Chapter 22: Psychotherapeutic Agents

The nurse working with the family of a child prescribed methylphenidate should implement what strategy to address possible adverse effects?

A plan to address the child's loss of appetite

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?

Increase fiber intake.

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?

Increased blood glucose

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

White blood cell count

A nurse is providing care for a client diagnosed with attention deficit hyperactivity disorder (ADHD) who has been taking methylphenidate for several months. When monitoring for potential adverse effects, the nurse should include what assessments?

sleep patterns

Phenothiazines such as chlorpromazine are occasionally used for clinical indications not associated with psychiatric illness. What indications would be included? Select all that apply.

nausea and vomiting preoperative restlessness

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?

relieve the symptoms for which they were prescribed.

The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to:

stay in bed for the next half hour.

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 client who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine. The client has been taking the medication for more than 40 years. What adverse effect will the client most likely experience?

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

The nurse is preparing to administer chlorpromazine intramuscularly to a client. What action should the nurse implement during administration?

Encourage the client lie down for 30 to 60 minutes after the injection. For IM administration of chlorpromazine, the nurse should have the client lie down for 30 to 60 minutes after the injection to prevent orthostatic hypotension. Massage is unnecessary, and the ventrogluteal site is used. The nurse should use a 1½-inch (3.8-cm) needle.

A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?

Extrapyramidal

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?

Potential for abuse

The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?

the importance of adherence to prescribed treatment

A prescriber has written for olanzapine for a client diagnosed with schizophrenia. What additional tests should the nurse anticipate the prescriber to order? Select all that apply.

weight cholesterol profile Fasting blood sugar The administration of an atypical antipsychotic (SGA) medication such as olanzapine can put the client at a higher risk of acquiring type 2 diabetes. The client should be weighed and a family history documented to indicate type 2 diabetes risk. Laboratory work for fasting blood sugar, total and low-density lipoprotein (LDL) cholesterol, and triglycerides should be taken and compared at periodic intervals. Blood pressure would be part of the routine assessment by the nurse and not the prescriber. Blood type is not indicated for the client.

The nurse administers chlorpromazine intramuscularly to the preoperative client who is intensely anxious about surgery the next morning. What education should the nurse provide this client?

"Remain lying down for at least half an hour after the injection."

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?

"We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention."

After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent?

Clozapine

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

Clozapine

The nurse is providing education to a client who has been prescribed clozapine. During teaching, the nurse should inform the client of the need for regular monitoring of what laboratory test during the initial months of therapy and periodically thereafter?

Complete blood count (CBC)

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?

Diabetes mellitus

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?

Disorganized and often bizarre thinking

Serotonin abnormalities are thought to be involved in the following disorders:

Mental depression and sleep disorders.

A nurse caring for a client with attention deficit hyperactivity disorder (ADHD) may administer which CNS stimulants? (Select all that apply.)

Methylphenidate (Concerta) Dextroamphetamine (Dexedrine)

The nurse on the unit has several clients taking clozapine. For which client is clozapine, an antipsychotic, contraindicated?

The 45-year-old with bone marrow depression

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.

The nurse admits a client newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason why the nurse includes the family when collecting the nursing history?

The client may not be able to provide a sufficient history.

A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority?

The client will remain safe.

A nurse is teaching the client about CNS medications and how they are addictive. What is primary reason CNS medications are addictive?

The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine.

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:

have undiagnosed diabetes.

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."

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?

"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients." Black clients tend to respond more rapidly; experience a higher incidence of adverse effects, including tardive dyskinesia; and metabolize antipsychotic drugs more slowly than white clients. When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients.

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?

It needs to be determined if the child still has symptoms that require treatment.

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 administering a CNS stimulant to a client with narcolepsy. The nurse understands that this drug does not cause cardiac and other systemic stimulatory effects like other CNS stimulants. Which drug is the nurse most likely administering?

Modafinil

The nurse in the emergency department admits a client that takes lithium for bipolar disorder. The client is experiencing seizures and is hypotensive. What does the nurse anticipate this client's lithium level will be?

3.1 mEq/L

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?

Hyperactivity

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?

2

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?

Measurement of height and body weight Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.