psych ch 56

Which drug would be indicated for the treatment of narcolepsy?

Modafinil

A client experiencing psychosis is admitted through the emergency department and administered chlorpromazine 25 mg intramuscularly. After administration of the medication, what is the nurse's priority assessment?

Behavior and cognition The nurse will evaluate the effectiveness of the drug in diminishing psychotic symptoms because this is the purpose of administering the drug.

Olanzapine has been prescribed for a new client. What should the nurse assess or confirm before administration of olanzapine?

Blood glucose Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus.

The nurse expects to monitor a client's white blood count weekly when the client is prescribed:

Clozapine

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.

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?

How long has your son been exhibiting symptoms? Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality.

What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?

Lip smacking Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.

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)

For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months?

White blood cells

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

Which client statement reflects an understanding of typical length of antipsychotic medication therapy?

"I may always have to take this medication."

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 The success or failure of treatment is largely dependent on the client's adherence to treatment. For most clients, this supersedes the immediate significance of nutrition or teaching about therapeutic effects.

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 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."

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." Clients with dementia may become agitated because of environmental or medical problems. Alleviating such causes, when possible, is safer and more effective than administering antipsychotic drugs. Inappropriate use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems.

.What psychiatric client is most likely to have the lowest risk of extrapyramidal effects?

A client taking clozapine 25 mg PO t.i.d. Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. Chlorpromazine is a typical antipsychotic, one of the older drugs, which does cause the extrapyramidal effects. Navane is part of the thioxanthene group of typical antipsychotics. This group of drugs has low sedative and hypotensive effects but can cause extrapyramidal effects. Haloperidol is a butyrophenone group drug used in psychiatric disorders. Usually, it produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects.

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 72-year-old client is prescribed haloperidol for acute psychosis. The nurse caring for the client notes changes in the assessment of increased temperature, tachycardia, urinary incontinence, and lethargy. Based on the assessment, what is happening to the client?

The client has developed neuroleptic malignant syndrome.

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." Periodically, the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which would indicate the need for continued treatment.

After administration of haloperidol to an acutely dehydrated client, the nurse should prioritize what nursing assessment?

blood pressure Haloperidol can cause hypotension in clients who are volume depleted or receiving antihypertensive drugs.

A client is being treated with clozapine. What should the nurse monitor most closely?

White blood cell count

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 client diagnosed with bipolar disorder Black clients respond more rapidly to antipsychotic medications and have a greater risk for development of disfiguring adverse effects, such as tardive dyskinesia. Consequently, these clients should be started off at the lowest possible dose and monitored closely. Clients from Asian countries (e.g., India, Turkey, Malaysia, China, Japan, Indonesia) receive lower doses of neuroleptics and lithium to achieve the same therapeutic response as seen in clients in the United States. Arab American clients metabolize antipsychotic medications more slowly than Asian Americans do and may require lower doses to achieve the same therapeutic effects as in Caucasians.

The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit?

Disorganized and often bizarre thinking Behavioral manifestations of psychosis include agitation, behavioral disturbances, delusions, disorganized speech, hallucinations, insomnia, and paranoia.

A client's medication has been changed to clozapine. What assessment should the nurse perform to identify a life-threatening adverse effect early?

Vital signs monitoring Neuroleptic malignant syndrome can be a life-threatening adverse effect of atypical non-phenothiazines. It is causes wide variations in all the client's vital signs.

Which test should be scheduled every week for a patient taking clozapine?

WBC count Use of the drug clozapine has been associated with severe agranulocytosis, (i.e., decreased white blood cells), so weekly WBC count tests are scheduled.

What client is being treated with a typical antipsychotic?

An agitated client who was given haloperidol during acute psychosis Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.

When monitoring a client for possible neuroleptic malignant syndrome, the nurse will plan to implement what intervention into client care? Select all that apply.

Assess temperature every 8 hours. Monitor for signs of respiratory distress. Document urinary output into client records every 8 hours. Neuroleptic malignant syndrome, a rare but potentially fatal adverse effect, is characterized by rigidity, severe hyperthermia, agitation, confusion, delirium, dyspnea, tachycardia, respiratory failure, and acute renal failure. While tachycardia is a characteristic, cardiac arrhythmias are not commonly noted with this condition.

The psychiatric nurse is conducting health education addressing the adverse effects of clozapine. What teaching point should the nurse convey to the client?

"There's a possibility that this drug might cause you to gain weight and have high blood sugar levels." Hyperglycemia and weight gain are potential adverse effects of atypical antipsychotics.

A client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client?

Extrapyramidal effects

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 The negative symptoms of schizophrenia include flat or blunted emotions, lack of pleasure or interest in things (anhedonia), and limited speech. The positive symptoms of schizophrenia, and the most recognizable symptoms, include delusions (e.g., paranoia or distorted perceptions of other people's intentions) and hallucinations.

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.

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 Tardive dyskinesia is a syndrome consisting of irreversible, involuntary movements such as rhythmic movements of the tongue (tongue thrusting), face, and jaw. Extrapyramidal syndrome causes fine tremors, disruption of gait, restlessness, and facial grimacing.

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. Neuroleptic malignant syndrome is characterized by fever, sweating, tachycardia, muscle rigidity, tremor, incontinence, stupor, leukocytosis, elevated creatinine phosphokinase levels, and renal failure.

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. Goals that relate to care following discharge may include ensuring that the patient takes medications as prescribed and returns for all scheduled follow-up appointments with health care providers.