Chapter 4: Psychopharmacology
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. When used in combination with anxiolytic medication, alcohol leads to
caffeine leads to
effects.
1. increased; increased
2. increased; decreased
3. decreased; decreased
4. decreased; increased
effects, and
2. Which information should the nurse include in a staff education program about the history of
psychopharmacology?
1. Some antipsychotic medications can cure mental illnesses.
2. Psychotropic medications are used as adjunctive therapy.
3. Antidepressants were the first type of mental health drugs.
4. Mood stabilizers help eliminate bipolar mental disorders.
3. A client was recently admitted to the inpatient unit after a suicide attempt and is prescribed a
selective serotonin reuptake inhibitor (SSRI). Which sign or symptom would the nurse include in
the teaching session about serotonin syndrome?
1. Constipation
2. Myoclonus
3. Hypothermia
4. Impotence
4. A client was recently admitted to the inpatient unit after a suicide attempt and has not responded to
SSRIs or tricyclic antidepressants. The client asks the nurse, “Why can’t monoamine oxidase
inhibitors (MAOIs) be added to what I am on now?” Which response should the nurse make?
1. “Electroconvulsive therapy is your best option at this point.”
2. “Combined use can lead to a life-threatening condition called hypertensive crisis.”
3. “There is no reason why an MAOI couldn’t be added to your therapy.”
4. “They can’t be used together because their mechanisms of action are very
different.”
49
5. A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago and
asks why he has gained 12 lbs (5.4 kg) since then. Which response by the nurse is appropriate?
1. “I’m surprised you have gained; weight loss is the typical pattern when taking
lithium.”
2. “Your weight gain is more likely related to food intake than medication.”
3. “Weight gain is a common but troubling side effect. Let’s talk about some
strategies for safely improving your nutrition and exercise habits.”
4. “There’s not much you can do about the weight gain. It’s better than being
emotionally unstable, though.”
6. The nurse is assessing a client who has a diagnosis of schizophrenia and takes an antipsychotic
agent daily. Which finding requires further nursing assessment immediately?
1. Respirations of 20 breaths/minute
2. Weight gain of 8 lbs (3.6 kg) in 2 months
3. Temperature of 101oF (38.3 oC)
4. Excess salivation
7. An aging client with chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol)
for hypertension and an antipsychotic. Given the combined side effects of these drugs, what
teaching should the nurse provide?
1. “Make sure you concentrate on taking slow, deep, cleansing breaths.”
2. “Watch your diet and try to engage in some regular physical activity.”
3. “Rise slowly when you change position from lying to sitting or sitting to standing.”
4. “Wear sunscreen and try to avoid midday sun exposure.”
8. A client with depression and substance abuse has an interrupted sleep pattern and demands a
sedative. Which teaching would the nurse provide about sedative-hypnotics?
1. “Sedative-hypnotics are potentially addictive and gradually lose their effectiveness
as one builds up tolerance to them.”
2. “Sedative-hypnotics work best in combination with other techniques.”
3. “Sedative-hypnotics are not permitted for use in clients with substance abuse
disorders.”
4. “Sedative-hypnotics are not as effective as the antidepressant medications for
treating sleep disturbances.”
50
9. Which information should the nurse share with the client about tricyclic antidepressant
medications?
1. Strong or aged cheese should not be eaten while taking them.
2. Their full therapeutic potential may not be reached until 4 weeks.
3. They may cause hypomania or recent memory impairment.
4. They should not be given with antianxiety agents.
10. The client is taking a selective serotonin reuptake inhibitor (SSRI). Which finding indicates the
client is having a therapeutic effect from the SSRI?
1. Psychosis is reduced.
2. Neuropathy pain is relieved.
3. Panic attacks are prevented.
4. Obsessions are controlled.
11. In the treatment of anxiety disorders, benzodiazepines (such as Ativan and Xanax) are indicated
for
use and have a
abuse potential.
1. short-term; high
2. long-term; high
3. short-term; low
4. long-term; low
12. Which client would the nurse instruct to obtain routine blood-level monitoring?
1. A client taking lithium
2. A client taking buspirone
3. A client taking chlorpromazine
4. A client taking paroxetine
13. As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to
include?
1. Avoid foods high in tyramine.
2. Maintain a consistent sodium intake.
3. Consume at least 3,000 to 3,500 mL of fluid per day.
4. Watch for signs of tardive dyskinesia.
14. A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which
potentially fatal side effect will the nurse teach the client about?
51
1.
2.
3.
4.
Agranulocytosis
Akathisia
Pseudoparkinsonism
Akinesia
15. The client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which
signs and symptoms of a potentially fatal side effect will the nurse teach the client about?
1. Blurring vision, dry mouth, and constipation
2. Sore throat, fever, and malaise
3. Tremor, shuffling gait, and rigidity
4. Fine tremor, tinnitus, and nausea
16. The client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which
laboratory result would reveal a potentially fatal side effect of this medication?
1. Elevated white blood cell count
2. Elevated bleeding times
3. Low platelet count
4. Low absolute neutrophil count
17. A client is taking a monoamine oxidase inhibitor (MAOI). When teaching the client about diet,
which foods will the nurse caution the client to avoid?
1. Pepperoni pizza and red wine
2. Bagels with cream cheese and tea
3. Apple pie and coffee
4. Potato chips and diet cola
18. An elderly client has been diagnosed with major depression and is prescribed a selective serotonin
reuptake inhibitor (SSRI). Which side effect would the nurse monitor for in this client?
1. Diarrhea
2. Pseudoparkinsonism
3. Hypertensive crisis
4. Hyponatremia
19. To which client would the nurse most likely administer a benzodiazepine?
1. One with alcohol withdrawal
2. One taking cough medicine
52
3. One with schizophrenia
4. One taking opioid pain agents
20. Which medication would the nurse most likely administer to treat the extrapyramidal side effects
of antipsychotic medications?
1. Diazepam (Valium)
2. Amitriptyline (Elavil)
3. Benztropine (Cogentin)
4. Methylphenidate (Ritalin)
21. A female client takes a maintenance dosage of lithium carbonate for bipolar disorder. She has
come to the community health clinic, stating that she “has had the flu for several days.” She
describes her symptoms as muscle weakness, coughing, headache, fever, and gastrointestinal
upset. Her temperature is 100.9°F (38.3°C). Which situation does the nurse anticipate?
1. She has consumed some foods high in tyramine while taking lithium carbonate.
2. She has stopped taking her lithium carbonate.
3. She has probably developed a tolerance to the lithium carbonate.
4. She has signs and symptoms of toxicity from the lithium carbonate.
22. An 8-year-old client, Logan, takes methylphenidate (Ritalin) for attention deficit-hyperactivity
disorder (ADHD). The client’s mother reports to the nurse that the client has a very poor appetite
and is losing weight. Which teaching will the nurse provide?
1. Administer Logan’s medication immediately after meals.
2. Give Logan’s medication at bedtime.
3. Skip a dose of the medication when Logan does not eat anything.
4. Assure Logan’s mother that Logan will eat when he is hungry.
23. The male client is experiencing a psychotic episode. He is in good physical health but has allergies
to penicillin, prochlorperazine (Compazine), and bee stings. Which antipsychotic medication
would be contraindicated for the client?
1. Haloperidol, because it is used only in elderly clients
2. Clozapine, because it is a typical, first-generation antipsychotic
3. Risperidone, because it exacerbates symptoms of depression
4. Thioridazine, because of cross sensitivity among phenothiazines
53
24. The physician prescribes an additional medication for a client taking an antipsychotic agent. The
medication is to be administered “prn for EPS.” When will the nurse plan to administer this
medication?
1. When the client’s white blood cell count falls below 3,000/mm3
2. When the client exhibits tremors and a shuffling gait
3. When the client reports having a dry mouth
4. When the client experiences a seizure
25. In which of the following cases is treatment with a CNS stimulant contraindicated?
1. A client with depression and ADHD
2. A client with bulimia and ADHD
3. A client with ADHD and a history of smoking
4. A client who has had ADHD since childhood
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
26. The nurse is preparing to assess a client before the physician prescribes a regimen of
psychopharmacological therapy. Which components will the nurse assess? (Select all that apply.)
1. Medical history
2. Physical examination findings
3. Ethnocultural characteristics
4. Current medication
5. Marital status
54
Chapter 4: Psychopharmacology
Answer Section
MULTIPLE CHOICE
1. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antianxiety agents.
Page: 67
Heading: Antianxiety Agents > Interactions
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 While alcohol leads to increased effects, caffeine does not lead to increased
effects.
2 Anxiolytic medications work through depression of certain central nervous
system (CNS) functions. Alcohol, which is a CNS depressant, would
increase/potentiate their effects. Caffeine, which is a CNS stimulant, would
decrease/inhibit their effects.
3 Alcohol does not lead to decreased effects, but caffeine does lead to decreased
effects
4 Alcohol does not lead to decreased effects and caffeine does not lead to
increased effects.
PTS: 1
CON: Evidence-Based Practice
2. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Discuss historical perspectives related to psychopharmacology.
Page: 60
Heading: Historical Perspectives
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
55
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Psychotropic medications, like antipsychotics, are not a “cure” for mental
illness.
2 Most mental health practitioners who prescribe psychotropic medications for
their clients use them as an adjunct to individual or group psychotherapy.
3 Antidepressants were not the first type of mental health drug. They were
developed later in the 1950s.
4 Psychotropic medication, like mood stabilizers, cannot eliminate bipolar mental
disorders.
PTS: 1
CON: Evidence-Based Practice
3. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antidepressants.
Page: 71
Heading: Table 4-4 Drug Interactions with SSRIs
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Diarrhea, not constipation, is a symptom of serotonin syndrome.
2 Myoclonus is a symptom of serotonin syndrome.
3 Hyperthermia, not hypothermia, is a sign of serotonin syndrome.
4 Impotence may be a side effect of an SSRI antidepressant, but it is not a
symptom of serotonin syndrome.
PTS: 1
CON: Evidence-Based Practice
4. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antidepressants.
Page: 71
Heading: Table 4-4 Drug Interactions With SSRIs
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Evidence-Based Practice
56
Difficulty: Moderate
Feedback
1 The statement, “Electroconvulsive therapy is your best option at this point,”
does not provide accurate information to the client. The client is asking about
MAOIs.
2 If MAOIs are taken with other antidepressants, a hypertensive crisis could
result. Thus, the nurse would tell the client, “Combined use can lead to a
life-threatening condition called hypertensive crisis.”
3 The statement, “There is no reason why an MAOI couldn’t be added to your
therapy,” is false; use of an MAOI with an SSRI or tricyclic antidepressants
could cause harm to the client.
4 Although the mechanisms of action are different, this is not why they cannot be
taken together. If taken together, the client could be harmed.
PTS: 1
CON: Evidence-Based Practice
5. ANS: 3
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: mood-stabilizing agents.
Page: 76
Heading: Lithium Maintenance
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Weight gain, not weight loss, is typical with lithium treatment.
2 In this situation, weight gain is from the medication, not from food intake.
3 Weight gain is a common side effect of lithium therapy. To ensure compliance,
the nurse should help the client develop strategies to prevent excessive weight
gain, while stressing the importance of no drastic changes in sodium intake.
4 Telling a client there is “not much you can do” and “it is better than being
emotionally unstable” are nontherapeutic responses.
PTS: 1
CON: Evidence-Based Practice
6. ANS: 3
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 82
57
Heading: Table 4-12 Safety Issues in Planning and Implementing Care for Clients Taking
Antipsychotic Medication
Integrated Processes: Clinical Problem-solving Process (Nursing Processes)
Client Need: Physiological Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Twenty breaths per minute is considered normal and does not need follow-up.
2 Slow weight gain is not concerning and does not need further assessment.
3 A fever could be one of the first signs of an infection caused by reduced
immunity from agranulocytosis secondary to antipsychotic medication. This
would require further assessment.
4 While drooling (excess salivation) is a sign of pseudoparkinsonism, it is not
life-threatening and does not have to be assessed immediately.
PTS: 1
CON: Evidence-Based Practice
7. ANS: 3
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antipsychotics.
Page: 82
Heading: Antipsychotic Agents > Contraindications and Precautions and Table 4-12 Safety Issues
in Planning and Implementing Care for Clients Taking Antipsychotic Medication
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Slow, deep, cleansing breaths will not prevent the client from having a syncopal
episode.
2 While watching diet is important, it will not prevent the client from
experiencing side effects from the combination of an antipsychotic and the
propranolol.
3 The antipsychotic medication can cause orthostatic hypotension that could be
magnified by the propranolol. To counteract this combined effect, the nurse
should teach the client to rise slowly when changing positions.
4 While antipsychotics do cause photosensitivity, propranolol (antihypertensive)
does not. Therefore, wearing sunscreen will not prevent syncopal episodes from
the combined effect of propranolol and an antipsychotic.
PTS: 1
CON: Evidence-Based Practice
58
8. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: sedative-hypnotics.
Page: 87
Heading: Sedative-Hypnotics > Action and Contraindications and Precautions
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Sedative-hypnotics are potentially addictive and should be used with caution by
clients with a history of substance abuse. Tolerance can easily develop.
2 The statement, “sedative-hypnotics work best in combination with other
techniques,” is not accurate.
3 While sedative-hypnotics can become habit forming, they are used with caution
in clients with substance use disorder; they are not contraindicated.
4 Sedative-hypnotics are used for short-term treatment of sleep disturbances, so
this statement is misleading.
PTS: 1
CON: Evidence-Based Practice
9. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antidepressants.
Page: 92
Heading: Summary and Key Points
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 The statement is misleading to the client because MAOIs should not be taken
with strong or aged cheese, not tricyclics.
2 It may take several weeks (up to 4 weeks) for tricyclic medications to reach their
full therapeutic effect.
3 Tricyclic antidepressants do not cause hypomania or recent memory
impairment.
4 Tricyclic antidepressants can be administered with antianxiety agents.
PTS: 1
CON: Evidence-Based Practice
59
10. ANS: 4
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antidepressants.
Page: 65
Heading: Table 4-2 Effects of Psychotropic Influence on Neurotransmitters
Integrated Processes: Clinical Problem-solving Process (Nursing Processes)
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Antipsychotics, not SSRIs, are used to reduce psychosis.
2 Serotonin and norepinephrine reuptake inhibitors, not SSRIs, are used to provide
relief of neuropathy pain.
3 Tricyclic antidepressants, not SSRIs, prevent panic attacks.
4 SSRIs help control obsessions and would indicate a therapeutic effect.
PTS: 1
CON: Evidence-Based Practice
11. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antianxiety agents.
Page: 69
Heading: Antianxiety Agents > Indications and Table 4-3 Safety Issues and Nursing Interventions
for Clients Taking Antianxiety Agents
Integrated Processes: Nursing Process)
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Because tolerance to benzodiazepines occurs, there is high risk for abuse.
Therefore, they should be used as a short-term intervention for anxiety.
2 Benzodiazepines should not be used for long-term treatment of anxiety because
the abuse potential is high.
3 While benzodiazepines should be used short-term, they have a high abuse
potential, not low.
4 Benzodiazepines should not be used for long-term treatment of anxiety, as they
have high abuse potential, not low.
PTS: 1
CON: Evidence-Based Practice
60
12. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: mood-stabilizing agents.
Page: 78
Heading: Mood Stabilizing Agents > Lithium Maintenance and Table 4-10 Safety Issues and
Nursing Interventions for Clients Taking Mood Stabilizers
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Blood level monitoring is required for lithium.
2 Routine blood-level monitoring is not required for buspirone.
3 Routine blood-level monitoring is not required for chlorpromazine.
4 Routine blood-level monitoring is usually not done for paroxetine.
PTS: 1
CON: Evidence-Based Practice
13. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 78
Heading: Mood Stabilizing Agents > Interactions and Table 4-10 Safety Issues and Nursing
Interventions for Clients Taking Mood Stabilizers
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Foods high in tyramine should be avoided for clients who take monoamine
oxidase inhibitors, not lithium.
2 The client should maintain a consistent sodium intake to prevent hyponatremia
and lithium toxicity. Because lithium is an imperfect substitute for sodium,
anything that depletes sodium will make more receptor sites available to lithium
and increase the risk for lithium toxicity.
3 The client should consume at least 2,000 to 3,000 mL of fluid per day, not 3,000
to 3,500.
4 Tardive dyskinesia occurs with long-term use of antipsychotics, not lithium.
PTS: 1
CON: Evidence-Based Practice
61
14. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antipsychotics.
Page: 83
Heading: Clozapine (Clozaril) and the Risk for Agranulocytosis
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Easy
Feedback
1 Clozapine can lead to agranulocytosis. Agranulocytosis is a potentially fatal
disorder in which the client’s white blood cell count drops to extremely low
levels, placing the client at great risk for infections.
2 While extrapyramidal side effects can occur with atypical antipsychotics
(clozapine), akathisia is not life-threatening.
3 While the client is not as high risk for pseudoparkinsonism, pseudoparkinsonism
is not life-threatening.
4 The client is at low risk for akinesia since clozapine is an atypical antipsychotic,
and akinesia is not life-threatening.
PTS: 1
CON: Evidence-Based Practice
15. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications drugs: antipsychotics.
Page: 81
Heading: Table 4-12 Safety Issues in Planning and Implementing Care for Clients Taking
Antipsychotic Medications
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Blurred vision, dry mouth, and constipation are anticholinergic side effects that
are not life-threatening and are not signs of agranulocytosis.
2 Sore throat, fever, and malaise are symptoms of agranulocytosis, which is a
potentially fatal disorder in which the client’s white blood cell count drops to
extremely low levels. This places the client at great risk for infections.
62
3
Tremor, shuffling gait, and rigidity are extrapyramidal side effects, not signs of
agranulocytosis. Clozapine has a low occurrence for extrapyramidal side effects.
4 Fine tremor, tinnitus, and nausea are not side effects of clozapine (Clozaril).
PTS: 1
CON: Evidence-Based Practice
16. ANS: 4
Chapter: Chapter 4 Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 83
Heading: Clozapine (Clozaril) and the Risk for Agranulocytosis
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 A decreased, not increased, white blood cell count occurs with clozapine.
2 An elevated (prolonged) bleeding time can occur with valproic acid and
carbamazepine, not with clozapine.
3 A low platelet count can occur with valproic acid and carbamazepine, not with
clozapine.
4 A low absolute neutrophil count is indicative of agranulocytosis, a potentially
fatal disorder in which the client’s white blood cell count and neutrophil count
drop to extremely low levels.
PTS: 1
CON: Evidence-Based Practice
17. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antidepressants.
Page: 72
Heading: Table 4-7 Diet Restrictions for Clients on MAOI Therapy
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Both pepperoni pizza and red wine are high in tyramine and should be avoided
to prevent a hypertensive crisis.
2 Although bagels with cream cheese can be eaten, tea may only be used
63
occasionally while on MAOI therapy.
While apple pie can be eaten at any time, coffee may only be used occasionally
while on MAOI therapy.
4 While potato chips are allowed, diet cola may only be used occasionally while
on MAOI therapy.
PTS: 1
CON: Evidence-Based Practice
3
18. ANS: 4
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antidepressants.
Page: 74
Heading: Table 4-8 Safety Issues and Nursing Interventions for Clients Taking Antidepressants
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Difficult
Feedback
1 SSRIs cause constipation, not diarrhea.
2 Pseudoparkinsonism occurs with antipsychotics, not SSRIs.
3 A hypertensive crisis occurs with monoamine oxidase inhibitors, not SSRIs.
4 The elderly client is especially prone to hyponatremia when SSRIs are taken.
PTS: 1
CON: Evidence-Based Practice
19. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antianxiety agents.
Page: 67
Heading: Antianxiety Agents > Action
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Evidence-Based Practice
Difficulty: Difficult
Feedback
1 Benzodiazepines would be given to a client with alcohol withdrawal.
Benzodiazepines are much like alcohol in their effects on GABA receptors,
which explains why benzodiazepines may be used for the management of
alcohol withdrawal.
2 Benzodiazepines are not given with cough medicines. The U.S. Food and Drug
64
Administration (2016a) added a black box warning (its strongest warning)
related to the serious risks and possible death associated with combining
benzodiazepines with cough medicines.
3 Even though clients with schizophrenia can take benzodiazepines, the drug most
likely to be administered to a schizophrenic is an antipsychotic.
4 There are serious risks and possible death associated with combining
benzodiazepines with opioid pain medicines. The U.S. Food and Drug
Administration (2016a) added a black box warning (its strongest warning) to
benzodiazepine labels.
PTS: 1
CON: Evidence-Based Practice
20. ANS: 3
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antipsychotics.
Page: 81
Heading: Issues in Antipsychotic Maintenance Therapy > Extrapyramidal Side Effects
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Diazepam (Valium) would not be prescribed for the extrapyramidal side effects
of antipsychotic medications. Diazepam is a benzodiazepine, an antianxiety
agent.
2 Amitriptyline (Elavil) would not be prescribed for the extrapyramidal side
effects of antipsychotic medications. Amitriptyline is an antidepressant.
3 Benztropine (Cogentin) is one of the most commonly used medications for
extrapyramidal side effects.
4 Methylphenidate (Ritalin) would not be prescribed for the extrapyramidal side
effects of antipsychotic medications. Methylphenidate is used for attention
deficit-hyperactivity disorder.
PTS: 1
CON: Evidence-Based Practice
21. ANS: 4
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 78
Heading: Table 4-10 Safety Issues and Nursing Interventions for Clients Taking Mood Stabilizers
Integrated Processes: Nursing Process
65
Client Need: Physiological Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 The nurse would not anticipate the cause to be foods high in tyramine. If the
client was on monoamine oxidase inhibitors and tyramine was consumed, then a
hypertensive crisis could occur. However, this is not the case in this situation.
2 Discontinuation of lithium carbonate is not likely because the client is not
showing signs of mania.
3 The development of tolerance to lithium carbonate is not likely.
4 The client has developed signs and symptoms of lithium toxicity because of the
loss of fluids and sodium from the flu. Nausea, vomiting, headache, muscle
weakness, confusion, and seizures are signs of lithium toxicity.
PTS: 1
CON: Evidence-Based Practice
22. ANS: 1
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 91
Heading: Applying the Nursing Process in Psychopharmacological Therapy > Agents for Attention
Deficit/Hyperactivity Disorder (ADHD) > Planning and Implementation
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 To reduce the anorexia associated with methylphenidate (Ritalin), the
medication should be given after meals.
2 Administering Logan’s medication at bedtime could keep him awake at night.
3 Logan will likely have a decrease in appetite from the effects of the medication.
The medication should not be skipped.
4 Assuring Logan’s mother that he will eat when hungry does not help improve
Logan’s appetite. The medication is causing the anorexia, not Logan.
PTS: 1
CON: Evidence-Based Practice
23. ANS: 4
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
66
Page: 79
Heading: Applying the Nursing Process in Psychopharmacological Therapy > Antipsychotic
Agents > Contraindications and Precautions
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Safety
Difficulty: Difficult
Feedback
1 Haloperidol would not be contraindicated because haloperidol is not only given
to older adult clients.
2 Clozapine would not be contraindicated. It is a second-generation, atypical
antipsychotic, not a first-generation, typical antipsychotic.
3 Risperidone would not be contraindicated because it does not exacerbate
depression. The client has psychotic episode for which risperidone can be
administered.
4 Thioridazine would be contraindicated. There may be cross-sensitivity among
phenothiazines. Both prochlorperazine (Compazine) and thioridazine (Mellaril)
are phenothiazines. Since the client has a known allergy to one phenothiazine,
he should not be given another phenothiazine.
PTS: 1
CON: Safety
24. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 83
Heading: Issues in Antipsychotic Maintenance Therapy
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Application [Applying]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 A low white blood cell count is not an example of extrapyramidal side effects
(EPS). It is a sign of agranulocytosis.
2 Tremors and a shuffling gait are examples of extrapyramidal side effects (EPS),
so the nurse would administer the medication at this time.
3 Dry mouth is not an extrapyramidal side effect (EPS). It is a sign of an
anticholinergic side effect.
4 Seizure is not an extrapyramidal side effect (EPS) so the nurse would not
administer the drug at this time. Seizures occur in some clients taking
antipsychotics because they lower the seizure threshold.
PTS: 1
CON: Evidence-Based Practice
67
25. ANS: 2
Chapter: Chapter 4, Psychopharmacology
Objective: Describe indications, actions, contraindications, precautions, side effects, and nursing
implications for the following classifications of drugs: antianxiety agents.
Page: 67
Heading: Antianxiety Agents > Action
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1 Stimulants are not contraindicated in persons who have attention
deficit-hyperactivity disorder (ADHD) in depression and are frequently used in
conjunction with antidepressant medication in clients with both disorders.
2 Due to the side effects of weight loss, stimulants are contraindicated in
treatment of individuals who have bulimia or anorexia nervosa.
3 Stimulants should be used with caution in clients who have a history of
substance use but are not contraindicated.
4 Stimulants are not contraindicated for persons who have had ADHD since
childhood and are used commonly for both adults and children with ADHD.
PTS: 1
CON: Evidence-Based Practice
MULTIPLE RESPONSE
26. ANS: 1, 2, 3, 4
Chapter: Chapter 4, Psychopharmacology
Objective: Apply the steps of the nursing process to the administration of psychotropic
medications.
Page: 60
Heading: The Role of the Nurse in Psychopharmacology > Assessment
Integrated Processes: Nursing Process
Client Need: Physiological Integrity
Cognitive Level: Knowledge [Remembering]
Concept: Evidence-Based Practice
Difficulty: Moderate
Feedback
1
The nurse should assess medical history to determine any physical conditions
that may cause some psychotropic medications to be contraindicated.
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2
The nurse should perform a physical examination to determine any current
physical problems that could affect medications.
3
The nurse should assess ethnocultural characteristics to determine genetic
variation, dietary preferences, and CYP450 isoenzyme variations to
psychotropic medications.
4
The nurse should assess current medications to determine possible interactions
with prescribed psychotropic medications.
5
Marital status is not an essential component to assess. Marital status will not
affect medication effectiveness, interactions, or contraindications.
PTS: 1
CON: Evidence-Based Practice
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Chapter 5: Relationship Development and Therapeutic Communication
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. Which is the most essential task for a nurse to accomplish prior to forming a therapeutic
relationship with a client?
1. Clarify personal attitudes, values, and beliefs.
2. Obtain thorough assessment data.
3. Determine the client’s length of stay.
4. Establish personal goals for the interaction.
2. The nurse is caring for an older male client who states, “You remind me so much of my late wife.”
During subsequent encounters with the client, he expresses overwhelming feelings of affection
toward the nurse and states, “I don’t know what I would do if you weren’t my nurse. No one cares
for me like you do.” How should the nurse respond?
1. Promote safety and immediately terminate the relationship with the client.
2. Encourage the client to ignore these thoughts and feelings.
3. Immediately reassign the client to another staff member.
4. Help the client to clarify the meaning of the relationship.
3. The nurse has just met a new client and is beginning to get to know the client. Which would be the
priority nursing action during this phase of the nurse-client relationship?
1. Acknowledge the client’s actions and generate alternative behaviors.
2. Establish rapport and develop treatment goals.
3. Attempt to find alternative placement for the client.
4. Explore how thoughts and feelings about this client may adversely impact nursing
care.
4. Which client action would a nurse expect during the working phase of the nurse-client
relationship?
1. The client gains insight and incorporates alternative behaviors.
2. The client establishes rapport with the nurse and mutually develops treatment
goals.
3. The client explores feelings related to reentering the community.
4. The client explores personal strengths and weaknesses that impact behavioral
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