Introduction to Clinical Pharmacology

9th Edition Visovsky Test Bank

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Chapter 10: Drug Therapy for Mental Health
Visovsky: Introduction to Clinical Pharmacology, 9th Edition

MULTIPLE CHOICE

1. Which drug category is useful in promoting sleep among patients with insomnia?
a. Sedatives
b. ACE inhibitors
c. Atypical antipsychotics
d. Selective serotonin reuptake inhibitors
ANS: A
Sedatives are drugs that have the main purpose of promoting sleep by changing signals in
the central nervous system and reducing responses to stimulation.

DIF: Cognitive Level: Knowing REF: p. 184

2. You are preparing to give the benzodiazepine Valium to a patient as a premedication before
surgery. The patient asks you how this drug works. What is your best response?
a. “This drug works by binding to receptors acting with GABA to induce sleep.”
b. “This drug is acts by preventing binding to the benzodiazepine receptors.”
c. “This drug acts by inhibiting GABA responses to relax muscles.”
d. “This drug acts by binding to opioid receptors.”
ANS: A
Benzodiazepines are sedating hypnotic drugs that depress the CNS by binding to
benzodiazepine (BNZ) receptors that act with gamma-aminobutyric acid (GABA) receptors
to enhance GABA effects, resulting sleep and muscle relaxation.

DIF: Cognitive Level: Applying REF: p. 186

3. You are caring for a patient in the clinic setting who has been taking a benzodiazepine
alprazolam (Xanax) for anxiety. What potential problem should you observe this patient
for?
a. Seizure activity
b. Addiction
c. Insomnia
d. Anorexia
ANS: B
The benzodiazepines have a higher risk for addiction and dependency than do the
nonbenzodiazepines. They also carry a black box warning for central nervous system
depression. Overdoses are possible and serious.

DIF: Cognitive Level: Understanding REF: p. 185

4. Which drug would you anticipate will be given to a patient who experienced an overdose of
a benzodiazepine?
a. Rifampin
 b. Naloxone
c. Flumazenil
d. Epinepherine
ANS: C
The drug flumazenil (Romazicon) is a benzodiazepine receptor antagonist and is an antidote
used to reverse an overdose of either a benzodiazepine sedative or a nonbenzodiazepine
sedative. For adults, it is given intravenously with an initial dose of 0.2 mg. If there is no
response after 45 seconds, the dose can be repeated. After that, it can be repeated every
minute for a total of 4 doses.

DIF: Cognitive Level: Knowing REF: p. 187

5. For which patient would benzodiazepines be contraindicated?

a. A female with breast cancer.
b. A woman who is 20 weeks pregnant.
c. A male who has a history of smoking.
d. A male who is about to undergo surgery.
ANS: B
Pregnancy is an absolute contraindication for the benzodiazepines because they have a high
risk for causing birth defects. Although the chemical structure of the nonbenzodiazepines
(benzodiazepine agonists) is different, these drugs bind to the same receptors and have
similar actions. As a result, they are not recommended during pregnancy.

DIF: Cognitive Level: Applying REF: p. 185

6. What specific information should be part of the teaching plan for a patient taking a
nonbenzodiazepine sedative?
a. These drugs can interact with many foods and beverages.
b. These drugs can cause you to be physically active at night.
c. These drugs must be takes for at least 6 weeks to see any effects.
d. Excess caffeine intake can work to increase the effectiveness of these drugs.
ANS: B
When taking a nonbenzodiazepine (benzodiazepine agonist), be aware that drugs from this
class can cause you to be physically active at night, even going for a drive, without your
knowledge or memory of the event. It is best to have a family member or friend watch out
for these effects when you first start taking the drug.

DIF: Cognitive Level: Applying REF: p. 186

7. You are preparing to teach a patient with anxiety disorder about the actions of the
nonbenzodiazepine drug buspirone. What would you inform the patient about how this drug
works?
a. “Buspirone acts by affecting the serotonin and dopamine neurotransmitters.”
b. “Buspirone acts by inhibiting GABA pathways to decrease anxiety.”
c. “Buspirone acts by affecting the monoamine oxidase pathway.”
d. “Buspirone acts by inhibiting the action of dopamine receptors.”
ANS: A
 A newer drug from the nonbenzodiazepine class, buspirone, reduces anxiety through a
variety of actions affecting the serotonin and dopamine neurotransmitters.

DIF: Cognitive Level: Applying REF: p. 187

8. Which drug is classified as a benzodiazepine?

a. Lorazepam (Ativan)
b. Buspirone (BuSpar)
c. Benztropine (Cogentin)
d. Chlorpromazine (Thorazine)
ANS: A
Lorazepam (Ativan) is a benzodiazepine.

DIF: Cognitive Level: Knowing REF: p. 186

9. The family members of a patient admitted for hallucinations and delusions tells you that the
patient is currently taking chlorpromazine (Thorazine) for the treatment of schizophrenia.
Which statement about this drug is true?
a. Throazine is associated with a higher risk of extrapyramidal symptoms.
b. Thorazine relieves anxiety symptoms associated with schizophrenia.
c. Thorazine is used for acute schizoaffective disorders.
d. Thorazine is used for chronic mental illness.
ANS: D
Typical antipsychotics, such as Thorazine, are more commonly used for long-term
management of chronic mental illnesses associated with psychosis.

DIF: Cognitive Level: Understanding REF: p. 190

10. The family of a patient who has been taking the antipsychotic fluphenazine (Prolixin) for the
last 2 years. The patient’s family reports the patient has suddenly begun smacking her lips,
and involuntarily sticking out her tongue. What would be your best first action?
a. Call the healthcare provider to report these symptoms.
b. Tell the family to hold the next dose of fluphenazine.
c. Inform the family that these symptoms are expected, and of no concern.
d. Tell the family that these symptoms will disappear over time as the drug dose
stabilizes.
ANS: A
The main adverse effects of typical antipsychotics are extrapyramidal symptoms (EPS),
related to the decrease in dopamine, many are severe and some may be irreversible so it is
important to recognize very early in treatment. The healthcare provider should be called
immediately, and often, the drug is discontinued.

DIF: Cognitive Level: Applying REF: p. 193

11. You are about to begin teaching a patient with a psychosis about taking typical antipsychotic
drugs. Which of the following statements would you include in your teaching plan?
a. “Do not abruptly stop taking this drug.”
 b. “Take these drugs with a glass of grapefruit juice.”
c. “Take these drugs at night with your sleep drug.”
d. “You will experience the effects of these drugs within 30 minutes of taking them.”
ANS: A
Continue to take the drugs as prescribed. It may take several weeks before significant
changes occur. Do not suddenly stop taking these drugs as this can result in nausea,
dizziness and tremors. You can take many of these drugs with food to avoid GI upset, but
these drugs can interact with grapefruit juice. Do not drink alcohol or use any sedatives
while using these drugs to prevent deep sedation and other dangerous side effects.

DIF: Cognitive Level: Applying REF: p. 193

12. A patient who has been taking the atypical antipsychotic risperidone (Risperdal) reports
weight gain after taking the drug for 3 months. What would you tell this patient?
a. “Stop this drug immediately.”
b. “Weight gain can be an adverse effect of this drug.”
c. “Weight gain is an expected side-effect of this drug.”
d. “I will notify your healthcare provider, so the drug can be changed.”
ANS: C
For patients taking atypical antipsychotics, weight gain is associated with these drugs.

DIF: Cognitive Level: Applying REF: p. 194

13. You are teaching a patient about the adverse effects associated with selective serotonin
reuptake inhibitors (SSRIs). Which adverse effect would you inform your patient about?
a. Metallic taste.
b. Sexual dysfunction.
c. Cardiovascular disease.
d. Extrapyramidal symptoms.
ANS: B
Expected side effects of SSRI’s include sexual side effects in men and women that include
decreased sex drive and decreased ability to orgasm and erectile dysfunction. Other adverse
effects include nausea (during the first 2 weeks), drowsiness, insomnia, dry mouth,
decreased appetite increased sweating and constipation.

DIF: Cognitive Level: Applying REF: p. 197

14. A patient who has been prescribed a serotonin norepinephrine reuptake inhibitor (SNRI) one
week ago reports that she has not noticed any difference in her depression level since
beginning this drug. What is your best response?
a. “Begin taking two tablets daily to increase blood serum levels.”
b. “Add a tablet of St, John’s Wort to increase the drug’s effects.”
c. “You should call your healthcare provider immediately.”
d. “It may take several weeks for this drug to take effect.”
ANS: D
The patient should see effects within a few weeks of taking the drug, with maximum effects
at 6 to 8 weeks.
 DIF: Cognitive Level: Applying REF: p. 200

15. A young adult patient taking an SSRI for the past 2 weeks comes in for an evaluation and
follow-up appointment. Which potential side effect should you check for in this patient?
a. Suicidal thoughts.
b. Psychotic episodes.
c. Delusional thinking.
d. Schizo-affective disorders.
ANS: A
SSRI’s may cause thoughts of suicide, most likely in children and young adults. Remind the
patients and their families that this is just a side effect of the drug and should be reported to
the healthcare providers immediately.

DIF: Cognitive Level: Applying REF: p. 197

16. Which of the following drugs classifications for the treatment of mental health problems is
contraindicated for patients with vision problems?
a. Antipsychotics.
b. Tricyclic antidepressants.
c. Selective serotonin reuptake inhibitors.
d. Serotonin norepinephrine reuptake inhibitors.
ANS: B
TCAs should not be used in patients with glaucoma because these drugs can increase
intraocular pressure.

DIF: Cognitive Level: Knowing REF: p. 202

17. A patient who has been taking imipramine comes to the clinic for a routine follow-up
appointment. Which of the following assessments would be appropriate to perform?
a. Skin assessment.
b. Hearing assessment.
c. Elimination assessment.
d. Vital signs and weight assessment.
ANS: D
Assess vital signs including baseline weight. TCAs can cause hypotension and weight gain.

DIF: Cognitive Level: Applying REF: p. 202

18. You are caring for a patient who will begin treatment for anxiety and depression that has
been unresponsive to other drugs with isocarboxazid. Which of the following statements
made by the patient would indicate understanding of the teaching related to this drug?
a. “I will take both my isocarboxazid and my SSRI drugs at the same time each day.”
b. “I will avoid situations that cause me to lose fluids and become dehydrated.”
c. “I will avoid eating foods containing tyramine that can increase blood pressure.”
d. “I will take my isocarboxazid weekly, as this drug is long-acting”
ANS: C
 Patients taking MAO-Is risk of hypertensive crisis from taking foods or drinks high in
tyramine. Tyramine is an amino acid that is involved in the release of norepinephrine.
Normally, tyramine is broken down by monoamine oxidases (enzymes). When the patient is
taking an inhibitor of the enzyme (MAO-Is), there is an increase in norepinephrine which
can then significantly increase blood pressure. This can cause sudden and severe
hypertension.

DIF: Cognitive Level: Applying REF: p. 199

19. Which of the following drugs would be appropriate for the treatment of bipolar illness?
a. Lithium
b. Sertoline
c. Alprazolam
d. Chlorpromazine
ANS: A
Lithium is specifically used for patients with bipolar disorder who are in an acute manic
phase.

DIF: Cognitive Level: Knowing REF: p. 205

20. You have just completed teaching with a patient who is beginning lithium. Which of the
following statements made by the patient demonstrates understanding of this drug?
a. “I will need to increase my salt intake while taking this drug.”
b. “I will need regular blood testing while taking this drug.”
c. “I may develop mild memory loss while taking this drug.”
d. “Lithium cannot be taken with tyrosine-containing foods.”
ANS: B
Serum lithium levels need to be monitored frequently while the patient is taking the drug.
Blood levels are checked 4 days after the patient starts taking lithium. Desired level for
acute mania is 0.8 to 1.2 mEq/L. Any levels over 1.5 mEq are considered toxic. Levels >3
mEq/L are associated with coma, organ failure, and even death.

DIF: Cognitive Level: Applying REF: p. 205

21. You are taking the history of a patient who is suspected of having lithium toxicity. What
symptoms would you expect the patient to report?
a. Increased drowsiness, weakness and nausea.
b. Heart palpitations, seizures, and muscle spasm.
c. Decreased urine output, vision loss and irritability.
d. Increased mania, excessive salivation and tachycardia.
ANS: A
Signs and symptoms of lithium toxicity include nausea, vomiting, increased drowsiness,
muscle weakness, severe hand tremor and incoordination. Report these symptoms to the RN
or healthcare provider immediately.

DIF: Cognitive Level: Knowing REF: p. 205

MULTIPLE RESPONSE

1. Which symptoms would you expect a patient who is experiencing mania? (Select all that
apply.)
a. Catatonia
b. CNS depression
c. Increased energy
d. Grandiose notions
e. Poor judgement
f. Excessive sleepiness
ANS: C, D, E
Symptoms of mania include: increased energy, grandiose notions, poor judgement,
increased sexual desire, racing thoughts, irritability, increased energy, inappropriate social
behavior & increased talking

DIF: Cognitive Level: Knowing REF: p. 204

2. What disorders would a selective serotonin uptake inhibitor (SSRI) be prescribed for?
(Select all that apply.)
a. Psychosis.
b. Depression.
c. General anxiety disorder.
d. Traumatic stress disorder.
e. Manic depressive disorder.
f. Obsessive-compulsive disorder.
ANS: B, C, D, F
SSRIs can be used in a variety of conditions including depression, premenstrual dysphoric
disorder (PMDD), posttraumatic stress disorder, obsessive-compulsive disorder, and general
anxiety disorder.

DIF: Cognitive Level: Knowing REF: p. 197

3. Too much serotonin can lead to the adverse effect known as serotonin syndrome. Which of
the following symptoms are associated with serotonin syndrome? (Select all that apply.)
a. Confusion.
b. Restlessness
c. Dilated pupils.
d. Increased sweating.
e. Severe constipation.
f. Extremely high blood pressure.
ANS: A, B, C, D, F
Serotonin syndrome is a potentially life-threatening disorder characterized by confusion,
restlessness, extremely high blood pressure, dilated pupils, increased sweating, seizures and
tremors.

DIF: Cognitive Level: Knowing REF: p. 194

4. You are caring for a patient with schizophrenia who is taking antipsychotic drugs for the
control of hallucinations and delusions. Which symptoms experienced by the patient would
alert you to that the development of neuroleptic malignant syndrome? (Select all that apply.)
a. Pinpoint pupils.
b. Muscle rigidity.
c. Elevated temperature.
d. Unstable blood pressure.
e. Increased white blood count.
f. Extremely low creatinine kinase
ANS: B, C, D, E
Neuroleptic malignant syndrome is a potentially life-threatening condition characterized by
muscle rigidity, elevated temperature, unstable blood pressure, increased white blood cell
count, elevated creatinine kinase and hyperkalemia.

DIF: Cognitive Level: Understanding REF: p. 192

5. You are preparing to teach a patient about the drug amitriptyline. Which of the following
statements should be included in your teaching plan? (Select all that apply.)
a. “Use sugarless gum or candy to relieve dry mouth”.
b. “Keep out of the sun while taking this drug.”
c. “This drug can relieve depression quickly.”
d. “Move slowly when changing positions.”
e. “Avoid ripe cheeses and smoked meats.”
f. “This drug can affect your sleeping.”
ANS: A, B, D, F
TCAs can cause dry mouth, so using sugarless gum, candy or ice ships can help. Sun
sensitivity can occur, so staying out of the sun and the use of sunscreen is recommended.
Orthostatic blood pressure changes can occur, so patients need to be told to change positions
carefully. This drug can cause either drowsiness, or difficulty sleeping.

DIF: Cognitive Level: Applying REF: p. 202