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A patient has been taking haloperidol for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects?
- A. Increased paranoia
- B. Drowsiness and dizziness
- C. Involuntary motor symptoms
- D. Dry mouth and constipation
Correct Answer: C
Rationale: Extrapyramidal symptoms are manifested by involuntary motor symptoms, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.
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A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) states that he -felt awful when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome?
- A. Agitation
- B. Drowsiness
- C. Tremors
- D. Bradycardia
- E. Sweating
Correct Answer: A,C,E
Rationale: Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others.
A patient has been taking lithium for 1 year, and the most recent lithium level is 0.5 mEq/L. What concern will the nurse have, if any?
- A. The level is too low, indicating a subtherapeutic dose.
- B. The level is within the therapeutic range.
- C. The level is too high, indicating a toxic dose.
- D. No concerns, as lithium levels do not need monitoring.
Correct Answer: A
Rationale: Therapeutic lithium levels are typically between 0.6 and 1.2 mEq/L for maintenance therapy. A level of 0.5 mEq/L is subtherapeutic, which may reduce the effectiveness of the treatment. Monitoring lithium levels is critical due to its narrow therapeutic index.
A patient has been taking the selective serotonin reuptake inhibitor (SSRI) sertraline for about 6 months. At a recent visit, she tells the nurse that she has been interested in herbal therapies and wants to start taking St. John's wort. Which response by the nurse is appropriate?
- A. That should be no problem.
- B. Good idea! Hopefully you'll be able to stop taking the Zoloft.
- C. Be sure to stop taking the herb if you notice a change in side effects.
- D. Taking St. John's wort with this medication may cause severe interactions and is not recommended.
Correct Answer: D
Rationale: The herbal product St. John's wort must not be used with SSRIs because of the potential for serotonin syndrome. The other responses by the nurse are inappropriate.
A patient wants to take a ginseng dietary supplement. The nurse instructs the patient to look for which potential adverse effect?
- A. Drowsiness
- B. Palpitations and anxiety
- C. Dry mouth
- D. Constipation
Correct Answer: B
Rationale: Elevated blood pressure, chest pain or palpitations, anxiety, insomnia, headache, nausea, vomiting, and diarrhea are potential adverse effects of ginseng. Drowsiness, difficulty with urination, and constipation are not potential adverse effects of ginseng.
A patient has been taking the monoamine oxidase inhibitor (MAOI) phenelzine for 6 months. The patient wants to go to a party and asks the nurse, -Will just one beer be a problem? I Which advice from the nurse is correct?
- A. You can drink beer as long as you have a designated driver.
- B. Now that you've been on the drug for 6 months, there will be no further dietary restrictions.
- C. If you begin to experience a throbbing headache, rapid pulse, or nausea, you'll need to stop drinking.
- D. You need to avoid all foods that contain tyramine, including beer, while taking this medication.
Correct Answer: D
Rationale: Foods containing tyramine, such as beer and aged cheeses, should be avoided while a patient is taking an MAOI. Drinking beer while taking an MAOI may precipitate a dangerous hypertensive crisis. The other options are incorrect.