Pharm - PREP U Psychotic Disorder Practice Q's

For which client would the nurse question the use of antipsychotic medication therapy? A. An older adult client whose delusions and psychosis are attributable to dementia B. An older adult client whose schizophrenia was treated with phenothiazines when first diagnosed 30 years ago C. A middle-aged adult client whose current psychotic episode resulted from not adhering to the prescribed medication therapy D. A young adult client diagnosed with schizophrenia and who has recently been using cocaine and heroin

A Rationale: Many antipsychotics are associated with increased risk of death in older adults who have dementia. Black box warnings address this risk. The other listed clients would likely be administered antipsychotic medications.

The nurse is monitoring for adverse effects in a client who has been prescribed chlorpromazine. What interventions should the nurse incorporate into the plan of care? Select all that apply. A. Monitor urinary output. B. Assess for hallucinations. C. Take and record daily weight. D. Monitor white blood cell (WBC) count. E. Monitor for facial edema.

A,C,D Rationale:The nurse assesses the fluid and electrolyte status for a possible fluid volume deficit, making it necessary to measure the client's weight daily and assess for signs of dehydration. In addition, the nurse assesses for increased anticholinergic effects, such as diminished fluid status and urinary retention. The nurse assesses for aspiration related to depressed cough reflex. It is important to monitor renal and hepatic function along with the complete blood count. A depression in white blood cell count requires discontinuation of the medication. Excessive fluid volume is not associated with this medication. The medication is prescribed to eliminate hallucinations.

The nurse is providing education to a client who has been prescribed an antipsychotic drug. Which statement suggests that the client understands the typical length of medication therapy? A. ''I will need medication if my hallucinations get worse.'' B. ''I may always have to take this medication.'' C. ''Medications are less effective once my symptoms subside.'' D. ''If I take good care of myself, I'll be off medications soon.''

B Rationale:People with schizophrenia usually need to take antipsychotics 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 taking their medication. Symptoms tend to increase when medications are stopped. While ineffective self-care is a factor, it is not the only trigger for an acute psychotic episode.

Antipsychotic drugs are contraindicated in clients with what medical issues? A. Peptic ulcer disease, mild hypertension, chronic joint pain, and kidney failure B. Nausea, severe hypotension, or intractable hiccups C. Kidney damage, chronic obstructive lung disease, mild hypotension, and chronic bone pain D. Liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease

D Rationale:Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.

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. Blood urea nitrogen (BUN) B. Prothrombin time (PT) C. Partial thromboplastin time (PTT) D. Complete blood count (CBC)

D Rationale: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 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. "Sometimes people who take this drug are more prone to getting infections such as colds and flus.'' C. ''You'll have to eat more protein while you're taking this drug to help heal any wounds.'' D. ''There's a chance that you could develop breathing problems when using this drug, making you vulnerable to pneumonia.''

A Rationale:Hyperglycemia and weight gain are potential adverse effects of atypical antipsychotics. These drugs do not compromise the immune system, cause respiratory complications, or create a need for a high-protein diet.

A client who began treatment with clozapine 2 weeks ago is now reporting worsening flulike symptoms, including a high fever. The nurse's assessment should be conducted with the goal of identifying signs and symptoms of what possible adverse medication reaction? A. Anemia B. Thrombocytopenia C. Leukocytosis D. Agranulocytosis

D Rationale:Atypical antipsychotics have been known to cause agranulocytosis, which is a deficiency of granulocytes (type of white blood cells) in the blood, causing increased vulnerability to infection. The client is showing signs and symptoms of infection, and blood work is necessary to rule out the possibility of this serious adverse effect. Leukocytosis is an increase in the number of white cells in the blood. Anemia involves a decrease in red blood cells (RBCs), while thrombocytopenia is a condition in which the client has a low blood platelet count. None of the remaining conditions are associated with clozapine therapy.

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment? A. Core body temperature B. Visual acuity C. Deep tendon reflexes D. Blood pressure

D Rationale:Haloperidol can cause hypotension in clients who are volume depleted or receiving antihypertensive drugs. The client is unlikely to develop hyperthermia, diminished reflexes, or visual dysfunctions.

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. Parkinson's disease B. Postoperative headaches C. Peptic ulcer disease D. Preoperative restlessness E. Nausea and vomiting

D, E Preoperative restlessness Nausea and vomiting Rationale: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.

The nurse is monitoring a client for possible neuroleptic malignant syndrome. What interventions will the nurse implement in client care? Select all that apply. A. Monitor for signs of respiratory distress. B. Monitor bradycardia every 4 hours. C. Assess temperature every 8 hours. D. Perform a daily bedside electrocardiogram (ECG). E. Document urinary output every 8 hours.

A,C,E Monitor for signs of respiratory distress. Assess temperature every 8 hours. E. Document urinary output every 8 hours. Rationale:Neuroleptic malignant syndrome, a rare but potentially fatal adverse effect, is characterized by rigidity, severe hyperthermia, agitation, confusion, delirium, dyspnea, tachycardia, respiratory failure, and acute renal failure. While tachycardia is a characteristic, cardiac arrhythmias are not commonly noted with this condition.

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. Near-constant lip smacking B. Reporting hearing ''voices'' C. Sits with back to the wall to keep others from ''hurting me'' D. Repeated, involuntary twisting of the arms E. Inability to stay seated for any length of time

A,D,E Rationale: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 nurse observing a client notices that the client has developed muscle rigidity, altered mental status, tachycardia, and sweating. The nurse interprets these findings as suggesting which disorder A. Extrapyramidal syndrome B. Neuroleptic malignant syndrome (NMS) C. Agranulocytosis D. Tardive dyskinesia

B Rationale: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 nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus? A. Potential therapeutic effects of medication B. The importance of adherence to prescribed treatment C. Maintenance of adequate nutrition D. The need for weekly blood coagulation testing

B Rationale:The success or failure of treatment is largely dependent on the client's adherence to treatment. For most clients, this supersedes the immediate significance of nutrition or teaching about therapeutic effects. There is no need for weekly coagulation tests.

The nurse is reviewing a prescription for chlorpromazine. The nurse would contact the prescribing health care provider regarding a contraindication for the client with what medical diagnosis? Select all that apply. A. Hyperthyroidism B. Cirrhosis C. Stroke D. Parkinson's E. Atrial fibrillation

B,C,D Contraindications to chlorpromazine include liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, and severely depressed states. None of the other options are contraindications for chlorpromazine use.

The nurse is planning care for a client who is receiving treatment for acute psychosis. What goals would be appropriate during the first week of treatment? Select all that apply. Ensuring the client's compliance with oral drug therapy Preventing additional psychotic episodes Normalizing the client's ability to cope with environment Decreasing the client's symptoms Normalizing the patterns of sleeping and eating

D,E Decreasing the client's symptoms 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.