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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.
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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.
A nurse is preparing a patient for electroconvulsive therapy. Which of the following would the nurse include in the patient?s plan of care? Select all that apply.
- A. Ensuring that there is a signed informed consent on the patient?s chart
- B. Telling the patient he can have fluids but no food before the procedure
- C. Alerting the patient to the possibility of confusion after the treatment
- D. Informing the patient that he can leave his dentures in place for the treatment
- E. Ensuring that the patient is closely supervised for at least the first 12 hours afterward
Correct Answer: A,C,E
Rationale: ECT requires informed consent (A), warning about post-procedure confusion (C), and close supervision afterward (E) due to risks like disorientation. Patients must be NPO (no food or fluids) before ECT, and dentures must be removed to prevent airway obstruction, making B and D incorrect.
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.
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.
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.