symptoms can be life threatening

Question 23

For which specific side effect must you monitor when an older adult is prescribed lithium to treat psychosis?

Answer 23

Dehydration

Question 24

A patient on the psychiatric unit is being monitored for adverse effects of antipsychotic medications. What are the adverse effects of these drugs? (select all that apply)

Answer 24

1. Seizures

2. Neuroleptic malignant syndrome

Question 25

A patient who is newly prescribed an antidepressant drug is also taking St. John’s wort. What instruction should the nurse give this patient?

Answer 25

Stop taking the St. Johns wort

Question 26

A nurse working on the psychiatric unit is admitting a patient with depression. What interventions are used to treat this condition? (select all that apply)

Answer 26

1. Counseling
2. Psychotherapy
3. Antidepressant drugs
4. Hospitalization

Question 27

The nurse is discharging a patient with a prescription for antipsychotic medication. What important principle should you include when teaching a patient about the use of this drug?

Answer 27

The patient should change positions slowly to avoid postural hypotenstion

Question 28

The nurse is admitting a patient and completing a list of home drugs taken by the patient. Which comments made by a patient who is taking benzodiazepines may indicate to the nurse that the patient has become dependent on the drugs? (select all that apply)

Answer 28

1. I’m not feeling the effects of the drug

2. I need this drug to get me through the day

Question 29

Which statements about depression are accurate? (select all that apply)

Answer 29

1. Depression can occur at my age
2. Women are more likely than men to seek treatment for depression
3. Many older adults with depression are undiagnosed and untreated
4. Children with depression pretend to be sick and refuse to go to school

Question 30

Which statement by a patient who has been prescribed an SSRI indicates a need for additional teaching?

Answer 30

“These drugs have more side effects than tricyclic antidepressants”

Question 31

The nurse is caring for an older adult who is taking a benzodiazepine. The nurse knows that what is the most important principle to consider when giving antianxiety medications such as benzodiazepines to older adults?

Answer 31

Older adults should be monitored for respiratory depression

Question 32

Which are signs of a patient’s dependence on benzodiazepine drugs? (select all that apply)

Answer 32

1. Strong desire to discontinue taking the drug

2. Irritability, nervousness, or trouble sleeping when the drug is stopped

Question 33

A nurse is discharging a patient who has received information on antidepressant medication. What patient statement indicates the need for further instruction?

Answer 33

“With this medication, I hope to be over my depression by the end of the week.”

Question 34

The nurse is discharging a patient with a prescription for an antianxiety drug. The nurse knows that what information is most important to include when teaching a patient about antianxiety drugs such as benzodiazepines?

Answer 34

If benzodiazepines must be stopped, the patient will need to be weaned off the dose.

Question 35

A patient makes an appointment with the Health Care Provider (HCP) with complaints of moderate-to-severe anxiety. Which treatment methods can the patient anticipate the HCP will suggest? (select all that apply)

Answer 35

1. Lifestyle changes
2. Group therapy
3. Counseling
4. Antianxiety drugs

Question 36

The school nurse knows that a child who pretends to be sick, gets in trouble at school, and has a pessimistic attitude may have which condition?

Answer 36

Depression

Question 37

A patient asks the nurse why selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and other antidepressant drugs must be avoided for at least 14 days after discontinuing monoamine oxidase inhibitors (MAOIs)? What is the best response by the nurse?

Answer 37

To avoid a life-threatening drug interaction

Question 38

You overhear family members of a patient who has been prescribed an antidepressant drug say that the patient is having suicidal thoughts. What is your next best action?

Answer 38

Ask the patient if he/she is having suicidal thoughts

Question 39

A nurse is instructing a patient who is being discharged with a prescription for an antipsychotic drug. What antipsychotic drug requires patients to avoid temperature extremes?

Answer 39

Quetiapine (Seroquel)

Question 40

A pediatric nurse knows that children receiving any sedating drug need to be watched for unusual or paradoxical responses. What is a paradoxical response?

Answer 40

One that is opposite of what is expected.

Question 41

The prescriber just ordered eszopiclone (Lunesta) for a patient for insomnia. Before giving the drug, what is the most important assessment the nurse should do?

Answer 41

Assess the patient’s present mental status.

Question 42

A nurse is caring for a patient with a history of sleep deprivation. The nurse knows that an important outcome of sleep deprivation is related to what problem?

Answer 42

Heightened risk for infection

Question 43

The nurse is discharging a patient with a prescription for an insomnia medication. What statement about insomnia medications is true and should be included in patient teaching?

Answer 43

Insomnia medication can cause traveler’s amnesia.

Question 44

The nurse is caring for a patient who has a history of insomnia. The nurse knows that drugs to relieve insomnia can cause some degree of depression of what system?

Answer 44

Central nervous system (CNS)

Question 45

A nurse in a residential setting for older adults is giving a patient zolpidem (Ambien) for insomnia for the first time. Besides assessing the patient’s level of consciousness, what is the most important follow-up care the nurse should check for this patient

Answer 45

Check the patient’s vital signs

Question 46

The evening shift nurse is about to administer a sedative to a patient. The nurse knows that what types of drugs are considered sedatives. (select all that apply)

Answer 46

1. Antihistamines
2. Benzodiazepines
3. Skeletal muscle relaxants
4. Benzodiazepine receptor agonists

Question 47

The nurse is discharging a patient with a new prescription for a sedative and instructs the patient about the intended outcomes. What are these intended responses? (select all that apply)

Answer 47

1. Sleep duration is increased
2. Person is sedated and sleep induced
3. Length of time to fall asleep is decreased
4. Insomnia relieved and sleep improved

Question 48

The nurse is discharging a patient with a new prescription for benzodiazepine receptor agonists. What is the most important instruction the nurse needs to give to the patient?

Answer 48

Have another person with you the first night you take the drug to see if sleepwalking will be a problem.

Question 49

The emergency department (ED) nurse has been ordered to give romazicon (Flumazenil) intravenously to a patient who overdosed on a benzodiazepine. The nurse knows that this drug should not be given to anyone with a history of what type of disorder?

Answer 49

Seizure