Deck 14: Antipsychotic Drugs

Question 1

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

A) Haloperidol
B) Risperidone
C) Fluphenazine
D) Trifluoperazine

Answer 1

Risperidone

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.

Answer 2

2900 cells/mm³ and 1450 cells/mm³.

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.

Answer 3

Take the patient's vital signs.

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.

Question 5

A patient receiving a traditional low-potency antipsychotic medication should assess closely for what possible peripheral nervous system related side effect?

A) Urinary frequency
B) Urinary retention
C) Hypertension
D) Diarrhea

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?

A) Blood pressure, pulse, and respirations
B) Urinary output
C) Abnormal involuntary movements (AIMS scale)
D) Temperature

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.

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.

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?

A) "It is much less expensive."
B) "It has a lower risk for seizure activity."
C) "It is sometimes effective when other drugs fail."
D) "It has a lower risk for causing blood abnormalities."

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.

Question 11

Considering potency, what should the nurse closely monitor a patient receiving a traditional high-potency antipsychotic medication for:

A) adrenergic effects.
B) extrapyramidal side effects.
C) anticholinergic side effects.
D) changes in pain perception.

Question 12

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

A) Divalproex sodium
B) Amitriptyline
C) Haloperidol
D) Paroxetine

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

Question 14

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

A) Aripiprazole
B) Ziprasicone
C) Quetiapine
D) Risperidone

Question 15

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

A) Akathisia
B) Mydriasis
C) Hypotension
D) Constipation

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

Question 17

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

A) Hallucinations
B) Range of affect
C) Personal hygiene
D) Social interactions

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?"

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?

A) Acute dystonia
B) Tardive dyskinesia
C) Drug-induced parkinsonism
D) Neuroleptic malignant syndrome (NMS)

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?

A) Notifying the health care provider
B) Administering PRN doses of an anticholinergic drug
C) Implementing behavioral modification techniques to help the patient manage these motions.
D) Counseling the patient about the social ramifications of these movements by others.

Question 21

A patient prescribed which medication should be counseled about the drug's tendency to cause weight gain? (Select all that apply.)

A) Olanzapine
B) Dantrolene
C) Benztropine
D) Chlorpromazine
E) Ziprasidone

Question 22

Which patient diagnosed with schizophrenia and receiving antipsychotic medication should receive the nurse's priority attention based on presenting characteristics?

A) The one assessed with diaphoresis and a temperature of 104°F
B) The one reporting feelings of neck and shoulder stiffness
C) The one reporting auditory hallucinations of loudly clanging church bells
D) The who chanting, "I am the messiah, delivered to earth from the heavens above"

Question 23

When comparing major differences between traditional and atypical antipsychotic drugs, which statements are correct? (Select all that apply.)

A) Traditional antipsychotic drugs produce more EPSEs.
B) Traditional antipsychotic drugs are more likely to produce weight gain.
C) Traditional antipsychotic drugs alter dopamine and serotonin transmission.
D) Atypical medications have a greater therapeutic effect on both positive and negative symptoms.
E) Atypical medications are more likely to cause tardive dyskinesia.

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.

Question 25

Which information should the nurse include in the teaching plan for a patient receiving clozapine?

A) "Abstain from using tobacco products."
B) "Increase your daily carbohydrate intake."
C) "Notify your health care provider if you start drooling."
D) "You will need monthly electrocardiographic tracings done."

Question 26

Patient teaching for individuals taking risperidone should include what interventions? (Select all that apply.)

A) Measures to prevent episodes of orthostatic hypotension
B) Strategies to maintain fluid and electrolyte balance
C) Information on the importance of monthly WBC count monitoring
D) Dietary management to avoid weight gain
E) Self-monitoring for facial tics

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?

A) "I will be able to have a few glasses of wine."
B) "I have to use sun block when I go to the beach."
C) "It is important for me to dress warmly in all seasons."
D) "If I miss a dose, I will take an extra one the next day."

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?

A) Osteoporosis
B) Metabolic syndrome
C) Polycystic ovary disease
D) Neuroleptic malignant syndrome (NMS)