Question 1

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

A,B,C,D

Question 2

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

Accepted Answer

Chlorpromazine is a typical antipsychotic that can cause anticholinergic side effects, including urinary retention, which can be problematic for someone with benign prostatic hyperplasia (BPH).

Question 3

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?

Accepted Answer

The statement "I hope that I can discontinue this medicine after I go back to see my doctor" indicates a misunderstanding about the nature of treatment for bipolar disorder, which often requires long-term medication management. This shows a need for further education on the part of the client regarding the duration and commitment to medication therapy for bipolar disorder.

Question 4

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?

Accepted Answer

Olanzapine (Zyprexa), like many antipsychotic medications, often requires 6-8 weeks to see a significant improvement in symptoms of schizophrenia. This timeframe allows the medication to achieve its full therapeutic effect.

Question 5

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

When assessing a client who is prescribed chlorpromazine for schizophrenia, the nurse should perform an eye exam and ask if there have been changes in vision (A) because chlorpromazine may cause ocular changes. The nurse should also ask the client questions regarding amount of alcohol intake (C) because alcohol can worsen the side effects of chlorpromazine. Lastly, the nurse should determine the date of the client's last menstrual period (D) because chlorpromazine can cause menstrual irregularities. Drawing blood to check a lipid profile (B) and thyroid function (E) is not necessary for assessing a client who is prescribed chlorpromazine for schizophrenia.

Question 6

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?

Accepted Answer

The client is experiencing acute dystonic reaction, which are serious and potentially life-threatening emergencies. Diphenhydramine is an antihistamine that can quickly reduce the symptoms of acute dystonic reaction. The healthcare provider should be notified immediately and diphenhydramine should be administered as soon as possible. Option A is incorrect because chlorpromazine is another antipsychotic that has a higher incidence of causing acute dystonic reaction. Option B is incorrect because it assumes the client is faking and does not address the potential emergency. Option D is incorrect because engaging in conversation does not address the client's acute dystonic reaction.

Question 7

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?

Accepted Answer

The young adult client is displaying negative symptoms of schizophrenia, such as a lack of interest in personal hygiene and routine social activities, as well as difficulty with motivation and initiative (unwillingness to get out of bed to go to school). The drop in grades is also common with negative symptoms of schizophrenia. While depression may be present, the symptoms described are more indicative of negative symptoms of schizophrenia rather than depression alone. Post-traumatic stress syndrome and insomnia are not applicable to the symptoms described.

Question 8

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?

Accepted Answer

The answer of The nurse is preparing discharge instructions for...

Question 9

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?

Accepted Answer

The combination of a low-potency drug like chlorpromazine and a high-potency drug like haloperidol is referred to as a "shotgun" approach. The goal is to target both the positive and negative symptoms of schizophrenia. The typical starting dose for chlorpromazine is 100 mg, while the typical starting dose for haloperidol is 1-2 mg. Therefore, the best choice is 100 mg of chlorpromazine and 2 mg of haloperidol.

Question 10

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?

Accepted Answer

Haloperidol (Haldol) can take 2-4 weeks for significant improvement in psychotic symptoms to be noted, so no immediate changes to the medication regimen are typically necessary after only 5 days.

Question 11

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?

Accepted Answer

Aripiprazole is a partial dopamine agonist, meaning it acts as a dopamine receptor stimulator when dopamine levels are low and as an antagonist when dopamine levels are high. It also has antagonistic activity at serotonin type 2A receptors. This dual mechanism of action allows it to improve both the positive and negative symptoms of schizophrenia.

Question 12

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?

Accepted Answer

Laughing inappropriately at sad events is a symptom of psychosis and can make it difficult for the client to maintain friendships at school. This behavior can make the client seem insensitive or uncaring to peers, which can lead to social isolation.

Question 13

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

Accepted Answer

The answer of The nurse is caring for a client...

Question 14

The nurse suspects a client is demonstrating negative symptoms of schizophrenia and will be a challenge to treat because of which barriers? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

The answer of The nurse suspects a client is demonstrating...

Question 15

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?

Accepted Answer

Lorazepam (Ativan) is a benzodiazepine that can be used to treat acute agitation and anxiety in a paranoid individual. It helps to calm the individual and allows for a greater chance of successful treatment. Antipsychotics such as clozapine, risperidone, and loxapine may also be used to treat paranoia, but they may take longer to take effect and the client is currently too agitated to receive them orally, hence the need for intramuscular administration. However, the aggressive behavior must be addressed first with a benzodiazepine.

Question 16

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?

Accepted Answer

The answer of A client is treated in the emergency...

Question 17

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?

Accepted Answer

The most appropriate response is to suggest taking the medication at bedtime to minimize drowsiness during waking hours. This may help the client better tolerate the side effect. It is also important to remind the client not to discontinue the medication without the healthcare provider's approval. The other options may not effectively address the concern and could potentially lead to nonadherence to the treatment plan.

Question 18

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?

Accepted Answer

Diphenhydramine is used to reverse acute dystonia, which presents as muscle spasms of the tongue, as a result of trifluoperazine (Stelazine) medication. It works by blocking dopamine receptors and reducing the activity of acetylcholine, which is often elevated in dystonic reactions. It is not used to decrease saliva and mucous secretions, prevent anaphylaxis, or sedate the client.

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?

Accepted Answer

Involuntary, unusual tongue and face movements are symptoms of tardive dyskinesia, a serious side effect of haloperidol decanoate. Clients should notify their healthcare provider immediately if they experience these symptoms. Nausea, weight gain, constipation, and dry mouth are common side effects of the medication, but do not require immediate notification of the healthcare provider.

Question 20

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

Accepted Answer

A) Family history of first-degree relatives with schizophrenia is relevant because schizophrenia and other psychotic disorders can have a genetic component. B) Use of illegal substances is important to assess because certain substances can induce psychotic symptoms, including auditory hallucinations. E) History of a dysfunctional family is relevant because environmental factors, including family dynamics, can influence the development or exacerbation of psychiatric conditions.

Quiz 20: Pharmacotherapy of Psychoses

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

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 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?

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

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 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?

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 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 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 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?

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?

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

The nurse suspects a client is demonstrating negative symptoms of schizophrenia and will be a challenge to treat because of which barriers? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

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 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 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 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?