NUR 2144 Pharmacology II Chapter 22 Psychotherapeutic Agents
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
Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include
dry mouth, hypotension, and glaucoma.
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).
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
A client calls the clinic reporting only being able to get a 1-month supply of pills for the client's son, who takes a CNS stimulant for ADHD. The nurse understands that these medications are given in limited numbers for what reason?
It reduces the likelihood of drug dependence or diversion.
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
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
Antipsychotic drugs are also known as neuroleptic drugs because
they cause numerous neurological effects.
The nurse is teaching parents of a pediatric client diagnosed with ADHD. Teaching has been about the disorder and its treatment. The nurse determines that teaching has been effective when the parents state which?
"We need to remember that our son is not a bad kid; he just has difficulty with impulse control and attention."
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
The nurse is aware that CNS stimulants are prescribed for clients with ADHD because these medications have what effect on behavior and attention?
Improving
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
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
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.
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
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
The community health nurse is conducting a class for parents of preschoolers. One of the parents asks if a child with ADHD will always have problems with hyperactivity. What is the nurse's best response?
"ADHD usually starts in childhood and may persist through adulthood."
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.
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.
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
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
A female client's physician orders a low-dose antipsychotic to manage her acute agitation. Her daughter states that her mother is improved but her cognitive functions are the same, if not worse, than last month. What is the best explanation for this development?
Antipsychotics do not improve memory loss and may further impair cognitive functioning.
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."
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
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
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."
The nurse is reviewing the care plan for a client who has been prescribed a central nervous system (CNS) stimulant. What nursing assessment question addresses the main goal of therapy?
"Has your quality of life improved since being prescribed this medication?"
A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask the client to confirm why the medication was prescribed?
"Have you ever been diagnosed with narcolepsy?"
A family member asks if a relative, who is taking prochlorperazine for schizophrenia, can go on a beach vacation. What is one point of education that the nurse would make sure the client and family understand?
"Prochlorperazine can make you very sensitive to light. Make sure you wear sunscreen and cover up as much as possible to prevent sunburn."
A patient has been prescribed lithium. Which intervention should the nurse perform while caring for the client? (Select all that apply.)
Administer lithium with food Continually monitor patient for drowsiness Increase fluid intake to about 3,000 mL/day
The nurse is caring for a client who has been prescribed lithium. Which nursing interventions are related to this medication? (Select all that apply.)
Administer lithium with food. Monitor client for drowsiness. Increase fluid intake to approximately 3000 mL/day.
Attention-deficit/hyperactivity disorder (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are both most effectively treated with the use of
CNS stimulants.
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
The client reports taking a phenothiazine antipsychotic. What medication does the nurse suspect the client has been prescribed?
Chlorpromazine
The nurse expects to monitor a client's white blood count weekly when the client is prescribed:
Clozapine
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
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?
What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?
Lip smacking
Anticonvulsive medications are sometimes used in the treatment of bipolar disorder. What other drug is used to treat bipolar disorder?
Lithium
Serotonin abnormalities are thought to be involved in the following disorders:
Mental depression and sleep disorders.
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
Which drug shares the abuse potential of amphetamines and is a Drug Enforcement Administration (DEA) schedule II controlled substance?
Methylphenidate, a centrally acting CNS stimulant
A client visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. These behaviors support which medical diagnosis?
Narcolepsy
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.
Your patient, a 6-year-old boy, is starting a regimen of methylphenidate (Ritalin) to control an attention deficit disorder. Family teaching should include which of the following?
This drug may cause insomnia, weight loss, and GI upset.
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.
Antipsychotic drugs are contraindicated in clients with:
liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular 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 importance of adherence to prescribed treatment
A client is being treated with clozapine. What should the nurse monitor most closely?
White blood cell count
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
Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include
schizophrenia.
Haloperidol (Haldol) is a potent antipsychotic that is associated with
severe extrapyramidal effects.
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
Before administering lithium to a patient, the nurse should check for the concomitant use of which drugs, which could cause serious adverse effects?
Ibuprofen Haloperidol Thiazide diuretics Antacids
Antipsychotic drugs are basically
dopamine receptor blockers.
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
A 9-year-old child receives antipsychotics to manage her disease. The child's mother asks why her daughter receives such a high dose of the medication compared with an adult. How will the nurse explain this to the mother?
"Children usually have a faster metabolic rate than adults and may therefore require relatively high doses for their size and weight."
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.
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.
A client who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine. The client has been taking the medication for more than 40 years. What adverse effect will the client most likely experience?
Tardive dyskinesia
Lithium toxicity can be dangerous. Patient assessment to evaluate for appropriate lithium levels would look for
serum lithium levels <1.5 mEq/L.
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.
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
A female client comes to the clinic for an examination after being on benzphetamine for 6 weeks with a weight loss of 30 pounds. The priority nursing diagnosis for this client would be which?
Imbalanced nutrition
A client, prescribed dextroamphetamine for attention deficit hyperactivity disorder (ADHD) has developed a common adverse effect of the medication since beginning therapy. Which initial intervention should the client be encouraged to implement?
Increase fiber intake.
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
Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which actions?
Positioning to decrease discomfort of dyskinesias Implementing safety measures to prevent injury Careful teaching to alert the patient and family about this adverse effect
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
Atomoxetine has been selected as the primary pharmacologic treatment for a young adult client diagnosed with attention deficit hyperactivity disorder (ADHD). What characteristics make this a good drug of choice for this population of clients? Select all that apply.
a lower potential for abuse a low risk for dependency is administered orally
