Download Nur409 Exam 4 2025 Questions With Answers(Simplified And Verified) and more Exams Nursing in PDF only on Docsity!
Nur409 Exam 4 2025 Questions With
Answers(Simplified And Verified)
A nurse assesses a patient receiving haloperidol [Haldol]. The nurse notices that the patient is shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? Dystonia Tardive dyskinesia Parkinsonism Akathisia Accurate Answer - Akathisia Haloperidol is a traditional antipsychotic medication with the adverse effects of extrapyramidal symptoms. Akathisia, or motor restlessness, is an extrapyramidal symptom. Dystonia manifests as severe spasm of the muscles of the tongue, face, neck, or back and may include upward deviation of the eyes, severe cramping, and impaired respiration. Tardive dyskinesia presents with involuntary twisting, writhing, wormlike movements of the tongue and face, lip smacking, and tongue flicking. Parkinsonism appears with bradykinesia, masklike facies, drooling, tremor, rigidity, shuffling gait, and stooped posture. The nurse has just administered the first dose of haloperidol [Haldol] to a patient with schizophrenia. Which finding, if present, is the most important for the nurse to report to the healthcare provider before administering the next dose of medication? Dry mouth Temperature of 101° F BP of 104/72 mm Hg Drowsiness Accurate Answer - Temperature of 101° F
Sudden high fever is a symptom of neuroleptic malignant syndrome, a rare but serious complication of high-potency, first-generation antipsychotics, such as haloperidol. The other findings are potential side effects of the drug but would not necessarily need to be reported to the healthcare provider. The nurse is caring for a patient receiving clozapine [Clozaril]. Which assessment finding is most indicative of an adverse effect of this drug? Blood urea nitrogen level of 25 mg/dL Blood glucose level of 60 mg/dL Bilirubin level of 2.5 mg/dL White blood cell (WBC) count of 2000/mm3 Accurate Answer - White blood cell (WBC) count of 2000/mm Clozapine, an atypical antipsychotic, carries a risk of fatal agranulocytosis. For this reason, the WBC count should be monitored and should be greater than 3500/mm3. Renal function (blood urea nitrogen) should not be affected by clozapine. Clozapine may cause metabolic effects, including diabetes, that would result in an increased blood glucose level (greater than 110 mg/dL). Elevated bilirubin indicates liver disease and is not commonly an adverse effect of clozapine. Which statement about aripiprazole would the nurse identify as true? It is the first representative of a unique class of antipsychotic drugs called dopamine system stabilizers. It must be administered on an empty stomach. Gynecomastia is a common adverse effect. It is safe to use in older adult patients with dementia-related psychosis. Accurate Answer - It is the first representative of a unique class of antipsychotic drugs called dopamine system stabilizers.
A 30-year-old man with anxiety and depression Accurate Answer
- A 78-year-old man with intractable hiccups A 48-year-old woman with schizoaffective disorder The primary indications for chlorpromazine, a first-generation antipsychotic agent, are schizophrenia and other psychotic disorders. It may also be used for schizoaffective disorder, bipolar disorder, suppression of emesis, and relief of intractable hiccups. Antipsychotics are not used for dementia because of increased mortality. Chlorpromazine is not a primary treatment for Alzheimer's disease or depression. The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? (Select all that apply.) The second-generation antipsychotics generally are more effective than the first-generation agents. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome. The lipid levels of patients receiving second-generation antipsychotics should be monitored. Schizophrenia is characterized by disordered thinking and loss of touch with reality. Accurate Answer - Most antipsychotic agents increase the risk of mortality in elderly patients with dementia. The lipid levels of patients receiving second-generation antipsychotics should be monitored. Schizophrenia is characterized by disordered thinking and loss of touch with reality. The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely
used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality. Which statements does the nurse include when teaching a patient about antipsychotic drug therapy? (Select all that apply.) "Restrict the use of antipsychotic drugs to 3 months to prevent the development of addiction." "Dilute oral preparations in fruit juice to improve their palatability." "Store oral preparations in a dark area." "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." "Take an over-the-counter sleep aid if you have trouble falling asleep at night." Accurate Answer - "Dilute oral preparations in fruit juice to improve their palatability." "Store oral preparations in a dark area." "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs." Patients should be informed that antipsychotic drugs do not cause addiction and that they should be taken as prescribed. Patients should be instructed to avoid all drugs with anticholinergic properties, including antihistamines and certain over-the-counter sleep aids, to prevent drug interactions. All of the other statements are appropriate to include in teaching the patient about the use of antipsychotic medications. When teaching the patient and family about clozapine therapy, which statements should the nurse include? (Select all that apply.)
signs and symptoms (e.g., unexplained fatigue, dyspnea, tachypnea, chest pain, palpitations) and advised to seek immediate medical attention if these develop. Clozapine should be withheld until myocarditis has been ruled out. If myocarditis is diagnosed, the drug should never be used again. The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? Blood pressure of 160/90 mm Hg Insomnia and diarrhea Sedation and dry mouth Tachypnea and wheezing Accurate Answer - Sedation and dry mouth Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The most serious common adverse effect is orthostatic hypotension; therefore, a blood pressure of 160/90 mm Hg probably is not caused by this drug. Respiratory problems are not commonly associated with the TCAs. The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? "Have you noticed dry mouth or blurred vision?" "Have you had any changes in your urine function?" "When was your last bowel movement?" "Have you had any changes in your mood or anxiety level?" Accurate Answer - "Have you had any changes in your mood or anxiety level?"
In the early phase of treatment for depression, suicide risk may increase. Patients should be monitored closely for worsening mood, unusual changes in behavior, and suicide risk. The other questions would be useful in assessing the patient for adverse effects of amitriptyline [Elavil], but assessing suicide risk is the most important intervention. The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? Sexual dysfunction Dry mouth Orthostatic hypotension Bradycardia Accurate Answer - Sexual dysfunction Fluoxetine [Prozac], a selective serotonin reuptake inhibitor (SSRI), does not cause anticholinergic effects, orthostatic hypotension, or cardiotoxicity, as do the tricyclic antidepressants. The most common adverse effects are sexual dysfunction, nausea, headache, and central nervous system stimulation. The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? Depressive psychosis Serotonin syndrome Escitalopram overdose Cholinergic crisis Accurate Answer - Serotonin syndrome Serotonin syndrome can occur within 2 to 72 hours after initiation of treatment with an SSRI. The symptoms include altered mental status,
The nurse is caring for a group of patients being treated for depression. Why might an SSRI be chosen over a TCA? To reduce the risk of suicide with overdose To avoid weight gain and other gastrointestinal (GI) effects To help prevent sexual dysfunction To prevent the risk of serotonin syndrome Accurate Answer - To reduce the risk of suicide with overdose The SSRIs may be chosen because they have fewer side effects and are safer with overdose. However, the SSRIs can cause sexual dysfunction and weight gain, and they carry a risk of serotonin syndrome. The nurse identifies which most common serious adverse effect of TCA therapy? Excitation Orthostatic hypotension Skin rash Sexual dysfunction Accurate Answer - Orthostatic hypotension Orthostatic hypotension is the most common adverse effect of tricyclic antidepressant therapy. The nurse is teaching a patient who has a new prescription for citalopram [Celexa]. Which statements are appropriate to include in the teaching plan? (Select all that apply.) "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." "When you stop taking this medication, you should not withdraw it abruptly." "You will need to move slowly from a sitting to a standing position to prevent dizziness from low blood pressure." "This medication often causes drowsiness. You should take it at bedtime."
"Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety." Accurate Answer - "This medication may cause some sexual side effects. Let your healthcare provider know about this if it occurs." "When you stop taking this medication, you should not withdraw it abruptly." "Let your family or your healthcare provider know if you experience a worsening mood, agitation, or increased anxiety." Citalopram [Celexa] and other SSRIs can cause sexual side effects that patients may be hesitant to report. SSRIs should be withdrawn slowly to prevent dizziness, headache, dysphoria, and/or other symptoms of withdrawal. The SSRIs do not generally cause orthostatic hypotension or drowsiness. All antidepressants initially increase the risk of suicide, and patients should be monitored for worsening mood and other signs of suicide risk. Which instructions does the nurse include when teaching a patient about phenelzine [Nardil] therapy? (Select all that apply.) "Take the medication as needed when you are feeling depressed." "If you experience a severe headache, inform your healthcare provider." "Profuse sweating is an expected side effect of this medication and will diminish with time." "Ginseng can be used to treat headache, which patients often experience when they first take phenelzine." "Avoid eating avocados when taking this drug." Accurate Answer
- "If you experience a severe headache, inform your healthcare provider." "Avoid eating avocados when taking this drug." Patients should be instructed to take MAOIs every day as prescribed— not PRN. They should be warned not to discontinue treatment once
Once a woman has had postpartum depression, it will not recur with future deliveries. Sertraline [Zoloft] is the drug of choice for treating postpartum depression in breast-feeding mothers. Accurate Answer - About 80% of women experience depressive symptoms after giving birth. Thyroid insufficiency has been indicated as a contributing factor in postpartum depression. Sertraline [Zoloft] is the drug of choice for treating postpartum depression in breast-feeding mothers. The drug of choice for postpartum depression is an SSRI, such as sertraline [Zoloft], because these drugs are effective, well tolerated, and present little risk of toxicity if taken in overdose. If a woman has responded to another antidepressant in the past, that drug should be used first. The risk of relapse is high, as is the risk of postpartum depression with subsequent pregnancies. The statements in options C and D are false. The nurse is caring for a patient with bipolar disorder (BPD) who is taking lithium [Lithobid]. Which abnormal laboratory value is most essential for the nurse to communicate to the healthcare provider because this patient is taking lithium? Sodium level of 128 mEq/L Prothrombin time of 8 seconds Blood urea nitrogen level of 25 mg/dL Potassium level of 5.6 mEq/L Accurate Answer - Sodium level of 128 mEq/L The sodium level is well below the normal range of 135 to 145 mEq/L. When the serum sodium level is reduced, lithium excretion also is reduced, and lithium accumulates. Because lithium has a narrow therapeutic index, this is a dangerous situation, which can result in symptoms of toxicity and even death.
The nurse is seeing several patients in the outpatient clinic today. Which patient most requires the nurse's immediate attention? A female patient with BPD who takes valproic acid [Depakene] and who reports nausea and vomiting A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/L A male patient with depression who takes fluoxetine [Prozac] and who reports sexual dysfunction A female patient with schizophrenia who takes haloperidol [Haldol] and who has a blood pressure of 102/72 mm Hg Accurate Answer
- A male patient with BPD who takes lithium and who has a lithium level of 1.6 mEq/ Lithium levels above 1.5 mEq/L should be reported, because this level may indicate impending serious toxicity. The other findings may be side effects of the drugs the patients are taking, but they are not priority problems. The nurse is caring for a patient taking lithium [Lithobid]. The nurse understands that many drugs interact with lithium. Which agent is safe to administer with lithium? Ibuprofen [Motrin] for muscle pain Hydrochlorothiazide (HCTZ) for edema Aspirin (ASA) for mild headache Diphenhydramine [Benadryl] for cold symptoms Accurate Answer
- Aspirin (ASA) for mild headache Aspirin is safe to use as an analgesic with lithium. Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can increase lithium levels by as much as 60%. Diuretics increase lithium levels by reducing the serum sodium level. Diphenhydramine has
The healthcare provider ordered lamotrigine [Lamictal] for long-term maintenance therapy of BPD. The nurse anticipates which dosing schedule? Starting at a high dose to quickly control mania Starting at a low dose and titrating up Starting at a high dose and titrating down Starting with a loading dose and then a low maintenance dose Accurate Answer - Starting at a low dose and titrating up Lamotrigine [Lamictal] is indicated for long-term maintenance therapy of BPD. The goal is to prevent affective relapses into mania or depression. To minimize the risk of serious rash, dosage should be low initially (25 to 50 mg/day) and then gradually increased. The nurse identifies which drugs as the principal mood stabilizers used in the treatment of bipolar disorder? (Select all that apply.) Lithium Risperidone Divalproex sodium [Depakote] Carbamazepine Venlafaxine [Effexor] Accurate Answer - Lithium Divalproex sodium [Depakote] Carbamazepine Lithium, divalproex sodium [Valproate], and carbamazepine are the principal mood stabilizers used in the treatment of bipolar disorder. Risperidone is an antipsychotic used in the management of bipolar disorder. Venlafaxine [Effexor] is an antidepressant used in the treatment of bipolar disorder. Which statements about the treatment of bipolar disorder does the nurse identify as true? (Select all that apply.)
Mood stabilizers are used to prevent recurrent manic-depressive episodes. Antipsychotics are used to treat depressive episodes. Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. Lithium and valproate are the preferred mood stabilizers for BPD. A lithium level of 2.0 mEq/L is considered therapeutic. Accurate Answer - Mood stabilizers are used to prevent recurrent manic- depressive episodes Antidepressants should be used with mood stabilizers in the treatment of patients with bipolar depression. Lithium and valproate are the preferred mood stabilizers for BPD. The statements in options A, C, and D are true. Antipsychotics are used to treat manic episodes. A lithium level above 1.5 mEq/L is considered to be above the therapeutic index. Lithium is used in the treatment of bipolar disorder and what other psychiatric disorders? (Select all that apply.) Alcoholism Bulimia Schizophrenia Hypertension Glucocorticoid-induced psychosis Accurate Answer - Alcoholism Bulimia Schizophrenia Glucocorticoid-induced psychosis Although approved only for treatment of BPD, lithium has been used with varying degrees of success in other psychiatric disorders, including alcoholism, bulimia, schizophrenia, and glucocorticoid- induced psychosis. Nonpsychiatric uses include hyperthyroidism,
Alprazolam [Xanax] is prescribed for an adult with panic attacks. The nurse recognizes that this drug exerts its therapeutic effect by interacting with which neurotransmitter? Norepinephrine Acetylcholine Serotonin (5-HT) Gamma-aminobutyric acid (GABA) Accurate Answer - Gamma- aminobutyric acid (GABA) Alprazolam is a benzodiazepine; this class of drugs reduces anxiety by potentiating the action of GABA. Which agent is most likely to be prescribed today for short-term management of insomnia? Secobarbital [Seconal Sodium] Meprobamate [Miltown] Zolpidem [Ambien] Flumazenil [Romazicon] Accurate Answer - Zolpidem [Ambien] Zolpidem is a benzodiazepine-like drug that is widely used in the treatment of insomnia. It is safer than the barbiturates (secobarbital) or miscellaneous sedative-hypnotics (meprobamate). Flumazenil is a reversal agent for the benzodiazepines. The nurse is caring for a patient with a seizure disorder who takes phenobarbital at bedtime each night to control seizures. Which symptom, if present, would most likely indicate an adverse effect of this drug? Morning sedation A respiratory rate of 30 breaths per minute Constipation
A blood pressure of 160/88 mm Hg Accurate Answer - Morning sedation The adverse effects of the barbiturates include respiratory depression, risk of suicide, risk of abuse, and hangover (sedation, impaired judgment, and reduced motor skills). The nurse in the emergency department is caring for a patient with a suspected overdose of diazepam [Valium]. Which agent is most likely to be administered to reverse the effects of diazepam? Naloxone [Narcan] Flumazenil [Romazicon] Acetylcysteine [Mucomyst] Vitamin K Accurate Answer - Flumazenil [Romazicon] Flumazenil [Romazicon], a benzodiazepine receptor antagonist, is the treatment of choice for overdose of the benzodiazepine diazepam [Valium]. Naloxone [Narcan] is used to reverse opioid overdose. Acetylcysteine [Mucomyst] is used to reverse acetaminophen [Tylenol] overdose. Vitamin K is used to reverse warfarin toxicity. The nurse is caring for a patient with insomnia. The patient asks if there are medications for sleep that are not controlled substances. Which statement by the nurse is correct? "Yes, there is a medication that works with your body's melatonin and is not a controlled substance." "No, all of the sleep medications are controlled substances." "There are some over-the-counter medications, and you can take those without discussing them with your healthcare provider." "Yes, but it is not for chronic insomnia." Accurate Answer - "Yes, there is a medication that works with your body's melatonin and is not a controlled substance."
