Question 1

A patient is brought to the emergency department with decreased respirations and somnolence.The nurse notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg.The patient is known to take alprazolam (Xanax)to treat anxiety.Which medication will the nurse anticipate the provider to order?

Accepted Answer

Flumazenil is the recommended benzodiazepine antagonist to treat overdose of benzodiazepines.This patient is unconscious and has bradycardia and hypotension,so the antagonist medication is indicated.Benztropine is an anticholinergic used to treat acute dystonia in patients taking phenothiazines.Lorazepam is a benzodiazepine and would only intensify the symptoms.Propranolol is a beta blocker used to treat akathisia in patients taking phenothiazines.

Question 2

A family member of a patient who has been taking fluphenazine (Prolixin)for 3 months calls to report that the patient is exhibiting agitation and restlessness.The nurse learns that the patient's delusional thinking and hallucinations have stopped since taking the medication.The nurse will perform which action?

Accepted Answer

The patient is exhibiting signs of akathisia and should receive a benzodiazepine.Patients usually do not experience tolerance to these drug side effects.The patient is experiencing resolution of symptoms.Discontinuing antipsychotics abruptly may lead to withdrawal symptoms.

Question 3

The nurse is preparing to administer loxapine (Loxitane)50 mg to a patient who has schizophrenia.The patient has been taking this medication twice daily for 15 months.The nurse notes smacking lip movements and involuntary movements of all extremities.Which action by the nurse is correct?

Accepted Answer

Tardive dyskinesia manifests as protrusion and rolling of the tongue,smacking of the lips,and involuntary movement of the body and extremities and is a serious adverse effect of antipsychotic medications.The provider should be notified,so the drug can be stopped and a different medication ordered.These are not symptoms of psychosis.Anticholinergic medications are used to combat acute dystonia.Increasing the dose of this medication would only exacerbate these adverse effects.

Question 4

The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given.The nurse will suggest contacting the patient's provider to discuss which intervention?

Accepted Answer

Noncompliance is common with antipsychotic medications.If patients spit out or hide pills,a liquid form can be used.A home health nurse is costly and unnecessary.Teaching the patient the importance of the medication is essential,but not always effective if the patient does not want to comply.Weekly intramuscular injections may be used if using the liquid form is not effective.

Question 5

The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine)75 mg BID to treat schizophrenia.A family member tells the nurse that the patient's agitation,hallucinations,and delusional symptoms have improved,but the patient continues to withdraw from social interaction and won't bathe unless reminded to do so.The nurse will tell the family member that

Accepted Answer

Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care.It is not likely that the negative symptoms will improve over time with this medication.Increasing the dose will not improve control of negative symptoms.This patient exhibits signs of schizophrenia.

Question 6

A patient has been taking risperidone (Risperdal)for 2 weeks.The patient reports drowsiness and headache.What will the nurse do?

Accepted Answer

Drowsiness and headaches are common side effects of atypical antipsychotics.Changing to aripiprazole will not improve the symptoms,since this drug is in the same drug class.These symptoms do not indicate altered serum glucose levels or agranulocytosis.

Question 7

A patient arrives in the emergency department with dehydration.The patient reports taking fluphenazine (Prolixin)to treat schizophrenia.The nurse notes rigid muscles and an altered mental status.The patient has a temperature of 103.6° F,a heart rate of 98 beats per minute,and a blood pressure of 90/58 mm Hg.The nurse will anticipate administering which medication?

Accepted Answer

The patient is exhibiting signs of neuroleptic malignant syndrome.Muscle relaxants,such as dantrolene,are usually given.Haloperidol is used to treat psychosis.Propranolol is used for treating akathisia.Tetrabenazine is sometimes used to treat symptoms of tardive dyskinesia.

Question 8

A patient who takes loxapine (Loxitane)to treat schizophrenia is noted to be restless and fidgety and is pacing around the room.The nurse caring for this patient will perform which action?

Accepted Answer

The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug.Benztropine is an anticholinergic used to combat acute dystonia side effects.These are not signs of psychosis,so it is not necessary to question whether or not the patient is taking the medication.These side effects are not as serious as those with tardive dyskinesia.

Question 9

The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin).The patient is exhibiting spasms of facial muscles along with grimacing,and the nurse notes upward eye movements.The nurse suspects which side effect?

Accepted Answer

Acute dystonia can occur within days of taking typical antipsychotics,and facial muscle spasms,grimacing,and upward eye movements are characteristic of this side effect.Akathisia is characterized by restlessness,pacing,and difficulty standing still.Pseudoparkinsonism is characterized by stooped posture,pill-rolling,shuffling gait,and tremors at rest.Tardive dyskinesia manifests as protrusion and rolling of the tongue,smacking of the lips,and involuntary movement of the body and extremities.

Question 10

The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia.Which statement by the patient indicates a need for further teaching?

Accepted Answer

Dystonia can cause muscle spasms and should be reported to the provider who can prescribe medications to treat this adverse effect.Patients should not drink alcohol,should use sunscreen,and will need close monitoring of lab values while taking these medications.

Question 11

A patient has begun taking buspirone hydrochloride (BuSpar)7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms.What will the nurse tell the patient?

Accepted Answer

Buspirone hydrochloride may not be effective until 1 to 2 weeks after continuous use.It is not necessary to increase the dose at this time.

Question 12

The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan)for the past 6 months to treat an anxiety disorder.The patient states that the medication is not working as well as previously.The nurse will

Accepted Answer

It is recommended that benzodiazepines be prescribed no longer than 3 or 4 months since the effectiveness lessens after 4 months as patients develop tolerance to the drug.Changing to another benzodiazepine will not change this.Increasing the dose is not indicated.This does not indicate worsening of the underlying disorder.

Question 13

A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine.What action will the nurse take?

Accepted Answer

Aliphatic phenothiazines,such as chlorpromazine,can cause a harmless pink or red-brown urine discoloration.There is no need to evaluate renal function with creatinine clearance,BUN,or urinalysis.The discoloration does not indicate that the medication has expired.

Question 14

A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril)is concerned about side effects.What information will the nurse include when teaching the patient about this medication?

Accepted Answer

Weight gain,drowsiness,and headaches are common side effects of non-typical antipsychotic medications.Anticholinergic side effects are less likely than with typical antipsychotics.Extrapyramidal side effects can occur,even though they are less likely.Clozapine can cause agranulocytosis,so patients who are taking this drug require frequent monitoring.

Question 15

A patient arrives in the emergency department complaining of difficulty breathing,dizziness,sweating,and heart palpitations.The patient reports having had similar episodes previously.The nurse will expect the provider to order which medication?

Accepted Answer

The patient is exhibiting signs of acute anxiety,so the anxiolytic lorazepam will be given.Flumazenil is a benzodiazepine antagonist,given for overdose of benzodiazepines.Haloperidol is given for acute psychosis.Propranolol is a beta blocker,used to treat akathisia in patients taking phenothiazines.

Question 16

The nurse is preparing to administer intramuscular haloperidol (Haldol)to a patient who has schizophrenia.What action will the nurse perform?

Accepted Answer

Haloperidol is a viscous liquid and should be injected deep into muscle tissue using a Z-track method.The injection site should not be massaged.Injections of long-term preparations of haloperidol are given every 2 to 4 weeks.Nurses should use a large-bore needle when injecting haloperidol.

Question 17

A patient who is taking fluphenazine (Prolixin)to treat psychosis is experiencing symptoms of acute dystonia.While performing a medication history,the nurse learns that the patient takes herbal medications.Which herbal supplement would be of concern?

Accepted Answer

Kava kava may increase the risk and severity of dystonia when taken with phenothiazines.

Question 18

The nurse is teaching a patient about taking an anxiolytic agent to treat grief-related anxiety.Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Psychotherapy or support groups should be part of therapy,with anxiolytics added as needed.Patients taking anxiolytic medications should not consume alcohol.Anxiolytic medications are generally given for a maximum of 3 to 4 months.Patients should not stop the medications abruptly.

Quiz 27: Antipsychotics and Anxiolytics

The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has schizophrenia.The patient has been taking this medication twice daily for 15 months.The nurse notes smacking lip movements and involuntary movements of all extremities.Which action by the nurse is correct?

The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given.The nurse will suggest contacting the patient's provider to discuss which intervention?

A patient has been taking risperidone (Risperdal) for 2 weeks.The patient reports drowsiness and headache.What will the nurse do?

A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and fidgety and is pacing around the room.The nurse caring for this patient will perform which action?

The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin) .The patient is exhibiting spasms of facial muscles along with grimacing,and the nurse notes upward eye movements.The nurse suspects which side effect?

The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia.Which statement by the patient indicates a need for further teaching?

A patient has begun taking buspirone hydrochloride (BuSpar) 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms.What will the nurse tell the patient?

The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder.The patient states that the medication is not working as well as previously.The nurse will

A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine.What action will the nurse take?

A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril) is concerned about side effects.What information will the nurse include when teaching the patient about this medication?

A patient arrives in the emergency department complaining of difficulty breathing,dizziness,sweating,and heart palpitations.The patient reports having had similar episodes previously.The nurse will expect the provider to order which medication?

The nurse is preparing to administer intramuscular haloperidol (Haldol) to a patient who has schizophrenia.What action will the nurse perform?

A patient who is taking fluphenazine (Prolixin) to treat psychosis is experiencing symptoms of acute dystonia.While performing a medication history,the nurse learns that the patient takes herbal medications.Which herbal supplement would be of concern?

The nurse is teaching a patient about taking an anxiolytic agent to treat grief-related anxiety.Which statement by the patient indicates understanding of the teaching?