Chapter 56: Drug Therapy for Psychotic Disorders
A client is being treated with clozapine. What should the nurse monitor most closely? AST, ALT and bilirubin White blood cell count Cardiac enzymes Urine quantity and quality
White blood cell count Explanation: Clozapine is associated with significant leukopenia. Subsequently, it is available only through the Clozaril Client Management System, which involves monitoring white blood cell count and compliance issues with only a 1-week supply being given at a time. The drug is not associated with changes in sliver function, cardiac enzymes, or urine output.
A nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame? 15 minutes 30 minutes 60 minutes 45 minutes
30 minutes Explanation: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes due to the potential for orthostatic hypotension and to prevent potential injuries related to a fall.
The nurse is teaching a client and caregiver about the antipsychotic medication which has been prescribed. The nurse determines the teaching is successful when they correctly choose which reaction should be reported immediately to the health care provider? Drowsiness Rigidity Orthostatic hypotension Dry mouth
Rigidity Explanation: The nurse should immediately report to the primary health care provider the following: rigidity, restlessness, inability to sit still, muscle spasms, mask-like expression, tremors, drooling, or involuntary rhythmic movements of the face, mouth, or extremities. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe
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? Neck spasms Abnormal eye movements Excessive salivation Cogwheel rigidity
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 nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame? 15 minutes 30 minutes 60 minutes 45 minutes
30 minutes Explanation: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes due to the potential for orthostatic hypotension and to prevent potential injuries related to a fall.
What client is being treated with a typical antipsychotic? A client who recently began taking ziprasidone A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client with schizophrenia who received paliperidone 6 mg PO daily An agitated client who was given haloperidol during acute psychosis
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 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? partial thromboplastin time (PTT) Prothrombin time (PT) blood urea nitrogen (BUN) Complete blood count (CBC)
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 nurse is explaining to another nurse the difference between first-generation antipsychotics and second-generation antipsychotics. What is the biggest benefit of the second-generation antipsychotics? Increased action on only dopamine receptors Increased extrapyramidal effects Decreased extrapyramidal effects Decreased cost for the client
Decreased extrapyramidal effects Explanation: Second-generation antipsychotics have decreased extrapyramidal side effects. The cost of second-generation antipsychotics depends on the exact medication. Second-generation antipsychotics work on both dopamine and serotonin receptors
In clients with acute psychosis, the treatment goal during the first week of treatment includes: Decreasing the client's medications and documenting patterns of sleeping and eating. Decreasing the client's symptoms and normalizing the patterns of sleeping and eating. Ensuring the client's compliance with oral drug therapy. Assessing the client for medical conditions, including obesity and hypertension.
Decreasing the client's symptoms and normalizing the patterns of sleeping and eating. Explanation: Overall, the goal of treatment is to relieve symptoms with minimal or tolerable adverse drug effects. In clients with acute psychosis, the goal during the first week of treatment is to decrease symptoms (e.g., aggression, agitation, combativeness, hostility) and normalize patterns of sleeping and eating. The next goals may be increased ability for self-care and increased socialization. Therapeutic effects usually occur gradually, over 1 to 2 months. Long-term goals include increasing the client's ability to cope with the environment, promoting optimal functioning in self-care and activities of daily living, and preventing acute episodes and hospitalizations
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? Slowed reaction time and poor coordination Disorganized and often bizarre thinking Short- and long-term memory deficits Short manic episodes followed by long depressive episodes
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.
The nursing instructor is discussing psychosis with the nursing students. What behavior would the instructor explain people with psychosis exhibit? Short manic episodes followed by long depressive episodes Disorganized and often bizarre thinking Short- and long-term-memory deficits Slowed reaction time and poor coordination
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.
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 client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client? hypoglycemia extrapyramidal effects bradycardia shortness of breath
extrapyramidal effects Explanation: Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, shortness of breath, or hypoglycemia.
A female client makes an appointment with her health care provider 2 weeks after beginning her prescription antipsychotic therapy. She states that she is still unable to cope and concentrate at work. What statement would be appropriate to include in the nurse's teaching? "Antipsychotics may take several weeks to achieve maximum therapeutic effect." "Therapeutic effects of antipsychotics should be evaluated every 2 weeks by your health care provider." "The medication should be effective by this time; I will consult the provider." "This medication may need to be changed; I will consult the provider."
"Antipsychotics may take several weeks to achieve maximum therapeutic effect." Explanation: Antipsychotics may take several weeks to achieve maximum therapeutic effect
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 provides medication teaching to a client prescribed clozapine as treatment for schizophrenia. Which instructions will the nurse emphasize with this client? Select all that apply. "Do not stop taking this medication." "Obtain weekly blood tests." "You will receive 1 month of medication at a time." "Do not drive while taking this medication." "Occasional flulike symptoms are normal."
"Do not stop taking this medication." "Obtain weekly blood tests." "You will receive 1 month of medication at a time." "Do not drive while taking this medication." "Occasional flulike symptoms are normal." Explanation: A client taking clozapine should be provided with specific teaching. The client will need weekly blood tests to evaluate the safety of the prescribed dosage. The medication should not be stopped abruptly. The client should not drive while taking this medication, as it may cause drowsiness. The client will only be prescribed 1 week of the medication at a time. Flulike symptoms should be reported to the health care provider
A client receiving outpatient therapy with antipsychotic therapy experiences dizziness from time to time. Which suggestion by the nurse would be appropriate? "Take the drug with meals." "Limit your salt intake." "Try taking sips of water frequently." "Get up slowly from the bed or chair."
"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.
The caregiver of a client who is started on antipsychotic drug therapy asks the nurse when the client's symptoms will improve. Which response by the nurse would be most appropriate? "It might take about 6 weeks or so before the drug is most effective." "Look for movements of their face, mouth, or jaw and that's the sign." "There's no way to tell but usually it takes about a week." "You should notice an improvement in the next day or two."
"It might take about 6 weeks or so before the drug is most effective." Explanation: Antipsychotics take time to produce the optimal effect, sometimes 6 to 10 weeks. Evidence of tongue, facial, or mouth movements suggests tardive dyskinesia, a late-appearing reaction that requires discontinuation of the drug.
When assessing a client with schizophrenia, the nurse observes positive and negative symptoms. Which would the nurse document as a positive symptom? Select all that apply. Flat affect Alogia Delusions Agitation Avolition
Agitation Delusions Explanation: Positive symptoms of schizophrenia include agitation, delusions, and hallucinations. Flat affect, alogia, and avolition are considered negative symptoms.
What client is being treated with a typical antipsychotic? A client who recently began taking ziprasidone A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client with schizophrenia who received paliperidone 6 mg PO daily An agitated client who was given haloperidol during acute psychosis
An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics
What client is being treated with a typical antipsychotic? An agitated client who was given haloperidol during acute psychosis A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client with schizophrenia who received paliperidone 6 mg PO daily A client who recently began taking ziprasidone
An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.
A caregiver of a client with nausea and vomiting is surprised when the nurse administers an antipsychotic to the client. The nurse explains this is a secondary use for the medication. Which medication has the nurse given the client?? Select all that apply. Chlorpromazine Lithium Prochlorperazine Clozapine Aripiprazole
Chlorpromazine Prochlorperazine Explanation: Chlorpromazine and prochlorperazine are antipsychotic medications that have antiemetic effects. Lithium, aripiprazole, and clozapine do not have secondary uses. Lithium is an antidepressant which acts as a mood stabilizer. During manic episodes of bipolar disorder, aripiprazole is used in clients with schizophrenia during the manic phase of bipolar disorder. Clozapine is used when a client is severely ill with schizophrenia and nonresponsive to other drugs.
A nurse is explaining to another nurse the difference between first-generation antipsychotics and second-generation antipsychotics. What is the biggest benefit of the second-generation antipsychotics? Increased action on only dopamine receptors Increased extrapyramidal effects Decreased extrapyramidal effects Decreased cost for the client
Decreased extrapyramidal effects Explanation: Second-generation antipsychotics have decreased extrapyramidal side effects. The cost of second-generation antipsychotics depends on the exact medication. Second-generation antipsychotics work on both dopamine and serotonin receptors
The nurse is conducting an ongoing assessment of a client who is prescribed loxapine. Which finding is most likely attributable to this medication? Dry mouth Skin dryness Hypertension Bradycardia
Dry mouth Explanation: Antipsychotics such as loxapine may cause adverse effects of dry mouth, drowsiness, akathisia, EPS, headache, and orthostatic hypotension. Antipsychotics are contraindicated in clients with severe hypertension. Bradycardia can be a sign of hypertensive crisis, which is an adverse effect of MAOIs. Skin dryness is a recognized adverse effect to clofazimine, a drug used to treat M. leprae.
A client is started on aripiprazole and the nurse notices the client is experiencing dry mouth and nasal congestion. What intervention does the nurse teach the client to minimize the side effects of the medication? Discussing feelings of nervousness or restlessnes Drinking frequent sips of water Calling the prescriber for an anticholinergic medication Consuming the medication with food
Explanation: Dry mouth and nasal congestion are generalized system reactions of aripiprazole. To relieve dry mouth, take frequent sips of water, suck on hard candy, or chew gum. Consuming more food will not address the dry mouth issue. The client is not feeling nervousness or restlessness. Calling the prescriber for an anticholinergic medication will exacerbate the dry mouth and nasal congestion issues
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 accelerated and drug elimination half-lives shortened, causing an increased risk of adverse effects. Metabolism may be accelerated and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives shortened, with resultant accumulation and increased risk of adverse effects.
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Explanation: Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.
A nurse observing a client notices the client has developed muscle rigidity, altered mental status, tachycardia, and sweating. The nurse interprets these findings as suggesting which of the following? Agranulocytosis Neuroleptic malignant syndrome (NMS) Tardive dyskinesia Extrapyramidal syndrome
Neuroleptic malignant syndrome (NMS) Explanation: NMS is a rare reaction characterized by a combination of extrapyramidal effects, hyperthermia, and autonomic disturbance. TD 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 is characterized by Parkinson-like symptoms, akathisia, and dystonia. Agranulocytosis is a reduction in white blood cells that can occur with clozapine
During the pre-administration assessment of clients being given an antipsychotic drug, the nurse observes the client for any behavior patterns that appear to be deviations from normal. What behaviors should a nurse note as being a deviation from normal? Select all that apply: Poor eye contact Inappropriate crying Failure to answer questions completely Inappropriate laughter Monotone speech pattern Explanation:
Poor eye contact Inappropriate crying Failure to answer questions completely Inappropriate laughter Monotone speech pattern Examples of deviation from normal include poor eye contact, failure to answer questions completely, inappropriate answers to questions, a monotone speech pattern, and inappropriate laughter, sadness, or crying
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 impaired liver function related to hepatotoxicity Risk for injury related to central nervous system depression Risk for imbalanced body temperature related to hypothalamic suppression Bowel incontinence related to gastrointestinal adverse effects
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.
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? Extrapyramidal syndrome Neuroleptic malignant syndrome Stevens-Johnson syndrome Tardive dyskinesia
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. The patient will return for follow-up appointments when the patient believes they are necessary. The patient will normalize sleeping and eating patterns. The patient will exhibit decreased symptoms of acute psychosis.
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
Which test should be scheduled every week for a patient taking clozapine? Blood glucose pH level Serum lithium WBC count
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.
Which test should be scheduled every week for a patient taking clozapine? Blood glucose WBC count pH level Serum lithium
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.
For clients taking clozapine, it is necessary to monitor what lab test for the first 6 months? PT/PTT Liver enzymes White blood cells Hemoglobin
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.
For which client would the nurse question the use of antipsychotic medication therapy? an older adult client whose delusions and psychosis are attributable to dementia an older adult client whose schizophrenia was treated with phenothiazines when first diagnosed 30 years ago a middle-aged adult client whose current psychotic episode resulted from not adhering to the prescribed medication therapy a young adult client diagnosed with schizophrenia and who has recently been using cocaine and heroin
an older adult client whose delusions and psychosis are attributable to dementia Explanation: Many antipsychotics are associated with increased risk of death in older adults who have dementia. Black box warnings address this risk. The other listed clients would likely be administered antipsychotic medications.
A nurse is assessing a client who has been receiving an antipsychotic. The nurse concludes this client will have a decreased potential of developing extrapyramidal side effects due to receiving which additional drug? Select all that apply. Aripiprazole Lithium Chlorpromazine Prochlorperazine Clozapine
aripiprazole clozapine Explanation: Atypical or second-generation antipsychotics (SGAs) are referred to atypical because the typical EP side effects are lessened. Aripiprazole and clozapine are classified as atypical antipsychotics. Lithium is an antidepressant mood stabilizer which has the adverse effects of headache, drowsiness, tremors, nausea, and polyuria. Chlorpromazine and prochlorperazine are conventional or first-generation antipsychotics (FGAs) which have EPS and TD as adverse effects.
The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment? deep tendon reflexes visual acuity blood pressure core body temperature
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 parenteral form of an antipsychotic is prescribed for a client who has become aggressive. When administering the drug, which site would be appropriate for the nurse to use? vastus lateralis gluteus deltoid ventrogluteal
gluteus Explanation: When giving an antipsychotic parenterally, the drug should be given IM in a large muscle mass such as the gluteus muscle. The deltoid muscle is not a large muscle. The vastus lateralis and the ventrogluteal are not large muscles when a client is aggressive; the larger the muscle the better; thus gluteus is the best choice.
A client with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client? remote work in customer service treatment for rheumatoid arthritis history of seizure disorder vegetarian eating plan
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.
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. sore throat increased thirst increased urination weight gain fever
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 nurse is caring for a client who has been taking an oral neuroleptic medication for several years. What assessment should the nurse prioritize to best address the risk for adverse effects? assessment of bowel pattern and stool character monitoring the client's cranial nerve function assessment of deep tendon reflexes monitoring the client for involuntary facial movements
monitoring the client for involuntary facial movements Explanation: The nurse would monitor for and teach the client and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Clients do not normally experience disruptions to bowel function, cranial nerve function, or deep tendon reflexes.
Phenothiazines such as chlorpromazine are occasionally used for clinical indications not associated with psychiatric illness. What indications would be included? Select all that apply. postoperative headaches peptic ulcer disease nausea and vomiting Parkinson's disease preoperative restlessness
preoperative restlessness nausea and vomiting Explanation: Chlorpromazine is administered rectally or intramuscularly for the control of nausea and vomiting. It is also used preoperatively for the control of restlessness and apprehension. It is not used to treat headaches. It should be avoided in clients diagnosed with Parkinson's disease and used with caution for those clients with peptic ulcer disease.
The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus? the need for weekly blood coagulation testing the importance of adherence to prescribed treatment maintenance of adequate nutrition potential therapeutic effects of medication
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 with schizophrenia is prescribed clozapine. For which information in the medical record will the nurse question giving this medication to the client? vegetarian eating plan history of seizure disorder treatment for rheumatoid arthritis remote work in customer service
· 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
What client is being treated with a typical antipsychotic? A client who recently began taking ziprasidone A client with schizophrenia who received paliperidone 6 mg PO daily A client whose thought disorder requires clozapine 25 mg PO b.i.d. An agitated client who was given haloperidol during acute psychosis
An agitated client who was given haloperidol during acute psychosis Explanation: Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.
Antipsychotic drugs are contraindicated in clients with: kidney damage, chronic obstructive lung disease, mild hypotension, and chronic bone pain. liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. peptic ulcer disease, mild hypertension, chronic joint pain, and kidney failure. nausea, severe hypotension, or intractable hiccups.
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Explanation: Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.
A female client makes an appointment with her health care provider 2 weeks after beginning her prescription antipsychotic therapy. She states that she is still unable to cope and concentrate at work. What statement would be appropriate to include in the nurse's teaching? "This medication may need to be changed; I will consult the provider." "Antipsychotics may take several weeks to achieve maximum therapeutic effect." "The medication should be effective by this time; I will consult the provider." "Therapeutic effects of antipsychotics should be evaluated every 2 weeks by your health care provider."
"Antipsychotics may take several weeks to achieve maximum therapeutic effect." Explanation: Antipsychotics may take several weeks to achieve maximum therapeutic effect.
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." "I'll ask the nurse practitioner if the haloperidol can be discontinued and another drug started." "I'll ask the nurse practitioner if the dosage can be increased." "I'll report this to the nurse practitioner and see if he will add another drug to enhance the effects of the haloperidol."
"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 client is started on aripiprazole and the nurse notices the client is experiencing dry mouth and nasal congestion. What intervention does the nurse teach the client to minimize the side effects of the medication? Discussing feelings of nervousness or restlessness Drinking frequent sips of water Calling the prescriber for an anticholinergic medication Consuming the medication with food
Drinking frequent sips of water Explanation: Dry mouth and nasal congestion are generalized system reactions of aripiprazole. To relieve dry mouth, take frequent sips of water, suck on hard candy, or chew gum. Consuming more food will not address the dry mouth issue. The client is not feeling nervousness or restlessness. Calling the prescriber for an anticholinergic medication will exacerbate the dry mouth and nasal congestion issues
The nurse is conducting an ongoing assessment of a client who is prescribed loxapine. Which finding is most likely attributable to this medication? Skin dryness Hypertension Bradycardia Dry mouth
Dry mouth Explanation: Antipsychotics such as loxapine may cause adverse effects of dry mouth, drowsiness, akathisia, EPS, headache, and orthostatic hypotension. Antipsychotics are contraindicated in clients with severe hypertension. Bradycardia can be a sign of hypertensive crisis, which is an adverse effect of MAOIs. Skin dryness is a recognized adverse effect to clofazimine, a drug used to treat M. leprae.
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. Metabolism may be accelerated and drug elimination half-lives shortened, causing an increased risk of adverse effects. Metabolism may be slowed and drug elimination half-lives shortened, with resultant accumulation and increased risk of adverse effects. Metabolism may be accelerated and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects.
Metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Explanation: Antipsychotic drugs undergo extensive hepatic metabolism and then elimination in urine. In the presence of liver disease (e.g., cirrhosis, hepatitis), metabolism may be slowed and drug elimination half-lives prolonged, with resultant accumulation and increased risk of adverse effects. Therefore, these drugs should be used cautiously in clients with hepatic impairment.
A nurse is speaking with a client's family since the family is suffering from psychosis. Which is a correct definition of psychosis? Psychosis refers to older clients who are confused. Psychosis refers to a spectrum of disorders that affect mood and behavior. Psychosis is a term reserved for only the most crazy clients. Psychosis is a term used for any client who is admitted to the psychiatric unit
Psychosis refers to a spectrum of disorders that affect mood and behavior. Explanation: Psychosis refers to a spectrum of disorders that affect mood and behavior. It is unrelated to being admitted to a psychiatric unit. Dementia is a term used for older clients who are confused. Psychosis can be treated, and a client may have his symptoms under control and not act crazy. Crazy is not a medical term.
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? Bowel incontinence related to gastrointestinal adverse effects Risk for impaired liver function related to hepatotoxicity Risk for imbalanced body temperature related to hypothalamic suppression Risk for injury related to central nervous system depression
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 is caring for a patient who is taking an oral neuroleptic medication. What would be important to include in the patient teaching? Tardive dyskinesias Orthostatic hypotension Bradycardia Urge incontinence
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 nurse provides medication teaching to a client prescribed clozapine as treatment for schizophrenia. Which instructions will the nurse emphasize with this client? Select all that apply. The client has been taking haloperidol for years and now has developed tardive dyskinesia. Which assessment findings would confirm this? The client's blood pressure is volatile. The client often smacks his lips and chews. The client has a history of repeated falls. The client is no longer experiencing relief of his psychotic symptoms.
The client often smacks his lips and chews. Explanation: The fourth presentation of EPS is called tardive dyskinesia. Tardive dyskinesia generally occurs late in haloperidol therapy and usually is irreversible. It is most commonly related to high doses and long-term use. Approximately 1 in 25 clients treated for a period of 1 year develops tardive dyskinesia. After treatment for 7 years, the incidence increases to one in four clients. Symptoms of tardive dyskinesia include involuntary lip-smacking, chewing, mouth movements, tongue protrusion, blinking, grimacing, and muscle-twitching of the limbs. It is not accompanied by changes in blood pressure or frequent falls
The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what client would the nurse expect to require a standard dosage? African American adolescent client diagnosed with schizophrenia Saudi Arabian older adult client diagnosed with schizophrenia White young adult client diagnosed with bipolar disorder Malaysian middle adult client diagnosed with bipolar disorder
White young adult client diagnosed with bipolar disorder Explanation: Only the White young adult has no indications for administering a smaller than usual dosage. Black and African American clients respond more rapidly to antipsychotic medications and have a greater risk for development of disfiguring adverse effects, such as tardive dyskinesia. Consequently, these clients should be started off at the lowest possible dose and monitored closely. Clients in Asian countries (e.g., India, Turkey, Malaysia, China, Japan, Indonesia) receive lower doses of neuroleptics and lithium to achieve the same therapeutic response as seen in clients in the United States. Arab American clients metabolize antipsychotic medications more slowly than Asian Americans do and may require lower doses to achieve the same therapeutic effects as in Caucasians. Additionally, because older adults may be more susceptible to adverse effects, doses are typically lower than in younger clients
Antipsychotic drugs are contraindicated in clients with: nausea, severe hypotension, or intractable hiccups. liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. peptic ulcer disease, mild hypertension, chronic joint pain, and kidney failure. kidney damage, chronic obstructive lung disease, mild hypotension, and chronic bone pain.
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease. Explanation: Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate a number of conditions. They are contraindicated in clients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. They should be used cautiously in people with seizure disorders, diabetes mellitus, glaucoma, prostatic hypertrophy, peptic ulcer disease, and chronic respiratory disorders.
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 the need for weekly blood coagulation testing maintenance of adequate nutrition potential therapeutic effects of medication
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.
The caregiver of a client who is started on antipsychotic drug therapy asks the nurse when the client's symptoms will improve. Which response by the nurse would be most appropriate? "There's no way to tell but usually it takes about a week." "You should notice an improvement in the next day or two." "Look for movements of their face, mouth, or jaw and that's the sign." "It might take about 6 weeks or so before the drug is most effective."
"It might take about 6 weeks or so before the drug is most effective." Explanation: Antipsychotics take time to produce the optimal effect, sometimes 6 to 10 weeks. Evidence of tongue, facial, or mouth movements suggests tardive dyskinesia, a late-appearing reaction that requires discontinuation of the drug.
The nurse is caring for an adolescent client who began taking an antipsychotic drug last month to treat newly-diagnosed schizophrenia. The client's symptoms have improved only slightly, and the client's parents wonder if the client is "beyond hope." What is the nurse's best response? "It's common for clients to have to try different drugs until the most effective one is identified." "Some clients do not respond to antipsychotic drugs and have to rely solely on cognitive behavioral therapy." "Do you feel like you've given the medication enough time to work?" "It might be necessary to take a combination of several antipsychotics before the benefits are seen."
"It's common for clients to have to try different drugs until the most effective one is identified." Explanation: A client who does not respond to one drug may react successfully to another agent. It is not common to have a client who does not demonstrate some improvement from medications so it would be incorrect to tell the parents that the child won't respond to any drug after trying only one medication. It is not common for a client to require "several" antipsychotics concurrently. Asking "Do you feel like you've given the medication enough time to work?" is inappropriate: if the question is rhetorical, it is condescending; if it is genuine, it is not something the parents can determine.
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? Extrapyramidal syndrome Neuroleptic malignant syndrome Stevens-Johnson syndrome Tardive dyskinesia
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 client who is experiencing withdrawal from alcohol has developed psychosis and is being treated with haloperidol. Which assessment findings should prompt the care team to assess the client for neuroleptic malignant syndrome? The client develops yellowed sclerae and intense pruritis (itchiness). The client demonstrates a significant increase in agitation after being given haloperidol. The client reports intense thirst and produces copious amounts of urine. The client develops muscle rigidity and a sudden, high fever.
The client develops muscle rigidity and a sudden, high fever. Explanation: Neuroleptic malignant syndrome is characterized by fever, sweating, tachycardia, muscle rigidity, tremor, incontinence, stupor, leukocytosis, elevated creatinine phosphokinase levels, and renal failure. Agitation, pruritis, thirst, and increased urine output are not indicative of neuroleptic malignant syndrome.
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 have influenza A and will need to be put into isolation. The client may have neuroleptic malignant syndrome, which will self-resolve in a few hours after rest and Tylenol. The client may have broken his arm and not remember what happened because of his schizophrenia. The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.
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.
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 will be discontinued immediately. The drug may need to be lowered in dosage or discontinued. The drug dosages will be increased to increase absorption. The drug will be continued with caution.
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 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. The drug dosages will be increased to increase absorption. The drug will be discontinued immediately. The drug will be continued with caution.
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.
The nurse is caring for a client who has been taking an oral neuroleptic medication for several years. What assessment should the nurse prioritize to best address the risk for adverse effects? monitoring the client for involuntary facial movements assessment of bowel pattern and stool character assessment of deep tendon reflexes monitoring the client's cranial nerve function
monitoring the client for involuntary facial movements Explanation: The nurse would monitor for and teach the client and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Clients do not normally experience disruptions to bowel function, cranial nerve function, or deep tendon reflexes.
The nurse is providing health education to a client who has been newly diagnosed with schizophrenia. What subject should be the primary focus? potential therapeutic effects of medication the need for weekly blood coagulation testing the importance of adherence to prescribed treatment maintenance of adequate nutrition
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.
