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Antipsychotics & Anxiolytics
Terms in this set (37)
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
they should consider discussing adding another medication.
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.
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?
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.
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?
Hold the dose and notify the provider of these medication adverse effects.
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.
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?
a. Contact the provider to discuss changing to benztropine (Cogentin).
Notify the provider of these symptoms and request an order for lorazepam (Ativan).
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.
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?
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.
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?
Changing to a liquid form of the mediation
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.
The nurse is preparing to administer intramuscular haloperidol (Haldol) to a patient who has schizophrenia. What action will the nurse perform?
Use the Z-track method and inject the medication into deep muscle tissue.
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.
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?
"I should use a heating pad to treat muscle spasms while taking this medication."
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.
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?
"You may experience weight gain, drowsiness, and headaches."
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.
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?
Suggest that the family member contact the provider to discuss an order for a benzodiazepine.
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.
. A patient has been taking risperidone (Risperdal) for 2 weeks. The patient reports drowsiness and headache. What will the nurse do?
Reassure the patient that these are common side effects of the medication.
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.
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
understand that the patient has developed tolerance to this drug.
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.
A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take?
Reassure the patient that this is a harmless side effect of this medication.
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.
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?
"Therapeutic effects may not be evident for another week."
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.
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?
Kava kava may increase the risk and severity of dystonia when taken with phenothiazines.
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?
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.
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 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.
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?
"I should try psychotherapy or a support group in addition to the medication."
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.
The client is known to have overdosed on a benzodiazepine medication. The nurse anticipates that which medication will most likely be ordered?
Romazicon is considered to be the benzodiazepine antagonist.
The nurse is preparing a dose of Mellaril. What is the highest priority intervention for the nurse while preparing the dose?
Avoid spilling the liquid on exposed skin.
If Mellaril is allowed to come in contact with exposed skin, contact dermatitis can result.
The client is an older adult who has been placed on Librium. The nurse recognizes that the dose of the drug _____ for this client.
should be decreased
The dose of Librium should be decreased for an older adult.
The client has been placed on Risperdal. He complains to the nurse of experiencing headaches. The highest priority action on the part of the nurse is to recognize that this is a(n) ________ the medication and call the physician.
expected side effect of
Headaches are an expected side effect of treatment with Risperdal.
The client has been placed on Ativan. The nurse is planning a client instructional session. Which herbal preparation should the nurse emphasize that the client avoid taking with Ativan?
Kava kava in combination with Ativan will increase the sedation effects of the Ativan.
A client is receiving an antipsychotic agent. Which laboratory result is of most concern?
Serum medication level below normal limits
A serum medication level below normal limits is a concern because subtherapeutic levels may allow for breakthrough psychotic symptoms.
A client is ordered to receive fluphenazine (Prolixin) to manage the psychotic symptoms of schizophrenia. The nurse assesses for which signs of anticholinergic effects?
Urinary retention and dry mouth
Urinary retention and dry mouth are the side effects of anticholinergics.
A client is brought to the emergency department unconscious. The client's spouse tells the nurse that the client was found in bed with an empty pill bottle nearby. The client's spouse believes that there were 20 to 25 diazepam (Valium) pills in the bottle. What represents an appropriate nursing priority?
Lavage the stomach using a nasogastric tube.
Because the client is unconscious, this is the correct course of action.
A client is ordered to receive diazepam (Valium). The nurse is teaching the client about her medication. Which information would be included in the teaching plan?
The client may develop tolerance after prolonged use.
Patients may become tolerant to Valium.
A client is taking an anxiolytic agent secondary to grief-related anxiety. The client questions the nurse about abruptly discontinuing these agents. The nurse's response is based on the knowledge that, when discontinuing these medications:
the dosage must be tapered to avoid withdrawal.
Discontinuing anxiolytic agents abruptly may lead to withdrawal symptoms.
A client is experiencing severe EPS effects. In addition to administering a lower dose of the antipsychotic agents, the nurse would anticipate administering a medication in which category?
Anticholinergics, such as benztropine (Cogentin), are used to decrease the EPS effects associated with antipsychotic medications.
A client is ordered to receive chlordiazepoxide (Librium) for severe anxiety. The nurse monitors for which symptoms of severe anxiety or panic attack?
Dyspnea and heart palpitations
Dyspnea and heart palpitations are symptoms of severe anxiety; also experienced is chest pain, dizziness, or faintness.
Client teaching is important when antipsychotics are taken after discharge from the hospital. Nursing instruction should include giving which information to the client and family?
The drugs should not be discontinued without consulting a healthcare provider.
Antipsychotic medications affect symptoms while they are used. If they are stopped, the symptoms will recur.
Extrapyramidal symptoms are a side effect of perphenazine (Trilafon). The nurse should assess and observe for which sign of akathisia?
Restlessness and constant moving about
Akathisia is described as restless, agitated movement.
A client has been taking a phenothiazine for 1 week. She contacts the crisis intervention clinic because she is still having symptoms. The nurse's response is based on the premise that the desired effects usually take _____ to manifest.
3 to 6 weeks
The client may feel some effect in 7 to 10 days, but generally it takes 6 weeks for the medication to take full effect.
A client is to be treated with Prolixin. The highest priority nursing intervention related to the client's vital signs is to monitor for:
The phenothiazine group's major side effect is hypotension.
What is a common side effect for which the nurse must monitor during administration of both phenothiazine and non-phenothiazine medications?
These medications are known for their extrapyramidal symptoms.
The client has been diagnosed with schizophrenia and is exhibiting a loss of function and motivation. The nurse recognizes that these symptoms are categorized as:
Negative symptoms are manifested as the inability to initiate voluntary motor function. The others are considered positive symptoms.
A client is to receive a dose of fluphenazine hydrochloride (Prolixin) by intramuscular injection. What is the most important nursing intervention related to the injection?
Administer the drug using Z-tracking.
This medication is very viscous and requires Z-track, deep IM injection to avoid muscle irritation.
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