Psychotherapeutic Agents

1.

A group of patients are being screened to see which patients would be the best candidate for a psychotherapeutic drug trial that helps people concentrate longer on activities. Which patient would be best suited for this trial?
A)
A 28-year-old salesperson who alternates between overactivity and periods of depression
B)
A 32-year-old hyperactive nursing student who cannot focus long enough to take a test
C)
A 55-year-old physician who suddenly falls asleep during the day without warning
D)
A 16-year-old youth who say he can make the light turn on by pointing at it and hears voices
Ans:
B

Feedback:

Attention-deficit disorders involve various conditions characterized by an inability to concentrate on one activity for longer than a few minutes. The nursing student needing accommodations has an attention-deficit disorder. The salesperson exhibits signs of mania, which are characterized by periods of extreme overactivity and excitement followed by extreme depression. The physician is experiencing narcolepsy, which is defined as daytime sleepiness and sudden periods of loss of wakefulness. The teenager is schizophrenic and is exhibiting paranoia, hallucinations, and delusions.

2.

What nursing intervention is appropriate for a 70-year-old female patient receiving lithium?
A)
Instruct the patient to use barrier contraceptives.
B)
Monitor blood glucose levels.
C)
Monitor fluid and sodium intake.
D)
Encourage the patient to check daily for weight loss.
Ans:
C

Feedback:

Older patients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly. A 70-year-old patient would not be concerned about the use of contraceptives. These drugs alone do not affect glucose levels. Weight loss is usually not associated with lithium use.

3.

A nurse is caring for a patient who is taking lithium for mania. The nurse’s assessment includes a notation of a lithium serum level of 2.4 mEq/L. The nurse anticipates seeing what?
A)
Fine tremors of both hands
B)
Slurred speech
C)
Clonic movements
D)
Nausea and vomiting
Ans:
C

Feedback:

Serum levels of 2 to 2.5 mEq/L may produce ataxia, clonic movements, possible seizures, and hypotension. Fine hand tremors, slurred speech, and nausea and vomiting are indicative of lithium levels less than 1.5 mEq/L.

4.

The nurse administers chlorpromazine intramuscularly to the preoperative patient who is extremely anxious about surgery in the morning. What priority teaching point will the nurse provide this patient?
A)
“Remain recumbent for at least 30 minutes after the injection.”
B)
“Do not eat for 1 hour after the drug is administered.”
C)
“Encourage fluids with the goal of 3,000 mL/d.”
D)
“Avoid eating avocados and oranges when taking this medication.”
Ans:
A

Feedback:

When giving a parenteral form of an antipsychotic, the patient should remain recumbent to decrease the risk of injury if orthostatic hypotension occurs. Eating after drug injection should not interfere with the drug’s absorption and although adequate hydration should be maintained there is no need to increase fluid intake. Avocados and oranges are not contraindicated in patients receiving this medication.

5.

The nurse is presenting an in-service at a children’s unit on hyperactivity. The nurse is told that a 6-year-old on the unit is being treated with methylphenidate (Ritalin). The presenting nurse talks about discharge teaching for this patient and the importance of monitoring what?
A)
Long bone growth
B)
Visual acuity
C)
Weight and complete blood count
D)
Urea and nitrogen levels
Ans:
C

Feedback:

Methylphenidate is associated with weight loss, bone marrow suppression, and cardiac arrhythmias. Weight, blood count, and cardiac function should be monitored regularly. The drug is not associated with renal dysfunction, visual changes, or growth retardation, so those values would not need to be regularly evaluated as part of drug therapy.

6.

The nurse is caring for a patient taking an oral neuroleptic medication. What is the nurse’s priority assessment to monitor for?
A)
Urge incontinence
B)
Orthostatic hypotension
C)
Bradycardia
D)
Tardive dyskinesia
Ans:
D

Feedback:

The nurse would monitor for and teach the patient and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Oral neuroleptic agents do not cause urge incontinence, orthostatic hypotension, or bradycardia.

7.

A psychotic patient is admitted through the emergency department. The physician has ordered chlorpromazine (Thorazine) 25 mg intramuscularly. After administration of the medication, what is the nurse’s priority to evaluate?
A)
The patient’s ability to ambulate
B)
Return of the patient’s appetite
C)
A decrease in psychotic symptoms
D)
Blood pressure and pulse
Ans:
C

Feedback:

The nurse will evaluate the effectiveness of the drug in diminishing psychotic symptoms because this is the purpose of administering the drug. Monitoring blood pressure, pulse, and appetite is part of all patient care but is not the priority evaluation criterion for this patient. The ability to ambulate and maintain adequate nutrition would be assessed but is not the priority evaluation for this patient.

8.

A patient diagnosed with bipolar disorder is to be discharged home in 48 hours. The nurse has completed patient teaching regarding the use of lithium. What statement by the patient indicates an understanding of their responsibility?
A)
“I will increase my salt intake.”
B)
“I will increase my fluid intake.”
C)
“I will decrease my salt intake.”
D)
“I will decrease my fluid intake.”
Ans:
B

Feedback:

To maintain a therapeutic lithium level, the patient must increase fluids. A decrease in consumption of fluids can lead to toxicity. An increase in salt intake can lead to lithium excretion and a decrease in effectiveness. A decrease in salt intake can cause retention, also leading to toxicity. Adequate salt intake is necessary to keep serum levels in therapeutic range but need not be increased or decreased.

9.

A patient has just been prescribed a phenothiazine. During patient teaching about this drug, what would be important for the nurse to tell the patient?
A)
“The urine can turn pink or reddish.”
B)
“The urine output will be decreased.”
C)
“Diarrhea can be an adverse effect.”
D)
“Hyperexcitability can occur.”
Ans:
A

Feedback:

Phenothiazines can cause the urine to turn pink or reddish. The patient should be informed that this is a simple color change and is not caused by blood in his urine. Decreased urine output is not associated with this drug. Constipation is usually an adverse effect of the drug. Drowsiness, not hyperexcitability, can occur.

10.

A patient, in the manic phase of bipolar disorder, is being discharged home on an antimanic drug. What antimanic drug is used for long-term maintenance of bipolar disorders?
A)
Aripiprazole (Abilify)
B)
Lamotrigine (Lamictal)
C)
Quetiapine (Seroquel)
D)
Ziprasidone (Geodon)
Ans:
B

Feedback:

Lamotrigine is used for long-term maintenance of bipolar disorders. Aripiprazole and ziprasidone are used for acute manic and mixed episodes of bipolar disorders. Quetiapine is used as adjunct or monotherapy for the treatment of manic episodes associated with bipolar disorder.

11.

A 16-year-old youth has just been diagnosed with schizophrenia. The parents ask the nurse what causes schizophrenia. What would be the nurse’s best response?
A)
“Schizophrenia is caused by pain that the brain perceives.”
B)
“Schizophrenia is thought to occur due to trauma experienced in childhood.”
C)
“Schizophrenia is thought to reflect a fundamental biochemical abnormality.”
D)
“Schizophrenia is caused by seizure activity in the brain.”
Ans:
C

Feedback:

This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality. Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. Schizophrenia is not caused by pain, childhood trauma, or seizure activity.

12.

A patient on chlorpromazine is feeling better and decides they no longer need their medication. The nurse teaches the patient that abrupt withdrawal of a typical antipsychotic medication can result in what?
A)
Insomnia
B)
Tardive dyskinesia
C)
Somnolence
D)
Constipation
Ans:
A

Feedback:

Sudden withdrawal can cause cholinergic effects such as diarrhea, gastritis, nausea, vomiting, dizziness, arrhythmias, drooling, and insomnia. Abrupt withdrawal of a typical antipsychotic generally does not cause tardive dyskinesia, somnolence, or constipation.

13.

A patient’s medication has been changed to clozapine (Clozaril). The nurse evaluates this patient for which life-threatening adverse effect?
A)
Renal insufficiency
B)
Emphysema
C)
Neuroleptic malignant syndrome
D)
Cerebrovascular accident (CVA)
Ans:
C

Feedback:

Neuroleptic malignant syndrome can be a life-threatening adverse effect of atypical non-phenothiazines. Renal insufficiency, emphysema, and CVA are not commonly seen adverse effects of atypical non-phenothiazines.

14.

The nurse is caring for an adolescent patient who began taking an antipsychotic drug last month to treat newly diagnosed schizophrenia. The drug has not been effective and the mother asks the nurse if this means the adolescent’s symptoms cannot be controlled by drugs. What is the nurse’s best response?
A)
Patients commonly have to try different drugs until the most effective drug is identified.
B)
Some patients do not respond to drugs and have to rely solely on behavior therapy.
C)
Most likely your child was not taking the medication properly as prescribed.
D)
He may need to take multiple drugs before effects will be seen that control his symptoms.
Ans:
A

Feedback:

A patient who does not respond to one drug may react successfully to another agent. Responses may also vary because of cultural issues. The selection of a specific drug depends on the desired potency and patient tolerance of the associated adverse effects. It is not common to have a patient who does not demonstrate some improvement from medications so it would be incorrect to tell the mother the child won’t respond to any drug after trying only one medication. There is no indication the drug was taken improperly and even properly administered drugs will not work on all patients. Multiple drug therapy is not indicated by the question.

15.

Haloperidol is a “typical” antipsychotic drug. What adverse effect is associated with this drug?
A)
Bradycardia
B)
Bradypnea
C)
Extrapyramidal effects
D)
Hypoglycemia
Ans:
C

Feedback:

Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, bradypnea, or hypoglycemia.

16.

The pharmacology instructor is explaining to their class the difference between the “typical” and the “atypical” groups of antipsychotic drugs. What medication would the instructor explain to the students has fewer extrapyramidal effects and greater effectiveness than older antipsychotic drugs in relieving negative symptoms of schizophrenia?
A)
Chlorpromazine (Thorazine)
B)
Clozapine (Clozaril)
C)
Thiothixene (Navane)
D)
Haloperidol (Haldol)
Ans:
B

Feedback:

Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. Chlorpromazine is a typical antipsychotic, one of the older drugs, which does cause the extrapyramidal effects. Navane is part of the thioxanthene group of typical antipsychotics. This group of drugs has low sedative and hypotensive effects but can cause extrapyramidal effects. Haloperidol is a butyrophenone group drug used in psychiatric disorders. Usually, it produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects.