Chapter 23: Antipsychotic Drugs

The nurse is caring for an adolescent client who began taking an antipsychotic drug last month to treat newly-diagnosed schizophrenia. The client's symptoms have improved only slightly, and the client's parents wonder if the client is "beyond hope." What is the nurse's best response? "It's common for clients to have to try different drugs until the most effective one is identified." "Some clients do not respond to antipsychotic drugs and have to rely solely on cognitive behavioral therapy." "Do you feel like you've given the medication enough time to work?" "It might be necessary to take a combination of several antipsychotics before the benefits are seen."

"It's common for clients to have to try different drugs until the most effective one is identified."

A client is prescribed clozapine (Clozaril). The client and family should be instructed on the adverse effects of this medication. What laboratory test is most important in the first 6 months of the medication regime? Weekly liver enzymes Daily blood glucose Monthly creatinine levels Weekly WBC counts

Weekly WBC counts

A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse? "Dopamine is an enzyme that regulates your temperature." "Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." "Dopamine is a medication that is given to fight infections and help with pain." "Dopamine is a part of the brain that controls your impulses and thoughts."

"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."

The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy? "I may always have to take this medication." "I will need medication if my hallucinations get worse." "If I take good care of myself, I'll be off medications soon." "Medications are less effective once my symptoms subside."

"I may always have to take this medication."

A female client 25 years of age has begun taking lithium for treatment of bipolar disorder. Which statement indicates that the client needs further instruction? "I will need to come to the clinic regularly for blood tests." "I will need to stop taking my birth control pills while I take lithium." "My lithium dose may change depending on the results of my blood tests." "I will call the health care provider if I experience diarrhea."

"I will need to stop taking my birth control pills while I take lithium."

When the nurse is engaging in teaching with clients taking anti-psychotic medications and their families, what would be important to include to decrease adverse effects of the medication? The client must eat three nutritious meals daily. Take only OTC medications with anti-psychotic drugs. Cough medicines potentiate the actions of anti-psychotic drugs. Alcohol should be avoided.

Alcohol should be avoided.

What client is being treated with a typical antipsychotic? An agitated client who was given haloperidol during acute psychosis A client with schizophrenia who received paliperidone 6 mg PO daily A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client who recently began taking ziprasidone

An agitated client who was given haloperidol during acute psychosis

The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed? Theophylline Haloperidol Chlorpromazine Thiothixene

Chlorpromazine

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 Decreased cost for the client Increased extrapyramidal effects Increased action on only dopamine receptors

Decreased extrapyramidal effects

A mother is concerned about recent behaviors by her young-adult son, and asks the nurse about what behaviors characterize schizophrenia. The nurse knows that the characteristics of schizophrenia include what actions? (Select all that apply.) Disordered thinking Abnormal behavior Repetitive actions Impaired socialization Sexual promiscuity

Disordered thinking Abnormal behavior Impaired socialization

The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit? Slowed reaction time and poor coordination Short manic episodes followed by long depressive episodes Disorganized and often bizarre thinking Short- and long-term-memory deficits

Disorganized and often bizarre thinking

Then nurse is caring for a client who has a diagnosis of schizophrenia. The nurse understands that the client's condition is thought to be most likely related to an increased level of activity of what neurotransmitter? Dopamine Norepinephrine Acetylcholine Adenosine

Dopamine

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? Neuroleptic malignant syndrome Agranulocytosis Extrapyramidal symptoms Gastrointestinal problems

Extrapyramidal symptoms

A male client tells the nurse he is going to stop taking his medication because he is always having fine tremors and slurred speech. These reactions are preventing him from teaching art classes like he used to do. The nurse knows that what action could help him? He could stop taking his medication and see if he still has schizophrenia. He could learn to teach other classes via online education so that he wouldn't have to talk out loud. He could talk with his health care provider and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic. He could tell his health care provider that the antipsychotics are not working and he needs a larger dose, or another medication added.

He could talk with his health care provider and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic.

When participating in care planning for a child who has been diagnosed with schizophrenia, the nurse should be aware of what fact? Pharmacologic treatment is contraindicated in children who have schizophrenia. It is not clear which drugs are safest and most effective in children with schizophrenia. Cognitive-behavioral therapy is the most effective intervention for schizophrenia in children. Schizophrenia is self-limiting in children, and treatment is focused on psychosocial support.

It is not clear which drugs are safest and most effective in children with schizophrenia.

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) Tardive dyskinesia Extrapyramidal syndrome Agranulocytosis

Neuroleptic malignant syndrome (NMS)

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? Lower cost The possibility of oral administration Reduced adverse effects Absence of black box warnings

Reduced adverse effects

After teaching a group of nursing students about adverse reactions associated with antipsychotic drugs, the instructor determines that the teaching was successful when the students identify which as an irreversible adverse reaction associated with the use of antipsychotics? Tardive dyskinesia Extrapyramidal syndrome Neuroleptic malignant syndrome (NMS) Serotonin syndrome

Tardive dyskinesia

The nurse on the unit has several clients taking clozapine. For which client is clozapine, an antipsychotic, contraindicated? The 16-year-old with an upper respiratory infection The 23-year-old with diabetes insipidus The 32-year-old with osteoarthritis The 45-year-old with bone marrow depression

The 45-year-old with bone marrow depression

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 demonstrates a significant increase in agitation after being given haloperidol. The client develops muscle rigidity and a sudden, high fever. The client reports intense thirst and produces copious amounts of urine. The client develops yellowed sclerae and intense pruritis (itchiness).

The client develops muscle rigidity and a sudden, high fever.

The client has been taking haloperidol for years and now has developed tardive dyskinesia. Which assessment findings would confirm this? The client is no longer experiencing relief of his psychotic symptoms. The client has a history of repeated falls. The client often smacks his lips and chews. The client's blood pressure is volatile.

The client often smacks his lips and chews.

What disease process is haloperidol used to treat? muscular dystrophy early-onset dementia Tourette's syndrome myasthenia gravis

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? Muscular dystrophy Alzheimer's disease Tourette's syndrome Myasthenia gravis

Tourette's syndrome

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment? visual acuity blood pressure core body temperature deep tendon reflexes

blood pressure

A client is being discharged from the unit. The nurse is to provide discharge education, including giving the client information about his medications. One of the medications is quetiapine (Seroquel). The nurse should educate the client that which food is contraindicated when taking this medication? Sugar Grapes Grapefruit Salt

grapefruit

What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia? Lip smacking Disorientation Abnormal eye movements Urinary incontinence

lip smacking

Antipsychotic drugs are contraindicated in clients with: liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. kidney damage, chronic obstructive lung disease, mild hypotension, and chronic bone pain. nausea, severe hypotension, or intractable hiccups. peptic ulcer disease, mild hypertension, chronic joint pain, and kidney failure.

liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.

The nurse is caring for a client who has been taking an oral neuroleptic medication for several years. What assessment should the nurse prioritize to best address the risk for adverse effects? assessment of bowel pattern and stool character monitoring the client's cranial nerve function assessment of deep tendon reflexes monitoring the client for involuntary facial movements

monitoring the client for involuntary facial movements

A resident of a long-term care facility is experiencing insomnia since being transferred to the facility. What antipsychotic would best help this client sleep? trifluoperazine aripiprazole paliperidone quetiapine

quetiapine

Chlorpromazine IM has been ordered for a client on the unit. The nurse caring for a client instructs the client to: not eat or drink for 1 hour after the drug is administered. take the medication prior to 6:00 PM. remain recumbent for at least 30 minutes after the injection. stay active for at least 30 minutes after taking the medication.

remain recumbent for at least 30 minutes after the injection.

Which antipsychotic medication classification has fewer extrapyramidal reactions? First generation Second generation Third generation All antipsychotics

second generation

A client's medication has been changed to clozapine. What assessment should the nurse perform to identify a life-threatening adverse effect early? monitoring urine output lung auscultation vital signs monitoring observation for bleeding

vital signs monitoring

For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months? Liver enzymes Hemoglobin White blood cells PT/PTT

White blood cells

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? partial thromboplastin time (PTT) Complete blood count (CBC) Prothrombin time (PT) blood urea nitrogen (BUN)

Complete blood count (CBC)

Extrapyramidal symptoms include all of the following except: Dystonia. Tardive dyskinesia. Dystocia. Akathisia.

Dystocia

The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus? maintenance of adequate nutrition potential therapeutic effects of medication the need for weekly blood coagulation testing the importance of adherence to prescribed treatment

the importance of adherence to prescribed treatment

A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority? The client will demonstrate independent health maintenance. The client will interact therapeutically with peers. The client will participate in activities of daily living (ADL). The client will remain safe.

The client will remain safe.

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

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

A family member asks if a relative, who is taking prochlorperazine for schizophrenia, can go on a beach vacation. What is one point of education that the nurse would make sure the client and family understand? "The client may become very agitated in a new environment, so he shouldn't go on vacation with the family. Instead, he will need to be hospitalized." "The client will probably gain weight due to a side effect of prochlorperazine, so he could be ridiculed at the beach." "Prochlorperazine can make you very sensitive to light. Make sure you wear sunscreen and cover up as much as possible to prevent sunburn." "The client will need to have his blood pressure monitored closely because it will probably rise from being out in the sun."

"Prochlorperazine can make you very sensitive to light. Make sure you wear sunscreen and cover up as much as possible to prevent sunburn."

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 have influenza A and will need to be put into isolation. The client may have broken his arm and not remember what happened because of his schizophrenia. The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately. The client may have neuroleptic malignant syndrome, which will self-resolve in a few hours after rest and Tylenol.

The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.

A client has been admitted to the hospital following an acute schizophrenic episode. Which would be a priority question for the nurse to ask the client's family during the initial interview? "What was the client doing or experiencing when the episode occurred?" "Does the client sleep well?" "Does the client participate in social and family activities?" "Does the client need help with activities of daily living?"

"What was the client doing or experiencing when the episode occurred?"

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. expect urinary urgency for the next few hours. report any new onset of chest pain promptly. perform deep breathing and coughing exercises.

stay in bed for the next half hour.

The nurse is providing teaching about a typical antipsychotic newly prescribed for the client. The nurse cautions the client against actions that may cause increased central nervous system (CNS) depression. What should the nurse caution the client against? maintaining an inconsistent sleep schedule consumption of alcohol use of over-the-counter NSAIDs tobacco use

consumption of alcohol

The nurse is monitoring a client for possible neuroleptic malignant syndrome. What interventions will the nurse implement in client care? Select all that apply. Assess temperature every 8 hours. Monitor bradycardia every 4 hours. Monitor for signs of respiratory distress. Perform a daily bedside electrocardiogram (ECG). Document urinary output into client records every 8 hours.

Assess temperature every 8 hours. Monitor for signs of respiratory distress. Document urinary output into client records every 8 hours.

A 21-year-old client refuses to take his oral antipsychotic medication. What would be the appropriate action for the nurse do? Force the client to take his oral medication by holding his nose shut and putting the pill in his mouth. Attempt to reason with the client. If he still refuses, contact the provider for further instructions. Give him a similar medication IM because you know he needs some type of antipsychotic. Argue with the client and give up if you don't win the argument.

Attempt to reason with the client. If he still refuses, contact the provider for further instructions.

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. have the flu. have a urinary tract infection. be making up the symptoms simply to get attention.

have undiagnosed diabetes.