Chapter 27: Antipsychotics and Anxiolytics
The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect? a. Acute dystonia b. Akathisia c. Pseudoparkinsonism d. Tardive dyskinesia
ANS: A Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 375 TOP: NURSING PROCESS: Assessment/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient has begun taking buspirone hydrochloride (BuSpar) 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms. What will the nurse tell the patient? a. "Therapeutic effects may not be evident for another week." b. "The provider may need to increase the dose to 15 mg twice daily." c. "Notify the provider and request an order for another anxiolytic." d. "Stop taking the drug and notify the provider that it doesn't work."
ANS: A Buspirone hydrochloride may not be effective until 1 to 2 weeks after continuous use. It is not necessary to increase the dose at this time. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 381 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given. The nurse will suggest contacting the patient's provider to discuss which intervention? a. Changing to a liquid form of the mediation b. Providing a home health nurse to supervise medication administration c. Teaching the patient the importance of taking the medication d. Weekly intramuscular injections of the medication
ANS: A Noncompliance is common with antipsychotic medications. If patients spit out or hide pills, a liquid form can be used. A home health nurse is costly and unnecessary. Teaching the patient the importance of the medication is essential, but not always effective if the patient does not want to comply. Weekly intramuscular injections may be used if using the liquid form is not effective. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 373 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient arrives in the emergency department with dehydration. The patient reports taking fluphenazine (Prolixin) to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a temperature of 103.6° F, a heart rate of 98 beats per minute, and a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication? a. Dantrolene (Dantrium) b. Haloperidol (Haldol) c. Propranolol (Inderal) d. Tetrabenazine (Xenazine)
ANS: A The patient is exhibiting signs of neuroleptic malignant syndrome. Muscle relaxants, such as dantrolene, are usually given. Haloperidol is used to treat psychosis. Propranolol is used for treating akathisia. Tetrabenazine is sometimes used to treat symptoms of tardive dyskinesia. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 372 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take? a. Notify the provider and request orders for creatinine clearance and BUN levels. b. Reassure the patient that this is a harmless side effect of this medication. c. Tell the patient to come to the clinic for a urinalysis. d. Tell the patient to discard any drug on hand and request a new prescription.
ANS: B Aliphatic phenothiazines, such as chlorpromazine, can cause a harmless pink or red-brown urine discoloration. There is no need to evaluate renal function with creatinine clearance, BUN, or urinalysis. The discoloration does not indicate that the medication has expired. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 380 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient has been taking risperidone (Risperdal) for 2 weeks. The patient reports drowsiness and headache. What will the nurse do? a. Counsel the patient to request changing to aripiprazole (Abilify). b. Reassure the patient that these are common side effects of the medication. c. Suggest that the patient have serum glucose testing. d. Suggest that these may be signs of agranulocytosis.
ANS: B Drowsiness and headaches are common side effects of atypical antipsychotics. Changing to aripiprazole will not improve the symptoms, since this drug is in the same drug class. These symptoms do not indicate altered serum glucose levels or agranulocytosis. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 377 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching? a. "I should not drink alcohol while taking this medication." b. "I should use a heating pad to treat muscle spasms while taking this medication." c. "I should use sunscreen while taking this medication." d. "I will need frequent blood tests while taking this medication."
ANS: B Dystonia can cause muscle spasms and should be reported to the provider who can prescribe medications to treat this adverse effect. Patients should not drink alcohol, should use sunscreen, and will need close monitoring of lab values while taking these medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 372 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient is brought to the emergency department with decreased respirations and somnolence. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg. The patient is known to take alprazolam (Xanax) to treat anxiety. Which medication will the nurse anticipate the provider to order? a. Benztropine (Cogentin) b. Flumazenil (Romazicon) c. Lorazepam (Ativan) d. Propranolol (Inderal)
ANS: B Flumazenil is the recommended benzodiazepine antagonist to treat overdose of benzodiazepines. This patient is unconscious and has bradycardia and hypotension, so the antagonist medication is indicated. Benztropine is an anticholinergic used to treat acute dystonia in patients taking phenothiazines. Lorazepam is a benzodiazepine and would only intensify the symptoms. Propranolol is a beta blocker used to treat akathisia in patients taking phenothiazines. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 384 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has schizophrenia. The patient has been taking this medication twice daily for 15 months. The nurse notes smacking lip movements and involuntary movements of all extremities. Which action by the nurse is correct? a. Administer the medication as ordered to treat these symptoms of psychosis. b. Hold the dose and notify the provider of these medication adverse effects. c. Request an order for an anticholinergic medication such as benztropine (Cogentin). d. Suggest that the provider increase the dose to 125 mg twice daily.
ANS: B Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities and is a serious adverse effect of antipsychotic medications. The provider should be notified, so the drug can be stopped and a different medication ordered. These are not symptoms of psychosis. Anticholinergic medications are used to combat acute dystonia. Increasing the dose of this medication would only exacerbate these adverse effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 375 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action? a. Contact the provider to discuss changing to benztropine (Cogentin). b. Notify the provider of these symptoms and request an order for lorazepam (Ativan). c. Question the patient about adherence to the drug regimen. d. Recognize these signs of a serious adverse drug reaction and notify the provider
ANS: B The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug. Benztropine is an anticholinergic used to combat acute dystonia side effects. These are not signs of psychosis, so it is not necessary to question whether or not the patient is taking the medication. These side effects are not as serious as those with tardive dyskinesia. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 375 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril) is concerned about side effects. What information will the nurse include when teaching the patient about this medication? a. "You are more likely to experience dry mouth, constipation, and urinary retention." b. "You may experience weight gain, drowsiness, and headaches." c. "You will not experience extrapyramidal side effects with this medication." d. "You will not need frequent lab work while taking this medication."
ANS: B Weight gain, drowsiness, and headaches are common side effects of non-typical antipsychotic medications. Anticholinergic side effects are less likely than with typical antipsychotics. Extrapyramidal side effects can occur, even though they are less likely. Clozapine can cause agranulocytosis, so patients who are taking this drug require frequent monitoring. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 378 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient who is taking fluphenazine (Prolixin) to treat psychosis is experiencing symptoms of acute dystonia. While performing a medication history, the nurse learns that the patient takes herbal medications. Which herbal supplement would be of concern? a. Ginkgo b. Ginseng c. Kava kava d. St. John's wort
ANS: C Kava kava may increase the risk and severity of dystonia when taken with phenothiazines. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 371 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A patient arrives in the emergency department complaining of difficulty breathing, dizziness, sweating, and heart palpitations. The patient reports having had similar episodes previously. The nurse will expect the provider to order which medication? a. Flumazenil (Romazicon) b. Haloperidol (Haldol) c. Lorazepam (Ativan) d. Propranolol (Inderal)
ANS: C The patient is exhibiting signs of acute anxiety, so the anxiolytic lorazepam will be given. Flumazenil is a benzodiazepine antagonist, given for overdose of benzodiazepines. Haloperidol is given for acute psychosis. Propranolol is a beta blocker, used to treat akathisia in patients taking phenothiazines. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 381 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
A family member of a patient who has been taking fluphenazine (Prolixin) for 3 months calls to report that the patient is exhibiting agitation and restlessness. The nurse learns that the patient's delusional thinking and hallucinations have stopped since taking the medication. The nurse will perform which action? a. Reassure the family member that tolerance to these side effects will subside over time. b. Remind the family member that complete drug effects may not occur for several more weeks. c. Suggest that the family member contact the provider to discuss an order for a benzodiazepine. d. Tell the family member to withhold the medication and notify the patient's provider.
ANS: C The patient is exhibiting signs of akathisia and should receive a benzodiazepine. Patients usually do not experience tolerance to these drug side effects. The patient is experiencing resolution of symptoms. Discontinuing antipsychotics abruptly may lead to withdrawal symptoms. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 380 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75 mg BID to treat schizophrenia. A family member tells the nurse that the patient's agitation, hallucinations, and delusional symptoms have improved, but the patient continues to withdraw from social interaction and won't bathe unless reminded to do so. The nurse will tell the family member that a. all symptoms will eventually resolve over time with this medication. b. the patient may need an increased dose of the antipsychotic medication. c. these results may indicate that the patient does not have schizophrenia. d. they should consider discussing adding another medication.
ANS: D Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely that the negative symptoms will improve over time with this medication. Increasing the dose will not improve control of negative symptoms. This patient exhibits signs of schizophrenia. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 373 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity
The nurse is preparing to administer intramuscular haloperidol (Haldol) to a patient who has schizophrenia. What action will the nurse perform? a. Massage the site after injecting the medication to ensure complete absorption. b. Teach the patient to return every week to receive medication doses. c. Use a small bore needle when injecting the medication. d. Use the Z-track method and inject the medication into deep muscle tissue.
ANS: D Haloperidol is a viscous liquid and should be injected deep into muscle tissue using a Z-track method. The injection site should not be massaged. Injections of long-term preparations of haloperidol are given every 2 to 4 weeks. Nurses should use a large-bore needle when injecting haloperidol. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 374 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will a. contact the provider to discuss changing to another benzodiazepine. b. notify the provider and discuss increasing the dose of lorazepam. c. suspect worsening of the anxiety disorder. d. understand that the patient has developed tolerance to this drug.
ANS: D It is recommended that benzodiazepines be prescribed no longer than 3 or 4 months since the effectiveness lessens after 4 months as patients develop tolerance to the drug. Changing to another benzodiazepine will not change this. Increasing the dose is not indicated. This does not indicate worsening of the underlying disorder. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 380 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
The nurse is teaching a patient about taking an anxiolytic agent to treat grief-related anxiety. Which statement by the patient indicates understanding of the teaching? a. "I may have wine with dinner to help with relaxation." b. "I may need to take this medication for up to a year." c. "I may stop taking the medication when my symptoms go away." d. "I should try psychotherapy or a support group in addition to the medication."
ANS: D Psychotherapy or support groups should be part of therapy, with anxiolytics added as needed. Patients taking anxiolytic medications should not consume alcohol. Anxiolytic medications are generally given for a maximum of 3 to 4 months. Patients should not stop the medications abruptly. DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 381 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies