Chapter 07: Psychotherapeutic Drug Therapy

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant (TCA) to not expect to see a difference in mood or anxiety level for up to: a. 5 days. b. 2 to 3 weeks. c. 4 to 5 weeks. d. 6 weeks.

ANS: B

It is important that the client understand that TCAs typically take 2 to 3 weeks to take effect so he will not become discouraged when he does not see immediate results.

DIF: Cognitive Level: Comprehension REF: p. 70 | Table 7.2

OBJ: 4 TOP: Antidepressant Medications

KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity a. Avoid foods high in sodium content. b. Avoid alcoholic beverages. c. Ensure that protein intake is 60 g/day. d. Take a potassium supplement.

2. A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor (MAOI). Which is the most important teaching point the nurse must include in his care plan?

ANS: B

This client should be given a list of foods and beverages that are restricted when taking MAOIs, such as some alcoholic beverages, sausage and bologna, and some cheeses. Sodium, protein, and potassium are not factors when MAOIs are taken.

DIF: Cognitive Level: Application REF: p. 72 | Box 7.2

OBJ: 4 TOP: Antidepressant Medications

KEY: Nursing Process Step: Planning MSC: Client Needs: Physiological Integrity a. Increased pulse and respirations b. Hyperactivity and difficulty concentrating c. Increased tearing and increased urinary output d. Sedation, disorientation, and hallucinations

3. A female client is 3-days postoperative and has been receiving meperidine (Demerol) for pain control. The family mentions to the nurse that the client has been taking phenelzine (Nardil) for years for her depression. The client did not list this medication on admission. What signs and symptoms should the nurse look for in case of reaction between these two medications?

ANS: D

Nardil is a monoamine oxidase inhibitor; therefore, symptoms of CNS depression such as sedation, disorientation, and hallucinations, rather than increased vital signs, hyperactivity and difficulty concentrating, and increased tearing and urination, most likely would occur as a reaction between these two medications.

DIF: Cognitive Level: Application REF: p. 71 OBJ: 4

TOP: Antidepressant Medications KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity

4. The nurse is aware that he or she may be administering the new antianxiety medication pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating: a. depression. b. psychotic episodes. c. neuropathic pain. d. bipolar disorder.

ANS: C

Pregabalin (Lyrica) has been found to be effective for the treatment of neuropathic pain, as well as seizure disorders. This medication is not used for any of the other options listed.

DIF: Cognitive Level: Knowledge REF: p. 71 OBJ: 3

TOP: Antianxiety Medications KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity

5. Selective serotonin reuptake inhibitors (SSRIs) are most health care providers’ drug of choice for the treatment of depression because: a. the side effects are more manageable than with other antidepressants. b. they are the only class safe for long-term therapy. c. this is the oldest class of antidepressants. d. they are fast-acting medications.

ANS: A

The side effect most commonly reported, gastrointestinal (GI) upset, usually can be avoided if the client takes the medication with food. SSRIs can be used for both short- and long-term therapy; they are not the oldest class of antidepressants; and they usually take a few weeks before onset of effect.

DIF: Cognitive Level: Comprehension REF: p. 72 OBJ: 4

TOP: Antidepressant Medications KEY: Nursing Process Step: Assessment

MSC: Client Needs: Physiological Integrity

6. In preparing discharge planning for a client who has been prescribed lithium for the treatment of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the need to monitor his or her diet for intake of: a. potassium. b. carbohydrates. c. protein. d. sodium.

ANS: D

Lithium is a salt that is absorbed into the bloodstream and is excreted by the kidneys at a faster rate than sodium. Therefore, clients must monitor their sodium and fluid intake, as well as their activity level. The other options are not a concern when lithium is taken.

DIF: Cognitive Level: Comprehension REF: p. 72

OBJ: 5

TOP: Antimanic Medications KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Physiological Integrity a. Take the dose immediately, and then take the second dose 3 hours late. b. Take half of a dose now, and then take the second dose at the normal time. c. Eliminate the dose missed, and take the second dose at the normal time. d. Immediately take the missed dose, and take the second dose at the normal time.

7. A female client calls the clinic for advice after forgetting to take her morning dose of twice-daily lithium 5 hours ago. Which instructions should the nurse give the client?

ANS: C

Because lithium should be taken at the same time each day and the therapeutic range is narrow, 5 hours after the first dose was missed would be too close to take the second dose to try to make it up. Altering the schedule for one missed dose could cause more problems with future doses.

DIF: Cognitive Level: Analysis REF: p. 72

OBJ: 5

TOP: Antimanic Medications KEY: Nursing Process Step: Intervention

MSC: Client Needs: Physiological Integrity

8. A female client who has had bipolar disorder for several years decides to stop all of her medications because she is tired of the side effects. She also cancels all appointments with her therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client is considered: a. depressed. b. noncompliant. c. suffering from an anxiety disorder. d. possessing obsessive-compulsive tendencies.

ANS: B

Noncompliance occurs with many individuals with mental health disorders because of the ways the side effects of the medication affect an individual as well as other factors. It is important to work with clients to prevent noncompliance. Depression, anxiety disorder, and obsessive-compulsive tendencies are not indicated in the situation described.

DIF: Cognitive Level: Application REF: p. 77

OBJ: 9

TOP: Noncompliance KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity a. Try to coerce him into taking his medication. b. Ensure that the client and those around him are safe, and monitor for additional symptoms of his schizophrenia while maintaining trust with the client. c. Crush his antipsychotic medications and put them in his food to stop the process of his withdrawal from reality. d. Speak to his family about seeking an involuntary emergency hold in a mental health facility to get him back on his medications.

9. A male client with schizophrenia lives in an assisted-living complex for individuals with mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his antipsychotic medication and therefore stops taking his medication after much discussion with his treatment team. He is progressively withdrawing from reality but is not a safety risk at this point to himself or others. What is the best response of the nurse and treatment team?

ANS: B

The Patient Self-Determination Act states that individuals who are not in an emergency or safety-threatening situation cannot be coerced, forced, or talked into following a suggested course, such as taking medication against their will. All three remaining options go against the Act. In addition, an involuntary emergency hold in a mental facility is not reasonable because the client is not a threat to himself or others.

DIF: Cognitive Level: Analysis REF: p. 78 OBJ: 9

TOP: Informed Consent KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

10. An adult female client has been diagnosed recently with mild depression but opts not to take the medication prescribed by her physician after talking with the physician about the benefits, risks, possible outcomes, and side effects. She decides to investigate alternative treatments. This client is making this decision based on the premise of: a. informed consent. b. noncompliance. c. client education. d. right to privacy.

ANS: A

Informed consent most accurately describes the situation because all aspects of taking the medication were discussed with the client before she made the decision to not take the medication. If she had already been in agreement with the regimen rather than seeking other alternatives, she would have been considered noncompliant. Client teaching, such as how and when to take the medication, would occur if she decided to take the medication. The client’s right to privacy is not addressed in this scenario.

DIF: Cognitive Level: Application REF: p. 78 OBJ: 9

TOP: Informed Consent KEY: Nursing Process Step: Evaluation

MSC: Client Needs: Safe and Effective Care Environment a. Lithium b. Depakene c. Neurontin d. Risperdal

11. The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia. The nurse would expect to see which medication ordered for this client?

ANS: D

Risperdal is an antipsychotic medication that is used for schizophrenia. The other options are all antimanic medications.

DIF: Cognitive Level: Comprehension REF: p. 73 OBJ: 2

TOP: Antipsychotic (Neuroleptic) Medications

KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity a. Pupil dilation b. Increased saliva production c. Decreased heart rate d. Constricted airway

12. Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system. Which of the following is considered a sympathetic response?

ANS: A

Pupil dilation is a sympathetic response. All the other options are examples of a parasympathetic response.

DIF: Cognitive Level: Comprehension REF: p. 69 | Table 7.1

OBJ: 1 TOP: How Psychotherapeutic Drug Therapy Works

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

13. While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands and then sits back down. The nurse knows that this client most likely is experiencing the side effect of: a. drug-induced parkinsonism. b. dystonia. c. akathisia. d. akinesia.

ANS: C

Akathisia is an extrapyramidal side effect (EPSE) of antipsychotic drugs that causes an individual to be unable to sit still. The other options are also EPSEs but are not evident in the scenario.

DIF: Cognitive Level: Knowledge REF: p. 74 | Table 7.7

OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity a. Drug-induced parkinsonism b. Neuroleptic malignant syndrome (NMS) c. Tardive dyskinesia d. Dystonia

14. is a side effect that can occur while a client is taking an antipsychotic medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation.

ANS: B

NMS is a very serious side effect of antipsychotic drugs that can lead to coma and death. Muscle rigidity is usually the first symptom, with symptoms progressing rapidly after the onset and reaching peak intensity in 3 days. The other options are also side effects of antipsychotics but do not describe NMS.

DIF: Cognitive Level: Knowledge REF: p. 74 | Table 7.7

OBJ: 6 TOP: Antipsychotic (Neuroleptic) Medications

KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity a. benzodiazepines b. tricyclics c. azaspirones d. beta-blockers

15. The constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias.

ANS: D

In the past, beta-blockers were strictly cardiac drugs, but new research has found this class of drugs to be successful as adjunctive treatment for social phobias. The other options are antianxiety and antidepressant medications; they are not used for cardiac arrhythmias.

DIF: Cognitive Level: Knowledge REF: p. 70 | Table 7.2

OBJ: 3 TOP: Antianxiety Medications

KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity a. Fresh fruit b. Whole milk c. Hot dogs and ham d. Fresh vegetables

16. When educating a client being treated with lithium, which item(s) in his or her diet should be monitored or avoided?

ANS: C

Lithium and sodium compete for elimination from the body through the kidneys. An increase or decrease in salt affects proper elimination of lithium from the body. Processed foods like hot dogs and ham contain larger amounts of sodium.

DIF: Cognitive Level: Knowledge REF: p. 72 OBJ: 5

TOP: Guidelines for clients taking lithium

KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity a. Nurse b. CMA c. Physician d. Therapist

17. The CMA is administering an antianxiety medication to a client. Monitoring side effects is the responsibility of which member of the health care team?

ANS: A

While all care providers should be aware of the actions and side effects of the client’s medication, the nurse remains responsible for monitoring drug effectiveness and adverse reactions.

DIF: Cognitive Level: Knowledge REF: p. 75 OBJ: 7

TOP: Drug administration KEY: Nursing Process Step: Intervention

MSC: Client Needs: Safe and Effective Care Environment

Multiple Response

1. Which of the following are basic responsibilities of nurses who administer psychotherapeutic drugs? (Select all that apply.)

a. Monitoring and evaluating the client’s response to the medication b. Continually assessing the client’s condition c. Adjusting medication dosages according to therapeutic levels d. Assisting in the coordination of the client’s care e. Teaching clients about their medications f. Administering prescribed medications

ANS: A, B, D, E, F

These responsibilities require nurses to be cognizant of all aspects of medication administration. Adjusting medication dosages is not within the nurse’s scope of practice.

DIF: Cognitive Level: Comprehension REF: p. 75 OBJ: 7

TOP: Client Care Guidelines KEY: Nursing Process Step: Implementation

MSC: Client Needs: Physiological Integrity a. Teach signs and symptoms of side effects and what to do if these occur. b. Provide written information regarding the purpose, dosage, route, and dosing schedule. c. Ask the client and significant other to verbally explain when it is necessary to contact the physician should side effects occur. d. Provide written information regarding how the client should decrease dosages in response to side effects or improvement in symptoms.

2. The nurse is developing a teaching plan for a client who has been diagnosed recently with a mental health disorder and has been prescribed a psychotropic medication. Which interventions regarding the medication should the nurse include in the teaching plan? (Select all that apply.)

ANS: A, B, C

The nurse should teach signs and symptoms of side effects, provide information about the drug, and have the client and significant other verbally explain when it is necessary to call the physician. The nurse should never provide written information about decreasing dosages without contacting the physician. The physician will determine whether side effects can be controlled, or if dosage adjustments are necessary. In addition, improvement in symptoms is most likely the desired effect of the medication and ensures that the dosage and medications are correct.

DIF: Cognitive Level: Application REF: p. 75

OBJ: 8

TOP: Client Teaching

KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention | Nursing Process Step: Evaluation

MSC: Client Needs: Physiological Integrity a. Delusions b. Hallucinations c. Apathy d. Anhedonia e. Illusions

3. Clients diagnosed with Type I-Positive Schizophrenia symptoms respond better to antipsychotic medications. Manifestations of Type I Schizophrenia include which of the following? (Select all that apply.)

ANS: A, B, E

Type I: Positive symptoms include delusions, illusions, and hallucinations and have a good response to medications. Type II: Negative symptoms include anhedonia, apathy, and flat affect and usually do not respond well to antipsychotic medications.

DIF: Cognitive Level: Application REF: p. 74 OBJ: 6

TOP: Positive and Negative Symptoms of Schizophrenia

KEY: Nursing Process Step: Intervention MSC: Client Needs: Physiological Integrity