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15. A nurse observes rhythmic, involuntary facial movements in a client who has been receiving antipsychotic drugs. The client also makes chewing movements and, at times, his tongue protrudes. The nurse interprets these findings as which of the following? A) Stevens-Johnson syndrome B) Neuroleptic malignant syndrome C) Tardive dyskinesia D) Extrapyramidal syndrome

Ans: C Feedback: Tardive dyskinesia is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome (EPS), neuroleptic malignant syndrome (NMS), and Stevens-Johnson syndrome do not cause rhythmic, involuntary facial movements.

17. After administering an antipsychotic to a client, the nurse would immediately report which of the following? A) Orthostatic hypotension B) Dry mouth C) Rigidity D) Drowsiness

Ans: C Feedback: The nurse should immediately report to the primary health care provider if the client displays signs of rigidity. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.

14. A nurse assesses a client receiving antipsychotic drugs for which of the following adverse reactions? A) Hypertension B) Skin dryness C) Dry mouth D) Bradycardia

Ans: C Feedback: The nurse should monitor the client for mouth dryness. Antipsychotic drugs cause hypotension, not hypertension. Skin dryness and bradycardia are not adverse reactions related to the administration of antipsychotic drugs.

3. A client is prescribed an antipsychotic drug that also has an antiemetic effect. Which of the following would the nurse identify as having this effect? Select all that apply. A) Lithium (Eskalith) B) Aripiprazole (Abilify) C) Chlorpromazine (Thorazine) D) Prochlorperazine (Compazine) E) Clozapine (Clozaril)

Ans: C, D Feedback: Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are antipsychotic medications that have antiemetic effects. Lithium, aripiprazole, and clozapine do not.

13. The nurse is providing care to a client receiving clozapine (Clozaril). The nurse would be alert for an increased risk of bone marrow suppression if the client is also receiving which of the following? Select all that apply. A) Immunological agents B) Anticholinergics C) Opioids D) Anticoagulants

Ans: A Feedback: The concomitant use of clozapine and immunological drugs can increase the severity of bone marrow suppression. The use of anticholinergics in combination with antipsychotics can increase the risk of tardive dyskinesia and psychotic symptoms. Opioids and anticoagulants are not associated with interactions involving antipsychotic drugs.

16. A nurse is caring for a client with schizophrenia. The physician has prescribed olanzapine in a disintegrating tablet form for the client. Which of the following points should the nurse include in the teaching plan for the client? A) Remove the tablet with dry hands. B) Take the tablet with a full glass of water. C) Add extra salt to food. D) Avoid tea or coffee.

Ans: A Feedback: The nurse should instruct the client to remove the olanzapine tablet with dry hands and place the entire tablet in his or her mouth. Wet or damp hands may cause the medication to begin disintegrating prior to entering the client's mouth. There is no need to add extra salt to food. The client is required to take orally disintegrating olanzapine, so there is no need to take any fluid with the drug. Also, there is no need to avoid tea or coffee.

2. After teaching a group of nursing students about antipsychotic drugs, the instructor determines that the teaching was successful when the students identify aripiprazole (Abilify) as exerting its effect on which of the following in the brain? Select all that apply. A) Serotonin B) Dopamine C) Norepinephrine D) Muscarinic E) Nicotinic

Ans: A, B Feedback: Atypical antipsychotic drugs like aripiprazole (Abilify) are thought to act on serotonin and dopamine receptors in the brain. The conventional, or first-generation, antipsychotics (FGAs) work to diminish the positive symptoms by blocking dopamine transmission.

12. When administering antipsychotic drugs, the nurse would need to keep in mind that which of the following atypical antipsychotics are most commonly associated with weight gain? Select all that apply. A) Olanzapine (Zyprexa) B) Risperidone (Risperdal) C) Ziprasidone (Geodon) D) Quetiapine (Seroquel) E) Clozapine (Clozaril)

Ans: A, B Feedback: Olanzapine (Zyprexa) and risperidone (Risperdal) are atypical antipsychotics that are most commonly associated with weight gain. None of the other drugs are associated with weight gain.

18. A client is prescribed clozapine. The nurse instructs the client on the need for weekly laboratory testing for which of the following? A) Serum lithium B) WBC count C) Blood glucose D) pH level

Ans: B Feedback: Use of the drug clozapine has been associated with severe agranulocytosis (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for clients who have been administered lithium, not clozapine. There is no need to check blood glucose or pH level.

9. Which of the following are reasons a nurse may need to contact the client's physician to administer an antipsychotic drug intramuscularly instead of orally? Select all that apply. A) Client is combative. B) Client refuses the medication. C) Client won't allow the nurse to inspect the oral cavity. D) Client has difficulty swallowing. E) Client is elderly.

Ans: A, B, C Feedback: A nurse may need to contact the client's physician to administer an antipsychotic drug intramuscularly instead of orally because the client is combative, refuses the medication, or refuses to allow the nurse to inspect the oral cavity. Clients who have difficulty swallowing may be given an oral liquid in lieu of an IM injection.

23. A client is receiving antipsychotic therapy. As part of the client's plan of care, the nurse assesses the client for possible adverse reactions. Which of the following would lead the nurse to suspect that the client is experiencing extrapyramidal effects? Select all that apply. A) Mask-like facial appearance B) Increased motor activity C) Facial grimacing D) Delusions E) Flat affect

Ans: A, B, C Feedback: Manifestations of extrapyramidal syndrome include Parkinson-like symptoms—fine tremors, muscle rigidity, mask-like appearance of the face, slowness of movement, slurred speech, and unsteady gait; akathisia—extreme restlessness and increased motor activity; and dystonia—facial grimacing and twisting of the neck into unnatural positions. Delusions and flat affect are manifestations associated with schizophrenia.

25. The nurse is providing care to an older adult who is receiving antipsychotic therapy. The primary health care provider prescribes an oral liquid concentrate. When administering the drug, the nurse would mix the drug with which of the following? Select all that apply. A) Fruit juice B) Milk C) Pudding D) Soup E) Green leafy vegetables

Ans: A, B, C, D Feedback: Oral liquid concentrates are available for patients who can more easily swallow a liquid. To aid in administration to debilitated or elderly patients, oral drugs can be mixed in liquids such as fruit juices, tomato juice, milk, or carbonated beverages. Semisolid foods, such as soups or puddings, may also be used. Green leafy vegetables would be an inappropriate choice based on the usual texture of the food and the inability to mix the drug solution with the food.

8. Before administering a prescribed antipsychotic drug to a client, the nurse observes the client for any behavior patterns that appear to be deviations from normal. Which of the following would the nurse identify as a deviation? Select all that apply. A) Poor eye contact B) Monotone speech pattern C) Inappropriate laughter D) Failure to answer questions completely E) Inappropriate crying

Ans: A, B, C, D, E Feedback: Examples of deviation from normal include poor eye contact, failure to answer questions completely, inappropriate answers to questions, a monotone speech pattern, and inappropriate laughter, sadness, or crying.

1. A nurse would assess a client treated with an antipsychotic medication for which of the following behaviors if the antipsychotic medication was stopped? Select all that apply. A) Hallucinations B) Anhedonia C) Delusions D) Dystonia E) Flattened affect

Ans: A, B, C, E Feedback: Antipsychotic medications help control symptoms associated with psychotic disorders such as hallucinations, delusions, disorganized speech, behavior disturbances, social withdrawal, flattened affect, and anhedonia. Dystonia would be noted as an adverse reaction with antipsychotic drugs.

6. When teaching a client who is to receive antipsychotic therapy, the nurse would include which of the following as a common skin reaction that might occur when initiating therapy? Select all that apply. A) Urticaria B) Stevens-Johnson syndrome C) Photosensitivity D) Hyperpigmentation E) Toxic epidermal necrolysis

Ans: A, C Feedback: Urticaria and photosensitivity are common skin reactions a nurse should warn a client about when the client is initiated on antipsychotic therapy.

11. When assessing a client receiving antipsychotic drugs, the nurse would suspect that the client is experiencing extrapyramidal syndrome (EPS) based on assessment of which of the following? Select all that apply. A) Fine tremor B) Hypotension C) Akathisia D) Anhedonia E) Dystonia

Ans: A, C, E Feedback: The signs of EPS include fine tremors, muscle rigidity, mask-like appearance of the face, slowness of movement, slurred speech, unsteady gait, akathisia, and dystonia. Anhedonia is a manifestation of schizophrenia.

20. A nurse is administering haloperidol to a client with schizophrenia. The nurse determines that the drug is effective when there is improvement in which of the following? Select all that apply. A) Agitation B) Alogia C) Concrete thinking D) Delusions E) Hallucinations

Ans: A, D, E Feedback: Haloperidol is a conventional antipsychotic that is used to control the positive symptoms of schizophrenia, such as agitation, delusions, and hallucinations. Effectiveness of the drug would lead to a decrease in these positive symptoms. Atypical antipsychotics help to diminish the negative symptoms such as alogia and problems with concrete thinking.

24. A nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame? A) 15 minutes B) 30 minutes C) 45 minutes D) 60 minutes

Ans: B Feedback: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes.

22. The caregiver of a client who is started on antipsychotic drug therapy asks the nurse when the client's symptoms will improve. Which response by the nurse would be most appropriate? A) "You should notice an improvement in the next day or two." B) "It might take about 6 weeks or so before the drug is most effective." C) "There's no way to tell but usually it takes about a week." D) "Look for movements of his face, mouth, or jaw and that's the sign."

Ans: B Feedback: Antipsychotics take time to produce the optimal effect, sometimes 6 to 10 weeks. Evidence of tongue, facial, or mouth movements suggest tardive dyskinesia, a late-appearing reaction that requires discontinuation of the drug.

21. A client comes to the emergency department and tells the nurse, "I've been hiccoughing constantly for the past 6 or 7 hours and nothing I do to stop them seems to work." The nurse would expect the primary health care provider to prescribe which of the following? A) Prochlorperazine B) Chlorpromazine C) Haloperidol D) Olanzapine

Ans: B Feedback: Chlorpromazine may be used to treat uncontrolled hiccoughs. Prochlorperazine may be used as an antiemetic. Haloperidol and olanzapine are not indicated for uncontrolled hiccoughs.

10. A nurse caring for a client receiving clozapine (Clozaril) needs to be mindful of the symptoms that indicate bone marrow suppression. Assessment of which of the following would lead the nurse to suspect that the client is experiencing bone marrow suppression? Select all that apply. A) Hypertension B) Sore throat C) Fever D) Chills E) Weakness

Ans: B, C, D, E Feedback: Symptoms that indicate bone marrow suppression include lethargy, weakness, fever, sore throat, malaise, mucous membrane ulceration, and "flu-like" complaints.

26. A client with schizophrenia is prescribed antipsychotic therapy. When developing the plan of care for the client, the nurse integrates understanding that the client is at risk for extrapyramidal syndrome. The nurse would expect to assess the client for this adverse reaction at which time? A) Once a week B) At the initiation of therapy C) When the dose is reduced D) Every 3 months E) When the dose is increased

Ans: B, C, E Feedback: The nurse should assess for EPS during initial therapy and whenever the dosage is increased or decreased.

7. When describing tardive dyskinesia (TD) associated with the use of antipsychotic medication, which of the following would the nurse integrate into the teaching plan? Select all that apply. A) TD is an early-appearing adverse reaction. B) TD involves rhythmic, involuntary movements of the facial structures. C) TD is a reversible adverse effect of antipsychotic drugs. D) TD is less likely to occur with the use of atypical psychotics. E) TD can occur after discontinuation of antipsychotic drug therapy.

Ans: B, D, E Feedback: TD is a late-appearing reaction that is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. TD is nonreversible, can occur during antipsychotic drug therapy or after discontinuation, and is less likely to occur with the use of atypical antipsychotics.

4. A nurse should be able to differentiate between the typical and atypical antipsychotics. Which of the following would the nurse identify as an atypical antipsychotic? Select all that apply. A) Lithium (Eskalith) B) Aripiprazole (Abilify) C) Chlorpromazine (Thorazine) D) Prochlorperazine (Compazine) E) Clozapine (Clozaril)

Ans: B, E Feedback: Aripiprazole (Abilify) and clozapine (Clozaril) are classified as atypical antipsychotics.

19. Antipsychotic therapy with a conventional antipsychotic has been started for a client with schizophrenia. Assessment reveals that the client is experiencing drowsiness that is affecting his ability to function. The nurse notes that the client needs assistance with his activities of daily living and ambulating. Which nursing diagnosis would the nurse most likely identify? A) Risk for Infection B) Risk for Unstable Blood Glucose Level C) Risk for Injury D) Impaired Physical Mobility

Ans: C Feedback: Antipsychotic drugs may cause extreme drowsiness and sedation, especially during the first or second weeks of therapy. This reaction may impair mental or physical abilities. The patient may need assistance with activities of daily living due to the experience of extreme sedation. This includes cueing or help with eating, dressing, and ambulating. Therefore, Risk for Injury would be most appropriate. Risk for Infection would be appropriate if the client was receiving clozapine. Risk for Unstable Blood Glucose Level would be appropriate if the client was receiving an atypical antipsychotic due to the increased risk for weight gain and subsequent development of diabetes. Impaired Physical Mobility would be appropriate if the client was experiencing EPS or TD.

5. After teaching a group of nursing students about antipsychotics, the instructor determines that the teaching was successful when the students identify which of the following as a typical antipsychotic? Select all that apply. A) Lithium (Eskalith) B) Aripiprazole (Abilify) C) Chlorpromazine (Thorazine) D) Haloperidol (Haldol) E) Fluphenazine (Prolixin)

Ans: C, D, E Feedback: Chlorpromazine, haloperidol, and fluphenazine are classified as typical antipsychotics.