A patient with schizophrenia receives a dose of risperidone [Risperdal Consta] IM. The nurse
teaching this patient about this medication will make which statement?
B.
Risperidone given intramuscularly is a depot preparation used for long-term therapy. Significant release of the drug does not occur until 2 to 3 weeks after injection; therefore, patients must take an oral antipsychotic medication until drug levels are raised.
Therapeutic levels are reached 4 to 6 weeks after injection.
Patients need injections every 2 weeks.
With IM dosing, the incidence of extrapyramidal symptoms is substantial
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?
C.
Clozapine can cause agranulocytosis. If the absolute neutrophil count (ANC) drops below
1000/mcL, the drug must be discontinued permanently.
Blood counts must be evaluated weekly, and this evaluation should be continued for several weeks after withdrawal of the drug.
Fever, sore throat, and mouth ulcers are symptoms of agranulocytosis and should be reported immediately.
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.
One way to promote adherence to a medication regimen is to teach patients about drug side effects and how to minimize undesired responses.
Family members should be encouraged to oversee medication management for outpatients, because patients themselves may fail to appreciate the need for therapy or may be unwilling to take prescribed medications.
It is not true that an abstinence syndrome occurs when these drugs are withdrawn.
These drugs are not used PRN; they must be given on a regular basis.
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.
Anticholinergic effects are common with FGAs, so this statement indicates a need for further teaching. Neuroendocrine effects, orthostatic hypertension, and sedation can occur with FGAs
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 The amantadine is withdrawn 2 months later, and the parkinsonism returns.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:
D.
Neuroleptic-induced parkinsonism is treated with some of the same drugs used for idiopathic parkinsonism, such as amantadine.
If parkinsonism is severe, switching to an SGA may help, because the risk of parkinsonism is much lower with these drugs.
An anticholinergic medication
may be used initially.
A recurrence of parkinsonism when the drug is withdrawn does not indicate
idiopathic parkinsonism.
These drugs should not be used indefinitely.
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
ANS: C , D , E
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?
C.
Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This patient shows signs of this adverse effect.
Acute dystonia is characterized by severe spasm of muscles in the face,
tongue, neck, or back, and by opisthotonus.
Akathisia is characterized by constant motion.
Parkinsonism is characterized by bradykinesia, drooling, tremor, rigidity, and a shuffling gait
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?
D.
The patient is showing signs of akathisia, which can resemble an exacerbation of psychosis.
If the two are confused and the provider orders more of the FGA, the symptoms may actually increase.
Anticholinergic medications may be used.
A low-potency FGA may be ordered
A benzodiazepine or beta blocker may be prescribed
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?
C.
The patient is showing signs of parkinsonism, an extrapyramidal effect associated with antipsychotic medications.
Anticholinergic medications are indicated.
A direct dopamine antagonist would counter the effects of the antipsychotic and remove any beneficial effect it has.
Increasing the dose of the antipsychotic medication would only worsen the extrapyramidal
symptoms.
A second-generation antipsychotic medication may be used if parkinsonism is severe; This patient is exhibiting mild symptoms, so this is not necessary at this point
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?
B.
When patients begin therapy with antipsychotic medications, some symptoms resolve sooner than
others. During the first week, agitation, hostility, anxiety, and tension may resolve, but other symptoms may take several months to improve.
It is not necessary to increase the dose in the first week.
IM dosing is indicated for patients with severe, acute schizophrenia and for long-term maintenance.
Sedation is normal.
Once an effective dose has been determined, the entire dose can be taken at bedtime, but not in the initial days of therapy.
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?
C.
An early reaction to antipsychotic drugs is acute dystonia. Initial treatment consists of an
anticholinergic medication, such as diphenhydramine.
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
ANS: A , C , D
Patients must have at least two symptoms with 1-month duration of active symptoms.
One symptom must be delusions, hallucinations, or disordered speech. Patients must have continuous
signs of disturbance for longer than 6 months.
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
ANS: A , B , D
SGAs are more likely than FGAs to cause agranulocytosis and anticholinergic effects and are
metabolized by CYP3A4 enzymes
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
ANS: C , D , E
Neuroleptic malignant syndrome is characterized by “lead pipe” rigidity, sudden high fever, and
autonomic instability.
Treatment requires supportive measures, drug therapy, and immediate withdrawal of the antipsychotic medication.
Dantrolene is used to relax muscles and reduce heat production. Intravenous fluids are used to maintain hydration.
Anticholinergic medications and beta blockers are not helpful.
A patient who has diabetes mellitus is diagnosed with schizophrenia and the provider orders thioridazine. The patient asks the nurse why the provider has not 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?
B.
Olanzapine is an SGA and, although it has fewer extrapyramidal side effects than the FGA the provider has ordered, it has an increased risk of metabolic side effects, which is contraindicated in
patients with diabetes.
It is more expensive, but this is not the most important reason for not
prescribing it.
Thioridazine has more side effects than olanzapine, but the side effects caused by olanzapine are more critical for this patient.
Thioridazine does not have a faster onset of action
A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to:
C.
MAOIs increase 5-HT availability, thus greatly increasing the risk of serotonin syndrome.
MAOIs should be withdrawn at least 14 days before an SSRI is started.
An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to:
D.
For many patients, taking the entire dose of a TCA at bedtime is advantageous for facilitating
adherence, minimizing daytime sedation, and promoting sleep. However, older adult patients are
at greater risk for cardiotoxicity and may experience intolerable effects on the heart if the entire
dose is taken at once; therefore, twice-daily dosing is recommended in the elderly
A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss:
B.
A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient?
C.
Bruxism is a side effect of SSRIs and can result in headache and jaw pain. Patients who experience
these signs should be evaluated for bruxism by a dentist, who can determine whether the patient
may benefit from the use of a mouth guard.
Headache and jaw pain are not signs of extrapyramidal side effects. Discontinuing the antidepressant is not indicated, because depression may return.
Stress-relieving methods and relaxation techniques are not recommended, because these symptoms occur during sleep
A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for:
B.
Use of venlafaxine late in pregnancy can result in a neonatal withdrawal syndrome characterized
by irritability, abnormal crying, tremor, respiratory distress, and possibly seizures. Poor appetite
and disturbed sleep are not part of this withdrawal syndrome. Serotonin syndrome is not likely.
Sustained mydriasis occurs as an adverse effect in patients taking the drug
A patient is brought to the emergency department after taking a handful of TCA pills. The nurse will expect to provide what when caring for this patient?
Select all that apply.
a. Cardiac monitoring
b. Cholinesterase inhibitors
c. Gastric lavage and activated charcoal
d. Sedative medications
e. Procainamide
ANS: A , B , C
Patients who overdose with a TCA should have cardiac monitoring, because cardiac side effects can occur.
Cholinesterase inhibitors are given to counteract anticholinergic side effects.
Gastric lavage followed by activated charcoal can reduce absorption of the TCA.
Sedative drugs would only increase the sedative effects of the TCA.
Procainamide causes cardiac depression and is not recommended to treat TCA dysrhythmias
A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about:
C.
Patients with severe depression benefit more from a combination of drug therapy and psychotherapy than from either component alone, so this patient should ask the provider about
nondrug therapies.
Once a drug has been selected for treatment, it must be used for 4 to 8 weeks before its efficacy can be assessed.
Until a drug has been used at least 1 month without success, it
should not be considered a failure. Adding a second medication, changing to a different medication, and increasing the dose of this medication should all be reserved until the current drug is deemed to have failed after at least 4 weeks.
Which patients are candidates for MAOIs?
Select all that apply.
a. Patients who have not responded to SSRIs and TCAs
b. Patients with atypical depression
c. Patients with bulimia nervosa
d. Patients with hypotension
e. Patients with postpartum depression
ANS: A , B , C
A patient whose spouse has died recently reports feeling down most of every day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect?
A.
This patient has symptoms of major depression, which include depressed mood, loss of pleasure
in usual activities, insomnia, weight loss, and feelings of fatigue. For a diagnosis of major
depression, these symptoms must be present most of the day, nearly every day, for at least 2 weeks.
A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient?
B.
Patients taking an MAOI should be counseled to follow strict dietary restrictions and to avoid all
foods containing tyramine. Patients who consume such foods when taking an MAOI experience a
hypertensive episode.
A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a “drug holiday.” What teaching by the nurse would best describe a drug holiday?
B.
A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? Select all that apply.
a. Electroconvulsive therapy
b. Moderate use of alcohol to reduce stress
c. Psychotherapy
d. Regular sleep and exercise
e. Using a chart to monitor mood changes
ANS: C , D , E
BPD should be treated with a combination of drugs and adjunctive psychotherapy, because drug
therapy alone is not optimal.
Other measures, such as regular sleep and exercise and recognizing
early symptoms of mood change, help minimize extreme mood swings.
A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do?
A.
Divalproex sodium is used to control symptoms during manic episodes and can prevent relapse into mania.
It is less effective than lithium at reducing the risk of suicide.
It can cause thrombocytopenia, which results in bruising and is an indication for immediate drug withdrawal.
Weight gain can be serious and chronic.
All of these findings are an indication for withdrawing the drug and should be reported to the provider.
Until platelet levels determine whether the bruises are drug induced, it is not appropriate to ask the patient if they are self-inflicted
A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?
A.
Carbamazepine can cause several neurologic side effects early in treatment, including vertigo and
headaches.
Carbamazepine induces cytochrome P450 enzymes and
can accelerate its own metabolism, which would reduce the amount of drug and decrease side
effects, so an increased dose is not appropriate
c.
A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order?
B.
In almost all cases of mania, divalproex sodium is the drug of choice, except for euphoric mania
symptoms. Lithium is used to treat euphoric mania.
A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient?
D.
Patients taking lithium may experience reduced incorporation of iodine into the thyroid hormone, resulting in goiter and hypothyroidism. Administration of levothyroxine or withdrawing the lithium will reverse both.
A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient’s lithium level is 0.8 mEq/L. What will the nurse do?
B.
A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about
lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching?
D.
A patient with bipolar disorder is admitted to the hospital. The patient has been taking lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level, the nurse caring for this patient will anticipate orders for which laboratory tests?
Select all that apply.
a. Calcium level
b. Complete blood count with differential
c. Liver function tests
d. Renal function tests
e. Serum potassium
f. Thyroid function tests
ANS: B , D , F
Patients taking lithium can develop a mild, reversible leukocytosis, so annual CBC evaluation with
differential is recommended. Chronic lithium use is associated with degenerative changes in the
kidneys, so renal function should be assessed annually. Lithium can reduce the incorporation of
iodine into thyroid hormone and can inhibit thyroid secretion; therefore, thyroid hormone and
thyroid-stimulating hormone (TSH) levels should be measured annually.
The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse:
A.
A patient with bipolar disorder has frequent manic episodes alternating with depressive
episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to:
A.
Risperidone is an antipsychotic often used in conjunction with lithium to help manage symptoms
during manic episodes, regardless of whether psychotic symptoms occur.
The (fill in the blanke) were the first modern antipsychotic agents. (fill in the blank), our prototype of the low-potency neuroleptics, belongs to this family.
C.
The (fill in the blank) stand out because they are the family to which (fill in the blank), the prototype of the high-potency FGAs.
C.
Which drugs should be avoided because they activate dopamine receptors and might thereby counteract the beneficial effects of antipsychotic treatment. Select all that apply.
a. Levodopa
b. Bromocriptine
c. Benzotropine
d. Diphenhydramine
e. Amantadine
a, b
Which drugs are used to suppress symptoms associated with akathisia? Select all that apply.
a. cogentin
b. benadryl
c. propranolol
d. ativan
e. amantadine
a, c, d
Both drugs are vesicular monoamine transporter 2 (VMAT2) inhibitors and approved by the FDA to treat tardive dyskinesia.
A.
Which drugs should be avoided when prescribing haloperidone due to QT prolongation? Select all that applly.
a. amiodarone
b. atropine
c. erythromycin
d. adenosine
e. quinidine
a, c, e
Drugs that induce cytochrome P450 isoenzymes such as (fill in the blank) can lower clozapine levels. Select all that apply.
a. phenytoin
b. rifampin
c. ketoconazole
d. erythromycin
e. atropine
a, b
Drugs that inhibit P450 isoenzymes (fill in the blank) can raise clozapine levels. Select all that apply.
a. phenytoin
b. rifampin
c. ketoconazole
d. erythromycin
e. atropine
c, d.
Author
BodeS
ID
363869
Card Set
CH 26-28
Description
Chapter 26, “Antipsychotic Agents and Their Use in Schizophrenia”
Chapter 27, “Antidepressants”
Chapter 28, “Drugs for Bipolar Disorder”