Prep U, PN 125:Chapter 22:Psychotherapeutic Agents

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

Clozapine Explanation: 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 test should be scheduled every week for a patient taking clozapine?

WBC count Explanation: 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.

The nurse knows the medication methylphenidate is used to treat attention deficit hyperactivity disorder(ADHD). What type of medication is methylphenidate?

a central CNS stimulant Explanation: Methylphenidate, a drug used in the treatment of ADHD, is a central CNS stimulant. It is not as SSRI, respiratory stimulant or anorectic agent.

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. Explanation: Signs of excessive CNS stimulation include: agitation, confusion, hyperactivity, difficulty concentrating on tasks, hyperactivity, nervousness, restlessness and sympathetic nervous system stimulation (e.g., increased heart rate and blood pressure, pupil dilation, slowed gastrointestinal motility, and other symptoms). Signs of moderate CNS depression include drowsiness or sleep; decreased muscle tone; decreased ability to move; and decreased perception of sensations such as pain, heat, and cold.

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

The client will remain safe. Explanation: Safety is a priority over other goals. Goals such as participation in ADLs, health maintenance, and participation in relationships are valid, but safety is a priority.

A nurse is reviewing a client's serum lithium level and determines that the level is therapeutic by which result?

0.8 mEq/L Explanation: Therapeutic serum lithium levels range from 0.6 mEq/L to 1.2 mEq/L, so a level of 0.8 mEq/L would be considered therapeutic. A level of 0.2 mEq/L would be nontherapeutic. Levels above 1.2 mEq/L would be considered toxic.

The nurse is preparing to administer oral chlorpromazine to a client. What action should the nurse include in administration?

Administer the day's last dose 1 to 2 hours before bedtime. Explanation: For oral administration of chlorpromazine, the nurse should give the last dose of the day 1 to 2 hours before bedtime, as peak sedation occurs in about 2 hours. The drug is not given on alternating days, and there is no need to avoid dairy products. It is unnecessary for the client to hold the drug under the tongue.

A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia?

Diabetes mellitus Explanation: The development of polyuria and polydipsia is indicative of diabetes mellitus. Risperidone has been associated with weight gain, diabetes, and dyslipidemia. Adverse effects of risperidone do not include urinary tract infection, renal calculus, or the development of hyperthyroidism.

A client with schizophrenia has been taking haloperidol for several years. In order to reduce the client's risk of extrapyramidal effects during the transition from haloperidol to an atypical antipsychotic, the care team should implement which intervention?

Gradually taper the dose of haloperidol. Explanation: When discontinuing haloperidol, it is essential to taper the dosage to prevent extrapyramidal symptoms. If the medication is abruptly discontinued, the client is at risk for this condition. A drug holiday would exacerbate symptoms, and ECT is not indicated. Concurrent administration of two drugs has the potential to exacerbate adverse effects.

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 Explanation: Methylphenidate is clinically used to treat ADHD and narcolepsy. The drug is not indicated in the treatment of obesity, respiratory depression, or anxiety.

The nurse is preparing to provide education to a client who has been prescribed clozapine for schizophrenia. What is the most important aspect of client teaching?

Maintaining medication regimen consistently Explanation: The client should be instructed to maintain the medication regimen to control symptoms of schizophrenia. Reporting signs of neuralgia is not taught because the medication does not have this effect. The medications will cause weight gain and should not be stopped in the event that weight gain develops. The use of alcohol is strictly prohibited with antipsychotic agents.

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

Modafinil Explanation: Modafinil is used to treat narcolepsy. Atomoxetine is administered for attention deficit hyperactivity disorder (ADHD). Guarana is an herbal supplement high in caffeine; it is not administered for narcolepsy. Caffeine is not administered for narcolepsy.

A female client 70 years of age is receiving lithium. Which nursing intervention is appropriate for this client?

Monitor fluid and sodium intake every 12 hours. Explanation: Older clients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly. A client age 70 years would not be concerned about the use of contraceptives. These drugs alone do not affect glucose levels. Weight loss is usually not associated with lithium use.

The nurse is providing education to a client who has been prescribed clozapine. The nurse should emphasize the importance of what monitoring routine during teaching?

Regular complete blood counts Explanation: Clozapine is associated with life-threatening decrease in white blood cells (agranulocytosis). It is essential to monitor the complete blood count due to this risk. Weekly liver enzymes, monthly creatinine levels (kidney function), and INR monitoring (blood clotting function) are not recommended with clozapine therapy.

The nurse is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching?

Tardive dyskinesias Explanation: 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 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?

The drug may need to be lowered in dosage or discontinued. Explanation: 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, 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. Explanation: Schizophrenic clients have a higher than normal incidence of diabetes. The flu usually has a fever along with respiratory symptoms. A urinary tract infection may cause burning and frequent urination, but thirst is not normally a symptom. Also, UTIs are not more common in schizophrenics. A client could be making up symptoms, but the nurse should first consider other options that could be causing the symptoms.

A nurse is providing care for a client diagnosed with attention deficit hyperactivity disorder (ADHD) who has been taking methylphenidate for several months. When monitoring for potential adverse effects, the nurse should include what assessments?

sleep patterns Explanation: Because methylphenidate is a central nervous system (CNS) stimulant, it carries the potential to disturb sleep patterns. The client's pupillary response, orientation, and sexual function are less likely to be affected.

An adolescent client has been taking methylphenidate for the treatment of attention deficit hyperactivity disorder (ADHD) for 3 years, 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 Explanation: Suppression of weight and height may occur in children taking this medication, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

Serotonin abnormalities are thought to be involved in the following disorders:

Mental depression and sleep disorders. Explanation: Normal levels of serotonin in the brain produce mood elevation or euphoria, increasing mental alertness and capacity for work, decrease fatigue and drowsiness, and prolong wakefulness. Abnormalities alter these functions.

A nursing instructor is describing the effects of CNS stimulants and their potential for addiction due to their euphoric sensations. The instructor determines that the discussion was successful when the students identify which substance as being involved with this pleasurable feeling?

dopamine Explanation: Stimulants enhance dopamine transmission to areas of the brain that interpret well-being. To maintain pleasurable feelings, people continue the use of stimulants, which leads to their abuse and the potential for addiction. Low serotonin levels are believed to cause depression and anxiety. Epinephrine is a hormone that increases cardiac output. Low levels of norepinephrine are believed to lead to ADHD and depression.

An adult client diagnosed with narcolepsy admits being embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the client by explaining what aspect of the etiology?

"This is the result of neurologic factors over which you have no direct control." Explanation: Narcolepsy is a neurologic sleep disorder, not the result of mental illness or psychological problems. It is most likely due to several genetic abnormalities, but family history is not noted to be highly significant. Learning that improvement of sleeping habits is important, but it will not address embarrassment.

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. Explanation: Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.

A 24-year-old client is being seen in the emergency department because of a high fever and cannot move the right arm. During the history-taking process, The nurse discovers the client is being treated with an antipsychotic medication for schizophrenia. The nurse knows that what may be happening with this client?

The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately. Explanation: Neuroleptic malignant syndrome (NMS) is a rare reaction characterized by extrapyramidal effects, hyperthermia, and autonomic disturbance. NMS is potentially fatal and requires immediate treatment. NMS does not self-resolve. Influenza A is not characterized by having an immobile arm. Usually a schizophrenic client would be able to tell you how he had broken his arm.

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

White blood cells Explanation: 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 female client 25 years of age has begun taking lithium for treatment of bipolar disorder. Which statement indicates that the client needs further instruction?

"I will need to stop taking my birth control pills while I take lithium." Explanation: Women of childbearing age are often prescribed contraceptives during lithium therapy because lithium is a pregnancy category D and is contraindicated during pregnancy and lactation. The client understands the need to come in regularly for blood tests, and that the lithium level may need to be adjusted depending upon the blood work. Client also understands that diarrhea is one of the early signs of lithium toxicity.

A client is prescribed clozapine. When developing the teaching plan for this client, the nurse would integrate which knowledge?

Only a 1-week supply is dispensed at a time. Explanation: The nurse should include information that only a 1-week supply of clozapine is dispensed at a time because of the medication's high risk for abuse. Clozapine is a pregnancy category B drug, not a pregnancy category C drug. Clozapine does not cause urinary retention. The client's WBC count has to be checked every week, not every month, because of the medication's ability to affect WBC production.

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. Explanation: Haloperidol is highly protein bound. Therefore, if it is administered along with another drug that is highly protein bound, it is likely to cause higher blood levels, leading to an increased risk for toxic effects. It does not decrease the risk for muscular contractions and spasms or increase drug

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

White blood cell count Explanation: 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 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. Explanation: Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.