Pre Chapter 56: Drug Therapy for Psychotic Disorders

A client receiving outpatient therapy with antipsychotic therapy experiences dizziness from time to time. Which suggestion by the nurse would be appropriate?

"Get up slowly from the bed or chair."

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?

"It might take about 6 weeks or so before the drug is most effective."

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

Clozapine-

A client who has been receiving treatment for psychosis presents to the clinic for follow up. On assessment, the nurse discovers the client is currently displaying rhythmic, involuntary facial movements to include chewing-like movements and tongue protrusion. The nurse interprets these findings as an indication of which disorder?

Tardive dyskinesia

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

The nurse suspects that a client receiving olanzapine is developing type 2 diabetes. Which finding would help support the nurse's suspicion? Select all that apply.

The nurse would suspect development of type 2 diabetes based on assessment of increased thirst and urination and weight gain. Fever and sore throat would suggest an infection, possibly due to agranulocytosis from clozapine therapy.

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

WBC count-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 patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.

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

White blood cells

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?

monitoring the client for involuntary facial movements-The nurse would monitor for and teach the client and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Clients do not normally experience disruptions to bowel function, cranial nerve function, or deep tendon reflexes.

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?

monitoring the client for involuntary facial movements

A client's medication has been changed to clozapine. What assessment should the nurse perform to identify a life-threatening adverse effect early?

vital signs monitoring

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 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 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."

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?

30 minutes

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 use of olanzapine creates a significant risk of hyperglycemia. This is of particular concern in patients and clients who have diabetes mellitus. Smoking affects the pharmacodynamics of olanzapine, but this is less likely to result in serious adverse effects. Obesity, low BMI, and recent antibiotic use are not associated with a significantly increased risk of adverse effects.

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?

Blood pressure

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

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 client is started on aripiprazole and the nurse notices the client is experiencing dry mouth and nasal congestion. What intervention does the nurse teach the client to minimize the side effects of the medication?

Drinking frequent sips of water

The nurse is conducting an ongoing assessment of a client who is prescribed loxapine. Which finding is most likely attributable to this medication?

Dry mouth

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?

The nurse is conducting an ongoing assessment on a client with schizophrenia who is receiving chlorpromazine. Assessment findings include excessive drowsiness and the need for assistance with ADLs and ambulation. Which nursing diagnosis should the nurse prioritize for this client?

Injury Risk-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 client 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, Injury Risk would be most appropriate. Infection Risk would be appropriate if the client was receiving clozapine. Hyperglycemia 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.

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

Lip smacking

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.

Which drug would be indicated for the treatment of narcolepsy?

Modafinil

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)

The nurse is teaching a client and caregiver about the antipsychotic medication which has been prescribed. The nurse determines the teaching is successful when they correctly choose which reaction should be reported immediately to the health care provider?

Rigidity

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 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- Typical antipsychotics cause significant sedation, which creates a risk for injury. These drugs are not severely hepatotoxic and are not linked to bowel incontinence. Thermoregulatory disruptions are similarly unlikely.

The nurse is teaching a caregiver about the antipsychotic which has been prescribed to the client. The nurse determines the session is successful when the caregiver correctly chooses which points concerning potential TD? Select all that apply.

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.

The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching?

Tardive dyskinesias

A client is being treated with clozapine. What should the nurse monitor most closely?

White blood cell count

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 develops muscle rigidity and a sudden, high fever.

The nurse should be able to distinguish signs of extrapyramidal syndrome (EPS) in clients taking antipsychotics so they can be quickly reported to the client's health care provider. What are signs of EPS? Select all that apply:

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.

The nurse is preparing to teach a client with psychosis about clozapine. The nurse will point out the importance of which weekly laboratory test to this client?

WBC count

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

White blood cells-Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. However, despite these advantages, it is a second-line drug, recommended only for clients who have not responded to treatment with at least two other antipsychotic drugs or who exhibit recurrent suicidal behavior. The reason for the second-line status of clozapine is its association with agranulocytosis, a life-threatening decrease in white blood cells (WBCs), which usually occurs during the first 3 months of therapy. A BLACK BOX WARNING alerts health practitioners to this dangerous side effect. Weekly WBC counts are required during the first 6 months of therapy; if acceptable WBC counts are maintained, then WBC counts can be monitored every 2 weeks.

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?

cbc

A client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client?

extrapyramidal effects

A client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client?

extrapyramidal effects-Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, shortness of breath, or hypoglycemia.

A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client?

history of seizure disorder

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

lip smacking

Antipsychotic drugs are contraindicated in clients with:

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

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 nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?

the importance of adherence to prescribed treatment