Drugs for Depression, Anxiety, and Psychosis

Understanding Pharmacology Essentials for Medication Safety

Nursing
34
Questions
0
True/False
28
Choices
6
Essay
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Questions

Q1
Free

Which statement about depression is true?

Multiple Choice
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A) Depression does not affect the way a person interacts with others.
B) Men are twice as likely to experience depression as women.
C) Many older adults with depression are undiagnosed and untreated.
D) Women are less likely than men to seek treatment for depression.
Answer:
C) Many older adults with depression are undiagnosed and untreated.

Explanation:
Because depression is often mistaken for a normal part of aging, many older adults with depression may be undiagnosed and untreated. Depression affects the way people feel about themselves and how they interact with others. Women are twice as likely as men to experience depression and women are also more likely than men to seek treatment.
Q2
Free

Which statement about psychiatric disorders is true?

Multiple Choice
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A) The underlying cause of most mental illness is genetic.
B) The incidence of anxiety and depression decreases with age.
C) Childrens psychiatric issues are usually short term and mild.
D) Mental illnesses are a common reason for seeking health care.
Answer:
D) Mental illnesses are a common reason for seeking health care.

Explanation:
Major mental illnesses are the most common cause of disability in the United States. About 23% of North American adults experience a clinically diagnosable mental illness each year. Between 9% and 13% of children younger than age 18 experience serious emotional disturbance with functional impairment, whereas 5% to 9% have serious emotional disturbance with extreme functional impairment caused by a mental illness. Only a small percentage of mental illnesses have a genetic origin. Anxiety and depressive disorders tend to increase with age.
Q3
Free

Which characteristic is typical of bipolar disorder?

Multiple Choice
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A) Severe highs and severe lows
B) Increased risk for suicide
C) Persistently low moods
D) Lack of pleasure in life
Answer:
A) Severe highs and severe lows

Explanation:
Bipolar disorder, also called manic-depression, is characterized by cycling moods from severe highs (mania) and severe lows (depression). Increased risk for suicide and lack of pleasure in life are characteristics of major depression. Persistently low moods are characteristic of both major depression and dysthymia.
Q4

A patient with depression has all of the following symptoms. For which symptom is he or she likely to receive treatment at an inpatient facility rather than as an outpatient?

Multiple Choice
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A) Expressing anger at a situation or person
B) Suggesting a plan to hurt oneself
C) Crying off and on for several hours or days
D) Sleeping for 12 hours or longer daily
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Q5

Which theory about the cause of depression is supported by research?

Multiple Choice
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A) Heredity or genetics
B) Altered neuroendocrine function
C) Psychosocial factors
D) Neurotransmitter level imbalance
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Q6

A patient who was prescribed citalopram (Celexa) 1 week ago for depression reports feeling no different now from 1 week ago and wants to stop taking the drug. What is the nurses best response?

Multiple Choice
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A) Treatment for depression is highly individual and this may not be the right drug for you.
B) Most drugs for depression take at least 2 weeks to start making you feel better.
C) Are you certain that you are taking the drug exactly the way it was prescribed?
D) Be sure to stop smoking because cigarette smoking inactivates this drug.
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Q7

A patient is prescribed bupropion (Wellbutrin SR) 100 mg twice daily. It is time for the second dose today and the drug sent up from the pharmacy is Wellbutrin 100 XL. What is the nurses best action?

Multiple Choice
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A) Administer the Wellbutrin XL tablet in place of the Wellbutrin SR tablet.
B) Cut the Wellbutrin XL tablet in half and then administer it.
C) Call the pharmacy and obtain a Wellbutrin SR 100 mg tablet.
D) Hold the dose and notify the prescriber.
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Q8

Which statement by a patient with chronic depression who is prescribed fluoxetine (Prozac) indicates to the nurse the need for additional teaching?

Multiple Choice
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A) It may take from 2 to 8 weeks for my depression to improve.
B) If I have suicidal thoughts, I will contact my prescriber immediately.
C) I will check my pulse every day and report irregular rhythms to my prescriber.
D) When I am feeling better and no longer depressed, I will stop taking the Prozac.
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Q9

Which assessment is most important for the nurse to measure or perform before administering the first dose of amitriptyline (Elavil) to a patient?

Multiple Choice
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A) Heart rate and rhythm
B) Core body temperature
C) Level of consciousness
D) Blood pressure in the sitting position
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Q10

The parents of a 12-year-old who was prescribed fluoxetine (Prozac) inform the nurse that their child is having trouble sleeping. What is the nurses best response?

Multiple Choice
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A) This is a normal expected side effect of fluoxetine.
B) We may need to ask the prescriber to order something to help your child sleep.
C) Children are more sensitive to the effects of this drug and may need a lower dose.
D) Before bedtime be sure that your child does not eat or drink anything with caffeine.
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Q11

A patient has been taking mirtazapine (Remeron) for the last 3 months. Which blood laboratory result from the patient does the nurse report to the prescriber?

Multiple Choice
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A) Lactate dehydrogenase 122 mg/dL
B) International normalized ratio (INR) 1.3
C) White blood cell count (WBC) 2100/mm3
D) Platelet count 356,000/mm3
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Q12

Which precaution is most important for the nurse to teach a patient who is prescribed any antidepressant drug?

Multiple Choice
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A) Avoid drinking grapefruit juice while taking this drug.
B) Avoid drinking alcoholic beverages while taking this drug.
C) Be sure to wear sunscreen and a hat when going outdoors.
D) Drink at least 3 liters of fluid every day while taking this drug.
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Q13

Although serotonin reuptake inhibitors (SSRIs) are used more commonly now to treat anxiety disorders than are benzodiazepines, for which patient situation does the nurse expect a benzodiazepine to be prescribed instead of an SSRI?

Multiple Choice
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A) The patient is 18 years old.
B) Anxiety has been present daily for 6 months.
C) The patient has compulsive repetitive actions.
D) The anxiety attack is severe with hallucinations.
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Q14

A patient who has been prescribed clonazepam (Klonopin) for the last 3 months tells the nurse that he wants to stop this drug because he constantly feels like he is in a fog. What is the nurses best response?

Multiple Choice
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A) Quit taking the drug today and I will have the prescriber change your medication to another drug category.
B) Continue to take this drug as prescribed because most patients eventually get used to the foggy sensation.
C) We will give you a final dose of this drug today intravenously and then start you on a different drug.
D) I will contact the prescriber but it will still be necessary to take this drug at a lower dosage for awhile.
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Q15

Which statement about a common anxiety disorder is accurate?

Multiple Choice
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A) Panic disorders develop over a period of hours to days.
B) Generalized anxiety disorder occurs when a person experiences excessive anxiety daily for 2 months.
C) Phobic disorders are recurrent persistent fears of certain objects or situations that can cause panic attacks.
D) Posttraumatic stress disorder is the result of frightening thoughts and dreams.
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Q16

What is the advantage of treating a patient with anxiety with a benzodiazepine drug rather than a selective serotonin reuptake inhibitor (SSRI)?

Multiple Choice
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A) Benzodiazepines are not likely to cause patient dependence when used for an extended period of time.
B) Benzodiazepines have milder side effects and almost no adverse effect when compared with SSRIs.
C) Benzodiazepines control anxiety and allow patients to live a relatively normal lifestyle.
D) Benzodiazepines act to treat anxiety within 20 minutes and can be given on an as-needed basis.
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Q17

What type of medication could be prescribed for a patient who experiences anxiety when speaking before a group?

Multiple Choice
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A) A benzodiazepine drug
B) An SSRI drug
C) A beta blocker
D) A TCA drug
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Q18

A patient asks the nurse why the prescriber is changing his anxiety medication from lorazepam (Ativan) to sertaline (Zoloft). What is the nurses best response?

Multiple Choice
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A) Sertraline is a stronger drug and will do a better job of controlling your anxiety.
B) Sertraline has milder side effects and a decreased risk for drug dependence.
C) Sertraline acts much faster to get the symptoms of your anxiety under control.
D) Sertraline can be taken only when needed to control symptoms of anxiety.
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Q19

On admission to the acute care unit a patient tells the nurse that she stopped taking her prescribed clonazepam (Klonopin) 2 days ago. What is the nurses best first action?

Multiple Choice
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A) Ask the patient why she stopped taking the clonazepam.
B) Administer a dose of clonazepam immediately.
C) Document this information as the only action.
D) Notify the prescriber and watch for seizures.
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Q20

A patient who has been prescribed diazepam (Valium) reports taking the as-needed (PRN) drug more often to keep anxiety symptoms under control and does not want the prescriber to stop prescribing it. What is the nurses best interpretation of this information?

Multiple Choice
expand_more
A) The patient may be developing signs of drug dependence.
B) The patient may be developing signs of drug tolerance.
C) The patients anxiety is becoming more severe.
D) The patient should stop taking the drug immediately.
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Q21

A female patient who has been prescribed diazepam (Valium) for anxiety tells the nurse that she and her husband are planning to have a child. What is the nurses best response?

Multiple Choice
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A) Before becoming pregnant your dosage of diazepam will need to be decreased.
B) You should always discuss any changes in your medications and lifestyle with your prescriber.
C) Consult with your prescriber because taking diazepam while pregnant has been associated with birth defects.
D) Diazepam may cause withdrawal effects when taken during pregnancy.
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Q22

How do the major antipsychotic drugs exert their effects to reduce psychotic episodes?

Multiple Choice
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A) They block dopamine receptors and reduce neuronal impulse transmission.
B) They redirect nerve impulses away from excitatory areas of the brain and into brain inhibitory areas.
C) They enhance the breakdown of excitatory neurotransmitter chemicals so that impulse transmission is slower.
D) They block the reuptake of neurotransmitters so that the concentration of these chemicals is increased in the brain.
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Q23

The family of a patient who was prescribed chlorpromazine (Thorazine) report that the patient continually rolls his tongue and smacks his lips. What is the nurses best action?

Multiple Choice
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A) Reassure the patient and family that this response is an expected side effect of the drug.
B) Instruct the family to ensure that the patient drinks plenty of fluids and performs oral hygiene at least three times daily.
C) Instruct the family to hold the next dose of the drug and have the patient seen by the prescriber as soon as possible.
D) Emphasize to the family that this drug cannot be stopped quickly and to gradually reduce the dose over a 2- to 3-week period.
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Q24

An older patient taking lithium carbonate (Eskalith) for 2 months has all of the following conditions. Which symptom does the nurse report to the prescriber as a possible side effect that may require a change of drug or drug dosage?

Multiple Choice
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A) Dry mouth
B) Increased belching after meals
C) Weight loss of 6 lb in 1 week
D) International normalized ratio (INR) of 1.1
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Q25

Four hours after receiving risperidone (Risperdal), the patient on the psychiatric unit has a temperature elevation of 2 F. What is the nurses best action?

Multiple Choice
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A) Administer the next dose of the drug as prescribed.
B) Assess the patient for other signs and symptoms of infection.
C) Hold the next drug dose and notify the prescriber immediately.
D) Attempt to arouse the patient from sleep by gently shaking his or her arm.
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Q26

Which food or beverage does the nurse teach a patient who is prescribed quietiapine (Seroquel) to avoid?

Multiple Choice
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A) Coffee and caffeine
B) Fresh berries and vegetables
C) Aged cheese and smoked meat
D) Grapefruit and grapefruit juice
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Q27

Which safety precaution is most important for the nurse to teach an older adult who is prescribed chlorpromazine (Thorazine)?

Multiple Choice
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A) Avoid going barefoot, even in the house.
B) Change positions slowly when rising to stand.
C) Drink plenty of water to avoid having to strain during a bowel movement.
D) Use a thermometer to check the temperature of your bath or shower water to avoid a scald injury.
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Q28

A patient who has been prescribed prochlorperazine (Compazine) calls the clinic and reports pink-tinged urine. What is the nurses best action?

Multiple Choice
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A) Ask the patient whether grapefruit or grapefruit juice has been ingested within the last 24 hours.
B) Remind the patient to drink more water to prevent this drug from damaging the kidneys.
C) Reassure the patient that this is an expected side effect of the drug and needs no action.
D) Instruct the patient to hold the next drug dose and notify the prescriber immediately.
Answer:

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Q29

[Multiple Response] Which are common treatment methods for depression? (Select all that apply.)
a. Counseling
b. Surgery
c. Group meetings
d. Psychotherapy
e. Shock therapy

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Q30

[Multiple Response] A patient has been prescribed amitriptyline (Elavil). What does the nurse plan to include in the teaching plan for this patient? (Select all that apply.)
a. Smoking cigarettes can decrease the effectiveness of amitriptyline in treating your depression.
b. Check your pulse every day and report any irregular rhythms to your prescriber right away.
c. Amitriptyline should help to improve your depression symptoms within 7 to 14 days.
d. Avoid driving or operating dangerous equipment until you know how the drug will affect you.
e. Be sure to include foods with lots of fiber in your diet to prevent the side effect of constipation.

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Q31

[Multiple Response] Which are common anxiety disorders? (Select all that apply.)
a. Dysthymia
b. Panic disorder
c. Bipolar disorder
d. Phobic disorder
e. Obsessive-compulsive disorder

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Q32

[Multiple Response] A patient with anxiety is prescribed oxazepam (Serax). What safety measures must the nurse be sure to include in this patients plan of care? (Select all that apply.)
a. Call for help when getting out of bed.
b. Use a walker for ambulation.
c. Assess gait for steadiness.
d. Change positions slowly.
e. Take two tablets whenever a dose is missed.

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Q33

[Multiple Response] A patient with anxiety is prescribed oxazepam (Serax). What safety measures must the nurse be sure to include in this patients plan of care? (Select all that apply.)
a. Call for help when getting out of bed.
b. Use a walker for ambulation.
c. Assess gait for steadiness.
d. Change positions slowly.
e. Take two tablets whenever a dose is missed.

Essay
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Q34

A patient is prescribed 30 mg of chlorpromazine (Thorazine) intramuscularly. The drug available is 25 mg per 1 mL. How many milliliters does the nurse draw into the syringe? _____ mL

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