Chapter 22: Psychotherapeutic Agents

The child is diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will most likely be administered in conjunction with treatment?

central nervous system (CNS) stimulants Explanation: Attention deficit hyperactivity disorder (ADHD) is characterized by persistent hyperactivity, short attention span, and difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used; they do not affect CNS stimulation.

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.

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 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.

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 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 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.

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 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.

What are common skin reactions that a nurse should warn a client about when they are initiated on antipsychotic therapy? (Select all that apply.)

Urticaria Photosensitivity Explanation: Urticaria and photosensitivity are common skin reactions that a nurse should warn a client about when they are initiated on antipsychotic therapy.

A client reports insomnia during a routine visit. What should the nurse assess first regarding the most likely cause?

Daily intake of caffeine-containing products Explanation: The daily intake of caffeine should be assessed to determine if the intake is sufficient to disturb sleep. The amount of exercise the client engages in is important but not as critical as caffeine consumption. The family history of insomnia and sleep is not critical to assess. Amphetamines also have the potential to disrupt sleep, but caffeine use is far more prevalent.

A patient is undergoing lithium therapy at a health care facility. The patient informs the nurse that he is taking antacids for heartburn. Which is a possible effect of the interaction of lithium with antacids?

Decreased effectiveness of lithium Explanation: Combining lithium with antacids may result in decreased effectiveness of lithium. Increased risk of lithium toxicity, increased risk for bipolar disorder, and increased psychotic symptoms are not possible effects of combining lithium and antacids.

A 10-year-old child is being administered CNS stimulants for ADHD. What should the nurse instruct the parents to record periodically?

Weight and growth Explanation: The nurse should instruct the parents to monitor the weight and growth patterns of the child. Child's social interaction or sleeping pattern need not be recorded unless specified by the primary-care provider. Since the drugs administered for ADHD do not cause urinary retention, there is no need to monitor urinary patterns.

The nurse practitioner knows not to prescribe an anorexiant for weight loss to a client with:

depression who takes an antidepressant. Explanation: Amphetamines and anorexiants should not be taken concurrently or within 14 days of antidepressant medications. There is no indication that they should not be taken by a client who has a history of diabetes, kidney stones, or diverticulitis.

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 female client relates that she is taking diazepam for a muscle relaxant and modafinil for treatment of narcolepsy. Additionally, she informs you that she takes a contraceptive. As part of client education, the nurse would include:

Modafinil may decrease the effects of her contraceptive, and she may need to use other protection. Explanation: Modafinil may increase the effects of citalopram, clomipramine, diazepam, phenytoin, propranolol, sertraline, tricyclic antidepressants, and warfarin. It may decrease the effects of cyclosporine and oral contraceptives.

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 bipolar client is being discharged home in 48 hours. What statement by the client indicates an understanding of treatment with lithium?

"I will increase my fluid intake." Explanation: In order to maintain a therapeutic lithium level the client must increase fluids. A decrease in fluids can lead to toxicity. An increase in salt intake can lead to lithium excretion and a decrease in effectiveness. A decrease in salt intake can cause fluid retention, also leading to toxicity. Maintaining salt intake is necessary to keep serum levels in therapeutic range.

A client asks to have a year's worth of prescription refills for methylphenidate, explaining that it is very hard to leave work for clinic appointments. How should the nurse respond to that request to best assure client safety?

"The prescription dose is always started as low as possible, and the refills are monitored to prevent abuse." Explanation: When a central nervous system stimulant is prescribed, it is started with a low dose that is then increased as necessary, usually at weekly intervals, until an effective dose or the maximum daily dose is reached. The number of doses that can be obtained with one prescription should be limited; this reduces the likelihood of drug dependence or diversion (use by people for whom the drug is not prescribed). None of the other options effectively address this risk for injury.

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 classification of central nervous system (CNS) stimulants frequently prescribed for exogenous obesity is:

Amphetamines Explanation: The CNS stimulant group prescribed for exogenous obesity is amphetamines. The anorexiants are prescribed for general obesity.

The instructor is discussing psychosis with the nursing students. The instructor knows that teaching was effective when the students identify what behaviors are exhibited by people with psychosis?

Disorganized and often bizarre thinking Explanation: Psychosis is characterized by disorganized thought processes, agitation, behavioral disturbances, delusions, hallucinations, insomnia, and paranoia. Psychosis is not characterized by slow reaction time and poor coordination, short manic episodes followed by depression or short/long-term memory deficits.

Then nurse is caring for a client who has a diagnosis of schizophrenia. The nurse understands that the client's condition is thought to be most likely related to an increased level of activity of what neurotransmitter?

Dopamine Explanation: Scientists have attributed schizophrenia to increased dopamine activity in the brain. The serotonergic and glutamatergic systems are also thought to play a role. Norepinephrine, acetylcholine, and adenosine are not currently thought to have major involvement in the pathophysiology of schizophrenia.

Which interventions should the nurse perform regarding the diet of a patient who is being administered lithium?

Ensure that extra salt is added to foods. Explanation: The nurse should ensure that food for the patient contains extra salt. To avoid gastric distress, the nurse should administer the drug with meals and not on an empty stomach. The patient should be instructed to drink at least 10, not five, large glasses of fluid each day. There is no need to increase food intake during the drug regimen.

The nurse is aware that medication dosage for a child with ADHD is stopped occasionally for what reason?

Evaluation of treatment regimen Explanation: A drug holiday (i.e., stopping drug therapy) is recommended at least annually to evaluate the child's treatment regimen. Dosage adjustments are usually needed as the child grows and hepatic metabolism slows. Also, drug holidays decrease weight loss and growth suppression.

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 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.

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.

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.

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.

For which patient are CNS stimulants contraindicated?

Patients with severe hypertension Explanation: CNS stimulants are contraindicated for patients with severe hypertension. CNS stimulants are not contraindicated in patients younger than 20 or patients with Parkinson's disease. Even though CNS stimulants are not contraindicated in patients with renal dysfunction, they need to be administered with extreme caution.

A patient has been administered an antipsychotic. Which reaction should be reported immediately?

Rigidity Explanation: The nurse should immediately report to the primary health care provider if the patient displays signs of rigidity. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe.

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.

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.

The use of what would a nurse identify as placing a client receiving lithium therapy at increased risk for toxicity?

Thiazide diuretic Explanation: A thiazide diuretic-lithium combination increases the risk of lithium toxicity because sodium is lost and lithium is retained. Lithium effectiveness is decreased with tromethamine and antacids. Psyllium interferes with the absorption of lithium, leading to nontherapeutic levels.

The nurse has admitted a client with a probable diagnosis of narcolepsy. The nurse assesses the client for what symptoms that are characteristic of this disorder? (Select all that apply.)

Unpredictable sleep during daytime hours Daytime drowsiness Cataplexy Explanation: Narcolepsy is characterized by daytime drowsiness, unpredictable "sleep attacks," and cataplexy, which is episodic loss of muscle functioning.

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.

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.

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

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

A 72-year-old man is taking Adderall XR for the treatment of narcolepsy. He is currently having problems with not being able to swallow large tablets or capsules. The man also wears dentures, which makes it even more difficult for him to swallow medication. He is in the clinic to talk to the nurse about his problem. The nurse will instruct him to

open the capsule and sprinkle the beads in applesauce. Explanation: The benefits of Adderall XR are its once-daily dosing, its longer duration of action, and its potential for sprinkle administration. For patients with difficulty swallowing, Adderall XR's capsule may be opened and the beads sprinkled in applesauce. It is not advisable to suggest the use of an alternative drug. Patients should be told not to crush the beads after opening the capsule because this would alter drug absorption. Ingesting the capsule with 8 ounces of water will not solve the patient's difficulty with swallowing.

A client with an acute onset of disorganized thinking and hallucinations is prescribed an intramuscular dose of chlorpromazine. How soon after administration can the nurse assess for therapeutic effect?

within 20 minutes Explanation: Chlorpromazine is well absorbed and distributed to most body tissues, and it reaches high concentrations in the brain. After intramuscular administration, the onset of action is 10 to 15 minutes, with a peak at 15 to 20 minutes. An intramuscular dose of the medication has a duration of 4 to 6 hours. An oral dose of the medication has an onset of action of 30 to 60 minutes and will peak between 2 and 4 hours.

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 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.

A nurse who works at an outpatient mental health clinic follows numerous clients who have schizophrenia, many of whom are being treated with olanzapine. Which client likely has the highest susceptibility to the adverse effects of olanzapine?

A client who has type 1 diabetes and who practices poor glycemic control Explanation: The use of olanzapine creates a significant risk of hyperglycemia. This is of particular concern in patients and clients who have diabetes mellitus. Smoking affects the pharmacodynamics of olanzapine, but this is less likely to result in serious adverse effects. Obesity, low BMI, and recent antibiotic use are not associated with a significantly increased risk of adverse effects.

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 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects?

Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol. The cause of these symptoms is the relative lack of dopamine stimulation (i.e., excess dopamine blockade) and relative excess of cholinergic stimulation. Neuroleptic malignant syndrome and agranulocytosis are relatively rare, although potentially fatal adverse effects. Gastrointestinal problems are considered uncommon adverse effects of the drug.

The nurse is assessing an adolescent client diagnosed with attention deficit hyperactivity disorder (ADHD) for therapeutic effects of methylphenidate. The nurse should focus on improvement associated with what client functions? Select all that apply.

behavior motor task performance cognitive task performance Explanation: For clients with ADHD, the nurse assesses for improved behavior and performance of cognitive and psychomotor tasks. Endurance and stamina are not considered.

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.

A 13-year-old child is prescribed atomoxetine to be administered at 07:00. When will this medication reach its peak plasma level?

08:00 to 09:00 Explanation: Atomoxetine is rapidly absorbed with peak plasma levels in 1 to 2 hours. If the client takes the medication at 07:00, it will peak at 08:00 to 09:00.

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 understands that the main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. What is a secondary goal for their use?

To have clients use the drugs appropriately Explanation: The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately.

What disease process is haloperidol used to treat?

Tourette's syndrome Explanation: Haloperidol is used in treating Tourette's syndrome, which is a disorder characterized by involuntary movements and vocalizations. Muscular dystrophy, Alzheimer's disease, and myasthenia gravis are not treated with atypical antipsychotics.

The client has been taking chlorpromazine for more than 40 years. What adverse effect will the client most likely be experiencing?

extrapyramidal effects Explanation: A client who has taken chlorpromazine on a long-term basis will be at risk for late extrapyramidal effects. 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 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 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 teenage client, treated with dextroamphetamine for attention deficit hyperactivity disorder (ADHD) for the last 10 years, is now diagnosed with hyperthyroidism. What intervention should be implemented with this client to provide safe management of all conditions?

Discontinue the dextroamphetamine. Explanation: Dextroamphetamine, an amphetamine, is contraindicated upon the development of hyperthyroidism. The client will require a higher-calorie count, not a discontinuation of a high-calorie count. The client will not require an assessment for pulmonary edema. The client will only require a proton pump inhibitor if gastric hyperacidity occurs.

Which drug would be indicated for the treatment of narcolepsy?

Modafinil Explanation: Modafinil would be indicated for the treatment of narcolepsy. Atomoxetine, dexmethylphenidate, and lisdexamfetamine are indicated for the treatment of attention deficit disorders.

After reviewing information about antipsychotic agents, a group of students demonstrate understanding of the material when they identify which as an atypical antipsychotic agent?

Clozapine Explanation: Clozapine is classified as an atypical antipsychotic. Haloperidol, loxapine, and pimozide are considered typical antipsychotics.

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.

The parents of a child receiving a central nervous system stimulant for treatment of attention deficit disorder asks the nurse why they are stopping the drug for a time. Which statement by the nurse would be most appropriate?

"We need to check and see if he still has symptoms that require drug therapy." Explanation: Periodically, the drug therapy needs to be interrupted to determine if the child experiences a recurrence of symptoms, which would indicate the need for continued treatment.

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.

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.

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.

A client with a history of schizophrenia has been receiving antipsychotic therapy for several years. Which would indicate to the nurse that the client is experiencing pseudoparkinsonism?

Cogwheel rigidity Explanation: Pseudoparkinsonism is manifested by cogwheel rigidity, muscle tremors, drooling, a shuffling gait, and slow movements. Abnormal eye movements, neck spasms, and excessive salivation would suggest dystonia.

A client is receiving haloperidol. The nurse would be especially alert for the development of which adverse effect?

Extrapyramidal Explanation: Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Sedation, anticholinergic effects, and hypotension can occur, but the risk for these is much less when compared with the risk for extrapyramidal effects.

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.

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.

A client has been receiving chlorpromazine as treatment for psychosis. Which assessment finding indicates to the nurse that the client is experiencing an extrapyramidal effect of the medication?

motor restlessness Explanation: Chlorpromazine has severe adverse effects that impact the central nervous system, the cardiac system, and the hematologic system. Extrapyramidal effects may also occur including motor restlessness, or akathisia. Fatigue, dizziness, and slurred speech are central nervous system effects from the medication.

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.

The nurse understands that methylphenidate is commonly prescribed and usually given daily for the first 3 to 4 weeks for what purpose?

To assess beneficial and adverse effects Explanation: Methylphenidate is commonly prescribed and is usually given daily for the first 3 to 4 weeks of treatment to allow caregivers to assess beneficial and adverse effects.

A diabetic patient being treated for obesity tells the nurse that the patient is having adverse effects from the drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which adverse effects would need the nurse's immediate attention?

Increased blood glucose Explanation: All of the patient's adverse effects should be addressed by the nurse. However, the most critical effect that needs immediate attention would be the increased blood glucose. Drug therapy for the increased blood glucose may need to be altered. The patient should monitor blood glucose levels carefully and report abnormal findings as soon as possible. Medication can help his dry eyes, and a dose adjustment with the dextroamphetamine may be necessary if the jitteriness is profound and does not subside. Sympathomimetic action of the dextroamphetamine may lead to an inability to ejaculate and either increased or decreased libido. The patient may need to seek counseling for this concern.

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.

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.

inability to stay seated for any length of time repeated, involuntary twisting of the arms near-constant lip smacking Explanation: 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.

The nurse is participating in a family meeting with the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) and prescribed dextroamphetamine. The nurse should discuss what black box warning associated with this medication?

potential for abuse Explanation: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Anticholinergic effects, stroke, and hyperglycemia are not addressed in a black box warning for this drug.

The nurse is planning care for a client who has been prescribed a CNS stimulant. What should the nurse establish as the primary goal of therapy?

relieve the symptoms for which they were prescribed. Explanation: The main goal of therapy with CNS stimulants is to relieve symptoms of the disorders for which they are given. A secondary goal is to have clients use the drugs appropriately. Stimulants are often misused and abused by people who want to combat fatigue and delay sleep, such as long-distance drivers, students, and athletes. College students reportedly use stimulants as study aids. Use of stimulants for these purposes is not justified.

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 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 is reviewing a prescription for an antipsychotic medication. The nurse would contact the prescribing health care provider regarding a contraindication for the client with what medical diagnosis? Select all that apply.

Dementia Glaucoma Parkinson's Atrial fibrillation Seizure disorder Explanation: Antipsychotic drugs are contraindicated in the presence of underlying diseases that could be exacerbated by the dopamine-blocking effects of these drugs, such as Parkinson's disease. Most of the antipsychotic medications have been shown to prolong the QTc interval, leading to increased risk of serious cardiac arrhythmias. Antipsychotics are contraindicated for use in older adult patients with dementia because this use is associated with an increased risk of cardiovascular (CV) events and death. Some of the antipsychotic medications have anticholinergic effects; caution should be used in the presence of medical conditions, such as glaucoma, that could be exacerbated by the anticholinergic effects of the drugs. In addition, care should be taken in clients with seizure disorders because the threshold for seizures could be lowered by some antipsychotic medications. This information makes all options correct.

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.

A client is to be started on amphetamine therapy for attention deficit hyperactivity disorder. Which medication has less physical dependence and abuse than other amphetamines?

Lisdexamfetamine Explanation: Lisdexamfetamine is approved for treatment of ADHD. The drug reportedly delays the stimulation associated with other amphetamines and may be less prone to abuse. Dextroamphetamine and amphetamine, dextroamphetamine, and methamphetamine are prone to abuse.

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.

An adolescent client has been taking dextroamphetamine 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 amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

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 client is being prescribed dextroamphetamine for the treatment of attention deficit hyperactivity disorder (ADHD). During health education, the nurse should make the client aware of the black box warning relating to what potential risk issue?

Potential for abuse Explanation: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars.

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 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 Explanation: 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 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.

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.

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 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?

agranulocytosis Explanation: 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.

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 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 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 male client tells the nurse he is going to stop taking his medication because he is always having fine tremors and slurred speech. These reactions are preventing him from teaching art classes like he used to do. The nurse knows that what action could help him?

He could talk with his health care provider and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic. Explanation: Fine tremors and slurred speech are common symptoms of extrapyramidal syndrome. Symptoms may decrease if the amount of the medication is decreased or if the client is changed to a second-generation antipsychotic medication. A large dose of medication or adding another first-generation antipsychotic medication would increase the symptoms. Changing his profession may be necessary, but getting on the correct drug and dosage is of primary concern. Schizophrenia is not cured by the antipsychotic medications. The symptoms are managed, so by stopping the drug the client is at risk of showing all the symptoms of schizophrenia.

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 with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client?

history of seizure disorder Explanation: Clozapine is contraindicated for use in a client with a history of seizure disorders. The medication is not contraindicated for any specific eating plan. Treatment for rheumatoid arthritis is not a contraindication for this medication. The type of employment is not identified as a contraindication for this medication.