Question 1

Which drug would a nurse expect to produce a favorable response for both positive and negative symptoms?&#10;A) Haloperidol&#10;B) Risperidone&#10;C) Fluphenazine&#10;D) Trifluoperazine

Accepted Answer

Risperidone has been shown to improve both positive and negative symptoms of schizophrenia, making it a better choice than the other options. Haloperidol, fluphenazine, and trifluoperazine are all typical antipsychotics that primarily target positive symptoms, but may worsen negative symptoms.

Question 2

A nurse reviews laboratory reports for a patient who has taken clozapine for 1 year. Which WBC and granulocyte values would prompt the nurse to notify the health care provider of the need to suspend treatment?

A) 2900 cells/mm³ and 1450 cells/mm³.
B) 3500 cells/mm³ and 1850 cells/mm³.
C) 4000 cells/mm³ and 2000 cells/mm³.
D) 4500 cells/mm³ and 2500 cells/mm³.

Accepted Answer

Clozapine is an antipsychotic medication that can cause agranulocytosis, a serious condition where the WBC count and granulocyte count decrease to dangerously low levels. The normal range of WBC count is 4000-11000 cells/mm³, and the normal range of granulocyte count is 2000-8000 cells/mm³. In this case, the patient's WBC count is already below the normal range, and the granulocyte count is even lower. Therefore, the nurse should notify the healthcare provider to suspend treatment to prevent further complications.

Question 3

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic. What is the nurse's best first action when suspecting that a patient is experiencing neuroleptic malignant syndrome (NMS)?

A) Take the patient's vital signs.
B) Position the patient in the semi-Fowler position.
C) Begin oxygen by nasal cannula at 2 L/min.
D) Place the patient on one-to-one supervision.

Take the patient's vital signs.

Accepted Answer

The nurse's best first action when suspecting NMS is to take the patient's vital signs to assess for hyperthermia, which is a hallmark sign of NMS. The other options may be appropriate interventions, but they should come after confirming the diagnosis of NMS through vital signs and completing a thorough assessment.

Question 4

Which patient receiving antipsychotic medication has the greatest risk for the development of neuroleptic malignant syndrome (NMS) and should be most carefully monitored for this serious adverse reaction?

A) One who has a history of hypothermia.
B) One with an elevated serum prolactin level.
C) One who began treatment with a high-potency drug.
D) One whose antipsychotic medication therapy began more than 6 months.

Accepted Answer

Patients who begin treatment with high-potency antipsychotic medications, such as haloperidol and fluphenazine, have a greater risk for NMS development than those starting with low-potency drugs. Therefore, this patient should be most carefully monitored for signs of NMS. A history of hypothermia and elevated prolactin levels are not known risk factors for NMS. The duration of antipsychotic medication therapy is not a significant factor in NMS development.

Question 5

A patient receiving a traditional low-potency antipsychotic medication should assess closely for what possible peripheral nervous system related side effect?&#10;A) Urinary frequency&#10;B) Urinary retention&#10;C) Hypertension&#10;D) Diarrhea

Accepted Answer

One of the common side effects of traditional low-potency antipsychotic medication is urinary retention, which can be due to the anticholinergic effects of the medication. This is a peripheral nervous system related side effect.

Question 6

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, concerns for safety and physiologic stability require that the patient be carefully monitored for what antiadrenergic effect? (Select all that apply.)

A) Tardive dyskinesia
B) Dystonia
C) Drug-induced parkinsonian movements
D) Orthostatic hypotension
E) Reflex tachycardia.

Accepted Answer

After receiving an intramuscular injection of a traditional antipsychotic drug and being placed in seclusion, monitoring vital signs such as blood pressure, pulse, and respirations is the most important aspect of physical assessment to check for any adverse reactions or side effects from the medication. Urinary output, abnormal involuntary movements, and temperature may also be monitored, but are not as crucial in the immediate aftermath of the medication administration.

Question 7

After an unsuccessful trial with fluphenazine, a patient's medication was changed to trifluoperazine. Three months later the patient is still hallucinating and delusional. What is the most likely explanation for the persistent symptoms?

A) Trifluoperazine is a low-potency antipsychotic, and the patient might need higher doses.
B) The patient has not taken trifluoperazine long enough to decrease symptoms significantly.
C) Delusions and hallucinations are negative symptoms of schizophrenia that do not respond to traditional antipsychotic medications.
D) Both fluphenazine and trifluoperazine are traditional antipsychotics, and the patient does not respond well to this class of drug.

Accepted Answer

Both fluphenazine and trifluoperazine are traditional antipsychotics, and the patient does not respond well to this class of drug. This suggests that the patient may need to try a different type of antipsychotic medication, such as an atypical antipsychotic, or a combination of medications. It is also possible that the patient's symptoms are not solely due to schizophrenia and may require additional treatment interventions.

Question 8

A patient who takes haloperidol 10 mg/day orally developed restlessness, agitation, and an inability to sit still. The nurse then administered a PRN dose of haloperidol 5 mg intramuscularly. One hour later the patient's symptoms were worse. What is the most likely explanation for the increase in symptoms?

A) The PRN medication has not yet taken effect.
B) The patient needs an increase in the dosage of haloperidol to control the rising agitation.
C) The patient was experiencing akathisia, which worsened after receiving the haloperidol medication.
D) The nurse should consider an adjunctive dose of an antianxiety drug such as lorazepam.

Accepted Answer

The patient's symptoms of restlessness, agitation, and inability to sit still are consistent with akathisia, a common side effect of haloperidol. The administration of an additional dose of haloperidol likely worsened these symptoms, as akathisia can be exacerbated by antipsychotic medications. The nurse should consider alternative treatments for the patient, such as decreasing the dose of haloperidol or adding an adjunctive medication like an antianxiety drug.

Question 9

A patient is being switched to clozapine from therapy using a traditional antipsychotic. The patient asks, &#34;What's the advantage of the new drug?&#34; What is the nurse's best response?&#10;A) &#34;It is much less expensive.&#34;&#10;B) &#34;It has a lower risk for seizure activity.&#34;&#10;C) &#34;It is sometimes effective when other drugs fail.&#34;&#10;D) &#34;It has a lower risk for causing blood abnormalities.&#34;

Accepted Answer

Clozapine is often used as a last resort for patients who do not respond well to traditional antipsychotics, so it may be more effective in treating the patient's symptoms. Additionally, clozapine has a lower risk of causing movement disorders and may have fewer other side effects than traditional antipsychotics. However, it is important to note that clozapine requires close monitoring for potential blood abnormalities, so the nurse should also educate the patient on this potential risk.

Question 10

An adult diagnosed with schizophrenia was started on clozapine 4 days ago. At 2100 today, the patient's vital signs are temperature 101°F; pulse 143 beats/min; respirations 20 breaths/min; blood pressure 100/60 mm Hg. What is the nurse's best action regarding the 2100 dose of clozapine?

A) Recognize the alterations in vital signs as typical for early therapy, and administer the medication.
B) Hold the medication, and notify the health care provider.
C) Give the drug and continue to monitor vital signs every 4 hours.
D) Postpone the dose until vital signs are normal.

Accepted Answer

The patient's elevated temperature, tachycardia, and hypotension may be indicative of a serious adverse reaction known as clozapine-induced agranulocytosis or myocarditis. Therefore, the nurse should hold the medication and promptly notify the healthcare provider for further evaluation and management of the patient.

Question 11

Considering potency, what should the nurse closely monitor a patient receiving a traditional high-potency antipsychotic medication for:&#10;A) adrenergic effects.&#10;B) extrapyramidal side effects.&#10;C) anticholinergic side effects.&#10;D) changes in pain perception.

Accepted Answer

The answer of Considering potency, what should the nurse closely...

Question 12

Which medication from the patient's pharmacologic profile would most likely led to the development of neuroleptic malignant syndrome?&#10;A) Divalproex sodium&#10;B) Amitriptyline&#10;C) Haloperidol&#10;D) Paroxetine

Accepted Answer

The answer of Which medication from the patient's pharmacologic profile...

Question 13

A patient diagnosed with schizophrenia and well managed with medication therapy tells the clinic nurse, "I stopped taking my antipsychotic medication 2 days ago." What assessment finding would the nurse expect at this visit?

A) Mood instability
B) Paranoid delusions
C) No evidence of symptoms
D) Mental clouding and confusion

Accepted Answer

The answer of A patient diagnosed with schizophrenia and well...

Question 14

Which third-generation antipsychotic medication acts by stabilizing the dopamine system?&#10;A) Aripiprazole&#10;B) Ziprasicone&#10;C) Quetiapine&#10;D) Risperidone

Accepted Answer

The answer of Which third-generation antipsychotic medication acts by stabilizing...

Question 15

When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for which common extrapyramidal (EPSE) side effect?&#10;A) Akathisia&#10;B) Mydriasis&#10;C) Hypotension&#10;D) Constipation

Accepted Answer

The answer of When a patient is taking a traditional...

Question 16

A patient diagnosed with schizophrenia has experienced good symptom control through medication therapy. Today, the patient is admitted with paranoia and auditory hallucinations. The nurse should initially determine if the patient's symptoms are related to which possible trigger?

A) Not taking the drug as prescribed
B) Activation of serotonin receptors
C) Development of tolerance to the drug
D) An expected illness-exacerbation cycle

Accepted Answer

The answer of A patient diagnosed with schizophrenia has experienced...

Question 17

When assessing for a positive outcome to drug therapy with fluphenazine, the nurse would look primarily for improvement in which focus area?&#10;A) Hallucinations&#10;B) Range of affect&#10;C) Personal hygiene&#10;D) Social interactions

Accepted Answer

The answer of When assessing for a positive outcome to...

Question 18

An antipsychotic medication is prescribed for a 72-year-old patient with a psychiatric disorder. It is most critical for the nurse to obtain information about which preexisting condition by asking what assessment question?

A) "Are you being treated for cataracts?"
B) "Have you ever been diagnosed with heart disease?"
C) "Do you have diabetes mellitus?
D) "Are you being treated for chronic bronchitis?"

Accepted Answer

The answer of An antipsychotic medication is prescribed for a...

Question 19

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic. What is the nurse's best first action when suspecting that a patient is experiencing neuroleptic malignant syndrome (NMS)?

A) Take the patient's vital signs.
B) Position the patient in the semi-Fowler position.
C) Begin oxygen by nasal cannula at 2 L/min.
D) Place the patient on one-to-one supervision.

Accepted Answer

The answer of A patient who takes a traditional antipsychotic...

Question 20

A patient has taken a traditional antipsychotic medication for several years is now demonstrating involuntary tongue movements and lip smacking. What should be the nurse's initial action?&#10;A) Notifying the health care provider&#10;B) Administering PRN doses of an anticholinergic drug&#10;C) Implementing behavioral modification techniques to help the patient manage these motions.&#10;D) Counseling the patient about the social ramifications of these movements by others.

Accepted Answer

The answer of A patient has taken a traditional antipsychotic...

Question 21

A patient prescribed which medication should be counseled about the drug's tendency to cause weight gain? (Select all that apply.)&#10;A) Olanzapine&#10;B) Dantrolene&#10;C) Benztropine&#10;D) Chlorpromazine&#10;E) Ziprasidone

Accepted Answer

The answer of A patient prescribed which medication should be...

Question 22

Which patient diagnosed with schizophrenia and receiving antipsychotic medication should receive the nurse's priority attention based on presenting characteristics?&#10;A) The one assessed with diaphoresis and a temperature of 104&#176;F&#10;B) The one reporting feelings of neck and shoulder stiffness&#10;C) The one reporting auditory hallucinations of loudly clanging church bells&#10;D) The who chanting, &#34;I am the messiah, delivered to earth from the heavens above&#34;

Accepted Answer

The answer of Which patient diagnosed with schizophrenia and receiving...

Question 23

When comparing major differences between traditional and atypical antipsychotic drugs, which statements are correct? (Select all that apply.)&#10;A) Traditional antipsychotic drugs produce more EPSEs.&#10;B) Traditional antipsychotic drugs are more likely to produce weight gain.&#10;C) Traditional antipsychotic drugs alter dopamine and serotonin transmission.&#10;D) Atypical medications have a greater therapeutic effect on both positive and negative symptoms.&#10;E) Atypical medications are more likely to cause tardive dyskinesia.

Accepted Answer

The answer of When comparing major differences between traditional and...

Question 24

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion. Over the next 2 hours, concerns for safety and physiologic stability require that the patient be carefully monitored for what antiadrenergic effect? (Select all that apply.)

A) Tardive dyskinesia
B) Dystonia
C) Drug-induced parkinsonian movements
D) Orthostatic hypotension
E) Reflex tachycardia.

Accepted Answer

The answer of During a psychiatric emergency, a patient is...

Question 25

Which information should the nurse include in the teaching plan for a patient receiving clozapine?&#10;A) &#34;Abstain from using tobacco products.&#34;&#10;B) &#34;Increase your daily carbohydrate intake.&#34;&#10;C) &#34;Notify your health care provider if you start drooling.&#34;&#10;D) &#34;You will need monthly electrocardiographic tracings done.&#34;

Accepted Answer

The answer of Which information should the nurse include in...

Question 26

Patient teaching for individuals taking risperidone should include what interventions? (Select all that apply.)&#10;A) Measures to prevent episodes of orthostatic hypotension&#10;B) Strategies to maintain fluid and electrolyte balance&#10;C) Information on the importance of monthly WBC count monitoring&#10;D) Dietary management to avoid weight gain&#10;E) Self-monitoring for facial tics

Accepted Answer

The answer of Patient teaching for individuals taking risperidone should...

Question 27

A patient is to be discharged on a maintenance dose of a high-potency antipsychotic medication. Which remark indicates that discharge teaching about the medication was effective?&#10;A) &#34;I will be able to have a few glasses of wine.&#34;&#10;B) &#34;I have to use sun block when I go to the beach.&#34;&#10;C) &#34;It is important for me to dress warmly in all seasons.&#34;&#10;D) &#34;If I miss a dose, I will take an extra one the next day.&#34;

Accepted Answer

The answer of A patient is to be discharged on...

Question 28

A 60-year-old female patient who has taken traditional antipsychotic medication for 20 years should be screened for which potential side effect?&#10;A) Osteoporosis&#10;B) Metabolic syndrome&#10;C) Polycystic ovary disease&#10;D) Neuroleptic malignant syndrome (NMS)

Accepted Answer

The answer of A 60-year-old female patient who has taken...

Deck 14: Antipsychotic Drugs