Question 1

A patient who has taken three doses of haloperidol suddenly cries out for help. The nurse observes that the patient's eyes are rolled upward in a fixed gaze. The nurse should document this behavior using what term?

Accepted Answer

The behavior observed by the nurse is consistent with oculogyric crisis, which is a dystonic reaction that can occur as a side effect of haloperidol. Akathisia is a motor restlessness, nystagmus is rapid eye movement, and tardive dyskinesia is a neurological disorder characterized by involuntary movements of the face and limbs. None of these accurately describe the behavior observed in this scenario.

Question 2

A psychiatric nurse should base care of patients diagnosed with Parkinson disease and patients demonstrating extrapyramidal side effects (EPSEs) caused by antipsychotic drug therapy on what premise concerning symptoms?

Accepted Answer

Both Parkinson's disease and extrapyramidal side effects (EPSEs) from antipsychotic drugs involve an imbalance between acetylcholine and dopamine in the brain, not solely deficits in dopamine synthesis or neurodegeneration of the substantia nigra.

Question 3

Which neurotransmitter is most affected by an anticholinergic drug?

Accepted Answer

Anticholinergic drugs block the action of acetylcholine, the neurotransmitter responsible for regulating important bodily functions such as muscle movement, memory, and cognition. Therefore, A is the correct answer.

Question 4

A patient began trihexyphenidyl therapy for treatment of drug-induced parkinsonism. Which finding demonstrates a positive response to the medication?

Accepted Answer

Trihexyphenidyl is an anticholinergic medication commonly used to treat drug-induced parkinsonism. It works by blocking the action of acetylcholine in the brain, which helps to improve symptoms such as tremors, rigidity, and difficulty with movement. A positive response to trihexyphenidyl therapy would be demonstrated by a decrease in parkinsonian symptoms such as improved gait stability and decreased rigidity. Options A and C are not specific to the treatment of parkinsonism, and option D indicates a negative response to the medication.

Question 5

When developing a teaching plan for a patient receiving benztropine, what is a priority nursing consideration?

Accepted Answer

A priority nursing consideration when developing a teaching plan for a patient receiving benztropine is to inform the patient that anticholinergic drugs often cause blurred vision. This is important because it can impair the patient's ability to perform tasks such as driving or reading, and they may need to take extra precautions or avoid certain activities while taking this medication.

Question 6

A patient has taken perphenazine for a year. The nurse observes lip smacking and grinding teeth. Which tool should the nurse use to complete the client's assessment?

Accepted Answer

The nurse should use the Abnormal Involuntary Movement Scale (AIMS) to assess for signs of extrapyramidal side effects (EPSE) such as lip smacking and teeth grinding, which may be caused by perphenazine. SAD PERSONS is a suicide risk assessment tool and CAGE is a tool used to screen for alcohol dependence, neither of which are appropriate for this situation.

Question 7

When patients are treated with antipsychotic medications, a variety of side effects and adverse reactions may occur. Which possible reaction presents the highest risk for patient injury? (Select all that apply.)

Accepted Answer

The answer of When patients are treated with antipsychotic medications,...

Question 8

Of the patients the nurse will see at the mental health center, which one should be assessed most carefully for extrapyramidal side effects (EPSEs)?

Accepted Answer

Haloperidol is a typical antipsychotic medication that has a high potential for causing extrapyramidal side effects (EPSEs), such as tardive dyskinesia, dystonia, and akathisia. The risk of EPSEs is highest in young patients and those receiving high doses of the medication. Therefore, the 18-year-old woman experiencing a first episode of schizophrenia who is prescribed haloperidol should be assessed most carefully for EPSEs. Olanzapine is an atypical antipsychotic medication that has a lower risk of EPSEs than haloperidol. Lorazepam is a benzodiazepine medication that does not cause EPSEs. Amitriptyline is a tricyclic antidepressant medication that has a low risk of causing EPSEs.

Question 9

An older adult patient who takes trihexyphenidyl begins taking diphenhydramine (Benadryl) for cold symptoms. The nurse should carefully monitor this patient for what possible anticholinergic effect?

Accepted Answer

The answer of An older adult patient who takes trihexyphenidyl...

Question 10

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The nurse should use which term to document these findings?

Accepted Answer

The described symptoms are consistent with akathisia, which is a common side effect of antipsychotic medication characterized by restlessness and an inability to sit still. Dystonia refers to persistent muscle contractions and spasms, dyskinesia refers to involuntary movements, and bradykinesia refers to slowness of movement, none of which are indicated by the patient's symptoms.

Question 11

Which medication from a patient's pharmacologic profile is most likely to precipitate neuroleptic malignant syndrome (NMS)?

Accepted Answer

Haloperidol is a typical antipsychotic medication that has a higher risk of causing NMS compared to atypical antipsychotics like risperidone and clozapine. Diphenhydramine is an antihistamine and not typically associated with NMS.

Question 12

Which symptom of Parkinson disease has the highest priority for nursing intervention?

Accepted Answer

Dysphagia, or difficulty swallowing, is a common symptom of Parkinson's disease that can lead to aspiration and pneumonia. Nursing interventions such as providing thickened liquids and pureed foods, positioning the patient properly during meals, and monitoring for signs of aspiration are crucial to prevent complications and ensure that the patient receives adequate nutrition and hydration. While tremors and other movement disorders associated with Parkinson's disease are also important to manage, dysphagia has the highest priority for nursing intervention due to its potentially life-threatening consequences. Akathisia and tardive dyskinesia are not typically associated with Parkinson's disease but instead are side effects of antipsychotic medications frequently used to treat symptoms of psychosis or agitation in patients with dementia or other cognitive disorders.

Question 13

Which patient receiving fluphenazine should be monitored most closely for extrapyramidal side effects (EPSEs)?

Accepted Answer

Older adults, especially women, are at a higher risk for developing extrapyramidal side effects (EPSEs) when taking antipsychotic medications like fluphenazine.

Question 14

A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when watching television. The patient says, "I couldn't sleep last night because I needed to pace." What is the expected intervention by the patient's primary health care provider?

Accepted Answer

The symptoms described are indicative of akathisia, a common side effect of antipsychotic drugs characterized by restlessness and an inability to stay still. An anticholinergic drug can help alleviate these symptoms by counteracting the imbalance of neurotransmitters caused by the antipsychotic medication.

Question 15

A patient prescribed haloperidol for a diagnosis of schizophrenia has a dystonic reaction. Benztropine 2 mg is given intramuscularly and then continued orally twice daily. Three days later, the patient has fever, disorientation, and tachycardia. What is the most likely cause of the latest signs and symptoms?

Accepted Answer

The symptoms suggest anticholinergic toxicity, a potential side effect of benztropine. The fever, disorientation, and tachycardia are consistent with this diagnosis. Tardive dyskinesia takes longer to develop and is a potential long-term side effect of antipsychotic medications. Extrapyramidal symptoms are a possible side effect of haloperidol, but the patient was given benztropine to manage these symptoms. Dopaminergic benztropine effects exacerbating psychosis is an unlikely cause of the symptoms.

Question 16

The nurse providing patient teaching regarding an anticholinergic drug demonstrates an understanding of this classification of medication by including what instruction?

Accepted Answer

Anticholinergic medications can cause decreased sweating and increased body temperature, which can lead to heat exhaustion or heat stroke, especially during hot weather or strenuous activity. Therefore, it is important to limit strenuous activity on hot days. The other options are not related to the effects of anticholinergic medications.

Question 17

Which statement by the nurse indicates an understanding of the safe and effective administration of an anticholinergic medication?

Accepted Answer

Abruptly stopping an anticholinergic medication can cause withdrawal symptoms such as sweating, nausea, and restlessness. Therefore, it is important to taper off the medication under the guidance of a healthcare provider. Avoiding foods high in tyramine is important for individuals taking monoamine oxidase inhibitors (MAOIs), not anticholinergic medications. Taking oral medications on an empty stomach may not be necessary for all anticholinergic medications and a multivitamin and mineral supplement may be recommended in general, but not specifically for the administration of an anticholinergic medication.

Question 18

A patient who has taken three doses of haloperidol suddenly cries out for help. The nurse observes that the patient's eyes are rolled upward in a fixed gaze. The nurse should administer which drug from the patient's PRN list?

Accepted Answer

The patient is showing signs of acute dystonia, which is a potential side effect of haloperidol. Benztropine is an anticholinergic medication commonly used to treat dystonia. Vitamin E, carbidopa, and amantadine are not typically used to treat dystonia.

Question 19

An elderly nursing home resident has been diagnosed with type 2 diabetes, hypertension, and dementia. The patient begins taking an antipsychotic drug for agitation. Tremor and bradykinesia develop, so an anticholinergic is added to the drug regimen. Within 3 days, the patient displays a marked cognitive deficit. Which medication is the most likely cause of the cognitive change?

Accepted Answer

Anticholinergic medications can cause cognitive deficits, especially in older adults and those with dementia. The use of an anticholinergic in combination with an antipsychotic medication can further increase the risk of cognitive impairment. While the other medications may have side effects, they are not as likely to cause cognitive deficits.

Question 20

The nurse caring for a patient receiving a dopaminergic drug should assess the individual for early symptoms of what schizophrenia-associated condition?

Accepted Answer

The answer of The nurse caring for a patient receiving...

Quiz 13: Antiparkinsonian Drugs