Chapter 22: Psychotherapeutic Agents (Combined)
When the nurse is engaging in teaching with clients taking anti-psychotic medications and their families, what would be important to include to decrease adverse effects of the medication?
Alcohol should be avoided. Explanation: Alcohol should be avoided because it may cause excessive drowsiness and decreased awareness of safety hazards in the environment.
What client is being treated with a typical antipsychotic?
An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.
The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?
blood pressure Explanation: 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.
A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?
"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain." Explanation: Dopamine is a neurotransmitter in the sympathetic nervous system that deals with pleasure and reward in the brain. Dopamine is not an enzyme or a part of the brain. Dopamine is a medication, but it does not fight infection or help with pain.
The nurse on the unit has several clients taking clozapine. For which client is clozapine, an antipsychotic, contraindicated?
The 45-year-old with bone marrow depression Explanation: Contraindications to antipsychotic drugs include bone marrow depression, liver damage, coronary artery disease, coma, and severe hypotension or hypertension. The use of clozapine is not contraindicated in clients with upper respiratory infection, diabetes insipidus or osteoarthritis.
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 should be able to differentiate between the typical and atypical antipsychotic. Which are classified as atypical antipsychotics? (Select all that apply.)
Aripiprazole (Abilify) Clozapine (Clozaril) Explanation: Aripiprazole (Abilify) and clozapine (Clozaril) are classified as atypical antipsychotics.
The nurse is caring for a client who is prescribed haloperidol long term. What assessment should the nurse prioritize?
Assessment for involuntary movements Explanation: 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.
The nursing student is reviewing information learned in anatomy and physiology class about the nervous system. The student recalls that the nervous system has how many divisions?
2 Explanation: The nervous system has two main divisions: the central nervous system and the peripheral nervous system.
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 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 efficacy.
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.
The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus?
the importance of adherence to prescribed treatment Explanation: 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.
A client is being prescribed a central nervous system stimulant. Which will have the lowest risk of abuse and dependence?
Atomoxetine Explanation: Atomoxetine is administered for ADHD and has a lower abuse and dependence capability. Dextroamphetamine, dextroamphetamine and amphetamine, and dexmethylphenidate have strong potential for abuse and dependence.
Which antipsychotic medications have antiemetic effects? (Select all that apply.)
Chlorpromazine (Thorazine) Prochlorperazine (Compazine) Explanation: Chlorpromazine (Thorazine) and prochlorperazine (Compazine) are antipsychotic medications that have antiemetic effects.
The school nurse is conducting a screening of kindergarten students. The nurse will assess the children for what characteristics of ADHD? (Select all that apply.)
Hyperactivity Impulsivity Short attention span Explanation: ADHD is characterized by hyperactivity, impulsivity, and a short attention span. Most often, they do not get along well with other children because of their impulsivity and difficulty maintaining control.
A 21-year-old client refuses to take his oral antipsychotic medication. What would be the appropriate action for the nurse do?
Attempt to reason with the client. If he still refuses, contact the provider for further instructions. Explanation: If a client refuses his medication, attempt to reason with him. If this doesn't work, contact the provider regarding this problem because parenteral administration of this medication may be necessary. Never force a client to take a pill by holding his nose shut. Never give a different medication without a new order from the provider. Arguing with a client and giving up will not solve the issue.
A 9-year-old child receives antipsychotics to manage her disease. The child's mother asks why her daughter receives such a high dose of the medication compared with an adult. How will the nurse explain this to the mother?
"Children usually have a faster metabolic rate than adults and may therefore require relatively high doses for their size and weight." Explanation: Children usually have a faster metabolic rate than adults and may therefore require relatively high doses of antipsychotics for their size and weight.
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 female client asks why it is not legal to have a year's worth of prescription refills for Ritalin, since she has been on it for more than a year. She would also like to have the largest dose possible, so she can use the prescription for 2 months, instead of one. She explains that it is very hard to get off work and come in for appointments. The nurse's best response would be:
"The prescription dose is always started as low as possible and the refills are monitored to prevent abuse." Explanation: When a CNS stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose (i.e., decreased symptoms) or the maximum daily dose is reached. In addition, the number of doses that can be obtained with one prescription should be limited. This action reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed).
Parents bring a 15-year-old male into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What is an appropriate question to ask the parents?
How long has your son been exhibiting symptoms? Explanation: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality.
A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?
It reduces the likelihood of drug dependence or diversion. Explanation: When a CNS stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose (i.e., decreased symptoms) or the maximum daily dose is reached. In addition, the number of doses that can be obtained with one prescription should be limited. This action reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed).
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 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.
The nurse is caring for a client who takes clozapine. The nurse would be most concerned if this client displays what symptom?
Temperature of 102°F Explanation: The nurse would be most concerned about a client's temperature of 102 because clozapine can cause agranulocytosis.
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.
While reviewing a medication history, the nurse sees that a school-age client has been prescribed haloperidol. Based on this information, the nurse suspects that the client may have been diagnosed with what disease process?
Tourette's syndrome Explanation: Haloperidol is used in treating Tourette's syndrome in children. It is not used to treat muscular dystrophy, Alzheimer's disease, or myasthenia gravis.
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse must assess the child. The priority assessment since he is on this medication would be which?
height and weight. Explanation: The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric client. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.
The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response?
"ADHD usually starts in childhood and may persist through adulthood." Explanation: ADHD usually starts in childhood and may persist through adulthood.
The pediatric client has been prescribed methylphenidate. Which statement should be included in the teaching plan for a client receiving methylphenidate?
"Adverse effects include hypertension and nervousness." Explanation: Adverse effects of methylphenidate include hypertension, tachycardia, nervousness, and appetite suppression with resulting weight loss. The drug has a high potential for abuse and dependence. The last dose of any CNS stimulant is usually taken at least 6 hours before bedtime to prevent interference with sleep.
A family member asks if a relative, who is taking prochlorperazine for schizophrenia, can go on a beach vacation. What is one point of education that the nurse would make sure the client and family understand?
"Prochlorperazine can make you very sensitive to light. Make sure you wear sunscreen and cover up as much as possible to prevent sunburn." Explanation: Photosensitivity is a side effect of prochlorperazine. Severe sunburn can occur. The client may get more agitated, but he should not be denied a vacation nor should he be hospitalized because his family is vacationing. Weight gain can occur when taking a second-generation antipsychotic medication, but prochlorperazine is a first-generation antipsychotic. Being in the sun does not change blood pressure.
The school nurse is conducting a screening of kindergarten students. The nurse will assess the children for what characteristics of ADHD? (Select all that apply.) -Hyperactivity -Improved retention -Impulsivity -Short attention span -Playing well with others
-Hyperactivity -Impulsivity -Short attention span Explanation: ADHD is characterized by hyperactivity, impulsivity, and a short attention span. Most often, they do not get along well with other children because of their impulsivity and difficulty maintaining control.
A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?
Antipsychotics do not improve memory loss and may further impair cognitive functioning. Explanation: If antipsychotic drugs are used to control acute agitation in older adults, they should be used in the lowest effective dose for the shortest effective duration. If the drugs are used to treat dementia, they may relieve some symptoms (e.g., agitation, hallucinations, hostility, suspiciousness, uncooperativeness), but they do not improve memory loss and may further impair cognitive functioning.
A high-school-age client, brought to the emergency department (ED) by friends after taking a "whole handful of dextroamphetamine," is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose?
Cardiac monitoring Explanation: Dextroamphetamine misuse may cause sudden death or serious cardiovascular events. It is essential to obtain a baseline electrocardiogram (ECG) and blood pressure reading. These assessments are priorities over blood glucose monitoring, respiratory assessment, and cognitive assessment.
Dexmethylphenidate has been prescribed to Scott, a 7-year-old boy who was diagnosed with ADHD. The mother asks how this medication will help her son. Which would be the most accurate description of the purpose of this medication?
Dexmethylphenidate will improve Scott's attention span so that he will be able to complete a task. Explanation: Dexmethylphenidate is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space. This activity results in improved attention spans, decreased distractibility, and increased ability to follow directions or complete tasks, and decreased impulsivity and aggression in patients with ADHD. Although dexmethylphenidate does not produce a physical dependence, it may induce tolerance or psychic dependence.
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.
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 Explanation: 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.
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.
Monitoring of patients taking lithium includes periodically obtaining a serum lithium level; at what level may toxic reactions occur?
Greater than 1.5 mEq/mL Explanation: Toxic reaction may occur when serum lithium levels are greater than 1.5 mEq/mL
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 aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?
Improving Explanation: CNS stimulants improve behavior and attention in clients with ADHD
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.
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.
A client who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine. The client has been taking the medication for more than 40 years. What adverse effect will the client most likely experience?
Tardive dyskinesia Explanation: A client who has taken chlorpromazine on a long-term basis will be at risk for late extrapyramidal effects, such as tardive dyskinesia. Hypertension is not an adverse effect of chlorpromazine, but hypotension is an adverse effect. Central nervous system agitation is not an adverse effect of chlorpromazine, but central nervous system depression is an adverse effect. Urinary frequency is not an adverse effect of chlorpromazine, but urinary retention is an adverse effect.
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 nurse is teaching the client about CNS medications and how they are addictive. What is primary reason CNS medications are addictive?
The medication stimulates the brain's pleasure centers with enhanced neurotransmission of dopamine. Explanation: CNS medications have a high degree of addiction potential because they stimulate the brain's pleasure centers with enhanced neurotransmission of dopamine. CNS stimulants do not promote sleep. CNS stimulants do not change visual acuity. Decreased dopamine does not produce feelings of euphoria.
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.
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.
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.
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.
While caring for a client who is receiving antipsychotic therapy, the nurse observes lip smacking, a darting tongue, and slow and aimless arm movements. The nurse interprets this as:
tardive dyskinesia. Explanation: Tardive dyskinesia involves abnormal muscle movements such as lip smacking and tongue darting, slow and aimless arm and leg movements, and chewing movements. Akathisia is manifested by continued restlessness and an inability to sit still. Pseudoparkinsonism is manifested by muscle tremors, cogwheel rigidity, drooling, shuffling gait, and slow movements. Dystonia is manifested by spasms of the tongues, neck, back, and legs.
Many bipolar patients quit taking their medications. Research has now indicated that what may be effective in the long-term prevention of recurrent psychosis?
Lamictal 25 mg po q day Explanation: Several studies indicate that Lamictal 25 mg po q day is effective in long-term prevention of recurrent psychosis.
A client receiving outpatient therapy with antipsychotic therapy experiences dizziness from time to time. Which suggestion by the nurse would be appropriate?
"Get up slowly from the bed or chair." Explanation: If dizziness occurs when changing positions, the nurse should encourage the client to rise slowly when getting out of the bed or a chair. Frequent sips of water help alleviate dry mouth. Taking the drug with meals would have no effect on the client's dizziness. Limiting salt intake would have no effect on the client's dizziness.
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.
What is the recommended amount of caffeine for a nonpregnant woman to consume daily?
250 mg of caffeine Explanation: Some authorities recommend that normal, healthy, nonpregnant adults consume not more than 250 mg of caffeine daily. 125 mg of caffeine is lower than the recommended safe amount of consumption. 500 mg to 1 g is more than the recommended daily consumption of caffeine.
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 Explanation: 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 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?
Complete blood count (CBC) Explanation: 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.
A client with schizophrenia has been taking haloperidol for several years. The care team and the client have collaborated and chosen to transition the client to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. 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 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 Explanation: 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.
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. Explanation: 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 no longer needs the medication.
A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenager who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite?
Reduced adverse effects Explanation: Atypical antipsychotics may be more effective in relieving some symptoms than typical antipsychotics, and they usually produce milder adverse effects. A major drawback is the high cost of these drugs. All antipsychotics are available for the oral route. There are several black box warnings relating to atypical antipsychotics.
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?
Tardive dyskinesia Explanation: 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?
The patient will take medications as prescribed. Explanation: 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.
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?
"I may always have to take this medication." Explanation: 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.
A client is prescribed doxapram as part of the treatment plan. Which would be important for the nurse to do when caring for this client? Select all that apply.
Keep a suction machine nearby Avoid giving the client coffee, tea, and carbonated beverages Measure urinary intake and output Palpate the bladder for distention Explanation: Clients receiving modafinil may develop nausea, so the nurse should keep a suction machine nearby in case the client vomits. Coffee, tea, and carbonated beverages should be avoided when the client is taking a CNS stimulant. Urinary retention may occur, so it is important to monitor the client's intake and output and palpate the bladder for distention. Doxapram is given intravenously. The drug should be administered with food or immediately afterward but not on an empty stomach.
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?
Lip smacking Explanation: Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.
Anticonvulsive medications are sometimes used in the treatment of bipolar disorder. What other drug is used to treat bipolar disorder?
Lithium Explanation: The mainstay for treatment of mania has always been lithium. Many other drugs are used successfully in treating bipolar disorders including aripiprazole, olanzapine, quetiapine, and ziprasidone, which are atypical antipsychotics; and lamotrigine, an antiepileptic agent. Valium is a sedative and antianxiety agent. Flexeril is a muscle relaxant. Restoril is a hypnotic agent.
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 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.
The nurse suspects that a client receiving olanzapine is developing type 2 diabetes. Which finding would help support the nurse's suspicion? Select all that apply.
increased thirst weight gain increased urination Explanation: The nurse would suspect development of type 2 diabetes based on assessment of increased thirst and urination and weight gain. Fever and sore throat would suggest an infection, possibly due to agranulocytosis from clozapine therapy
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?
"Continue the prescribed dose. It may take several days to work." Explanation: 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.
A black, male client routinely takes haloperidol to manage his psychosis. Recently, he presented to the health care provider's (HCP's) office with signs of tardive dyskinesia, and his HCP modified the drug regimen over time. The client will now take the drug olanzapine and discontinue the haloperidol. What will the nurse tell the client to help decrease his anxiety about the new drug regimen?
"When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients." Explanation: Black clients tend to respond more rapidly; experience a higher incidence of adverse effects, including tardive dyskinesia; and metabolize antipsychotic drugs more slowly than white clients. When compared with haloperidol, olanzapine has been associated with fewer extrapyramidal reactions in black clients.
The nurse administers chlorpromazine intramuscularly to a client. The nurse would maintain the client in bed for at least how long after administering the drug?
½ hour Explanation: After administering parenteral forms of antipsychotic agents, the nurse should keep the client recumbent for approximately ½ hour to reduce the risk of orthostatic hypotension.
Ms. James is started on olanzapine for the treatment of psychotic symptoms associated with schizophrenia. What is part of the routine monitoring for patients on olanzapine?
Monitoring for signs of diabetes, including elevated blood glucose levels Explanation: Precautions should be taken if the patient has diabetes, because all use of atypical antipsychotics is associated with substantially elevated blood glucose levels. Patients who are not diagnosed with diabetes at the start of therapy still remain at risk for developing significant hyperglycemia while taking olanzapine or any other atypical antipsychotic. Patients without a history of diabetes are at risk for developing diabetes from therapy; the more diabetic risk factors present, the more likely hyperglycemia may develop. In addition to elevated glucose levels, patients may gain weight (a significant number of patients gain more than 7% of their baseline weight), have decreased insulin sensitivity, have lipid elevations, and develop metabolic syndrome (increased visceral fat, as measured by waist circumference; hyperglycemia; hypertension; and dyslipidemia), putting them at increased risk for cardiovascular problems.
The nurse observes that a client with a long history of chlorpromazine therapy demonstrates lip smacking and appears to be chewing continually. The nurse should recognize that this client is likely experiencing what adverse effect of the medication?
Tardive dyskinesia Explanation: Tardive dyskinesia occurs as the result of long-term use of chlorpromazine. Clients may experience lip smacking, tongue protrusion, and facial grimaces and may have choreic movements of the trunk and limbs. Akathisia is a form of restlessness, and dystonias are uncoordinated movements. Neuroleptic malignant syndrome is an acute complication.
A patient has been prescribed lithium. Which intervention should the nurse perform while caring for the client? (Select all that apply.)
Administer lithium with food Continually monitor patient for drowsiness Increase fluid intake to about 3,000 mL/day Explanation: The nurse should administer lithium with food, continually monitor patient for drowsiness, and increase fluid intake to about 3,000 mL/day. Antacids should not be administered because they reduce the potency of the lithium. Blood sample should be obtained immediately before, not after, the dose.
A client visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. These behaviors support which medical diagnosis?
Narcolepsy Explanation: Narcolepsy is characterized by daytime sleep attacks in which the person goes to sleep at any place or at any time. Sleep apnea is episodes of apnea, temporary cessation of breathing, during sleep. Insomnia is the inability to sleep. This client is not exhibiting signs and symptoms consistent with substance abuse.
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 is providing education on the safe use of caffeine. The nurse would strongly discourage use in clients with a history of what disorders? Select all that apply.
cardiac dysrhythmias bipolar disorder history of stroke Explanation: CNS stimulants stimulate the cardiovascular system and thus are contraindicated in clients with cardiovascular disorders (e.g., angina, dysrhythmias, and hypertension) that are likely to be aggravated by the drugs. They also are contraindicated in clients with anxiety or agitation, glaucoma, or hyperthyroidism. They are usually contraindicated in clients with a history of drug abuse. Caffeine is not recommended for people with a history of stroke, peptic ulcer disease, bipolar mood disorder, and schizophrenia. Reasonable consumption of caffeine is not contraindicated for clients diagnosed with hypothyroidism or cataracts.
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
electrocardiogram (ECG). Explanation: In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
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.
