WGU Psych - C476: Psychosis Meds

11 Signs of Serotonin Syndrome

1. Confusion 2. Shivers 3. Restlessness 4. Goosebumps 5. Tachycardia 6. Labile BP 7. Diaphoresis 8. Dilated pupils 9. Twitching 10. Diarrhea 11. Headache

7 Extra Pyramidal Symptoms (EPS)

1. acute dyskinesias 2. dystonic reactions 3. tardive dyskinesia 4. Parkinsonism 5. akinesia 6.akathisia 7. neuroleptic malignant syndrome.

A pt is prescribed fluphenazine (Prolixin) and c/o severe muscle spasms. On examination, HR is 110 BPM; BP, 160/92 mmHg; and Temp 101.5 degress F. Which nursing diagnosis takes priority? 1. Check the chart for prn of benzatropine mesylate (Cogentin) because of increased manifestation of EPS. 2. Hold the next dose of Prolixin and call the prescriber immediately to report findings. 3. Schedule an examination with the pt's physician to evaluate cardiovascular function. 4. Ask the pt about any recreational drug use and ask the provider to order a drug screen.

Answer: 2. Because NMS is r/t use of neuroleptic drugs such as fluphenazine (Prolixin); the next dose should be held and the prescriber notified immediately of this potentially life-threatening complication. Hint: Severe muscle spasms, increased HR, HTN, and hyperpyrexia are all symptoms of neuroleptic malignant syndrome (NMS). NMS is rare but potentially fatal complication of neuroleptic drugs. 1. The symptoms are not indicative of EPS which include but are not limited to: tremors, dystonia, akinesia, and akathisia. 3. Elevated BP and HR in this situation are not due to cardiac problems but to NMS from the use of neuroleptic medication. 4. Drug use can cause the listed symptoms but when the nurse understands the relationship between neuroleptics and NMS; the nurse also recognizes the risk for this life-threatening condition.

A woman is prescribed risperidone (Risperdal) 1mg bid. At her 3-month follow-up, the pt states, "I knew it was a possible side-effect, but I can't believe I am not getting my periods anymore." Which teaching is a priority? 1. "Sometimes amenorrhea is a temporary side-effect of medications and should resolve itself." 2. "I am sure this was very scary for you. How long has been since your last menstrual period?" 3. "Although your menstrual cycles have stopped , there is still a small potential for you to become pregnant." 4. "Maybe the amenorrhea is not due to your medication. Have your menstrual cycles been regular in the past?"

Answer: 3. It is important for nurses to teach pts taking antipsychotic medications about the potential for amenorrhea and that even though they are not regularly having their menstrual cycle ovulation may still occur. Hint: Pay attention to key words in the question such as "teaching " in this case. Answer 2 and 4 can be immediately discarded because they are assessment interventions and not teaching. 1. Amenorrhea is a side effect of antipsychotic medications , such as Risperdal and when it occurs it resolves only if the pt is taken off the medication. 2. Empathy r/t the concern is appropriate, but asking the pt further questions such as how long the pt has been without her menstrual periods constitutes an assessment. The question is asking for further teaching needs. An assessment does not answer the question. 4. Asking the pt more questions about her amenorrhea while appropriate does not answer the question . The question is asking for further teaching needs and asking about regularity of her periods is an assessment.

A pt is prescribed aripiprazole (Abilify) 10mg q AM. The pt complains of sedation and dizziness . Vital signs demonstrate BP , 100/60 mmHg; HR 80 BPM; RR 20; and temp 97.4 degrees F. Which nursing diagnosis takes priority? 1. Risk for noncompliance r/t irritating side effects. 2. Knowledge deficit r/t new medication prescribed. 3. Risk for injury r/t orthostatic hypotension. 4. Activity intolerance r/t dizziness and drowsiness.

Answer: 3. Risk for injury r/t orthostatic hypotension which is a s/e of the medication is a priority diagnosis. It is important to recognize increased risk of injury (fall) r/t orthostatic hypotension. Aripiprazole (Abilify) is an antipsychotic. It is prescribed for persons with thought disorders. 1. Noncompliance is a concern; however it is not a priority nursing diagnosis. 2. Knowledge deficit is a concern but not a priority nursing diagnosis. 4. Activity intolerance is a concern; however it is not a priority nursing diagnosis.

A pt has an order for, " ziprasidone (Geodon) 20mg IM q4 hrs prn for agitation with a maximum daily dose of 40mg /day." Administration times are documented in the MAR (Medication Administration Record). Which times indicate safe medication administration? 1. "0800 and 1100" 2. "1200, 1700, and 2100" 3. "0900, 1200, and 2100" 4. "1300 and 1700"

Answer: 4. The Medication Administration Record (MAR) documenting that ziprasidone was administered at 1300 and 1700 is 4 hrs apart (q 4 hrs) and equals the maximum daily dose of 40mg/day. This would be appropriate documentation for the order for, " ziprasidone (Geodon) 20mg IM q4 hrs prn for agitation with a maximum daily dose of 40mg /day." Hint: First note how often prn medication can be administered and then to be able to understand how the maximum daily dose would affect the number of times the medication can be administered. 1. The medication is ordered q 4hrs. Because there are only three hours between 0800 and 1100, the medication was administered incorrectly. 2. Although there are 4 hours between administration times in this answer, the pt would have received 60 mg/day of ziprasidone, exceeding the maximum daily dose. 3. This documentation of administration has only three hours between 0900 and 1200, not q 4 hrs per order, and if given three times in ONE day (=60mg) exceeds the maximum daily dose of 40mg/daily.

A pt is newly prescribed hydroxyzine (Atarax) 50mg q hs and clozapine (Clozaril) 25mg bid. Which is an appropriate nursing diagnosis for this pt? 1. Risk for injury r/t serotonin syndrome. 2. Risk for injury r/t possible seizure. 3. Risk for injury r/t clozapine toxicity. 4. Risk of injury r/t depressed mood.

Answer: 2. A s/e of clozapine is that it lowers the seizure threshold. The nurse would need to place the pt taking clozapine on seizure precautions. Hydroxyzine (Atarax) is an antianxiety medication (also used as antihistamine) and clozapine (Clozaril) is an atypical antipsychotic with many side effects. 1. Although hydroxyzine affects serotonin, clozapine does not have much impact on serotonin and the risk for serotonin syndrome is low. 3. There is no test for clozapine blood levels. Signs that too much clozapine has been taken include, but are not limited to: Excessive sedation or hypersalivation. 4. Hydroxyzine and clozapine are not used for treating depression and this answer is incorrect

A pt diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize? 1. Remind the pt that the medication takes 6-8 weeks to take full effect. 2. Instruct the pt and family about the many food-drug and drug-drug interactions. 3. Teach the pt about the possible sexual side-effects and insomnia that can occur. 4. Educate the pt about taking the medication prescribed even after symptoms improve.

Answer: 2. Because there are numerous drug-food and drug-drug interactions that may precipitate a hypertensive crisis during treatment with MAOIs, it is critical that the nurse prioritize this teaching. Phenelzine (Nardil) , an antidepressant , is categorized as a monoamine oxidase inhibitor (MAOI). 1. It is important for the nurse to teach a pt who has been prescribed phenelzine that this medication takes 6-8 weeks to take full effect, Compared w/ other answer choices, this topic is not prioritized. 3. It is important for the nurse to teach a pt who has been prescribed phenelzine that possible sexual side effects and insomnia can occur with the use of this drug. Otherwise symptoms are not a severe as a hypertensive crisis, so compared with the other answer choices, this teaching topic is not prioritized. 4. It is important for the nurse to educate the pt about consistently taking the prescribed medications even after improvement of symptoms. However, compared with other answer choices, this teaching topic is not prioritized.

Lithium carbonate (lithium) is to mania as clozapine (Clozaril) is to: 1. Anxiety 2. Depression 3. Psychosis 4. Akathisia

Answer: 3. Clozapine (clozaril) an atypical antipsychotic , is used to treat symptoms of thought disorders, such as, but not limited to: psychosis. Lithium carbonate (Lithium , Li) is a mood stabilizing medication that is used to treat symptoms of bipolar affective disorder (BPAD). Symptoms of BPAD include but are no limited to: mania, labile mood, and depression. 1. Benzodiazepines and selective serotonin reuptake inhibiters (SSRIs) are medications to assist pts with anxiety. SSRIs start to show an effect in 2-3 weeks and may take 4-6 weeks to reach full effect with regular use. 2. Medications that assist pts with depression are monoamine oxidase inhibitors (MAOIs) tricyclic antidepressants, and SSRIs. 4. Akathisia is an EPS manifestation that occurs as a result of the use of antipsychotic medications. Meds to treat EPS such as akathisia are anticholinergic or antihistamine drugs.

A pt is exhibiting sedation , auditory hallucinations (AH), dystonia, and grandiosity. The pt is prescribed haloperidol Haldol 5mg tid and trihexyphenidyl (Artane) 4mg bid. Which statement about these medications is accurate? 1. Artane would assist the pt with sedation. 2. Artane would assist the pt with auditory hallucinations (AH). 3. Haldol would assist the pt in decreasing grandiosity. 4. Haldol would assist the pt with dystonia.

Answer: 3. Haldol , an antipsychotic would decrease an individual's grandiosity, which is one of many symptoms of a thought disorder. Trihexyphenidyl (Artane) , is an anticholinergic medication. It is prescribed to counteract extrapyramidal symptoms (EPS) which are s/e of all antipsychotic medications. Dystonia, involuntary muscle movements or spasms of face/arms/legs/neck are manifestation of EPS. 1. Sedation is a s/e of Haldol, not EPS, it is not affected by Artane. 2. Haldol is an antipsychotic used to treat auditory hallucinations (AH). 4. Haldol, similar to all antipsychotics causes dystonia. Medications such as Artane are used to counteract EPS manifestations such as dystonia. (Cogentin and Benadryl) may also be used.

Which atypical antipsychotic medication has the highest potential for a pt to experience serious side-effects? 1. Haloperidol (Haldol) 2. Chlorpromazine (Thorazine) 3. Risperidone (Risperdal) 4. Clozapine (Clozaril)

Answer: 4. Clozaril an atypical antipsychotic has side effects including sedation , weight gain, and hypersalivation, because of these side-effects and the life-threatening side of effect of agranulocytosis; clozapine (Clozaril) is usually used as a last resort after other failed medication trials. Diagnostic lab tests (CBC) need to be performed twice monthly. Hint: Read the question carefully. It calls for "Atypical." Answers 1 and 2 can be immediately eliminated. 1. Although Haldol can have side-effects. It is a "typical" not an "atypical" antipsychotic medication. The question is asking for atypical. 2. Although Thorazine can have side effects. It is a "typical" not an "atypical" antipsychotic medication. The question is asking for atypical. 3. Risperdal and Clozaril are both atypical antipsychotics, however, based on studies Clozaril has the highest potential for adverse side effects.

Which symptoms would the nurses expect to assess in a pt experiencing serotonin syndrome? 1. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis. 2. Hypomania, akathisia, cardiac arrhythmias, and panic attacks. 3. Dizziness, lethargy, headache, and nausea. 4. Orthostatic hypotension, urinary retention, constipation, and blurred vision.

Answer: 1. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis all are symptoms of serotonin syndrome. Other symptoms included dilated pupils, loss of muscle coordination or twitching, diarrhea, headache, shivering, and goose bumps. If this syndrome were suspected, the offending agent would be discontinued immediately. Serotonin syndrome is a potentially life-threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells. Most often this occurs when 2 drugs used concurrently potentiate serotoninergic neurotransmission. 2. Hypomania, akathisia, cardiac arrhythmias, and panic attacks are all symptoms associated with discontinuation syndrome from tricyclic antidepressants, not serotonin syndrome. 3. Dizziness, lethargy, headache, and nausea are symptoms associated with discontinuation syndrome from selective serotonin reuptake inhibitors, not serotonin syndrome. Discontinuation syndrome occurs with the abrupt discontinuation of any class of antidepressants. 4. Orthostatic hypotension , urinary retention , constipation, and blurred vision are side effects associated with the use of tricyclics and heterocyclics, not symptoms of serotonin syndrome.

A pt prescribed quetiapine (Seroquel) 50mg bid has a nursing diagnosis of risk for injury r/t sedation. Which nursing intervention appropriately addressed this pt's problem? 1. Assess for homicidal and suicidal ideations. 2. Remove clutter from the environment to prevent injury. 3. Monitor orthostatic changes in pulse or BP. 4. Evaluate for auditory and visual hallucinations.

Answer: 2. Removing cutter from the pt's environment would assist the pt in avoiding injury due to tripping and falling. It is important for the nurse to ensure the environment is cutter-free especially when the pt may be sedated. Quetiapine (Seroquel) is an atypical antipsychotic in the treatment of thought disorders. A significant s/e of Seroquel is sedation. 1. Although the nurse should monitor for homicidal & suicidal ideation, this answer does not r/t the nursing diagnosis noted in the question. 3. There is a potential for orthostatic changes when a pt is prescribed quetiapine. However, orthostatic changes are not r/t the sedation described in the nursing diagnosis. 4. Although, it is important for the nurse to evaluate for auditory & visual hallucinations while a pt is taking Seroquel, such evaluation does not r/t the stated nursing diagnosis.

A pt has been prescribed ziprasidone (Geodon) 40mg bid. Which of the following interventions are important r/t to this medication? Select all that apply. 1. Obtain a baseline EKG initially and periodically throughout treatment. 2. Teach the pt to take the medication with meals. 3. Monitor the pt's pulse because of the possibility of palpitations. 4. Institute seizure precautions, and monitor closely. 5. Watch for signs and symptoms and of manic episode.

Answers - 1, 2, 3: 1. Geodon has the potential, in rare cases, to elongate the QT interval; a baseline and periodic EKG would be necessary. 2. Geodon needs to be taken with meals for it to be absorbed effectively. It is important for the nurse to teach the pt the need to take Geodon with meals. 3. Palpitations can be a side effect of Geodon and would need to be monitored. Ziprasidone (Geodon) is an atypical antipsychotic used to treat symptoms related to altered thought process. 4. Seizure precautions are needed with bupropion (Wellbutrin) and clozapine (Clozaril), not ziprasidone (Geodon). 5. A manic episode is not a side effect of Geodon.

A pt diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the pt? Select all that apply. 1. Ask the pt about suicidal ideations r/t depressed mood. 2. Discuss the need to take medications, even when symptoms improve. 3. Instruct the pt about risks of abruptly stopping the medication. 4. Alert the pt to risks of dry mouth, sedation, nausea, and sexual side effects. 5. Remind the pt that the medication's full effect may not occur for 6-8 weeks.

Answers: 2, 3, 4, 5 2. Discussing the need for medication compliance, even when the symptoms improve , is a teaching point that the nurse would need to review w/ a pt who is newly prescribed sertraline. 3. Instructing the pt about risk for discontinuation syndrome is a teaching point that the nurse would need to review w/ a pt who is newly prescribed sertraline. 4. Alerting the pt to the risks of dry mouth, sedation, nausea, and sexual side-effects is a teaching point that the nurse would need to review w/ the pt who is newly prescribed sertraline. 5. Reminding the pt that sertraline's full effect may not occur for 6-8 weeks is a teaching point that the nurse would need to review with a pt who is newly prescribed sertraline. Sertraline (Zoloft) is a serotonin reuptake inhibitor (SSRI). 1. Because of the numerous suicides associated with mood disorders, it is important to monitor pts for suicidal ideations r/t depressed mood. However, this is a pt assessment and not a teaching intervention.

For the past year, a pt has received haloperidol (Haldol). The nurse administering the pt's next dose notes a twitch on the right side of the pt's face & tongue movements. Which nursing intervention takes priority? Give haloperidol (Haldol) and benzatropine (Cogentin) 1mg IM prn per order. 2. Assess for other signs of hyperglycemia resulting from the use of haloperidol. 3. Check the pt's temperature and assess for mental status. 4. Hold the haloperidol, and call the physician.

Haloperidol (Haldol), is a typical antipsychotic used in the treatment of thought disorders. A side effect is tardive dyskinesia (TD) the s/s are: bizarre facial, & tongue movements , stiff neck, and difficulty swallowing. Long-term treatment w/ antipsychotics poses risk. The symptoms can be irreversible. 1. Benzatropine (Cogentin) may be given to reduce s/s of TD. However, because TD is potentially irreversible, it is important that the nurse hold the medication and talk to the prescriber before giving the next dose of haloperidol . 2. Antipsychotic medications such as haloperidol can cause metabolic changes, and the pt would need monitoring. However, the symptoms in the question do not reflect hyperglycemia. 3. Another s/e of antipsychotic medications is neuroleptic malignant syndrome (NMS). The s/s of NMS are muscle rigidity, hyperpyrexia, (107 degrees F), tachycardia, tachypnea, fluctuations in blood pressures, diaphoresis, and rapid deterioration of ,mental status to stupor or coma. The symptoms in the question do not reflect NMS.

A pt is prescribed clozapine (Clozaril) 12.5mg q AM and 50mg q HS. Clozapine (Clozaril) is available in 25mg tabs. How many tabs would be administered daily? _________________tablets

Hint: Note: key words in the question such as "daily." Then, calculate the number of tablets for each scheduled dose and add these together to get the TOTAL DAILY number of tabs. Set up ratio and proportion problem based on the number of mg contained in ONE tab. Solve by cross multiplication and solving for "x" by division. Administer 2.5 tabs daily Solve by: 12.5mg/x tab = 25mg/1 tab =0.5 tab 50mg/x tab =25mg/1 tab =2 tab 0.5 tab + 2 tabs =2.5 tabs/daily

Antagonist for Barbituate

None

A pt is prescribed risperidone (Risperdal) 4mg bid. After the pt is caught cheeking the medication; liquid medication is prescribed. The label reads 0.5mg /mL. How many mLs would the nurse administer daily? _______________mL

The nurse will administer 16mL daily. Solve by: 0.5mg/ 1 mL = 4mg/x mL = 8 mL 8 mL X 2 doses (bid) = 16 mL Hint: Note: key words in the question such as "daily." The individual dosage calculates as 8mL, but the daily dose is 16mL. Set up the ratio and proportion problem based on the number of mg contained in 1 mL. Cross multiply and solve for "x" by division. Administer 16 mL daily.

6 Anticholinergic effects

dry mouth, blurred vision, photophobia, dry mouth, urinary retention or hesitancy, tachycardia, constipation

Antagonist for Benzodiazapine

flumazenil

9 Signs of Neuroleptic Malignant Syndrome

● Sudden high fever ● Blood pressure fluctuations ● Diaphoresis ● Tachycardia ● Muscle rigidity ● Drooling ● Decreased level of consciousness ● Coma ● Tachypnea