Pharmacology Chapter 22
use a 1.5 inch (3.8 cm) needle for the injection change the needle after filling the syringe use the ventrogluteal muscle for the injection instruct the client to lie down for 30 to 60 minutes after the injection
A client with psychosis is prescribed an intramuscular dose of chlorpromazine. Which action(s) will the nurse take when preparing and administering this medication? Select all that apply.
The client will remain safe.
A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority?
How long has your son been exhibiting symptoms?
Parents bring a 15-year-old male into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What is an appropriate question to ask the parents?
Assess temperature every 8 hours. Monitor for signs of respiratory distress. Document urinary output into client records every 8 hours.
The nurse is monitoring a client for possible neuroleptic malignant syndrome. What interventions will the nurse implement in client care? Select all that apply.
relieve the symptoms for which they were prescribed.
The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy?
blood pressure
The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?
"We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention."
The nurse is teaching parents of a pediatric client diagnosed with ADHD. Teaching has been about the disorder and its treatment. The nurse determines that teaching has been effective when the parents state which?
stay in bed for the next half hour.
The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to:
Disorganized and often bizarre thinking
The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit?
"We need to check and see if he still has symptoms that require drug therapy."
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?
have undiagnosed diabetes.
A client, who has been diagnosed with schizophrenia and is taking an antipsychotic medication, reports constant thirst, frequent urination, and feeling nauseous. The nurse knows that the client may:
history of seizure disorder
A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client?
Increase fiber intake.
A client, prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD) has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement?
Rigidity
A patient has been administered an antipsychotic. Which reaction should be reported immediately?
"ADHD usually starts in childhood and may persist through adulthood."
The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response?
behavior motor task performance cognitive task performance
The nurse is assessing an adolescent client diagnosed with attention deficit hyperactivity disorder (ADHD) for therapeutic effects of methylphenidate. The nurse should focus on improvement associated with what client functions? Select all that apply.
Measurement of height and body weight
An adolescent client has been taking dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) for 3 years, achieving significant improvements in behavior and mood. When assessing the child during a scheduled follow-up appointment, the nurse should prioritize what physical assessment to monitor for a potential adverse reaction to the therapy?
Gluteus
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?
Weight and growth
A 10-year-old child is being administered CNS stimulants for ADHD. What should the nurse instruct the parents to record periodically?
It needs to be determined if the child still has symptoms that require treatment.
A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain?
Discontinue the dextroamphetamine.
A teenage client, treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years, is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions?
½ hour
The nurse administers chlorpromazine intramuscularly to a client. The nurse would maintain the client in bed for at least how long after administering the drug?
To have clients use the drugs appropriately
The nurse understands that the main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. What is a secondary goal for their use?
A plan to address the child's loss of appetite
The nurse working with the family of a child prescribed methylphenidate should implement what strategy to address possible adverse effects?
Tourette's syndrome
While reviewing a medication history, the nurse sees that a school-age client has been prescribed haloperidol. Based on this information, the nurse suspects that the client may have been diagnosed with what disease process?
Risk for injury related to central nervous system depression
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?
Diabetes mellitus
A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?
Lisdexamfetamine
A client is to be started on amphetamine therapy for attention deficit hyperactivity disorder. Which medication has less physical dependence and abuse than other amphetamines?
Cardiac monitoring
A high-school-age client, brought to the emergency department (ED) by friends after taking a "whole handful of dextroamphetamine," is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose?
Ischemic changes on his electrocardiograms
A male client is diagnosed with narcolepsy by his physician. He asks the physician to prescribe modafinil, because it works so well for his friend. The physician will not prescribe the medication because of what aspect of the client's history?
Hyperactivity
A nurse who is providing care on a pediatric client has conducted a medication reconciliation. In light of the fact that the client takes methylphenidate, the nurse is justified in considering a history of what health problem?
"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse."
A female client asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be:
open the capsule and sprinkle the beads in applesauce.
A 72-year-old man is taking Adderall XR for the treatment of narcolepsy. He is currently having problems with not being able to swallow large tablets or capsules. The man also wears dentures, which makes it even more difficult for him to swallow medication. He is in the clinic to talk to the nurse about his problem. The nurse will instruct him to
"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients."
A black, male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the health care provider's (HCP's) office with signs of tardive dyskinesia, and his HCP modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?
Phentermine
A group of nursing students are reviewing information about CNS stimulants. The students demonstrate understanding of the information when they identify which drug as being used to treat obesity?
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?
A client who has type 1 diabetes and who practices poor glycemic control
A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine. Which client likely has the highest susceptibility to the adverse effects of olanzapine?
dopamine
A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling?
Record a daily summary of client's behavior.
A pediatric client has been admitted to the floor and started on Ritalin therapy for AHDH. The nurse knows that an important daily intervention for this client would be which?
Reduced adverse effects
A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenager who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite?
Clozapine
After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent?
Urine turning pink to reddish-brown
Which would be important for a nurse to include in the teaching plan for a client taking fluphenazine?
Increased blood glucose
A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?
Extrapyramidal
A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?
False
During periods of dehydration, the client is at risk for lower serum lithium levels.
It reduces the likelihood of drug dependence or diversion.
A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?
motor restlessness
A client has been receiving chlorpromazine as treatment for psychosis. Which assessment finding indicates to the nurse that the client is experiencing an extrapyramidal effect of the medication?
Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task.
Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication?
Patients with severe hypertension
For which patient are CNS stimulants contraindicated?
Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.
Moderate CNS depression is characterized by:
Greater than 1.5 mEq/mL
Monitoring of patients taking lithium includes periodically obtaining a serum lithium level; at what level may toxic reactions occur?
Bizarre behavior
Psychosis is a severe mental illness characterized by what?
extrapyramidal effects
The client has been taking chlorpromazine for more than 40 years. What adverse effect will the client most likely be experiencing?
Clozapine
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
"Adverse effects include hypertension and nervousness."
The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?
increased risk for toxic effects of haloperidol therapy.
A nurse is caring for a patient who is taking haloperidol. The patient has orders for a new drug, and the nurse notes that it is highly protein bound. The nurse will plan care based on a(n):
electrocardiogram (ECG).
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
Hypertension
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather's antidepressant to improve his mood. After immediately phoning the boy's stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
"I will increase my fluid intake."
A bipolar client is being discharged home in 48 hours. What statement by the client indicates an understanding of treatment with lithium?
The patient will take medications as prescribed.
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?
Tardive dyskinesias
The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching?
What inappropriate response to stimuli has the client had?
The nurse is interviewing a new client and their family shortly after a hospital admission. The client has been diagnosed with schizophrenia. What would be an appropriate question to ask the family members of this client?
Administer the day's last dose 1 to 2 hours before bedtime.
The nurse is preparing to administer oral chlorpromazine to a client. What action should the nurse include in administration?
Obtain weekly blood tests." "Do not stop taking this medication." "Do not drive while taking this medication
The nurse provides medication teaching to a client prescribed clozapine as treatment for schizophrenia. Which instructions will the nurse emphasize with this client? Select all that apply.
To assess beneficial and adverse effects
The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose?
Lip smacking
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?
An agitated client who was given haloperidol during acute psychosis
What client is being treated with a typical antipsychotic?
Modafinil
What is the central nervous system stimulant of choice to treat narcolepsy?
Inhibiting the release of dopamine in the brain
When describing the action of conventional antipsychotic medications to a group of nursing students, which would the instructor address?
WBC count
Which test should be scheduled every week for a patient taking clozapine?
3.5
A 14 year-client with symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The client weighs 154 lbs. How many mg of pimozide should the client be administered?
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.
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?
07:00 and 11:30
A 12-year-old has been prescribed dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take the initial daily dose of dextroamphetamine at what times?
2
The nursing student is reviewing information learned in anatomy and physiology class about the nervous system. The student recalls that the nervous system has how many divisions?
"This medication can cause uncontrollable urges to spend money or to shop."
A client who has been taking oral aripiprazole for treatment of bipolar disorder asks, "I have started buying so many things online lately. Will this medication help me control that?" Which response will the nurse make to the client?
within 20 minutes
A client with an acute onset of disorganized thinking and hallucinations is prescribed an intramuscular dose of chlorpromazine. How soon after administration can the nurse assess for therapeutic effect?
Extrapyramidal symptoms
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?
Potential for abuse
A client is being prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD). During health education, the nurse should make the client aware of the black box warning relating to what potential risk issue?
Drinking frequent sips of water
A client is started on aripiprazole and the nurse notices the client is experiencing dry mouth and nasal congestion. What intervention does the nurse teach the client to minimize the side effects of the medication?
"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."
A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?
Gradually taper the dose of haloperidol.
A client with schizophrenia has been taking haloperidol for several years. The care team and the client have collaborated and chosen to transition the client to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the client's risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsychotic, the care team should implement which intervention?
