Question 1

Which medication from the patient's pharmacologic profile would most likely led to the development of neuroleptic malignant syndrome?

Accepted Answer

Neuroleptic malignant syndrome (NMS) is a rare but serious adverse reaction to antipsychotic medications. Haloperidol is a typical antipsychotic medication and is more commonly associated with the development of NMS than atypical antipsychotics such as quetiapine, olanzapine or risperidone. Divalproex sodium is an anticonvulsant used for the treatment of epilepsy and bipolar disorder, Amitriptyline is a tricyclic antidepressant, and Paroxetine is a selective serotonin reuptake inhibitor used for the treatment of depression, anxiety, and other psychiatric disorders.

Question 2

An antipsychotic medication is prescribed for a 72-year-old patient with a psychiatric disorder.It is most critical for the nurse to obtain information about which preexisting condition by asking what assessment question?

Accepted Answer

It is most critical for the nurse to obtain information about any preexisting heart disease because antipsychotic medications can cause changes in heart rhythm and potentially lead to serious cardiac complications, including sudden death.

Question 3

A nurse reviews laboratory reports for a patient who has taken clozapine for 1 year.Which WBC and granulocyte values would prompt the nurse to notify the health care provider of the need to suspend treatment?

Accepted Answer

Clozapine is an antipsychotic medication that can cause agranulocytosis, a serious condition in which the number of white blood cells (WBCs) and granulocytes decreases significantly. The normal range for WBCs is 4000-11000 cells/mm3, and for granulocytes, it is 1500-7800 cells/mm3. Any values below these ranges are considered abnormal and may require suspension of treatment. In option A, both the WBC and granulocyte values are well below the normal ranges and would prompt the nurse to notify the healthcare provider. Option B has a WBC value within the normal range but a low granulocyte value. Options C and D have values within or close to the normal range and would not require suspension of treatment.

Question 4

When assessing for a positive outcome to drug therapy with fluphenazine, the nurse would look primarily for improvement in which focus area?

Accepted Answer

Fluphenazine is an antipsychotic medication primarily used to treat symptoms of schizophrenia, such as hallucinations and delusions. Therefore, the nurse would look for improvement in these symptoms as the primary focus area for a positive outcome to drug therapy with fluphenazine. Improvement in range of affect, personal hygiene, and social interactions may also be important, but they are not the primary focus areas for this medication.

Question 5

A patient receiving a traditional low-potency antipsychotic medication should assess closely for what possible peripheral nervous system related side effect?

Accepted Answer

Urinary retention is a possible side effect of traditional low-potency antipsychotic medications, as these drugs can cause anticholinergic effects. Anticholinergic effects can lead to urinary retention, constipation, dry mouth, and blurred vision. Urinary frequency, hypertension, and diarrhea are not typically associated with low-potency antipsychotic medications.

Question 6

Which drug would a nurse expect to produce a favorable response for both positive and negative symptoms?

Accepted Answer

Risperidone has been shown to improve both positive and negative symptoms of schizophrenia, making it a better choice than the other options. Haloperidol, fluphenazine, and trifluoperazine are all typical antipsychotics that primarily target positive symptoms, but may worsen negative symptoms.

Question 7

After an unsuccessful trial with fluphenazine, a patient's medication was changed to trifluoperazine.Three months later the patient is still hallucinating and delusional.What is the most likely explanation for the persistent symptoms?

Accepted Answer

Both fluphenazine and trifluoperazine are traditional antipsychotics, and the patient does not respond well to this class of drug. This suggests that the patient may require a different class of medication, such as atypical antipsychotics, or may benefit from a combination of medications.

Question 8

During a psychiatric emergency, a patient is given a traditional antipsychotic drug intramuscularly and placed in seclusion.Over the next 2 hours, which aspect of physical assessment is most important?

Accepted Answer

Blood pressure, pulse, and respirations are the most important aspects of physical assessment to monitor during a psychiatric emergency where a traditional antipsychotic drug has been given intramuscularly and the patient has been placed in seclusion. These vital signs can indicate any adverse reactions to the medication and can also provide clues about the patient's overall physiological status.

Question 9

A patient is being switched to clozapine from therapy using a traditional antipsychotic.The patient asks, "What's the advantage of the new drug?" What is the nurse's best response?

Accepted Answer

Clozapine is often used as a last resort for patients who do not respond well to traditional antipsychotics, so it may be more effective in treating the patient's symptoms. Additionally, clozapine has a lower risk of causing movement disorders and may have fewer other side effects than traditional antipsychotics. However, it is important to note that clozapine requires close monitoring for potential blood abnormalities, so the nurse should also educate the patient on this potential risk.

Question 10

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm." The patient is diaphoretic.What is the nurse's best first action when suspecting that a patient is experiencing neuroleptic malignant syndrome (NMS)?

Accepted Answer

The nurse's best first action when suspecting that a patient is experiencing NMS is to take vital signs to assess for signs of fever, tachycardia, and hypertension. This will help the nurse determine if the patient's symptoms are consistent with NMS and if immediate medical intervention is necessary. Positioning the patient in semi-Fowler position, beginning oxygen, and placing the patient on one-to-one supervision may be appropriate interventions depending on the severity of the patient's symptoms, but they are not the best first action.

Question 11

A patient diagnosed with schizophrenia has experienced good symptom control through medication therapy.Today, the patient is admitted with paranoia and auditory hallucinations.The nurse should initially determine if the patient's symptoms are related to which possible trigger?

Accepted Answer

Non-adherence to medication is a common cause of symptom relapse in patients with schizophrenia. The nurse should initially determine whether the patient has been taking the medication as prescribed.

Question 12

A patient who takes haloperidol 10 mg/day orally developed restlessness, agitation, and an inability to sit still.The nurse then administered a PRN dose of haloperidol 5 mg intramuscularly.One hour later the patient's symptoms were worse.What is the most likely explanation for the increase in symptoms?

Accepted Answer

The patient's symptoms of restlessness, agitation, and inability to sit still suggest the presence of akathisia, a common side effect of haloperidol. The administration of an additional dose of haloperidol may have worsened the akathisia, leading to an increase in symptoms. The nurse should consider alternative treatments for akathisia, such as benzodiazepines or beta-adrenergic blockers.

Question 13

When a patient is taking a traditional antipsychotic medication, the nurse should assess carefully for which common extrapyramidal (EPSE) side effect?

Accepted Answer

Akathisia is a common extrapyramidal side effect (EPSE) of traditional antipsychotic medications. It is characterized by restlessness, difficulty sitting still, and a strong urge to move around. Mydriasis (dilated pupils), hypotension (low blood pressure), and constipation are not typically associated with EPSEs of antipsychotic medications.

Question 14

A patient has taken a traditional antipsychotic medication for several years is now demonstrating involuntary tongue movements and lip smacking.What should be the nurse's initial action?

Accepted Answer

The patient's symptoms are indicative of tardive dyskinesia, a common side effect of long-term use of traditional antipsychotics. The nurse should notify the healthcare provider immediately so that the medication regimen can be reevaluated and adjusted as needed. Administering an anticholinergic drug may worsen the situation and is not considered a first-line treatment option. Implementing behavioral modification techniques or counseling the patient about social ramifications may be helpful, but they should not be the initial action taken without addressing the underlying issue of medication side effects.

Question 15

A patient diagnosed with schizophrenia and well managed with medication therapy tells the clinic nurse, "I stopped taking my antipsychotic medication 2 days ago." What assessment finding would the nurse expect at this visit?

Accepted Answer

When a patient with schizophrenia who is well-managed with medication therapy stops taking their antipsychotic medication, it is possible not to observe immediate evidence of symptoms due to the medication's lasting effects in the body. Symptoms may take some time to reappear as the medication gradually wears off.

Question 16

Which third-generation antipsychotic medication acts by stabilizing the dopamine system?

Accepted Answer

Aripiprazole acts as a dopamine stabilizer, meaning it can both stimulate or inhibit dopamine activity, depending on the needs of the individual. This is in contrast to other antipsychotics, which primarily act as dopamine antagonists.

Question 17

A patient who takes a traditional antipsychotic medication says, "I feel shaky and very warm" and is observed to be diaphoretic.The nurse should further assess for what complication?

Accepted Answer

The symptoms described by the patient, such as feeling shaky, very warm, and being diaphoretic, are indicative of Neuroleptic Malignant Syndrome (NMS), a potentially life-threatening condition associated with the use of antipsychotic medications.

Question 18

Considering potency, what should the nurse closely monitor a patient receiving a traditional high-potency antipsychotic medication for:

Accepted Answer

With traditional high-potency antipsychotic medications, the nurse should closely monitor for extrapyramidal side effects, including dystonia, akathisia, and parkinsonism. These side effects are more likely with high-potency medications and can lead to significant discomfort and decreased adherence to the medication regimen.

Question 19

Which patient receiving antipsychotic medication has the greatest risk for the development of neuroleptic malignant syndrome (NMS) and should be most carefully monitored for this serious adverse reaction?

Accepted Answer

Patients who begin treatment with high-potency antipsychotic medications have an increased risk for developing NMS. Therefore, they should be most carefully monitored for this serious adverse reaction. Patients with a history of hypothermia may also be at increased risk for NMS, but this is not the greatest risk factor. An elevated serum prolactin level and the duration of antipsychotic therapy are not significant risk factors for developing NMS.

Question 20

An adult diagnosed with schizophrenia was started on clozapine 4 days ago.At 2100 today, the patient's vital signs are temperature 101°F; pulse 143 beats/min; respirations 20 breaths/min; blood pressure 100/60 mm Hg.What is the nurse's best action regarding the 2100 dose of clozapine?

Accepted Answer

The patient's vital signs, specifically an elevated temperature and tachycardia, may indicate a potentially serious adverse reaction, such as agranulocytosis, which is a risk associated with clozapine therapy. Holding the medication and notifying the provider is the best action to take in this situation. Continuing to monitor vital signs after administration or postponing the dose until vital signs are normal may not address the potential adverse reaction.

Quiz 14: Antipsychotic Drugs