Question 1

Which drug would a nurse expect to produce a favorable response for both positive and negative symptoms?

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?

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)?

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?

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?

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, which aspect of physical assessment is most important?

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?

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?

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, "What's the advantage of the new drug?" What is the nurse's best response?

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?

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:

Accepted Answer

Traditional high-potency antipsychotic medications are more likely to cause extrapyramidal side effects, such as muscle rigidity, tremors, and tardive dyskinesia, so the nurse should closely monitor these symptoms in the patient. Adrenergic effects, anticholinergic side effects, and changes in pain perception are not as closely related to the use of high-potency antipsychotic medications.

Question 12

Which medication from the patient's pharmacologic profile would most likely led to the development of neuroleptic malignant syndrome?

Accepted Answer

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal side effect of antipsychotic medications, particularly first-generation antipsychotics such as haloperidol. Symptoms of NMS include muscle rigidity, fever, altered mental status, and autonomic dysfunction. The other medications listed (divalproex sodium, amitriptyline, and paroxetine) are not typically associated with the development of NMS.

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?

Accepted Answer

When a patient with schizophrenia who is well-managed with medication therapy stops taking their antipsychotic medication, it is possible not to observe immediate evidence of symptoms due to the medication's lasting effects in the body. Symptoms may take some time to reappear as the medication gradually wears off.

Question 14

Which third-generation antipsychotic medication acts by stabilizing the dopamine system?

Accepted Answer

Aripiprazole acts as a dopamine system stabilizer because its partial agonism at dopamine D2 receptors can both stimulate or inhibit the dopamine system depending on the level of dopamine activity. This unique pharmacological property differentiates it from other antipsychotic medications.

Question 15

When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for which common extrapyramidal (EPSE) side effect?

Accepted Answer

Akathisia is a common extrapyramidal side effect seen with traditional antipsychotic medications. Mydriasis is not an EPSE side effect, but rather refers to dilation of the pupil. Hypotension and constipation are potential side effects of antipsychotic medication, but they are not specific to EPSE.

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?

Accepted Answer

The nurse should first determine if the patient is not taking the medication as prescribed, as this could be a potential trigger for the return of symptoms. It is important to rule out nonadherence before exploring other possible triggers.

Question 17

When assessing for a positive outcome to drug therapy with fluphenazine, the nurse would look primarily for improvement in which focus area?

Accepted Answer

Fluphenazine is an antipsychotic medication primarily used to treat schizophrenia and other psychotic disorders. Its main therapeutic effect is in reducing the positive symptoms of psychosis, such as hallucinations and delusions. Therefore, when assessing for a positive outcome to drug therapy with fluphenazine, the nurse would primarily look for improvement in these focus areas. Improvements in personal hygiene, range of affect, and social interactions may also occur, but they are not the primary focus of this medication.

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?

Accepted Answer

Antipsychotic medications can have cardiovascular side effects, so it is important to obtain information about preexisting heart conditions before administering the medication. Asking about cataracts, diabetes, or chronic bronchitis may also be important but is not as critical in relation to the administration of an antipsychotic medication.

Question 19

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm" and is observed to be diaphoretic. The nurse should further assess for what complication?

Accepted Answer

The symptoms described by the patient, such as feeling shaky, very warm, and being diaphoretic, are indicative of Neuroleptic Malignant Syndrome (NMS), a potentially life-threatening condition associated with the use of antipsychotic medications.

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?

Accepted Answer

The patient is exhibiting symptoms of tardive dyskinesia, a common side effect of long-term use of traditional antipsychotic medications. The nurse should notify the health care provider immediately to assess the need for medication adjustment or cessation to prevent further development of this irreversible condition. Administering anticholinergic drugs or implementing behavioral modification techniques may not effectively manage the symptoms of tardive dyskinesia. Counseling the patient about the social ramifications of these movements is not a priority at this time since the nurse's initial action should be focused on preventing further harm to the patient's health.

Quiz 14: Antipsychotic Drugs