Chapter 56 Drugs for Psychotic Disorders

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

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

What client is being treated with a typical antipsychotic?

An agitated client who was given haloperidol during acute psychosis

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

White blood cells

Which antipsychotic would the nurse identify as a highly potent agent?

Fluphenazine

A client is taking antipsychotic medication and asks the nurse what dopamine is. What is a correct response by the nurse?

"Dopamine is a neurotransmitter that deals with pleasure and reward in the brain."

Antipsychotic drugs are contraindicated in clients with:

liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.

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."

A female client is diagnosed with Alzheimer-type dementia. She resides in a long-term care facility. The client's daughter asks the health care provider to prescribe an antipsychotic to control her mother's outbursts of anger and depression. The provider orders a psychiatric consultation for the client. The client's daughter asks, "Why doesn't the provider just order an antipsychotic?" What is the nurse's best response to this family member?

"Use of antipsychotic drugs exposes clients to adverse drug effects and does not resolve underlying problems."

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."

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

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

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?

When writing a plan of care for a client beginning drug therapy for treatment of schizophrenia, which might be an appropriate nursing diagnosis?

Impaired Physical Mobility related to sedation

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

Lip smacking

Which drug would be indicated for the treatment of narcolepsy?

Modafinil

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

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 muscle rigidity and a sudden, high fever.

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

The client may be having a neuroleptic malignant syndrome reaction to his antipsychotic medication and needs treatment immediately.

Which test should be scheduled every week for a patient taking clozapine?

WBC count

The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what client would the nurse expect to require a standard dosage?

White young adult client diagnosed with bipolar disorder

The nurse is preparing to give prescribed haloperidol to an acutely dehydrated client. After administration, the nurse should prioritize what nursing assessment?

blood pressure

A client's thought disorder has been treated with haloperidol. For what adverse effect should the nurse most closely monitor the client?

extrapyramidal effects

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

For clients diagnosed with schizophrenia, drug therapy is usually indicated for:

At least 1 year after an initial psychotic episode and at least 5 years after multiple episodes.

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?

Decreased extrapyramidal effects

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

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

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.

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."