The nurse is teaching a client receiving a tricyclic antidepressant. Which of the following symptoms related to its anticholinergic effects could the client experience?
Increased appetite, diarrhea, and glaucoma
Xerostomia, constipation, and urinary retention
✓
Excessive salivation, tachycardia, and urinary incontinence
Nightmares, increased libido, and blurred vision
Correct Answer
Xerostomia, constipation, and urinary retention
The drug blocks muscarinic receptors and causes anticholinergic effects. This results in reduced salivation (xerostomia), decreased peristalsis (constipation), and relaxation of the detrusor muscle, causing urinary retention.
Question 2
A client with bipolar disorder has a subtherapeutic lithium level. What will the nurse expect to assess in this client?
Ability to sit down and eat a well-balanced meal
A decrease in impulsivity and hyperactivity
Rapid, pressured speech along with interrupting others
✓
Sleeping 6–8 consecutive hours per night
Correct Answer
Rapid, pressured speech along with interrupting others
Rapid, pressured speech is a classic sign of mania. If the drug level is considered subtherapeutic, this means it is not working favorably. The other options indicate the manic behavior is being well managed.
Question 3
Which of the following observations indicates that lisdexamfetamine has been effective for a 10-year-old diagnosed with ADHD?
The child is able to sit and play a game for 30 minutes with a friend.
✓
The child received two notes from their school due to inappropriate behavior.
The child sleeps 8 hours per night and still falls asleep during the day.
The child has difficulty following verbal instructions from the teacher.
Correct Answer
The child is able to sit and play a game for 30 minutes with a friend.
This demonstrates the child's ability to remain focused on the task at hand.
Question 4
A client has been taking fluoxetine for 2 weeks. They tell the nurse they do not think the medication is working because they still feel depressed. What is the nurse's best response?
"This drug takes about 4–6 weeks before you may see full therapeutic effects."
✓
"This may not be the best medication for you. Let me call the provider to get something different."
"You might still be depressed, but you look and sound a lot better."
"I will call the provider and ask if the dosage can be increased."
Correct Answer
"This drug takes about 4–6 weeks before you may see full therapeutic effects."
The brain has to adapt to these types of drugs. Although a person can feel some benefit in 2 weeks, full effects can take 4–6 weeks. It is important to emphasize this to the client or else they will simply stop taking the drug.
Question 5
Which adverse effect should the nurse assess for in a client who is taking haloperidol?
Hypertension
Nausea and vomiting
Tremors
✓
Weight loss
Correct Answer
Tremors
Tremors, pseudoparkinsonism, and akinesia are extrapyramidal side effects that can occur with haloperidol.
Question 6
The nurse has completed medication education for a client prior to their receiving phenelzine. The nurse evaluates the education as effective when the client makes which statement?
"I should use almond milk instead of whole milk and need to avoid aged cheeses."
✓
"Eating seafood could cause my blood pressure to become very low."
"I guess I cannot have steak and eggs anymore."
"Instead of white bread, I should use whole wheat."
Correct Answer
"I should use almond milk instead of whole milk and need to avoid aged cheeses."
Whole milk and aged cheeses are high in tyramine and therefore should be avoided.
Question 7
A hospitalized client was discharged on clozapine. The client is concerned about the potential significant adverse effects. Instructions on the REMS program were explained. To avoid difficulty with obtaining access immediately after discharge, what would the nurse expect from the inpatient pharmacy to ensure consistency?
A 3-day supply will be provided to the client to allow time for them to fill their prescription from their pharmacy.
A maximum of a 7-day supply of this medication will be provided upon client discharge.
The inpatient pharmacist will call the client's outside pharmacy to ensure they fill the prescription immediately.
Inpatient pharmacies will dispense a day's supply of clozapine that aligns with the client's monitoring frequency.
✓
Correct Answer
Inpatient pharmacies will dispense a day's supply of clozapine that aligns with the client's monitoring frequency.
Clozapine can cause a significant decrease in the neutrophil count, increasing the risk of infection. Also, abrupt discontinuation of clozapine can result in significant complications for client treatment. To ensure the client does not have a gap in the treatment, this is a modification to the REMS program.
Question 8
Which antidepressant would be the best choice for a client experiencing sexual dysfunction from a selective serotonin reuptake inhibitor (SSRI)?
Fluoxetine
Phenelzine
Venlafaxine
Bupropion
✓
Correct Answer
Bupropion
This is a norepinephrine dopamine reuptake inhibitor. SSRIs, SNRIs, and MAOIs all cause some degree of sexual dysfunction.
Question 9
Zolpidem is the most appropriate choice for clients with which condition?
Obstructive sleep apnea (OSA) and respiratory problems
Increased sleep latency and maintaining sleep
✓
Difficulty initiating sleep and early morning awakenings
Maintaining sleep during the night due to anxiety and depression
Correct Answer
Increased sleep latency and maintaining sleep
Zolpidem is useful for initiating sleep (sleep latency) and ensuring the client stays asleep during the night.
Question 10
A 10-year-old child is receiving methylphenidate. The parent tells the nurse the child will not sleep while on the medication. What is the best response?
"This is a serious adverse reaction. We will need to contact the provider."
"Do not give the medication after 6 p.m."
✓
"You can give 25 mg diphenhydramine at bedtime."
"Cut the bedtime dose in half so that it will not interfere with sleep."
Correct Answer
"Do not give the medication after 6 p.m."
Because this drug is a stimulant, it should not be taken near the evening or it will interrupt sleep.