Because triazolam acts very quickly, the client should take it after getting into bed.
Correct Answer
True
True. Triazolam is a benzodiazepine hypnotic with a very rapid onset, so it is taken once the client is in bed to prevent falls and injury from sudden drowsiness.
Category: Anxiolytics and Hypnotics
Question 2
CNS stimulants can make motor and verbal tics worse.
Correct Answer
True
True. Stimulants such as methylphenidate can intensify existing tics, so a personal or family history of Tourette syndrome is a reason for caution, and tics are monitored during therapy.
Category: Stimulants and Nonstimulants
Question 3
CNS stimulants should not be given during MAOI therapy or soon after it because the combination can cause dangerously high blood pressure.
Correct Answer
True
True. Both stimulants and MAOIs increase catecholamine activity, so combining them, or starting a stimulant before the MAOI has cleared, can cause a hypertensive crisis.
Category: Stimulants and Nonstimulants
Question 4
Because of its high potential for misuse and dependence, methylphenidate is placed in Schedule II of the Controlled Substances Act.
Correct Answer
True
True. Methylphenidate has accepted medical use for ADHD and narcolepsy but a high potential for misuse and dependence, which places it in Schedule II.
Category: Stimulants and Nonstimulants
Question 5
Blood for a serum lithium level is drawn as a trough, before the morning dose is taken.
Correct Answer
True
True. Lithium levels are measured at their lowest point, well after the previous evening's dose, so the client holds the morning dose until the blood is drawn to get an accurate result.
Category: Mood Stabilizers
Question 6
Lithium is eliminated unchanged by the kidneys, so adequate kidney function is essential during therapy.
Correct Answer
True
True. Lithium is not metabolized by the liver; the kidneys excrete it unchanged, so reduced renal function lets it accumulate. Lithium is generally avoided in severe renal impairment, and renal function is monitored during therapy.
Category: Mood Stabilizers
Question 7
Neuroleptic malignant syndrome presents with high fever, severe muscle rigidity and unstable blood pressure.
Correct Answer
True
True. Neuroleptic malignant syndrome is a rare but potentially fatal reaction to antipsychotics marked by sudden high fever, extreme rigidity, blood pressure changes, tachycardia and dysrhythmias. The drug is stopped and the client is cooled and treated urgently.
Category: Antipsychotics
Question 8
Clients taking antipsychotics should change positions slowly because orthostatic hypotension is a common adverse effect.
Correct Answer
True
True. Many antipsychotics block alpha-adrenergic receptors and cause a drop in blood pressure on standing, so clients rise slowly to prevent dizziness and falls.
Category: Antipsychotics
Question 9
Duloxetine taken late in pregnancy can cause a newborn syndrome with irritability, tremor and breathing difficulty.
Correct Answer
True
True. Exposure to duloxetine late in pregnancy has been linked to a neonatal syndrome with irritability, constant crying, tremor, feeding difficulty, respiratory distress and possible seizures, so its use in pregnancy is weighed carefully.
Category: Antidepressants
Question 10
Suvorexant promotes sleep by blocking receptors for orexin, a neuropeptide that promotes wakefulness.
Correct Answer
True
True. Suvorexant is an orexin receptor antagonist; blocking orexin signaling suppresses the drive to stay awake. It is a Schedule IV drug taken shortly before bedtime when the client can stay in bed for a full night.
Category: Anxiolytics and Hypnotics
Question 11
Abrupt withdrawal of guanfacine can cause rebound hypotension.
Correct Answer
False
False. Guanfacine and clonidine are alpha-2 agonists that lower sympathetic outflow, so stopping them suddenly can cause rebound hypertension. They are tapered when discontinued.
Category: Stimulants and Nonstimulants
Question 12
Second-generation antipsychotics cause more extrapyramidal symptoms than first-generation antipsychotics.
Correct Answer
False
False. Extrapyramidal symptoms are mainly a problem with first-generation drugs such as haloperidol. Second-generation drugs cause fewer extrapyramidal symptoms but more metabolic effects such as weight gain and hyperglycemia.
Category: Antipsychotics
Question 13
Lurasidone should be taken on an empty stomach to improve its absorption.
Correct Answer
False
False. Lurasidone is taken with food, which increases its absorption. It is an atypical antipsychotic used for schizophrenia and bipolar depression.
Category: Antipsychotics
Question 14
MAOIs are first-line antidepressants for most clients with major depression.
Correct Answer
False
False. MAOIs are rarely used and are reserved for depression that has not responded to other drugs, because their food and drug interactions can cause hypertensive crisis, stroke or myocardial infarction.
Category: Antidepressants
Question 15
SSRIs cause more anticholinergic effects and cardiotoxicity than tricyclic antidepressants.
Correct Answer
False
False. SSRIs act mainly on serotonin and have little affinity for muscarinic, histamine or alpha-1 receptors (paroxetine has some anticholinergic effect), so they cause far fewer anticholinergic and cardiac effects than tricyclics such as amitriptyline.
Category: Antidepressants
Question 16
Ramelteon is a Schedule IV controlled substance.
Correct Answer
False
False. Ramelteon is a melatonin receptor agonist that is not a controlled substance and can be used long term for insomnia with trouble falling asleep. Zolpidem, eszopiclone and the orexin antagonists are Schedule IV.
Category: Anxiolytics and Hypnotics
Question 17
Taking a nonbenzodiazepine hypnotic such as zolpidem with a high-fat meal speeds its onset of sleep.
Correct Answer
False
False. A high-fat meal delays absorption and slows the onset of nonbenzodiazepine hypnotics, so clients are taught not to take them with or right after a heavy, fatty meal.
Category: Anxiolytics and Hypnotics
Question 18
Orexin receptor antagonists such as lemborexant are used to treat narcolepsy.
Correct Answer
False
False. Narcolepsy results from a loss of the wake-promoting neuropeptide orexin, so drugs that block orexin receptors, such as lemborexant and suvorexant, are contraindicated in narcolepsy. They are used for insomnia.
Category: Anxiolytics and Hypnotics
Question 19
CNS stimulants commonly increase appetite and cause weight gain in children.
Correct Answer
False
False. Stimulants commonly reduce appetite and cause weight loss, so children's weight, food intake and growth are monitored during therapy.
Category: Stimulants and Nonstimulants
Question 20
Clozapine is usually the first antipsychotic prescribed for newly diagnosed schizophrenia.
Correct Answer
False
False. Clozapine is reserved for schizophrenia that has not responded to other treatments, because it can cause severe neutropenia, and absolute neutrophil counts are monitored during therapy. Other second-generation drugs are usually tried first.
Category: Antipsychotics