Chapter 31-Anti Psychotics

Question 1

1. A patient with schizophrenia has been taking an antipsychotic drug for several days. The nurse enters the patient’s room to administer a dose of haloperidol [Haldol] and finds the patient having facial spasms. The patient’s head is thrust back, and the patient is unable to speak. What will the nurse do?
   a.
   Administer the haloperidol as ordered.
   b.
   Discuss increasing the haloperidol dose with the provider.
   c.
   Request an order to give diphenhydramine.
   d.
   Request an order to give levodopa.

Answer 1

C

Question 2

2. A patient who is taking a first-generation antipsychotic (FGA) drug for schizophrenia comes to the clinic for evaluation. The nurse observes that the patient has a shuffling gait and mild tremors. The nurse will ask the patient’s provider about which course of action?
   a.
   Administering a direct dopamine antagonist
   b.
   Giving an anticholinergic medication
   c.
   Increasing the dose of the antipsychotic drug
   d.
   Switching to a second-generation antipsychotic drug

Answer 2

B

Question 3

3. A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine [Symmetrel]. The amantadine is withdrawn 2 months later, and the parkinsonism returns. The nurse will expect the provider to:
   a.
   give anticholinergic medications.
   b.
   make a diagnosis of idiopathic parkinsonism.
   c.
   resume the amantadine indefinitely.
   d.
   try a second-generation antipsychotic (SGA).

Answer 3

D

Question 4

4. A nurse and a nursing student are discussing the plan of care for a patient with schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has become restless and constantly needs to be in motion. Which statement by the student indicates a need for further education?
   a.
   “Anticholinergic medications may help control these symptoms.”
   b.
   “Because this may be an exacerbation of psychosis, the provider may increase the dose of the FGA.”
   c.
   “The provider may try a low-potency FGA instead of the high-potency FGA.”
   d.
   “This patient may need to take a benzodiazepine or a beta blocker.”

Answer 4

B

Question 5

5.	A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble speaking and chewing and observes slow, wormlike movements of the patient’s tongue. The nurse recognizes which adverse effect in this patient?
a.
Acute dystonia
b.
Akathisia
c.
Parkinsonism
d.
Tardive dyskinesia

Answer 5

D

Question 6

6. A nurse provides teaching for a patient about to begin taking an FGA drug for schizophrenia. Which statement by the patient indicates a need for further teaching about side effects of these drugs?
   a.
   “Dry mouth and constipation are uncommon with this medication.”
   b.
   “I may experience gynecomastia and galactorrhea.”
   c.
   “I may feel lightheaded or dizzy and should sit or lie down if this occurs.”
   d.
   “Sedation may occur initially, but will subside in 1 to 2 weeks.”

Answer 6

A

Question 7

7. A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine [Clozaril]. The nurse teaches the family about the medication and its side effects. Which statement by a family member indicates a need for further teaching about this drug?
   a.
   “Blood counts are necessary for several weeks after discontinuation of the drug.”
   b.
   “Fever, sore throat, and sores in the mouth should be reported immediately.”
   c.
   “If the ANC is less than 3000, the drug will be discontinued permanently.”
   d.
   “Use of this drug requires weekly evaluation of blood work.”

Answer 7

C

Question 8

8. A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse teaching this patient about this medication will make which statement?
   a.
   “You will experience therapeutic levels of this drug in 1 to 2 weeks.”
   b.
   “You will need injections of this drug every 6 weeks.”
   c.
   “You will need to take an oral antipsychotic drug for 3 weeks.”
   d.
   “You probably will not have extrapyramidal symptoms with this drug.”

Answer 8

C

Question 9

9.	A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has been taking the drug daily in two divided doses. The individual complains of daytime drowsiness. The patient’s family reports a decrease in the person’s hostility and anxiety but states that the patient remains antisocial with disordered thinking. What will the nurse tell the patient and the family?
a.
An increased dose of the drug may be needed.
b.
Intramuscular dosing may be needed.
c.
Some symptoms take months to improve.
d.
The entire dose may be taken at bedtime.

Answer 9

C

Question 10

10. A patient in whom drug therapy has failed several times in the past is readmitted to a hospital to begin therapy for schizophrenia. What will the nurse do to help improve adherence?
    a.
    Encourage the patient to take responsibility for medication management.
    b.
    Teach the patient about drug side effects and how to manage them.
    c.
    Tell the patient that an abstinence syndrome will occur if the drug is stopped.
    d.
    Tell the patient that the drug may be taken as needed to control symptoms.

Answer 10

B

Question 11

11. A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider hasn’t ordered olanzapine [Zyprexa], which the patient has seen advertised on television. Which response by the nurse is the most important reason that this patient is not receiving olanzapine?
    a.
    “Olanzapine is more expensive than thioridazine.”
    b.
    “Olanzapine causes more metabolic side effects than thioridazine.”
    c.
    “Thioridazine has fewer side effects than olanzapine.”
    d.
    “Thioridazine has a faster onset of action than olanzapine.”

Answer 11

B

Question 12

1.	A nurse in a mental health hospital finds a patient with schizophrenia who takes haloperidol [Haldol] lying rigid in bed with a temperature of 41.3°C. A cardiac monitor shows cardiac dysrhythmias. What will be included in the treatment of this patient? (Select all that apply.)
a.
Anticholinergic medications
b.
Beta blockers
c.
Dantrolene
d.
Intravenous fluids
e.
Withdrawal of haloperidol

Answer 12

C. D. E.

Question 13

2.	Which side effects are more common in second-generation antipsychotic medications than in first-generation antipsychotic medications? (Select all that apply.)
a.
Agranulocytosis
b.
Anticholinergic effects
c.
Extrapyramidal symptoms
d.
Metabolism by CYP3A4
e.
Prolactin elevation

Answer 13

A. B. D.

Question 14

3.	What are negative symptoms of schizophrenia? (Select all that apply.)
a.
Delusions
b.
Disordered thinking
c.
Poor judgment
d.
Poor self-care
e.
Poverty of speech

Answer 14

C. D. E.

Question 15

4. A parent reports being afraid that a child may have schizophrenia because of disorganized speech and asocial behaviors. The nurse will tell this parent that which of the following must also be present to make a diagnosis? (Select all that apply.)
   a.
   A decrease in self-care, job, or school function
   b.
   A history of substance abuse
   c.
   A 1-month duration of active phase symptoms
   d.
   Continuous signs of disturbance for longer than 6 months
   e.
   The presence of manic episodes

Answer 15

A. C. D.