Wednesday, January 13, 2021

Chapter 13: Antiparkinsonian Drugs

1. A psychiatric nurse should base care of patients diagnosed with Parkinson's disease and
patients demonstrating extrapyramidal side effects (EPSEs) caused by antipsychotic drug therapy
on the premise that symptoms
A. are the same for both problems
B. result from de cits in dopamine synthesis
C. result from acetylcholine and dopamine imbalance
D. are produced by neurodegeneration of the substantia nigra
ANS:
In both problems, acetylcholine and dopamine are not in balance. In Parkinson's disease, this
results from neurodegeneration of the substantia nigra, and in the case of EPSEs, the cause is
blockade of dopamine receptors in the basal ganglia. The other options are not valid premises

2. A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when
watching television. The nurse should use which term to document these ndings
A. Dystoni
B. Akathisi
C. Bradykinesi
D. Dyskinesi
ANS:
A patient with akathisia describes feeling restless, jittery, and unable to sit, and has restless legs
that feel better only if the patient is moving. Dystonia refers to sustained, twisted muscle
contractions. Dyskinesia refers to jerky motions. Bradykinesia refers to slow movement

3. A patient who is receiving an antipsychotic drug is restless, paces, and cannot sit still when
watching television. The patient says, "I couldn't sleep last night because I needed to pace." The
nurse's communication to the health care provider would be to suggest
A. prescribing an anticholinergic drug
B. discontinuing the antipsychotic drug
C. prescribing dopaminergic medication
D. using an antihistamine at bedtime to promote sleep
ANS:
The patient's motor symptoms can be assessed as akathisia. Anticholinergic medication provides
relief for some patients. The nurse should report the patient's symptoms to the health care
provider and anticipate the order to begin anticholinergic therapy. The other options do not
provide acceptable alternatives

4. A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The
nurse observes that the patient's eyes are rolled upward in a xed gaze. The nurse should assess
this nding as
A. akathisia
B. nystagmus
C. tardive dyskinesia

1
fi
A

fi
.

fi
.

fi
?

 Wednesday, January 13, 2021

D. an oculogyric crisis
ANS:
Oculogyric crisis is a speci c dystonia in which the eyes roll upward and remain in a xed
position. It results from involuntary muscle spasms and occurs early in the course of treatment.
Akathisia refers to motor restlessness. Nystagmus refers to a different type of abnormal eye
movements. Tardive dyskinesia refers to abnormal movements primarily of the face and mouth
muscle

5. A patient who has taken three doses of haloperidol (Haldol) suddenly cries out for help. The
nurse observes that the patient's eyes are rolled upward in a xed gaze. The nurse should
administer which drug from the patient's PRN list
A. Vitamin
B. Carbidopa (Sinemet
C. Benztropine (Cogentin
D. Amantadine (Symmetrel
ANS:
Benztropine is an anticholinergic that can be given orally or parenterally in case of an
emergency, such as oculogyric crisis or dystonic reaction. The other options would not relieve
the dystonia

6. A patient has taken perphenazine (Prolixin) for a year. The nurse observes lip smacking and
grinding teeth. Which tool should the nurse use to complete the assessment
A. AIM
B. EPS
C. SAD PERSON
D. CAGE questionnair
ANS:
AIMS is the Abnormal Involuntary Movement Scale. It was developed to screen for tardive
dyskinesia. EPSE refers to extrapyramidal side effects. The other tools are for assessing alcohol
abuse and suicidality

7. Which symptom of Parkinson's disease has the highest priority for nursing intervention
A. Tremo
B. Akathisi
C. Dysphagi
D. Tardive dyskinesi
ANS:
Dysphagia is dif culty swallowing. Because dysphagia can lead to a compromised airway, it is
the priority symptom among those listed

8. A patient diagnosed with Parkinson's disease begins levodopa therapy. The nurse understands
that administration of levodopa will
A. improve symptoms of Parkinson's disease by increasing dopamine in the CNS
B. improve symptoms of Parkinson's disease by decreasing levels of GABA
C. cause the patient to develop symptoms of depression and an unsteady gait

2
A

fi
S

fi
)

fi
?

fi
?

 Wednesday, January 13, 2021

D. lead to an increased risk of dysphagia
ANS:
Levodopa is converted to dopamine in the central nervous system (CNS), so its administration
will cause a reduction in the symptoms of Parkinson's disease related to dopamine de ciency.
The other options are incorrect. Levodopa increases dopamine levels. Levodopa is not associated
with changes in -aminobutyric acid (GABA). Levodopa will improve the patient's swallowing
ability and gait, and will reduce symptoms of depression

9. The nurse caring for a patient receiving a dopaminergic drug should assess the individual for
early symptoms of
A. psychosis
B. uid imbalance
C. tardive dyskinesia
D. labile hypertension
ANS: A
Dopamine excess is associated with schizophrenia. When dopaminergic drugs are given,
symptoms of psychosis might appear or be exacerbated. Tardive dyskinesia is associated with
dopamine de ciency. The other options are unrelated

10. Which statement by the nurse should be included in the teaching plan for patients receiving
anticholinergic agents
A. "Avoid eating foods high in tyramine.
B. "Do not abruptly stop taking the drug.
C. "Take oral medications on an empty stomach.
D. "Take a multivitamin and mineral supplement daily.
ANS:
Tapering off the drug over a 1-week period is advisable instead of abruptly stopping the drug.
This prevents uncomfortable withdrawal symptoms. Avoiding foods high in tyramine is
important teaching for patients taking monoamine oxidase inhibitors (MAOIs). The other
statements are not applicable

11. A patient began trihexyphenidyl (Artane) for treatment of drug-induced parkinsonism. Which
nding demonstrates a positive response to the medication
A. Blood pressure returns to patient's normal range
B. Gait is steady with decreased rigidity
C. Patient reports fewer feelings of depression
D. Patient has tremors with voluntary movement
ANS:
Gait disturbance, tremor, bradykinesia, and rigidity are symptoms of drug-induced parkinsonism.
Reduction in these symptoms constitutes a positive outcome. The other options are not expected
outcomes

3
fi
fl
A

fi
.

"

"

"

"

fi
 Wednesday, January 13, 2021
12. When developing a teaching plan for a patient receiving benztropine (Cogentin), a priority
consideration for the nurse is
A. anticholinergic drugs often cause blurred vision
B. urinary frequency may impair the patient's concentration
C. akathisia produced by the drug will make concentration dif cult
D. increased peristalsis might cause gastrointestinal distress and impair concentration
ANS:
CNS effects include confusion, drowsiness, and decreased memory and learning. This might
affect the patient's ability to learn. Anticholinergics do not cause urinary frequency, akathisia, or
increased peristalsis

13. A patient who takes haloperidol (Haldol) for a diagnosis of schizophrenia has a dystonic
reaction. Benztropine (Cogentin) 2 mg is given intramuscularly and then continued orally twice
daily. Three days later, the patient has fever, disorientation, and tachycardia. Select the best
analysis of this scenario
A. Tardive dyskinesia has emerged
B. Benztropine toxicity has developed
C. Extrapyramidal symptoms have returned
D. Dopaminergic benztropine effects have exacerbated the psychosis
ANS:
CNS hyperstimulation from anticholinergics causes fever, disorientation, excitement, agitation,
delirium, and hallucinations as well as cardiovascular, urinary, and gastrointestinal symptoms.
Collectively, these ndings indicate anticholinergic toxicity. The symptoms described in the
scenario do not accurately re ect any of the other options

14. An older adult patient who takes trihexyphenidyl (Artane) for drug-induced parkinsonism
begins taking diphenhydramine (Benadryl) for cold symptoms. The nurse should carefully
monitor this patient for
A. polyuri
B. tachycardia
C. constipation
D. hypothermia
ANS:
An anticholinergic effect on the vagus nerve causes tachycardia by removing the braking effect
on the sinoatrial node. The additive effects of trihexyphenidyl and diphenhydramine would be
likely to produce tachycardia, which could lead to cardiac decompensation in an older adult. In
terms of priority of problems, hyperthermia may occur later, after toxic levels of anticholinergics
had been ingested; constipation would be less life-threatening than cardiac decompensation.
Anticholinergics cause urinary retention, not polyuria

15. Patient teaching for a patient beginning an anticholinergic drug should include
A. limiting uid intake to 1000 ml/day
B. limiting strenuous activity on hot days
C. eating small, frequent meals to decrease nausea
D. wearing adequate clothing to prevent hypothermia

4
A

fl
.

fi
.

fl
:

fi
.

 Wednesday, January 13, 2021

ANS:
An anticholinergic side effect is decreased sweating. Sweating produces body cooling through
evaporation. Heat stroke is a greater possibility when the body cannot cool itself. The other
options have no particular relevance to anticholinergic therapy

16. Which patient receiving uphenazine (Prolixin) should be monitored most closely for
EPSEs
A. 35-year-old ma
B. 45-year-old woma
C. 74-year-old woma
D. Patient with a 5-year history of schizophreni
ANS: C
Women, older adults, patients with affective symptoms, and patients with rst episodes of
schizophrenia have a higher risk for EPSEs

17. An elderly nursing home resident has been diagnosed with type 2 diabetes, hypertension, and
dementia. The patient begins taking an antipsychotic drug for agitation. Tremor and bradykinesia
develop, so an anticholinergic is added to the drug regimen. Within 3 days the patient displays a
marked cognitive de cit. Which medication is the most likely cause of the cognitive change
A. Antihypertensiv
B. Anticholinergi
C. Antipsychoti
D. Antidiabeti
ANS:
Anticholinergic medications often produce cognitive changes in older adults. Although the other
medications listed might produce untoward effects, because the symptoms appeared after the
introduction of the anticholinergic, one would suspect this drug rst

18. Of the patients the nurse will see at the mental health center, which one should be assessed
most carefully for EPSEs
A. 59-year-old man with severe mental illness for 20 years; takes olanzapine (Zyprexa
B. 18-year-old woman with a rst episode of schizophrenia; takes haloperidol (Haldol
C. 26-year-old man with generalized anxiety disorder; takes lorazepam (Ativan
D. 30-year-old woman with depression; takes amitriptyline (Elavil
ANS: B
Risk factors for EPSEs include female gender, rst episode of schizophrenia, and use of a
traditional antipsychotic medication. The other patients are at lower or no risk because of taking
an atypical antipsychotic, a tricyclic antidepressant, and an antianxiety drug. Men are at lower
risk

19. Which medication from a patient's pharmacologic pro le is most likely to precipitate
neuroleptic malignant syndrome (NMS)
A. Diphenhydramine (Benadryl
B. Risperidone (Risperdal
C. Haloperidol (Haldol

5
.

fi
n

fl
fi
)

fi
a

fi
.

fi
)

fi
)

 Wednesday, January 13, 2021

D. Clozapine (Clozaril
ANS:
Haloperidol is a rst-generation high-potency antipsychotic drug. It has a greater risk for
producing NMS than atypical antipsychotic drugs. Diphenhydramine is not an antipsychotic
drug

20. Which neurotransmitter is most affected by an anticholinergic drug

A. Acetylcholin
B. Dopamin
C. Serotoni
D. GAB
ANS:
Anticholinergic drugs inhibit acetylcholine, thereby preventing stimulation of the cholinergic
excitatory pathways. The other neurotransmitters are associated with the etiology of
schizophrenia, anxiety, and depression

MULTIPLE RESPONS
..

1. When patients are treated with antipsychotic medications, a variety of side effects and adverse
reactions may occur. Sequence the following list in order of intervention priority, beginning with
the most urgent
A. Akathisi
B. Dystonic reactio
C. NM
D. Tardive dyskinesi
ANS: A, B, C,
NMS is considered a medical emergency requiring immediate intervention to save the patient's
life. A dystonic reaction is extremely uncomfortable and requires swift intervention to restore
patient comfort. Akathisia is uncomfortable but is not considered an emergency. Tardive
dyskinesia is a serious, possibly unremitting problem that might require discontinuing the
medication. It develops over weeks, months, or years

6
.

fi
n