Antipsychotics

After taking chlorpromazine (Thorazine) for 1 month, a client presented to the emergency department with severe muscle rigidity, tachycardia, and a temperature of 105. The nurse expects the physician to recognize which condition and implement which treatment. 1. Neuroleptic malignant syndrome and treated by d/c Thorazine and administering dantrolene (Dantrium) 2. Neuroleptic malignant syndrome and treated by increasing Thorazine dosage and administering an antianxiety medication 3. Dystonia and treated by administering trihexyphenidyl (Artane) 4. Dystonia and treat by administering bromocriptine (Parlodel)

1 The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? 1. Temperature of 104 2. Respirations of 22 3. Weight gain of 8 pounds in 2 months 4. Excessive salivation

1 When assessing a client diagnosed with schizophrenia who takes an antipsychotic medication daily, the nurse should immediately address a temperature of 104. A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

The nurse notes that a client with schizophrenia is receiving an antipsychotic medication and is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medical complication. 1. Parkinsonism 2. Tardive dyskinesia 3. Hypertensive crisis 4. Neuroleptic malignant syndrome

2 Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, mask-like facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of MOAI and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by the nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths" 2. "Watch your diet and try to engage in some regular exercise" 3. "Rise slowly when you change position from lying to sitting or from sitting to standing" 4. "Wear sunscreen and try to avoid midday sun exposure"

3 The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic and beta-blocker medications can decrease blood pressure leading to orthostatic hypotension.

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address the type of symptom? 1. Haloperidol (Haldol) to address the negative symptom 2. Clonazepam (Klonopin) to address the positive symptom 3. Risperidone (Risperdal) to address the positive symptom 4. Clozapine (Clozaril) to address the negative symptom

3 The nurse should expect the physician to order Risperidone to address the positive symptoms of schizophrenia. Risperidone is an atypical antipsychotic medication used to reduce positive symptoms, including disturbances in the content of thought, form of thought, and sensory perception.

The nurse is speaking to a group at the senior citizen's center about Parkinson's disease and explains the importance of avoiding what when taking an anticholinergic medication? a. Strenuous exercise in high environmental temperature b. Fluids high in potassium c. Foods high in Vitamin K d. Anything containing red dye

A Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal temperature as this could result in fever and heatstroke. Elderly people taking anticholinergic drugs do not need to avoid fluids high in potassium, foods high in vitamin K, or anything containing red dye.

A patient is newly diagnosed with parkinsonism. Parkinsonism, which may occur in association with long-term use of antipsychotics, can be treated with what drug type? a. Anticholinergic agents b. Monoamine oxidase inhibitors (MAOIs) c. Synthetic antiviral agents d. Dopaminergic drugs

A Anticholinergic drugs that are centrally active are useful in treating parkinsonism. MAOIs, synthetic antiviral agents, and dopaminergic agents are not used to treat parkinsonism so they are incorrect

The expected outcome for a patient taking benztropine as drug therapy for Parkinson's disease would be what? a. Decrease in rigidity b. Decrease in light-headedness c. Decrease in disorientation d. Decrease in flushing

A Benztropine should cause a decrease in rigidity. Light-headedness, disorientation, and flushing are all adverse effects of benztropine and can be expected with a patient taking this drug.

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in white blood cells can occur.)

A patient asks the nurse why a second drug is given with his drugs for Parkinson's disease. The nurse notes that this drug, an anticholinergic, is given to control or minimize which symptoms? (Select all that apply) A. Drooling B. Constipation C. Muscle rigidity D. Bradykinesia E. Dry mouth

A,C

The expected side effects of the anticholinergic drugs used to treat Parkinson's disease include (Select all that apply) A. dry mouth and decreased salivation B. urinary retention C. decreased GI motility and constipation D. pupillary constriction E. smooth muscle relaxation

ABCE

A 10-year-old boy has been prescribed an antiparkinsonian drug. Which drug would the nurse expect as the first choice for this child? a. Benztropine (Cogentin) b. Diphenhydramine (Benadryl) c. Trihexyphenidyl (Artane) d. Procyclidine (Kemadrin)

B

A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril) is concerned about side effects. What information will the nurse include when teaching the patient about this medication? a. "You are more likely to experience dry mouth, constipation, and urinary retention." b. "You may experience weight gain, drowsiness, and headaches." c. "You will not experience extrapyramidal side effects with this medication." d. "You will not need frequent lab work while taking this medication."

B

A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take? a. Notify the provider and request orders for creatinine clearance and BUN levels. b. Reassure the patient that this is a harmless side effect of this medication. c. Tell the patient to come to the clinic for a urinalysis. d. Tell the patient to discard any drug on hand and request a new prescription.

B

A schizophrenic client will be discharged on an antipsychotic medication. The nurse should include all of the following in the teaching plan EXCEPT: a. avoid excessive exposure to sunlight. b. eliminate cheese and chocolate from the diet. c. immediately report chills and sore throat. d. continue the medication exactly as prescribed.

B

The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching? a. "I should not drink alcohol while taking this medication." b. "I should use a heating pad to treat muscle spasms while taking this medication." c. "I should use sunscreen while taking this medication." d. "I will need frequent blood tests while taking this medication."

B

The nurse notes that a client with schizophrenia and receiving an antipsychotic medicine is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? a. Parkinsonism b. Tardive dyskinesia c. Hypertensive crisis d. Neuroleptic malignant syndrome

B

What class of drug is quetiapine? a. Norepinephrine reuptake inhibitor b. Atypical antipsychotic c. Serotonin antagonist and reuptake inhibitor (SARI) d. Tricyclic antidepressant

B

A patient, newly diagnosed with Parkinson's disease, has been prescribed an anticholinergic drug. What common adverse effect of anticholinergic agents used for the treatment of Parkinson's disease will the nurse share with the patient? a. Blood dyscrasias b. Diaphoresis c. Memory loss d. Diarrhea

C Most people diagnosed with Parkinson's disease are older adult men so it is important for the nurse to warn the patient that memory loss may occur to reduce anxiety the patient may experience with this adverse effect. Blood dyscrasias are not associated with these drugs. Constipation is more likely than diarrhea and lack of sweating rather than diaphoresis is associated with anticholinergics.

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

C. (When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.)

During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

D

The nurse is administering risperidone (Risperdal) to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? a. Get adequate sunlight b. Continue driving as usual c. Avoid foods rich in potassium d. Get up slowly when changing positions

D

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? a. Platelet count b. Blood glucose level c. Liver function study d. White blood cell count

D A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 mm3 (3x109/L). Agranulocytosis could be fatal if undetected and untreated. The other lab studies are not related specifically to the use of this medication.

The nurse is administering risperidone to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? a. Get adequate sunlight b. Continue driving as usual c. Avoid foods rich in potassium d. Get up slowly when changing positions

D Risperidone can cause orthostatic hypotension. Sunlight should be avoided by the client taking this medication. With any psychotropic medication, caution needs to be taken (such as driving or other activities requiring alertness) until the individual can determine whether their level of alertness is affected. Food interaction is not a concern.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

a. (The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.)