Pharmacology Ch. 17

Symptoms of schizophrenia are thought to be associated with which receptor sites? 1. Dopamine type 2 2. Adrenergic 3. Beta 2 4. Cholinergic

Correct Answer: 1 Rationale 1: Although other receptor sites can be involved, it appears that dopamine type 2 receptors are the most responsible. Rationale 2: There is another site thought to be more responsible for these effects. Rationale 3: There is another site thought to be more responsible for these effects. Rationale 4: There is another site thought to be more responsible for these effects.

The patient is receiving risperidone (Risperdal). During morning assessment, the nurse notes that the patient has a temperature of 102 degrees F. What is the priority nursing intervention? 1. Contact the physician, as this could be a symptom of neuroleptic malignant syndrome. 2. Contact the physician, as this could be a symptom of an acute urinary infection. 3. Contact the physician, as this could be a symptom of a bacterial pneumonia. 4. Contact the physician, as this could be a symptom of extrapyramidal side effects.

Correct Answer: 1 Rationale 1: Neuroleptic malignant syndrome includes symptoms of elevated temperature, unstable blood pressure, profuse sweating, dyspnea, muscle rigidity, and incontinence. Rationale 2: Patients with acute urinary infections do run elevated temperatures; however, when the patient is receiving an antipsychotic drug and runs an elevated temperature, a different condition must be considered first. Rationale 3: Patients with bacterial pneumonias do run elevated temperatures; however, when the patient is receiving an antipsychotic drug and runs an elevated temperature, a different condition must be considered first. Rationale 4: An elevated temperature is not an extrapyramidal side effect.

An older female patient with psychosis has been taking haloperidol (Haldol) for 1 week. The patient has been making wormlike movements with her tongue. How would the nurse evaluate this finding? 1. An adverse effect likely caused by the medication, known as tardive dyskinesia 2. A normal reaction to the medication that will likely go away in a week or two 3. A desired sign that the patient has not been taking the medication 4. A sign of the patient's underlying psychosis, indicating that the medication is not effective

Correct Answer: 1 Rationale 1: Older female patients on Haldol have a higher incidence of tardive dyskinesia (an adverse effect). Tardive dyskinesia is characterized by wormlike movements of the tongue. Rationale 2: This reaction is common but will not go away in a week or two. Rationale 3: While this effect does indicate the patient is taking the medication, it is not desirable. Rationale 4: This is not an effect of the underlying disease.

The relapse rate for psychotic patients who are not compliant and discontinue their medications is 1. 60-80%. 2. 50-70%. 3. 30-40%. 4. 20-50%.

Correct Answer: 1 Rationale 1: The relapse rate for psychotic patients who are not compliant and discontinue their medications is 60 to 80%. Rationale 2: This is not the relapse rate for this situation. Rationale 3: This is not the relapse rate for this situation. Rationale 4: This is not the relapse rate for this situation.

A patient with a history of suicidal behavior with schizophrenia stopped taking clozapine (Clozaril) after 4 weeks of therapy. The patient is currently experiencing a return of hallucinations. What might the nurse assess when determining the reason the patient stopped taking the medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Feeling sedated all the time 2. Significant weight gain 3. Agitation 4. Fatigue and headache 5. Uncontrollable sexual urges

Correct Answer: 1,2,3,4 Rationale 1: Patients do not like the side effect of being sedated all the time. Rationale 2: Substantial weight gain has been reported in some patients taking this medication. This is a reason some stop taking the medication. Rationale 3: Agitation may be an extrapyramidal symptom of treatment with this medication and is an unwanted adverse effect. Rationale 4: Fatigue and headache are possible side effects of this medication. Rationale 5: Side effects include loss of libido, not uncontrollable sexual urges.

During an assessment, the nurse determines a patient is demonstrating symptoms of a psychosis. What did the nurse assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient says, "The servants need to be disciplined." 2. The patient says, "The voice told me to cut myself." 3. The patient laughs when asked about the health of a family member hospitalized for cancer treatment. 4. The patient asks to close the room door so "that man can't get to me." 5. The patient says, "I have not been able to get any sleep for months."

Correct Answer: 1,2,3,4 Rationale 1: This statement is an example of a grandiose delusion. Rationale 2: This statement is an example of an auditory hallucination. Rationale 3: During a psychotic episode, the patient's mood and affect may vary widely and be inappropriate, such as laughing at sad events. Rationale 4: This statement is an example of a delusion in which someone is trying to harm the patient. Rationale 5: The lack of sleep is not a symptom of psychosis.

A patient who exhibits both positive and negative signs of schizophrenia has tried a number of medications without success due to intolerable side effects. How would the nurse categorize the next logical drug choice for this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. As a dopamine-serotonin system stabilizer 2. As an atypical drug 3. As a conventional drug 4. As a third generation drug 5. As a second generation drug

Correct Answer: 1,2,4 Rationale 1: Dopamine-serotonin system stabilizers were developed due to side effects of previously developed drugs. Rationale 2: The drug of choice will control both positive and negative symptoms of schizophrenia; therefore, it is an atypical drug. Rationale 3: Conventional drugs treat only the positive signs of schizophrenia. Rationale 4: Third generation antipsychotics are used when drugs from a lower generation are ineffective. Rationale 5: Second class antipsychotics do not have the properties needed by this patient.

A patient has been well controlled on an oral liquid medication for schizophrenia. Today the patient's caregiver reports return to both positive and negative symptoms over the last week. Which nursing assessment questions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Have you changed the fluid you are using to mix with the medication?" 2. "Have you changed pharmacies?" 3. "What was the patient's last fasting blood glucose measurement?" 4. "Has the patient started smoking again?" 5. "Is the patient drinking more milk than usual?"

Correct Answer: 1,2,4 Rationale 1: Mixing the liquid medication in cola, tea, or caffeine-containing liquids may change effectiveness. Rationale 2: The patient should not switch brands of medication. Rationale 3: Blood glucose management is important but would not cause these symptoms. Rationale 4: Smoking may decrease effectiveness of some medications. Rationale 5: Drinking more milk is not an issue with these medications.

A patient taking risperidone (Risperdal) for schizophrenia is experiencing signs of hypotension with certain activities since starting this medication. What should the nurse teach the patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Avoid being outside in the heat of the day. 2. Avoid hot baths or hot showers. 3. Avoid vitamin C-containing preparations. 4. Change positions slowly, especially from lying or sitting to standing. 5. Take frequent naps during the day.

Correct Answer: 1,2,4 Rationale 1: The patient should avoid any situation that might cause overheating, especially in hot weather, to reduce the risk of hypotension. Rationale 2: Hot baths and hot showers should be avoided to decrease the chance of hypotension. Rationale 3: There is no association between vitamin C-containing products and hypotension. Rationale 4: Changing positions slowly will help reduce orthostatic hypotension. Rationale 5: Frequent naps will not affect the symptoms of hypotension.

The nurse is performing the initial assessment on a patient admitted to the psychiatric unit. The patient hears voices saying to cut the patient's arms with razor blades until they bleed. The nurse should assess for which findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Family history of first-degree relative with schizophrenia 2. Use of illegal substances 3. Recent episodes of anxiety 4. Family history of heart disease 5. History of a dysfunctional family

Correct Answer: 1,2,5 Rationale 1: A person has a 5-10 times greater risk of getting schizophrenia if a first-degree relative has the disorder. Rationale 2: Use of drugs such as cocaine can produce hallucinations or paranoia. Rationale 3: A history of anxiety has no connection to the development of schizophrenia. Rationale 4: A family history of heart disease has no connection to the development of schizophrenia. Rationale 5: Family dynamics can affect coping skills, which can influence the onset of schizophrenia

While conducting a health history, the nurse notes that the patient is demonstrating positive signs of schizophrenia. What did the nurse assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Disorganized sentence structure 2. Kicking the nurse 3. Not responding to questions 4. Difficulty following instructions 5. Stating that God wants the patient to go home

Correct Answer: 1,2,5 Rationale 1: Disorganized speech is a positive symptom of schizophrenia. Rationale 2: Combativeness is a positive symptom of schizophrenia. Rationale 3: Lack of responsiveness is a negative symptom of schizophrenia. Rationale 4: Difficulty following instructions is not a positive symptom of schizophrenia. Rationale 5: A delusion is a positive symptom of schizophrenia.

The patient has been admitted to the hospital for the treatment of schizophrenia. The patient's mother says to the nurse, "This is all so confusing. How did he get this? Did I do something?" Which nursing responses are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Schizophrenia is a biological brain disorder." 2. "Schizophrenia is linked to drinking alcohol during pregnancy." 3. "Research indicates that a very stressful environment causes schizophrenia." 4. "Research indicates that schizophrenia is a genetic disorder." 5. "Schizophrenia is due to too much dopamine in certain parts of the brain."

Correct Answer: 1,4,5

The physician has prescribed haloperidol (Haldol) for the patient with schizophrenia. What is the priority patient outcome? 1. The patient will consume adequate fluids and a high-fiber diet. 2. The patient will be compliant with taking the medication as prescribed. 3. The patient will report a decrease in auditory hallucinations. 4. The patient will report symptoms of restlessness.

Correct Answer: 2 Rationale 1: Adequate fluids and fiber will decrease the side effect of constipation, but this is not the priority outcome. Rationale 2: Medication compliance is a priority for patients with schizophrenia. Relapse of symptoms will occur without the medications. Rationale 3: A decrease in auditory hallucinations is an expected effect of haloperidol (Haldol), but this is not the priority outcome. Rationale 4: The symptom of restlessness is known as akathisia. This would be important to report but is not the priority outcome.

The nurse has completed diet education for a group of patients who are receiving antipsychotic medications. If the medication education has been effective, patients will eliminate what choice from their menu selection? 1. Meats with a high-fat content 2. Beverages with caffeine 3. Refined breads and desserts 4. Shellfish and peanuts

Correct Answer: 2 Rationale 1: Although unhealthy, high-fat meats do not affect the action of antipsychotic medications. Rationale 2: The use of caffeine-containing substances will decrease the effect of antipsychotic medications. Rationale 3: Although unhealthy, refined breads and desserts do not affect the action of antipsychotic medications. Rationale 4: Many individuals are allergic to shellfish and peanuts, but they do not affect the action of antipsychotic medications.

The patient is receiving antipsychotic medications and tells the nurse he has not had a bowel movement for 2 days. What is the best initial action of the nurse? 1. Hold the medication until the patient has a bowel movement. 2. Have the patient drink prune juice and additional fluids. 3. Contact the physician for an order for a Fleet Enema. 4. Contact the physician for an order for a stool softener.

Correct Answer: 2 Rationale 1: Antipsychotic medications should not be held because of constipation. Rationale 2: Constipation is a common side effect of antipsychotic medications. The best approach is to have the patient increase dietary fiber and fluids and to exercise to prevent constipation. Rationale 3: Contacting the physician for an order for a Fleet Enema is premature. Rationale 4: Contacting the physician for an order for a stool softener is premature.

The nurse has completed medication education with the patient who is receiving risperidone (Risperdal). The nurse evaluates that the education has been effective when the patient makes which statement? 1. "I must call my doctor if I start to have a lot of nightmares." 2. "I must have my blood work done while taking this medication." 3. "I must call my doctor if I start to lose a lot of weight." 4. "I must call my doctor if I notice any a metallic taste in my mouth."

Correct Answer: 2 Rationale 1: Nightmares are not a side effect of risperidone (Risperdal). Rationale 2: Agranulocytosis can be a life-threatening side effect of risperidone (Risperdal), which may also suppress bone marrow and lower infection-fighting ability. It is very important, therefore, that the patient have regular blood work done while on this medication. Rationale 3: Weight gain, not weight loss, is a serious side effect of risperidone (Risperdal). Rationale 4: A metallic taste is not a side effect of risperidone (Risperdal).

A patient with a psychiatric history is communicating using made-up words and indicates he doesn't care about anything. This patient would most likely be 1. demonstrating symptoms of depression. 2. demonstrating positive symptoms of schizophrenia. 3. demonstrating negative symptoms of schizophrenia. 4. demonstrating symptoms of bipolar disorder

Correct Answer: 2 Rationale 1: These are not symptoms of depression. Rationale 2: The use of made-up words and detachment from life most likely indicate he is demonstrating the positive symptoms of schizophrenia. Rationale 3: These are not negative symptoms of schizophrenia. Rationale 4: These are not symptoms of bipolar disorder.

The nurse is assessing a female patient who has been taking chlorpromazine for schizophrenia. What should the nurse include in this assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ask the patient if she is compliant with the use of St. John's wort as an adjunctive medication. 2. Draw blood to check a lipid profile. 3. Ask the patient questions regarding amount of alcohol intake. 4. Determine the date of her last menstrual period. 5. Draw blood to check thyroid function.

Correct Answer: 2,3,4 Rationale 1: St. John's wort may result in an increase in the risk and severity of dystonia. Rationale 2: Antipsychotic drugs have cardiometabolic effects. A lipid profile should be drawn at each visit. Rationale 3: It is important to assess for alcohol use as this could cause excessive drowsiness. Rationale 4: It is important to assess for pregnancy as this drug is Pregnancy Category C. Rationale 5: There is no indication that antipsychotics affect thyroid function, and nothing in the scenario indicates the need to check thyroid function.

The nurse suspects a patient is demonstrating negative symptoms of schizophrenia and will be a challenge to treat because of which barriers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient feels that the symptoms are normal. 2. Family members feel the patient is going through a period of depression. 3. The patient is suspicious of the motives of the health care provider. 4. Family members have labeled the patient as lazy. 5. The patient is indifferent to obtaining help.

Correct Answer: 2,4,5 Rationale 1: Patients with a psychosis rather than the negative symptoms of schizophrenia are often unaware that their bizarre behavior is not normal. Rationale 2: Negative symptoms of schizophrenia are often mistaken for depression. Rationale 3: Suspicion that someone is trying to do harm is characteristic of delusions. Rationale 4: Negative symptoms of schizophrenia are often mistaken for laziness. Rationale 5: Negative symptoms are characteristic of the indifferent personality typical of many patients with schizophrenia.

The patient is receiving clozapine (Clozaril) for the treatment of schizophrenia. The nurse evaluates that this medication has been effective when the patient makes which statement? 1. "I will start going to group therapy." 2. "I think I am ready for discharge, as I feel better." 3. "I am not hearing the voices anymore." 4. "I promise not to skip breakfast anymore."

Correct Answer: 3 Rationale 1: A patient stating he will go to group therapy does not indicate the remission of any psychotic symptoms. Rationale 2: A patient stating he feels better and is ready for discharge does not indicate the remission of any psychotic symptoms. Rationale 3: Therapeutic effects of clozapine (Clozaril) include remission of a range of psychotic symptoms to include delusions, paranoia, auditory hallucinations, and irrational behavior. Rationale 4: A patient stating he will not skip breakfast does not indicate the remission of any psychotic symptoms.

A patient overdosed on risperidone (Risperdal) 20 minutes ago. The nurse should prepare to take which action? 1. Administer a CNS depressant 2. Administer an anticholinergic 3. Administer activated charcoal 4. Symptom management since there is no other treatment

Correct Answer: 3 Rationale 1: CNS depressants likely will worsen symptoms. Rationale 2: Anticholinergic agents likely will worsen symptoms. Rationale 3: Activated charcoal will bind the Risperdal that has not been absorbed and prevent absorption into the bloodstream. Rationale 4: symptom management might be warranted, but given that the overdose occurred only 20 minutes ago, there is a different effective treatment.

Which drug would be indicated for a schizophrenic who needs management of both positive and negative symptoms? 1. Thioridazine HCL (Mellaril) 2. Haloperidol (Haldol) 3. Clozapine (Clozaril) 4. Chlorpromazine (Thorazine)

Correct Answer: 3 Rationale 1: Conventional antipsychotic agents like thioridazine HCL (Mellaril) are indicated for positive symptoms. Rationale 2: Conventional antipsychotic agents like haloperidol (Haldol) are indicated for positive symptoms. Rationale 3: Clozaril is an atypical antipsychotic indicated for positive and negative symptoms of schizophrenia. Rationale 4: Conventional antipsychotic agents like chlorpromazine (Thorazine) are indicated for positive symptoms.

A patient experiencing an extrapyramidal adverse effect is not able to relax. How would the nurse record this information in the medical record? 1. As dystonia 2. As tardive dyskinesia 3. As akathisia 4. As secondary parkinsonism

Correct Answer: 3 Rationale 1: Dystonia involves severe muscle spasms, particularly of the back, neck, tongue, and face. Rationale 2: Tardive dyskinesia is characterized by unusual tongue and face movements such as lip smacking. Rationale 3: The inability to relax is akathisia. Rationale 4: Secondary parkinsonism includes tremor, muscle rigidity, stooped posture, and a shuffling gait.

The patient is receiving risperidone (Risperdal). What is a priority outcome for this patient? 1. The patient reports any narrowing of the field of vision. 2. The patient reports any joint pain or swelling. 3. The patient reports any signs of a sore throat or an infection. 4. The patient reports any yellowish halos around lights

Correct Answer: 3 Rationale 1: Narrowing of the field of vision is not a side effect of risperidone (Risperdal). Rationale 2: Joint pain or swelling is not a side effect of risperidone (Risperdal). Rationale 3: Signs of a sore throat or an infection could indicate agranulocytosis, which is a life-threatening side effect of risperidone (Risperdal). Rationale 4: Yellowish halos around lights are not a side effect of risperidone (Risperdal).

the patient receives quetiapine (Seroquel) and asks the nurse how the medication works. What is the best response by the nurse? 1. "Quetiapine (Seroquel) decreases norepinephrine in your brain, and that decreases your auditory hallucinations." 2. "Quetiapine (Seroquel) increases norepinephrine in your brain, and that decreases your feelings of depression." 3. "Quetiapine (Seroquel) decreases dopamine in your brain, and that decreases your symptoms." 4. "Quetiapine (Seroquel) increases dopamine in your brain, and that helps you to think more clearly."

Correct Answer: 3 Rationale 1: Quetiapine (Seroquel) does not decrease norepinephrine in the brain. Rationale 2: Quetiapine (Seroquel) does not increase norepinephrine in the brain. Rationale 3: Quetiapine (Seroquel) acts by interfering with the binding of dopamine to its receptors in the brain. Rationale 4: Quetiapine (Seroquel) does not increase dopamine in the brain.

The nurse is managing the care of a group of patients with schizophrenia. The patients are receiving conventional antipsychotic medications. When assessing for anticholinergic side effects, which would the nurse immediately report to the physician? 1. Acute dystonia 2. Complaint of a severe headache 3. Hypertension 4. Urinary retention

Correct Answer: 4 Rationale 1: Acute dystonia must be reported immediately to the physician, but this is not an anticholinergic side effect. Rationale 2: Headaches are not anticholinergic side effects. Rationale 3: Hypotension, not hypertension, is a cardiac side effect, not an anticholinergic side effect. Rationale 4: Urinary retention is an anticholinergic side effect of conventional antipsychotics. This must be reported immediately to the physician.

A patient who has been treated with antipsychotic agents for schizophrenia has an elevated blood pressure, dyspnea, and an extremely high temperature. The nurse prepares to treat which disorder? 1. Akathisia 2. Extrapyramidal side effects 3. Acute dystonias 4. Neuroleptic malignant syndrome

Correct Answer: 4 Rationale 1: Akathisia is an inability to rest or relax. Rationale 2: Extrapyramidal side effects include dystonia, akathisia, secondary parkinsonism, and tardive dyskinesia. Rationale 3: Acute dystonias involve severe muscle spasms, particularly of the back, neck, tongue, and face. Rationale 4: The condition that causes an elevated blood pressure, dyspnea, and high temperature is neuroleptic malignant syndrome.

The patient who is receiving antipsychotic medication complains of having a dry mouth. The patient refused the morning dose of the medication. What is the best response by the nurse? 1. "Why are you refusing the medicine?" 2. "I can give you benztropine (Cogentin) for your dry mouth." 3. "I will let your doctor know about your dry mouth." 4. "A dry mouth is common, but drinking more water will help."

Correct Answer: 4 Rationale 1: Asking the patient why he is refusing his medication is an inappropriate question, as the nurse knows the patient has been complaining of a dry mouth. Rationale 2: Benztropine (Cogentin) is indicated for extrapyramidal side effects, not for a dry mouth. Rationale 3: Dry mouth is a common side effect treated by nursing interventions, not physician's orders. Rationale 4: The symptom of dry mouth is very common with antipsychotic medications. The best approach is to have the patient suck on sugarless candy, chew gum, or have frequent drinks of water.

The patient with schizophrenia is sitting quietly in a chair. The patient does not respond much to what is happening and has a lack of interest in the environment. How does the nurse interpret this assessment? 1. The patient is most likely very depressed. 2. The patient is most likely hearing voices. 3. The patient is experiencing positive symptoms. 4. The patient is experiencing negative symptoms.

Correct Answer: 4 Rationale 1: There isn't any evidence to support that the patient is very depressed. Rationale 2: There isn't any evidence to support that the patient is hearing voices. Rationale 3: Positive symptoms include hallucinations, delusions, and a disorganized thought or speech pattern. Rationale 4: Negative symptoms are those that subtract from normal behavior. These symptoms include a lack of interest, motivation, responsiveness, or pleasure in daily activities.

The patient has been receiving chlorpromazine (Thorazine) for the treatment of schizophrenia. The nurse assesses that the patient has tardive dyskinesia. What findings support this conclusion? 1. Tremor, muscle rigidity, and a shuffling gait 2. Severe muscle spasms of the back, neck, and tongue 3. An inability to rest or relax, and restlessness 4. Unusual facial movements and lip smacking

Correct Answer: 4 Rationale 1: Tremor, muscle rigidity, and a shuffling gait are known as parkinsonism, not tardive dyskinesia. Rationale 2: Severe muscle spasms of the back, neck, and tongue are known as acute dystonia, not tardive dyskinesia. Rationale 3: An inability to rest or relax and restlessness are known as akathisia, not tardive dyskinesia. Rationale 4: Tardive dyskinesia is characterized by unusual tongue and face movements, such as lip smacking, and wormlike motions of the tongue.