PrepU Chapter 56
For which adverse reactions should the nurse monitor the patient who has been administered antipsychotic drugs?
Dry mouth
A female client makes an appointment with her health care provider 2 weeks after beginning her prescription antipsychotic therapy. She states that she is still unable to cope and concentrate at work. What statement would be appropriate to include in the nurse's teaching?
"Antipsychotics may take several weeks to achieve maximum therapeutic effect."
The wife of a client who is taking haloperidol calls the clinic and reports that her husband has taken the first dose of the drug and it is not having a therapeutic effect. An appropriate response by the nurse would be which?
"Continue the prescribed dose. It may take several days to work."
A female client is diagnosed with Alzheimer-type dementia. She resides in a long-term care facility. The client's daughter asks the health care provider to prescribe an antipsychotic to control her mother's outbursts of anger and depression. The provider orders a psychiatric consultation for the client. The client's daughter asks, "Why doesn't the provider just order an antipsychotic?" What is the nurse's best response to this family member?
"Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems."
The parents of a child receiving a central nervous system stimulant for treatment of attention deficit disorder asks the nurse why they are stopping the drug for a time. Which statement by the nurse would be most appropriate?
"We need to check and see if he still has symptoms that require drug therapy."
What psychiatric client is most likely to have the lowest risk of extrapyramidal effects?
A client taking clozapine (Clozaril) 25 mg PO t.i.d.
A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine (Zyprexa). Which client likely has the highest susceptibility to the adverse effects of olanzapine?
A client who has type 1 diabetes and who practices poor glycemic control
The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis?
An agitated client who was given haloperidol during acute psychosis
What client is being treated with a typical antipsychotic?
An agitated client who was given haloperidol during acute psychosis
Assessment of a client with psychosis who is prescribed antipsychotic therapy reveals that the client finds no pleasure in activities that are normally pleasurable. The nurse would document this as which of the following?
Anhedonia
A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation?
Antipsychotic
For clients diagnosed with schizophrenia, drug therapy is usually indicated for:
At least 1 year after an initial psychotic episode and at least 5 years after multiple episodes.
A 17-year-old client has just been diagnosed with schizophrenia. When educating the family about the cause of this disease, the nurse should address what factors? Select all that apply.
Biochemical disruptions
Psychosis is a severe mental illness characterized by what?
Bizarre behavior
A nurse is explaining to another nurse the difference between first-generation antipsychotics and second-generation antipsychotics. What is the biggest benefit of the second-generation antipsychotics?
Decreased extrapyramidal effects
In clients with acute psychosis, the treatment goal during the first week of treatment includes:
Decreasing the client's symptoms and normalizing the patterns of sleeping and eating.
A man is brought into the emergency department and is screaming about the government spying on him and is talking to a wall. The nurse goes to take his pulse and he becomes violent. The nurse understands that the client reacts this way because of which reasons
During a psychotic episode, clients do not perceive reality in the same way as others; therefore, touch may seem like a violent act.
A client's thought disorder has been treated with haloperidol (Haldol). For what adverse effect should the nurse most closely monitor the client?
Extrapyramidal effects
A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects?
Extrapyramidal symptoms
A parenteral form of an antipsychotic is prescribed for a client who has become aggressive. When administering the drug, which site would be most appropriate for the nurse to use?
Gluteus
A client is being discharged from the unit. The nurse is to provide discharge education, including giving the client information about his medications. One of the medications is quetiapine (Seroquel). The nurse should educate the client that which food is contraindicated when taking this medication?
Grapefruit
A 77-year-old patient with physiologic dementia has been admitted to the unit. Haldol has been ordered for this patient. What are some facts about Haldol? (Select all that apply.)
It is classed as an anti-psychotic. Its dosage needs to be lowered in the older adult population. It should not be used to control behavior with dementia.
A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following symptoms would be categorized as a negative symptom of schizophrenia?
Lack of interest in normal activities
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?
Lip smacking
A male client's health care provider orders antipsychotic medications for him. He experiences little or no side effects from the medications and is able to function successfully in both his home and work environments. Six weeks later, he is diagnosed with hepatitis B. He begins to experience adverse reactions to his medications. A possible reason for the adverse reactions might be that, in the presence of liver disease, what may happen?
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.
The nurse is caring for a client who has been taking an oral neuroleptic medication for several years. What assessment should the nurse prioritize to best address the risk for adverse effects?
Monitoring the client for involuntary facial movements
A nurse observing a client notices the client has developed muscle rigidity, altered mental status, tachycardia, and sweating. The nurse interprets these findings as suggesting which of the following?
Neuroleptic malignant syndrome (NMS)
Which of the following atypical antipsychotics are associated with weight gain? Select all that apply:
Olanzapine (Zyprexa) Risperidone (Risperdal)
During the pre-administration assessment of clients being given an antipsychotic drug, the nurse observes the client for any behavior patterns that appear to be deviations from normal. What behaviors should a nurse note as being a deviation from normal? Select all that apply:
Poor eye contact Monotone speech pattern Inappropriate laughter Failure to answer questions completely Inappropriate crying
The parents of a 17-year-old boy have just received word that he has been diagnosed with schizophrenia and will require drug therapy. Which of the following etiologic factors is most likely to have contributed to this disease?
Processes during fetal neurodevelopment may have resulted in schizophrenia.
A nurse is planning the care of a client who has been diagnosed with schizophrenia and who will begin treatment with a typical antipsychotic. The nurse should identify what nursing diagnosis?
Risk for injury related to central nervous system depression
A nurse is charting on a client who has repetitive tongue and jaw movements, and a facial tick. What term could the nurse use to document these findings?
Tardive dyskinesia
A nurse observes rhythmic, involuntary facial movements in a patient who has been administered antipsychotic drugs. The patient also makes chewing movements and, at times, his tongue protrudes. What is the most likely reason for the patient's behavior?
Tardive dyskinesia
While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:
Tardive dyskinesia
The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching?
Tardive dyskinesias
A client who is experiencing withdrawal from alcohol has developed psychosis and is being treated with haloperidol. Which assessment findings should prompt the care team to assess the client for neuroleptic malignant syndrome?
The client develops muscle rigidity and a sudden, high fever.
A client in the locked psychiatric unit continually states he is the king of England, even though the staff has corrected him. How could the nurse best document this in the client's chart?
The client is delusional.
A 24-year-old client is being seen in the emergency department because of a high fever and cannot move the right arm. During the history-taking process, The nurse discovers the client is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client?
The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.
T/F: Typical antipsychotics block dopamine receptors.
True
A client's medication has been changed to clozapine (Clozaril). What assessment should the nurse perform to identify a life-threatening adverse effect early?
Vital signs monitoring
Which test should be scheduled every week for a patient taking clozapine?
WBC count
A client is being treated with clozapine. What should the nurse monitor most closely?
White blood cell count
For clients taking clozapine (Clozaril), it is necessary to monitor what lab test for the first 6 months?
White blood cells
A client who begun treatment with clozapine 2 weeks ago is now reporting worsening flu-like symptoms, including a high fever. The nurse's assessment should be conducted with the goal of identifying signs and symptoms of what possible adverse medication reaction?
agranulocytosis
During health education with the nurse, what subject should be the primary focus for a client newly diagnosed with schizophrenia?
the importance of adherence to prescribed treatment
For clients taking clozapine, it is necessary to regularly monitor what lab test during the initial months of therapy and periodically thereafter?
white blood cell (WBC) count
A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?
"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."
Which client statement reflects an understanding of typical length of antipsychotic medication therapy?
"I may always have to take this medication."
The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what client would the nurse expect to require a standard dosage?
Caucasian young adult diagnosed with bipolar disorder
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
Clozapine
The nurse is caring for a patient who is receiving drug therapy for a psychotic disorder. Which goals should the nurse include in a care plan for the patient following discharge from the hospital?
The patient will take medications as prescribed.
During an intake assessment, the nurse notes that the client cannot sit still and continually stands up and walks around the room. The nurse knows that the term for this behavior is:
akathisia.
After administration of haloperidol to an acutely dehydrated client, the nurse should prioritize what nursing assessment?
blood pressure
Antipsychotic drugs are contraindicated in clients with:
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.