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A patient who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the patient?s physician because the nurse suspects which of the following?
- A. Severe anemia
- B. Neuroleptic malignant syndrome
- C. Encephalitis
- D. Agranulocytosis
Correct Answer: D
Rationale: Fever, sore throat, and mouth sores in a patient taking clozapine suggest agranulocytosis, a serious side effect involving a dangerous drop in white blood cells, requiring immediate medical attention. Anemia, neuroleptic malignant syndrome, and encephalitis have different symptom profiles.
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After teaching a patient who is prescribed imipramine about the drug, the nurse determines that the teaching was effective when the patient states which of the following?
- A. I need to be careful because the drug can make me sleepy.
- B. I don?t have to worry about getting dizzy when I get up from lying down.
- C. I might notice some excess saliva in my mouth at different times.
- D. I need to avoid foods with fiber because diarrhea can occur.
Correct Answer: A
Rationale: Imipramine, a tricyclic antidepressant, commonly causes sedation, so the patient?s statement about sleepiness indicates effective teaching. Dizziness (orthostatic hypotension) is a concern, dry mouth (not excess saliva) is typical, and constipation (not diarrhea) is a side effect, making other options incorrect.
The nurse is reviewing the medical records of several patients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a patient at greater risk for tardive dyskinesia?
- A. Male gender
- B. Age 30 to 45 years
- C. History of depression
- D. Short duration of treatment
Correct Answer: None
Rationale: Tardive dyskinesia risk factors include older age, female gender, longer treatment duration, and certain conditions, not depression. None of the options (male gender, age 30?45, depression, short duration) are primary risk factors, suggesting a possible test error, but none apply.
The nurse is caring for a 70-year-old psychiatric patient who has been prescribed a number of medications. When teaching the patient about the medications, which explanation would be most appropriate?
- A. Your stomach empties more quickly as you age; therefore, you may feel the effect of your medications almost immediately.
- B. Your entire GI system speeds up, so your medications are digested much more quickly. Therefore, it is important that you not drive after you take your medications.
- C. Because of your age and related changes in liver functioning, you may have medication levels in your system with the potential to be toxic.
- D. Because of age-related circulation changes, your body will be able to deliver therapeutic doses of your medication to select body sites more quickly.
Correct Answer: C
Rationale: Aging reduces liver function, decreasing metabolism of medications, which can lead to higher drug levels and potential toxicity in older adults. Stomach emptying slows with age, the GI system does not speed up, and circulation changes do not enhance drug delivery as described.
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.
After teaching a patient who is receiving phenelzine, the nurse determines that the teaching was successful when the patient states the need to avoid which of the following?
- A. Fresh cottage cheese
- B. Cooked sliced ham
- C. Tap beers
- D. Soy milk
Correct Answer: C
Rationale: Phenelzine, an MAOI, requires avoiding tyramine-rich foods and drinks like tap beers, which can cause a hypertensive crisis. Fresh cottage cheese, cooked ham, and soy milk are generally safe, as they have low tyramine content.