PN119 PrepU Chapter 23

The nurse on a psychiatric unit contributes to the care of many clients, most of whom have physical as well as psychiatric health problems. For which client would clozapine (Clozaril) most likely be contraindicated?

45-year-old with bone marrow suppression

A male client comes into the emergency department and is agitated, swiping his arms at "the bugs" and screaming that Harry Potter sent the bugs to take him away. After two security officers help to restrain the client, the doctor orders 5 mg of Haldol STAT. How would the nurse administer this drug?

5 mg IM in the client's gluteus maximus

The wife of a patient 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:

"Continue the prescribed dose. It may take several days to work."

A client asks the nurse dopamine is. What is a correct response by the nurse?

"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."

When the nurse is engaging in patient teaching with patients taking anti-psychotic medications and their families, what would be important to include to decrease adverse effects of the medication?

Alcohol should be avoided.

A client is trying to answer the nurse's questions about her symptoms, but every time she starts a sentence she cannot finish it. What is the correct term for this symptom?

Alogia

What client is being treated with a typical antipsychotic?

An 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 male client refuses to take his oral antipsychotic medication. What should the nurse do?

Attempt to reason with the client. If he still refuses, contact the provider for further instructions.

A 17-year-old client has just been diagnosed with schizophrenia. When educating the family about the cause of this disease, the nurse should address what factors? Select all that apply.

Biochemical disruptions

Psychosis is a severe mental illness characterized by what?

Bizarre behavior

A mother is concerned about recent behaviors by her young-adult son, and asks the nurse about what behaviors characterize schizophrenia. The nurse knows that the characteristics of schizophrenia include what actions? (Select all that apply.)

Disordered thinking Abnormal behavior Impaired socialization

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 man is brought into the emergency department by a friend. The man is screaming about the government spying on him and is talking to a wall. The nurse goes to take his pulse and he becomes violent. The nurse understands that the client reacts this way because of which of the following reasons?

During a psychotic episode, clients do not perceive reality in the same way as others; therefore, touch may seem like a violent act.

Extrapyramidal symptoms include all of the following except:

Dystocia.

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

Extrapyramidal effects

A client is being discharged from the unit. The nurse is asked to provide discharge education for the client, including giving the client information about his medications. One of the medications is quetiapine (Seroquel). The nurse should educate the client that which food is contraindicated when taking this medication?

Grapefruit

Mr. Hall is prescribed haloperidol for acute psychosis. As the nurse caring for him, you note the following changes in his afternoon assessment: increased temperature, tachycardia, urinary incontinence, and lethargy. Based on the assessment, what is happening to Mr. Hall?

He has developed neuroleptic malignant syndrome.

A male client is being seen in the emergency department because he has a high fever and cannot move his arm. During the history-taking process, he says he is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client?

He may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.

The nurse knows that which of the following is true about tardive dyskinesia?

It is irreversible.

A patient has been admitted to the hospital following an acute schizophrenic episode. Which of the following would be an appropriate question for the nurse to ask the patient's family during the initial interview?

It would be appropriate to ask both of the above questions.

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

Lip smacking

A patient diagnosed with schizophrenia is being seen by the home care nurse. What is the most important aspect of patient teaching with this patient?

Maintain medication regime

Chlorpromazine IM has been ordered for a patient on your unit. The nurse caring for the patient knows that they should instruct the patient to what?

Remain recumbent for at least 30 minutes after the injection

Which antipsychotic medication classification has fewer extrapyramidal reactions?

Second generation

A nurse is charting a client who has repetitive tongue thrusting, jaw movements, and a facial tick. What term could the nurse use in charting to describe these findings?

Tardive dyskinesia

A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience?

Tardive dyskinesia

For which patient is clozapine, an antipsychotic, contraindicated?

The 45-year-old with bone marrow depression

A client in the locked psychiatric unit continually tells the nurse he is the king of England, even though the staff has corrected him that he is not the king of England. How could the nurse best describe this in the client's chart?

The client is delusional.

A patient who is experiencing withdrawal from heavy alcohol use have developed psychosis and been treated with haloperidol. Which of the following assessment findings should prompt the care team to assess the patient for neuroleptic malignant syndrome?

The patient develops muscle rigidity and a sudden, high fever.

A child suffers from tics and verbal outbursts while awake. The patient is prescribed haloperidol (Haldol). What disease process is haloperidol (Haldol) used to treat?

Tourette's syndrome

Mania is characterized by extreme overactivity and excitement.

True

Typical antipsychotics block dopamine receptors.

True

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

White blood cell count

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

White blood cells

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:

akathisia.

A nurse is caring for a patient who is to start antipsychotic drug therapy. In order to best promote adherence to the drug therapy, the nurse will begin by

developing a trusting relationship with the patient.

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.

Antipsychotic drugs are contraindicated in clients with:

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

The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to:

stay in bed for the next half hour.