MS II QUIZ #13

What is the indication for risperidone (Resperdal)?

Psychosis

Rationale: Risperidone is a second-generation antipsychotic used to treat schizophrenia and other psychotic disorders. It works by blocking dopamine (D2) and serotonin (5-HT2A) receptors, which reduces hallucinations, delusions, and disorganized thinking.

A nurse is caring for a client who has paranoid schizophrenia and is taking quetiapine. The nurse should observe the client for which of the following adverse effects?

Drowsiness

Rationale: Quetiapine has strong antihistamine (H1) blockade, causing sedation and drowsiness, especially early in therapy.

Nurse is collecting data from a client who has schizophrenia who stopped taking chlorpromazine (Thorazine). What is the most common reason for patient that is non-adherent to this medication?

EPS (Extrapyramidal Symptoms)

Rationale: First-generation antipsychotics like chlorpromazine commonly cause extrapyramidal symptoms (EPS) (akathisia, dystonia, parkinsonism). These distressing effects often lead to noncompliance.

A nurse is caring for a client who has schizophrenia and is receiving clozapine. For which of the following findings should the nurse monitor to determine if the medication is having a therapeutic effect?

Decreased auditory hallucinations

Rationale: The goal of antipsychotic therapy is reduction in positive symptoms (hallucinations, delusions).

A nurse is caring for a client who has schizophrenia and taking haloperidol. The nurse observes that the client has developed a stooped posture and shuffling gait. The nurse should document these findings as which of the following extrapyramidal side effects of haloperidol?

Pseudoparkinsonism

Rationale: Dopamine blockade in the nigrostriatal pathway causes Parkinson-like symptoms (rigidity, bradykinesia, shuffling gait).

A nurse is collecting data from client who has just begun therapy with alprazolam (Xanax) to treat anxiety. The nurse should observe the client for which of the following adverse effects of this medication?

Sedation

Rationale: Benzodiazepines enhance GABA, producing CNS depression → sedation is common.

A nurse is collecting data from a group of clients who have anxiety disorders and have prescriptions for various psychotropic medications. The nurse should recognize which of the following clients as having an increased risk for suicide?

A client who has an obsessive-compulsive disorder and takes fluoxetine

Rationale: SSRIs carry an FDA black box warning for increased suicidal ideation, especially early in therapy and in younger clients.

A nurse is preparing to administer buspirone (Buspar) to a client who has generalized anxiety disorder. The nurse should plan to monitor the client for which of the following adverse reactions?

Headache

Rationale: Buspirone (non-benzodiazepine anxiolytic) commonly causes headache, dizziness, nausea. It does not cause sedation or dependence.

A nurse is reviewing the morning laboratory report for a client who has bipolar disorder and recently started taking lithium. The client's current lithium level is 1.2 mEq/L. Which of the following actions should the nurse plan to take?

Administer the regular dose of lithium.

Rationale: Therapeutic range for acute mania is 0.8–1.4 mEq/L. A level of 1.2 is therapeutic.

A nurse is reviewing a client’s medication administration record. Which of the following medications should the nurse recognize as potentially interacting with the client’s prescribed lithium?

furosemide (Lasix)

Rationale: Diuretics decrease sodium levels. The kidneys retain lithium when sodium is low → lithium toxicity risk.

A nurse is caring for a client who has depression and is taking a monoamine oxidase inhibitor (MAOI). The nurse should inform the client that his diet may include which of the following foods?

Cottage cheese & Cream Cheese (Banana?)

Rationale: Fresh cheeses are low in tyramine. Aged cheeses are high in tyramine and must be avoided.

A nurse is reinforcing teaching with a client who is to begin taking a selegiline (Emsam) an MAOI, in addition to a selective serotonin reuptake inhibitor (SSRI). Which of the following statements should the nurse include in the teaching?

"You will need to be off the SSRI for at least two weeks before starting the MAOI."

Rationale: Combining causes serotonin syndrome. A 2-week washout (5 weeks for fluoxetine) is required.

A nurse at a mental health facility is discussing antidepressant medications with a newly licensed nurse, comparing selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)? Which of the following information should the nurse include about TCAs?

Increased risk for cardiovascular adverse effects

Rationale: TCAs block cardiac sodium channels → risk for dysrhythmias, orthostatic hypotension, QT prolongation.

A nurse is reinforcing teaching with a client who has depression about a new prescription for fluoxetine (Prozac). Which of the following statements by the client indicates understanding of the teaching?

"I may experience sedation and sleepiness."

Rationale: SSRIs can cause CNS effects such as insomnia or sedation, especially early in therapy

A nurse is collecting data from a client who reports taking several herbal supplements. Which of the following supplements should the nurse tell the client can increase sedation in clients who take CNS depressant medications such as amitriptyline?

Valerian supplement

Rationale: Valerian has CNS depressant effects → additive sedation with antidepressants.

A nurse is collecting data from a client who is to begin taking alprazolam (Xanax). Which of the following findings should the nurse identify is a contraindication to this medication?

Alcohol use disorder

Rationale: Benzodiazepines + alcohol = severe CNS depression and respiratory depression.

A nurse is reviewing a client's medication administration record. For which of the following medications should the nurse place the client on fall precautions?

diazepam (Valium)

Rationale: Causes sedation, dizziness, impaired coordination → fall risk.

A nurse is collecting data from a client who is to start taking amitriptyline for depression. Which of the following dietary supplements should the nurse instruct the client to avoid?

Valerian

Rationale: Additive CNS depression.

A nurse is collecting data from a client who is taking bupropion (Zyban). Which of the following findings indicates the medication is effective?

Decrease in urge to smoke

Rationale: Bupropion reduces nicotine cravings via dopamine/norepinephrine effects.

What is the adverse effect of olanzapine (Zyprexa)?

Weight gain (Increases appetite)

Rationale: Strong metabolic effects: ↑ appetite, hyperglycemia, dyslipidemia.

Client has generalized anxiety disorder and has been prescribed alprazolam (Xanax). What is the instruction of the nurse?

Watch out for drowsiness and lightheadedness

Rationale: CNS depression + orthostatic hypotension.

When taking fluoxetine (Prozac) patient needs to report which of the following to the provider?

Weight gain or Weight loss

Rationale: SSRIs can cause weight gain or loss; significant changes require evaluation.

A client is taking diazepam (Valium). What information should the nurse give to the patient?

diazepam (Valium) can cause drowsiness

Rationale: CNS depressant; avoid driving.

What is the medication where patient needs to avoid foods containing tyramine?

MOAIs (it can cause hypertensive crisis)

Rationale: MAOIs + tyramine → hypertensive crisis due to excess norepinephrine.

A patient is taking lithium bicarbonate to treat bipolar. The nurse understand that the patient must maintain consistency of his intake. Which of the following dietary elements should the nurse include?

Sodium

Rationale: Low sodium increases lithium reabsorption → toxicity risk.

A nurse is modifying the diet of a client who has Parkinson's disease and a prescription for selegiline (Emsam), a monamine oxidase inhibitor (MAOI). Which of the following foods should the nurse eliminate from the client's diet?

Cheddar cheese

Rationale: Aged cheeses are high in tyramine.

A nurse is reinforcing dietary teaching to a client who is starting a MAOIs. Which of the following food choices the nurse should identify as having the highest tyramine content?

Avocado

Rationale: Overripe avocados contain high tyramine levels.

A nurse is teaching a client about with bipolar disorder taking lithium carbonate. Which of the following findings should the nurse monitor as adverse effect of this medication?

Hypothyroidism (can develop goiter)

Rationale: Lithium inhibits thyroid hormone synthesis → goiter, hypothyroidism.

What is the common adverse effect of citalopram (Celexa)?

Nausea is the most common

Rationale: GI upset is the most common early SSRI effect.

A patient is taking antipsychotic medication for 1 week. What would the nurse expect the patient experience? (SATA)

sedation/drowsiness

orthostatic hypotension

Anticholinergic effects

Early extrapyramidal symptoms: acute dystonia, parkinsonism, akathisia

Rationale: Dopamine blockade causes EPS; alpha-1 blockade causes hypotension; histamine blockade causes sedation.

A patient is taking lorazepam (Ativan) for 2 months, suddenly the medication was stopped. What is the patient at risk to develop?

Anxiety

Rationale: Benzodiazepine withdrawal → anxiety, tremors, seizures.

A patient is taking sertralin (Zoloft) daily for 10 days. He reports that the medication does not help with his depression. What will be the explanation be?

Medication becomes effective after at least 2 weeks/several weeks

Rationale: Antidepressants take 2–6 weeks for full effect.

What are the signs of neuroleptic malignant syndrome that is life threatening due to the adverse reaction of antipsychotic drugs? (SATA)

1.) Muscle rigidity

2.) Elevated temperature

3.) Diaphoresis

4.) Unresponsiveness

5.) Unstable BP

Patient teaching for taking Buproprion hydrochloride?

It should not be crushed

Rationale: Extended-release form; crushing increases seizure risk.

What adverse effect of buspirone (Buspar) should the nurse prioritize?

Slurred speech

Rationale: Could indicate CNS toxicity — requires immediate evaluation.

A long-time patient with schizophrenia in the inpatient unit has developed involuntary movements of his tongue. What has this patient developed?

This patient has developed Tardive Dyskinesia

Rationale: Late, irreversible EPS from long-term dopamine blockade.

A nurse is caring for a client who begins showing signs of alcohol withdrawal delirium. Which of the following medications should the nurse administer?

lorazepam (Ativan)

Rationale: Benzodiazepines prevent seizures and reduce CNS hyperactivity.

A nurse is collecting data from a client who has schizophrenia and recently stopped taking chlorpromazine after 8 years. The nurse notes choreiform movements, lip smacking, and spastic facial distortions. The nurse should document these findings as indicating which of the following conditions?

Tardive Dyskinesia

Rationale: Lip smacking, facial grimacing are classic late EPS.

Since the summer weather began, a patient taking lithium for manic episodes has been walking daily. What important instruction should the nurse provide to this patient?

Maintain hydration

Rationale: Dehydration increases lithium levels → toxicity risk.