PHARMACOLOGICAL AND PARENTERAL Q and A (New) Download to Score

PHARMACOLOGICAL AND PARENTERAL Q and A 1. The client taking sertraline for treatment of depression for the past 11 months reports feeling much better and wishes to discontinue the medication. Which is the nurse’s most appropriate response? A. “The medication will have to be reduced gradually to prevent undesirable symptoms.” B. “You should not stop the medication without talking to your health care provider first.” C. “It appears that the medication has worked very well. It should be safe to discontinue its use.” D. “You should take this medication indefinitely to prevent recurrence of depressive symptoms.” ANSWER: A A. Sertraline (Zoloft) is an SSRI antidepressant. Stopping these abruptly can cause withdrawal symptoms. The dose should be reduced gradually. B. Clients have the right to discontinue medication treatment, although it is advisable that the client should discuss this with the HCP and taper off rather than discontinue abruptly. C. It should not be discontinued. Antidepressants should not be stopped abruptly due to precipitating symptoms of withdrawal. D. Treatment with antidepressants may effectively last for months to several years but should not be used indefinitely. 2. The client calls the clinic to discuss medications being taken and possible adverse effects. The nurse should conclude that the client is experiencing a common side effect of sertraline when the client provides which information? A. States last bowel movement was 5 days ago B. Feeling palpitations and an irregular heartbeat C. BP was 170/90 mm Hg when taken one day ago D. States needing to drink fluids more often than usual ANSWER: D A. Diarrhea (not constipation) is a more common side effect of sertraline. Constipation is more commonly a side eflect of both TCAs and MAOIs due to their anticholinergic side effects. B. An irregular heart rhythm is more commonly a side effect of TCAs. C. Hypertension is more commonly a side effect of MAOIs. D. The nurse should consider that the client has a dry mouth when stating the need to drink fluids more often than usual. Dry mouth is a common side effect of sertraline (Zoloft). 3. The client’s dose of mirtazapine was increased from 15 to 30 mg at bedtime two days ago. When the nurse is preparing to administer mirtazapine, the client reports having insomnia, irritability, and panic attacks. What should the nurse do next? A. Document the symptoms, hold the dose, and notify the HCP. B. Telephone the HCP to request a pm sedative to help the client sleep. C. Have the client participate in a card game with other clients on the unit. D. Reassure the client that these symptoms will subside after taking this dose. ANSWER: A A. Mirtazapine (Remeron) is an antidepressant. Adverse effects include insomnia, irritability, panic attacks, and suicidal ideation. A change in medication may be needed rather than a dosage increase. B. The nurse is ignoring the possible adverse effects of mirtazapine. C. The client should be in a low-stimulus environment. D. It can take 1 to 2 weeks before the desired therapeutics effects are observed, but the symptoms indicate that the client is having an adverse effect. 4. The client is started on citalopram for treatment of depression. Which information is most important for the nurse to include when teaching the client? A. “Activity levels should be increased to include a daily exercise routine.” B. “If sexual side effects become unbearable, consult your health care provider.” C. “Taking St. John’s wort with your citalopram can enhance its effectiveness.” D. “Take your blood pressure every morning and report any significant changes.” ANSWER: B A. The client’s activity level is likely to increase with treatment for depression. A daily exercise routine is recommended for everyone and not just those taking antidepressants. B. Sexual dysfunction is a common side effect associated with the use of SSRIs; the client taking citalopram (Celexa), an SSRI, should consult the HCP if having unbearable sexual side effects. C. Taking St. John’s wort with citalopram can cause serotonin syndrome. D. Cardiovascular effects are associated with the use of TCAs; there is no need to take the BP daily. 5. The client taking imipramine is preparing for a summer vacation. Which information should the nurse include when planning client education regarding imipramine? Select all that apply. A. Drink additional fluids and add extra fiber to the diet B. Stop imipramine if experiencing any unpleasant side effects. C. Avoid alcohol, which can cause an additive depressant effect. D. Request an “as needed” sleeping pill in the event of insomnia. E. Wear sunglasses, protective clothing, and sunscreen while outdoors. ANSWER: A, C, E A. TCAs such as imipramine (Tofranil) may cause constipation. Increasing liquids and dietary fiber can reduce constipation. B. Clients should not abruptly stop taking any antidepressant medication. C. Alcohol combined with imipramine (Tofranil) can cause CNS depression. D. TCAs usually cause sedation and should not be combined with a sleeping agent. E. Wearing sunglasses, protective clothing, and sunscreen protects against photosensitivity, a concern with TCAs. 6. The client taking paroxetine telephones the mental health clinic nurse and states, “Since I started taking St. John’s wort, I have had a high fever and muscle stiffness, and I am sweating a lot.” Which statement is most appropriate? A. “You may have the flu; call your primary provider to make an appointment.” B. “Take ibuprofen, drink fluids, and rest; call tomorrow if the symptoms worsen.” C. “Could you have doubled up on your medication, taking more than prescribed?” D. “You should be taken to the emergency department right away to be evaluated.” ANSWER: D A. Making an appointment with another HCP delays the client receiving appropriate treatment; this client may require hospitalization due to serotonin syndrome. B. The client should not be instructed to call tomorrow. The client should be assessed in the ED because serotonin syndrome is possible and can be life-threatening. C. Asking whether the client doubled up taking paroxetine is not a priority at this time. D. Fever, muscles stiffness (rigidity), and diaphoresis are symptoms of serotonin syndrome, a potentially fatal condition that may occur with concurrent use of St. John’s wort and paroxetine (Paxil). The client should be taken to the ED. 7. The nurse is assessing the client who has begun therapy with duloxetine. Which assessment parameter should be the nurse’s priority? A. 1 . Relief of neuropathic pain B. 2. Increase in anxiety or irritability C. 3. Liver function test (LFT) results D. 4. Experiencing suicidal ideations ANSWER: D A. Duloxetine is used in relieving neuropathic pain, but assessing its effectiveness is of lesser importance than assessing for suicidal ideation. B. While assessing if the medication is effective, assessing the level of increased anxiety or irritability is of lesser importance than assessing for suicidal ideation. Beneficial effects of duloxetine may not be felt for approximately 4 weeks. C. LFTs are completed to evaluate for complications if the client is experiencing abdominal pain or an enlarged liver and are not routinely completed. D. Duloxetine (Cymbalta) is a serotonin norepinephrine reuptake inhibitor (SSNRI) used in the treatment of major depression. Suicidal ideation is the most acute threat to life and should be assessed, especially when initiating duloxetine. 8. The client admitted for inpatient treatment of an anxiety disorder has been taking fluoxetine for the past 9 months. The HCP prescribes a new antianxiety medication and discontinues fluoxetine. What is the nurse’s most appropriate intervention? A. Monitor the client closely for dizziness and lethargy due to discontinuation syndrome. B. Teach the client relaxation measures to use while adjusting to the new antianxiety drug. C. Call the HCP to question whether fluoxetine should be tapered rather than discontinued. D. Reassure the client that there is little risk of adverse effects when discontinuing fluoxetine. ANSWER: D A. While it is important to monitor the client when a medication is changed, the client should not experience discontinuation syndrome when fluoxetine is discontinued. B. Although teaching relaxation measures is important, the focus of the question is a change in medication. Reassuring the client is most appropriate. C. Tapering of fluoxetine is unnecessary. Other antidepressants such as TCAs, SSRIs, norepinephrine reuptake inhibitors, and dopamine agonists should be tapered over a 2- to 4-week period to avoid discontinuation syndrome. D. Because of its long half-life, there is a relatively low risk of adverse effects when discontinuing fluoxetine (Prozac). The client should be reassured and taught about the change of antianxiety medication. 9. The nurse is teaching the client newly started on propranolol for acute situational anxiety disorder. In addition to treating the client’s anxiety, the nurse should inform the client that propranolol’s use is effective in treating which associated problem? A. Bradycardia B. Hand tremors C. Muscle spasms D. Hypertensive crisis ANSWER: B A. A side effect of propranolol is bradycardia. B. Propranolol (Inderal), a beta blocker, has been shown to be effective in ameliorating the somatic symptoms of anxiety such as hand tremor. C. Muscle spasms are extrapyramidal symptoms not associated with propranolol use. D. Hypertensive crisis is an adverse effect of MAOIs and can be treated by phentolamine, not propranolol. 10. The client is placed on lorazepam for short-term treatment of anxiety. Which instruction by the nurse is most important with lorazepam use? A. “Take a second tablet if your anxiety is not being adequately relieved.” B. “If lorazepam is less effective after a few weeks, notify your provider.” C. “Avoid catfeinated foods and beverages, including tea and chocolate.” D. “If you are experiencing drowsiness or dizziness, notify your provider.” ANSWER: B A. The nurse should instruct the client on taking the medication exactly as prescribed and not to take an additional dose. B. This instruction is most important. Lorazepam (Ativan) is a benzodiazepine anxiolytic and sedative-hypnotic medication. If it is less effective after a few weeks, the client may be developing a tolerance to lorazepam, and the HCP should be notified of this. C. While an excess of caffeine can increase anxiety, this is not the most important instruction. D. Drowsiness and dizziness are expected side effects and need not be reported to an HCP unless excessive. 11 . The nurse is developing a teaching plan for the client prescribed nortriptyline. Which self- care aspects should be included to minimize medication side effects and prevent injury? Select all that apply. A. Avoid eating processed meats, cheeses, and wines. B. Suck on candy or ice chips to keep your mouth moist. C. Run water in the bathroom to stimulate urination If needed. D. Increase fluid and fiber in the diet to prevent constipation. E. Avoid driving until vision is completely clear to prevent injury. F. Increase exposure to sunlight to facilitate vitamin D absorption. ANSWER: B, C, D, E A. Dietary restrictions are necessary with MAOIS, not TCAs. B. Dry mouth is a side effect of nortriptyline (Pamelor) and can be relieved with hard candy, ice, or water. C. Urinary retention is a side effect of nortripty-line; running water stimulates urination. D. Constipation is a side effect of nortriptyline; fluid and fiber help relieve constipation. E. Blurred vision is a side effect of nortriptyline; driving is dangerous until vision is clear. F. TCAs cause photosensitivity, clients should use sun protection measures. 12. The new nurse describes the action of TCAs as relieving symptoms of depression by inhibiting neuronal uptake of the neurotransmitters serotonin and norepinephrine. Place an X on the labeled site where the new nurse is stating that inhibition takes place. Neuronal uptake of the neurotransmitters occurs at the receptor sites on the postsynaptic neuron. 13. Since taking the antidepressant doxepin, the female client has been reporting a decrease in sexual desire. She tells the nurse she “just isn’t that interested” because she “just doesn’t enjoy sex any-more.” She and her partner agree that they miss the excitement they used to share. Which is the most helpful response by the nurse? A. “Perhaps you could try some alternatives to your normal sexual routines to enhance your sexual relationship.” B. “This often happens when couples are together for a longer period of time. Tell me how you would feel about a referral for counseling.” C. “This may be due to your medication. How would you feel about talking to your doctor about changing to a different type of antidepressant?” D. “Try to wait for a while. This is a temporary effect of your therapy, and as your depression gets better your interest in sexual activity should increase.” ANSWER: C A. It is not therapeutic to attribute the concern to boredom within the relationship. B. It is not therapeutic to dismiss the concern as a normal course for the relationship. C. The most therapeutic response is to ask the client how she feels about contacting the HCP; switching to another antidepressant may be necessary if sexual dysfunction side effects become intolerable. D. A side effect of antidepressants is sexual dysfunction; it is not a temporary effect. 14. The nurse is developing the teaching plan for the client who is started on amitriptyline. Which information is most appropriate to include? A. Discuss a calorie-controlled diet plan suitable to the client’s preferences. B. Inform about possible sexual dysfunction and be ready to provide support. C. Instruct to stop amitriptyline immediately if having a sudden elevation in BP. D. Advise to take amitriptyline upon waking up to manage the side effect of insomnia. ANSWER: A A. Weight gain is often a major concern for clients taking TCAs such as amitriptyline (Elavil). A calorie-controlled diet plan will assist in avoiding weight gain. B. Sexual dysfiinction is most commonly associated with the use of SSRIs and not TCAs. C. Sudden hypertension results from food medication interactions associated With MAOIs and not TCAs. D. Antidepressants are more likely to cause sedation rather than stimulation and therefore are frequently taken at bedtime. 15. The client taking tranylcypromine develops a list of possible meal plans. Which meal plans should the nurse identify as safe for the client? Select all that apply. A. Pepperoni pizza, Caesar salad, 16 oz iced tea B. Grilled pork loin, rice, green beans, 12 oz diet clear soda C. Grilled salmon, steamed broccoli, 12 oz lemonlime soda D. Baked chicken, mashed potatoes and gravy, 8 oz 2% milk E. Granola with raisins and almonds, low-fat yogurt, and 8 oz coffee F. Beef burritos with sour cream and guacamole topping, corn chips, 12 oz beer ANSWER: B, C, D A. Tyramine is found in the pepperoni and should not be eaten while taking an MAOI. B. Grilled pork loin, rice, green beans, 12 oz diet clear soda is a meal that includes no items containing tyramine and is safe for the client. C. Grilled salmon, steamed broccoli, 12 oz lemon-lime soda is appropriate for a meal, as it contains no tyramine and is safe for the client. D. Baked chicken, mashed potatoes and gravy, 8 oz 2% milk is an appropriate meal that contains no tyramine and is safe for the client. E. Raisins and yogurt both contain tyramine and should not be eaten while taking an MAOI. F. Sour cream, avocados, and beer all contain tyramine and should not be eaten while taking an MAOI. 16. The newly hospitalized client admits using heroin 8 hours ago. Which assessment findings, if observed in the client, should the nurse associate with heroin withdrawal? A. Mental confusion, drowsiness, and hypotension B. Dysphoric mood, pupillary dilation, and sweating C. Pinpoint pupils, constipation, and urinary retention D. No withdrawal signs until 2 to 3 days have passed ANSWER: B A. Mental confusion, drowsiness, hypotension, and respiratory depression are signs of heroin overdose. B. Dysphoric mood, pupillary dilation, and sweating are signs of heroin withdrawal. Heroin is an opioid. C. Pinpoint pupils, constipation, and urinary retention are common signs of heroin (opioid) overdose. D. Withdrawal symptoms from heroin, a short- aeting drug, occur within 6 to 8 hours afier the last dose, peak within 1 to 3 days, and gradually subside over 5 to 10 days. 17. The nurse is reviewing client information for adverse effects of trazodone. Which finding should the nurse identify as an adverse effect unique to trazodone? A. Priapism B. Weight gain C. Hepatic failure D. Cardiac dysrhythrnias ANSWER: A A. Prolonged or inappropriate erections are a rare but problematic side effect of treatment with trazodone (Oleptro). If left untreated, it can lead to impotence. B. Weight gain is associated with many of the TCAs. C. Hepatic failure is a life-threatening condition reported in the use of nefazodone. D. Cardiac dysrhythmias are associated with many of the TCAs. 18. The client taking lithium for bipolar disorder participated in a recreational game of basketball in the mental health unit gym. The client is now feeling nauseated and shaky, has blurred vision, and is finding it hard to stand. Considering this information, which action should be taken by the nurse? A. Instruct the client to sit and rest for a while in a cool place. B. Call the HCP to request an order for a STAT serum lithium level. C. Give the prn prescribed antiemetic with a large glass of cold water. D. Alert the emergency team for the client’s impending cardiac arrest. ANSWER: B A. Having the client rest will not resolve the symptoms if the serum lithium level is elevated. B. The client is showing signs of lithium (Lithane) toxicity, especially apparent after participating in high levels of physical activity. The HCP should be notified for a STAT lithium level and corrective action. The therapeutic range for maintenance of bipolar disorder is 0.6—1.2 mEq/L. Signs of toxicity are seen when the level is above 1.5 mEq/L. C. Administering an antiemetic will not resolve the symptoms if the serum lithium level is elevated. D. The nurse is misinterpreting the symptoms if the emergency team is notified for an impending cardiac arrest. 19. At discharge, the nurse documents that the client taking lithium has an accurate understanding of self-care. On which client statement should the nurse base this judgment? A. “I need to have my blood lithium level checked every 2 weeks.” B. “I should take my lithium on an empty stomach for best absorption.” C. “I know I need to restrict foods high in sugar while I’m taking lithium.” D. “I need to eat foods containing sodium and drink 2 to 3 liters of fluid daily.” ANSWER: D A. Lithium levels should be checked every 1 to 2 months, not every 2 weeks. B. Lithium often causes stomach upset and can be taken with food for better tolerance. C. Sugary foods should only be avoided if weight gain becomes a problem. D. The client must consume adequate dietary sodium as well as 2500 to 3000 mL of fluid per day to prevent dehydration leading to lithium toxicity. 20. The mother asks the nurse why the anticonvulsant valproic acid is being prescribed for her adolescent who is beginning therapy for control of aggressive behaviors. The nurse’s response is based on the fact that valproic acid is helpful in reducing manic and impulsive behavior by what mechanism of action? A. Block the effects of dopamine at the postsynaptic neuron B. Enhance the reuptake of norepinephrine and serotonin in the CNS C. Alter sodium channels in the neurons, thus decreasing nerve impulse transmission D. Increase garruna-aminobutyric acid (GABA) levels to inhibit CNS neurotransmission ANSWER: D A. Antipsychotics (not valproic acid) block the effects of dopamine at the postsynaptic neuron. B. Lithium (not valproic acid) is thought to enhance the reuptake of norepinephrine and serotonin in the CNS. C. Another anticonvulsant, such as carbamazepine and not valproic acid, alters sodium channels in neurons, thus decreasing synaptic transmission. D. Valproic acid (Depakote) increases levels of GABA, an inhibitory neurotransmitter in the CNS. 21 . The nurse is comparing the client’s serum lithium level to a lithium toxicity chart to determine the symptoms of significance for assessment. Place an X on the chart column that includes signs the client might have if the client’s serum lithium level is 3.6 mEq/L. Symptoms of lithium (Lithane) toxicity begin to appear at blood levels greater than 1.5 mEq/L. The third column lists symptoms of lithium levels above 3.5 mEq/L, some of which include impaired consciousness, nystagmus, seizures, and arrhythmias. The first column lists symptoms of lithium levels between 1.5 and 2.0 mEq/L. The middle column lists symptoms of serum levels between 2.0 and 3.5 mEq/L. 22. New medications are prescribed for the client taking lithium. Which medication, if prescribed, should the nurse question with the HCP? A. Isosorbide dinitrate by mouth tid B. Preclnisone 20 mg by mouth daily C. Furosernide 80 mg by mouth daily D. Insulin aspart 2 units subcut with meals ANSWER: C A. Isosorbide dinitrate (Isordil) does not interact with lithium. B. Prednisone (Deltasone) does not interact with lithium. C. The nurse should question the use of furosemide (Lasix). Furosemide is a loop diuretic that promotes sodium loss and lithium (Lithane) retention. It can increase serum lithium levels, resulting in toxicity. D. Insulin aspart (NovoLog) does not interact with lithium, but lithium should be used cautiously in clients with DM. 23. The nurse is providing instructions to the client taking alprazolam. Which substances should the client be instructed to avoid? Select all that apply. A. Alcohol B. Caffeine C. Narcotics D. Antioxidants E. Antihistamines F. Antidepressants ANSWER: A, C, E, F A. Those taking alprazolam (Xanax) should avoid drinking alcohol because it may increase CNS side effects. B. Caffeine does not depress the CNS or cause additive effects with alprazolam. C. The use of alprazolam and narcotics concurrently can increase CNS side effects. D. Antioxidants do not depress the CNS or cause additive effects. E. The client taking alprazolam should avoid antihistamines because they may increase CNS side effects. F. The concurrent use of antidepressants and alprazolam can cause additive effects. 24. The nurse telephones the HCP to request a pm anxiolytic medication order for a hospitalized client having occasional anxiety. Which medication, if prescribed, should the nurse question regarding its effectiveness for prn use? A. Buspirone B. Lorazepam C. Clorazepate D. Clonazepam ANSWER: A A. Buspirone (BuSpar), an antianxiety agent in the azaspirodecanedione drug classification, is not recommended for pro use because of a 10- to 14-day delay in therapeutic onset. The nurse should question the order if prescribed for prn use. B. Lorazepam (Ativan) is a benzodiazepine and has a rapid onset of therapeutic effectiveness, and is appropriate for prn use. C. Clorazepate (Tranxene) is a benzodiazepine and has a rapid onset of therapeutic effectiveness, and is appropriate for prn use. D. Clonazepam (Klonopin) is a benzodiazepine and has a rapid onset of therapeutic effectiveness, and is appropriate for pro use. 25. The nurse is reviewing documentation on four clients prior to administering medications. The nurse should immediately withhold the medication and notify the HCP about which client? A. Client 1 B. Client 2 C. Client 3 D. Client 4 ANSWER: D A. Aripiprazole (Abilil‘y) is an atypical antipsychotic. Tremors, shuffling gait, and rigidity are signs of pseudoparkinsonism, a side effect of aripiprazole. Although the HCP should be notifled, this client’s symptoms are reversible with treatment with benztropine, an anticholinergic medication. B. The involuntary muscular movements indicate that this client is experiencing dystonia. Although the HCP should be notified because the dose may need adjustment or a different medication prescribed, this client is not priority. C. Involuntary deviation and fixation of the eye-balls, usually in the upward position, suggests oculogyric crisis. This is an extrapyramidal side effect of some antipsychotic medications. Although the HCP should be notified because the dose may need adjustment or a different medication prescribed, this client is not priority. D. Lip smacking and uncontrolled rhythmic movement of the mouth, face, and extremities suggest tardive dyskinesia. This client is priority because the medication should be immediately withdrawn and the HCP notified because these symptoms may be irreversible. 26. The parent of the adolescent taking chlordiazepoxide for the past 2 months telephones the nurse requesting to have the dose increased. The parent states, “Chlordiazepoxide is being given as directed, but my child’s anxiety is increasing.” Which should be the nurse’s best interpretation of this situation? A. The client may be developing tolerance to chlordiazepoxide and needs the dose reevaluated. B. The client may be skipping drug doses when not anxious and now needs the dose doubled. C. The client is becoming resistant to the drug effects, and an alternative medication is needed. D. The client’s anxiety may be hormone-related, and larger doses of chlordiazepoxide are needed. ANSWER: A A. Physical and psychological dependence are often associated with the use of benzodiazepines, such as chlordiazepoxide (Librium). The client is describing tolerance, a sign of dependence, and the dose needs reevaluation. B. Doses should not be doubled if medication is being skipped. Skipping chlordiazepoxide reduces the therapeutic effects. C. Resistance is not the same as dependence; chlordiazepoxide will continue to exert its pharmacological effect with higher doses. Increasing the dosage is not indicated in the development of dependence. D. Insufficient information is provided in the situation to determine if the client’s anxiety is hormone related. 27. The nurse is reviewing the medications for all assigned clients on an inpatient psychiatric unit. The nurse anticipates assessing for extrapyramidal symptoms (BPS) in clients taking which antipsychotic medication? A. Clozapine B. Risperidone C. Haloperidol D. Ziprasidone ANSWER: C A. Clozapine (Clozaril) is a member of the newer generation of antipsychotics with less potential for EPS. B. Risperidone (Risperdal) is a member of the newer generation of antipsychotics with less potential for EPS. C. Haloperidol (Haldol), a conventional antipsychotic, is the only medication listed with a high probability of EPS. D. Ziprasidone (Geodon) is a member of the newer generation of antipsychotics with less potential for EPS. 28. The nurse is assessing the client newly started on benztropine mesylate. Which findings indicate that the client is experiencing the most common side effects of benztropine mesylate? A. Dizziness, headache, and insomnia B. Weight gain, tremors, and sedation C. Blurred vision, dry mouth, and constipation D. Headache, dry mouth, and sexual dysfimction ANSWER: C A. Hypertension, dizzineStss, headache, and insomnia are frequently seen with the use of MAOIs. B. Weight gain, tremors, and sedation are commonly associated with atypical antipsychotics. C. Blurred vision, dry mouth, and constipation are common side effects of the anticholinergic agents, such as benztropine mesylate (Cogentin). This medication is used to counteract the extrapyramidal symptoms secondary to the use of typical antipsychotics. D. Headache, dry mouth, and sexual dysfunction are associated with SSRIs. 29. The nurse is discussing the prescribed atypical antipsychotic medication therapy with the client with schizophrenia. What information should the nurse include in this discussion? Select all that apply. A. Atypical antipsychotic medications will affect the client’s hallucinations and inappropriate emotional responses. B. Atypical antipsychotic medications are prescribed after other medications have proven ineffective in treating symptoms. C. The greatest concern with taking atypical antipsychotic medications is that they produce extrapyramidal side effects. D. Regular laboratory appointments will need to be scheduled to monitor the client’s blood glucose levels. E. The client may experience an increase in appetite and weight gain when taking an atypical antipsychotic medication. ANSWER: A, D, E A. Atypical antipsychotic medications are designed to target both positive and negative symptoms, which include hallucinations and inappropriate emotional responses. B. Atypical antipsychotic medications are generally chosen as first-line treatment over conventional antipsychotics. C. Atypical antipsychotic medications are often favored over conventional antipsychotic medications because they are less likely to cause anti-cholinergic and extra pyramidal side effects. D. Atypical antipsychotic medications can increase the risk of elevated blood glucose levels so regular laboratory testing is performed. E. This classification of medications can increase the risk of metabolic syndrome characterized by elevated blood glucose levels, increased appetite, and weight gain. 30. The HCP prescribes haloperidol 4 mg tid oral liquid for the client diagnosed with schizophrenia. How many milliliters should the nurse administer from a bottle labeled “haloperidol 2 mg/mL” for each dose? _____. (Record your answer as a whole number.) 31 . The HCP prescribes risperidone to manage the hallucinations of the client diagnosed with paranoid schizophrenia. Which client statements reflect a need for further education regarding the medication‘s side effects? Select all that apply. A. “Diarrhea may be a problem for me.” B. “I’ll most likely develop high blood pressure.” C. “Being too nervous is a side effect of my medicine.” D. “ll will need to watch what I eat so I won’t gain weight.” E. “Getting up too quickly when I’m sitting can make me dizzy.” F. “ll will need to be careful driving because this can make me drowsy.” ANSWER: A , B A. Constipation, not diarrhea, is a characteristic side effect of risperidone. The client needs additional teaching. B. Hypotension, not hypertension, is a characteristic side effect of risperidone. The client needs additional teaching. C. Nervousness is a side effect of an atypical antipsychotic medication. D. Weight gain is a potential side effect of atypical antipsychotic medications. E. Orthostatic hypotension is a side effect of an atypical antipsychotic medication. F. Drowsiness is a potential side effect of an atypical antipsychotic medication. 32. The muse administers risperidone to the client experiencing hallucinations. Which physiological disorder should the nurse assess for considering the risk of developing this disorder as a side effect of IiSperidone? A. Asthma B. Hypertension C. Crohn’s disease D. Diabetes mellitus ANSWER: D A. There is no known increased risk for the development of respiratory disease. B. Hypotension rather than hypertension is a known potential side effect of antipsychotic medications. C. There is no known increased risk for GI diseases. D. The use of the antipsychotic medication risperidone (Risperdal) appears to increase the risk of diabetes, especially in the first few months of drug therapy. 33. The nurse is educating the client concerning the possible side effects of a newly prescribed traditional antipsychotic medication. Which client statement reflects a need for flirther education regarding the side effects of this classification of medication? A. “I need to get up from bed slowly so I will not get dizzy.” B. “The medication can cause constipation, so I need to eat fiber.” C. “I may need a sleeping pill because insomnia is a possible side effect.” D. “I can’t risk gaining weight, so I will need to add some exercise to my routine.” ANSWER: C A. Dizziness is a possible side effect of traditional antipsychotic medications. B. Constipation is a possible side effect of traditional antipsychotic medications. C. Drowsiness, not insomnia, is a common side effect of such medications. The client needs further teaching when making this statement. D. Weight gain is a possible side effect of traditional antipsychotic medications. 34. The client is being treated with Clozapine. Which findings during the nurse‘s assessment indicate that the client is experiencing adverse effects of Clozapine? Select all that apply. A. Dehydration B. Agranulocytosis C. Increasing anxiety D. Extreme salivation E. Blood glucose 192 mg/dL ANSWER: B , D, E A. Dehydration is not an adverse effect of clozapine. B. Agranulocytosis (failure of the bone marrow to produce enough neutrophils) is an adverse effect of clozapine (Clozaril). About 20 percent of Jewish people develop agranulocytosis, which has been attributed to a specific genetic haplotype. C. Increasing anxiety is not an adverse effect of clozapine. D. Hypersalivation is an adverse effect of clozapine. E. Hyperglycemia is an adverse effect of clozapine. 35. The client diagnosed with BPD is taking Olanzapine. The nurse evaluates that Olanzapine is effective when observing a reduction in which behaviors? Select all that apply. A. Levels of anxiety B. The use of splitting C. Thoughts of paranoia D. Feelings of depression E. Expression of hostility ANSWER: A , C , E A. With BPD, a reduction in the client’s anxiety indicates Olanzapine (Zyprexa) is effective. B. Cognitive restructuring techniques, rather than medications, are more likely to improve the overuse of the defense mechanism splitting. C. With BPD, a reduction in the client’s paranoia indicates olanzapinc is effective. D. Olanzapine has not shown a more significant rate of improvement for depression over time than has placebo. E. With BPD, a reduction in the client’s hostility indicates olanzapinc is effective.