NU141- Chapter 22 Psychotherapeutic Agents

Antipsychotic drugs are basically a. serotonin reuptake inhibitors. b. norepinephrine blockers. c. dopamine receptor blockers. d. acetylcholine stimulators.

c. dopamine receptor blockers

Lithium toxicity can be dangerous. Patient 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. serum lithium levels <1.5 mEq/L

Due to the actions of caffeine, the nurse is concerned when it is consumed by clients with what medical diagnosis? Select all that apply.

cardiac dysrhythmias bipolar disorder history of stroke

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?

cardiac monitoring

The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment?

central nervous system (CNS) stimulants

Antipsychotic

drug used to treat disorders involving thought processes; dopamine receptor blocker that helps affected people to organize their thoughts and respond appropriately to stimuli

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

electrocardiogram (ECG).

A 13-year-old has been prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) since age 10, 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

Mania

state of hyperexcitability; one phase of bipolar disorders, which alternate between periods of severe depression and mania

Schizophrenia

the most common type of psychosis; characteristics include hallucinations, paranoia, delusions, speech abnormalities, and affective problems

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

"I may always have to take this medication."

The nurse is teaching a client who is prescribed fluphenazine about the drug. Which client statement indicates that the client has understood the instructions?

"I shouldn't be alarmed if my urine turns pink or reddish brown."

A patient expresses that being diagnosed with narcolepsy has been devastating for him. Which statement by the patient should the nurse focus on initially during the assessment?

"I sometimes wonder if it is worth living a life that has so many restrictions."

A client with a history of schizophrenia has been receiving antipsychotic therapy for several years. Which would indicate to the nurse that the client is experiencing pseudoparkinsonism?

Cogwheel rigidity

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 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

A female client is diagnosed with renal insufficiency. The nurse develops a teaching plan based on the diagnosis and antipsychotic drug usage. The client asks the nurse why it is so important to have renal function tests routinely. The nurse replies that if renal function test results become abnormal, what may be a consequence?

The drug may need to be lowered in dosage or discontinued.

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?

Alcohol should be avoided.

What would the nurse's pre-administration assessment of a client receiving a CNS stimulant for the treatment of obesity include? (Select all that apply.)

Blood pressure Pulse Weight Respiratory rate

Monitoring what laboratory test is most important in the first months of clozapine therapy?

regular complete blood counts

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?

A client who has type 1 diabetes and who practices poor glycemic control

The nurse is caring for a client who is prescribed haloperidol long term. What assessment should the nurse prioritize?

Assessment for involuntary movements

A 21-year-old client refuses to take his oral antipsychotic medication. What would be the appropriate action for the nurse do?

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

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

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?

Record a daily summary of client's behavior.

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

Attention-deficit/hyperactivity disorder (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are both most effectively treated with the use of a. neuroinhibitors. b. dopamine receptor blockers. c. major tranquilizers. d. CNS stimulants.

d. CNS stimulants

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?

dopamine

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?

Gluteus

Monitoring of patients taking lithium includes periodically obtaining a serum lithium level; at what level may toxic reactions occur?

Greater than 1.5 mEq/mL

The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?

Improving

A female client relates that she is taking diazepam for a muscle relaxant and modafinil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of client education, the nurse would include:

Modafinil may decrease the effects of her contraceptive, and she may need to use other protection.

A female client 70 years of age is receiving lithium. Which nursing intervention is appropriate for this client?

Monitor fluid and sodium intake every 12 hours.

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 clinic nurse provides all the phone numbers of the health care providers to the family of a schizophrenic patient. What is one intervention the healthcare provider can initiate to show support of the patient?

Provide safety measures such as side rails to the patient

A patient has been administered an antipsychotic. Which reaction should be reported immediately?

Rigidity

A 10-year-old child is being administered CNS stimulants for ADHD. What should the nurse instruct the parents to record periodically?

Weight and growth

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."

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."

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."

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."

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

White blood cells

The nurse knows the medication methylphenidate is used to treat attention deficit hyperactivity disorder(ADHD). What type of medication is methylphenidate?

a central CNS stimulant

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.

A client has been treated with chlorpromazine for many years. The nurse observes that a client with a long history of chlorpromazine therapy demonstrates lip smacking and appears to be chewing continually. The nurse should recognize that this client is likely experiencing what adverse effect of the medication?

tardive dyskinesia

What client is being treated with a typical antipsychotic?

An agitated client who was given haloperidol during acute psychosis

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

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 inquiry?

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

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

Clozapine

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

A child suffers from tics and verbal outbursts while awake. The client is prescribed haloperidol. What disease process is haloperidol used to treat?

Tourette's syndrome

What medication is an example of a phenothiazine antipsychotic?

chlorpromazine

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."

The main goal of therapy when using CNS stimulants is to:

relieve the symptoms for which they were prescribed.

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

For which patient are CNS stimulants contraindicated?

Patients with severe hypertension

The peditric client has been prescribed mehtylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?

"Adverse effects include hypertension and nervousness."

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 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?

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

A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation?

Antipsychotic

A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?

Antipsychotics do not improve memory loss and may further impair cognitive functioning.

The nurse practitioner is prescribing CNS medications. The nurse practitioner knows that central nervous system stimulants can be used successfully to treat which disorders? Select all that apply.

Attention deficit/hyperactivity disorder Drug-induced respiratory depression Narcolepsy Sleep apnea Fatigue

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

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?

A female client comes to the clinic for an examination after being on benzphetamine for 6 weeks with a weigt loss of 30 pounds. The priority nursing diagnosis for this client would be which?

Imbalanced nutrition

A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action?

Inform the prescriber and monitor for GI and CNS effects

A client is prescribed doxapram as part of the treatment plan. Which would be most important for the nurse to do when caring for this client? Select all that apply.

Keep a suction machine nearby Avoid giving the client coffee, tea, and carbonated beverages Measure urinary intake and output Palpate the bladder for distention

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

Lip smacking

Anticonvulsive medications are sometimes used in the treatment of bipolar disorder. What other drug is used to treat bipolar disorder?

Lithium

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

Mental depression and sleep disorders.

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 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

The nurse is caring for a client who takes clozapine. The nurse would be most concerned if this client displays what symptom?

Temperature of 102°F

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 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.

Bipolar disorder

behavioral disorder that involves extremes of depression alternating with hyperactivity and excitement

The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose?

To assess beneficial and adverse effects

Before administering lithium to a patient, the nurse should check for the concomitant use of which drugs, which could cause serious adverse effects? a. Ibuprofen b. Haloperidol c. Thiazide diuretics d. Antacids e. Ketoconazole f. Theophylline

a. Ibuprofen b. Haloperidol c. Thiazide diuretics d. Antacids

Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which actions? a. Positioning to decrease discomfort of dyskinesias b. Implementing safety measures to prevent injury c. Encouraging the patient to chew tablets to prevent choking d. Careful teaching to alert the patient 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. Positioning to decrease discomfort of dyskinesias b. Implementing safety measures to prevent injury d. Careful teaching to alert the patient and family about this adverse effect

Attention deficit disorder

behavioral syndrome characterized by an inability to concentrate for longer than a few minutes and excessive activity

Haloperidol (Haldol) is a potent antipsychotic that is associated with a. severe extrapyramidal effects. b. severe hyperactivity. c. severe hypotension. d. severe anticholinergic effects.

a. severe extrapyramidal effects

Your patient, a 6-year-old boy, is starting a regimen of methylphenidate (Ritalin) to control an attention deficit disorder. Family teaching should include which of the following? a. This drug can be shared with 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. d. This drug should not be stopped for any reason for several years.

b. This drug may cause insomnia, weight loss, and GI upset

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. dry mouth, hypotension, and glaucoma

A presurgical client has reported a history of illicit amphetamine use. The nurse is concerned because of the effect this type of abuse has on what physiological functions? Select all that apply.

central nervous system (CNS) sympathetic nervous system (SNS)

Mental disorders are now 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. schizophrenia

What should the nurse assess regarding a client's reports of insomnia?

daily intake of caffeine-containing products

The nurse should recognize what as the primary goal of treatment for haloperidol therapy?

decreased agitation and combativeness

A client is prescribed olanzapine for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of olanzapine, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?

diabetes mellitus

The client has been taking chlorpromazine for more than 40 years. What adverse effect will the client most likely be experiencing?

extrapyramidal effects

Major tranquilizer

former name of antipsychotic drugs; the name is no longer used because it implies that the primary effect of these drugs is sedation, which is no longer thought to be the desired therapeutic action

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 antipsycotic, the care team should implement which intervention?

gradually taper the dose of haloperidol

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.

A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which?

height and weight.

Narcolepsy

mental disorder characterized by daytime sleepiness and periods of sudden loss of wakefulness

What is the central nervous system stimulant of choice to treat narcolepsy?

modafinil

A client visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. These behaviors support which medical diagnosis?

narcolepsy

A nurse has participated in a family meeting with the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed dextroamphetamine. The nurse should discuss what black box warning associated with this medication?

potential for abuse

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?

reduced adverse effects

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?

"ADHD usually starts in childhood and may persist through adulthood."

An adult client, diagnosed with narcolepsy, admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?

"This is the result of neurological factors over which you have no direct control."

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?

Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task.

Moderate CNS depression is characterized by:

Drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.

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?

It reduces the likelihood of drug dependence or diversion.

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?

Phentermine

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.

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

WBC count

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. they cause numerous neurological effects

A nursing student is learning about drugs that affect the central nervous system. The student knows that some clien'ts with schizophrenia are given which drugs? Select all that apply.

antipsychotic drugs neuroleptics

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

blood pressure

The nurse is caring for a client who has been diagnosed with narcolepsy. Which problem could the client experience related to the disease?

hallucinations

Neuroleptic

a drug with many associated neurological adverse effects that is used to treat disorders that involve thought processes (e.g., schizophrenia)

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

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:

"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse."

A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to get off work and come in for refill appointments. How should the nurse respond to that request to best assure client safety?

"The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse."

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."

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

What should the nurse's pre-administration assessment of a client receiving a CNS stimulant for respiratory depression include? (Select all that apply.)

Blood pressure Pulse Respiratory rate Respiratory pattern Review recent lab work

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 school nurse is conducting a screening of kindergarten students. The nurse will assess the children for what characteristics of ADHD? (Select all that apply.)

Hyperactivity Impulsivity Short attention span

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 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 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.

A client who has a diagnosis of schizophrenia is likely to have which pathophysiologic effect?

increased dopamine

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):

increased risk for toxic effects of haloperidol therapy.

Antipsychotic drugs are contraindicated in clients with:

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

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?

What inappropriate response to stimuli has the client had?