Charter College, Anchorage - NURSING NU1005

Chapter 27: Drug Therapy for Psychiatric Problems

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)What term means to have fixed false beliefs or opinions that are held despite a lack of supporting evidence?

1. 1. Anxiety
   2. Delusion
   3. Psychosis
   4. Obsession

2. Which statement about psychiatric disorders is true?
   1. Depression is less common than mania.
   2. Minor mental illnesses are usually caused by prescription drug use.
   3. Psychiatric disorders most often in young adults and decrease with age.
   4. Major mental illnesses are the most common cause of disability in the United States.

3. An imbalance of which type of naturally occurring substances in the brain is thought to be responsible for depression?
   1. Enzymes
   2. Receptors
   3. Neurotransmitters
   4. Endocrine hormones

4. Which antidepressant drug belongs to the tricyclic antidepressant (TCA) category?
   1. Amitriptyline (Elavil)
   2. Bupropion (Wellbutrin)
   3. Citalopram (Celexa)
   4. Duloxetine (Cymbalta)

5. Which problem can be a side effect of antidepressants in children and adolescents?
   1. Suicidal thoughts
   2. Profound anemia
   3. Craving for cigarettes
   4. Severe hypertension

6. Which drug used to treat depression is a combination of a reuptake inhibitor and a receptor blocker?
   1. Fluoxetine (Prozac)
   2. Sertraline (Zoloft)
   3. Tramadol (Rybix)
   4. Trazodone (Desyrel)

7. What is the most common side effect of benzodiazepines used to treat anxiety?
   1. Widely dilated pupils
   2. Excessive sweating

1. 3. Hyperactivity
   4. Sleepiness

8. Which drug used to treat psychosis can cause the urine to turn pink or reddish brown?
   1. Alprazolam (Xanax)
   2. Amitriptyline (Elavil)
   3. Prochlorperazine (Compazine)
   4. Quetiapine (Seroquel)

9. Which side effect is most common to all antianxiety drugs?
   1. Sedation
   2. Weight gain
   3. Excess excitement
   4. Urinary retention

10. What potential problem can occur in an infant being breastfed while the mother takes a selective serotonin reuptake inhibitor?
    1. Suicide ideation
    2. Acute depression
    3. Excess excitement
    4. Weight loss

ADVANCED CONCEPTS

11. Which statement about depression is true?
    1. Depression does not affect the way an individual interacts with others.
    2. Men are twice as likely to experience depression as women.
    3. Many older adults with depression are undiagnosed and untreated.
    4. Women are less likely than men to seek treatment for depression.

12. Which characteristic is typical of bipolar disorder?
    1. Severe highs and severe lows
    2. Increased risk for suicide
    3. Persistently low moods
    4. Lack of pleasure in life

13. A patient with depression has all of the following symptoms. For which symptom is he or she likely to receive treatment at an inpatient facility rather than as an outpatient?
    1. Expressing anger at a situation or individual
    2. Suggesting a plan to hurt oneself
    3. Crying off and on for several hours or days
    4. Sleeping for 12 hours or longer daily

14. Which theory about the cause of depression is supported by research?
    1. Heredity or genetics
    2. Altered neuroendocrine function
    3. Psychosocial factors
    4. Neurotransmitter level imbalance

15. A patient who was prescribed citalopram (Celexa) 1 week ago for depression reports feeling no different now from 1 week ago and wants to stop taking the drug. What is your best response?
    1. “Treatment for depression is highly individual and this may not be the right drug for you.”
    2. “Most drugs for depression take at least 2 weeks to start making you feel better.”
    3. “Are you certain that you are taking the drug exactly the way it was prescribed?”
    4. “Be sure to stop smoking because cigarette smoking inactivates this drug.”

16. A patient is prescribed bupropion (Wellbutrin SR) 100 mg twice daily. It is time for the second dose today and the drug sent up from the pharmacy is Wellbutrin 100 XL. What is your best action?
    1. Administer the Wellbutrin XL tablet in place of the Wellbutrin SR tablet.
    2. Cut the Wellbutrin XL tablet in half and then administer it.
    3. Call the pharmacy and obtain a Wellbutrin SR 100 mg tablet.
    4. Hold the dose and notify the prescriber.

17. Which statement by a patient with chronic depression who is prescribed fluoxetine (Prozac) indicates the need for additional teaching?
    1. “It may take from 2 to 8 weeks for my depression to improve.”
    2. “If I have suicidal thoughts, I will contact my prescriber immediately.”
    3. “I will check my pulse every day and report irregular rhythms to my prescriber.”
    4. “When I am feeling better and no longer depressed, I will stop taking the Prozac.”

18. Which assessment is most important to measure or perform before administering the first dose of amitriptyline (Elavil) to a patient?
    1. Heart rate and rhythm
    2. Core body temperature
    3. Level of consciousness
    4. Blood pressure in the sitting position

19. The parents of a 12-year-old who was prescribed fluoxetine (Prozac) inform you that their child is having trouble sleeping. What is your best response?
    1. “This is a normal expected side effect of fluoxetine.”
    2. “We may need to ask the prescriber to order something to help your child sleep.”
    3. “Children are more sensitive to the effects of this drug and may need a lower dose.”
    4. “Before bedtime be sure that your child does not eat or drink anything with caffeine.”

20. A patient has been taking mirtazapine (Remeron) for the last 3 months. Which blood laboratory result should be reported to the prescriber?
    1. Lactate dehydrogenase 122 mg/dL
    2. International normalized ratio (INR) 1.3
    3. White blood cell count (WBC) 2100/mm³
    4. Platelet count 356,000/mm³

21. Which precaution is most important to teach a patient who is prescribed any antidepressant drug?
    1. “Avoid drinking grapefruit juice while taking this drug.”
    2. “Avoid drinking alcoholic beverages while taking this drug.”
    3. “Be sure to wear sunscreen and a hat when going outdoors.”
    4. “Drink at least 3 L of fluid every day while taking this drug.”

22. Although serotonin reuptake inhibitors (SSRIs) are used more commonly now to treat anxiety disorders than are benzodiazepines, for which patient situation would you expect a benzodiazepine to be prescribed instead of an SSRI?
    1. The patient is 18 years old.
    2. Anxiety has been present daily for 6 months.
    3. The patient has compulsive repetitive actions.
    4. The anxiety attack is severe with hallucinations.

23. A patient who has been prescribed clonazepam (Klonopin) for the last 3 months tells you that he wants to stop this drug because he constantly feels like he is in a “fog.” What is your best response?
    1. “Quit taking the drug today and I will have the prescriber change your medication to another drug category.”
    2. “Continue to take this drug as prescribed because most patients eventually get used to the foggy sensation.”
    3. “We will give you a final dose of this drug today intravenously and then start you on a different drug.”
    4. “I will contact the prescriber but it will still be necessary to take this drug at a lower dosage for a while.”

24. Which statement about a common anxiety disorder is accurate?

1. 1. Panic disorders develop over a period of hours to days.
   2. Generalized anxiety disorder occurs when an individual experiences excessive anxiety daily for 2 months.
   3. Phobic disorders are recurrent persistent fears of certain objects or situations that can cause panic attacks.
   4. Posttraumatic stress disorder is the result of frightening thoughts and dreams.

25. What is the advantage of treating a patient with anxiety with a benzodiazepine drug rather than a selective serotonin reuptake inhibitor (SSRI)?
    1. Benzodiazepines are not likely to cause patient dependence when used for an extended period of time.
    2. Benzodiazepines have milder side effects and almost no adverse effect when compared with SSRIs.
    3. Benzodiazepines control anxiety and allow patients to live a relatively normal lifestyle.
    4. Benzodiazepines act to treat anxiety within 30 minutes and can be given on an as- needed basis.

26. What type of medication could be prescribed for a patient who experiences anxiety when speaking before a group?
    1. A benzodiazepine drug
    2. An SSRI drug
    3. A beta blocker
    4. A TCA drug

27. A patient asks why the prescriber is changing his anxiety medication from lorazepam (Ativan) to sertraline (Zoloft). What is your best response?

1. 1. “Sertraline is a stronger drug and will do a better job of controlling your anxiety.”
   2. “Sertraline has milder side effects and a decreased risk for drug dependence.”
   3. “Sertraline acts much faster to get the symptoms of your anxiety under control.”
   4. “Sertraline can be taken only when needed to control symptoms of anxiety.”

28. On admission to the acute care unit a patient tells you that she stopped taking her prescribed clonazepam (Klonopin) 2 days ago. What is your best first action?
    1. Ask the patient why she stopped taking the clonazepam.
    2. Administer a dose of clonazepam immediately.
    3. Document this information as the only action.
    4. Notify the prescriber and watch for seizures.

29. A patient who has been prescribed diazepam (Valium) reports taking the as-needed (PRN) drug more often to keep anxiety symptoms under control and does not want the prescriber to stop prescribing it. What is your best interpretation of this information?
    1. The patient may be developing signs of drug dependence.
    2. The patient may be developing signs of drug tolerance.
    3. The patient’s anxiety is becoming more severe.
    4. The patient should stop taking the drug immediately.

30. A female patient who has been prescribed diazepam (Valium) for anxiety tells you that she and her husband are planning to have a child. What is your best response?
    1. “Before becoming pregnant your dosage of diazepam will need to be decreased.”
    2. “You should always discuss any changes in your medications and lifestyle with your prescriber.”
    3. “Consult with your prescriber because taking diazepam while pregnant has been associated with birth defects.”

1. 4. “Diazepam may cause withdrawal effects including miscarriage when taken during pregnancy.”

31. How do the major antipsychotic drugs exert their effects to reduce psychotic episodes?
    1. They block dopamine receptors and reduce neuronal impulse transmission.
    2. They redirect nerve impulses away from excitatory areas of the brain and into brain inhibitory areas.
    3. They enhance the breakdown of excitatory neurotransmitter chemicals so that impulse transmission is slower.
    4. They block the reuptake of neurotransmitters so that the concentration of these chemicals is increased in the brain.

32. The family of a patient who was prescribed chlorpromazine (Thorazine) report that the patient continually rolls his tongue and smacks his lips. What is your best action?
    1. Reassure the patient and family that this response is an expected side effect of the drug.
    2. Instruct the family to ensure that the patient drinks plenty of fluids and performs oral hygiene at least three times daily.
    3. Instruct the family to hold the next dose of the drug and have the patient seen by the prescriber as soon as possible.
    4. Emphasize the family that this drug cannot be stopped quickly and to gradually reduce the dose over a 2- to 3-week period.

33. An older patient taking lithium carbonate (Eskalith) for 2 months has all of the following conditions. Which finding should you report to the prescriber as a possible side effect that may require a change of drug or drug dosage?
    1. Dry mouth

1. 2. Increased belching after meals
   3. Weight loss of 6 lb in 1 week
   4. International normalized ratio (INR) of 1.1

34. Four hours after receiving risperidone (Risperdal), the patient on the psychiatric unit has a temperature elevation of 2^o F. What is your best action?
    1. Administer the next dose of the drug as prescribed.
    2. Assess the patient for other signs and symptoms of infection.
    3. Hold the next drug dose and notify the prescriber immediately.
    4. Attempt to arouse the patient from sleep by gently shaking his or her arm.

35. Which food or beverage should you teach a patient who is prescribed quetiapine (Seroquel) to avoid?
    1. Coffee and caffeine
    2. Fresh berries and vegetables
    3. Aged cheese and smoked meat
    4. Grapefruit and grapefruit juice

36. Which safety precaution is most important to teach an older adult who is prescribed chlorpromazine (Thorazine)?
    1. “Avoid going barefoot, even in the house.”
    2. “Change positions slowly when rising to stand.”
    3. “Drink plenty of water to avoid having to strain during a bowel movement.”
    4. “Use a thermometer to check the temperature of your bath water to avoid a scald injury.”

37. A patient who has been prescribed prochlorperazine (Compazine) calls the clinic and reports pink-tinged urine. What is your best action?
    1. Ask if the patient consumed grapefruit or grapefruit juice during the last 24 hours.
    2. Remind the patient to drink more water to prevent this drug from damaging the kidneys.
    3. Reassure the patient that this is an expected side effect of the drug and needs no action.
    4. Instruct the patient to hold the next drug dose and notify the prescriber immediately.

38. A patient is prescribed 30 mg of chlorpromazine (Thorazine) intramuscularly. The drug available is 25 mg/mL. How many milliliters will you draw into the syringe?
    1. 0.8 mL
    2. 1 mL
    3. 1.2 mL
    4. 1.4 mL

39. A patient is prescribed Ziprasidone (Geodon), 80 mg twice a day. Tablets from the pharmacy are 20 mg per tablet. How many tablets will you give for each dose?
    1. 2 tablets
    2. 4 tablets
    3. 6 tablets
    4. 8 tablets

40. A patient prescribed fluoxetine (Prozac) develops anxiety, diaphoresis, confusion, tremors, restlessness, and a heart rate of 114 per minute. What adverse effect do you recognize?
    1. Allergic reaction

1. 2. Angioedema
   3. Serotonin syndrome
   4. Stevens-Johnson syndrome

MULTIPLE RESPONSE ADVANCED CONCEPTS

1. Which are common treatment methods for depression? (select all that apply)
   1. Counseling
   2. Surgery
   3. Group meetings
   4. Psychotherapy
   5. Shock therapy
   6. Drug therapy with lithium carbonate

2. A patient has been prescribed amitriptyline (Elavil). What should you plan teach this patient? (select all that apply)
   1. “Smoking cigarettes can decrease the effectiveness of amitriptyline in treating your depression.”
   2. “Check your pulse every day and report any irregular rhythms to your prescriber right away.”
   3. “Amitriptyline should help to improve your depression symptoms within 7 to 14 days.”
   4. “Avoid driving or operating dangerous equipment until you know how the drug will affect you.”
   5. “Be sure to include foods with lots of fiber in your diet to prevent the side effect of constipation.”
   6. “Tell the patient that this drug can cause urine to appear orange or red.”

3. What are common anxiety disorders? (select all that apply)
   1. Dysthymia
   2. Panic disorder
   3. Bipolar disorder
   4. Phobic disorder
   5. Obsessive-compulsive disorder
   6. Depression

4. A patient with anxiety is prescribed oxazepam (Serax). What safety measures must you teach a patient taking this drug? (select all that apply)
   1. Call for help when getting out of bed.
   2. Use a walker for ambulation.
   3. Assess gait for steadiness.
   4. Change positions slowly.
   5. Take two tablets whenever a dose is missed.
   6. Always use a bedside commode, even at home.

5. An older adult prescribed clozapine (Clozaril) tells you that his last bowel movement was 5 days ago. Which instructions would you share with this patient? (select all that apply)
   1. Use a bedpan or bedside commode.
   2. Drink extra fluids with meals and throughout the day.
   3. Take the stool softener ordered by your prescriber.
   4. Increase exercise activity during the day.
   5. Take a daily multivitamin.
   6. Consume lots of vegetables and fruits in your diet.