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Chapter 13: Psychopharmacologic Drugs

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 13: Psychopharmacologic Drugs

12 problems · 0 figures

Case Study 13.1.1 §13.1 source ↗

Table 13.11 in the book ↗
Vital Signs Physical Examination
Temperature: 97.6°F

• Head, ears, eyes, nose, throat (HEENT): Normocephalic, bilateral eyes red and puffy, positive clear nasal drainage, and minimal eye contact. Ears and throat unremarkable. No lymphadenopathy. Thyroid nonpalpable with positive rise upon swallowing.

• Cardiovascular: Audible S1, S2. Rhythm regular. No murmurs, rubs, or gallops. No peripheral edema bilaterally. Radial and DP pulses 2+.

• Respiratory: Lungs clear bilaterally in all fields. No use of accessory muscles.

• Gastrointestinal: Abdomen round, soft, and nontender. Bowel sounds present in all four quadrants.

• Musculoskeletal: Active and full range of motion in bilateral upper extremities and lower extremities with 5/5 muscle strength.
Blood pressure: 106/68 mm Hg
Heart rate: 74 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 98% on room air
Height: 5'5"
Weight: 124 lb

Read the following clinical scenario to answer the questions that follow.

Jadalyn Sanchez is a 21-year-old female student who arrives at the university’s student health center with complaints of frequent crying throughout the day and lack of motivation or interest in being with friends or engaging in activities she used to enjoy. She describes a sense of helplessness and inadequacy at school. Jadalyn states it takes everything for her to get out of bed to attend classes. She has had no appetite and lost 12 pounds over the past month. She reports that her symptoms have been present for approximately 6 weeks. She denies any recent or past traumatic events or losses. She reports occasional dating but currently is not in any committed relationship. She is sexually active and states that she is compliant with her prescribed oral contraceptives. She denies tobacco or illicit drug use and says she drinks two or three 6 oz glasses of wine on the weekends. She does not recall being this sad in the past. She states normally she is very active, meets all due dates, and takes her academics very seriously. Her roommate talked her into coming to the center because of the drastic change.

Family History
Mother (age 50): History of depression
Father (age 54): History of hypertension and bipolar disorder
Sister (age 24): Panic disorder and ADHD
Brother (age 16): ADHD and GAD

Current Medications
Loestrin Fe 1/20, once daily

Jadalyn was prescribed fluoxetine 20 mg once daily. What is an important point for the nurse to emphasize to Jadalyn when teaching about these drugs?
  1. a.
    “Full therapeutic effects usually are seen in the first 2 weeks. If not, the dose can be increased.”
  2. b.
    “Take this medication in the morning to prevent nighttime insomnia.”
  3. c.
    “Avoid acetaminophen and take ibuprofen or aspirin when needed for pain or fever.”
  4. d.
    “This can increase your blood pressure, so notify the provider if you have headaches or blurred vision.”

Answer

B. “Take this medication in the morning to prevent nighttime insomnia.”
Fluoxetine has a stimulant effect and may interfere with sleep if taken close to bedtime. Therapeutic effects take 4–6 weeks.

Case Study 13.1.2 §13.1 source ↗

Table 13.11 in the book ↗
Vital Signs Physical Examination
Temperature: 97.6°F

• Head, ears, eyes, nose, throat (HEENT): Normocephalic, bilateral eyes red and puffy, positive clear nasal drainage, and minimal eye contact. Ears and throat unremarkable. No lymphadenopathy. Thyroid nonpalpable with positive rise upon swallowing.

• Cardiovascular: Audible S1, S2. Rhythm regular. No murmurs, rubs, or gallops. No peripheral edema bilaterally. Radial and DP pulses 2+.

• Respiratory: Lungs clear bilaterally in all fields. No use of accessory muscles.

• Gastrointestinal: Abdomen round, soft, and nontender. Bowel sounds present in all four quadrants.

• Musculoskeletal: Active and full range of motion in bilateral upper extremities and lower extremities with 5/5 muscle strength.
Blood pressure: 106/68 mm Hg
Heart rate: 74 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 98% on room air
Height: 5'5"
Weight: 124 lb

Read the following clinical scenario to answer the questions that follow.

Jadalyn Sanchez is a 21-year-old female student who arrives at the university’s student health center with complaints of frequent crying throughout the day and lack of motivation or interest in being with friends or engaging in activities she used to enjoy. She describes a sense of helplessness and inadequacy at school. Jadalyn states it takes everything for her to get out of bed to attend classes. She has had no appetite and lost 12 pounds over the past month. She reports that her symptoms have been present for approximately 6 weeks. She denies any recent or past traumatic events or losses. She reports occasional dating but currently is not in any committed relationship. She is sexually active and states that she is compliant with her prescribed oral contraceptives. She denies tobacco or illicit drug use and says she drinks two or three 6 oz glasses of wine on the weekends. She does not recall being this sad in the past. She states normally she is very active, meets all due dates, and takes her academics very seriously. Her roommate talked her into coming to the center because of the drastic change.

Family History
Mother (age 50): History of depression
Father (age 54): History of hypertension and bipolar disorder
Sister (age 24): Panic disorder and ADHD
Brother (age 16): ADHD and GAD

Current Medications
Loestrin Fe 1/20, once daily

Based on Jadalyn’s family history, which condition would be of most concern with her taking fluoxetine?
  1. a.
    Bipolar disorder
  2. b.
    Attention deficit hyperactivity disorder
  3. c.
    Generalized anxiety disorder
  4. d.
    Panic disorder

Answer

A. Bipolar disorder
If someone has an undiagnosed bipolar disorder, placing them on an antidepressant without a mood stabilizer can induce mania.

13-1 §13.RQ source ↗

The nurse is teaching a client receiving a tricyclic antidepressant. Which of the following symptoms related to its anticholinergic effects could the client experience?
  1. a.
    Increased appetite, diarrhea, and glaucoma
  2. b.
    Xerostomia, constipation, and urinary retention
  3. c.
    Excessive salivation, tachycardia, and urinary incontinence
  4. d.
    Nightmares, increased libido, and blurred vision

Answer

B. Xerostomia, constipation, and urinary retention
The drug blocks muscarinic receptors and causes anticholinergic effects. This results in reduced salivation (xerostomia), decreased peristalsis (constipation), and relaxation of the detrusor muscle, causing urinary retention.

13-2 §13.RQ source ↗

A client with bipolar disorder has a subtherapeutic lithium level. What will the nurse expect to assess in this client?
  1. a.
    A decrease in impulsivity and hyperactivity
  2. b.
    Rapid, pressured speech along with interrupting others
  3. c.
    Sleeping 6–8 consecutive hours per night
  4. d.
    Ability to sit down and eat a well-balanced meal

Answer

B. Rapid, pressured speech along with interrupting others
Rapid, pressured speech is a classic sign of mania. If the drug level is considered subtherapeutic, this means it is not working favorably. The other options indicate the manic behavior is being well managed.

13-3 §13.RQ source ↗

Which of the following observations indicates that lisdexamfetamine has been effective for a 10-year-old diagnosed with ADHD?
  1. a.
    The child received two notes from their school due to inappropriate behavior.
  2. b.
    The child sleeps 8 hours per night and still falls asleep during the day.
  3. c.
    The child is able to sit and play a game for 30 minutes with a friend.
  4. d.
    The child has difficulty following verbal instructions from the teacher.

Answer

C. The child is able to sit and play a game for 30 minutes with a friend.
This demonstrates the child’s ability to remain focused on the task at hand.

13-4 §13.RQ source ↗

A client has been taking fluoxetine for 2 weeks. They tell the nurse they do not think the medication is working because they still feel depressed. What is the nurse’s best response?
  1. a.
    “This may not be the best medication for you. Let me call the provider to get something different.”
  2. b.
    “You might still be depressed, but you look and sound a lot better.”
  3. c.
    “This drug takes about 4–6 weeks before you may see full therapeutic effects.”
  4. d.
    “I will call the provider and ask if the dosage can be increased.”

Answer

C. “This drug takes about 4–6 weeks before you may see full therapeutic effects.”
The brain has to adapt to these types of drugs. Although a person can feel some benefit in 2 weeks, full effects can take 4–6 weeks. It is important to emphasize this to the client or else they will simply stop taking the drug.

13-5 §13.RQ source ↗

Which adverse effect should the nurse assess for in a client who is taking haloperidol?
  1. a.
    Nausea and vomiting
  2. b.
    Tremors
  3. c.
    Weight loss
  4. d.
    Hypertension

Answer

B. Tremors
Tremors, pseudoparkinsonism, and akinesia are extrapyramidal side effects that can occur with haloperidol.

13-6 §13.RQ source ↗

The nurse has completed medication education for a client prior to their receiving phenelzine. The nurse evaluates the education as effective when the client makes which statement?
  1. a.
    “Eating seafood could cause my blood pressure to become very low.”
  2. b.
    “Instead of white bread, I should use whole wheat.”
  3. c.
    “I guess I cannot have steak and eggs anymore.”
  4. d.
    “I should use almond milk instead of whole milk and need to avoid aged cheeses.”

Answer

D. “I should use almond milk instead of whole milk and need to avoid aged cheeses.”
Whole milk and aged cheeses are high in tyramine and therefore should be avoided.

13-7 §13.RQ source ↗

A hospitalized client was discharged on clozapine. The client is concerned about the potential significant adverse effects. Instructions on the REMS program were explained. To avoid difficulty with obtaining access immediately after discharge, what would the nurse expect from the inpatient pharmacy to ensure consistency?
  1. a.
    A 3-day supply will be provided to the client to allow time for them to fill their prescription from their pharmacy.
  2. b.
    A maximum of a 7-day supply of this medication will be provided upon client discharge.
  3. c.
    Inpatient pharmacies will dispense a day’s supply of clozapine that aligns with the client’s monitoring frequency.
  4. d.
    The inpatient pharmacist will call the client’s outside pharmacy to ensure they fill the prescription immediately.

Answer

C. Inpatient pharmacies will dispense a day’s supply of clozapine that aligns with the client’s monitoring frequency.
Clozapine can cause a significant decrease in the neutrophil count, increasing the risk of infection. Also, abrupt discontinuation of clozapine can result in significant complications for client treatment. To ensure the client does not have a gap in the treatment, this is a modification to the REMS program.

13-8 §13.RQ source ↗

Which antidepressant would be the best choice for a client experiencing sexual dysfunction from a selective serotonin reuptake inhibitor (SSRI)?
  1. a.
    Fluoxetine
  2. b.
    Venlafaxine
  3. c.
    Bupropion
  4. d.
    Phenelzine

Answer

C. Bupropion
This is a norepinephrine dopamine reuptake inhibitor. SSRIs, SNRIs, and MAOIs all cause some degree of sexual dysfunction.

13-9 §13.RQ source ↗

Zolpidem is the most appropriate choice for clients with which condition?
  1. a.
    Increased sleep latency and maintaining sleep
  2. b.
    Difficulty initiating sleep and early morning awakenings
  3. c.
    Obstructive sleep apnea (OSA) and respiratory problems
  4. d.
    Maintaining sleep during the night due to anxiety and depression

Answer

A. Increased sleep latency and maintaining sleep
Zolpidem is useful for initiating sleep (sleep latency) and ensuring the client stays asleep during the night.

13-10 §13.RQ source ↗

A 10-year-old child is receiving methylphenidate. The parent tells the nurse the child will not sleep while on the medication. What is the best response?
  1. a.
    “Do not give the medication after 6 p.m.”
  2. b.
    “You can give 25 mg diphenhydramine at bedtime.”
  3. c.
    “Cut the bedtime dose in half so that it will not interfere with sleep.”
  4. d.
    “This is a serious adverse reaction. We will need to contact the provider.”

Answer

A. “Do not give the medication after 6 p.m.”
Because this drug is a stimulant, it should not be taken near the evening or it will interrupt sleep.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.