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A patient with the diagnosis of schizophrenia is hospitalized and is taking a phenothiazine drug. Which statement by this patient indicates that he is experiencing a common adverse effect of phenothiazines?
- A. I can't sleep at night
- B. I feel hungry all the time.
- C. Look at how red my hands are.
- D. My mouth has been so dry lately.
Correct Answer: D
Rationale: Phenothiazines produce anticholinergic-like adverse effects of dry mouth, urinary hesitancy, and constipation.
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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 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.
When a patient is receiving a second-generation antipsychotic drug, such as risperidone, the nurse will monitor for which therapeutic effect?
- A. Fewer panic attacks
- B. Decreased paranoia and delusions
- C. Decreased feeling of hopelessness
- D. Improved tardive dyskinesia
Correct Answer: B
Rationale: The therapeutic effects of the antipsychotic drugs include improvement in mood and affect, and alleviation or decrease in psychotic symptoms (decrease in hallucinations, paranoia, delusions, garbled speech). Tardive dyskinesia is a potential adverse effect of these drugs. The other options are incorrect.
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.
The nurse reads in the patient's medication history that the patient is taking buspirone. The nurse interprets that the patient may have which disorder?
- A. Anxiety disorder
- B. Depression
- C. Schizophrenia
- D. Bipolar disorder
Correct Answer: A
Rationale: Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.