Chapter 12 Psychopharmacology Test Bank

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

a) Sexual dysfunction

b) Myopathy

c) Exophthalmia

d) Liver failure

a) Sexual dysfunction

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

a) Schizophrenia

b) Seasonal affective disorder

c) Addictive disorders

d) Anxiety

b) Seasonal affective disorder

The most common therapy for seasonal affective disorder includes which of the following?

a) ECT

b) Deep brain stimulation

c) Phototherapy

d) Psychosurgery

c) Phototherapy

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

a) schizophrenia

b) cognitive disorders

c) depression

d) anxiety disorder

c) depression

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

a) Atypical antipsychotics block both serotonin and dopaminergic receptors.

b) There are no side effects with the typical antipsychotics.

c) Typical antipsychotics often lead to weight gain.

d) Atypical antipsychotics can cause arrhythmias and kidney failure in rare cases.

a) Atypical antipsychotics block both serotonin and dopaminergic receptors.

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

a) The potential for addiction and abuse of anxiolytics is low.

b) Caffeine beverages can increase the effect of sedative hypnotics.

c) Sedative hypnotics are effective analgesics.

d) Sudden cessation of alprazolam can cause rebound insomnia and nightmares.

d) Sudden cessation of alprazolam can cause rebound insomnia and nightmares.

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?

a) The client is highly agitated and trying to get out of the bed.

b) The client's heart rate is 120 and a slight arrhythmia is detected.

c) The client has a seizure in the recovery room.

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

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

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

a) Dry secretions

b) Memory loss

c) Severe muscle contractions

d) Emesis

c) Severe muscle contractions

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

a) The increase in the number of serotonin receptor sites in the central nervous system

b) The management of the symptomology related to depression

c) The inhibition of the hormonal cascade that affects the release of serotonin

d) Its ability to block the reuptake of serotonin

d) Its ability to block the reuptake of serotonin

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?

a) The foods interact with the drug to cause central nervous system depression, which could lead to coma and/or death.

b) The foods cause gastrointestinal distress, which may provoke ulceration of the gastric mucosa.

c) The foods contain amylase, an enzyme known to reduce liver perfusion.

d) The foods contain tyramine, which may provoke hypertensive crisis.

d) The foods contain tyramine, which may provoke hypertensive crisis.

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?

a) "Most people who are depressed experience a permanent improvement in their mood after their first treatment."

b) "The permanent memory loss associated with ECT is a small price to pay for curing your depression."

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

d) "You will probably not be able to use antidepressant medications for several months after the treatment, but they will likely be unnecessary."

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

Which of the following is the most effective treatment available for refractory major depression?

a) Phototherapy

b) Electroconvulsive therapy (ECT)

c) Deep brain stimulation

d) Psychosurgery

b) Electroconvulsive therapy (ECT)

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

a) Fear of becoming addicted

b) Intolerable side effects

c) Desire to control their own lives

d) Social stigma associated with taking psychotropic medications

b) Intolerable side effects

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?

a) Subcutaneously

b) Intravenously

c) Intramuscularly

d) Orally

c) Intramuscularly

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?

a) 2 pm

b) 12 pm

c) 8 am

d) 10 am

d) 10 am

A client is receiving ziprasidone as part of the treatment plan. On a return visit to the clinic, the client reports some anticholinergic side effects. When teaching the client about ways to minimize these effects, which statement would be most appropriate for the nurse to make? Select all that apply

a) "Make sure to include high fiber foods in your diet."

b) "Try sucking on some sugarless candies."

c) "Cut back on your calorie intake by 200 calories per day."

d) "Take the water pill your healthcare provider prescribed for swelling."

e) "Be sure to wear sunscreen with a SPF of at least 15."

a) "Make sure to include high fiber foods in your diet."

b) "Try sucking on some sugarless candies."

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

a) A client who is being treated with an atypical antidepressant

b) A client who is scheduled to begin electroconvulsive therapy (ECT) for the treatment of major depression

c) A client who has been admitted to the hospital with a diagnosis of lithium toxicity

d) A client who has a medication-induced movement disorder

d) A client who has a medication-induced movement disorder

During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate?

a) Instructing the client about relapse prevention

b) Discussing the timing of tapering the medication

c) Determining whether the medication is losing its effect

d) Assessing the client for target symptoms and side effects

d) Assessing the client for target symptoms and side effects

A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse?

a) Say that you and the client will monitor these side effects to be sure they do not increase in severity

b) Ask the client to return 3 days later to see the psychiatrist, who will be in the clinic on that day

c) Call the client's psychiatrist because her symptoms are indicative of moderate toxicity

d) Explain to the client that these are common side effects and that they will subside soon

c) Call the client's psychiatrist because her symptoms are indicative of moderate toxicity

Clients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in:

a) fat.

b) tyramine.

c) sugar.

d) sodium.

b) tyramine.

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?

a) "I'll teach you some techniques to help you remain calm and focused during the procedure."

b) "After their ECT, most clients say that the pain they experienced was very manageable."

c) "You'll be required to fast from solid food for 24 hours before your ECT procedure."

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

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

A client with a mood disorder is receiving psychopharmacologic therapy as part of the treatment plan. Place the interventions in the proper sequence that the nurse would complete them throughout the phases of the client's drug treatment.

a) Assessment for improvements in target symptoms

b) Cultural assessment and laboratory testing

c) Assisting with tapering of drug dosage

d) Client teaching about what to do if symptoms return

b) Cultural assessment and laboratory testing

a) Assessment for improvements in target symptoms

d) Client teaching about what to do if symptoms return

c) Assisting with tapering of drug dosage

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.

a) The client often smacks lips when at rest

b) The client reports nightmares and frequent awakenings at night

c) The client exhibits delusional thinking that is uncharacteristic

d) The client makes repetitive movements with the fingers

e) The client recently fainted after getting up quickly from a chair

a) The client often smacks lips when at rest

d) The client makes repetitive movements with the fingers

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

a) "If you notice that you have tremors in your arms or hands, stop taking the medication and tell your doctor."

b) "Make sure that you don't drink any alcohol when you're taking this medication."

c) "You might find that you have trouble falling asleep if you take this medication too late in the day."

d) "Ask your pharmacist for a list of the foods you should avoid while you're taking this medication."

b) "Make sure that you don't drink any alcohol when you're taking this medication."

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

a) dry mouth

b) diarrhea

c) constipation

d) runny nose

e) urinary retention

a) dry mouth

c) constipation

e) urinary retention

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

a) Awake and moving all extremities

b) Oriented to person, place, and time

c) Capable of spontaneous respirations

d) Communicating verbally and nonverbally

b) Oriented to person, place, and time

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) "The entire procedure typically lasts about 5 hours."

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

c) "If you show improvement after the treatment, your previous symptoms will not return."

d) "You will need to receive treatment twice a week for the rest of your life."

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

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

a) Tricyclic antidepressants

b) Selective serotonin reuptake inhibitors(SSRIs)

c) Atypical antidepressants

d) Monoamine oxidase inhibitors (MAOIs)

d) Monoamine oxidase inhibitors (MAOIs)

When the client asks the nurse how long it will take before the selective serotonin reuptake inhibitor (SSRI) antidepressant medication will be effective, which reply is most accurate and therapeutic?

a) "This is a good medication! It will be effective within 20 minutes of the first dose."

b) "It will probably take months for the medication to work. In the meantime, you should work on improving your attitude."

c) "If you believe it will work, then it will. You have to have faith!"

d) "You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication."

d) "You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication."

Which question(s) should the nurse include when assessing a client who is noncompliant with prescribed psychopharmacologic medications? Select all that apply.

a) "Are you afraid that you will become addicted to your prescribed medication?"

b) "Are you having trouble paying for your prescribed medications?"

c) "Are you confused about when you should take each of your medications?"

d) "Are you concerned about the stigma associated with taking the prescribed medications?"

e) "Are the side effects to your medications causing problems at work?"

All of the above

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.

a) Cost of the medication

b) Adverse reactions

c) Contraindications

d) Indications for use

e) Food and drug interactions

b) Adverse reactions

c) Contraindications

d) Indications for use

e) Food and drug interactions

After being presented with the potential benefits of ECT, a client has replied, "I've seen enough movies to know there's no way I'm going to have any shock therapy." Which response by the nurse would be most appropriate to address the client's concerns?

a) "Ultimately it will be up to your psychiatrist to decide whether you will have the treatment or not."

b) "You won't have to go through it alone. Doctors and nurses will be present the whole time to talk to you and protect you during ECT."

c) "The movies often exaggerate things. ECT has been shown to be safe and very effective."

d) "I know it looks violent, but you need to weigh the potential costs and benefits carefully before you make a decision."

c) "The movies often exaggerate things. ECT has been shown to be safe and very effective."

A client is being seen in the mental health clinic. The client has been on haloperidol for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. A nurse would document this chronic syndrome as:

a) dystonia.

b) akathisia.

c) neuroleptic malignant syndrome (NMS).

d) tardive dyskinesia.

d) tardive dyskinesia.

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?

a) Brain damage

b) Liver damage

c) Cardiac damage

d) Kidney damage

b) Liver damage

Which electrode placement during electroconvulsive therapy (ECT) is associated with the best outcomes?

a) Unilateral electrode placement on the client's right temporal area

b) Unilateral electrode placement on the client's left temporal area

c) Midline on the client's forehead, with one electrode above the other

d) Bilateral electrode placement on the client's temporal areas

d) Bilateral electrode placement on the client's temporal areas

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

a) Liver function tests

b) Cardiac enzymes

c) Blood urea nitrogen and creatinine

d) White blood cell count

d) White blood cell count

A nurse is talking with a group of parents who have children diagnosed attention deficit-hyperactivity disorder (ADHD). The children are receiving psychostimulant therapy as part of the treatment plan. During the discussion, each of the child's parents reports side effects. Which statement about side effects would the nurse expect to hear?

a) "Our child seems to be having trouble sleeping at night."

b) "Our child often reports being sick to the stomach."

c) "Our child has lost weight since starting this medication."

d) "Our child just doesn't seem to have any appetite."

d) "Our child just doesn't seem to have any appetite."

A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment?

a) Educating the client about the side effects of lithium

b) Ascertaining that the client is taking a full dose daily

c) Ensuring the client's blood levels reach a therapeutic and safe dose

d) Monitoring the client's cardiac status

c) Ensuring the client's blood levels reach a therapeutic and safe dose

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

a) hypotension

b) diabetes

c) agranulocytosis

d) hypertension

c) agranulocytosis

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) a bagel with cream cheese

b) a grilled cheddar cheese sandwich

c) a sausage and sauerkraut entree with red wine

d) a slide of pepperoni pizza with anchovies

a) a bagel with cream cheese

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?

a) Pseudoparkinsonism

b) Neuroleptic malignant syndrome (NMS)

c) Akathisia

d) Dystonia

a) Pseudoparkinsonism

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

a) Fried foods

b) Fava beans

c) Citrus fruit

d) Egg products

b) Fava beans

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

a) The effect the drug has on managing the client's symptomology

b) The way the body handles the medication

c) The greatest degree of expected responses achievable with minimal adverse reactions

d) How the client's age, gender, and size affect the metabolism of the drug.

b) The way the body handles the medication

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.

a) hallucinations

b) constipation

c) urinary retention

d) sedation

e) delusions

a) hallucinations

e) delusions

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

a) The outcome of the therapy has not been achieved

b) The target receptors are stimulated

c) Minor side effects are experienced

d) The biological activities related to the drug are inhibited

b) The target receptors are stimulated

An adult client has been taking citalopram for 4 months and notices a change in mood that is "better than it's been for years." The client has told the nurse, "I'm going to stop taking it, because I just don't think I need medication anymore." What is the nurse's best response?

a) "It's excellent that you're feeling better, but that's not a good idea because the drug is likely responsible for your improvement in mood."

b) "I'd strongly recommend against that. You've likely not yet experienced the drug's full effect."

c) "It's important that you taper off your medication very slowly to prevent a relapse of your depression."

d) "There are some simple strategies that I can teach you for managing the side effects of your medication."

a) "It's excellent that you're feeling better, but that's not a good idea because the drug is likely responsible for your improvement in mood."

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?

a) Diet

b) Sexual function

c) Body mass index

d) Bowel pattern

b) Sexual function

What is the difference between traditional and atypical antipsychotics?

a) Traditional antipsychotics work mostly as dopamine agonists, but antipsychotics work through antagonizing the dopamine receptor.

b) There are no major differences between these two classes of drugs; their advantages are that there is a wider spectrum of drugs from which to choose.

c) Traditional antipsychotics have a more powerful effect on the negative symptoms of schizophrenia, whereas atypical antipsychotics exert stronger effects on the positive symptoms.

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

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

The nurse provides education to a client who will begin ambulatory electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which client statement indicates a need for additional teaching?

a) "I will eat breakfast before my morning procedure."

b) "I will make sure my partner can drive me home after the procedure."

c) "I will wear loose, comfortable clothing for the procedure."

d) "I will remove my dentures before the procedure."

a) "I will eat breakfast before my morning procedure."

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

a) The amount of unmetabolized drug that reaches the blood stream after passing through the liver

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

c) The amount of time it takes for half the amount of the drug to leave the blood stream

d) The process of stimulating the drug's receptor sites

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

A drug that is an antagonist functions to do what?

a) Reduce synapses

b) Accelerate reuptake of neurotransmitters

c) Prevent natural or other substances from activating cell function

d) Stabilize a receptor in an inactive state

c) Prevent natural or other substances from activating cell function

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?

a) constipation

b) bradycardia

c) hypothermia

d) hyperreflexia

d) hyperreflexia

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

a) 4 months.

b) 6 months.

c) 8 months.

d) 2 months.

b) 6 months.

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

a) A seizure

b) Cardiac arrest

c) Brain damage

d) Amnesia

a) A seizure

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?

a) Kava

b) Melatonin

c) Lecithin

d) St. John's wort

b) Melatonin

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

a) Client age and length of time the depression have been affecting the client's quality of life

b) Presence of preexisting chronic mental and physical conditions

c) Electrode placement and the form and dosage of the electrical stimulus

d) Seizures that last less than 25 seconds and minimal EEG activity during the actual seizure

c) Electrode placement and the form and dosage of the electrical stimulus

A client is receiving risperidone as part of the treatment plan for schizophrenia. Assessment reveals breast enlargement and evidence of galactorrhea. The nurse interprets this effect as due to which occurrence?

a) Blockade of alpha-adrenergic receptors

b) Enhanced dopamine activity

c) Increased prolactin levels

d) Suppression of bone marrow function

c) Increased prolactin levels

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

a) Sadness, flattened affect, and anxious behavior

b) Dystonia, akathisia, and pseudoparkinsonism

c) Dystonia, flat affect, and cogwheeling

d) Shuffling gait, cogwheeling, and drooling

b) Dystonia, akathisia, and pseudoparkinsonism

When a client who is considering electroconvulsive therapy (ECT) asks the nurse how this treatment will improve his depression, the most appropriate response is ...

a) "It seems to affect the reuptake of serotonin and dopamine but with greater efficiency than tricyclic antidepressants or reuptake inhibitors."

b) "Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours."

c) "Stimulation of the frontal lobe of the brain appears to bring about the minimization or either elimination of depression."

d) "The seizure activity seems to stimulate the hypothalamus and pituitary encouraging the release of hormones that have antidepressant affects."

b) "Although the exact way the therapy works isn't completely understood, the results have been very encouraging among clients with symptoms similar to yours."

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

a) Traditional Chinese medicine

b) Music therapy

c) Light therapy

d) Aromatherapy

c) Light therapy

A client is prescribed antidepressant therapy and is being discharged on tricyclic antidepressants. When conducting discharge teaching with the client and family, the nurse would emphasize the need to be especially alert for:

a) dry mouth

b) suicide by overdose

c) seizures

d) hypotension

b) suicide by overdose

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?

a) Switch to a different selective serotonin reuptake inhibitor (SSRI).

b) Stop taking the medication.

c) Add diazepam as an adjunct.

d) Decrease the dosage of the medication.

d) Decrease the dosage of the medication.

A drug that is an agonist functions in which way?

a) Inhibits cell function by occupying receptor sites

b) Stabilizes a receptor in an inactive state

c) Accelerates or slows cellular processes

d) Blocks pain impulses

c) Accelerates or slows cellular processes

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

a) Changing the client's medication route to intramuscular depot

b) Administering a benzodiazepine 30 minutes prior to the antipsychotic

c) Transitioning from oral to intravenous antipsychotics

d) Establishing a system of rewards and consequences for adherence and nonadherence

a) Changing the client's medication route to intramuscular depot

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?

a) Administering naloxone as prescribed

b) Discontinuing the client's SSRI

c) Preparing the client for cardiac catheterization

d) Preparing the client for electroconvulsive therapy

b) Discontinuing the client's SSRI