Chapter 10

Holland/Adams/Brice, Core Concepts in Pharmacology 4th Edition Test Bank
Chapter 10

Question 1

Type: MCMA

The nurse is caring for a client with depression. The nurse recognizes which assessment findings to be symptoms of depression?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Lack of energy

Sleep disturbances

Feelings of despair

Increased energy

Euphoria

Correct Answer: 1, 2, 3

Rationale 1: Lack of energy is a symptom of depression.

Rationale 2: Sleep disturbances are a symptom of depression.

Rationale 3: Feelings of despair are a symptom of depression.

Rationale 4: Increased energy is incorrect because a lack of energy is a symptom of depression.

Rationale 5: Euphoria is incorrect because sadness is a symptom of depression.

Global Rationale: Lack of energy, sleep disturbances, and feelings of despair are all symptoms of depression.  Increased energy and euphoria are not symptoms of depression.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-1 Identify the general categories of mood disorders and their symptoms.

Question 2

Type: MCSA

The nurse is caring for a client diagnosed with bipolar disorder who is exhibiting the following symptoms: insomnia, exaggerated confidence, attention seeking, and easily agitated. Based on these symptoms, what does the nurse believe these symptoms are caused by?

Overdose of barbiturates

Mania

Side effects of lithium (Eskalith)

Depression

Correct Answer: 2

Rationale 1: Overdose of barbiturates is incorrect because these symptoms are signs of mania.

Rationale 2: Symptoms of mania include insomnia, exaggerated confidence, attention seeking, and a client’s being easily agitated.

Rationale 3: These symptoms are signs of mania.

Rationale 4: These symptoms are signs of mania.

Global Rationale: Symptoms of mania include insomnia, exaggerated confidence, attention seeking, and a client’s being easily agitated. Overdose of barbiturates, side effects of lithium (Eskalith) and depression are incorrect because these symptoms are signs of mania.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-1 Identify the general categories of mood disorders and their symptoms.

Question 3

Type: MCSA

The client asks the nurse what causes depression. What is the best answer by the nurse?

“There are many causes, including genetics, hormone changes, grief, substance abuse, and prescription drugs.”

“Most people are not really depressed. They are just looking for attention.”

“The main cause of depression is substance abuse.”

“Most people who are depressed suffer from seasonal affective disorder.”

Correct Answer: 1

Rationale 1: There are many causes of depression, including genetics, hormone changes, grief, substance abuse, and prescription drugs.

Rationale 2: “Most people are not really depressed. They are just looking for attention” is incorrect because many people are depressed.

Rationale 3: “The main cause of depression is substance abuse” is incorrect because while substance abuse can cause depression, it is not the main cause.

Rationale 4: “Most people who are depressed suffer from seasonal affective disorder” is incorrect because this can cause depression, but is not the main cause.

Global Rationale: There are many causes of depression, including genetics, hormone changes, grief, substance abuse, and prescription drugs. “Most people are not really depressed. They are just looking for attention” is incorrect because many people are depressed. “The main cause of depression is substance abuse” is incorrect because while substance abuse can cause depression, it is not the main cause. “Most people who are depressed suffer from seasonal affective disorder” is incorrect because this can cause depression, but is not the main cause.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-2 Explain the causes of major depressive disorder.

Question 4

Type: MCSA

A client is being treated for reoccurring severe depressive illness. The nurse expects the client to receive which type of treatment?

Grief counseling

Medication and psychotherapy

Medication only

Psychotherapy only

Correct Answer: 2

Rationale 1: Grief might not be the cause of the depression.

Rationale 2: Medication and psychotherapy would be the best treatment for recurring severe depressive illness.

Rationale 3: The best treatment would be a combination of medication and psychotherapy.

Rationale 4: The best treatment would be a combination of medication and psychotherapy.

Global Rationale: Medication and psychotherapy would be the best treatment for reoccurring severe depressive illness. Grief might not be the cause of the depression. The best treatment would be a combination of medication and psychotherapy. The best treatment would be a combination of medication and psychotherapy.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-2 Explain the causes of major depressive disorder.

Question 5

Type: MCSA

The physician has ordered a tricyclic antidepressant for a client with biological depression. The nurse expects to find which medications to be ordered for the client?

Amitriptyline (Elavil)

Citalopram (Celexa)

Duloxetine (Cymbalta)

Fluoxetine (Prozac)

Correct Answer: 1

Rationale 1: Amitriptyline (Elavil) is a tricyclic antidepressant.

Rationale 2: Citalopram (Celexa) is incorrect because this medication is an SSRI.

Rationale 3: Duloxetine (Cymbalta) is incorrect because this medication is an SSRI.

Rationale 4: Fluoxetine (Prozac) is incorrect because this medication is an SSRI.

Global Rationale: Amitriptyline (Elavil) is a tricyclic antidepressant. Citalopram (Celexa) is incorrect because this medication is an SSRI. Duloxetine (Cymbalta) is incorrect because this medication is an SSRI. Fluoxetine (Prozac) is incorrect because this medication is an SSRI.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-3 Discuss the pharmacologic management of patients with depression, bipolar disorder, and attention deficit–hyperactivity disorder (ADHD).

Question 6

Type: MCSA

The nurse is performing an assessment on a client who has been taking a tricyclic antidepressant for several weeks. Which common adverse effect of tricyclic antidepressants is most likely to occur?

Dry mouth

Bradycardia

Sedation

Orthostatic hypotension

Correct Answer: 4

Rationale 1: Dry mouth is incorrect because it is a side effect, but not the most common.

Rationale 2: Tricyclic antidepressants can cause tachycardia.

Rationale 3: Sedation is incorrect because it often occurs at the beginning of treatment and then goes away.

Rationale 4: Orthostatic hypotension is the most common adverse effect of tricyclic antidepressants.

Global Rationale: Orthostatic hypotension is the most common adverse effect of tricyclic antidepressants. Dry mouth is incorrect because it is a side effect, but not the most common. Tricyclic antidepressants can cause tachycardia. Sedation is incorrect because it often occurs at the beginning of treatment and then goes away.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-3 Discuss the pharmacologic management of patients with depression, bipolar disorder, and attention deficit–hyperactivity disorder (ADHD).

Question 7

Type: MCSA

The nurse is providing care to a client who is diagnosed with depression. The client asks the nurse which medication she is likely to be prescribed. What has become the drug of choice in treating depression?

SSRIs

MAOIs

SNRIs

TCAs

Correct Answer: 1

Rationale 1: SSRIs are the drug of choice for treating depression.

Rationale 2: SSRIs are the drug of choice for treating depression.

Rationale 3: SSRIs are the drug of choice for treating depression.

Rationale 4: SSRIs are the drug of choice for treating depression.

Global Rationale: SSRIs are the drug of choice for treating depression. MAOIs, SNRIs, and TCAs can all be used to treat depression, but these are not the current drug of choice.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Discuss the pharmacologic management of patients with depression, bipolar disorder, and attention deficit–hyperactivity disorder (ADHD).

Question 8

Type: MCSA

Which teaching instruction is most appropriate for a client who has just been prescribed an SSRI?

The full therapeutic effect takes one month.

Take the medication at bedtime.

The depression should improve immediately.

There are few side effects of SSRIs.

Correct Answer: 1

Rationale 1: Full therapeutic effect takes one month for SSRIs.

Rationale 2: The medication should be taken in the morning.

Rationale 3: The full therapeutic effect takes one month.

Rationale 4: There are many side effects for SSRIs.

Global Rationale: Full therapeutic effect takes one month for SSRIs. The medication should be taken in the morning, not at bedtime. Depression does not improve immediately because the full therapeutic effect takes one month. There are many side effects for SSRIs.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Discuss the pharmacologic management of patients with depression, bipolar disorder, and attention deficit–hyperactivity disorder (ADHD).

Question 9

Type: MCMA

Which teaching points should the nurse include for a client who has been prescribed an SSRI?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Add dietary fiber.

Drink adequate amounts of fluid.

Avoid laxatives.

Restrict fluid intake.

Avoid stool softeners.

Correct Answer: 1, 2

Rationale 1: Adding dietary fiber helps promote passage of stool.

Rationale 2: Drinking adequate amounts of fluid helps promote passage of stool.

Rationale 3: Laxatives might be necessary. The client should consult the health care provider.

Rationale 4: The client should drink adequate amounts of fluid.

Rationale 5: Stool softeners might be necessary. The client should consult the health care provider.

Global Rationale: Adding dietary fiber helps promote passage of stool. Drinking adequate amounts of fluid helps promote passage of stool. Laxatives and stool softeners might be necessary. The client should consult the health care provider. The client should drink adequate amounts of fluid.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-3 Discuss the pharmacologic management of patients with depression, bipolar disorder, and attention deficit–hyperactivity disorder (ADHD).

Question 10

Type: MCMA

A child diagnosed with ADHD would likely exhibit which symptoms?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Able to focus on a task for an extended period of time

Impulsiveness

Excessive talking

Easily distracted

Violent behavior

Correct Answer: 2, 3, 4

Rationale 1: A child with ADHD has difficulty focusing on tasks for extended periods of time.

Rationale 2: Children with ADHD are often easily distracted and impulsive, and often talk excessively.

Rationale 3: Children with ADHD are often easily distracted and impulsive, and often talk excessively.

Rationale 4: Children with ADHD are often easily distracted and impulsive, and often talk excessively.

Rationale 5: Children with ADHD are not typically violent.

Global Rationale: Children with ADHD are often easily distracted and impulsive, and often talk excessively. A child with ADHD has difficulty focusing on tasks for extended periods of time. Children with ADHA are not typically violent.

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-4 Identify symptoms of ADHD.

Question 11

Type: MCSA

The client receives amitriptyline (Elavil). What is a priority teaching point at discharge?

Do not rapidly stand up or change positions.

Begin a low-carbohydrate diet.

Avoid green, leafy vegetables.

Do not take aspirin with this drug.

Correct Answer: 1

Rationale 1: The most common side effect of tricyclic antidepressants is orthostatic hypotension. Clients must be taught to stand up or change positions slowly.

Rationale 2: Eating a low-carbohydrate diet, taking aspirin, and eating green, leafy vegetables have no effect on the action or side effects of this drug.

Rationale 3: Eating a low-carbohydrate diet, taking aspirin, and eating green, leafy vegetables have no effect on the action or side effects of this drug.

Rationale 4: Eating a low-carbohydrate diet, taking aspirin, and eating green, leafy vegetables have no effect on the action or side effects of this drug.

Global Rationale: The most common side effect of tricyclic antidepressants is orthostatic hypotension. Clients must be taught to stand up or change positions slowly. Eating a low-carbohydrate diet, taking aspirin, and eating green, leafy vegetables have no effect on the action or side effects of this drug.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 12

Type: MCSA

The client receives paroxetine (Paxil), and tells the nurse that sexual dysfunction has become a problem. What is the best response by the nurse?

“This side effect usually subsides in a few months.”

“This is common. Please discuss it with your physician.”

“Your depression is of primary concern right now.”

“You should stop the medication right away.”

Correct Answer: 2

Rationale 1: “This side effect usually subsides in a few months” is incorrect because this side effect of sexual dysfunction usually does not subside with long-term use.

Rationale 2: The most common side effect of SSRIs relates to sexual dysfunction. Clients should be encouraged to discuss this with their physician. The side effect of sexual dysfunction usually does not subside with long-term use. The nurse should address physiological concerns with the client without being condescending. Clients should not abruptly stop paroxetine (Paxil) because of withdrawal side effects.

Rationale 3: “Your depression is of primary concern right now” is incorrect because the nurse should address physiological concerns with the client without being condescending.

Rationale 4: “You should stop the medication right away” is incorrect because clients should not abruptly stop paroxetine (Paxil), due to withdrawal side effects.

Global Rationale: The most common side effect of SSRIs relates to sexual dysfunction. Clients should be encouraged to discuss this with their physician. The side effect of sexual dysfunction usually does not subside with long-term use. The nurse should address physiological concerns with the client without being condescending. Clients should not abruptly stop paroxetine (Paxil) because of withdrawal side effects.  “This side effect usually subsides in a few months” is incorrect because this side effect of sexual dysfunction usually does not subside with long-term use. “Your depression is of primary concern right now” is incorrect because the nurse should address physiological concerns with the client without being condescending. “You should stop the medication right away” is incorrect because clients should not abruptly stop paroxetine (Paxil), due to withdrawal side effects.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 13

Type: MCSA

The client receives sertraline (Zoloft) and lithium. Which assessment data are most indicative of a potentially serious complication?

Fever and lack of muscular coordination

Dry mouth and constipation

Anxiety and insomnia

Nausea and headache

Correct Answer: 1

Rationale 1: Fever and lack of muscular coordination could indicate serotonin syndrome, a serious complication of too much serotonin accumulation in the body. If untreated, death could occur.

Rationale 2: Dry mouth and constipation are incorrect because these are not side effects of sertraline (Zoloft).

Rationale 3: Anxiety and insomnia are incorrect because while anxiety and insomnia are side effects of sertraline (Zoloft), they are common and not life-threatening.

Rationale 4: Nausea and headache are incorrect because while nausea and headache are side effects of sertraline (Zoloft), they are common and not serious.

Global Rationale: Fever and lack of muscular coordination could indicate serotonin syndrome, a serious complication of too much serotonin accumulation in the body. If untreated, death could occur. Dry mouth and constipation are incorrect because these are not side effects of sertraline (Zoloft). Anxiety and insomnia are incorrect because while anxiety and insomnia are side effects of sertraline (Zoloft), they are common and not life-threatening. Nausea and headache are incorrect because while nausea and headache are side effects of sertraline (Zoloft), they are common and not serious.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 14

Type: MCMA

The client receives phenelzine (Parnate). Which dietary components would indicate the best planning by the nurse and client?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Tomato soup

Avocado salad

Grilled chicken breast

Bologna sandwich

Wine and beer, in moderation

Correct Answer: 1, 3

Rationale 1: Tomato soup does not contain tyramine. The client receiving an MAOI must avoid foods high in tyramine. A hypertensive crisis will result if the client eats foods high in tyramine.

Rationale 2: Avocado contains tyramine.

Rationale 3: Grilled chicken breast does not contain tyramine. The client receiving an MAOI must avoid foods high in tyramine. A hypertensive crisis will result if the client eats foods high in tyramine.

Rationale 4: Bologna contains tyramine.

Rationale 5: Wine and beer both contain tyramine.

Global Rationale: Tomato soup and grilled chicken breast do not contain tyramine. The client receiving an MAOI must avoid foods high in tyramine. A hypertensive crisis will result if the client eats foods high in tyramine. Avocado, bolgna, beer and wine all contain tyramine and should be avoided.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 15

Type: MCMA

The nurse evaluates a client taking a high daily dose of duloxetine (Cymbalta) for which signs and symptoms?

(Select all that apply.)

Suicidal ideation

Increased libido

Liver failure

Seizures

Hypotension

Correct Answer: 1, 3, 4

Rationale 1: Suicidal ideation is possible because Cymbalta can cause suicidal ideation.

Rationale 2: Cymbalta causes sexual dysfunction.

Rationale 3: Liver failure is possible because Cymbalta causes liver toxicity at high doses.

Rationale 4: Seizures are possible because Cymbalta lowers seizure threshold at high doses.

Rationale 5: Hypotension is not likely with a high dose of Cymbalta.

Global Rationale: Suicidal ideation is possible because Cymbalta can cause suicidal ideation. Cymbalta causes sexual dysfunction. Liver failure is possible because Cymbalta causes liver toxicity at high doses. Seizures are possible because Cymbalta lowers seizure threshold at high doses. Hypotension is not likely with a high dose of Cymbalta.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 16

Type: MCSA

A client has just begun therapy with lithium (Eskalith). The nurse notices the serum level of lithium for this client is 1.3 m/Eq/L. What is the normal range of lithium?

1.5–3.0 m/Eq/L.

0.6–1.5 m/Eq/L.

3.0–4.5 m/Eq/L.

0.1–0.6 m/Eq/L.

Correct Answer: B

Rationale 1: The normal range for serum lithium is 0.6–1.5 m/Eq/L.

Rationale 2: The normal range for serum lithium is 0.6–1.5 m/Eq/L.

Rationale 3: The normal range for serum lithium is 0.6–1.5 m/Eq/L.

Rationale 4: The normal range for serum lithium is 0.6–1.5 m/Eq/L.

Global Rationale: The normal range for serum lithium is 0.6—1.5 m/Eq/L. All the other ranges are incorrect.

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 17

Type: MCSA

A client receiving lithium (Eskalith) for bipolar disorder would be at risk for increased lithium toxicity if it were prescribed with which other medication?

Potassium citrate

There are no drug interactions with lithium (Eskalith).

Diuretics

Sodium bicarbonate

Correct Answer: 2

Rationale 1: Potassium citrate increases the rate of removal of lithium.

Rationale 2: There are many different medications that interact with lithium.

Rationale 3: Diuretics cause an increase in the excretion of sodium and increase the risk for toxicity.

Rationale 4: Sodium bicarbonate increases the rate of removal of lithium.

Global Rationale: Diuretics cause an increase in the excretion of sodium and increase the risk for toxicity. Potassium citrate increases the rate of removal of lithium. Diuretics cause an increase in the excretion of sodium and increase the risk for toxicity. Sodium bicarbonate increases the rate of removal of lithium.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 18

Type: MCMA

A client is taking Saint John’s wort and an SSRI. The nurse observes the client for which symptoms?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Mania

Confusion

Renal failure

Tachycardia

Hypertension

Correct Answer: 1, 2, 3, 5

Rationale 1: Mania is a sign of serotonin syndrome, which can occur when Saint John’s wort is taken with an SSRI.

Rationale 2: Confusion is a sign of serotonin syndrome, which can occur when Saint John’s wort is taken with an SSRI.

Rationale 3: Renal failure is a sign of serotonin syndrome, which can occur when Saint John’s wort is taken with an SSRI.

Rationale 4: Tachycardia is incorrect because this combination does not affect heart rate.

Rationale 5: Hypotension is incorrect because this combination would cause hypertension.

Global Rationale: Mania is a sign of serotonin syndrome, which can occur when Saint John’s wort is taken with an SSRI. Confusion is a sign of serotonin syndrome, which can occur when Saint John’s wort is taken with an SSRI. Renal failure is a sign of serotonin syndrome, which can occur when Saint John’s wort is taken with an SSRI. Tachycardia is incorrect because this combination does not affect heart rate. Hypotension is incorrect because this combination would cause hypertension.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-5 Know representative drug examples, and explain the mechanism of action, primary actions, and important adverse effects for each of the drug classes covered in this chapter.

Question 19

Type: MCSA

The nurse is caring for a client who has not responded to several antidepressant drugs. The nurse expects the physician to order which classification of medication for this client?

SNRI

TCA

SSRI

MAOI

Correct Answer: 4

Rationale 1: An MAOI is prescribed when other antidepressants do not work.

Rationale 2: An MAOI is prescribed when other antidepressants do not work.

Rationale 3: An MAOI is prescribed when other antidepressants do not work.

Rationale 4: An MAOI is used for treatment when other medications do not work to treat depression.

Global Rationale: An MAOI is used for treatment when other medications do not work to treat depression. SNRIs, TCAs, and SSRIs will all be prescribed prior to trying an MAOI due to the adverse reactions associate with MAOIs.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 20

Type: MCSA

The nurse instructs the client receiving MAOIs to avoid which item?

Foods containing tyramine

Calcium channel blockers

All dairy products

All physical activity

Correct Answer: 1

Rationale 1: The client receiving MAOI should avoid foods containing tyramine.

Rationale 2: Calcium channel blockers are given to treat hypertensive crisis in clients receiving MAOI therapy.

Rationale 3: The client should avoid cheese, except for cottage cheese, and should avoid sour cream and yogurt.

Rationale 4: This does not apply to MAOI therapy.

Global Rationale: The client receiving MAOI should avoid foods containing tyramine. Calcium channel blockers are given to treat hypertensive crisis in clients receiving MAOI therapy. The client should avoid cheese, except for cottage cheese, and should avoid sour cream and yogurt. Avoiding physical activity is not applicable with MAOI therapy.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 21

Type: MCSA

A child has been ordered the most commonly prescribed medication for ADHD. What medication does the nurse expect?

Clonidine (Catapres)

Methamphetamide (Desoxyn)

Methylphenidate (Ritalin)

Pemoline (Cylert)

Correct Answer: 3

Rationale 1: Clonidine (Catapres) is incorrect because methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD.

Rationale 2: Methamphetamide (Desoxyn) is incorrect because methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD.

Rationale 3: Methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD.

Rationale 4: Pemoline (Cylert) is incorrect because methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD.

Global Rationale: Methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD. Clonidine (Catapres) is incorrect because methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD. Methamphetamide (Desoxyn) is incorrect because methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD. Pemoline (Cylert) is incorrect because methylphenidate (Ritalin) is the most commonly prescribed medication for ADHD.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 22

Type: MCSA

The client is in a manic phase of bipolar disorder, and is receiving lithium. What will the nurse expect to assess when the client’s lithium level is 0.3 m/Eq/L?

Sedation

Calm behavior

Vomiting and diarrhea

Hyperactivity

Correct Answer: 4

Rationale 1: The client will be hyperactive, not sedated.

Rationale 2: The client’s lithium level is low. The client will continue to be manic and hyperactive, not calm.

Rationale 3: Vomiting and diarrhea are effects of lithium toxicity, not of low levels of lithium.

Rationale 4: Hyperactivity would be due to a level of 0.3, a very low lithium level. The client will continue to be hyperactive and manic when the lithium level is low.

Global Rationale: Hyperactivity would be due to a level of 0.3, a very low lithium level. The client will continue to be hyperactive and manic when the lithium level is low. The client will be hyperactive, not sedated. The client’s lithium level is low. The client will continue to be manic and hyperactive, not calm. Vomiting and diarrhea are effects of lithium toxicity, not of low levels of lithium.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 23

Type: MCSA

The mother of an 8-year-old client who is receiving methylphenidate (Ritalin) tells the nurse that her child has not slept well since being started on this drug. Which assessment data question is a priority for this client?

“Is your child having problems at school?”

“Do you give the medication with food?”

“Does your child have sleep apnea?”

“What time do you give your child the medication?”

Correct Answer: 4

Rationale 1: “Is your child having problems at school?” is incorrect because although school problems could be related to insomnia, the nurse should assess for side effects of the medication.

Rationale 2: “Do you give the medication with food?” is incorrect because there is no relationship between the side effect of insomnia and the intake of food.

Rationale 3: “Does your child have sleep apnea?” is incorrect because sleep apnea is uncommon in children.

Rationale 4: Stimulants such as methylphenidate cause insomnia. It is important for the nurse to know when the drug is taken. Methylphenidate should be taken early in the day to prevent insomnia.

Global Rationale: Stimulants such as methylphenidate cause insomnia. It is important for the nurse to know when the drug is taken. Methylphenidate should be taken early in the day to prevent insomnia. Is your child having problems at school?” is incorrect because although school problems could be related to insomnia, the nurse should assess for side effects of the medication. “Do you give the medication with food?” is incorrect because there is no relationship between the side effect of insomnia and the intake of food. “Does your child have sleep apnea?” is incorrect because sleep apnea is uncommon in children.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 24

Type: MCSA

Which statement is priority teaching at the time of discharge for the client who receives imipramine (Tofranil)?

“You will need to maintain a low-fat diet while on this medication.”

“You must maintain a normal intake of salt while on this medication.”

“Please notify your health care provider of any changes in urine quantity or quality.”

“You can stop the medication when you are no longer feeling depressed.”

Correct Answer: 3

Rationale 1: “You will need to maintain a low-fat diet while on this medication” is incorrect because a low-fat diet, although healthy, has no impact on the effectiveness of the medication.

Rationale 2: “You must maintain a normal intake of salt while on this medication” is incorrect because salt intake affects lithium, not tricyclic antidepressants.

Rationale 3: Urinary retention is a serious side effect of tricyclic antidepressants, and must be reported to the health care provider.

Rationale 4: “You can stop the medication when you are no longer feeling depressed” is incorrect because depressed clients should not stop their antidepressant medication just because they no longer feel depressed.

Global Rationale: Urinary retention is a serious side effect of tricyclic antidepressants, and must be reported to the health care provider. “You will need to maintain a low-fat diet while on this medication” is incorrect because a low-fat diet, although healthy, has no impact of the effectiveness of the medication. “You must maintain a normal intake of salt while on this medication” is incorrect because salt intake affects lithium, not tricyclic antidepressants. “You can stop the medication when you are no longer feeling depressed” is incorrect because depressed clients should not stop their antidepressant medication just because they no longer feel depressed.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 25

Type: MCSA

The client is receiving phenelzine (Parnate). She comes to the clinic and tells the nurse that she consumed two glasses of Chianti wine at lunchtime. What is the nurse’s priority action?

Assess the client’s blood pressure.

Discuss the effects of wine on the action of antidepressants.

Arrange for admittance to the psychiatric unit.

Discuss how wine can increase the symptoms of depression.

Correct Answer: 1

Rationale 1: Assessing the client’s blood pressure is appropriate because Chianti wine is high in dietary tyramine. This can result in a hypertensive crisis when combined with an MAOI drug. So the nurse must check the client’s blood pressure. It is important to discuss the effects of alcohol and antidepressants, but physiological assessment takes priority over education.

Rationale 2: Discussing the effects of wine on the action of antidepressants is incorrect because while it is important to discuss the effects of alcohol and antidepressants, physiological assessment takes priority over education. Likewise, alcohol can increase the symptoms of depression, but physiological assessment takes priority over education.

Rationale 3: Arranging for admittance to the psychiatric unit is incorrect because admittance to the psychiatric unit is not appropriate at this time; there is no evidence that the client is suicidal.

Rationale 4: Discussing how wine can increase the symptoms of depression is incorrect because while alcohol can increase the symptoms of depression, physiological assessment takes priority over education.

Global Rationale: Assessing the client’s blood pressure is appropriate because Chianti wine is high in dietary tyramine. This can result in a hypertensive crisis when combined with an MAOI drug. So the nurse must check the client’s blood pressure. It is important to discuss the effects of alcohol and antidepressants, but physiological assessment takes priority over education. Discussing the effects of wine on the action of antidepressants is incorrect because while it is important to discuss the effects of alcohol and antidepressants, physiological assessment takes priority over education. Likewise, alcohol can increase the symptoms of depression, but physiological assessment takes priority over education. Arranging for admittance to the psychiatric unit is incorrect because admittance to the psychiatric unit is not appropriate at this time; there is no evidence that the client is suicidal. Discussing how wine can increase the symptoms of depression is incorrect because while alcohol can increase the symptoms of depression, physiological assessment takes priority over education.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Question 26

Type: MCSA

The nurse has been doing medication education for the client receiving lithium (Eskalith). Which statement by the client indicates that teaching has been effective?

“I need to call my physician if I get sick with vomiting and diarrhea.”

“I need to restrict my intake of salt while I am taking lithium.”

“I don’t need to have my blood checked anymore after I leave the hospital.”

“I can stop taking my lithium when my moods are stable.”

Correct Answer: 1

Rationale 1: Vomiting and diarrhea can have a dehydrating effect on the body. This can lead to lithium toxicity.

Rationale 2: “I need to restrict my intake of salt while I am taking lithium” is incorrect because if a client does not have a regular intake of salt, the kidneys will stop excreting lithium, and lithium toxicity will result.

Rationale 3: “I don’t need to have my blood checked anymore after I leave the hospital” is incorrect because routine serum lithium levels are required every 2–3 months that a client is receiving this drug.

Rationale 4: “I can stop taking my lithium when my moods are stable” is incorrect because bipolar disorder is a chronic illness; treatment with a mood stabilizer like lithium is necessary throughout a client’s life.

Global Rationale: Vomiting and diarrhea can have a dehydrating effect on the body. This can lead to lithium toxicity. “I need to restrict my intake of salt while I am taking lithium” is incorrect because if a client does not have a regular intake of salt, the kidneys will stop excreting lithium, and lithium toxicity will result. “I don’t need to have by blood checked anymore after I leave the hospital” is incorrect because routine serum lithium levels are required every 2—3 months that a client is receiving this drug. “I can stop taking my lithium when my moods are stable” is incorrect because bipolar disorder is a chronic illness; treatment with a mood stabilizer like lithium is necessary throughout a client’s life.

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 10-6 Categorize drugs used for mood, emotional, and behavioral disorders based on their classes and drug actions.

Holland/Adams/Brice, Core Concepts in Pharmacology, 4th edition