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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.
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The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching?
- A. Grapefruit juice
- B. Salami sandwich
- C. Scrambled eggs
- D. Pancakes and maple syrup
Correct Answer: B
Rationale: Cured meats such as salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. The other foods listed do not contain tyramine.
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.
Which statements are true regarding the selective serotonin reuptake inhibitors (SSRIs)?
- A. Avoid foods and beverages that contain tyramine.
- B. Monitor the patient for extrapyramidal symptoms.
- C. Therapeutic effects may not be seen for about 4 to 6 weeks after the medication is started.
- D. If the patient has been on an MAOI, a 2- to 5-week or longer time span is required before beginning an SSRI medication.
- E. These drugs have anticholinergic effects, including constipation, urinary retention, dry mouth, and blurred vision.
- F. Cogentin is often also prescribed to reduce the adverse effects that may occur.
Correct Answer: C,D
Rationale: During SSRI therapy, therapeutic effects may not be seen for 4 to 6 weeks. To prevent the potentially fatal pharmacodynamic interactions that can occur between the SSRIs and the MAOIs, a 2- to 5-week washout period is recommended between uses of these two classes of medications. The other options apply to other classes of psychotherapeutic drugs, not SSRIs.
The wife of a patient who has been diagnosed with depression calls the office and says, -It's been an entire week since he started that new medicine for his depression, and there's no change! The medicine is not working! What is the nurse's best response?
- A. The medication may not be effective for him. He may need to try another type.
- B. It may take 4 to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does.
- C. It sounds like the dose is not high enough. I'll check about increasing the dosage.
- D. Some patients never recover from depression. He may not respond to this therapy.
Correct Answer: B
Rationale: Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect.
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.