Deck 20: Pharmacotherapy of Psychoses

Question 1

A client is prescribed aripiprazole (Abilify)to treat both the positive and negative symptoms of schizophrenia.What will the nurse explain as the medication's mechanism of action?

A)Increasing norepinephrine activity by blocking its synaptic reuptake
B)Partial agonist activity at dopamine type 2 (D₂ and D₃)and serotonin type 2
C)Inhibiting the reuptake of serotonin at the synapse
D)Binding to the GABA receptor

Answer 1

Partial agonist activity at dopamine type 2 (D₂ and D₃)and serotonin type 2

Question 2

An adolescent client diagnosed with a psychosis is having difficulty maintaining friendships at school.Which behavior does the nurse suspect is the cause of the client's difficulty with peer relationships?

A)Laughing inappropriately at sad events
B)Tremors and contraction of the extremities,drooling,and eyes rolling back in the head
C)Tremors,palpitations,diaphoresis,and tachycardia
D)Lack of energy,sleepiness,inability to concentrate,and inability to perform activities of daily living

Answer 2

Laughing inappropriately at sad events

Question 3

A young adult client is demonstrating a lack of interest in personal hygiene and routine social activities,a sudden drop in school grades,and a recent unwillingness to get out of bed to go to school.The nurse will assess for which health problem?

A)Depression and positive symptoms of schizophrenia
B)Depression and post-traumatic stress syndrome
C)Depression and insomnia
D)Depression and negative symptoms of schizophrenia

Answer 3

Depression and negative symptoms of schizophrenia

Question 4

A client with a history of suicidal behavior and schizophrenia stopped taking clozapine (Clozaril)after four weeks of therapy.The client is currently experiencing a return of hallucinations.What might the nurse assess when determining the reason the client stopped taking the medication?
Select all that apply.

A)Feeling sedated all the time
B)Significant weight gain
C)Agitation
D)Fatigue and headache
E)Lack of desire to consume alcohol

Question 5

The nurse is preparing discharge instructions for a client being treated with medication and psychotherapy for schizophrenia.What should the nurse address with the client prior to discharge?

A)The client smokes 1-3 cigarettes per day.
B)The client drinks 1-3 beers before bedtime per day.
C)The client likes to eat grapefruit for breakfast.
D)The client drinks 1-3 caffeinated sodas per day.

Question 6

A client was prescribed olanzapine (Zyprexa)four weeks ago to treat symptoms of schizophrenia.The client's family has noted only a small improvement in symptoms and asks about changing to another treatment.Which response by the nurse is the most appropriate?

A)"The client will need to see a psychotherapist in conjunction with the medication for there to be a major improvement in symptoms."
B)"It might take 6-8 weeks to see definite improvement in most symptoms."
C)"It might take 8-12 weeks to begin seeing improvement on this therapy."
D)"There should have been improvement within 1-2 weeks."

Question 7

The nurse is performing the initial assessment on a client admitted to the psychiatric unit.The client hears voices saying to cut the client's arms with razor blades until they bleed.What should the nurse assess this client for based on these initial findings?
Select all that apply.

A)Family history of first-degree relative with schizophrenia
B)Use of illegal substances
C)Recent episodes of anxiety
D)Family history of heart disease
E)History of a dysfunctional family

Question 8

The nurse is assessing a female client who is prescribed chlorpromazine for schizophrenia.Based on this information,what will the nurse include in the client assessment?
Select all that apply.

A)Perform an eye exam and ask if there have been changes in vision.
B)Draw blood to check a lipid profile.
C)Ask the client questions regarding amount of alcohol intake.
D)Determine the date of her last menstrual period.
E)Draw blood to check thyroid function.

Question 9

The nurse suspects a client is demonstrating negative symptoms of schizophrenia and will be a challenge to treat because of which barriers?
Select all that apply.

A)The client feels that the symptoms are normal.
B)Family members feel the client is going through a period of depression.
C)The client is suspicious of the motives of the health care provider.
D)Family members have labeled the client as lazy.
E)The client is indifferent to obtaining help.

Question 10

The nurse is providing discharge instructions to a client who is prescribed ziprasidone (Geodon)for acute mania associated with bipolar disorder.Which statement by the client indicates the need for further education regarding this medication?

A)"I need to report severe muscle spasms,especially of the neck,back,tongue,or face."
B)"I sure hate it that I can't have a beer with my buddies anymore."
C)"I hope that I can discontinue this medicine after I go back to see my doctor."
D)"I need to let the doctor know immediately if I begin to have dizziness,lightheadedness,or shortness of breath with an irregular heartbeat."

Question 11

A client prescribed clozapine (Clozaril)for treatment of schizophrenia is complaining of drowsiness after the first 2 weeks of therapy.Which response by the nurse is the most appropriate for this situation?

A)"Take the medication exactly as prescribed,and do not discontinue it without the health care provider's approval."
B)"Tell the health care provider that you cannot tolerate the drowsiness caused by the medication."
C)"It may take 6-8 weeks for the drowsiness to subside."
D)"Try taking the medication at bedtime."

Question 12

A client who was prescribed trifluoperazine (Stelazine)2 days ago presents with muscle spasms of the tongue.The health care provider orders diphenhydramine (Benadryl)50 mg IV.What is the rationale for this medication?

A)To decrease saliva and mucous secretions
B)To reverse the acute dystonia
C)To prevent anaphylaxis
D)To sedate the client

Question 13

A client with a history of benign prostatic hyperplasia is beginning treatment for schizophrenia.Which medication might be contraindicated for this client?

A)Fluphenazine
B)Chlorpromazine
C)Aripiprazole (Abilify)
D)Risperidone (Risperdal)

Question 14

A client in the emergency department tells the nurse about being chased by a serial killer." The client is currently paranoid and is aggressively fighting against any treatment.Which medication does the nurse anticipate will be prescribed for this client?

A)Clozapine (Clozaril)in intramuscular (IM)form
B)Risperidone (Risperdal)IM
C)Loxapine (Loxitane)IM
D)Lorazepam (Ativan)IM

Question 15

A client is treated in the emergency department for injuries received after running through thick brush in the woods.The client relates 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.Which item should the nurse further assess this client for based on the information provided?

A)A list of current prescription medications
B)Symptoms of depression
C)Family members' interpretation of the event
D)Whether the client might require restraints

Question 16

A client's medication regimen is being determined by the health care provider.Currently,the medications haloperidol (Haldol),a high-potency drug,and chlorpromazine,a low-potency drug,are being considered.Which doses of the medications does the nurse anticipate for this client?

A)2 mg of chlorpromazine and 2 mg of haloperidol (Haldol).
B)100 mg of chlorpromazine and 2 mg of haloperidol (Haldol).
C)100 mg of chlorpromazine and 100 mg of haloperidol (Haldol).
D)2 mg of chlorpromazine and 100 mg of haloperidol (Haldol).

Question 17

A client is prescribed fluphenazine (Prolixin)and is experiencing muscle spasms of the neck.The client is grimacing and having difficulty speaking.Which action should the nurse take?

A)Call the health care provider and prepare to give chlorpromazine (Thorazine)IM.
B)Distract the client to confirm the client is not faking a muscle spasm.
C)Call the health care provider and prepare to give diphenhydramine (Benadryl).
D)Engage the client in open-ended conversation to find out why the client is having difficulty speaking.

Question 18

A client prescribed haloperidol (Haldol)is not demonstrating an improvement of psychotic behavior after taking the medication for 5 days.The nurse would anticipate which dose change for the medication?

A)No changes are necessary,as it might take 2-4 weeks for significant improvement to be noted.
B)The dose of Haldol might be increased.
C)The order for Haldol might be discontinued.
D)Xanax might be added to improve the symptoms of psychotic behavior.

Question 19

A client is prescribed haloperidol decanoate (Haldol LA)IM to be administered once a month for treatment of schizophrenia.The nurse will instruct the client to notify the health care provider for which manifestation?

A)Involuntary,unusual tongue and face movements,such as lip smacking or rapid eye blinking
B)Nausea,sometimes accompanied with vomiting
C)Weight gain of 5 pounds or more in 2 weeks
D)Constipation and dry mouth

Question 20

The nurse is caring for a client with severe cardiovascular disease and schizophrenia.Which antipsychotic medication would be the safest treatment for this client?

A)Ziprasidone (Geodon)
B)Paliperidone (Invega)
C)Risperidone (Risperdal)
D)Aripiprazole (Abilify)

Question 21

The nurse is concerned that a client being treated with antipsychotic medication for schizophrenia is developing extrapyramidal symptoms.Which assessment findings support the nurse's concern?
Select all that apply.

A)Neck spasms
B)Fidgeting and rocking back and forth in the chair
C)Shuffling gait
D)Lip smacking and rapid eye blinking
E)Diaphoresis and muscle rigidity

Question 22

The nurse is instructing a client on the importance of having routine blood work preformed while taking a prescribed antipsychotic medication.Which symptoms would warrant the client to notify the health care provider immediately? Select all that apply.

A)Abdominal pain
B)Change in stool color
C)Increased thirst and urination
D)Frequent infections
E)Dry mouth

Question 23

The nurse is instructing a client on the medication risperidone (Risperdal).What should be included in this teaching?

A)Do not use alcohol while on this medication.
B)Watch for abnormal bruising,bleeding of the gums,blood in the feces,or any other abnormal bleeding.
C)Do not eat grapefruit or take grapefruit juice while on this medication.
D)Monitor for extreme thirst,hunger with weight loss,and increased urination.

Question 24

A client with acute symptoms of schizophrenia is prescribed ziprasidone (Geodon)IM.Which rhythm will the nurse assess this client for prior to administering the medication?

A)Normal sinus rhythm
B)Sinus irregularity
C)Increase in QT interval
D)Premature atrial contractions

Question 25

While conducting a health history,the nurse notes that the client is demonstrating positive signs of schizophrenia.Which clinical manifestations did the nurse find during the assessment of this client?
Select all that apply.

A)Disorganized sentence structure
B)Kicking the nurse
C)Not responding to questions
D)Difficulty following instructions
E)Stating that God wants the client to go home

Question 26

A client is experiencing fever,diaphoresis,muscle rigidity,and tachycardia for 4 hours.Current medications include aripiprazole (Abilify),enalapril (Vasotec),and atenolol (Tenormin).What will the nurse prepare to administer to this client?

A)Antipyretics,electrolytes,and muscle relaxants
B)Antipyretics,intravenous fluids,and lorazepam (Ativan)
C)Antipyretics,electrolytes,and a cooling blanket
D)Antipyretics,intravenous fluids,and Atropine

Question 27

A client prescribed olanzapine (Zyprexa)for mania associated with bipolar disorder is being discharged.Which client statement indicates more teaching is necessary about this medication?

A)"I take St.John's wort at bedtime to help me go to sleep."
B)"I'm going to weigh myself weekly to check for weight gain."
C)"I need to report symptoms of extreme thirst,insatiable hunger with weight loss,and increased urination."
D)"I might need to increase my intake of fiber and fluids."

Question 28

A client prescribed aripiprazole (Abilify)for schizophrenia is experiencing signs of hypotension with certain activities since starting this medication.What should the nurse teach the client?
Select all that apply.

A)Avoid being outside in the heat of the day.
B)Avoid hot baths or hot showers.
C)Avoid caffeine-containing preparations.
D)Change positions slowly,especially from lying or sitting to standing.
E)Take frequent naps during the day.

Question 29

A client is being evaluated for appropriate medication treatment for a new onset of psychosis.Which information in the history would indicate that haloperidol (Haldol)is contraindicated for this client?
Select all that apply.

A)Current treatment for Parkinson disease
B)History of seizure disorder
C)Malnourished
D)Currently prescribed lithium
E)Drinks a six-pack of beer every day

Question 30

The family of a client diagnosed with schizophrenia asks why medications are needed to help control the client's symptoms.Which responses by the nurse are appropriate in this situation?
Select all that apply.

A)Medications for schizophrenia work on the basal ganglia of the brain."
B)Most antipsychotic drugs block dopamine receptors to reduce the symptoms of the disorder."
C)They help correct the genetic component of the disorder."
D)They are really sedatives to stop the client from causing harm."
E)They stimulate dopamine receptors to reduce the symptoms of the disorder."

Question 31

The family of a client being treated for schizophrenia asks the nurse why the client's medication was changed to a new type just out on the market.Which responses by the nurse are appropriate?
Select all that apply.

A)The newer medications have fewer adverse effects."
B)Many clients prefer the new medication."
C)The newer medications cost less."
D)The newer medications are easier to get from the pharmacy."
E)The client's health care provider likes to try new medications."

Question 32

A client being treated for chronic schizophrenia develops tardive dyskinesia.Which interventions will the nurse prepare to perform for this client?
Select all that apply.

A)Administering a prescribed lower dose of the antipsychotic medication
B)Administering a benzodiazepine as prescribed
C)Administering tapered doses of the antipsychotic medication
D)Administering a newly prescribed atypical antipsychotic medication
E)Administering a higher dose of the currently prescribed antipsychotic medication

Question 33

A client prescribed antipsychotic medication for chronic schizophrenia abruptly stops taking the medication and is in the emergency department.Which findings does the nurse anticipate when assessing this client?
Select all that apply.

A)Nausea
B)Sweating
C)Vomiting
D)Salivation
E)Paralysis

Question 34

During an assessment,the nurse determines a client is demonstrating symptoms of a psychosis.Which clinical manifestations did the nurse find during the assessment of this client?
Select all that apply.

A)The client says,The servants need to be disciplined."
B)The client says,The voice told me to cut myself."
C)The client laughs when asked about the health of a family member hospitalized for cancer treatment.
D)The client asks to close the room door so that man can't get to me."
E)The client says,I have not been able to get any sleep for months."

Question 35

A client prescribed an atypical antipsychotic medication for bipolar disorder reports difficulty sleeping.What might the nurse want to discuss with the client?

A)Using alcohol to aid with sleep
B)Increasing fluid intake
C)Trying St.John's wort to help with sleeping
D)Avoiding the use of valerian

Question 36

A client being treated for schizophrenia admits to occasionally skipping medication doses.Based on this information,what will the nurse include in the client assessment?
Select all that apply.

A)Use of alcohol
B)Intensity of side effects
C)Understanding of the health problem
D)Belief that the medication is poison
E)Cost of the medication

Question 37

Treatment with an antipsychotic medication is being considered for an older adult client with dementia-related psychosis.Which medication would not be appropriate for this client?

A)Olanzapine (Zyprexa)
B)Clozapine (Clozaril)
C)Loxapine (Loxitane)
D)Aripiprazole (Abilify)

Question 38

A client being treated with antipsychotic medication for schizophrenia is overheard telling family that the problem has improved because the new medication is given at a low dose.How should the nurse respond to this client's comment?
Select all that apply.

A)The new medication has a higher potency,and a lower dose is needed."
B)The symptoms can be controlled with a lower dose."
C)The other medication was not working."
D)It is always better to start a new medication with a lower dose."
E)The other medication was too much for you since your symptoms are almost gone."