Principles And Practice of Psychiatric Nursing,10th Edition by Gail Wiscarz Stuart
Principles And Practice of Psychiatric Nursing,10th Edition by Gail Wiscarz Stuart
$2.99
Chapter 26: Psychopharmacology
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
| a. | “Make sure that you take your pulse before getting out of bed in the morning.” |
| b. | “Try taking your medication with breakfast if you begin experiencing nausea.” |
| c. | “You may need to reduce your fluids at night because of nocturnal urination.” |
| d. | “Remember to avoid red wine, nuts, and any cheese except cottage and cream.” |
ANS: B
This question requires the application of knowledge about selective serotonin reuptake inhibitors (SSRIs) to a specific plan for medication education. To reduce nausea, the patient should be advised to take the medicine with meals. When teaching patients who are taking tricyclic antidepressants (TCAs), one must emphasize that patients should dangle their legs over the bed and change positions slowly to prevent postural hypotension. It is also advisable for patients to increase fluids, exercise, and roughage intake to prevent the anticholinergic effects of antidepressants. Foods that contain tyramine (e.g., Chianti, nuts, cheese) are prohibited when patients are taking monoamine oxidase inhibitors (MAOIs). The primary synaptic activity for SSRIs is to inhibit the reuptake of 5-HT. The possible clinical effects of 5-HT include the following: gastrointestinal (GI) disturbances and sexual dysfunction. Fluoxetine hydrochloride (Prozac), an SSRI that is usually administered in the morning to reduce the potential of a side-effect profile that is 2+ for insomnia/agitation, also demonstrates a 3+ for GI disturbances.
DIF: Cognitive Level: Application REF: Text Page: 539
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
| a. | “When did you last take your phenelzine (Nardil)?” |
| b. | “Did you take your amitriptyline (Elavil) on schedule?” |
| c. | “What natural foods have you had in the last 24 hours?” |
| d. | “Have you had any alcohol to drink within the last 24 hours?” |
ANS: A
This question requires analytical decision making to identify hypertensive crises and data for the evaluation process. Knowing when the last dose of the monoamine oxidase inhibitor (MAOI) was taken helps determine immediate treatment. Although the ingestion of alcohol is pertinent to determining what tyramine-containing foods the patient may have had, it is not as crucial as knowing when the last dose of MAOI was consumed. Although natural foods may produce similar bioactivity and other antidepressants should not be taken along with an MAOI, these answers do not reflect medication assessment and evaluation. The patient is experiencing the clinical manifestation of hypertensive crisis. The classic symptoms of this condition are severe occipital headache, dilated pupils, hypertension, and palpitations or arrhythmias. This syndrome can be caused when the patient who is taking an MAOI ingests food containing tyramine, an amino acid released from foods that undergo hydrolysis (e.g., fermentation, aging, pickling, smoking, spoilage). This inhibits the monoamine oxidase and allows tyramine to reach the adrenergic nerve endings and cause the release of excess norepinephrine, which causes hypertensive crisis. To confirm the physical syndrome, first determine whether the patient is taking an MAOI. Knowing when the last dose was ingested provides a window for the duration of hypertension and therapeutic nursing interventions.
DIF: Cognitive Level: Analysis REF: Text Page: 545
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
| a. | “If you cannot take medication, would you consider a course of 6 to 10 electroconvulsive therapy (ECT) treatments offered on an outpatient basis? ECT treatments usually work immediately.” |
| b. | “Do you recall the two of us discussing that blurred vision may occur but that it will resolve shortly? In the meantime, let’s discuss how to best avoid getting injured until your vision clears up.” |
| c. | “I understand your concern considering that you need to work to receive health insurance. Would you like me to ask the psychiatrist to change your medication?” |
| d. | “You may need to apply for a sick leave for 6 months until your depression improves enough to lessen the medication dosage.” |
ANS: B
Blurred vision, an anticholinergic side effect of antidepressant and antipsychotic medications, will usually resolve within 1 to 2 weeks. The most therapeutic intervention is the one that assesses the patient’s recall of medication teaching. Moreover, it offers a strategy to assist the patient to cope during work time. The nurse must apply knowledge of the anticholinergic side effects of antidepressants and antipsychotics to select the appropriate nursing intervention for the patient’s problem. Although ECT may be offered when patients are unable to take medication, it is premature to suggest ECT or other medications, and these suggestions reflect a knowledge deficit. It is considered best to encourage patients to maintain activities of daily living and work, if possible.
DIF: Cognitive Level: Application REF: Text Page: 542
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
| a. | “Do you recall that we discussed the need for you to take the medication for up to 1 year before trying to taper off the drug? Let’s discuss why it’s not advisable to stop your medication abruptly.” |
| b. | “It is not recommended that you stop the antidepressants abruptly. I strongly suggest that you continue seeing me regularly to ensure that any change in your condition will be treated immediately.” |
| c. | “You should not discontinue your medication without consulting your psychiatrist. You will very likely experience withdrawal symptoms and become more depressed than you were before.” |
| d. | “Although it isn’t wise to stop the medication as you have, you seem to be handling things very well. Call me if you have any questions and follow-up with your psychiatrist in a year.” |
ANS: A
Most patients who respond initially to antidepressant therapy require at least 1 year of therapy and may take medication on a lifetime basis. This is similar to patients who take antihypertensives or insulin. The patient’s statement alerts the nurse to set clear therapy goals that extend beyond medication assessment. Prozac takes 2 to 4 weeks to reach a steady state and is maintained in the body for several weeks after it is discontinued, but the nurse’s suggestion of tapering off the medication is a wise intervention for this patient, who seems impulsive about medication adherence. A patient with a knowledge deficit and nonadherence potential requires communication that recalls prior teaching and that builds on the knowledge he or she already has. Reminding the patient of the time it takes to become depressed provides anticipatory guidance about the possibility of needing medication on a lifetime basis. Sarcastic humor is usually a poor response that demeans the patient and may reflect the nurse’s impatience and a judgmental attitude toward the patient, and a laissez-faire response does not reflect a caring attitude. Withdrawal usually is not a problem for medications with a long half-life.
DIF: Cognitive Level: Analysis REF: Text Pages: 536-537
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Original price was: $100.00.$75.00Current price is: $75.00.
Original price was: $40.00.$30.00Current price is: $30.00.
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
Original price was: $30.00.$20.00Current price is: $20.00.
