Chapter 22: Psychotherapeutic Agents

The pediatric 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."

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

daily intake of caffeine-containing products

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

improving

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 is teaching the client about CNS medications and how they are addictive. What is primary reason CNS medications are addictive?

medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine

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

modafinil

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

weight and growth

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

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

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

lithium

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

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."

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 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.

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."

A patient has been prescribed lithium. Which intervention should the nurse perform while caring for the client?

-administer lithium with food -continually monitor patient for drowsiness -increase fluid intake to about 3,000 mL/day

A nursing student is learning about drugs that affect the central nervous system. The student knows that some client's with schizophrenia are given which drugs?

-antipsychotic drugs -neuroleptics

What should the nurse's pre-administration assessment of a client receiving a CNS stimulant for attention deficit hyperactivity disorder include?

-blood pressure -pulse -respiratory rate -behavior pattern

A nurse should be able to differentiate between the typical and atypical antipsychotics. Which are classified as typical antipsychotics?

-chlorpromazine (Thorazine) -haloperidol (Haldol) -fluphenazine (Prolixin)

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?

When participating in care planning for a child who has been diagnosed with schizophrenia, the nurse should be aware of what fact?

It is not clear which drugs are safest and most effective in children with schizophrenia.

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.

What client is being treated with a typical antipsychotic?

agitated client who was given haloperidol during acute psychosis

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

antipsychotic

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

A young client has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which goal of care is the priority?

client will remain safe

A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects?

extrapyramidal symptoms

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

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 prescriber has written for olanzapine for a client diagnosed with schizophrenia. What additional tests should the nurse anticipate the prescriber to order?

-weight -cholesterol profile -fasting blood sugar

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

clozapine

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 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 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

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

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

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