Chapter 55: Drug Therapy for Psychotic Disorders

A psychiatric nurse is providing care for a female patient with schizophrenia whose medication regimen includes oral chlorpromazine. When administering this medication, the nurse should do which of the following? A. Have the patient hold the drug under her tongue for at least 30 seconds. B. Administer the drug 1 to 2 hours before bedtime. C. Instruct the patient to avoid dairy products for 1 hour before and 2 hours after administration. D. Administer the drug on alternating days.

Administer the drug 1 to 2 hours before bedtime.

A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenage girl who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite? A. Lower cost B. The possibility of oral administration C. Reduced adverse effects D. Absence of black box warnings

Reduced adverse effects

A patient is prescribed clozapine (Clozaril). The patient and family should be instructed on the adverse effects of this medication. What laboratory test is most important in the first months of the medication regime? A. Regular complete blood counts B. Daily INR C. Monthly creatinine levels D. Weekly liver enzymes

Regular complete blood counts

A teenage boy has begun to exhibit the characteristic signs and symptoms of schizophrenia. During his mother's pregnancy, during what time in development could she have experienced an intrauterine insult? A. First trimester B. Conception C. Third trimester D. Second trimester

Second trimester

A patient in her 60s has been living with schizophrenia since she was a young woman and was treated with chlorpromazine for many years. The nurse who is meeting the patient for the first time observes that the patient continually smacks her lips and appears to be chewing. The nurse should recognize that this patient is likely experiencing what problem? A. Dystonias B. Tardive dyskinesia C. Akathisia D. Neuroleptic malignant syndrome

Tardive dyskinesia

A patient has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which of the following goals of care is the priority? A. The patient will participate in activities of daily living. B. The patient will demonstrate independent health maintenance. C. The patient will interact therapeutically with peers. D. The patient will remain safe.

The patient will remain safe.

A child suffers from tics and verbal outbursts in the classroom and while he is awake. The patient is prescribed haloperidol (Haldol). What disease process is haloperidol (Haldol) used to treat? A. Tourette's syndrome B. Early-onset dementia C. Myasthenia gravis D. Muscular dystrophy

Tourette's syndrome

A patient is experiencing an episode of psychosis. He is belligerent, loud, and abusive when you enter the room. What is the best response by the nurse during future interactions? A. Respond to him in an assertive tone. B. Delegate care to the technician. C. Use a calm, soft voice. D. Place him in the quiet room.

Use a calm, soft voice

A patient's medication administration record orders the IM administration of chlorpromazine. When administering this drug, the nurse should A. have the patient massage the injection site for 1 to 2 minutes after the injection. B. administer the drug into the deltoid muscle with a 1 1/2-inch needle. C. have the patient lie down for 30 to 60 minutes after the injection. D. observe the patient while he or she self-administers the drug.

have the patient lie down for 30 to 60 minutes after the injection.

A patient has been achieving an acceptable reduction in his positive and negative signs of schizophrenia after several weeks of treatment with clozapine. The patient has asked the nurse if it is acceptable for him to have "a few drinks from time to time." How should the nurse best respond to the patient's inquiry? A. "If you notice that your symptoms are worsening when you drink, you should stop doing it." B. "When you're taking clozapine, it's best to avoid drinking alcohol altogether." C. "That's okay in most cases, but it's advisable to limit it to beer and wine and to avoid spirits." D. "That shouldn't present a problem, provided you make sure that you're safe when you do it."

"When you're taking clozapine, it's best to avoid drinking alcohol altogether."

An elderly patient with a long-standing history of schizophrenia has been admitted to the hospital for treatment of hyponatremia. The nurse reviews the patient's medical chart and reads that the patient was previously treated with phenothiazine antipsychotics. What medication may this patient have been treated with? A. Acetylsalicylic acid (aspirin) B. Chlorpromazine (Thorazine) C. Aminophylline (Theophylline) D. Dantrolene sodium (Dantrium)

Chlorpromazine (Thorazine)

Parenteral haloperidol has been ordered for a patient who is experiencing an acute psychotic episode. The nurse should recognize what primary goal of treatment? A. Decreased CNS stimulation B. Increased sophistication of thinking C. Decreased agitation and combativeness D. Increased insight into delusional thinking

Decreased agitation and combativeness

A patient is admitted to the hospital for cardiac surgery and has just come up to the postsurgical unit from the recovery room. He develops unprecedented confusion and states, "I see bugs up and down the walls. They are going to get me." The nurse suspects the patient is suffering from what symptom? A. Delusions B. Schizophrenia C. Depression D. Delirium

Delirium

A patient is prescribed olanzapine (Zyprexa) for the treatment of schizophrenia. The patient tells the nurse he is voiding three times each night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed? A. Hyperthyroidism B. Diabetes mellitus C. Urinary tract infection D. Renal calculi

Diabetes mellitus

A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience? A. Hypertension B. Central nervous system agitation C. Urinary frequency D. Extrapyramidal effects

Extrapyramidal effects

A patient with schizophrenia has been taking haloperidol for several years. The care team and the patient have collaborated and chosen to transition the patient to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the patient's risk of extrapyramidal effects during this transition, the care team should do which of the following? A. Arrange for weekly electroconvulsive therapy during the time of transition. B. Have a 2- to 3-week "drug holiday" between stopping the haloperidol and starting the atypical antipsychotic. C. Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks. D. Gradually taper the dose of haloperidol.

Gradually taper the dose of haloperidol.

A patient who has a diagnosis of schizophrenia is likely to have which of the following pathophysiologic effects? A. Increased serum potassium B. Decreased numbers of glutamate receptors C. Decreased interaction with GABA D. Increased dopamine

Increased dopamine

A patient diagnosed with schizophrenia is being seen by the home care nurse. What is the most important aspect of patient teaching with this patient? A. Report signs of neuralgia. B. Maintain the medication regimen. C. Limit alcohol intake to two drinks per day. D. Stop medications if weight gain occurs.

Maintain the medication regimen.

A 22-year-old man's increasingly bizarre behavior has culminated in a diagnosis of schizophrenia. In light of current treatment modalities for schizophrenia, the nurse should anticipate that the patient is most likely to be prescribed what drug? A. Chlorpromazine (Thorazine) B. Haloperidol (Haldol) C. Olanzapine (Zyprexa) D. Prochlorperazine (Compazine)

Olanzapine (Zyprexa)

A person is seen wandering the streets and talking in an animated way to people who are not there. From what disorder do you suspect the person is suffering? A. Delusions B. Depression C. Psychosis D. Confusion

Psychosis