CH 56 Drugs for Psychotic Disorders (E4)
A client has been treated with chlorpromazine (Largactil) 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? A) tardive dyskinesia B) akathisia C) dystonias D) neuroleptic malignant syndrome
A
A client who has a diagnosis of schizophrenia is likely to have which pathophysiologic effect? A) increased dopamine B) increased serum potassium C) decreased numbers of glutamate receptors D) decreased interaction with GABA
A
A client with schizophrenia has been taking haloperidol (Haldol) 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? A) gradually taper the dose of haloperidol B) have a 2- to 3-week "drug holiday" between stopping the haloperidol and starting the atypical antipsychotic C) administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks D) arrange for weekly electroconvulsive therapy (ECT) during the time of transition
A
A man is hospitalized because of a relapse of his psychotic disorder. He states, "I quit taking my medicines because I always forget to take them at least one time a day." Which of the following regimens for his antipsychotic medications will increase medication adherence? A) monthly injection by a home care nurse B) low-dose daily therapy C) daily visits to the clinic to receive his medications D)( once-a-week drug therapy
A
A man is taking chlorpromazine (Largactil). He develops a high fever, respiratory depression, and diminished level of consciousness. What condition has the patient developed? A) neuroleptic malignant syndrome B) dystonia C) anhedonia D) akathisia
A
A nurse is following up with a client who takes chlorpromazine (Largactil) for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? SELECT ALL THAT APPLY. A) Disorganized speech B) Bizarre behavior C) Impaired social interactions D) Hallucinations E) Decreased motivation
A, B, D
Which statement made by a man indicates that he requires further patient teaching regarding adherence to his medication regimen? A) "If I experience muscle spasms in my neck, I must report that to the health care provider." B) "If I experience sudden fever and difficulty breathing, I must report that to the health care provider." C) "If I experience sedation, I must cut down on my medication." D) "If I experience dizziness, I must report that to the health care provider."
C
A client is prescribed olanzapine (Zyprexa) for the treatment of schizophrenia. The client tells the nurse he 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? A) urinary tract infection B) diabetes mellitus C) renal calculi D) hyperthyroidism
B
A nurse is assessing a client who recently began taking haloperidol (Haldol). Which of the following findings is the priority to report to the provider? A) Shuffling gait B) Neck spasms C) Drowsiness D) Sexual dysfunction
B
A nurse is providing teaching for a client who is to begin taking risperidone (Risperdal). Which of the following instructions should the nurse include? A) "Add extra snacks to your diet to prevent weight loss." B) "Notify the provider if you have trouble sleeping." C) "You may begin to have mild seizures while taking this medication." D) "This medication is likely to increase your libido."
B
A nurse is teaching a client, who has schizophrenia, strategies to cope with anticholinergic effects of fluphenazine (Modecate). Which of the following should the nurse suggest to the client to minimize these effects? A) Take the medication in the morning to prevent insomnia. B) Chew sugarless gum to moisten the mouth. C) Use cooling measures to decrease fever. D) Take an antacid to relieve nausea.
B
A patient is taking thiothixene (Navane). Which of the following outcomes is desirable with this medication? A) decreased heart rate and diminished agitation B) blood pressure within normal limits and diminished psychosis C) heart rate of 60 beats/min with increased pulse pressure D) a widened QT complex and normal ST segment
B
A woman reports to the prescriber that she has developed a fever, sore throat, and malaise after starting clozapine (Clozaril) therapy. Which of the following interventions is most important? A) Treat the patient with a broad-spectrum antibiotic. B) Discontinue the clozapine and obtain a complete blood count with differential. C) Inform the patient that this is normal when taking clozapine. D) Assess the patient for diminished mental alertness.
B
In light of current treatment modalities, the nurse should anticipate that the client newly diagnosed with schizophrenia will most likely prescribed what drug? A) chlorpromazine (Largactil) B) olanzapine (Zyprexa) C) haloperidol (Haldol) D) prochlorperazine (Compazine)
B
In monitoring the status of a patient on a course of a phenothiazine antipsychotic, the nurse needs to be most aware that an adverse effect of phenothiazine antipsychotics is the development of which of the following? A) glaucoma B) akathisia C) hypertension D) diabetes
B
The client has been taking chlorpromazine (Largactil) for more than 40 years. What adverse effect will the client most likely be experiencing? A) hypertension B) extrapyramidal effects C) central nervous system agitation D) urinary frequency
B
When administering oral chlorpromazine (Largactil), the nurse should implement which intervention? A) Have the client hold the drug under the tongue for at least 30 seconds. B) Administer the drug 1 to 2 hours before bedtime. C) Administer the drug on alternating days. D) Instruct the client to avoid dairy products for 1 hour before and 2 hours after administration.
B
A 68-year-old man is seen by a home care nurse. He has been taking chlorpromazine (Largactil) since 1969 for schizophrenia. Which of the following adverse effects are most commonly seen after use of chlorpromazine for long periods? A) lethargy B) amnesia C) tardive dyskinesia D) dystonia
C
A patient is receiving haloperidol decanoate 100 mg intramuscularly. What assessment should the nurse make before and after the administration of the medication? A) pulse rate B) respiratory rate C) blood pressure D) mental status
C
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? A) lower cost B) the possibility of oral administration C) reduced adverse effects D) absence of black box warnings
C
The nurse should administer chlorpromazine (Largactil) in which of the following ways? A) intramuscularly into the deltoid muscle B) subcutaneously into the abdomen C) intramuscularly in the ventrogluteal muscle D) subcutaneously in the small of the back
C
The nurse should recognize what as the primary goal of treatment for haloperidol (Haldol) therapy? A) increased insight into delusional thinking B) increased sophistication of thinking C) decreased agitation and combativeness D) decreased central nervous system (CNS) stimulation
C
What disease process is haloperidol (Haldol) used to treat? A) muscular dystrophy B) early-onset dementia C) Tourette's syndrome D) myasthenia gravis
C
What medication is an example of a phenothiazine antipsychotic? A) aminophylline (Phyllocontin) B) acetylsalicylic acid (Asprin) C) chlorpromazine (Largactil) D) dantrolene sodium (Dantrum)
C
A client has been achieving an acceptable reduction in the positive and negative signs of schizophrenia after several weeks of treatment with clozapine (Clozaril). 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? A) "If you notice that your symptoms are worsening when you drink, you should stop doing it." B) "That shouldn't present a problem, provided you make sure that you're safe when you do it." C) "That's okay in most cases, but it's advisable to limit it to beer and wine and to avoid spirits." D) "When you're taking clozapine, it's best to avoid drinking alcohol altogether."
D
A nurse is providing discharge teaching to a client who has a new prescription for clozapine (Clozaril). Which of the following statements should the nurse include in the teaching? A) "You should have a high-carbohydrate snack between meals and at bedtime." B) "You are likely to develop hand tremors if you take this medication for a long period of time." C) "You may experience temporary numbness of your mouth after each dose." D) "You should have your white blood cell count monitored every week."
D
A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority? A) The client will demonstrate independent health maintenance. B) The client will interact therapeutically with peers. C) The client will participate in activities of daily living (ADL). D) The client will remain safe.
D
An elderly woman with dementia is receiving haloperidol (Haldol). What adverse effect is this woman at increased risk for developing? A) anorexia B) increased temperature C) infection D) tardive dyskinesia
D
Monitoring what laboratory test is most important in the first months of clozapine (Clozaril) therapy? A) weekly liver enzymes B) daily international normalized ratio (INR) C) monthly creatinine levels D) regular complete blood counts
D
What intervention should the nurse administering chlorpromazine (Largactil) intramuscularly implement? A) Teach the client to self-administer the drug. B) Administer the drug into the deltoid muscle with a 1 1/2-inch needle. C) Have the client massage the injection site for 1 to 2 minutes after the injection. D) Encourage the client lie down for 30 to 60 minutes after the injection.
D
