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A patient is brought to the emergency department by her brother, who reports that the patient became very agitated and started hallucinating. Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The brother states that the patient is taking paroxetine for depression. Which of the following would the nurse most likely suspect?
- A. Neuroleptic malignant syndrome
- B. Acute dystonic reaction
- C. Serotonin syndrome
- D. Hypothyroidism
Correct Answer: C
Rationale: Paroxetine, an SSRI, can cause serotonin syndrome, characterized by agitation, hallucinations, tachycardia, incoordination, vomiting, and diarrhea, especially if combined with other serotonergic agents. Neuroleptic malignant syndrome and dystonic reactions are linked to antipsychotics, and hypothyroidism presents differently.
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A nurse is reviewing information about a psychiatric medication that describes the amount of the drug that actually reaches systemic circulation unchanged. The nurse identifies this as which of the following?
- A. First-pass effect
- B. Bioavailability
- C. Solubility
- D. Biotransformation
Correct Answer: B
Rationale: Bioavailability is the proportion of a drug that reaches systemic circulation unchanged. The first-pass effect reduces bioavailability, solubility affects dissolution, and biotransformation is metabolism, not systemic delivery.
The nurse observes an older adult patient who has been taking antipsychotic medications for 8 months. The patient is smacking her lips and blinking her eyes rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?
- A. Ask if the patient has been experiencing side effects.
- B. Contact the patient?s physician for a different medication order.
- C. Document the patient?s symptoms of tardive dyskinesia.
- D. Instruct the patient to begin tapering off the medication.
Correct Answer: C
Rationale: Lip smacking, rapid blinking, and tongue protrusion indicate tardive dyskinesia, a serious side effect of long-term antipsychotic use. Documenting these symptoms is the most appropriate initial action to ensure accurate reporting and prompt physician review. Asking about side effects is vague, contacting the physician follows documentation, and tapering is premature without medical orders.
A nursing instructor is teaching a class on the pharmacodynamics of psychiatric medications. The instructor determines that additional teaching is needed when the students identify which of the following as a site of action?
- A. Receptor
- B. Ion channels
- C. Neurotransmitters
- D. Enzymes
Correct Answer: C
Rationale: Pharmacodynamics involves how drugs act on the body, typically at receptors, ion channels, or enzymes. Neurotransmitters are chemicals that transmit signals, not sites of drug action, indicating a need for further teaching.
A nurse is caring for a psychiatric patient who is receiving an antacid that contains aluminum salts. Which action by the nurse would be most appropriate?
- A. Give the antacid 1 hour before the antipsychotic medication.
- B. Give the antacid at the same time as the antipsychotic medication.
- C. Administer the antacid 1 hour after the antipsychotic medication.
- D. Administer the antacid just before the patient goes to sleep.
Correct Answer: A
Rationale: Aluminum-containing antacids can bind with antipsychotics in the gut, reducing absorption. Administering the antacid 1 hour before the antipsychotic ensures proper absorption of the medication. Giving them together or after may interfere, and bedtime administration is irrelevant to absorption timing.
A patient is prescribed medication for a psychiatric disorder. After 3 days, the patient tells the nurse that he or she has been constipated. Which instruction would the nurse give the patient?
- A. You need to eat more high-protein foods such as meat and peanut butter.
- B. You need to eat more fruits and vegetables and drink more water.
- C. Ask your psychiatrist to prescribe a stool softener for you.
- D. This side effect should disappear within a week or so.
Correct Answer: B
Rationale: Constipation, a common side effect of psychiatric medications, can be managed by increasing dietary fiber (fruits and vegetables) and hydration (water). High-protein foods may worsen constipation, a stool softener may be premature without dietary changes, and waiting for resolution dismisses the patient?s discomfort.