Chapter 10: Drug Therapy for Mental Health

Multiple Choice

1. Which drug category is useful in promoting sleep among patients with insomnia?

a. Sedatives b. ACE inhibitors c. Atypical antipsychotics d. Selective serotonin reuptake inhibitors

ANS: A

Sedatives are drugs that have the main purpose of promoting sleep by changing signals in the central nervous system and reducing responses to stimulation.

DIF: Cognitive Level: Knowing REF: p. 184 a. “This drug works by binding to receptors acting with GABA to induce sleep.” b. “This drug is acts by preventing binding to the benzodiazepine receptors.” c. “This drug acts by inhibiting GABA responses to relax muscles.” d. “This drug acts by binding to opioid receptors.”

2. You are preparing to give the benzodiazepine Valium to a patient as a premedication before surgery. The patient asks you how this drug works. What is your best response?

ANS: A

Benzodiazepines are sedating hypnotic drugs that depress the CNS by binding to benzodiazepine (BNZ) receptors that act with gamma-aminobutyric acid (GABA) receptors to enhance GABA effects, resulting sleep and muscle relaxation.

DIF: Cognitive Level: Applying REF: p. 186 a. Seizure activity b. Addiction c. Insomnia d. Anorexia

3. You are caring for a patient in the clinic setting who has been taking a benzodiazepine alprazolam (Xanax) for anxiety. What potential problem should you observe this patient for?

ANS: B

The benzodiazepines have a higher risk for addiction and dependency than do the nonbenzodiazepines. They also carry a black box warning for central nervous system depression. Overdoses are possible and serious.

DIF: Cognitive Level: Understanding REF: p. 185 a. Rifampin b. Naloxone c. Flumazenil d. Epinepherine

4. Which drug would you anticipate will be given to a patient who experienced an overdose of a benzodiazepine?

ANS: C

The drug flumazenil (Romazicon) is a benzodiazepine receptor antagonist and is an antidote used to reverse an overdose of either a benzodiazepine sedative or a nonbenzodiazepine sedative. For adults, it is given intravenously with an initial dose of 0.2 mg. If there is no response after 45 seconds, the dose can be repeated. After that, it can be repeated every minute for a total of 4 doses.

DIF: Cognitive Level: Knowing REF: p. 187 a. A female with breast cancer. b. A woman who is 20 weeks pregnant. c. A male who has a history of smoking. d. A male who is about to undergo surgery.

5. For which patient would benzodiazepines be contraindicated?

ANS: B

Pregnancy is an absolute contraindication for the benzodiazepines because they have a high risk for causing birth defects. Although the chemical structure of the nonbenzodiazepines (benzodiazepine agonists) is different, these drugs bind to the same receptors and have similar actions. As a result, they are not recommended during pregnancy.

DIF: Cognitive Level: Applying REF: p. 185 a. These drugs can interact with many foods and beverages. b. These drugs can cause you to be physically active at night. c. These drugs must be takes for at least 6 weeks to see any effects. d. Excess caffeine intake can work to increase the effectiveness of these drugs.

6. What specific information should be part of the teaching plan for a patient taking a nonbenzodiazepine sedative?

ANS: B

When taking a nonbenzodiazepine (benzodiazepine agonist), be aware that drugs from this class can cause you to be physically active at night, even going for a drive, without your knowledge or memory of the event. It is best to have a family member or friend watch out for these effects when you first start taking the drug.

DIF: Cognitive Level: Applying REF: p. 186 a. “Buspirone acts by affecting the serotonin and dopamine neurotransmitters.” b. “Buspirone acts by inhibiting GABA pathways to decrease anxiety.” c. “Buspirone acts by affecting the monoamine oxidase pathway.” d. “Buspirone acts by inhibiting the action of dopamine receptors.”

7. You are preparing to teach a patient with anxiety disorder about the actions of the nonbenzodiazepine drug buspirone. What would you inform the patient about how this drug works?

ANS: A

A newer drug from the nonbenzodiazepine class, buspirone, reduces anxiety through a variety of actions affecting the serotonin and dopamine neurotransmitters.

DIF: Cognitive Level: Applying REF: p. 187 a. Lorazepam (Ativan) b. Buspirone (BuSpar) c. Benztropine (Cogentin) d. Chlorpromazine (Thorazine)

8. Which drug is classified as a benzodiazepine?

ANS: A

Lorazepam (Ativan) is a benzodiazepine.

DIF: Cognitive Level: Knowing REF: p. 186 a. Throazine is associated with a higher risk of extrapyramidal symptoms. b. Thorazine relieves anxiety symptoms associated with schizophrenia. c. Thorazine is used for acute schizoaffective disorders. d. Thorazine is used for chronic mental illness.

9. The family members of a patient admitted for hallucinations and delusions tells you that the patient is currently taking chlorpromazine (Thorazine) for the treatment of schizophrenia. Which statement about this drug is true?

ANS: D

Typical antipsychotics, such as Thorazine, are more commonly used for long-term management of chronic mental illnesses associated with psychosis.

DIF: Cognitive Level: Understanding REF: p. 190 a. Call the healthcare provider to report these symptoms. b. Tell the family to hold the next dose of fluphenazine. c. Inform the family that these symptoms are expected, and of no concern. d. Tell the family that these symptoms will disappear over time as the drug dose stabilizes.

10. The family of a patient who has been taking the antipsychotic fluphenazine (Prolixin) for the last 2 years. The patient’s family reports the patient has suddenly begun smacking her lips, and involuntarily sticking out her tongue. What would be your best first action?

ANS: A

The main adverse effects of typical antipsychotics are extrapyramidal symptoms (EPS), related to the decrease in dopamine, many are severe and some may be irreversible so it is important to recognize very early in treatment. The healthcare provider should be called immediately, and often, the drug is discontinued.

DIF: Cognitive Level: Applying REF: p. 193 a. “Do not abruptly stop taking this drug.” b. “Take these drugs with a glass of grapefruit juice.” c. “Take these drugs at night with your sleep drug.” d. “You will experience the effects of these drugs within 30 minutes of taking them.”

11. You are about to begin teaching a patient with a psychosis about taking typical antipsychotic drugs. Which of the following statements would you include in your teaching plan?

ANS: A

Continue to take the drugs as prescribed. It may take several weeks before significant changes occur. Do not suddenly stop taking these drugs as this can result in nausea, dizziness and tremors. You can take many of these drugs with food to avoid GI upset, but these drugs can interact with grapefruit juice. Do not drink alcohol or use any sedatives while using these drugs to prevent deep sedation and other dangerous side effects.

DIF: Cognitive Level: Applying REF: p. 193 a. “Stop this drug immediately.” b. “Weight gain can be an adverse effect of this drug.” c. “Weight gain is an expected side-effect of this drug.” d. “I will notify your healthcare provider, so the drug can be changed.”

12. A patient who has been taking the atypical antipsychotic risperidone (Risperdal) reports weight gain after taking the drug for 3 months. What would you tell this patient?

ANS: C

For patients taking atypical antipsychotics, weight gain is associated with these drugs.

DIF: Cognitive Level: Applying REF: p. 194 a. Metallic taste. b. Sexual dysfunction. c. Cardiovascular disease. d. Extrapyramidal symptoms.

13. You are teaching a patient about the adverse effects associated with selective serotonin reuptake inhibitors (SSRIs). Which adverse effect would you inform your patient about?

ANS: B

Expected side effects of SSRI’s include sexual side effects in men and women that include decreased sex drive and decreased ability to orgasm and erectile dysfunction. Other adverse effects include nausea (during the first 2 weeks), drowsiness, insomnia, dry mouth, decreased appetite increased sweating and constipation.

DIF: Cognitive Level: Applying REF: p. 197 a. “Begin taking two tablets daily to increase blood serum levels.” b. “Add a tablet of St, John’s Wort to increase the drug’s effects.” c. “You should call your healthcare provider immediately.” d. “It may take several weeks for this drug to take effect.”

14. A patient who has been prescribed a serotonin norepinephrine reuptake inhibitor (SNRI) one week ago reports that she has not noticed any difference in her depression level since beginning this drug. What is your best response?

ANS: D

The patient should see effects within a few weeks of taking the drug, with maximum effects at 6 to 8 weeks.

DIF: Cognitive Level: Applying REF: p. 200 a. Suicidal thoughts. b. Psychotic episodes. c. Delusional thinking. d. Schizo-affective disorders.

15. A young adult patient taking an SSRI for the past 2 weeks comes in for an evaluation and follow-up appointment. Which potential side effect should you check for in this patient?

ANS: A

SSRI’s may cause thoughts of suicide, most likely in children and young adults. Remind the patients and their families that this is just a side effect of the drug and should be reported to the healthcare providers immediately.

DIF: Cognitive Level: Applying REF: p. 197 a. Antipsychotics. b. Tricyclic antidepressants. c. Selective serotonin reuptake inhibitors. d. Serotonin norepinephrine reuptake inhibitors.

16. Which of the following drugs classifications for the treatment of mental health problems is contraindicated for patients with vision problems?

ANS: B

TCAs should not be used in patients with glaucoma because these drugs can increase intraocular pressure.

DIF: Cognitive Level: Knowing REF: p. 202 a. Skin assessment. b. Hearing assessment. c. Elimination assessment. d. Vital signs and weight assessment.

17. A patient who has been taking imipramine comes to the clinic for a routine follow-up appointment. Which of the following assessments would be appropriate to perform?

ANS: D

Assess vital signs including baseline weight. TCAs can cause hypotension and weight gain.

DIF: Cognitive Level: Applying REF: p. 202 a. “I will take both my isocarboxazid and my SSRI drugs at the same time each day.” b. “I will avoid situations that cause me to lose fluids and become dehydrated.” c. “I will avoid eating foods containing tyramine that can increase blood pressure.” d. “I will take my isocarboxazid weekly, as this drug is long-acting”

18. You are caring for a patient who will begin treatment for anxiety and depression that has been unresponsive to other drugs with isocarboxazid. Which of the following statements made by the patient would indicate understanding of the teaching related to this drug?

ANS: C

Patients taking MAO-Is risk of hypertensive crisis from taking foods or drinks high in tyramine. Tyramine is an amino acid that is involved in the release of norepinephrine. Normally, tyramine is broken down by monoamine oxidases (enzymes). When the patient is taking an inhibitor of the enzyme (MAO-Is), there is an increase in norepinephrine which can then significantly increase blood pressure. This can cause sudden and severe hypertension.

DIF: Cognitive Level: Applying REF: p. 199 a. Lithium b. Sertoline c. Alprazolam d. Chlorpromazine

19. Which of the following drugs would be appropriate for the treatment of bipolar illness?

ANS: A

Lithium is specifically used for patients with bipolar disorder who are in an acute manic phase.

DIF: Cognitive Level: Knowing REF: p. 205 a. “I will need to increase my salt intake while taking this drug.” b. “I will need regular blood testing while taking this drug.” c. “I may develop mild memory loss while taking this drug.” d. “Lithium cannot be taken with tyrosine-containing foods.”

20. You have just completed teaching with a patient who is beginning lithium. Which of the following statements made by the patient demonstrates understanding of this drug?

ANS: B

Serum lithium levels need to be monitored frequently while the patient is taking the drug. Blood levels are checked 4 days after the patient starts taking lithium. Desired level for acute mania is 0.8 to 1.2 mEq/L. Any levels over 1.5 mEq are considered toxic. Levels >3 mEq/L are associated with coma, organ failure, and even death.

DIF: Cognitive Level: Applying REF: p. 205 a. Increased drowsiness, weakness and nausea. b. Heart palpitations, seizures, and muscle spasm. c. Decreased urine output, vision loss and irritability. d. Increased mania, excessive salivation and tachycardia.

21. You are taking the history of a patient who is suspected of having lithium toxicity. What symptoms would you expect the patient to report?

ANS: A

Signs and symptoms of lithium toxicity include nausea, vomiting, increased drowsiness, muscle weakness, severe hand tremor and incoordination. Report these symptoms to the RN or healthcare provider immediately.

DIF: Cognitive Level: Knowing REF: p. 205

Multiple Response

1. Which symptoms would you expect a patient who is experiencing mania? (Select all that apply.)

a. Catatonia b. CNS depression c. Increased energy d. Grandiose notions e. Poor judgement f. Excessive sleepiness

ANS: C, D, E

Symptoms of mania include: increased energy, grandiose notions, poor judgement, increased sexual desire, racing thoughts, irritability, increased energy, inappropriate social behavior & increased talking

DIF: Cognitive Level: Knowing REF: p. 204 a. Psychosis. b. Depression. c. General anxiety disorder. d. Traumatic stress disorder. e. Manic depressive disorder. f. Obsessive-compulsive disorder.

2. What disorders would a selective serotonin uptake inhibitor (SSRI) be prescribed for? (Select all that apply.)

ANS: B, C, D, F

SSRIs can be used in a variety of conditions including depression, premenstrual dysphoric disorder (PMDD), posttraumatic stress disorder, obsessive-compulsive disorder, and general anxiety disorder.

DIF: Cognitive Level: Knowing REF: p. 197 a. Confusion. b. Restlessness c. Dilated pupils. d. Increased sweating. e. Severe constipation. f. Extremely high blood pressure.

3. Too much serotonin can lead to the adverse effect known as serotonin syndrome. Which of the following symptoms are associated with serotonin syndrome? (Select all that apply.)

ANS: A, B, C, D, F

Serotonin syndrome is a potentially life-threatening disorder characterized by confusion, restlessness, extremely high blood pressure, dilated pupils, increased sweating, seizures and tremors.

DIF: Cognitive Level: Knowing REF: p. 194 a. Pinpoint pupils. b. Muscle rigidity. c. Elevated temperature. d. Unstable blood pressure. e. Increased white blood count. f. Extremely low creatinine kinase

4. You are caring for a patient with schizophrenia who is taking antipsychotic drugs for the control of hallucinations and delusions. Which symptoms experienced by the patient would alert you to that the development of neuroleptic malignant syndrome? (Select all that apply.)

ANS: B, C, D, E

Neuroleptic malignant syndrome is a potentially life-threatening condition characterized by muscle rigidity, elevated temperature, unstable blood pressure, increased white blood cell count, elevated creatinine kinase and hyperkalemia.

DIF: Cognitive Level: Understanding REF: p. 192 a. “Use sugarless gum or candy to relieve dry mouth”. b. “Keep out of the sun while taking this drug.” c. “This drug can relieve depression quickly.” d. “Move slowly when changing positions.” e. “Avoid ripe cheeses and smoked meats.” f. “This drug can affect your sleeping.”

5. You are preparing to teach a patient about the drug amitriptyline. Which of the following statements should be included in your teaching plan? (Select all that apply.)

ANS: A, B, D, F

TCAs can cause dry mouth, so using sugarless gum, candy or ice ships can help. Sun sensitivity can occur, so staying out of the sun and the use of sunscreen is recommended. Orthostatic blood pressure changes can occur, so patients need to be told to change positions carefully. This drug can cause either drowsiness, or difficulty sleeping.

DIF: Cognitive Level: Applying REF: p. 202