Holland/Adams/Brice, Core Concepts in Pharmacology 5th Edition Test Bank
Chapter 11

Question 1

Type: MCMA

The nurse is caring for a client with depression. The nurse recognizes which assessment findings to be symptoms of depression? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Lack of energy
2. Sleep disturbances
3. Feelings of despair
4. Increased energy
5. Euphoria

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 141

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-1 Explain the situational and biological causes of major depressive disorder.

Question 2

Type: MCSA

The nurse is caring for a client diagnosed with bipolar disorder who is exhibiting the following symptoms: insomnia, exaggerated confidence, attention seeking, and easily agitated. Based on these symptoms, what does the nurse believe these symptoms are caused by?

1. Overdose of barbiturates
2. Mania
3. Side effects of lithium (Eskalith)
4. Depression

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Page Number: 152

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-4 Identify symptoms of bipolar disorder and extreme mania.

Question 3

Type: MCSA

The client asks the nurse what causes depression. What is the best answer by the nurse?

1. “There are many causes, including genetics, hormone changes, grief, substance abuse, and prescription drugs.”
2. “Most people are not really depressed. They are just looking for attention.”
3. “The main cause of depression is substance abuse.”
4. “Most people who are depressed suffer from seasonal affective disorder.”

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 140

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-1 Explain the situational and biological causes of major depressive disorder.

Question 4

Type: MCSA

A client is being treated for reoccurring severe depressive illness. The nurse expects the client to receive which type of treatment?

1. Grief counseling
2. Medication and psychotherapy
3. Medication only
4. Psychotherapy only

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 142

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-2 Discuss the pharmacologic management and psychotherapeutic approaches to treatment of severe depression.

Question 5

Type: MCSA

The physician has ordered a tricyclic antidepressant for a client with biological depression. The nurse expects to find which medications to be ordered for the client?

1. Amitriptyline (Elavil)
2. Citalopram (Celexa)
3. Duloxetine (Cymbalta)
4. Fluoxetine (Prozac)

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 144

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 6

Type: MCSA

The nurse is performing an assessment on a client who has been taking a tricyclic antidepressant for several weeks. Which common adverse effect of tricyclic antidepressants is most likely to occur?

1. Dry mouth
2. Bradycardia
3. Sedation
4. Orthostatic hypotension

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 146

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 7

Type: MCSA

The nurse is providing care to a client who is diagnosed with depression. The client asks the nurse which medication she is likely to be prescribed. What has become the drug of choice in treating depression?

1. SSRIs
2. MAOIs
3. SNRIs
4. TCAs

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 144

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 8

Type: MCSA

Which teaching instruction is most appropriate for a client who has just been prescribed an SSRI?

1. The full therapeutic effect takes one month.
2. Take the medication at bedtime.
3. The depression should improve immediately.
4. There are few side effects of SSRIs.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 150

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 9

Type: MCMA

Which teaching points should the nurse include for a client who has been prescribed an SSRI? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Add dietary fiber
2. Drink adequate amounts of fluid
3. Avoid laxatives
4. Restrict fluid intake
5. Avoid stool softeners

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 151

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 10

Type: MCMA

A child diagnosed with ADHD would likely exhibit which symptoms? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Able to focus on a task for an extended period of time
2. Impulsiveness
3. Excessive talking
4. Easily distracted
5. Violent behavior

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Page Number: 154

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-6 Identify symptoms of ADHD.

Question 11

Type: MCSA

The client receives amitriptyline (Elavil). What is a priority teaching point at discharge?

1. Do not rapidly stand up or change positions.
2. Begin a low-carbohydrate diet.
3. Avoid green, leafy vegetables.
4. Do not take aspirin with this drug.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 146

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 12

Type: MCSA

The client receives paroxetine (Paxil), and tells the nurse that sexual dysfunction has become a problem. What is the best response by the nurse?

1. “This side effect usually subsides in a few months.”
2. “This is common. Please discuss it with your physician.”
3. “Your depression is of primary concern right now.”
4. “You should stop the medication right away.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 145

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 13

Type: MCSA

The client receives sertraline (Zoloft) and lithium. Which assessment data are most indicative of a potentially serious complication?

1. Fever and lack of muscular coordination
2. Dry mouth and constipation
3. Anxiety and insomnia
4. Nausea and headache

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 145

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 14

Type: MCMA

The client receives phenelzine (Nardil). Which dietary components would indicate the best planning by the nurse and client? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Tomato soup
2. Avocado salad
3. Grilled chicken breast
4. Bologna sandwich
5. Wine and beer, in moderation

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 148

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 15

Type: MCMA

The nurse evaluates a client taking a high daily dose of duloxetine (Cymbalta) for which signs and symptoms? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Suicidal ideation
2. Increased libido
3. Liver failure
4. Seizures
5. Hypotension

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 146

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 16

Type: MCSA

A client has just begun therapy with lithium (Eskalith). The nurse notices the serum level of lithium for this client is 1.3 mEq/L. What is the normal range of lithium?

1. 1.5–3.0 mEq/L.
2. 0.6–1.5 mEq/L.
3. 3.0–4.5 mEq/L.
4. 0.1–0.6 mEq/L.

Cognitive Level: Remembering

Client Need: Physiological Integrity

Page Number: 153

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-5 Discuss the pharmacologic management of severe depression and when patients display extreme shifts to mania.

Question 17

Type: MCSA

A client receiving lithium (Eskalith) for bipolar disorder would be at risk for increased lithium toxicity if it were prescribed with which other medication?

1. Potassium citrate
2. There are no drug interactions with lithium (Eskalith)
3. Diuretics
4. Sodium bicarbonate

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 153

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-5 Discuss the pharmacologic management of severe depression and when patients display extreme shifts to mania.

Question 18

Type: MCMA

A client is taking St. John’s wort and an SSRI. The nurse observes the client for which symptoms? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Mania
2. Confusion
3. Renal failure
4. Tachycardia
5. Hypotension

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 157

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 19

Type: MCSA

The nurse is caring for a client who has not responded to several antidepressant drugs. The nurse expects the physician to order which classification of medication for this client?

1. SNRI
2. TCA
3. SSRI
4. MAOI

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 148

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 20

Type: MCSA

The nurse instructs the client receiving MAOIs to avoid which item?

1. Avocado
2. Baked chicken
3. Cottage cheese
4. Apple

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 149

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 21

Type: MCSA

A child has been ordered the most commonly prescribed medication for ADHD. What medication does the nurse expect?

1. Clonidine (Kapvay)
2. Methamphetamine (Desoxyn)
3. Methylphenidate (Ritalin)
4. Sertraline (Zoloft)

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 155

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 11-7 Discuss CNS stimulants and nonstimulant drugs for ADHD.

Question 22

Type: MCSA

The client is in a manic phase of bipolar disorder, and is receiving lithium. What will the nurse expect to assess when the client’s lithium level is 0.3 mEq/L?

1. Sleepiness
2. Calm behavior
3. Relaxed appearance
4. Hyperactivity

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 152

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-4 Identify symptoms of bipolar disorder and extreme mania.

Question 23

Type: MCSA

The mother of an 8-year-old client who is receiving methylphenidate (Ritalin) tells the nurse the child has not slept well since being started on this drug. Which assessment question is a priority for this client?

1. “Is your child having problems at school?”
2. “Do you give the medication with food?”
3. “Does your child have sleep apnea?”
4. “What time do you give your child the medication?”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Numbers: 155 and 157

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-7 Discuss CNS stimulants and nonstimulant drugs for ADHD.

Question 24

Type: MCSA

Which statement is priority teaching at the time of discharge for the client who receives imipramine (Tofranil)?

1. “You will need to maintain a low-fat diet while on this medication.”
2. “You must maintain a normal intake of salt while on this medication.”
3. “Please notify your healthcare provider of any changes in urine quantity or quality.”
4. “You can stop the medication when you are no longer feeling depressed.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 147

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 25

Type: MCSA

The client is prescribed phenelzine (Nardil). The client tells the nurse that they consumed two glasses of Chianti wine at lunchtime. What is the nurse’s priority action?

1. Assess the client’s blood pressure.
2. Discuss the effects of wine on the action of antidepressants.
3. Arrange for admittance to the psychiatric unit.
4. Discuss how food can increase the symptoms of depression.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 149

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-3 Explain the antidepressant drug classes and how they restore chemical imbalances of neurotransmitters in the brain.

Question 26

Type: MCSA

The nurse has been doing medication education for the client receiving lithium (Eskalith). Which statement by the client indicates that teaching has been effective?

1. “I need to call my physician if I excessively sweat during exercise.”
2. “I need to restrict my intake of salt while I am taking lithium.”
3. “I don’t need to have my blood checked anymore after I leave the hospital.”
4. “I can stop taking my lithium when my moods are stable.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 153

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 11-5 Discuss the pharmacologic management of severe depression and when patients display extreme shifts to mania.

Question 27

Type: MCMA

Which are treatment interventions used in severe depression? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Cognitive-behavioral therapies

2. Electroconvulsive therapies

3. Long-term hospitalization

4. Transcranial magnetic stimulation

5. Medications

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 142

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-2 Discuss the pharmacologic management and psychotherapeutic approaches to treatment of severe depression.

Question 28

Type: MCSA

The nurse is caring for a client prescribed atomoxetine (Strattera) for ADHD. The client asks how this medication helps with the ADHD. Which is the nurse’s best response?

1. The medication will decrease capability to complete assigned work.

2. The medication will increase ability to focus on tasks and reduce hyperactivity.

3. The medication will stimulate the heart rate and blood pressure.

4. The medication will dull the effects of the stress.

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Page Number: 156

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 11-6 Identify symptoms of ADHD.