Chapter 5: Mood and Cognition Medications Answer Key

You can review additional information regarding these answers in the corresponding section in which the Critical Thinking activities appear.

5.4 CNS Depressants

2. Lorazepam is a benzodiazepine, which is a CNS depressant.  The riskiest side effects associated with the use of lorazepam are respiratory depression and oversedation. Other central nervous system depressants, such as scopolamine and alcohol, can cause additive effects and should be avoided when taking lorazepam.  Sedation, drowsiness, respiratory depression, hypotension, and unsteadiness may occur when taking lorazepam, so these side effects should be considered when participating in activities on the cruise.
3. Flumazenil IV will be given in incremental doses until the client is more awake. Supportive care will include airway management, oxygen and fluids as needed until the client is awake and responsive, and breathing well. Lab work would include a toxicology screen to determine what other substances may have been ingested.  Once stabilized, mental health supports will need to be implemented.
4. After administration, monitor vital signs such as BP and HR. Anticipate hypotension. Monitor RR and oxygen sats and ensure airway is supported with positioning and oxygen if needed. Assess sedation level and anticipate the client will be drowsy. Implement fall risk precautions to avoid a fall. Assess seizure activity including the duration and characteristics.  Avoid giving other sedative type medications.

5.5 CNS Stimulants

Client and parent education about methylphenidate should include taking the medication in the morning and not after 4 p.m.  It is important to monitor the child’s growth and weight and to provide food and snacks that the child likes if weight loss is a concern.  Methylphenidate has a Black Box Warning due to its high abuse potential, and signs of misuse should be reported to the provider.  The risks of drinking alcohol while taking this medication should also be discussed.

5.6 Antidepressants

Learning Activity 1

1. a. A client taking an SSRI medication like fluoxetine is at risk for developing serotonin syndrome if they have liver dysfunction or are taking other serotonergic medications. Other serotonergic meds include other antidepressants such as SNRIs, MAOIs or TCAs. Other meds include pain meds such as tramadol, fentanyl or other meds such as lithium. Symptoms of serotonin syndrome begin with mild symptoms, that includes nausea, anxiety, tremor and sweating, and can progress to include confusion, elevated temperature, and rapidly changing levels of blood pressure.

1. b.The nurse should advise the client of the potential for suicidal thoughts with this medication and advise her to notify her provider if she has any thoughts of self-harm.

1.c. Common side effects of SSRIs that the nurse should discuss with the client include sedation, low blood pressure that can cause dizziness, suicidal thoughts, heart palpitations, sexual dysfunction, and anticholinergic side effects such as dry mouth.  Clients should be advised to avoid drinking alcohol when taking an SSRI.

1.d. The nurse should advise the client that it may take up to 12 weeks to reach therapeutic levels of this medication where they feel better.

2. Patient Education – Venlafaxine and Sleep. You can provide the following education:

• Timing of venlafaxine:
  Venlafaxine ER can be activating for some individuals. Taking it at bedtime may contribute to insomnia.
  → It may be helpful to take venlafaxine in the morning instead.
  → Morning dosing may also improve daytime fatigue and anhedonia.
• Other nursing interventions
  • Keeping a sleep diary to monitor patterns
  • Reviewing sleep hygiene strategies
• Ongoing risk assessment:
  Although the patient denies active suicidal intent or plan this requires ongoing assessment.

3. Aripiprazole, a 2nd generation antipsychotic medication, may be used to augment their current medication regime for treatment resistant depression.

5.7 Mood Stabilizers

1. The nurse should explain that symptoms of manic episodes include rapid speech, hyperactivity, reduced need for sleep, poor judgment, hostility, aggression, decreased impulse control, and risky behaviors.  For more information about mania and bipolar disorder, review the “Disorders of the CNS System” section.
2. Symptoms of lithium toxicity include diarrhea, vomiting, drowsiness, muscular weakness, and a lack of coordination. At higher lithium levels, giddiness, ataxia, blurred vision, tinnitus, and a large output of dilute urine may be seen. Lithium toxicity is prevented by regularly monitoring serum lithium levels to maintain a therapeutic range between 0.6 to 1.2 mmol/L. [1]
3. The nurse should advise the client that lithium reaches therapeutic range within 1 to 3 weeks.

5.8 Antipsychotics

1. Answer A There is a risk of neutropenia, and in severe cases agranulocytosis. Routine blood work is ordered to monitor their white cell count.

Why the other answers are incorrect:

Answer B – incorrect – Blood tests are not routinely done to monitor clozapine blood levels unless there is a specific concern, so this is not the main reason for frequent lab work.

Answer C – incorrect – Clozapine does not commonly cause electrolyte changes that require routine monitoring, so this is not the primary reason for frequent blood tests.

Answer D – incorrect – Blood tests cannot measure changes in neurotransmitters to determine how well clozapine is working, so this is not an accurate reason.

2. Answer B. Clozapine is associated with a potentially life-threatening adverse effect—agranulocytosis, which most commonly occurs within the first few months of treatment. Fever and chills in a patient taking clozapine are red-flag symptoms that may indicate severe neutropenia or agranulocytosis with infection.

Because agranulocytosis can progress rapidly and lead to sepsis, the patient requires urgent medical evaluation, including immediate CBC with differential and clinical assessment. Delaying evaluation or managing the symptoms conservatively would place the patient at significant risk.

Why the other options are incorrect:

• A. Flu-like symptom counseling alone is inappropriate because fever in a patient on clozapine must be assumed to be agranulocytosis until proven otherwise.
• C. Advising blood work “tomorrow” delays potentially life-saving evaluation; this situation warrants immediate assessment.
• D. Stopping clozapine without urgent medical evaluation is unsafe; the priority is to rule out agranulocytosis and treat any infection, not simply reschedule.

5.9 Anticonvulsants

1. Gabapentin is classified as an anti-seizure medication, but it is also used to help relieve neuropathic pain that clients with diabetes often describe as a “burning” or “tingling” sensation in their lower extremities.
2. Gabapentin is a CNS depressant and can cause sedation, dizziness, and ataxia that increase a client’s risk for falls.
3. The nurse should plan to monitor for worsening depression, suicidal ideation, fever, rash, lymphadenopathy, dizziness, sleepiness, stumbling, and a lack of coordination.  Development of any of these signs should be reported to the provider; suicidal ideation requires urgent notification.

5.10 Anti-Parkinson’s

1. Levodopa, the metabolic precursor of dopamine, crosses the blood-brain barrier and is then converted to dopamine in the brain. Carbidopa is combined with levodopa to help prevent the breakdown of levodopa before it is able to cross the blood-brain barrier.
2. Clients taking carbidopa and levodopa have reported suddenly falling asleep without prior warning of sleepiness while engaged in activities of daily living, including operation of motor vehicles. Clients should be advised to exercise caution while driving or operating machines during treatment with carbidopa and levodopa.
3. Dyskinesia is involuntary muscle movements including tics. If a client develops dyskinesia while taking carbidopa-levodopa, dosing adjustment or alternate drug therapy is required.