Deck 24: Pharmacotherapy of Psychoses

Question 1

The nurse is caring for a client who is being treated for schizophrenia, but who also has a history of benign prostatic hypertrophy.Which of the following medications might not be the most advantageous for this client, given the above information?
1)Fluphenazine
2)Risperidone (Risperdal)
3)Chlorpromazine
4)Abilify

Answer 1

3

Question 2

The nurse is taking care of a client with severe cardiovascular disease and schizophrenia.Which of the following antipsychotic medications would be the safest treatment for this client with the given information?
1)Aripiprazole (Abilify)
2)Ziprasidone (Geodon)
3)Risperidone (Risperdal)
4)Paliperidone (Invega)

Answer 2

3

Question 3

A nurse working in a psychiatric center notices a patient walking down the hall with his head tilted to the left, as if having a muscle spasm in his neck.There is no facial expression, and the patient is having difficulty speaking.The nurse checks the patient's MAR and sees that the patient was recently started on fluphenazine (Prolixin).Which of the following actions should the nurse take?
1)Call the physician and prepare to give biperidin (Akineton)IM.
2)Call the physician and prepare to give chlorpromazine (Thorazine)IM.
3)Distract the patient to confirm that he is not faking a muscle spasm.
4)Engage the patient in open-ended conversation to find out why he is tilting his
Head and acting like he has difficulty speaking.

Answer 3

1

Question 4

A client recently prescribed an atypical antipsychotic medication for bipolar disorder is smoking a cigarette outside the office while waiting to be seen by the health care provider for a routine follow-up visit.The nurse might discuss which of the following with the patient
1)The client should discontinue smoking because nicotine will affect drug action.
2)The client should gradually cut down on the number of cigarettes smoked per day.
3)The client should be careful to smoke about the same number of cigarettes per
Day)
4)The client should increase fluid intake if she continues smoking while taking the medication.

Question 5

A client is being treated in the ED for abrasions and deep wounds received after running through thick brush and briars in the woods.The client states that she was being followed by a large man in dark clothing.A witness to this event claims there was no one chasing the client into the woods.The nurse should further assess the client for which of the following? (Select all that apply.)
1)Symptoms of depression
2)Signs of illegal substance use
3)List of current prescription medications
4)Signs of psychosis
5)Whether the client might require restraints

Question 6

A client who was started on trifluoperazine (Stelazine)two days ago presents with muscle spasms of the tongue.The physician orders diphenhydramine (Benadryl)50 mg IV.The reason for administering Benadryl to this client is:
1)To decrease saliva and mucous secretions.
2)To sedate the patient.
3)To reverse the acute dystonia.
4)To prevent anaphylaxis.

Question 7

A teenager is brought to the family physician's office for fever, complaints of a sore throat, and abdominal discomfort.The caretaker indicates that the teen has been diagnosed with a psychosis and is having some difficulty maintaining friendships through school.Which of the following behaviors might the nurse suspect is causing the client difficulty with peers?
1)Laughing inappropriately at sad events
2)Tremors, palpitations, diaphoresis, and tachycardia
3)Tremors and contraction of the extremities, drooling, and eyes rolling back in the head
4)Lack of energy, sleepiness, inability to concentrate, and inability to perform
Activities of daily living

Question 8

A mother brings her 18-year-old daughter to the health care clinic to be seen because she has noted that her daughter has gradually displayed symptoms of depression, such as loss of desire for personal hygiene, a lack of interest in her normal social activities, a sudden drop in grades at school, and recent unwillingness to get out of bed to go to school.The nurse will want to assess for which of the following?
1)Depression and positive symptoms of schizophrenia
2)Depression and negative symptoms of schizophrenia
3)Depression and insomnia
4)Depression and post-traumatic stress syndrome

Question 9

A client who was started on treatment for schizophrenia with clozapine (Clozaril)is complaining of drowsiness on the medication after the first two weeks of therapy.The best response of the nurse would be:
1)"It may take 6-8 weeks for the drowsiness to subside."
2)"Try taking the medication at bedtime."
3)"Tell the physician that you cannot tolerate the drowsiness caused by the
Medication."
4)"Take exactly as prescribed, and do not discontinue the medication without
Approval of the physician."

Question 10

The police were called to report a naked client running from house to house in a quiet suburban neighborhood, banging on the front door frantically asking to get in because of being chased by a "serial killer".The client was apprehended and brought to the ED.Upon arrival at the ED, the client became paranoid, and aggressively fought against any treatment by ED personnel.The nurse can anticipate administering which of the following?
1)Loxapine (Loxitane)IM
2)Clozapine (Clozaril)IM
3)Lorazepam (Ativan)IM
4)Risperidone (Risperdal)IM

Question 11

The nurse is performing an assessment for a routine follow up on a 25-year-old female client who takes chlorpromazine for schizophrenia.Which of the following should the nurse perform? Select all that apply.
1)Determine with help from the client the date of her last menstrual period.
2)Perform an eye exam, and ask if there have been changes in vision.
3)Ask the client questions regarding amount of alcohol use.
4)Draw blood to check a lipid profile.
5)Draw blood to check thyroid function.

Question 12

The nurse is caring for a client who has been prescribed haloperidol (Haldol)2 mg p.o.Symptoms of psychotic behavior have not improved after the fifth day on the Haldol.Because the dose is such a small amount, the nurse anticipates which of the following?
1)The dose of Haldol might be increased.
2)No changes, as it might take 2-4 weeks for significant improvement to be noted.
3)The order for Haldol might be discontinued.
4)Xanax might be added to improve the symptoms of psychotic behavior.

Question 13

Proper diagnosis of positive and negative symptoms of schizophrenia is important for selection of proper drug treatment.Clients with negative symptoms of schizophrenia are more challenging to recognize.The nurse recognizes the following as barriers to treatment: (Select all that apply.)
1)The client is indifferent to obtaining help.
2)The client is suspicious of the motives of the health care provider.
3)Family members feel the client is going through a period of depression.
4)Family members have labeled the client as lazy.
5)The client feels that the symptoms are normal.

Question 14

The nurse is reading though a client's physical and social history prior to planning discharge instructions.The client was admitted with symptoms of delusions and a dysfunctional affect.The diagnosis was schizophrenia.The client was placed on appropriate medication and follow-up with psychotherapy.Which of the following should the nurse address with the client prior to discharge?
1)The client smokes 1-3 cigarettes per day.
2)The client drinks 1-3 Cokes per day.
3)The client drinks 1-3 beers before bedtime per day.
4)The client likes to eat grapefruit for breakfast.

Question 15

The nurse is providing discharge instructions to a client who has recently been prescribed ziprasidone (Geodon)for acute mania associated with bipolar disorder.The nurse recognizes that further instruction is needed when the client states:
1)"I sure hate it that I cannot have a beer with my buddies anymore."
2)"I hope that I can discontinue this medicine after I go back to see my doctor."
3)"I need to let the doctor know immediately if I begin to have dizziness,
Lightheadedness, or shortness of breath with an irregular heartbeat."
4)"I need to report severe muscle spasms, especially of the neck, back, tongue, or
Face."

Question 16

A caregiver returns to the office with a family member who had been placed on clozapine (Clozaril)for suicidal behavior with schizophrenia.The caregiver states that the client quit taking the medicine after four weeks of therapy, and symptoms of hallucinations are returning.Which of the following might the nurse assess to determine the reason the client quit taking treatment? Select all that apply.
1)Difficulties with constipation
2)Significant weight gain
3)Feeling sedated all the time
4)Fatigue and headache
5)Agitation

Question 17

The nurse is performing the initial assessment on a client admitted to the psychiatric unit.The client hears voices that tell him that he must cut the skin on his arms with razor blades until he bleeds from the cuts.The nurse should assess for: (Select all that apply.)
1)Use of illegal substances.
2)History of a dysfunctional family.
3)Family history of heart disease.
4)Recent episodes of anxiety.
5)Family history of first-degree relative with schizophrenia.

Question 18

A client returns for a four-week follow-up visit with the health care provider after having been started on olanzapine (Zyprexa)for symptoms of schizophrenia.The care provider states that the family has noted only a small amount of improvement in symptoms, and questions the need to change to another treatment.The nurse's best response is:
1)"It might take 8-12 weeks to begin seeing improvement on this therapy."
2)"The client will need to see a psychotherapist in conjunction with the medication for there to be a major improvement in symptoms."
3)"There should have been improvement within 1-2 weeks."
4)"It might take 6-8 weeks to see definite improvement in most symptoms."

Question 19

A client is being discharged from the psychiatric unit after starting treatment for schizophrenia.The client is going to receive haloperidol decanote (Haldol LA)IM once monthly after discharge.Of which of the following would the nurse teach the client to notify the health care provider immediately?
1)Weight gain of five pounds or more in two weeks
2)Constipation and dry mouth
3)Nausea sometimes accompanied with vomiting
4)Involuntary, unusual tongue and face movements, such as lip smacking or rapid
Eye blinking

Question 20

According to categories, haloperidol (Haldol)is a high-potency drug, while chlorpromazine is a low-potency drug.The nurse could anticipate the doses of each drug to be which of the following?
1)2 mg of chlorpromazine and 100 mg of haloperidol (Haldol)
2)100 mg of chlorpromazine and 2 mg of haloperidol (Haldol)
3)2 mg of chlorpromazine and 2 mg of haloperidol (Haldol)
4)100 mg of chlorpromazine and 100 mg of haloperidol (Haldol)

Question 21

A client seen in the ED with acute symptoms of schizophrenia is given ziprasidone (Geodon)IM.Within 15 minutes, the client is subdued and much less restless.The nurse proceeds to connect the patient to a heart monitor, and calls for the 12-lead EKG as ordered.The nurse is going to assess the EKG results for which of the following?
1)Normal sinus rhythm
2)Premature atrial contractions
3)Sinus irregularity
4)Increase in QT interval

Question 22

A client who was treated with olanzapine (Zyprexa)for mania associated with bipolar disorder is getting ready for discharge home.Which of the following statements by the client would indicate to the nurse that more teaching is necessary?
1)"I might need to increase my intake of fiber and fluids."
2)"I'm going to weigh myself weekly to check for weight gain."
3)"I take Saint John's wort at bedtime to help me go to sleep."
4)"I need to report symptoms of extreme thirst, insatiable hunger with weight loss, and increased urination."

Question 23

A client on risperidone (Risperdal)for acute mania with bipolar disorder is getting ready for discharge home.The nurse should teach the client which of the following prior to discharge?
1)Watch for abnormal bruising, bleeding of the gums, blood in the feces, or any other abnormal bleeding.
2)Do not eat grapefruit or take grapefruit juice while on this medication.
3)Do not use alcohol while on this medication.
4)Monitor for extreme thirst, hunger with weight loss, and increased urination.

Question 24

A client is being seen for a follow-up appointment with the health care provider.The client is taking aripiprazole (Abilify)for schizophrenia.Upon assessment, the nurse discovers that the client has been experiencing signs of hypotension with certain activities since starting this medication.Which of the following would be appropriate to teach the client? Select all that apply.
1)Avoid hot baths or hot showers.
2)Avoid being outside in the heat of the day.
3)Avoid caffeine-containing preparations.
4)Change positions slowly, especially from lying or sitting to standing.

Question 25

An elderly client with dementia-related psychosis needs treatment with an antipsychotic medication.Which of the following would not be recommended?
1)Aripiprazole (Abilify)
2)Olanzapine (Zyprexa)
3)Clozapine (Clozaril)
4)Loxapine (Loxitane)

Question 26

A client is brought to the ED with fever, diaphoresis, muscle rigidity, and tachycardia.These symptoms presented four hours ago.The client is taking aripiprazole (Abilify), enalapril (Vasotec), and atenolol (Tenormin).The nurse will prepare to give which of the following?
1)Antipyretics, electrolytes, and muscle relaxants
2)Antipyretics, intravenous D5NS, and lorazepam (Ativan)
3)Antipyretics, intravenous D5NS, and Atropine
4)Antipyretics, electrolytes, and a cooling blanket