Chapter 12: Psychopharmacology, Dietary Supplements & Biologic Foundations PrepU

A client with a diagnosis of depression has not seen her mood and affect improve with the use of antidepressants, and the worsening of her symptoms has prompted her physician to order ECT. Which of the nurse's following teaching points about the procedure is most accurate?

"Even though the exact way that ECT helps depression isn't known, the therapy has been shown to be safe and effective."

Which are anticholinergic side effects that may occur with the use of antipsychotic drugs? Select all that apply.

dry mouth

constipation

urinary retention

In providing post-op care for the client who has just undergone ECT, which of the following findings would indicate that ECT has been effective and the client is displaying normal sequelae of this procedure?

The client cannot remember to which inpatient unit he or she is returning.

In the process of electroconvulsive therapy, what is electricity used to induce?

a seizure

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client?

agranulocytosis

A 52-year-old woman is seeing a nurse therapist for moderate depression. The client has been taking fluoxetine (Prozac) for 3 weeks, but her mood has not improved. She states, "I need more than this to get better. I'm taking St. John's wort, too." Why does the nurse tell the client to immediately stop taking St. John's wort?

St. John's wort with fluoxetine may lead to serotonin syndrome.

Prior to undergoing ECT, brief general anesthesia is given to prevent which of the following?

Severe muscle contractions

Extrapyramidal side effects are characterized by a triad of symptoms, including what?

Dystonia, akathisia, and pseudoparkinsonism

A client is undergoing ECT. The nurse would be correct to inform the client of which aspect prior to the ECT?

NPO will be employed 8 hours prior to the procedure.

Explanation:

Prior to the ECT procedure, the client is NPO for 8 hours. The client will empty his bladder just before or after vital signs are taken prior to the ECT. The client will not be harmed or feel any pain. The client will be asleep during the procedure.

After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid what food(s)? Select all that apply.

tap beers

sauerkraut

Explanation:

Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine such as tap beers; matured and aged cheeses; air-dried, aged, and fermented meats; broad bean pods; concentrated yeast extract; sauerkraut; and soy sauce.

A client who is taking lithium is scheduled to come to the community mental health center to have a blood level obtained. The client takes the last dose of lithium each day at 10 p.m. The nurse tells the client to hold the morning dose. At which time would the nurse tell the client to come to the center to have the specimen drawn?

10 am

Explanation:

Because lithium is a drug with a narrow therapeutic range or index, blood levels are monitored frequently. Blood levels should be monitored 12 hours after the last dose of medication. In the hospital setting, nurses should withhold the morning dose of lithium until the serum sample is drawn to avoid falsely elevated levels. Individuals who are at home should be instructed to have their blood drawn in the morning about 12 hours after their last dose and before they take their first dose of medication.

A client comes to the clinic for an evaluation. During the interview, the client describes the frequent travel required by the job and feelings of being jet lagged all the time. The client asks, “Is there any supplement that I could use that might be helpful? Which suggestion would the nurse most likely include in the response?

Melatonin

Explanation:

Melatonin, a naturally occurring hormone secreted from the pineal gland, is used for treatment of insomnia and prevention of “jet lag” in air travelers.

Lecithin

a precursor to acetylcholine, is used to improve memory and treat dementia.

St. Johns Wort

is used for depression, pain, anxiety, insomnia, and premenstrual syndrome.

Kava

is used for anxiety reduction

Which is the most commonly seen adverse side effect of typical antipsychotics?

Extrapyramidal symptoms and tardive dyskinesia

Explanation:

The greatest hazard of typical antipsychotics involves adverse effects, such as extrapyramidal symptoms (EPSs) and tardive dyskinesia. Risk of EPSs and other movement disorders is highest for clients who use older, high-potency neuroleptics, such as haloperidol or perphenazine, for long periods.

A nurse is leading a medication education group for clients with depression. A client states he has read that herbal treatments are just as effective as prescription medications. The best response is ...

"We need to look at the research very closely to see how reliable the studies are."

The client has been taking a low-potency antipsychotic medication for a few weeks. The nurse monitors the client and suspects extrapyramidal side effects. Which finding(s) supports the nurse's suspicion? Select all that apply.

-individual reports dry mouth and thirst

-record shows no bowel movement for 5 days

-client reports vision is blurry and can't see well

-reports of difficulty urinating

The prescription of clozapine requires weekly blood samples for at least:

6 months.

Explanation:

Although agranulocytosis can occur with any antipsychotic, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment, then every 2 weeks for the next 6 months if the absolute neutrophil count (ANC) stays normal. If treatment with clozapine continues after 1 year and the ANC remains normal, the client is then tested monthly for as long as the drug is taken.

Which reason do clients cite most frequently as the cause for self-discontinuation of medication?

Intolerable side effects

The psychiatric-mental health nurse needs to have a basic understanding of information that is unique to individual medications. Which factors that affect pharmacokinetics should the nurse know? Select all that apply.

Contraindications

Adverse reactions

Indications for use

Food and drug interactions

The therapeutic range of serum lithium includes which levels?

0.8 to 1.2 mEq/L

Explanation:

Therapeutic serum lithium levels during acute mania range from 0.8 to 1.4 mEq/L. Therapeutic maintenance levels range from 0.4 to 1 mEq/L. Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic.

A client has been discharged from the hospital with a prescription for lorazepam. Which instruction should the nurse provide to this client?

“Make sure that you don't drink any alcohol when you're taking this medication.”

Explanation:

Interactions between benzodiazepines and alcohol can be lethal. Drowsiness, not insomnia, is likely. There are not dietary restrictions normally associated with benzodiazepine use, and these drugs are not a common cause of neuromuscular effects.

A client who has been admitted to the hospital after a suicide attempt has been diagnosed with major depression and the client's care team has recommended ECT. Which of the following teaching points should the nurse include in client education before the procedure?

"You might feel a bit confused or disoriented after your treatment, but this will pass."

The nurse is caring for a client who suffers from anxiety. The client informs the nurse that he has been taking the herb kava. What should the nurse be aware that kava is associated with?

Liver damage

Explanation:

Nurses should be aware that use of the herb kava (Piper methysticum) is associated with liver damage and should not be recommended to clients.

Excess tyramine caused by monoamine oxidase inhibitors (MAOIs) can result in what?

Hypertensive crisis

Explanation:

Normally, MAO breaks down tyramine; however, because MAOIs inhibit MAO, tyramine can accumulate in the bodies of clients taking these drugs and eating tyramine-rich foods. Tyramine also releases norepinephrine from nerve endings. These metabolic actions can precipitate a hypertensive crisis.

During which phase of drug treatment does the prescriber adjust or titrate the medication dosage to achieve the maximum amount of improvement with a minimum of side effects?

stabilization

Maintenance Phase

after the individuals target symptoms have improved, medications are usually continued to prevent relapse or return of symptoms.

prior to Initiation of medications what happens?

patients must undergo several assessments, such as psychiatric and physical examinations

Discontinuation Phase

some medications may be stopped, tapered or kept at the same dosage

Dietary modifications are most likely necessary when a client is being treated with which antidepressant?

Monoamine oxidase inhibitors (MAOIs)

Explanation:

MAOIs are antidepressants that are well known for their multiple drug and food interactions. As such, dietary modifications are necessary. Such modifications are not normally necessary when a client is receiving SSRIs, tricyclic antidepressants, or atypical antidepressants.

A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying?

Pseudoparkinsonism

Explanation:

Symptoms of pseudoparkinsonism include the classic triad of Parkinson's disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms.

Akathisia

the inability to sit still or restlessness, is more common in middle aged clients

Dystonia

is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating the use of an antipsychotic

NMS- nueroleptic mailgnant syndrome

is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever.

St. John's wort is an herbal product for ...

depression

A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?

Intramuscularly

Explanation:

If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly. Antipsychotic medications are not normally administered by the intravenous or subcutaneous routes, and oral administration is more challenging when a client is noncompliant with treatment.

Which side effect is associated with selective serotonin reuptake inhibitors (SSRIs)?

Sexual dysfunction

Explanation:

SSRIs block neuronal transport of serotonin, which stimulates many postsynaptic receptor sites and probably contributes to associated side effects. These include nausea, vomiting, weight changes, agitation or restlessness, and delayed or impaired orgasm.

A client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence?

Changing the client's medication route to intramuscular depot

Explanation:

Depot medications can effectively compensate for a client's lack of adherence and are likely to be more effective in the long term than a system of rewards and consequences. Antipsychotics are not administered intravenously.

The nurse has been asked to explain electroconvulsive therapy to a client and his family. Which of the following statements made by the nurse would be correct?

"A tapering schedule may be used to end your treatments to try to prevent rehospitalization."

An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply.

The client often smacks lips when at rest

The client makes repetitive movements with the fingers

Explanation :

Tardive dyskinesia is usually characterized by repetitive involuntary movements.

Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)?

Atypical antipsychotics block both serotonin and dopaminergic receptors.

Explanation:

Typical antipsychotics do have side effects, often lead to weight gain, and, in rare cases, cause dysrhythmias and kidney failure. Thus, atypical antipsychotics block both serotonin and dopaminergic receptors is the correct answer.

When responsible for the recovery care of a client receiving electroconvulsive therapy (ECT), the psychiatric nurse provides care until the client is ...

Oriented to person, place, and time

Explanation:

According to ECT guidelines, interventions are provided as needed until the client is awake, alert, and oriented to person, place, and time. The other options provided do not signal termination of treatment care.

A nurse is assessing a client with schizophrenia who is receiving antipsychotic drug therapy. The nurse would correlate a change in which findings with the drug's effectiveness on target symptoms? Select all that apply.

hallucinations

delusions

Explanation:

Psychiatric medications and other biologic interventions are indicated for target symptoms, which are specific measurable symptoms expected to improve with treatment. For a client with schizophrenia, target symptoms would include hallucinations and delusions. Unfortunately, even when drugs have a high affinity and selectivity for a specific neurotransmitter, the body will respond, causing problems that are not related to the target symptoms. These unwanted effects of medications are called side effects. Side effects often include sedation, constipation, and urinary problems, such as retention.

When explaining the term "pharmacokinetics" to a client who is being educated on a newly prescribed medication, it would be appropriate to define it as

The way the body handles the medication

A client receiving antipsychotic therapy develops an acute dystonic reaction. Which medication would the nurse most likely expect the health care provider to prescribe as treatment?

Benztropine

Explanation:

Although diphenhydramine, amantadine and propranolol may be used as treatment for medication-related movement disorders, an anticholinergic agent such as benztropine would be most likely prescribed to treat the acute reaction. Anticholinergic agents inhibit acetylcholine and thereby restore the balance of the neurotransmitters.

Which client is most likely to benefit from treatment with an antiparkinsonism agent?

A client who has a medication-induced movement disorder

Explanation:

Antiparkinsonism agents have been used to treat medication-induced movement disorders, such as neuroleptic-induced parkinsonism.

A drug that is an antagonist functions to do what?

Prevent natural or other substances from activating cell function

Explanation:

Drug antagonists block the actions of everything in the agonist spectrum. These chemicals bind to and block a receptor, producing no response and preventing agonists from binding or attaching to the receptor.

A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition?

Intramuscularly

When teaching a client about restrictions for tranylcypromine, the nurse will tell the client to avoid which food?

Fava beans

Explanation:

Tranylcypromine (Parnate) is a monoamine oxidase inhibitor; clients must avoid foods containing tyramine. Fava beans contain tyramine.

A nurse is administering a monoamine oxidase inhibitor (MAOI) to a client with depression. Prior to administration of the medication, which will the nurse include when providing information? Select all that apply.

- If foods with tyramine are ingested, a hypertensive crisis may occur.

- There may be interactions when taking other MAOIs and antidepressants.

- There is a risk for experiencing decreased libido and impotence.

When discussing the effects of a newly prescribed psychotropic drug with the client, the nurse explains the process of clearance as

How much of the drug is excreted out of the body in a specific period of time.

A psychiatric-mental health nurse is conducting a review class on psychopharmacology as part of the orientation program at a community mental health center for a group of newly hired nurses. When describing the various classes of drugs commonly prescribed at the center, which agent would the nurse most likely include as a selective serotonin reuptake inhibitor? Select all that apply.

Escitalopram

Sertraline

Paroxetine

Escitalopram, sertraline and paroxetine are classified as selective serotonin reuptake inhibitors.

Duloxetine and venlafaxine are classified as what?

serotonin norepinephrine reuptake inhibitors.

When referring to the pharmacodynamics of a medication, what is the result of an agonistic effect?

the target receptors are stimulated

A client with schizophrenia is erratic in adhering to the antipsychotic regimen. What action best addresses this client's lack of adherence?

Changing the client's medication route to intramuscular depot

Antidepressants are considered the treatment of choice for major depression; however, they should be used most cautiously in clients with a history of:

cardiac or seizure disorders.

Explanation:

Antidepressants, especially tricyclic antidepressants, can cause cardiac dysrhythmias.

A client with a history of depression has been receiving outpatient treatment for several months but the client's partner has now brought the client to the emergency department. The partner states that the client had visual hallucinations earlier in the day. The client has an unstable gait and vomited on the way to the hospital. In addition to monitoring the client's vital signs, the care team should prioritize what action?

Discontinuing the client's SSRI

Explanation:

It is likely that this client is experiencing serotonin syndrome, which is treated by discontinuing the offending medication and providing symptoms support. Naloxone is effective in cases of opioid overdose. Electroconvulsive therapy and cardiac catheterization would have no benefit.

The nurse is caring for a client admitted with factitious disorder. Which element(s) will the nurse likely find when reviewing the client's history in the electronic medical record? Select all that apply.

-intentional falsification of symptoms

-unnecessary surgical treatments

-clinical findings do not correlate with illness

Explanation:

A factitious disorder is one in which the individual intentionally falsifies, simulates, or creates medical symptoms as though there is an illness—when in fact there is no illness—for the sole purpose of primary gain. Factitious disorder is included with somatic disorders because the symptoms appear somatic in nature. Individuals with a somatic disorder often have long histories of medical and unnecessary surgical treatments by several different health care providers. The disorder features physical symptoms that suggest a medical condition is the cause, but typically, the clinical findings do not support the existence of a medical issue

A client is in the acute phase of mania and is receiving lithium. Which blood concentration of lithium is within the therapeutic range for acute mania?

0.9 mEq/L

Explanation:

During the acute phase of mania, lithium blood concentrations of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control.

A resident at a long-term care facility has been ordered an antipsychotic for dementia-related aggressive behavior. What element(s) should the nurse consider in administering this medication related to effects and use? Select all that apply.

-The resident must be monitored by the nurse for antipsychotic toxic effects.

-Due to lower body fat ratios in older adults, the resident may become toxic.

-A lower dose may be needed to obtain the desired effect to decrease aggression.

-The aggression may stem from interactions with other medications ordered.

Explanation:

For older clients who have dementia-related aggression, distressing repetitive behaviors, delusions, hallucinations, or agitation, the use of antipsychotic medications may be used to reduce and manage the incidence of symptoms. Specific monitoring must also be done. In an older adult, the half-life of a medication tends to increase by as much as five to six times, increasing the risk of toxicity. The effects accumulate slowly and may not be apparent for days or weeks after the initiation of the medication. Many antipsychotic medications, either by themselves or in interaction with other medications, can cause the very symptoms they are prescribed to treat, such as agitation or delusions. Toxic effects accumulate slowly and may not be seen for several weeks, even after medication is discontinued. A desired outcome is that aggressive behavior is lessened.

A client begins taking 40 mg of fluoxetine daily. The next day the client calls complaining of restlessness. Which interventions should the nurse advocate for to the client's prescribing physician first?

Decrease the dosage of the medication.

Explanation:

Side effects associated with SSRIs include nausea, vomiting, weight changes, agitation or restlessness, and delayed or impaired orgasm. Side effects are immediate; some experts believe that beginning with a subtherapeutic dose to improve initial tolerance can minimize side effects. Others posit that the starting dose should be the same as the maintenance dose. Side effects can be minimized by lowering the dose.

Which of the following is a common complementary and alternative medicine (CAM) modality used in the treatment of depression?

Light therapy

Explanation:

Clients with depression have been shown to benefit from light therapy (SAD), meditation, and herbal products.

Vagus nerve stimulation has been used as a treatment for ...

Depression

Explanation:

Vagus nerve stimulation (VNS) is an FDA-approved treatment that involves implantation of a device under the client's skin. Studies on VNS for refractory depression seem to be promising, with depression being relieved and relief sustained, in some studies, for as much as 24 months.

What is the difference between traditional and atypical antipsychotics?

Atypical antipsychotics work on dopamine-receptor and serotonin-receptor blockade, whereas traditional antipsychotics work on dopamine-receptor blockade.

Explanation:

Atypical antipsychotics work on dopamine receptors and serotonin receptors, thus affecting both positive and negative symptoms of schizophrenia.

The nurse provides care to a client who is prescribed phenelzine for the treatment of depression. Which client meal choice indicates a correct understanding of the nurse's teaching regarding foods that are low in tyramine?

a bagel with cream cheese

Explanation:

Phenelzine is a monoamine oxidase inhibitor (MAOI) medication; thus, it requires a diet that is low in tyramine. The client meal choice that is low in tyramine thus indicates a correct understanding of the nurse’s teaching is a bagel with cream cheese. The other options all include foods that are high in tyramine (e.g., cheddar cheese, pepperoni pizza with anchovies, sausage, sauerkraut, and red wine).

The nurse caring for the client taking clozapine should advocate for monitoring using which diagnostic test?

White blood cell count

Explanation:

Use of clozapine requires weekly monitoring of white blood cell (WBC) counts to assess for agranulocytosis. Clozapine suppresses the development of WBCs in 1 to 2% of all clients who take it. If WBC levels decrease significantly from baseline, immediate discontinuation of clozapine is recommended. Clients should never use clozapine with other agents that suppress WBC production, such as carbamazepine.

A client is admitted to the psychiatric unit with a diagnosis of major depression with psychotic features. When the client does not respond to antidepressant medications, ECT is ordered. What is the mechanism of action of this therapy?

The mechanism of action of ECT remains unknown.

When a client's family member questions the likelihood of long-term memory loss for a client scheduled for electroconvulsive therapy (ECT), the psychiatric nurse replies ...

"He may not immediately remember some of the events surrounding the treatment but his memory will return in a matter of hours to just weeks."

The nurse notes that a client with a mental health condition is prescribed a medication with a high therapeutic index. In which way would the nurse expect the dose of the medication to be affected?

There is a large range between the drug taking effect and the dose that causes toxicity.

Explanation:

The therapeutic index is the ratio of the maximum nontoxic dose to the minimum effective dose. A high therapeutic index means that there is a large range between the dose at which the drug begins to take effect and a dose that would be toxic to the body.

Typical antipsychotics work by blocking which receptor?

Dopamine

A client is receiving amitriptyline as part of the treatment plan for depression. The health care provider orders a drug plasma level. Which result would the nurse identify as being therapeutic?

180 ng/mL

Explanation:

Therapeutic blood levels for amitriptyline range from 110 to 250 ng/mL.

Light therapy is used as a treatment modality for individuals suffering from which of the following disorders?

Seasonal affective disorder

A 36-year-old client has been receiving a selective serotonin reuptake inhibitor for treatment of depression. The client is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which symptom of this syndrome?

hyperreflexia

Explanation:

Symptoms of serotonin syndrome include hyperreflexia, tachycardia, hyperthermia, and diarrhea. Serotonin syndrome can be life threatening. The treatment for serotonin syndrome is discontinuation of the medication and symptom management.

A nurse is performing an admission assessment. The client reports that it has been taking larger and larger amounts of medication to get the desired effect. Based on this information, the nurse interprets this as suggesting which effect(s)? Select all that apply.

Tolerance

Benzodiazepines and buspirone are included in which therapeutic category?

Anxiolytics

Explanation:

Benzodiazepines have the pharmacologic effects of anxiolysis, sedation, centrally mediated muscle relaxation, and elevation of the seizure threshold.

An adult client has just been prescribed paroxetine by his primary care provider. When assessing the client prior to the beginning of drug therapy, the nurse should include what assessment?

Sexual function

Explanation:

Selective serotonin reuptake inhibitors (SSRIs) often negatively affect the client's sexual function, so it is important to know the client's baselines. SSRIs do not typically cause weight gain and nutrition does not significantly affect therapy. Some clients develop diarrhea early in treatment, but an assessment of sexual functioning is a higher priority.

A client is experiencing acute mania and started on lithium therapy. After several doses, the client has a serum lithium level drawn. Which result would the nurse identify as being outside the therapeutic range?

0.6 mEq/L

Explanation:

During the acute phases of mania, lithium blood levels of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control. The therapeutic range for lithium is narrow, and patients in the higher end of that range usually experience more uncomfortable side effects. During maintenance, the dosage is reduced, and dosages are adjusted to maintain blood levels of 0.4 to 1 mEq/L.

Though the client does not exhibit any signs or symptoms of depression, a client's physician has prescribed a low dose of the antidepressant mirtazapine. What is the most likely rationale for the physician's action?

To make use of an off-label application of the medication

The effective minimization of the clinical symptoms of depression as a result of electroconvulsive therapy (ECT) has been proven to be a result of

Electrode placement and the form and dosage of the electrical stimulus

Explanation:

Research has proven that electrode location and the form and dosage of the electrical stimulus contribute to the clinical efficacy and cognitive effects of seizures.

A client with depression has a history of discontinuing medications and relapsing, often using alcohol and other substances to self-medicate. A new nurse case manager is evaluating the treatment plan developed to enhance the client's ability to manage the medication regimen. The case manager determines that the plan has been effective when the client makes which statement?

"The medicine doesn't seem to be working. I called my therapist and made an appointment to discuss other medications. In the meantime, I'm still taking this medication."

The client and family are receiving information on conversion disorder. The nurse determines that education has been successful when the client makes which statement(s)? Select all that apply.

"The first option of treatment is education about the diagnosis."

"About half of persons diagnosed can have immediate recovery."

"Physical therapy may be helpful for the affected body part."

A client comes into a psychiatric-mental health facility suffering from major depression. He tells the nurse that a relative of his who lives in Canada has undergone transcranial magnetic stimulation (TMS). He would like to know if he can receive the treatment. Which of the following is the nurse's best response?

The treatment is considered safe and minimally invasive.

Explanation:

TMS is considered the safest and least invasive of the new stimulating techniques now under research. Its advantage is that it has no side effects. TMS is not at this writing approved by the U.S. Food and Drug Administration (FDA), but a large clinical trial is underway to support FDA clearance of TMS and make it available for clinicians to treat major depression. TMS appears to achieve clinical improvement in clients with depression. TMS has been approved in Canada and Israel for refractory depression.

The mental health nurse instructs a client prescribed phenelzine to avoid aged foods, such as wine and cheese. For which reasons are these instructions important for client safety?

The foods contain tyramine, which may provoke hypertensive crisis.

In the discharge instructions for a client who is taking alprazolam, the nurse should include what?

Sudden cessation of alprazolam can cause rebound insomnia and nightmares.

Explanation:

Clients who are taking alprazolam need to be taught that this medication must not be stopped abruptly. Frequently, abrupt cessation will cause severe rebound insomnia as well as nightmares.

Which correctly describes the primary effect of a selective serotonin reuptake inhibitor (SSRI) antidepressant drug?

Its ability to block the reuptake of serotonin

Explanation:

An SSRI antidepressant drug's primary effect typically involves its ability to block the reuptake of serotonin, not the management of the symptomology related to depression, the inhibition of the hormonal cascase, nor the increase in the number of serotonin receptor sites.

A psychiatric-mental health nurse is reviewing the medication history of a client with depression who is receiving bupropion. When teaching the client about this medication, the nurse would integrate information about which neurotransmitter as being affected by this medication? Select all that apply.

Norepinephrine

Serotonin

Dopamine

A client is admitted to the mental health unit after feeding their hospitalized child crushed glass. The client is adamant that the child has a physical illness that health professionals have just not found yet, and the client has had the child hospitalized in critical condition several times. The nurse would most likely suspect which condition? Select all that apply.

- factitious disorder imposed on another

- caregiver-fabricated illness (formerly Munchausen syndrome by proxy)