Chapter 22: Psychotherapeutic Agents

A client's current drug regimen include modafinil. When planning this client's care, the nurse should prioritize the client's risk for:

Injury Modafinil is indicated for the treatment of narcolepsy, a disorder that creates a significant risk for injury. Neither narcolepsy nor modafinil are directly associated with hopelessness, confusion, or hallucinations.

Mania is characterized by extreme overactivity and excitement.

True Mania is characterized by periods of extreme overactivity and excitement (at the opposite pole from depression) and occurs in individuals with bipolar disorder who experience a period of depression followed by a period of mania. The cause of mania is not understood, but it is thought to be an overstimulation of certain neurons in the brain.

The nurse is providing drug teaching for a client newly prescribed a typical antipsychotic medication. What teaching points will the nurse include while talking with this client? Select all that apply.

Avoid use of the herb evening primrose., Inform all health providers of the medications you take., Never drink alcohol while taking this medication. The herb primrose can worsen symptoms and increase hyperexcitability, so it should be avoided. There are several drugs that are contraindicated including beta-blockers and anticholinergics, so the client should be sure to consult with the provider or pharmacist before taking any over-the-counter or newly prescribed medications. Alcohol is contraindicated because it worsens CNS effects of the drug. Decreased appetite or anorexia is more likely that an increase in appetite, so the client should be taught how to increase calorie intake. Photophobia is a common adverse effect, so client should be taught to avoid sunlight or wear dark glasses.

The nurse is working with a 12-year-old client who has been diagnosed with attention deficit hyperactivity disorder and prescribed methylphenidate. What statement by the client would suggest the presence of adverse drug effects?

"I just don't feel hungry very much these days." Anorexia is a common adverse effect of methylphenidate. Hypocoagulation, drowsiness, and aggression are not expected.

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 milligrams of pimozide should the client be administered?

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

What client is being treated with a typical antipsychotic?

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

A client who is being treated with a typical antipsychotic reports frequent nasal congestion are urinary hesitation. To what should the nurse most likely attribute these symptoms?

Anticholinergic effects Nasal congestion and urinary hesitation are manifestations of anticholinergic effects. Neuroleptic malignant syndrome primarily affects the CNS. Tardive dyskinesia involves involuntary movements. Extrapyramidal symptoms are movement related.

The nurse is caring for a client who is prescribed haloperidol long term. What assessment should the nurse prioritize?

Assessment for involuntary movements Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Leukopenia is less common, and there is no obvious threat to skin integrity. The client's T-cell levels will not be affected.

A client on the psychiatry unit with a long-standing history of schizophrenia has been prescribed risperidone. What assessment should the nurse prioritize in the care of this client?

Assessment of the client's behaviors and thought processes The nurse's priority should be to assess the signs and symptoms of the client's underlying health problem in order to identify therapeutic effects. The client's vital signs are not likely to be volatile, and hepatic and renal status are not commonly affected by risperidone. Bone marrow suppression is not an expected adverse effect.

A client who takes lithium for the treatment of bipolar disorder has been experiencing occasional constipation. What should the nurse teach the client about safely managing this problem?

Avoid taking psyllium supplements. Patients being treated with lithium should be encouraged not to use the herbal therapy psyllium, which is used to treat constipation and to lower cholesterol levels. If this agent is combined with lithium, the absorption of the lithium may be blocked, and the patient will not receive therapeutic levels. There is no need to avoid soluble fiber, and OTC stool softeners are likely safe, with the approval of the healthcare provider. The nurse should not teach the client that constipation must be accepted as inevitable.

A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action?

Inform the prescriber and monitor for GI and CNS effects. Therapeutic serum lithium levels range from 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic but would be unlikely to warrant admission to intensive care. The nurse should report the finding and assess for common adverse effects of toxicity, which include GI and CNS effects more often than respiratory effects.

The development of diabetes mellitus is associated with the use of typical antipsychotics.

False All of the atypical antipsychotics include a warning that there is a risk for the development of diabetes mellitus when these drugs are used.

During periods of dehydration, the client is at risk for lower serum lithium levels.

False During periods of sodium depletion or dehydration, the kidney reabsorbs more lithium into the serum, often leading to toxic levels.

A client with schizophrenia will exhibit fluctuations in mood swings from depression to mania.

False Schizophrenia is characterized by hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Bipolar disorder involves extremes of depression followed by hyperactivity and excitement (mania).

A psychiatric nurse is reviewing various antipsychotic agents. The nurse should identify what drug as having the highest potency?

Fluphenazine Fluphenazine is considered a highly potent antipsychotic. Prochlorperazine, thioridazine, and chlorpromazine are considered low-potency antipsychotics.

A client has a serum lithium level of 2.2 mEq/L. The nurse should expect to assess what symptoms? Select all that apply.

Hypotension, Seizures, Hyperreflexia Hypotension, hyperreflexia, and seizures would be noted with a serum lithium level between 2.0 and 2.5 mEq/L. Rash and epistaxis are not associated with lithium toxicity.

The nurse is caring for a client who has bipolar disorder and who receives lithium therapy. When reviewing the client's medication administration record, what drug would cause an increase in the client's risk of lithium toxicity?

Indomethacin Indomethacin and lithium, when combined, increase the risk of lithium toxicity. Psyllium interferes with the absorption of lithium leading to nontherapeutic levels. Antacids, like calcium carbonate, when combined with lithium, lead to a decrease in lithium effectiveness. Levothyroxine and vitamins would not be contraindicated.

A child with attention deficit hyperactivity disorder has been receiving methylphenidate for several years. The prescriber has explained a plan to temporarily discontinue the drug. What rationale for this action should the nurse explain?

It needs to be determined if the child still has symptoms that require treatment. Periodically the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which if they do occur, indicates the need for continued treatment. This is not done because the plan is to switch drugs if the current drug is effective or because of an increased risk. The absence of medicine will determine if he or she no longer needs the medication.

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

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.

The client was diagnosed with narcolepsy and prescribed modafinil on the last visit. When he or she return for follow-up care 2 months later, he or she report that he or she is able to stay awake all day but hate the dry mouth the drug causes. What strategies would the nurse provide this client to cope with this adverse effect?

Provide sugarless lozenges to suck. Sucking on sugarless lozenges and frequent mouth care can increase secretions and decrease discomfort. Increasing water or salt intake is not necessary, and there is no reason to avoid citrus fruits.

While caring for a client receiving antipsychotic therapy, the nurse observes cogwheel rigidity, tremors, and drooling. The nurse interprets this as what?

Pseudoparkinsonism Pseudoparkinsonism is manifested by muscle tremors, cogwheel rigidity, drooling, shuffling gait, and slow movements. Tardive dyskinesia involves abnormal muscle movements such as lip smacking, tongue darting, chewing movements, and slow aimless arm and leg movements. Dystonia is manifested by spasms of the tongues, neck, back, and legs.

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?

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.

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. After administering parenteral forms of antipsychotic agents, the nurse should keep the client recumbent in bed for approximately 30 minutes to reduce the risk of orthostatic hypotension. Urinary urgency and chest pain are not anticipated adverse effects, so would not need to be addressed. There is no obvious need for the client to perform deep breathing and coughing exercises.

The nurse determines the client may be displaying extrapyramidal effects on the basis of what assessment findings? Select all that apply.

The client exhibits hand tremors., The client's gait is uncoordinated. Ataxia, parkinsonism, and tremors are signs and symptoms of extrapyramidal effects. Insomnia and photophobia are adverse effects of typical antipsychotic medications but are not indicative of extrapyramidal effects. Verbal outbursts are unlikely to be related to drug therapy.

A client's medication regimen includes lithium. What assessment finding would suggest a therapeutic effect?

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 client taking lithium receives haloperidol. What data should indicate to the nurse that the client is experiencing encephalopathic syndrome? Select all that apply.

The client's hands are tremulous when at rest., The client's white cell count is greatly elevated., The client is much weaker than normal., The client is uncharacteristically disoriented. A lithium-haloperidol combination may result in an encephalopathic syndrome, consisting of weakness, lethargy, confusion, tremors, extrapyramidal symptoms, leukocytosis, and irreversible brain damage. Glucose levels are not affected by encephalopathic syndrome.

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

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 liver function, cardiac enzymes, or urine output.

The nurse is teaching a client who is prescribed fluphenazine about the drug. Which client statement indicates that the client has understood the instructions?

"I shouldn't be alarmed if my urine turns pink or reddish-brown." Phenothiazines, such as fluphenazine, can turn the urine pink or reddish-brown. Arrhythmias are not associated with fluphenazine. Nasal congestion, not a runny nose, is a possible adverse effect of fluphenazine. The development of diabetes is associated with atypical antipsychotics; fluphenazine is a typical antipsychotic.

The client has been taking an atypical antipsychotic medication for several years. During annual physical examinations, what assessment best addresses a likely adverse effect?

Fasting blood glucose level Clients taking atypical antipsychotic drugs are at increased risk of developing diabetes and should be regularly screened. Clients taking typical antipsychotics are at risk for prolonged QT intervals, but this is less likely with atypical antipsychotics. Hypotension, specifically orthostatic hypotension, is a potential adverse effect of typical antipsychotic medications. Passive range of motion is unlikely to be affected.

Typical antipsychotics block dopamine receptors.

True The antipsychotic drugs, which are essentially dopamine receptor blockers, are used to treat disorders that involve thought processes.