Test Bank: Introduction to Psychotropic Drugs Keltner: Psychiatric Nursing, 8th Edition,100% CORRECT

Test Bank: Introduction to Psychotropic Drugs Keltner: Psychiatric Nursing, 8th Edition MULTIPLE CHOICE 1. Which patient would be most at risk for adverse reactions when administered a highly protein bound medication? a. A healthy adolescent b. A 76-year-old patient with malnutrition c. A woman in the second trimester of pregnancy d. An adult with a fractured femur from a sporting accident ANS: B The older malnourished patient would have fewer serum proteins to bind the drug; therefore, higher amounts of free drug would be available to act immediately. The patients described in the distracters would have normal protein levels, so the drug would be bound as expected. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Physiologic Integrity 2. A novice nurse asks, “What is the role of psychopharmacology in the psychotherapeutic management model?” What response should the mentor provide concerning the role of psychopharmacology? a. Making it possible to use the least restrictive treatment alternatives. b. Preventing violence against nurses and family members. c. Assisting in the identification and achievement of desirable outcomes. d. Facilitating in the determinUatioSn ofNtheTresponOsible psychopathology. ANS: A By effectively treating psychotic symptoms, the incidence of violent behaviors has been reduced. This makes possible the use of the least restrictive treatment alternative, an important facet of psychotherapeutic management. Psychopharmacology does not make the other options possible. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. The parent of a teen diagnosed with schizophrenia asks, “What is the most likely factor causing this disorder?” The nurse’s reply would be based on understanding? a. Glutamate is present in higher than normal quantities resulting in the observable symptoms. b. There is a decrease in norepinephrine causing the basic symptoms. c. There is an increase in dopamine resulting in the classic symptoms. d. A decrease in GABA causes the psychotic symptoms. ANS: C Schizophrenic signs and symptoms are associated with an increase in circulating dopamine. Glutamate is associated with psychotic thinking but not with the other symptoms of schizophrenia. Norepinephrine is related to depression while GABA is a factor in anxiety disorders. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 4. The primary mechanisms of action of certain antidepressants result from neurotransmitter inactivation by enzyme-based metabolism and what other event? a. Electrochemical stimulation b. Stimulation of natural precursors c. Extraction of precursors from the bloodstream d. Reuptake into the presynaptic storage vesicles ANS: D Neurotransmitters are inactivated in two ways: (1) they are metabolized by enzymes and (2) they are taken back into the presynaptic storage vesicles—a process called reuptake. The other options have no physiologic basis in fact. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 5. When discussing treatment of an aggressive patient diagnosed with psychosis, a health care provider says, “I plan to prescribe the original antipsychotic drug.” Which medication is relevant to the statement? a. Paroxetine b. Clozapine c. Imipramine d. Chlorpromazine ANS: D NURSINGTB.COM Only chlorpromazine and clozapine are antipsychotics. Chlorpromazine is a traditional drug, introduced in the early 1950s, whereas clozapine is a newer drug, introduced in the 1990s. Paroxetine and imipramine are antidepressants. DIF: Cognitive level: Understanding TOP: Nursing process: Planning MSC: Client Needs: Physiologic Integrity 6. A nurse assesses a newly hospitalized patient with a long history of serious and persistent mental illness. What is the priority assessment information should the nurse obtain to minimize any risk associated with medication safety? a. Adverse reactions to drugs taken previously b. History of drug compliance and noncompliance c. Level of support available from significant others d. Length of time on various psychotropic medications ANS: A Information related to safety is the nurse’s priority. Adverse reactions to psychotropic medications can be dangerous, even life-threatening. If a patient has had an adverse reaction to a particular drug, it would be unwise to administer it again. The other options do not address a safety issue. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Physiologic Integrity 7. Studies demonstrate the need to focus on what nursing diagnosis to support the psychiatric patients’ understanding of psychopharmacology? a. Deficient knowledge related to drug therapy b. Impaired memory related to drug side effects c. Impaired decision-making related to drug dependency d. Disturbed thought processes related to anticipation of side effects ANS: A Research has shown that most patients do not know important facts about the medications prescribed for them. As a result, they are often noncompliant. As knowledge deficits are removed, better compliance can be expected. Data are not present to suggest applicability of the other options. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity 8. What is a realistic patient-focused outcome of patient teaching regarding psychotropic medications? a. Understanding physiologic responses to drug therapy b. Assessing effectiveness of prescribed drugs in controlling symptoms c. Describing onset, peak, and duration of action of each drug prescribed. d. Stating the purpose, dose, and significant side effects of each drug prescribed. ANS: D The correct response identifies basic information that each patient should have. Because the information is basic, the outcome, as stated, is realistic. The other options are less basic and less attainable. N R I G B.C M DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: Client Needs: Physiologic Integrity 9. A week after beginning fluoxetine, a patient reports, “I still feel so depressed all the time.” Based on knowledge of the medication’s pharmacodynamics, what is the nurse’s most effective intervention? a. Administering the medication when the patient’s stomach is empty b. Advising the health care provider that the drug is ineffective. c. Reassessing the expected outcomes of antidepressant therapy d. Educating the patient that the drug needs more time to be effective ANS: D One week is probably an insufficient time for antidepressants to become effective in reducing patient symptoms. The phenomenon of receptor down-regulation develops in 2 to 4 weeks. The other options are not supported by research studies. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 10. Bearing in mind the function of the blood-brain barrier, what is the danger associated with administering large doses of water-soluble drugs? a. Rapid development of tolerance b. High risk of adverse systemic effects c. Liver’s inability to metabolize water-soluble drugs d. Rapid passage into the brain increasing the risk of overdose ANS: B Water-soluble drugs penetrate the blood-brain barrier slowly and in insignificant amounts. A dose high enough to affect the brain would invariably cause adverse systemic side effects. The other effects are not related. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: Client Needs: Physiologic Integrity 11. A nurse administering a selective serotonin reuptake inhibitor (SSRI) antidepressant should carefully observe the patient for symptoms related to what possible reaction? a. Dopamine excess b. Decreased GABA level c. Increased serotonin level d. Decreased acetylcholine level ANS: C Depression is thought to be related to decreased amounts of the neurotransmitters norepinephrine and serotonin. SSRIs increase the reuptake of serotonin, increasing the availability of this neurotransmitter at the synapse. If the SSRI is effective, the increased serotonin will result in a decrease in symptoms of depression. The other options would not be related to SSRI administration. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 12. Bioavailability of orally admNinisRtereId drGugsBCitiaMlly associated with which physiologic phenomenon? a. Rate of renal excretion b. First-pass metabolism c. Synaptic transmission d. Blood-brain barrier ANS: B First-pass metabolism in the liver reduces the bioavailability of orally administered drugs. The other options do not occur first. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 13. A patient taking clozapine reports, “I get plenty of vitamin C by drinking 8 ounces of grapefruit juice each morning.” How should the nurse respond? a. “High doses of vitamin C support the immune system and general good health.” b. “Let’s talk about better juice choices, because grapefruit juice can cause a bad reaction while taking clozapine.” c. “Grapefruit juice lessens the effectiveness of your medication. You might need a dosage change.” d. “New research shows papaya juice is a better source of vitamin C than grapefruit juice.” ANS: B Only the correct option provides vital information based on the cytochrome P-450 enzyme system’s involvement in drug metabolism. Clozapine metabolism is inhibited by the ingestion of grapefruit juice, making the likelihood of a toxic reaction to the drug more likely, because the drug accumulates in the body. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 14. A patient taking a psychotropic medication reports, “This medicine isn’t working right for me. It’s causing side effects.” Select the nurse’s best comment to further assess the scenario. a. “Has the drug caused diaphoresis?” b. “Have you experienced urinary retention?” c. “Are you experiencing episodes of tachycardia?” d. “Tell me more about how the medication is affecting you.” ANS: D Open-ended communication techniques are important strategies for exploring the patient’s concerns. It is also important for the nurse to use culturally familiar terms. Patients are unlikely to know the meaning of terms such as tachycardia, diaphoresis, and urinary retention. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Physiologic Integrity 15. A patient takes a psychotropic medication that affects acetylcholine receptors. The patient reports dry mouth and constipation. What effect is the drug having on the acetylcholine receptors? a. Activation b. Antagonism c. Stimulation d. Paradoxical ANS: B NURSINGTB.COM The patient’s reports indicate suppression of the parasympathetic nervous system, which is associated with antagonism of the action of acetylcholine. The results described are not associated with any of the other options. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: Client Needs: Physiologic Integrity 16. A patient takes a psychotropic medication that affects serotonin receptors. The patient complains of anxiety, insomnia, and loss of appetite. What effect is the drug having on the serotonin receptors? a. Activation b. Antagonism c. Paradoxical d. Inhibition ANS: A The patient’s reports indicate activation of serotonin receptors. None of the other options correctly identifies this effect. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: Client Needs: Physiologic Integrity 17. A patient takes a psychotropic medication that affects norepinephrine receptors. The patient reports, “It feels like my heart is pounding in my chest.” What effect is the drug having on the norepinephrine receptors? a. Inhibition b. Activation c. Paradoxical d. Antagonism ANS: B The patient’s complaints indicate activation of norepinephrine receptors. The medication has stimulated the action of beta1-receptors. None of the other options correctly identifies this outcome. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: Client Needs: Physiologic Integrity 18. Which historical event marked the beginning of the evolution of psychotropic medications? a. The selective serotonin reuptake inhibitor (SSRI) classification of antidepressants was developed. b. Lithium was discovered in Australia. c. Clozapine, the first atypical antipsychotic drug, was marketed in the United States. d. Chlorpromazine, the first antipsychotic, is “discovered” in France. ANS: B Evolutionary events in the deNveloRpmIentGof pBsy.cChotrMopic drugs changed the care environment for patients with mental illness and had significant effects on the nurse’s role. The discovery of lithium in Australia in 1949 was the initial event that began the evolution of psychotropic medications. All the remaining options followed. DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment MULTIPLE RESPONSE 1. What information should the nurse include in patient teaching about psychotropic medication? (Select all that apply.) a. Drug pharmacokinetics b. Common drug interactions c. Management of common side effects d. Descriptive list of possible adverse effects e. Information regarding cost of the medications prescribed ANS: C, D, E Teaching about how to manage common annoying side effects, such as dry mouth and orthostatic hypotension, can promote medication compliance by the patient. Knowing what side effects to report promotes patient safety. In addition, knowing about common drug-drug interactions, such as the potentiating effects of alcohol on sedating drugs, promotes patient safety. Providing written materials is helpful to patients who can then refer to these resources rather than having to rely on memory. Pharmacokinetics is not an issue generally discussed with patients. Information related to cost is not considered a component of medication education. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 2. An outpatient diagnosed with schizophrenia has been omitting doses of medication. Which questions should the clinic nurse ask to determine the reasons for the problem? (Select all that apply.) a. “Are you experiencing any troublesome side effects?” b. “Is the medicine affecting your sexual performance?” c. “Does the medicine make you think slower?” d. “Do you believe your dose is too low?” e. “Do you believe you have an illness?” ANS: A, B, C, D, E The correct options refer to a common reason for patients not taking medication as prescribed. Usually a patient will stop taking prescribed medications if they belief that the dose is too high rather than too low. DIF: Cognitive level: ApplyinNg R I GTOBP:.NurC sMing process: Assessment MSC: Client Needs: PhysiologicUInteSgrityN T O