Question 1

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 (NMS), a rare but serious side effect of antipsychotic medications like fluphenazine. Treatment for NMS includes discontinuation of the offending medication and administration of dantrolene, which helps to reduce fever and muscle rigidity. Haloperidol is another antipsychotic medication that can worsen NMS symptoms, and propranolol and tetrabenazine are not indicated for NMS treatment.

Question 2

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

Accepted Answer

Chlorpromazine can cause reddish-brown urine as a harmless side effect, so the nurse should reassure the patient that this is not a cause for concern.

Question 3

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

Accepted Answer

The patient should be advised to try psychotherapy or a support group in addition to the medication as benzodiazepines are meant to be used only for a short-term basis and not as a long-term solution. Alcohol should also be avoided while taking benzodiazepines. The medication should only be stopped after consulting with a healthcare provider and if symptoms have improved.

Question 4

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 headache are common side effects of risperidone. It is important for the nurse to educate the patient about expected side effects and reassure them that they are common and usually transient. The nurse should also encourage the patient to report any concerning side effects to their healthcare provider. Switching to a different medication or ordering a serum glucose test is not indicated based on the reported symptoms. Agranulocytosis is a rare but serious side effect of some antipsychotic medications, but it is not associated with drowsiness and headache.

Question 5

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 symptoms of akathisia, which is a common side effect of loxapine. Lorazepam can help relieve this symptom.

Question 6

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

The symptoms described (facial muscle spasms, grimacing, and upward eye movements) suggest acute dystonia, which is a common extrapyramidal side effect of antipsychotic medications like fluphenazine. Akathisia is characterized by restlessness and an inability to sit still. Pseudoparkinsonism includes symptoms like tremors, shuffling gait, and rigidity, and usually appears within the first few weeks of starting an antipsychotic medication. Tardive dyskinesia is a late-occurring extrapyramidal side effect that may develop after long-term antipsychotic use, and is characterized by involuntary movements of the mouth, tongue, and limbs.

Question 7

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

Accepted Answer

The Z-track method is the preferred method of injection for intramuscular haloperidol. This method involves pulling the skin and tissue to the side before injecting the medication in order to prevent leakage and irritation at the injection site. Injecting the medication into deep muscle tissue also helps to ensure proper absorption and effectiveness of the medication. Massage is not recommended as it can cause further irritation and incorrect absorption. Weekly injections may not be the appropriate dosing schedule. A small-bore needle is not necessary and may prolong the injection process.

Question 8

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 experiencing extrapyramidal symptoms (EPS) which can occur with fluphenazine use. The nurse should suggest that the family member contact the provider to discuss an order for a medication to help with the agitation and restlessness, such as benztropine or diphenhydramine. Withholding the medication could lead to a return of the delusional thinking and hallucinations. Tolerance to these side effects may not necessarily occur and waiting for several more weeks for complete drug effects may not be practical for managing the agitation and restlessness.

Question 9

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 (Romazicon) is a benzodiazepine antagonist that can reverse the effects of alprazolam and other benzodiazepines. Given the patient's symptoms and vital signs, it is likely that the patient has taken too much alprazolam, resulting in respiratory depression and somnolence. Flumazenil can quickly reverse these effects and improve the patient's condition. The other options listed are not appropriate for this situation; benztropine is an anticholinergic medication used to treat extrapyramidal symptoms, lorazepam is another benzodiazepine that would worsen the patient's symptoms, and propranolol is a beta-blocker used to treat hypertension and cardiac arrhythmias, which are not primary concerns for this patient.

Question 10

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 it previously did. The nurse will:

Accepted Answer

The fact that the patient reports the medication is not working as well as it previously did is a sign of tolerance developing to the drug. Increasing the dose would not be appropriate and may lead to adverse effects. Switching to another benzodiazepine may be an option, but it should be done in consultation with the provider. The nurse should also assess for any potential worsening of the anxiety disorder.

Question 11

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

The use of a heating pad to treat muscle spasms while taking a typical antipsychotic medication can increase the risk of a serious and potentially fatal side effect called neuroleptic malignant syndrome (NMS). The patient should be instructed to use other methods of pain relief and to report any signs of muscle rigidity or fever to their healthcare provider immediately. The other statements indicate a good understanding of the medication and its potential side effects.

Question 12

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 (BuSpar) is a medication used to treat anxiety disorders. However, it may take several weeks for the therapeutic effects to become evident. The nurse should advise the patient to continue taking the medication as prescribed and follow up with the provider to discuss any concerns or potential changes to the medication regimen. Increasing the dose or switching to another medication should only be done under the guidance of a healthcare provider. The patient should not stop taking the medication without first consulting with their provider.

Question 13

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

The most common side effects of clozapine include weight gain, drowsiness, and headaches. It is important to inform the patient about these potential side effects so they can be aware and monitor any changes. Additionally, frequent lab work and monitoring of blood counts is necessary while taking clozapine to monitor for potential side effects such as agranulocytosis. Extrapyramidal side effects may occur with atypical antipsychotic medications, although they are less common than with traditional antipsychotics. Dry mouth, constipation, and urinary retention may also occur, but are not typically the most common side effects of clozapine.

Question 14

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 has been known to interact with antipsychotic medications and increase the risk of adverse reactions, such as acute dystonia. It is important for the nurse to address the use of herbal supplements with the prescriber and educate the patient on the potential risks associated with combining them with their prescribed medications.

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 due to stress at work. The nurse will expect the provider to order which medication?

Accepted Answer

Lorazepam (Ativan) is a benzodiazepine commonly used to treat anxiety and panic attacks, which aligns with the patient's symptoms and history of stress-related episodes.

Question 16

The nurse is caring for a patient who is 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 with use of the drug, 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

While the patient's positive symptoms (agitation, hallucinations, delusions) have improved, they are still experiencing negative symptoms such as social withdrawal and lack of self-care. This may indicate that the current antipsychotic medication is not fully effective in treating all aspects of the patient's schizophrenia. Switching to an atypical antipsychotic may be a beneficial option to consider, as these drugs are often better at treating both positive and negative symptoms.

Question 17

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

Changing to a liquid or injectable form of the medication may be a helpful intervention for a patient who has difficulty swallowing pills or frequently spits them out. This can improve medication adherence and prevent relapse of symptoms associated with schizophrenia. Providing a home health nurse or teaching the patient about medication importance may also be helpful, but changing the medication form is a more direct solution to the issue at hand. Administering another dose without medical advice is not recommended, as it may lead to overdose or other adverse effects.

Question 18

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 initial action by the nurse would be most appropriate?

Accepted Answer

The nurse should hold the dose of loxapine and notify the provider of the adverse effects of tardive dyskinesia, a potential side effect of long-term antipsychotic use. It is important to monitor the patient for signs and symptoms of movement disorders and report them promptly to the provider. While an anticholinergic medication such as benztropine may be ordered to manage these symptoms, the priority is to assess and report the adverse effects and hold the dose. Increasing the dose would not address the adverse effects and may exacerbate them.

Quiz 22: Antipsychotics and Anxiolytics