Prep-U Chapter 55 Psychiatric Nursing Pharmacology
Which of the following tests should be scheduled every week for a patient taking clozapine?
WBC count Explanation: Use of the drug clozapine has been associated with severe agranulocytosis, i.e., decreased white blood cells, so weekly WBC count tests are scheduled. Serum lithium tests are taken for patients who have been administered lithium, not clozapine. There is no need to take blood glucose or pH level tests.
The nurse is caring for 4 patients. Which patient would the nurse know that clozapine (Clozaril) is contraindicated in?
45-year-old with bone marrow depression Explanation: Clozapine is associated with bone marrow suppression, a life-threatening decrease in white blood cells. Because of their wide-ranging adverse effects, anti-psychotic drugs may cause or aggravate a number of conditions. They should be used very cautiously in patients with liver damage, coronary artery disease, cerebrovascular disease, parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. Options A, B, and C are incorrect.
Antipsychotic drugs are contraindicated in:
Clients with liver damage, coronary artery disease, severe hypertension, bone marrow depression, or cerebrovascular disease.
Which of the following antipsychotics would the nurse identify as a highly potent agent?
Fluphenazine is considered a highly potent antipsychotic. Chlorpromazine, thioridazine, and prochlorperazine are considered low-potent antipsychotics.
A client with dementia has been very agitated lately. What type of medication might the provider prescribe to help with the agitation?
Antipsychotic Explanation: Antipsychotic medications are used to treat agitation in clients with dementia. Antidepressant, antibiotic, and narcotic medications are not used to treat agitation in clients with dementia.
A nurse is charting a client who has repetitive tongue thrusting, jaw movements, and a facial tick. What term could the nurse use in charting to describe these findings?
Tardive dyskinesia
A patient is receiving clozapine. Which of the following would the nurse expect to monitor weekly?
White blood cell count Explanation: Clozapine is associated with significant leukopenia. Subsequently is it available only through the Clozaril Patient 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 platelet levels, cardiac enzymes, or serum electrolyte levels.
For clients taking clozapine (Clozaril), 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.
After reviewing information about antipsychotic agents, the students demonstrate understanding of the information when they identify which agent as an example of a typical antipsychotic?
Haloperidol Explanation: Haloperidol is a typical antipsychotic. Paliperdone is an atypical antipsychotic. Clozapine is an atypical antipsychotic. Ziprasidone is an atypical antipsychotic.
Mrs. Neller is started on haloperidol for schizophrenia. During the initial therapy in the hospital, she is placed on a cardiac monitor. As the nurse caring for Mrs. Neller, you note the QT interval has increased in length. What is the cause of this change in cardiac function?
Haloperidol has caused blocking of the alpha receptors within the heart. Explanation: One of the adverse effects is electrocardiographic change, which includes prolongation of the QT interval. This is caused because of blocking of the alpha receptors in the heart. Dromotropic stimulation results in increased conduction through the heart, which would cause the QT interval to be shortened. Inotropic effects increase the contractibility of the heart.
