Chapter 22: Psychotherapeutic Agents

The nurse is caring for a pt who has bipolar disorder and who receives lithium therapy. When reviewing the pt medication administration record, what drug would cause an increase in the pt risk for lithium toxicity? A) Vitamin B12 B) Levothyroxine C) Indomethacin D) Calcium carbonate

C

While caring for a pt receiving antipsychotic therapy, the nurse observes cogwheel rigidity, tremors, and drooling. The nurse interprets this as what? A) Tardive dyskinesia B) Dystonia C) Pseudoparkinsonism D) Akathisia

C

Select all that apply: A pt has a serum lithium level of 2.2 mEq/L. The nurse should expect to assess what symptoms? A) Epistaxis B) Full body rash C) Hypotension D) Seizures E) Hyperreflexia

C D E; Rash & epistaxis not associated w/ lithium toxicity

Your pt, a 6 yr old boy, is starting a regimen of Ritalin (methylphenidate) to control an ADD. Family teaching should include which of the following? A) This drug can be shared w/ other family members who might seem to need it B) This drug may cause insomnia, weight loss, and GI upset C) Do not alert the school nurse to the fact that this drug is being taken because the child could have problems later on D) This drug should not be stopped for any reason for several years

B

Mental disorders are not thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include: A) Depression B) Anxiety C) Seizures D) Schizophrenia

D

Select all that apply: The nurse determines the pt may be displaying extrapyramidal effects on the basis of what assessment findings? A) The pt has had uncharacteristic verbal outbursts B) The pt has an aversion to bright lights C) The pt has been experiencing insomnia and early morning awakening D) The pt exhibits hand tremors E) The pt gait is uncoordinated

D E; Insomnia & photophobia are not extrapyramidal; verbal outbursts not related to drug therapy

A chid with ADHD 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? A) It needs to be determined if the child still has symptoms that require treatment B) The risk for cumulative adverse effects is greater if the child doesn't have a break C) The drug likely needs to be switched to another agent that is less toxic D) The drug must be occasionally stopped to prevent anticholinergic effects

A

A pt who is being treated w/ a typical antipsychotic reports frequent nasal congestion and urinary hesitation. To what should the nurse most likely attribute these symptoms? A) Anticholinergic effects B) Tardive dyskinesia C) Neuroleptic malignant syndrome D) Extrapyramidal symtoms

A

A pt who takes lithium for the treatment of bipolar disorder has been experiencing occasional constipation. What should the nurse teach the pt about safely managing this problem? A) "Avoid taking psyllium supplements" B) "Do not take OTC stool softeners under any circumstances" C) "Avoid foods that are high in soluble fiber" D) "Occasional constipation is inevitable during lithium therapy"

A

Antipsychotic drugs are also known as neuroleptic drugs because: A) They cause numerous neurological effects B) They frequently cause epilepsy C) They are also minor tranquilizers D) They are the only drugs known to directly affect nerves

A

Haloperidol is a potent antipsychotic that is associated with: A) Severe extrapyramidal effects B) Severe sedation C) Severe hypotension D) Severe anticholinergic effects

A

The nurse is working w/ a 12-yr old pt who has been diagnosed w/ ADHD and is prescribed methylphenidate. What statement by the pt would suggest the presence of adverse drug effects? A) "Sometimes I just feel so mad at my teacher or my coach" B) "I just don't feel hungry very much these days" C) "I fell asleep on the bus last week and missed by stop" D) "I banged my shin last week and the bruise is still there"

B

A pt on the psychiatry unit w/ a long-standing history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize in the care of this pt? A) Monitoring the pt hepatic and renal status B) Monitoring the pt for indications of bone marrow suppression C) Assessment of the pt behaviors and thought processes D) Assessing the pt vital signs

C

Antipsychotic drugs are basically: A) Serotonin reuptake inhibitors B) Norepinephrine blockers C) Dopamine receptor blockers D) Acetylcholine stimulators

C

Lithium toxicity can be dangerous. Pt assessment to evaluate for appropriate lithium levels would look for: A) Serum lithium levels >3 mEq/L B) Serum lithium levels >4 mEq/L C) Serum lithium levels <1.5 mEq/L D) Undetectable serum lithium levels

C

A 14-yr old pt w/ symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The pt weighs 154 lb. How many milligrams of pimozide should the pt be administered?

3.5 mg; 154/2.2 = 70 70 X 0.05 = 3.5

The pt was diagnosed w/ narcolepsy and prescribed modafinil on his last visit. When he returns for follow-up care 2 months later, he reports the he is able to stay away all day but he hates the dry mouth the drug causes. What strategy would the nurse provide this pt to cope w/ this adverse effect? A) Provide sugarless lozenges to suck B) Avoid citrus fruits C) Increase water intake D) Increase salt intake

A

Select all that apply: Before administering lithium to a pt the nurse should check for the concomitant use of which of the following drugs that could cause serious adverse effects? A) Ibuprofen B) Haloperidol C) Thiazide diuretics D) Antacids E) Ketoconazole F) Theophylline

A B C D

Select all that apply: What data should indicate to the nurse that the pt is experiencing encephalopathic syndrome? A) The pt white cell count is greatly elevated B) The pt is much weaker than normal C) The pt is uncharacteristically disoriented D) The pt random blood glucose level is 145 mg/dL E) The pt hands are tremulous when at rest

A B C E

Select all that apply: Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the pt receiving antipsychotic drugs should include which of the following: A) Positioning to decrease discomfort of dyskinesias B) Implementing safety measures to prevent injury C) Encouraging the pt to chew tablets to prevent choking D) Careful teaching to alert the pt and family about this adverse effect E) Applying ice to the joints to prevent damage F) Pureeing all food to decrease the risk of aspiration

A B D

The pt has been taking an atypical antipsychotic med for several years. During annual physical examinations, what assessment best addresses a likely adverse effect? A) Fasting blood glucose level B) BP C) Electrocardiogram D) Assessment of passive range of motion

A; Hypotension and prolonged QT intervals is typical in typical antipsychotics; ROM is unlikely to be affected

The nurse is caring for a pt who is prescribed haloperidol for long term. What assessment should the nurse prioritize? A) Assessment for involuntary movements B) Monitoring the pt white cell differential C) Assessment of the pt skin integrity D) Monitoring the pt CD4 T-cell count

A; associated w/ increased risk of extrapyramidal adverse effects

A pt current drug regimen includes modafinil. When planning this pt care, the nurse should prioritize the pt risk for: A) Injury B) Hallucinations C) Acute confusion D) Hopelessness

A; treatment for narcolepsy which creates significant risk for injury

A pt med regimen includes lithium. What assessment finding would suggest a therapeutic effect? A) The pt refrains from aggressive or violent outbursts B) The pt denies severe depressive or manic episodes C) The pt denies audio or visual hallucinations D) The pt states that she now has purpose and direction in her life

B

Select all that apply: The nurse is providing drug teaching for a pt who is newly prescribed a typical antipsychotic med. What teaching points will the nurse include while talking with this pt? A) "Increased appetite can cause obesity, so take care to eat a healthy diet" B) "Inform all health providers of the meds you take" C) "Spending time outside in the sunshine will improve your mood" D) "Avoid use of the herb evening primrose" E) "Never drink alcohol while taking this med"

B D E

A psychiatric nurse is reviewing various antipsychotic agents. The nurse should identify what drug as having the highest potency? A) Thioridazine B) Prochlorperazine C) Fluphenazine D) Chlorpromazine

C

Which pt is being treated w/ a typical antipsychotic? A) A pt whose thought disorder requires clozapine 25 mg PO b.i.d B) A pt who recently began taking ziprasidone C) An agitated pt who has been given haloperidol during acute psychosis D) A pt w/ schizophrenia who received paliperidone 6 mg PO daily

C; others are atypical

The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to: A) Perform deep breathing and coughing exercises B) Report any new onset of chest pain promptly C) Stay in bed for the next half hour D) Expect urinary urgency for the next few hours

C; urgency & chest pain are not adverse effects; no need for deep breathing/coughing

True or false: The development of diabetes mellitus is associated w/ the use of typical antipsychotics.

False; W/ atypical

True or false: During periods of dehydration, the pt is at risk for lower serum lithium levels.

False; at risk for higher levels

True or false: A pt w/ schizophrenia will exhibit fluctuations in mood swings from depression to mania.

False; characterized by hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Bipolar is associated w/ this.

True or false: Mania is characterized by extreme overactivity and excitement.

True

Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include: A) Insomnia and hypertension B) Dry mouth, hypotension, and glaucoma C) Diarrhea and excessive urination D) Increased sexual drive and improved concentration

B

The nurse is planning care of a pt who has been diagnosed w/ schizophrenia and who will begin treatment w/ a typical antipsychotic. The nurse should identify what nursing diagnosis? A) Risk for impaired liver function related to hepatotoxicity B) Risk for injury related to CNS depression C) Bowel incontinence related to GI adverse effects D) Risk for imbalanced body temp related to hypothalamic suppression

B

The nurse is teaching a pt who is prescribed fluphenazine about this drug. Which pt statement indicates that the pt has understood the instructions? A) "I should call my doctor if I notice any heart irregularities" B) "I shouldn't be alarmed if my urine turns pink or reddish brown" C) "I might get a severely runny nose w/ this drug" D) "I might develop diabetes if I take this drug, but I'll be monitored closely"

B

A nurse is reviewing the serum lithium level of a pt w/ bipolar, which is 1.8 mEq/L. What is the nurse's best action? A) Inform the prescriber and perform a focused respiratory assessment B) Facilitate a transfer to the ICU C) Contact the prescriber and request a supplementary one of lithium D) Inform the prescriber and monitor for GI and CNS effects

D

A pt is being treated w/ clozapine. What should the nurse monitor most closely? A) AST, ALT, and bilirubin B) Urine quantity and quality C) Cardiac enzymes D) White blood cell count

D

ADD (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are most effectively treated with the use of: A) Neuroinhibitors B) Dopamin receptor blockers C) Major tranquilizers D) CNS stimulants

D

What assessment finding should lead the nurse to suspect that a pt receiving antipsychotic therapy is developing tardive dyskinesia? A) Abnormal eye movements B) Urinary incontinence C) Disorientation D) Lip smacking

D

True or false: Typical antipsychotics block dopamine receptors.

True