Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants

NCLEX
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Antipsychotic most appropriate in elderly patients with prostatic
Haliperidol
hypertrophy and chronic constipation.
Effective in treating acute dystonia caused by antipsychotic drugs: Amantidine, Trihexyphenidyl, Biperiden
Effective in managing rapidly cycling bipolar diorder in lithium
Valproic acid
non-responding patient populations:
Neurochemical abnormality most closely associated with schizo-
Dopaminergic Abnormality
phrenia:
Accepted first alternative for treating patients with bipolar disorder
Carbamazepine
not adequately responsive to lithium.
Most common antipsychotic neurological side effect: Akathisia
Least extrapyramidal side effects: Clozapine
A schizophrenic patient has been treated with haloperidol, loxap-
ine, thiothixene and lithium. If paranoid delusions persist, what Clozapine
other drug might be tried?
Side effects include anti-cholinergic, anti-adrenergic and ex-
Haloperidol
trapyramidal
Butyrophenone antipsychotic Haloperidol
An example of an "atypical" antipsychotic agent: Risperidone
Alpha Adrenergic Receptor, Muscarinic cholinergic receptor, H1
Site(s) of chlorpromazine (Thorazine) receptor blockade:
histamine receptor, serotonin 5-HT2 receptor
Associated with a LOW clinical potency but HIGH degree of
Chlorpromazine
sedation:
Antipsychotic drug with least extrapyramidal toxicity: Clozapine
Antipsychotic drug:least hypotensive effect Olanzapine
Psychological effect of antipsychotic drugs taken by nonpsychotic unpleasant, associated with decreased psychomotor perfor-
individuals: mance
False Positive Pregnancy test, Increased Libido in women, De-
Antipsychotic endocrine effect(s):
creased libido in men, amenorrhea-galactorrhea
Least likely to cause an increase in prolactin: Olanzapine
Cardiovascular effects of "high-dose" (low-potency) phenoth- Hypotension, decreased peripheral resistance, decreased stroke
iazines: volume, lengthening of the QT interval
Blockade of this receptor system most likely associated with
Dopamine
akisthisia side effect of antipsychotic treatment:
Toxic-confusion states due to antipsychotic medication associat- Muscarinic Cholinergic; dry mouth, urinary hesitancy, constipa-
ed with effects on this receptor system tion, loss of accommodation
Antipsychotic drug most likely to induce agranulocytosis (around
Clozapine
2% frequency)
Neurological adverse effect associated with antipsychotic drug
Tardive Dyskinesia
use: occurs late in therapy
Reasonable pharmacological step(s) to treat tardive dyskinesia: Start high dose diazepam
Ocular complication of antipsychotic drug treatment: causes reti-
Thioridazine
nal deposits; resembles an advance cases, retinitis pigmentosa
At the molecular level, best defined lithium effect Effect on Inositol Phosphates
Lithium carbonate is the preferred treatment for: Bipolar Disorder
Reduction of lithium renal clearance: Chlorothiazide, newer nosteroidal anti-inflammatory agents
Lithium: polydipsia/polyuria due to: Collecting tubule in adequately responsive to ADH
A client is to receive a dose of fluphenazine hydrochloride (Prolix-
in) by intramuscular injection. What is the most important nursing
intervention related to the injection?

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
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a. Massage the site vigorously after injection.
b. Administer the drug using Z-tracking. B ~ This medication is very viscous and requires Z-track, deep IM
c. Avoid rotating the injection sites. injection to avoid muscle irritation.
d. Select a 22- to 23-gauge needle.
The client has been diagnosed with schizophrenia and is exhibit-
ing a loss of function and motivation. The nurse recognizes that
these symptoms are categorized as: C ~ Negative symptoms are manifested as the inability to initi-
a. positive. ate voluntary motor function. The others are considered positive
b. paranoiac. symptoms.
c. negative.
d. incoherent.
What is a common side effect for which the nurse must monitor
during administration of both phenothiazine and non-phenoth-
iazine medications?
D ~ These medications are known for their extrapyramidal symp-
a. Hypertension
toms.
b. Renal failure
c. Increase in number of white blood cells
d. Extrapyramidal symptoms
A client is to be treated with Prolixin. The highest priority nursing
intervention related to the clients vital signs is to monitor for:
a. bradycardia.
C ~ The phenothiazine groups major side effect is hypotension.
b. hypertension.
c. hypotension.
d. tachypnea.
A client has been taking a phenothiazine for 1 week. She contacts
the crisis intervention clinic because she is still having symptoms.
The nurses response is based on the premise that the desired
effects usually take _____ to manifest. C ~ The client may feel some effect in 7 to 10 days, but generally
a. 1 week it takes 6 weeks for the medication to take full effect.
b. 1 to 3 weeks
c. 3 to 6 weeks
d. 3 to 5 months
Extrapyramidal symptoms are a side effect of perphenazine (Tri-
lafon). The nurse should assess and observe for which sign of
akathisia?
a. Restlessness and constant moving about A ~ Akathisia is described as restless, agitated movement.
b. Facial grimacing
c. Chewing motion
d. Involuntary eye movement
Client teaching is important when antipsychotics are taken after
discharge from the hospital. Nursing instruction should include
giving which information to the client and family?
a. Therapeutic effect should occur in 2 to 3 days with maximum
effect in 1 week.
B ~ Antipsychotic medications affect symptoms while they are
b. The drugs should not be discontinued without consulting a
used. If they are stopped, the symptoms will recur.
healthcare provider.
c. Taking barbiturates in small dosages with the drug is usually
permissible.
d. Rapid change in position has little effect on dizziness or blood
pressure.
A client is ordered to receive chlordiazepoxide (Librium) for severe
anxiety. The nurse monitors for which symptoms of severe anxiety
or panic attack?
A ~ Dyspnea and heart palpitations are symptoms of severe
a. Dyspnea and heart palpitations
anxiety; also experienced is chest pain, dizziness, or faintness.
b. Trembling, shaking, and gastrointestinal upset
c. Dizziness and anorexia
d. Drowsiness and blurred vision
A client is experiencing severe EPS effects. In addition to admin-
istering a lower dose of the antipsychotic agents, the nurse would
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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
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anticipate administering a medication in which category?
a. Cholinergics B ~ Anticholinergics, such as benztropine (Cogentin), are used to
b. Anticholinergics decrease the EPS effects associated with antipsychotic medica-
c. Antidepressants tions.
d. Dopamine agonists
A client is taking an anxiolytic agent secondary to grief-related
anxiety. The client questions the nurse about abruptly discontinu-
ing these agents. The nurses response is based on the knowledge
that, when discontinuing these medications: A ~ Discontinuing anxiolytic agents abruptly may lead to with-
a. the dosage must be tapered to avoid withdrawal. drawal symptoms.
b. the client must be evaluated for hyperglycemia.
c. hangover syndrome must be planned for.
d. blood levels must be monitored.
A client is ordered to receive diazepam (Valium). The nurse is
teaching the client about her medication. Which information would
be included in the teaching plan?
a. The medication causes high levels of energy and activity.
b. The medication is effective in aiding clients with suicidal D ~ Patients may become tolerant to Valium.
ideations.
c. The medication may be taken concurrently with other benzodi-
azepines.
d. The client may develop tolerance after prolonged use.
A client is brought to the emergency department unconscious.
The clients spouse tells the nurse that the client was found in bed
with an empty pill bottle nearby. The clients spouse believes that
there were 20 to 25 diazepam (Valium) pills in the bottle. What
B ~ Because the client is unconscious, this is the correct course
represents an appropriate nursing priority?
of action.
a. Administer an emetic agent followed by activated charcoal.
b. Lavage the stomach using a nasogastric tube.
c. Prepare the client for emergency surgery.
d. Monitor the client because there is no antidote.
A client is ordered to receive fluphenazine (Prolixin) to manage
the psychotic symptoms of schizophrenia. The nurse assesses for
which signs of anticholinergic effects?
C ~ Urinary retention & dry mouth are the side effects of anti-
a. Bradycardia and orthostatic hypotension
cholinergics.
b. Diarrhea and tachycardia
c. Urinary retention and dry mouth
d. Constipation and hypertension
A client is receiving an antipsychotic agent. Which laboratory
result is of most concern?
D ~ A serum medication level below normal limits is a concern be-
a. Serum sodium level of 138 mEq/L
cause subtherapeutic levels may allow for breakthrough psychotic
b. Blood glucose level of 100 mg/dl
symptoms.
c. White blood cell count of 6000/mm3
d. Serum medication level below normal limits
The client has been placed on Ativan. The nurse is planning a
client instructional session. Which herbal preparation should the
nurse emphasize that the client avoid taking with Ativan?
A ~ Kava kava in combination with Ativan will increase the seda-
a. Kava kava
tion effects of the Ativan.
b. St. Johns wort
c. Ginseng
d. Ginger
The client has been placed on Risperdal. He complains to the
nurse of experiencing headaches. The highest priority action on
the part of the nurse is to recognize that this is a(n) ________ the
medication and call the physician. B ~ Headaches are an expected side effect of treatment with
a. adverse reaction to Risperdal.
b. expected side effect of
c. life-threatening reaction to
d. anaphylactic reaction to

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The client is an older adult who has been placed on Librium. The
nurse recognizes that the dose of the drug _____ for this client.
a. is contraindicated
C ~ The dose of Librium should be decreased for an older adult.
b. should be increased
c. should be decreased
d. will not change
The nurse is preparing a dose of Mellaril. What is the highest
priority intervention for the nurse while preparing the dose?
a. Draw up the dosage of the liquid in an oral syringe. D ~ If Mellaril is allowed to come in contact with exposed skin,
b. Use a 21-gauge needle to administer the injection. contact dermatitis can result.
c. Start a new IV site before administering the drug.
d. Avoid spilling the liquid on exposed skin.
The client is known to have overdosed on a benzodiazepine
medication. The nurse anticipates that which medication will most
likely be ordered?
B ~ Romazicon is considered to be the benzodiazepine antago-
a. Tranxene
nist.
b. Romazicon
c. BuSpar
d. Librium
The nurse is caring for a patient in a state of hypnosis, which
A ~ Hypnosis is an extreme state of sedation in which the person
means the patient is in what state?
no longer senses or reacts to incoming stimuli. A state of tranquility
A) A state of extreme sedation in which the person no longer
is produced through minor tranquilizers by decreasing anxiety.
senses or reacts to incoming stimuli.
Anxiety is a feeling of tension, nervousness, apprehension, or fear.
B) A state of tranquility in which the person can be made to do
Sedation is the loss of awareness and reaction to environmental
whatever is suggested by others.
stimuli, which may lead to drowsiness. The state of suggestibility
C) A feeling of tension, nervousness, apprehension, or fear with
often seen in television programs is not an appropriate definition
high levels of awareness.
of hypnosis. If the brain stopped sending signals, the patient would
D) A state in which the brain is no longer sending out signals to
stop breathing and death would follow.
the body.
C ~ The barbiturates, being older drugs, have established pedi-
atric dosages. These drugs must be used with caution because
of the often unexpected responses. Children must be monitored
A nurse is caring for a 4-year-old child who is receiving a barbi- very closely for central nervous system (CNS) depression and
turate. What common adverse effect would the nurse assess for? excitability. The most common adverse effects are related to gen-
A) Decrease in respirations eral CNS depression. Other CNS effects may include drowsiness,
B) Vomiting somnolence, lethargy, ataxia, vertigo, a feeling of a hangover,
C) Excitability thinking abnormalities, paradoxical excitement, anxiety, and hal-
D) Dry mucous membranes lucinations. Alteration in respirations and dried mucous mem-
branes are adverse effects of antihistamines, which can be given
to calm children or induce sleep. Vomiting could occur with the use
of paraldehyde due to the unpleasant taste and odor of the drug.
D ~ The first action of the nurse would be to call the physician
A nurse is caring for a 9-year-old patient and has received an and question the order. The normal oral dosage for a pediatric
order for diazepam (Valium) 10 mg given orally q.i.d. What is the patient is 1 to 2.5 mg t.i.d. or q.i.d. The ordered dose would be
nurses priority action? unsafe for this patient. If the dosage was changed and the correct
A) Perform hand hygiene and prepare the drug. amount administered, the nurse would order the medication from
B) Send the order to the hospital pharmacy. the pharmacy if necessary and determine what time to start the
C) Determine when to administer the first dose. medication. She would then wash her hands in preparation for ad-
D) Call the physician and question the order. ministering the medication, but not until obtaining an appropriate
dosage of medication.
A nurse is discussing the use of alprazolam (Xanax) with a
68-year-old patient. What statement indicates that the patient has
an understanding of the drug? B ~ The onset of alprazolam is about 30 minutes. The drug must
A) When I stop having panic attacks, I can stop taking the drug. be tapered after long-term use and the duration is approximately
B) This drug will calm me down in about 30 minutes after I take it. 4 to 6 hours. Elderly patients usually have a reduced dosage.
C) One dose will keep me calm for about 24 hours.
D) I am taking an increased dose because of my age.
A nurse is about to administer a parenteral benzodiazepine to a
female patient in the hospital before the performance of a proce-

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
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dure. What is the priority nursing action before administration of
the drug? C ~ The priority action would be to help the patient up to void. After
A) Make sure that the side rails are up and the bed is in the lowest the medication is administered the patient should not get out of
position. bed because of possibly injury due to drowsiness. Safety should
B) Close the blinds and ensure appropriate room temperature for always be the priority concern. After administration of the drug the
the patient. nurse would ask visitors to leave before beginning the procedure,
C) Help the patient out of bed to the bathroom and encourage her make the room conducive to rest and sleep, and make sure that
to void. both side rails are up and the bed is in the lowest position.
D) Ask all visitors to leave the room and remain in the waiting area.
The nurse is caring for a 36-year-old man who experienced a
seizure 30 minutes before coming into the emergency room,
C ~ Phenobarbitals onset is between 10 and 60 minutes, depend-
where he begins to have another. What barbiturate has the fastest
ing on the route administered, and most likely this would be given
onset and would be most appropriate to give to the patient to
to the patient. Amobarbital is given for convulsions and the onset
quickly stop the seizure?
is between 15 and 60 minutes. Mephobarbitals onset is between
A) Amobarbital (Amytal Sodium)
30 and 60 minutes. Secobarbital is given for convulsive seizures
B) Mephobarbital (Mebaral)
of tetanus and has an onset of 1 to 4 hours.
C) Phenobarbital (Luminal)
D) Secobarbital (Seconal)
What anxiolytic drugs would be given to a premenopausal patient B ~ Buspirone is a newer anxiolytic drug that does not cause
who is a registered nurse planning to return to work at the hospital sedation or muscle relaxation. It is preferred when the patient
after anxiety is controlled? needs to be alert such as when driving or working. Alprazolam,
A) Alprazolam (Xanax) diazepam, and clorazepate are benzodiazepines, which cause
B) Buspirone (BuSpar) drowsiness, sedation, depression, lethargy, confusion, and de-
C) Diazepam (Valium) creased mental alertness. It would be unsafe for a nurse to func-
D) Clorazepate (Tranxene) tion in her role while taking one of these drugs.
C ~ Flumazenil is an antidote to benzodiazepine overdose and
A patient arrives at the emergency room after attempting suicide
is administered to reverse the effects of benzodiazepines when
by taking an entire bottle of diazepam. What antidote will the nurse
used for anesthesia. Phenobarbital, a barbiturate, would further
most likely administer?
depress the body functions of this patient. Dexmedetomidine is a
A) Phenobarbital (Luminal)
new hypnotic drug used in the intensive care unit for mechanically
B) Dexmedetomidine (Precedex)
ventilated patients. Ramelteon is also new; it is used as a hyp-
C) Flumazenil (Romazicon)
notic. Adverse effects of this drug include depression and suicidal
D) Ramelteon (Rozerem)
ideation.
The nurse is caring for a resident in a long-term care facility who is B ~ Special care should be taken when anxiolytic or hypnotic
African American with a history of an anxiety disorder. The patient drugs are given to African Americans. About 15% to 20% of
is receiving oral lorazepam (Ativan) 2 mg t.i.d. When developing African Americans are genetically predisposed to delayed me-
this patients plan of care, what priority assessment will the nurse tabolism of benzodiazepines. As a result, they may develop high
include? serum levels of these drugs, with increased sedation and an
A) Depression increased incidence of adverse effects. Depression is not a com-
B) Extreme sedation mon adverse effect. Phlebitis can occur at injection sites but this
C) Phlebitis patient is taking the medication orally. Nightmares occur during
D) Nightmares drug withdrawal.
An elderly patient has been taking zolpidem (Ambien) as a sleep
B ~ It is important for the nurse to understand that zolpidem
aid for the past 2 months. On admission to the assisted-living
must be withdrawn gradually over a 2-week period after prolonged
facility, it is determined that the drug is no longer needed. What is
use. If chloral hydrate is stopped suddenly, it will result in serious
an important nursing consideration concerning this drug?
adverse effects. Hallucinations and sundowning are not common
A) Hallucinations are common.
with withdrawal of the drug. The prescriber and the patient would
B) The drug needs to be withdrawn gradually.
determine the need for chloral hydrate to be substituted for an-
C) Another anxiolytic will need to be substituted.
other anxiolytic.
D) Sundowning is common with withdrawal from this drug.
Why would the nurse expect the patient with liver disease to B ~ The benzodiazepines are metabolized extensively in the liver.
receive a smaller dose of benzodiazepines? Patients with liver disease must receive a smaller dose and be
A) Excretion of the drug relies on liver function. monitored closely. Excretion is primarily through the urine. All of
B) The drugs are metabolized extensively in the liver. the answer options are true, but only the fact that the benzodi-
C) They are lipid soluble and well distributed throughout the body. azepines are metabolized in the liver explains why a patient with
D) The drugs are well absorbed from the gastrointestinal tract. liver disease would require smaller dosages.
When compared with benzodiazepines, buspirone (BuSpar) B ~ Buspirone, a newer antianxiety agent, has no sedative, anti-
stands out as unique among antianxiety drugs because of what convulsant, or muscle-relaxant properties, and its mechanism of
factor? action is unknown. However, it reduces the signs and symptoms

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A) Increases the central nervous system (CNS) depression of of anxiety without many of the central nervous system effects
alcohol and other drugs. and severe adverse effects associated with other anxiolytic drugs.
B) Lacks muscle relaxant and anticonvulsant effects. Most of the antianxiety drugs are rapidly absorbed from the GI
C) Causes significant physical and psychological dependence. tract, metabolized in the liver, have a significant drugdrug interac-
D) Rapidly absorbed from the gastrointestinal (GI) tract and me- tion with alcohol and other drugs, and can result in psychological
tabolized in the liver. dependence.
C ~ Abrupt cessation of these drugs may lead to a withdrawal
What would the nurse assess for when benzodiazepines are syndrome characterized by nausea, headache, vertigo, malaise,
abruptly stopped? and nightmares. When benzodiazepines are stopped abruptly the
A) Urinary retention and change in sexual functioning likelihood of withdrawal symptoms increases with the length of
B) Dry mouth, constipation, nausea, and vomiting time the patient took the medication. Urinary retention, change in
C) Nausea, headache, vertigo, malaise, and nightmares sexual functioning, dry mouth, constipation, nausea, and vomiting
D) In most cases nothing significant are all common adverse effects of the medications classified as
benzodiazepines.
The nurse is caring for a patient in intensive care unit receiving IV
lorazepam (Ativan) to reduce anxiety related to mechanical venti-
lation. While injecting the medication the nurse notes a decrease
in blood pressure and bradycardia. What is the nurses priority B ~ The nurses priority action is to slow the rate of injection be-
action? cause rapid injection of benzodiazepines can result in hypotension
A) Discontinue drug administration. and bradycardia and can lead to cardiac arrest.
B) Give the IV drug more slowly.
C) Notify the patients health care provider.
D) Document the reaction to the drug.
For what purpose would the nurse choose to administer a hyp-
D ~ Hypnotics are used to help people fall asleep by causing
notic instead of another classification of antianxiety drug?
sedation. Drugs that are effective hypnotics act on the reticular ac-
A) Treating insomnia
tivating system (RAS) and block the brains response to incoming
B) Treating seizure disorder
stimuli. Hypnotics would not be the most effective drugs to treat
C) Treating panic attach
seizure disorders, panic attack, or confusion with agitation.
D) Treating confusion and agitation
A, B, C ~ Abrupt cessation of benzodiazepines may lead to a
withdrawal syndrome characterized by nausea, headache, ver-
The nurse assesses the patient who had an abrupt withdrawal of
tigo, malaise, and nightmares. Withdrawal symptoms may be
benzodiazepines for withdrawal syndrome and would recognize
caused by the abrupt separation of benzodiazepine molecules
what symptoms as part of the syndrome? (SATA)
from their receptor sites and the resulting acute decrease in
A) Headache
gamma-aminobutyric acid (GABA) neurotransmission. Because
B) Nightmares
GABA is an inhibitory neurotransmitter, less GABA may produce
C) Malaise
a less inhibited central nervous system (CNS) and therefore
D) Bradycardia
symptoms of hyperarousal or CNS stimulation. The nurse would
E) Hypotension
not categorize hypotension or bradycardia as indicating benzodi-
azepine withdrawal.
A 75-year-old patient is brought to the emergency department
by his family. The family relates that the patient is complaining of
A ~ Common manifestations of benzodiazepine toxicity include
confusion, seizures, and abnormal perception of movement. The
increased anxiety, psychomotor agitation, insomnia, irritability,
nurse reviews all of the medication bottles found in the house and
headache, tremor, and palpitations. Less common but more se-
suspects the patient overdosed on what medication?
rious manifestations include confusion, abnormal perception of
A) Benzodiazepine
movement, depersonalization, psychosis, and seizures. These
B) Antihypertensive
symptoms are not found in association with options B, C, or D.
C) Sedative
D) Analgesic
The nurse is caring for a patient who experiences anxiety and
insomnia and is prescribed benzodiazepines. When developing
C ~ The most appropriate nursing diagnosis related to adverse
the plan of care, what would be an appropriate nursing diagnosis
effects of the drug is risk for injury related to CNS effects because
related to potential adverse effects of the drug?
benzodiazepines can have many CNS adverse effects. Anxiety is
A) Provide patient teaching about drug therapy.
the condition for which drug therapy is prescribed not related to
B) Anxiety related to drug therapy.
drug therapy. Patient teaching and avoiding adverse effects are
C) Risk for injury related to central nervous system (CNS) effects.
interventions and not nursing diagnoses.
D) Avoid preventable adverse effects, including abuse and de-
pendence.

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D ~ The home care nurse should provide thorough patient teach-
A patient is being discharged home from the hospital after re- ing, with a priority teaching point being the warning signs the
ceiving treatment for pneumonia. The patient is going home and patient may experience that indicate a serious adverse effect.
continuing to take the same drugs he or she was taking before Although this may have been discussed by the discharging nurse
he or she was hospitalized. These drugs include an antianxiety in the hospital, this is essential information for the patient to
medication and a medication for insomnia. The home care nurse thoroughly understand. By the time the home care nurse visits,
is following this patient. On the initial visit what is the nurses the patient should already have filled the prescriptions and know
priority teaching point? the names and purposes of the medications prescribed from the
A) The names and purposes of medications prescribed hospital nurse but it is a good idea to review this information,
B) How to contact the provider if needed although it is not a priority. Medications for insomnia should be tak-
C) The importance of taking medications for insomnia only occa- en as prescribed. The patient should have received the providers
sionally contact information when leaving the hospital but the home care
D) Warning signs that may indicate serious adverse effects nurse may need to review this, even though it is not the priority
teaching point.
Hypnotic drugs are used to aid people in falling asleep. What
C ~ Hypnotics are used to help people fall asleep by causing
physiological system does a hypnotic act on to be effective in
sedation. Drugs that are effective hypnotics act on the reticular
helping a patient to sleep?
activating system and block the brains response to incoming
A) Limbic system
stimuli. Hypnosis, therefore, is the extreme state of sedation, in
B) Sympathetic nervous system
which the person no longer senses or reacts to incoming stimuli.
C) Reticular activating system
The other options are incorrect.
D) Lymph system
A patient presents at the emergency department with respiratory
depression and excessive sedation. The family tells the nurse that
the patient has been taking medication throughout the evening D ~ Toxic effects of benzodiazepines include excessive seda-
and gives the nurse an almost empty bottle of benzodiazepines. tion, respiratory depression, and coma. Flumazenil (Anexate) is a
What other adverse effects would the nurse assess this patient specific antidote that competes with benzodiazepines for benzo-
for? diazepine receptors and reverses toxicity. Seizures, tachycardia,
A) Seizures and headache would not normally be associated with benzodi-
B) Tachycardia azepine toxicity.
C) Headache
D) Coma
A patient presents at the free clinic complaining of nervousness,
worrying about everything, and feeling very tense. What diagnose
C ~ Anxiety is a common disorder that may be referred to as
would the nurse suspect?
nervousness, tension, worry, or using other terms that denote an
A) Neurosis
unpleasant feeling. The other options would not be described by
B) Psychosis
these symptoms.
C) Anxiety
D) Depression
The nurse is caring for a patient who is taking a benzodiazepine.
B ~ Use benzodiazepines with caution in elderly or debilitated
The nurse knows that caution should be used when administering
patients because of the possibility of unpredictable reactions and
a benzodiazepine to the elderly because of what possible adverse
in patients with renal or hepatic dysfunction, which may alter
effect?
the metabolism and excretion of these drugs, resulting in direct
A) Acute renal failure
toxicity. Dosage adjustments usually are needed for such patients.
B) Unpredictable reactions
Acute renal failure, paranoia, and hallucinations are not commonly
C) Paranoia
related to therapy with these medications in the elderly.
D) Hallucinations
A 72-year-old patient presents at the emergency department with
respiratory depression and excessive sedation. The family tells D ~ Toxic effects of benzodiazepines include excessive sedation,
the nurse that the patient has been taking medication throughout respiratory depression, and coma. Flumazenil is an antidote for
the evening. The nurse suspects benzodiazepine overdose and the benzodiazepines. Hydroxyzine is an antihistamine with anti-
would expect what drug to be ordered? cholinergic effects and would not be appropriate for this patient.
A) Valium Valium would enhance the effects of benzodiazepines. Phenergan
B) Phenergan is not indicated for this patient; it is similar in actions to hydrox-
C) Hydroxyzine yzine.
D) Flumazenil
The nurse is caring for a patient who has not been able to sleep.
D ~ The most common adverse effects are related to general cen-
The physician orders a barbiturate medication for this patient.
tral nervous system (CNS) depression. CNS effects may include
What adverse effect should the nurse teach the patient about?
drowsiness, somnolence, lethargy, ataxia, vertigo, a resembling
A) Double vision
a hangover, thinking abnormalities, paradoxical excitement, anx-
B) Paranoia
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C) Tinnitus iety, and hallucinations. Barbiturate drugs generally do not cause
D) Thinking abnormalities double vision, paranoia, or tinnitus.
D ~ If an anxiolytic or hypnotic agent is the drug of choice for
an African American patient, the smallest possible dose should
be used, and the patient should be monitored very closely during
the first week of treatment. Dosage adjustments are necessary to
An older adult African American patient comes to the clinic and
achieve the most effective dose with the fewest adverse effects.
is diagnosed with generalized anxiety disorder (GAD). The physi-
In addition, older adults also require careful titration of dosage.
cian orders oral flurazepam 30 mg. What is the nurses priority
Older patients may be more susceptible to the adverse effects
action?
of these drugs, from unanticipated central nervous system (CNS)
A) Teach the patient about the prescribed medication.
adverse effects including increased sedation, dizziness, and even
B) Administer the first dose of medication.
hallucinations. Dosages of all of these drugs should be reduced
C) Tell patient to take first dosage after driving home.
and the patient should be monitored very closely for toxic effects
D) Talk to the physician about the dosage.
and to provide safety measures if CNS effects do occur. As a
result, the priority action is to talk to the physician about the
dosage. The other actions may be appropriate after a proper
dosage is ordered.
The nurse is caring for a patient who has a sedative hypnotic
B ~ Benzodiazepines undergo extensive hepatic metabolism. In
ordered. The nurse would consider this drug contraindicated if the
the presence of liver disease, the metabolism of most benzodi-
patient had what disorder?
azepines is slowed, with resultant accumulation and increased
A) Neurological diseases
risk of adverse effects. Neurological disorders, endocrine disor-
B) Liver failure
ders, and heart disease are not contraindications for the use of
C) Endocrine disorders
benzodiazepines.
D) Heart disease
B ~ The patient makes a correct statement when saying the drug
The nurse evaluates teaching as effective when a patient taking should not be stopped without talking to the health care provider
a benzodiazepine states, first because withdrawal of benzodiazepines require careful mon-
A) I should always take the medication with meals. itoring and should be gradually withdrawn. Medications do not
B) I should not stop taking this drug without talking to my health have to be taken with food, aspirin is not contraindicated, and the
care provider first. medication need only be taken while the condition being treated
C) I cannot take aspirin with this medication. continues. Patients with anxiety may only need the medication for
D) I will have to take this medication for the rest of my life. a few weeks whereas those with a seizure disorder may take it for
longer periods of time.
The nurse is caring for a patient treated with flumazenil (Anexate) A ~ Administration of flumazenil blocks the action of benzodi-
for benzodiazepine toxicity. After administering flumazenil what azepines. If the patient has been taking these medications for an
will the nurse carefully assess for? extended period of time, the blockage of the drugs effects could
A) Agitation, confusion, and seizures precipitate an acute benzodiazepine withdrawal syndrome with
B) Cerebral hemorrhage and dystonia symptoms including agitation, confusion, and seizures. Anexate
C) Hypertension and renal insufficiency does not cause cerebral hemorrhage and dystonia, hypertension,
D) Hypotension, dysrhythmias & cardiac arrest renal insufficiency, hypotension, dysrhythmias, and cardiac arrest.
The nurse administers promethazine (Phenergan) to the patient
before sending the patient to the preoperative holding area. What A ~ Antihistamines (promethazine, diphenhydramine [Benadryl])
is the rationale for administration of this drug? can be very sedating in some people. They are used as preop-
A) Sedation erative medications and postoperatively to decrease the need for
B) Oral secretions narcotics. Promethazine is not given for hypotension, bradycardia,
C) Hypotension and bradycardia confusion, or oral secretions.
D) Confusion
A, B, C, E ~ The adverse effects caused by barbiturates are more
What reasons can the nurse give for why barbiturates are no
severe than those associated with other, newer sedatives/hyp-
longer considered the mainstay for treatment of anxiety? (SATA)
notics. For this reason, barbiturates are no longer considered the
A) Adverse effects are more severe.
mainstay for the treatment of anxiety. In addition, the develop-
B) There is an increased risk of physical tolerance.
ment of physical tolerance and psychological dependence is more
C) There is an increased risk of psychological dependence.
likely with the barbiturates than with other anxiolytics. The most
D) The most common adverse effects are related to cardiac ar-
common adverse effects are related to central nervous system
rhythmias.
(CNS) depression. Hypersensitivity reactions to barbiturates are
E) Hypersensitivity reactions can sometimes be fatal.
sometimes fatal.
The nurse is teaching a class for nurses working in prenatal
clinics about the danger associated with use of benzodiazepines
during pregnancy and explains that what fetal anomalies result

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
NCLEX
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from maternal use of benzodiazepines during the first trimester
A, B, C, D ~ Benzodiazepines are contraindicated in pregnancy
of pregnancy? (SATA)
because a predictable syndrome of cleft lip or palate, inguinal
A) Cleft lip or palate
hernia, cardiac defects, microcephaly, or pyloric stenosis occurs
B) Inguinal hernia
when they are taken in the first trimester. Gastroschises, when the
C) Cardiac defects
abdominal organs are found outside the abdominal cavity, is not
D) Microencephaly
associated with use of benzodiazepine use in the first trimester.
E) Gastroschises
The nurse is caring for a newborn who was delivered from a A ~ Neonatal withdrawal syndrome may result in a baby born to
woman who took benzodiazepines for anxiety during the last 2 a mother who was taking benzodiazepines in the final weeks of
months of her pregnancy after her husband was killed in war. What pregnancy. The neonate may be given very small doses of ben-
will the nurse assess for in this newborn? zodiazepines that are withdrawn gradually to prevent symptoms.
A) Newborn withdrawal syndrome Hepatic dysfunction in the neonate is not associated with use of
B) Hepatic dysfunction benzodiazepines. Failure to thrive and learning deficiencies would
C) Failure to thrive be long-term problems and are not assessed during the neonatal
D) Learning deficiencies period.
The nurse is caring for a patient who received a new diagnosis of
cancer. The patient exhibits signs of a sympathetic stress reaction.
What signs and symptoms will the nurse assess in this patient A, B, C ~ Anxiety is often accompanied by signs and symptoms
consistent with an acute reaction to stress? (SATA) of the sympathetic stress reaction that may include sweating, fast
A) Profuse sweating heart rate, rapid breathing, and elevated blood pressure. Chron-
B) Fast heart rate ically anxious people may be afraid to interact with other people
C) Rapid breathing but this is not usually seen in an acute stress reaction.
D) Hypotension
E) Inability to interact with others
The nurse is caring for an older adult in the long-term care facility
who has begun to display signs of anxiety and insomnia. What is
A ~ The patient should be screened for physical problems, neuro-
the priority nursing action?
logical deterioration, or depression, which could contribute to the
A) Assess the patient for physical problems.
insomnia or anxiety. Only after physical problems are ruled out
B) Call the provider and request an antianxiety drug order.
would the nurse consider nondrug measures such as increased
C) Increase the patients social time, encouraging interaction with
socialization with other residents or family members. If nothing
others.
else is effective, pharmacological intervention may be necessary.
D) Suggest the family visit more often to reduce the residents
stress level.
B ~ A current hypothesis regarding the cause of depression is
a deficiency of norepinephrine, dopamine, or serotonin, which
The mental health nursing instructor is talking with the class about
are all biogenic amines, in key areas of the brain. Acetylcholine
depression. What deficiency does the instructor explain will result
is a neurotransmitter that communicates between nerves and
in depression?
muscles. Epinephrine is a catecholamine that serves as a neu-
A) Epinephrine, norepinephrine, and acetylcholine
rotransmitter that is released in the sympathetic branch of the
B) Norepinephrine, dopamine, and serotonin
autonomic nervous system and can be hormones when released
C) Acetylcholine, gamma-aminobutyric acid, and serotonin
from cells in the adrenal medulla. Gamma-aminobutyric acid is
D) Gamma-aminobutyric acid, dopamine, and epinephrine
a neurotransmitter that inhibits nerve activity and prevents over
excitability or stimulation.
What is the physiological action of tricyclic antidepressants
(TCAs)? D ~ TCAs inhibit presynaptic reuptake of norepinephrine and
A) Inhibiting monoamine oxidase inhibitors that break down nor- serotonin, which cause an accumulation of the neurotransmitters
epinephrine that is thought to create the antidepressant effect. Monoamine ox-
B) Inhibiting nerve activity, which prevents over excitability or idase inhibitors irreversibly inhibit monoamine oxidase that breaks
stimulation down norepinephrine and serotonin. Selective serotonin reuptake
C) Blocking the reuptake of serotonin, which increases the levels inhibitors block the reuptake of serotonin; gamma-aminobutyric
of norepinephrine acid inhibits nerve activity.
D) Inhibiting reuptake of norepinephrine and serotonin
A nurse is working with a 9-year-old child who exhibits signs and C ~ Fluvoxamine is a selective serotonin reuptake inhibitor that
symptoms of obsessive-compulsive disorder (OCD). What drug has established pediatric dosage guidelines for the treatment of
will the nurse anticipate may be prescribed for the child? obsessive-compulsive disorder. Isocarboxazid and phenelzine are
A) Phenelzine (Nardil) monoamine oxidase inhibitors and should be avoided in pediatric
B) Amitriptyline (Elavil) use because of the potential drugfood interactions and other seri-
C) Fluvoxamine (Prozac) ous adverse effects. Amitriptyline is also a tricyclic antidepressant
D) Isocarboxazid (Marplan) not recommended for pediatric use.

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
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A ~ Because all tricyclic antidepressants (TCAs) are similarly
A patient explains to a nurse that he had been taking amitriptyline
effective, the choice of which TCA depends on individual response
(Elavil) for depression and that his physician changed his medica-
to the drug and tolerance of adverse effects. A patient who does
tion to clomipramine (Anafranil). The patient is confused and does
not respond to one TCA may respond to another drug from this
not understand why his medication was changed. The nurses best
class. In addition, the nurse might inform the physician of the
response to the patient would be what?
patients question so the physician can explain his or her rationale
A) These drugs are similar but some patients respond better to
for changing medications. By asking the patient if he took the
one drug than another.
medication as prescribed, the nurse is insinuating that he may not
B) Did you take the amitriptyline like you should have?
have and could damage the trusting nursepatient relationship. The
C) Maybe the old medicine wasnt working anymore.
nurse has no basis for commenting that the medication might not
D) Clomipramine is newer and will be much better for you.
be working or that another drug would work better.
A patient comes to the mental health clinic for a regular appoint-
D ~ Adverse effects of fluoxetine include anorexia and weight loss.
ment. The patient tells the nurse he has been taking oral fluoxetine
Although teaching about healthy eating is a good idea, it is more
(Prozac) 20 mg daily for the past 3 weeks and that he has lost
important to teach the patient how to take the medication in a
3 pounds during that time due to a loss of appetite. What action
way that will reduce adverse effects as well as how to optimize
should the nurse take?
healthy calories to maintain weight. The patient should increase
A) Teaching the patient about healthy eating to maintain weight
caloric intake, not just fluid intake. The patient should continue
B) Congratulating the patient on his weight loss and commenting
the medication to see whether therapeutic effects are obtained
how well he looks
and adjust nutritional intake if necessary. More information about
C) Encouraging the patient to increase fluid intake to avoid further
the patients baseline weight is needed before congratulating the
weight loss
patient because a patient who is already too thin would not ap-
D) Reassuring the patient that a decrease in weight is a common
preciate the nurses comment.
adverse effect with this medication
A patient diagnosed with type 1 diabetes mellitus is receiving
insulin. The physician has prescribed a monoamine oxidase in- A ~ MAOIs can cause an additive hypoglycemic effect if taken
hibitor (MAOI) to treat this patients depression. What interaction with insulin or oral diabetic agents. This patient would have to be
will the nurse assess for with this drug combination? monitored closely and appropriate dosage adjustments made; he
A) Increased risk of hypoglycemia should be taught the importance of more frequent blood sugar
B) Increased risk of hyperglycemia monitoring. The drug combination in this question would not cause
C) Increase in appetite an increase in appetite or increased total cholesterol.
D) Increased total cholesterol
A patient has been taking Prozac (fluoxetine) for the past 3 years
for depression. She is seeing her gynecologist for premenopausal
symptoms and during the interview with the nurse she says that
she would like to try Sarafem because her friend is taking it and
she says it works great. The nurses best response is what? A ~ Prozac and Sarafem are different brand names for fluoxetine,
A) Sarafem and Prozac are different brand names for the same so there is no benefit in changing the patients medication regimen
generic medication. and, if taken together, would result in a drug overdose. The other
B) Before changing drugs it is important to consider how well you three responses are incorrect or inappropriate because they do
responded to Prozac. not recognize that both drugs are the same.
C) You cannot take both drugs at the same time so it will be
important to decide which is best.
D) When taking both of these drugs, it is best to take one in the
morning and one at night.
A 12-year-old patient is hospitalized with severe depression. The D ~ Recent studies have linked the incidence of suicide attempts
patient has been taking a selective serotonin reuptake inhibitor to the use of SSRIs in pediatric patients (see box 21.3 Focus on
(SSRI). What is the priority nursing action for the patient? the Evidence). The priority concern for the nurse would be safety
A) Monitor food intake for levels of tyramine. for the patient. Severe headache and reactions to tyramine-con-
B) Assess for weight loss and difficulty sleeping. taining foods are associated with monoamine oxidase therapy.
C) Monitor the patient for severe headaches. Weight loss and difficulty sleeping are of a lower priority concern
D) Implement suicide precautions. than the patients safety.
What drug, if prescribed for the patient, would indicate the need
B ~ Venlafaxine is used to treat and prevent depression in gener-
to assess the patient for depression characterized by anxiety and
alized anxiety disorder, social anxiety disorder; it also diminishes
addictive behaviors?
addictive behavior. Fluvoxamine is a selective serotonin reuptake
A) Imipramine (Tofranil)
inhibitor, tranylcypromine is a monoamine oxidase inhibitor, and
B) Venlafaxine (Effexor)
imipramine is a tricyclic antidepressant that are not indicated for
C) Fluvoxamine (Luvox)
treatment of anxiety disorder and addictive behavior.
D) Tranylcypromine (Parnate)
A patient receives a new prescription for fluvoxamine (Luvox).
What will the nurse instruct the patient about taking the medica-
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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
NCLEX
Study online at https://quizlet.com/combine/141615261,300516839
tion?
A) Take medication after eating breakfast. D ~ Fluvoxamine is a selective serotonin reuptake inhibitor that
B) Take medication with at least 8 ounces of liquid. should be taken once a day before bedtime. The medication does
C) The dosage may need to be increased if the patient is not not require 8 ounces of fluid for absorption. It should be taken for
feeling better in 2 weeks. at least 4 weeks before a therapeutic effect is noted.
D) The medication should be taken once a day before bedtime.
The patient presents to the emergency department with a
headache in the back of the head, palpitations, neck stiffness,
nausea, vomiting, sweating, dilated pupils, tachycardia, and chest
A ~ MAOIs have several serious adverse effects that can be fatal.
pain. Blood pressure measures 180/124 and heart rate is 168
This patients symptoms indicate fatal hypertensive crisis charac-
beats per minute. The spouse says the only medication he takes
terized by occipital headache, palpitations, neck stiffness, nau-
is something for depression but she does not know the name
sea, vomiting, sweating, dilated pupils, photophobia, tachycardia,
of the drug and the patient is also unable to supply the name.
and chest pain. It may progress to intracranial bleeding and fatal
What classification of antidepressant does the nurse suspect this
stroke. SSRIs and TCAs are not associated with these particular
patient is taking?
symptoms. Antianxiety antidepressants are not a classification of
A) Monoamine oxidase inhibitors (MAOIs)
antidepressants.
B) Selective serotonin reuptake inhibitors (SSRIs)
C) Tricyclic antidepressants (TCAs)
D) Antianxiety antidepressants
Obsessive-compulsive disorder (OCD) is a disorder that remains
under investigation as to its actual neurophysiology. What tricyclic
antidepressant is now approved by the Food and Drug Adminis-
A ~ Clomipramine is now also approved for use in the treatment of
tration to treat OCD?
OCD. Imipramine, nortriptyline, and amitriptyline are not approved
A) Clomipramine
for use in treating OCD.
B) Imipramine
C) Nortriptyline
D) Amitriptyline
A, B, C ~ When caring for a patient with a diagnosis of depression
it is always important for the nurse to assess for recent suicide
attempts, suicidal ideation, and any suicidal plans. After starting
The nurse interviews the family of a patient hospitalized with
the medication, as the patient begins to feel better, risk of suicide
severe depression who is prescribed a tricyclic antidepressant.
increases, so ongoing assessment is essential to the patients
What assessment data are important in planning this patients plan
safety. Other assessments include allergies, liver and kidney func-
of care? (SATA)
tion, glaucoma, benign prostatic hypertrophy, cardiac dysfunction,
A) Recent suicide attempts
GI obstruction, surgery, or recent myocardial infarction, all of
B) Gastrointestinal (GI) obstruction
which could be exacerbated by the effects of the drug. Assess
C) Affect
history of psychiatric problems, or myelography within the past 24
D) Physical pain
hours or in the next 48 hours, or is taking a monoamine oxidase
E) Personal responsibilities
inhibitor to avoid potentially serious adverse reactions. Physical
pain and personal responsibilities may be assessed but are not
priority assessments unless indicated by other diagnoses.
A ~ Fluvoxamine is indicated for the treatment of OCD and is clas-
A patient is admitted to the unit with obsessive-compulsive disor- sified as a selective serotonin reuptake inhibitor (SSRI). SSRIs
der (OCD). What drug might the nurse administer that has been are indicated for the treatment of depression, OCD, panic attacks,
found to be effective for treating OCD? bulimia, premenstrual dysphoria disorder, posttraumatic stress
A) Fluvoxamine disorder, social phobias, and social anxiety disorders. Phenelzine
B) Phenelzine is indicated for depression not responsive to other agents. De-
C) Desipramine sipramine and amitriptyline are tricyclic antidepressants indicated
D) Amitriptyline for treatment of depression especially if accompanied by anxiety
or sleep disturbances.
The patient has been severely depressed since her father died
B ~ Caution should be used with tricyclic antidepressants in
6 months ago. The physician has prescribed amitriptyline. The
patients with preexisting cardiovascular (CV) disorders because
nurse reviews the patients chart before administering the med-
of the cardiac stimulatory effects of the drug and with any condition
ication. What preexisting condition would require cautious use of
that would be exacerbated by the anticholinergic effects (e.g.,
this drug?
angle-closure glaucoma, urinary retention, prostate hypertrophy,
A) Osteosarcoma
GI or genitourinary surgery). There is no indication that caution is
B) Cardiovascular disorders
needed with patients diagnosed with osteosarcoma, closed head
C) Closed head injury
injury, or bleeding ulcer.
D) Bleeding ulcer

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
NCLEX
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B, C, E ~ MAOIs can cause drug-drug and drug-food interactions,
What priority teaching point does the nurse include in the teaching
which can precipitate cardiovascular effects that include ortho-
plan for a patient on a monoamine oxidase inhibitor (MAOI)?
static hypotension, arrhythmias, palpitations, angina, and the po-
(SATA)
tentially fatal hypertensive crisis. Priority teaching points include
A) Take medication at bedtime.
monitoring blood pressure which will elevate with tyramine inges-
B) Monitor blood pressure.
tion and the importance of not taking any OTC without physician
C) Do not take over-the-counter (OTC) drugs without talking to
or pharmacist consultation due to multiple drug-drug interactions.
physician.
When taking an MAOI, you would not necessarily take the drug at
D) Report double vision right away
bedtime or drink lots of fluid. Blurred, but not double, vision is an
E) Reduce tyramine intake
adverse effect of an MAOI.
A patient with severe depression has been hospitalized and the
B, C, D ~ Use of tricyclic antidepressants may lead to GI
physician has ordered amitriptyline. What common adverse effect
anticholinergic effects, such as dry mouth, constipation, nau-
will the nurse monitor and assess the patient for? (SATA)
sea, vomiting, anorexia, increased salivation, cramps, and diar-
A) Fever
rhea. Cardiovascular effects (e.g., orthostatic hypotension, hyper-
B) Myocardial Infarction
tension, arrhythmias, myocardial infarction, angina, palpitations,
C) Stroke
stroke) may occur. Fever and gynecomastia are not normally
D) Dry mouth
attributed to amitriptyline therapy.
E) Gynecomastia
ELAVIL

What is the BRAND NAME for AMITRIPTYLINE?

CELEXA

What is the BRAND NAME for CITALOPRAM?

LEXAPRO

What is the BRAND NAME for ESCITALOPRAM?

PROZAC

What is the BRAND NAME for FLUOXETINE?

NARDIL

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
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What is the BRAND NAME for PHENELZINE?

MARPLAN

What is the BRAND NAME for ISOCARBOXAZID?

PARNATE

What is the BRAND NAME for TRANYLCYPROMINE?

ATIVAN

What is the BRAND NAME for LORAZEPAM?

What is the THERAPEUTIC LEVEL for LITHIUM? 0.6-1.2

What is the BRAND NAME for OLANZAPINE?

SEROQUEL

What is the BRAND NAME for QUETIAPINE?

ABILIFY

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 Anti-Psychotic Drugs, Antipsychotics, Anxiolytics & Antidepressants
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What is the BRAND NAME for ARIPIPRAZOLE?

RISPERDAL

What is the BRAND NAME for RISPERIDONE?

GEODON?

What is the BRAND NAME for ZIPRASIDONA?

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