Chapter 56: Drug Therapy for Psychotic Disorders

A 14 year-client with symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The client weighs 154 lbs. How many mg of pimozide should the client be administered?

3.5 The client's weight in kg is 70 kg (154 ÷ 2.2). The prescription is for 0.05 mg/kg, and 0.05 X 70 = 3.5 mg.

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? a. "Continue the prescribed dose. It may take several days to work." b. "I'll ask the nurse practitioner if the dosage can be increased." c. "I'll ask the nurse practitioner if the haloperidol can be discontinued and another drug started." d. "I'll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol."

a. "Continue the prescribed dose. It may take several days to work." The nurse should instruct the wife to continue offering her husband the drug and that it will probably take several days to reach its full therapeutic effect. The dosage would not be increased, decreased, or discontinued.

During an intake assessment, the nurse notes that the client cannot sit still and continually stands up and walks around the room. The nurse knows that the term for this behavior is: a. akathisia. b. anhedonia. c. avolition. d. dystonia.

a. akathisia. Akathisia is defined as extreme restlessness and increased motor activity. Anhedonia is lack of joy or pleasurable feelings. Avolition is the inability to determine and initiate goals and activities. Dystonia is prolonged muscle contractions.

Phenothiazines such as chlorpromazine are occasionally used for clinical indications not associated with psychiatric illness. What indications would be included? Select all that apply. a. preoperative restlessness b. postoperative headaches c. nausea and vomiting d. Parkinson's disease e. peptic ulcer disease

a. preoperative restlessness c. nausea and vomiting Chlorpromazine is administered rectally or intramuscularly for the control of nausea and vomiting. It is also used preoperatively for the control of restlessness and apprehension. It is not used to treat headaches. It should be avoided in clients diagnosed with Parkinson's disease and used with caution for those clients with peptic ulcer disease.

Which antipsychotic medication classification has fewer extrapyramidal reactions? a. First generation b. Second generation c. Third generation d. All antipsychotics

b. Second generation Second-generation antipsychotics have fewer extrapyramidal side effects. First-generation antipsychotics have extrapyramidal side effects. There is no such thing as a third-generation antipsychotic. Not all antipsychotics have fewer extrapyramidal side effects.

The nurse expects to monitor a client's white blood count weekly when the client is prescribed: a. Aripiprazole b. Olanzapine c. Clozapine d. Quetiapine

c. Clozapine Clozapine is associated with significant leukopenia. Subsequently, is it available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. Aripiprazole, olanzapine, and quetiapine are not associated with leukopenia.

Which drug would be indicated for the treatment of narcolepsy? a. Atomoxetine b. Dexmethylphenidate c. Lisdexamfetamine d. Modafinil

d. Modafinil Modafinil would be indicated for the treatment of narcolepsy. Atomoxetine, dexmethylphenidate, and lisdexamfetamine are indicated for the treatment of attention deficit disorders.

For clients diagnosed with schizophrenia, drug therapy is usually indicated for: a. At least 1 month after an initial psychotic episode and at least 1 year after multiple episodes. b. At least 5 years after an initial psychotic episode and for life after multiple episodes. c. There are no recommended guidelines, each client has different needs. d. At least 1 year after an initial psychotic episode and at least 5 years after multiple episodes.

d. At least 1 year after an initial psychotic episode and at least 5 years after multiple episodes. In schizophrenia, antipsychotic drugs are usually given for years because there is a high rate of relapse (acute psychotic episodes) when drug therapy is discontinued, most often by clients who become unwilling or unable to continue their medication regimen. Drug therapy usually is indicated for at least 1 year after an initial psychotic episode and for at least 5 years, perhaps for life, after multiple episodes.

The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching? a. Urge incontinence b. Orthostatic hypotension c. Bradycardia d. Tardive dyskinesias

d. Tardive dyskinesias Consider warning patient or patient's guardians about the risk of development of tardive dyskinesias with continued use so they are prepared for that neurological change. Oral neuroleptic agents do not cause urge incontinence, orthostatic hypotension or bradycardia.

A client has been receiving chlorpromazine as treatment for psychosis. Which assessment finding indicates to the nurse that the client is experiencing an extrapyramidal effect of the medication? a. fatigue b. dizziness c. slurred speech d. motor restlessness

d. motor restlessness Chlorpromazine has severe adverse effects that impact the central nervous system, the cardiac system, and the hematologic system. Extrapyramidal effects may also occur including motor restlessness, or akathisia. Fatigue, dizziness, and slurred speech are central nervous system effects from the medication.

The nurse instructs a client about the medication haloperidol. Which client statement indicates that additional teaching is required? a. "I will expect to develop a sore throat." b. "I will notify my doctor of any side effects." c. "I will wear a sunscreen when I go outside." d. "I will not drive while taking this medication."

a. "I will expect to develop a sore throat." Clients receiving haloperidol should be instructed to notify the health care provider of sore throat, fever, and any adverse effects. Sunscreen should be applied before going outdoors while taking this medication since it can cause photosensitivity. Because the medication can cause drowsiness, the client should be instructed to avoid driving while taking haloperidol.

The psychiatric nurse is conducting health education addressing the adverse effects of clozapine. What teaching point should the nurse convey to the client? a. "There's a possibility that this drug might cause you to gain weight and have high blood sugar levels." b. "It is important to drink plenty of fluids while taking this drug, as it can potentially cause constipation." c. "There's a chance that you could develop breathing problems when using this drug, making you vulnerable to pneumonia." d. "You'll have to eat more protein while you're taking this drug to help heal any wounds."

a. "There's a possibility that this drug might cause you to gain weight and have high blood sugar levels." Hyperglycemia and weight gain are potential adverse effects of atypical antipsychotics. These drugs do not cause digestive or respiratory complications, or create a need for a high-protein diet.

A nurse is caring for a client with schizophrenia. The health care provider has prescribed Olanzapine to the client. Which point should the nurse include in the teaching plan for the client? a. Remove the tablet with dry hands. b. Take the tablet with full glass of water. c. Add extra salt to food. d. Avoid tea or coffee.

a. Remove the tablet with dry hands. 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 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

The nurse is caring for a client who has been receiving a prescription for haloperidol for treatment of psychosis. The nurse suspects that the client is developing neuroleptic malignant syndrome. What assessments would support this? (Select all that apply.) a. Severe hypothermia b. Confusion c. Bradycardia d. Dyspnea e. Acute renal failure

b. Confusion d. Dyspnea e. Acute renal failure Symptoms of neuroleptic malignant syndrome include severe hyperthermia, confusion, tachycardia, agitation, delirium, dyspnea, respiratory failure, and acute renal failure.

The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what client would the nurse expect to require a standard dosage? a. African American adolescent client diagnosed with schizophrenia b. Malaysian middle adult client diagnosed with bipolar disorder c. Saudi Arabian older adult client diagnosed with schizophrenia d. White young adult client diagnosed with bipolar disorder

d. White young adult client diagnosed with bipolar disorder Only the White young adult has no indications for administering a smaller than usual dosage. Black and African American clients respond more rapidly to antipsychotic medications and have a greater risk for development of disfiguring adverse effects, such as tardive dyskinesia. Consequently, these clients should be started off at the lowest possible dose and monitored closely. Clients in Asian countries (e.g., India, Turkey, Malaysia, China, Japan, Indonesia) receive lower doses of neuroleptics and lithium to achieve the same therapeutic response as seen in clients in the United States. Arab American clients metabolize antipsychotic medications more slowly than Asian Americans do and may require lower doses to achieve the same therapeutic effects as in Caucasians. Additionally, because older adults may be more susceptible to adverse effects, doses are typically lower than in younger clients.

The nurse is assessing a client with schizophrenia who was prescribed clozapine several months ago. Which metabolic effect indicates to the nurse that the client has stopped taking the medication? a. rapid heart rate b. elevated blood sugar c. report of constipation d. recent weight loss of 5 lb (2.3 kg)

d. recent weight loss of 5 lb (2.3 kg) Clozapine has several adverse effects. Metabolic effects include weight gain. If the client were taking the medication as prescribed, a weight loss of 5 lb (2.3 kg) would not have occurred. Rapid heart rate, hyperglycemia, and severe constipation are all adverse effects associated with taking the medication.

A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect? a. Sedation b. Anticholinergic c. Extrapyramidal d. Hypotension

c. Extrapyramidal Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Sedation, anticholinergic effects, and hypotension can occur, but the risk for these is much less when compared with the risk for extrapyramidal effects.

The nurse is caring for an adolescent client who began taking an antipsychotic drug last month to treat newly-diagnosed schizophrenia. The client's symptoms have improved only slightly, and the client's parents wonder if the client is "beyond hope." What is the nurse's best response? a. "It's common for clients to have to try different drugs until the most effective one is identified." b. "Some clients do not respond to antipsychotic drugs and have to rely solely on cognitive behavioral therapy." c. "Do you feel like you've given the medication enough time to work?" d. "It might be necessary to take a combination of several antipsychotics before the benefits are seen."

a. "It's common for clients to have to try different drugs until the most effective one is identified." A client who does not respond to one drug may react successfully to another agent. It is not common to have a client who does not demonstrate some improvement from medications so it would be incorrect to tell the parents that the child won't respond to any drug after trying only one medication. It is not common for a client to require "several" antipsychotics concurrently. Asking "Do you feel like you've given the medication enough time to work?" is inappropriate: if the question is rhetorical, it is condescending; if it is genuine, it is not something the parents can determine.

What client is being treated with a typical antipsychotic? a. An agitated client who was given haloperidol during acute psychosis b. A client with schizophrenia who received paliperidone 6 mg PO daily c. A client whose thought disorder requires clozapine 25 mg PO b.i.d. d. A client who recently began taking ziprasidone

a. An agitated client who was given haloperidol during acute psychosis Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.

Psychosis is a severe mental illness characterized by what? a. Bizarre behavior b. Increased social interaction c. Hypoactivity with aggressiveness d. Paranoid hallucinations

a. Bizarre behavior Anti-psychotic drugs are used mainly for the treatment of psychosis, a severe mental disorder characterized by disordered thought processes (disorganized and often bizarre thinking); blunted or inappropriate emotional responses; bizarre behavior ranging from hypoactivity to hyperactivity with agitation, aggressiveness, hostility, and combativeness; social withdrawal in which a person pays less-than-normal attention to the environment and other people; deterioration from previous levels of occupational and social functioning (poor self-care and interpersonal skills); hallucinations; and paranoid delusions.

A client with a history of schizophrenia has been receiving antipsychotic therapy for several years. Which would indicate to the nurse that the client is experiencing pseudoparkinsonism? a. Cogwheel rigidity b. Abnormal eye movements c. Neck spasms d. Excessive salivation

a. Cogwheel rigidity Pseudoparkinsonism is manifested by cogwheel rigidity, muscle tremors, drooling, a shuffling gait, and slow movements. Abnormal eye movements, neck spasms, and excessive salivation would suggest dystonia.

The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit? a. Disorganized and often bizarre thinking b. Slowed reaction time and poor coordination c. Short manic episodes followed by long depressive episodes d. Short- and long-term-memory deficits

a. Disorganized and often bizarre thinking Behavioral manifestations of psychosis include agitation, behavioral disturbances, delusions, disorganized speech, hallucinations, insomnia, and paranoia. They do not generally exhibit slowed reaction time, short manic episodes followed by long depressive episodes, or short- and long-term memory deficits.

The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis? a. Disorganized and often bizarre thinking b. Slowed reaction time and poor coordination c. Short manic episodes followed by long depressive episodes d. Short- and long-term memory deficits

a. Disorganized and often bizarre thinking Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia. Psychosis is not characterized by slow reaction time and poor coordination, short manic episodes followed by depression or short/long-term memory deficits.

A parenteral form of an antipsychotic is prescribed for a client who has become aggressive. When administering the drug, which site would be most appropriate for the nurse to use? a. Gluteus b. Deltoid c. Vastus lateralis d. Ventrogluteal

a. Gluteus When giving an antipsychotic parenterally, the drug should be given IM in a large muscle mass such as the gluteus muscle. The deltoid muscle is not a large muscle. The vastus lateralis and the ventrogluteal are not large muscles When a client is aggressive, the larger the muscle the better, thus gluteus is the best choice.

When describing the action of conventional antipsychotic medications to a group of nursing students, which would the instructor address? a. Inhibiting the release of dopamine in the brain b. Stimulating the release of dopamine in the brain c. Inhibiting the release of serotonin in the brain d. Stimulating GABA receptors in the brain

a. Inhibiting the release of dopamine in the brain Conventional antipsychotic medications are thought to act by inhibiting the release of dopamine in the brain and possibly increasing the firing of nerve cells in certain areas of the brain. Antipsychotic medications block dopamine release. Atypical antipsychotics or second-generation drugs act on serotonin and dopamine receptors. The neurotransmitter gamma-aminobutyric acid, is inhibitory and it influences cognition.

A 20-year-old man has begun treatment of the psychotic symptoms of schizophrenia using olanzapine (Zyprexa). Which of the following symptoms would be categorized as a negative symptom of schizophrenia? a. Lack of interest in normal activities b. Delusional thinking c. Auditory hallucinations d. Visual hallucinations

a. Lack of interest in normal activities The negative symptoms of schizophrenia include flat or blunted emotions, lack of pleasure or interest in things (anhedonia), and limited speech. The positive symptoms of schizophrenia, and the most recognizable symptoms, include delusions (e.g., paranoia or distorted perceptions of other people's intentions) and hallucinations.

What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia? a. Lip smacking b. Disorientation c. Abnormal eye movements d. Urinary incontinence

a. Lip smacking Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.

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? a. Neuroleptic malignant syndrome (NMS) b. Tardive dyskinesia c. Extrapyramidal syndrome d. Agranulocytosis

a. Neuroleptic malignant syndrome (NMS) NMS is a rare reaction characterized by a combination of extrapyramidal effects, hyperthermia, and autonomic disturbance. TD 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 is characterized by Parkinson-like symptoms, akathisia, and dystonia. Agranulocytosis is a reduction in white blood cells that can occur with clozapine.

The parents of a 17-year-old boy have just received word that he has been diagnosed with schizophrenia and will require drug therapy. Which of the following etiologic factors is most likely to have contributed to this disease? a. Processes during fetal neurodevelopment may have resulted in schizophrenia. b. Patterns of ineffective coping are likely to have culminated in schizophrenia. c. Childhood trauma is likely the major contributing factor to the boy's disease. d. The presence of multiple personalities is among the root causes of schizophrenia.

a. Processes during fetal neurodevelopment may have resulted in schizophrenia. Other theories for the etiology of schizophrenia include the proposal that the illness is caused by neurodevelopmental changes during brain development. It is suggested that the disease is acquired from the fetal brain's environment. This theory is contradictory to the genetic theory, suggesting that it is not a genetic disease but acquired. Schizophrenia is not thought to result from ineffective coping or trauma. People with schizophrenia do not have multiple personalities.

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? a. Risk for injury related to central nervous system depression b. Risk for impaired liver function related to hepatotoxicity c. Risk for imbalanced body temperature related to hypothalamic suppression d. Bowel incontinence related to gastrointestinal adverse effects

a. 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.

A client's medication regimen includes lithium. What assessment finding would suggest a therapeutic effect? a. The client denies severe depressive or manic episodes b. The client states that she now has purpose and direction in her life c. The client denies audio or visual hallucinations d. The client refrains from aggressive or violent outbursts

a. The client denies severe depressive or manic episodes Lithium is used to treat bipolar disorder, which is characterized by manic and depressive episodes. Lithium is intended to interrupt this cycle. Hallucinations, violence and hopelessness are not core characteristics of bipolar disorder.

A female client is diagnosed with renal insufficiency. The nurse develops a teaching plan based on the diagnosis and antipsychotic drug usage. The client asks the nurse why it is so important to have renal function tests routinely. The nurse replies that if renal function test results become abnormal, what may be a consequence? a. The drug may need to be lowered in dosage or discontinued. b. The drug will be discontinued immediately. c. The drug will be continued with caution. d. The drug dosages will be increased to increase absorption.

a. The drug may need to be lowered in dosage or discontinued. Because most antipsychotic drugs are extensively metabolized in the liver and the metabolites are excreted through the kidneys, the drugs should be used cautiously in clients with impaired renal function. Renal function should be monitored periodically during long-term therapy. If renal function test results (e.g., blood urea nitrogen) become abnormal, the drug may need to be lowered in dosage or discontinued.

A client is being treated with clozapine. What should the nurse monitor most closely? a. White blood cell count b. Urine quantity and quality c. Cardiac enzymes d. AST, ALT and bilirubin

a. White blood cell count Clozapine is associated with significant leukopenia. Subsequently, it is available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. The drug is not associated with changes in sliver function, cardiac enzymes, or urine output.

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. A client who is morbidly obese and who has a sedentary lifestyle b. A client who has type 1 diabetes and who practices poor glycemic control c. A client who has a body mass index of 16.5 (underweight) and who smokes one pack of cigarettes daily d. A client who was recently treated with intravenous antibiotics because of cellulitis in his lower leg

b. 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.

A client who is having an acute psychotic episode requires intramuscular administration of haloperidol and admission to the hospital's psychiatric unit. When should this client be switched to oral haloperidol? a. After a maintenance dose is determined b. After symptoms are under control c. After the client is able to self-administer medication d. After the client is discharged from the hospital

b. After symptoms are under control Intramuscular administration of haloperidol can be replaced with oral administration once symptoms are under control.

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? a. partial thromboplastin time (PTT) b. Complete blood count (CBC) c. Prothrombin time (PT) d. blood urea nitrogen (BUN)

b. Complete blood count (CBC) It is essential to monitor white blood cell counts via CBC in clients taking clozapine due to the risk of fatal agranulocytosis. Coagulation tests and measurement of BUN are not indicated.

The health care provider prescribed antipsychotic medication for a female client 2 months ago. She is noncompliant with her medication regimen and is symptomatic. The nurse is responsible for developing a plan of care to facilitate medication compliance. What would the nurse include in this plan? a. A written contract to ensure compliance b. Coordination of the efforts of several health and social service agencies or providers c. Immediate hospitalization for medication noncompliance lasting 1 week d. Administration of daily oral medications by the community health nurse

b. Coordination of the efforts of several health and social service agencies or providers The home care nurse must assist and support caregivers' efforts to maintain medications and manage adverse drug effects, other aspects of daily care, and follow-up psychiatric care. In addition, the home care nurse may need to coordinate the efforts of several health and social service agencies or providers.

In clients with acute psychosis, the treatment goal during the first week of treatment includes: a. Assessing the client for medical conditions, including obesity and hypertension. b. Decreasing the client's symptoms and normalizing the patterns of sleeping and eating. c. Decreasing the client's medications and documenting patterns of sleeping and eating. d. Ensuring the client's compliance with oral drug therapy.

b. Decreasing the client's symptoms and normalizing the patterns of sleeping and eating. Overall, the goal of treatment is to relieve symptoms with minimal or tolerable adverse drug effects. In clients with acute psychosis, the goal during the first week of treatment is to decrease symptoms (e.g., aggression, agitation, combativeness, hostility) and normalize patterns of sleeping and eating. The next goals may be increased ability for self-care and increased socialization. Therapeutic effects usually occur gradually, over 1 to 2 months. Long-term goals include increasing the client's ability to cope with the environment, promoting optimal functioning in self-care and activities of daily living, and preventing acute episodes and hospitalizations.

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? a. The client demonstrates a significant increase in agitation after being given haloperidol. b. The client develops muscle rigidity and a sudden, high fever. c. The client reports intense thirst and produces copious amounts of urine. d. The client develops yellowed sclerae and intense pruritis (itchiness).

b. The client develops muscle rigidity and a sudden, high fever. Neuroleptic malignant syndrome is characterized by fever, sweating, tachycardia, muscle rigidity, tremor, incontinence, stupor, leukocytosis, elevated creatinine phosphokinase levels, and renal failure. Agitation, pruritis, thirst, and increased urine output are not indicative of neuroleptic malignant syndrome.

Which test should be scheduled every week for a patient taking clozapine? a. Serum lithium b. WBC count c. Blood glucose d. pH level

b. 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.

What psychiatric client is most likely to have the lowest risk of extrapyramidal effects? a. a client taking chlorpromazine 50 mg PO t.i.d. b. a client taking clozapine 25 mg PO t.i.d. c. a client taking thiothixene 5 mg PO t.i.d. d. a client taking haloperidol 1.5 mg PO t.i.d.

b. a client taking clozapine 25 mg PO t.i.d. Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. Chlorpromazine is a typical antipsychotic, one of the older drugs, which does cause the extrapyramidal effects. Thioxanthene is a typical antipsychotic; it has low sedative and hypotensive effects but can cause extrapyramidal effects. Haloperidol is a butyrophenone group drug used in psychiatric disorders. Usually, it produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects.

The nurse is monitoring a client who is receiving antipsychotic drug therapy. What behaviors would cause the nurse to suspect the client is demonstrating an extrapyramidal effect? Select all that apply. a. sits with back to the wall to keep others from "hurting me" b. inability to stay seated for any length of time c. repeated, involuntary twisting of the arms d. near-constant lip smacking e. reporting hearing "voices"

b. inability to stay seated for any length of time c. repeated, involuntary twisting of the arms d. near-constant lip smacking Extrapyramidal effects include movement disorders such as tardive dyskinesia (e.g., lip smacking), akathisia (e.g., motor restlessness), and dystonia (e.g., twisting movements of the limbs). Neither paranoia nor auditory hallucinations are suggestive of extrapyramidal effects.

A client has been prescribed clozapine, an atypical nonphenothiazine. Clients taking these drugs should be monitored for what life-threatening adverse effect? a. Renal insufficiency b. Emphysema c. Agranulocytosis d. Cerebrovascular accident

c. Agranulocytosis Agranulocytosis can be a life-threatening adverse effect of atypical nonphenothiazines. The client's white blood cell counts must be checked before, during, and after clozapine therapy.

A nurse is working with a 29-year-old Asian American man who was recently diagnosed with schizophrenia and is starting to take haloperidol. The patient is currently working as a professional gardener. When developing a teaching plan for the patient, which of the following patient variables will the nurse consider most important when trying to minimize the risk of neuroleptic malignant syndrome? a. Dietary habits b. Work environment c. Daily fluid intake d. Ethnicity

c. Daily fluid intake Because the patient is a gardener, he probably works outdoors most of the time and may face the risk of dehydration, especially in the summer months. It is most important to assess his daily fluid intake. Patients are more likely to develop neuroleptic malignant syndrome if they are dehydrated. Even though he may be at risk for photosensitivity due to being outside in the sun, this adverse effect would not be as serious as neuroleptic malignant syndrome. Also, although dietary habits and cultural influences could contribute to adverse effects, they would not be as important as assessing his fluid intake.

For which adverse reactions should the nurse monitor the patient who has been administered antipsychotic drugs? a. Hypertension b. Skin eruptions c. Dry mouth d. Bradycardia

c. Dry mouth The nurse should monitor the patient for mouth dryness. Antipsychotic drugs cause hypotension, not hypertension. Skin eruptions and bradycardia are not adverse reactions related to the administration of antipsychotic drugs.

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? a. Stevens-Johnson syndrome b. Neuroleptic malignant syndrome c. Tardive dyskinesia d. Extrapyramidal syndrome

c. Tardive dyskinesia 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.

The nurse is caring for a patient who is receiving drug therapy for a psychotic disorder. Which goals should the nurse include in a care plan for the patient following discharge from the hospital? a. The patient will return for follow-up appointments when the patient believes they are necessary. b. The patient will exhibit decreased symptoms of acute psychosis. c. The patient will take medications as prescribed. d. The patient will normalize sleeping and eating patterns.

c. The patient will take medications as prescribed. Goals that relate to care following discharge may include ensuring that the patient takes medications as prescribed and returns for all scheduled follow-up appointments with health care providers. Normalizing sleep and eating patterns and decreasing symptoms are short-term (e.g., within the first week of treatment) goals of patients who experience acute psychotic episodes.

For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months? a. Liver enzymes b. Hemoglobin c. White blood cells d. PT/PTT

c. 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.

A client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client? a. bradycardia b. shortness of breath c. extrapyramidal effects d. hypoglycemia

c. 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's medication has been changed to clozapine. What assessment should the nurse perform to identify a life-threatening adverse effect early? a. monitoring urine output b. lung auscultation c. vital signs monitoring d. observation for bleeding

c. vital signs monitoring Neuroleptic malignant syndrome can be a life-threatening adverse effect of atypical nonphenothiazines. It causes wide variations in all the client's vital signs. However, it would be less likely to cause adventitious lung sounds, hemorrhage, or oliguria.

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? a. "Clients with dementia routinely become agitated due to their disease process." b. "Clients with dementia respond poorly to antipsychotic medications." c. "Clients with dementia respond well to antipsychotic medications." d. "Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems."

d. "Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems." Clients with dementia may become agitated because of environmental or medical problems. Alleviating such causes, when possible, is safer and more effective than administering antipsychotic drugs. Inappropriate use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems.

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? a. assessment of bowel pattern and stool character b. monitoring the client's cranial nerve function c. assessment of deep tendon reflexes d. monitoring the client for involuntary facial movements

d. 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.