Which of the following medications would be an appropriate PRN medication for an individuals with anxiety symptoms?
A. Buspirone
B. Alprazolam
C.
... [Show More] Fluoxetine
D. Sertraline
ANSWER: B --Benzodiazepam CNS depressant with quick onset of relaxation
A client who takes haloperidol begins to show tremors and a shuffling gait. Which of the following PRN medications should the nurse chose to administer for these symptoms?
A. Chlorpromazine
B. Diazepam
C. Benztropine
D. Amoxapine
ANSWER: C client is exhibiting signs of extrapyramidal syndrome (EPS)
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A child is taking guanfacine for ADHD. Which of the following would be part of the client education associated with administration of this medication?
A. Do not take with foods that contain tyramine
B. Always use sunblock when outdoors
C. Report for blood tests once a month
D. Do not discontinue medication abruptly
ANSWER: D Alpha Agonist (stimulates receptor)
1. The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics:
A. Remain in the system longer
B. Act more quickly to reduce delusions
C. Produce fewer extrapyramidal effects
D. Are risk free for neuroleptic malignant syndrome (NMS)
ANS: C Atypical antipsychotics produce less D2blockade; thus movement disorders are less of a problem. No evidence suggests that the medication remains in the system longer nor that it acts more quickly to reduce delusions. The atypicals are not risk free for NMS
2. The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a:
A. 30 mm Hg decrease in blood pressure reading
B. Respiratory rate of 24 respirations per minute
C. Temperature reading of 104° F
D. Pulse rate of 70 beats per minute
ANS: C Increased temperature is the cardinal sign of NMS. This BP is not a significant feature of NMS. There are no significant findings to support the options related to respirations or pulse rate.
3. A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would the nurse assess as the likely cause of these symptoms?
A. Decreased dopamine at receptor sites
B. Blockade of histamine
C. Cholinergic blockade
D. Adrenergic blocking
ANS: C Fluphenazine administration produces blockade of cholinergic receptors giving rise to anticholinergic effects, such as dry mouth, blurred vision, and constipation.
4. Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)?
A. Grimacing and lip smacking
B. Falling asleep in the chair and refusing to eat lunch
C. Experiencing muscle rigidity and tremors
D. Having excessive salivation and drooling
ANS: A
TD manifests as abnormal movements of voluntary muscle groups after a prolonged period of dopamine
blockade. Movements may affect any muscle group, but muscles of the face, mouth, tongue, and digits are
commonly affected. Falling asleep is reflective of the sedative effect of these medications. Muscle rigidity and drooling reflect EPS caused from imbalance between dopamine and acetylcholine.
5. A nurse administers a medication that potentiates the action of GABA. Which finding would be expected?
A. Reduced anxiety
B. Improved memory
C. More organized thinking
D. Fewer sensory perceptual alterations
ANS: A
Increased levels of GABA reduce anxiety, thus any potentiation of GABA action should result in anxiety
reduction. Memory enhancement is associated with acetylcholine and substance P. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations.
6. On the basis of current knowledge of neurotransmitter effects, a nurse could anticipate that the treatment plan for a patient with memory difficulties might include medications designed to:
A. inhibit GABA.
B. increase dopamine at receptor sites.
C. decrease dopamine at receptor sites.
D. prevent destruction of acetylcholine.
ANS: D
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 is known to affect anxiety level 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.
7. A patient has disorganized thinking associated with schizophrenia. A PET scan would most likely show dysfunction in which part of the brain?
A. Temporal lobe
B. Cerebellum
C. Brainstem
D. Frontal lobe
ANS: D
The frontal lobe is responsible for intellectual functioning. The temporal lobe is responsible for the sensation of hearing. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.
8. A nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the:
A. parasympathetic nervous system.
B. sympathetic nervous system.
C. reticular activating system.
D. medulla oblongata.
ANS: A
Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When acetylcholine action is inhibited by anticholinergic drugs, parasympathetic symptoms such as blurred
vision, dry mouth, constipation, and urinary retention appear. The functions of the sympathetic nervous system, the reticular activating system, and the medulla oblongata are not affected by anticholinergics.
9. The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing:
A. increased concentration of neurotransmitter in the synaptic gap.
B. decreased concentration of neurotransmitter in the synaptic gap.
C. destruction of receptor sites.
D. limbic system stimulation.
ANS: A
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.
10. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action?
A. Dopamine-blocking effects
B. Anticholinergic effects
C. Endocrine-stimulating effects
D. Ability to stimulate spinal nerves
ANS: A
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.
11. A nurse assesses that a patient demonstrates anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter?
A. GABA
B. Histamine
C. Acetylcholine
D. Norepinephrine
ANS: D
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.
12. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours ago. The patient will need teaching about a drug from which group?
A. Tricyclic antidepressants
B. Antimanic drugs
C. Benzodiazepines
D. Antipsychotic drugs
ANS: C
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.
13. A patient is hospitalized for severe depression. Of the medications listed below, a nurse can expect to provide the patient with teaching about:
A. clozapine (Clozaril)
B. chlordiazepoxide (Librium)
C. tacrine (Cognex)
D. fluoxetine (Prozac)
ANS: D
Fluoxetine is an SSRI. It is an antidepressant that blocks the reuptake of serotonin with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine is used to treat Alzheimer's disease.
14. A patient hospitalized with a mood disorder has an elevated unstable mood, aggressiveness, agitation, talkativeness, and irritability. A nurse begins care planning based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n):
A. anticholinergic.
B. mood stabilizer
C. psychostimulant
D. antidepressant
ANS: B
The symptoms describe a manic attack. Mania is effectively treated by the antimanic drug lithium and selected anticonvulsants such as carbamazepine, valproic acid, and lamotrigine. No drugs from the other classifications listed are effective in the treatment of mania.
15. A drug causes muscarinic receptor blockade. A nurse will assess the patient for:
A. gynecomastia
B. pseudoparkinsonism
C. orthostatic hypotension
D. dry mouth
ANS: D
Muscarinic receptor blockade includes atropine-like side 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 alpha-1 antagonism.
16. A patient tells a nurse, "My doctor prescribed Paxil [paroxetine] for my depression. I suppose I'll have side effects like I had when I was taking Tofranil [imipramine]." The nurse's reply should be based on the
knowledge that paroxetine is a(n):
A. tricyclic antidepressant
B. MAOI
C. selective serotonin reuptake inhibitor
D. selective norepinephrine reuptake inhibitor
ANS: C
Paroxetine is a selective serotonin reuptake inhibitor and will not produce the same side effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic
17. A nurse can anticipate anticholinergic side effects are likely when a patient is taking:
A. lithium (Lithobid).
B. isperidone (Risperdal).
C. buspirone (BuSpar).
D. fluphenazine (Prolixin).
ANS: D
Fluphenazine, a first-generation antipsychotic, exerts muscarinic blockade, 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 side effects.
18. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:
A. hypotensive shock.
B. hypertensive crisis.
C. cardiac dysrhythmia.
D. cardiogenic shock
ANS: B
Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis. In the
presence of MAOIs, tyramine is not destroyed by the liver and in high levels produces intense
vasoconstriction, resulting in elevated blood pressure.
19. A patient has taken many conventional antipsychotic drugs over years. The health care provider, concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics:
A. are less costly.
B. have higher potency.
C. are more readily available.
D. produce fewer motor side effects.
ANS: D
Atypical antipsychotic drugs often exert their action on the limbic system rather than the basal ganglia. The
limbic system is not involved in motor disturbances. Atypical antipsychotics are not more readily available. They are not considered to be of higher potency; rather, they have different modes of action. Atypical
antipsychotic drugs tend to be more expensive.
20. A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to alpha-1 receptors because the patient may experience:
A. increased psychotic symptoms.
B. a hypertensive crisis.
C. orthostatic hypotension.
D. severe appetite disturbance.
ANS: C
Sympathetic mediated vasoconstriction is essential for maintaining normal blood pressure in the upright
position. Blockage of alpha-1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic
hypotension may cause fainting and falls. Patients should be taught ways of minimizing this phenomenon. [Show Less]