Wednesday, January 13, 2021

Chapter 14: Antipsychotic Drugs

1. A patient receiving a traditional high-potency antipsychotic medication should be closely
monitored for
A. adrenergic effects
B. extrapyramidal side effects
C. anticholinergic side effects
D. changes in pain perception
ANS:
High-potency antipsychotics are more likely to cause extrapyramidal side effects (EPSEs) than
low-potency antipsychotics. The other effects are not related to potency classi cation

2. A patient receives a traditional low-potency antipsychotic medication. The nurse should assess
closely for
A. urinary frequenc
B. urinary retentio
C. hypertensio
D. diarrhe
ANS: B
Low-potency antipsychotics tend to cause anticholinergic side effects. Urinary retention and
other anticholinergic effects are important ndings for which the nurse should be alert. The other
effects would not be expected

3. A patient diagnosed with schizophrenia has taken thiothixene (Navane) 5 mg/day for 4 years
with good symptom control. Today, the patient is admitted with paranoia and auditory
hallucinations. The nurse should determine if the patient's symptoms are related to
A. not taking the drug as prescribe
B. activation of serotonin receptor
C. development of tolerance to the dru
D. an expected illness-exacerbation cycle
ANS:
When a patient does not respond to a drug, or when symptoms reappear after a good response to
the drug, the nurse should assess for compliance. Is the patient taking the drug? Is the patient
taking less of the drug than ordered? The other options are less relevant or of no value

4. When assessing for a positive outcome to drug therapy with uphenazine (Prolixin), the nurse
would look primarily for improvement in
A. hallucination
B. range of affec
C. personal hygien
D. social interaction
ANS:

1
A

fi
fl
fi
:

 Wednesday, January 13, 2021

Fluphenazine, a typical antipsychotic, will produce improvement in the positive symptoms
associated with schizophrenia, such as hallucinations. Less improvement is expected in negative
symptoms such as affect, activity, and grooming

5. A patient diagnosed with schizophrenia tells the clinic nurse, "I stopped taking my
antipsychotic medication two days ago." Previously, the patient was compliant and had good
symptom control. What assessment nding would the nurse expect at this visit
A. mood instabilit
B. Paranoid delusion
C. No evidence of symptom
D. Mental clouding and confusio
ANS: C
Antipsychotic drugs accumulate in fatty tissue and are released slowly. This explains why
symptoms might still be controlled for several days after discontinuing the drug

6. A patient is diagnosed with neuroleptic malignant syndrome. Which medication from the
patient's pharmacologic pro le most likely led to this problem
A. Divalproex sodium (Depakote
B. Amitriptyline (Elavil
C. Haloperidol (Haldol
D. Paroxetine (Paxil
ANS: C
Neuroleptic malignant syndrome is more likely to occur in patients taking traditional high-
potency antipsychotic drugs. The distracters are not antipsychotic drugs

7. During a psychiatric emergency, a patient is given a traditional antipsychotic drug

intramuscularly and placed in seclusion. Over the next 2 hours, concerns for safety and
physiologic stability require that the patient be carefully monitored for
A. tardive dyskinesi
B. gastrointestinal hyperactivity
C. drug-induced parkinsonian movements
D. orthostatic hypotension and cardiac arrhythmias
ANS: D
Hypotension is the major antiadrenergic effect of antipsychotic drugs. It is related to the blocking
of 1-receptors on peripheral blood vessels, preventing the vessels from constricting automatically
to positional changes. Hypotension is frequently noted following intramuscular administration
and is of concern because it relates to patient safety and injury from falls. Cardiac arrhythmias
may also occur, jeopardizing the patient's physiologic stability. Drug-induced parkinsonism and
tardive dyskinesia develop over time

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
A. all vital sign
B. Urinary output

fi
s

fi
.

 Wednesday, January 13, 2021

C. AIMS scale
D. Temperatur
ANS:
A traditional antipsychotic medication administered intramuscularly might produce the marked
antiadrenergic side effect of hypotension, thus making blood pressure an important assessment. It
may also precipitate cardiac arrhythmias, so monitoring pulse and respirations is important.
Decreased urinary output is related to anticholinergic side effects and would not be a priority
assessment during the rst 2 hours. The AIMS scale assesses for tardive dyskinesia, a late
complication of antipsychotic therapy. Temperature assessment is relevant if assessing for
neuroleptic malignant syndrome, a complication that develops after several doses of
antipsychotic medication

9. After an unsuccessful trial with uphenazine (Prolixin), a patient's medication was changed to
tri uoperazine (Stelazine). Three months later the patient is still hallucinating and delusional.
What is the most likely explanation for the persistent symptoms
A. Tri uoperazine (Stelazine) is a low-potency antipsychotic, and the patient might need higher
doses
B. The patient has not taken tri uoperazine (Stelazine) long enough to decrease symptoms
signi cantly
C. Delusions and hallucinations are negative symptoms of schizophrenia that do not respond to
traditional antipsychotic medications
D. Both uphenazine (Prolixin) and tri uoperazine (Stelazine) are traditional antipsychotics, and
the patient does not respond well to this class of drug
ANS: D
When a trial of a drug produces little change in symptoms and a new drug is to be prescribed, the
best plan is to use a drug of another class, because the response to a drug of the rst class will
usually be poor. The other options are misleading

10. Thioridazine (Mellaril) is prescribed for a 72-year-old patient with a psychiatric disorder. It is
most critical for the nurse to obtain information about preexisting
A. cataract
B. heart diseas
C. diabetes mellitu
D. chronic bronchiti
ANS:
The anticholinergic and antiadrenergic effects of this drug might produce re ex tachycardia and/
or arrhythmias. Individuals with known heart disease must be carefully evaluated before and
during therapy. The remaining options are not in uenced as directly by this medication

11. When a patient is taking a traditional antipsychotic medication, the nurse should assess
carefully for EPSEs, particularly
A. Akathisi
B. Mydriasi
C. Hypotensio
D. Constipatio

3
fl
fi
.

fl
A

fl
s

fi
.

fl
:

fl
.

fl
fl
.

fl
fi
.

 Wednesday, January 13, 2021

ANS:
It is estimated that more than 25% of all patients receiving antipsychotic medication experience
akathisia, a subjective feeling of restlessness and jitteriness and a desire to stand or walk.
Akathisia typically manifests itself early in treatment. The other options are not considered
EPSEs

12. A patient who takes haloperidol (Haldol) 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
A. The PRN medication has not yet taken effect
B. The patient needs an additional PRN dose of haloperidol to control the rising agitation
C. The patient was experiencing akathisia, which worsened after receiving the PRN medication.
D. The nurse should consider an adjunctive dose of an antianxiety drug such as lorazepam
(Ativan)
ANS: C
Akathisia is characterized by subjective feelings of restlessness accompanied by the inability to
sit still and the need to pace. It is an EPSE of antipsychotic medication, made more intense by
higher doses of medication and use of PRN doses. It is unnecessary to change to a more sedating
drug. The addition of an antianxiety drug is unnecessary

13. The patient receiving antipsychotic medication who should be most carefully monitored for
development of neuroleptic malignant syndrome is the individual who
A. has a history of hypothermia
B. has an elevated serum prolactin level
C. is beginning treatment with a high-potency drug
D. has taken antipsychotics for mor than 6 month
ANS:
Neuroleptic malignant syndrome (NMS) is more common among patients receiving high-
potency drugs. NMS is associated with hyperthermia and occurs within the rst 3 to 9 days of
administration. Prolactin levels and NMS are not causally related

14. An adult diagnosed with schizophrenia was started on clozapine (Clozaril) 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
A. Recognize the alterations in vital signs as typical for early therapy, and administer the
medication.
B. Hold the medication, notify the health care provider.
C. Give the drug and continue to monitor vital signs every 4 hours.
D. Postpone the dose until vital signs are normal
ANS:

4
A

fi
.

 Wednesday, January 13, 2021

Clozapine might cause agranulocytosis, a potentially fatal illness. Any symptoms or signs of
infection raise suspicion and call for investigation of white cell differential counts. Clozapine
should be withheld until the white blood cell (WBC) count and absolute neutrophil count (ANC)
are known. Administering the drug has the potential for further lowering the WBC count and
ANC

15. Which third-generation antipsychotic medication acts by stabilizing the dopamine system
A. Aripiprazole (Abilify
B. Ziprasicone (Geodon
C. Quetiapine (Seroquel
D. Risperidone (Risperdal
ANS: A
Aripiprazole is novel in action. It acts by stabilizing the dopamine system through partial
agonism of dopamine D2 and 5-HT2. The other drugs are atypical antipsychotics, which have
other modes of action that produce therapeutic effects

16. A patient is being switched to clozapine (Clozaril) from therapy using a traditional
antipsychotic. The patient asks, "What's the advantage of the new drug?" Select the nurse's best
response
A. "It is much less expensive.
B. "It has a lower risk for seizure activity.
C. "It is sometimes effective when other drugs fail.
D. "It has a lower risk for causing blood abnormalities.
ANS:
Clozapine is often effective against refractory schizophrenia. The distracters are incorrect
statements

17. Which drug would a nurse expect to produce a favorable response for both positive and
negative symptoms
A. Haloperidol (Haldol
B. Risperidone (Risperdal
C. Fluphenazine (Prolixin
D. Tri uoperazine (Stelazine
ANS:
Risperidone is an atypical antipsychotic. It has proven to be effective in managing both positive
and negative symptoms of schizophrenia in many patients. The other drugs are traditional
antipsychotics, all of which are more effective against positive symptoms

18. A patient has taken a traditional antipsychotic medication for several years. The nurse
observes involuntary tongue movements and lip smacking. The nurse should
A. notify the health care provider
B. administer PRN doses of an anticholinergic dru
C. offer a reward when the patient stops these motion
D. counsel the patient that the movements are annoying to other
ANS:

5
.

fl
A

"

"

"

"

 Wednesday, January 13, 2021

These symptoms suggest the presence of tardive dyskinesia and should be reported to the health
care provider, who will probably discontinue the drug or change to an atypical drug. The
movements are involuntary. Tardive dyskinesia does not respond to anticholinergic

19. A patient who takes a traditional antipsychotic medication says, "I feel shaky and very
warm." The patient is diaphoretic. The nurse should further assess for what complication
A. Acute dystoni
B. Tardive dyskinesi
C. Drug-induced parkinsonis
D. NM
ANS:
NMS is a relatively rare but serious reaction to antipsychotic therapy. It is characterized by
muscle rigidity, fever, sweating, autonomic instability, altered levels of consciousness, and
possible death. The data given in the scenario are not consistent with other options

20. 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 rst action
A. Take the patient's vital signs
B. Position the patient in the semi-Fowler's position
C. Begin oxygen by nasal cannula at 2 L/min
D. Place the patient on one-to-one supervisio
ANS: A
The signs and symptoms suggest that the patient might be experiencing NMS. The rst action
would be to check vital signs. NMS produces elevated temperature, blood pressure uctuations,
and irregular heart rate in addition to muscle rigidity and altered levels of consciousnes

21. A patient who takes a traditional antipsychotic medication says, "I feel shaky and very
warm." The patient is diaphoretic. The nurse anticipates that the health care provider will
prescribe
A. olanzapine (Zyprexa)
B. dantrolene (Dantrium)
C. benztropine (Cogentin)
D. chlorpromazine (Thorazine)
ANS:
Dantrolene is a drug of choice for treating NMS. It is a direct-acting skeletal muscle relaxant that
will be administered for 8 to 12 days after improvement

22. A nurse reviews laboratory reports for a patient who has taken clozapine (Clozaril) for 1 year.
Which value would prompt the nurse to notify the health care provider of the need to suspend
treatment? The total WBC count and granulocyte count are
A. 2900 cells/mm3 and 1450 cells/mm
B. 3500 cells/mm3 and 1850 cells/mm3
C. 4000 cells/mm3 and 2000 cells/mm3

6
D

fi
:

fi
fl
s

 Wednesday, January 13, 2021

D. 4500 cells/mm3 and 2500 cells/mm3
ANS: A
These values indicate that leukopenia is present. Agranulocytosis is a sometimes fatal side effect
of clozapine. The other values are above baseline

23. A nurse cares for four patients diagnosed with schizophrenia who are receiving antipsychotic
medication. Which patient will receive the nurse's priority attention? The patient
A. with diaphoresis and a temperature of 104°
B. who reports feelings of neck and shoulder stiffnes
C. who reports auditory hallucinations of church bells clanging loudl
D. who chants, "I am the messiah, delivered to earth from the heavens above
ANS: A
These ndings indicate NMS, a serious adverse reaction to antipsychotic medication. The other
ndings may be signi cant, but are a lesser priority

24. A patient is to be discharged on a maintenance dose of a high-potency antipsychotic

medication. Which remark indicates that discharge teaching about the medication was effective
A. "I will be able to have a few glasses of wine.
B. "I have to use sun block when I go to the beach.
C. "It is important for me to dress warmly in all seasons.
D. "If I miss a dose, I will take an extra one the next day.
ANS: B
The patient understands that antipsychotics cause photosensitivity and sunburn with minimal
exposure to the sun. The other remarks suggest that the patient does not understand the additive
effects of the antipsychotics and other central nervous system depressants, and does not
understand what to do in the event of a missed dose

25. A 60-year-old female patient who has taken traditional antipsychotic medication for 20 years
should be screened for
A. osteoporosi
B. metabolic syndrom
C. polycystic ovary disease
D. NM
ANS:
Traditional antipsychotic medications increase prolactin levels, placing patients at risk for
development of osteoporosis. Atypical antipsychotics increase the risk for metabolic syndrome.
Screening for NMS and polycystic ovary disease are not indicated

26. Which information should the nurse include in the teaching plan for a patient receiving
clozapine (Clozaril)
A. "Abstain from using tobacco products.
B. "Increase your daily carbohydrate intake.
C. "Notify your health care provider if you start drooling.
D. "You will need monthly electrocardiographic tracings done.
ANS:

7
fi
A

fi
S

fi
e

"

"

"

"

"

"

"

"

"

 Wednesday, January 13, 2021

Use of tobacco products speeds metabolism of clozapine in the liver, reducing the clozapine level
and diminishing its effectiveness in reducing symptoms. Increasing carbohydrate intake is
contraindicated because of the possibility of developing metabolic syndrome. Drooling is a
common side effect. Monthly electrocardiographic tracings are unnecessary, but annual or
semiannual tracings might be suggested, because arrhythmia development is possible

MULTIPLE RESPONS
..

1. Patient teaching for individuals taking risperidone (Risperdal) should include (select all that
apply)
A. measures to prevent episodes of orthostatic hypotension
B. strategies to maintain uid and electrolyte balance
C. importance of determining monthly WBC count
D. dietary management to avoid weight gain
E. self-monitoring for facial tics
ANS: A, D
Risperidone causes orthostatic hypotension, sedation, and appetite stimulation. When taken in
moderate doses, its favorable side effect pro le suggests that teaching regarding EPSEs and
tardive dyskinesia can be minimal. Fluid and electrolyte imbalance and agranulocytosis are not
usual side effect

2. When comparing major differences between traditional and atypical antipsychotic drugs,
which statements are correct? Select all that apply
A. Traditional antipsychotic drugs produce more EPSEs
B. Traditional antipsychotic drugs are more likely to produce weight gain
C. Traditional antipsychotic drugs alter dopamine and serotonin transmission
D. Atypical medications have a greater therapeutic effect on both positive and negative
symptoms
E. Atypical medications are more likely to cause tardive dyskinesia
ANS: A,
Traditional antipsychotics have a higher incidence of EPSEs and tardive dyskinesia. Atypical
antipsychotics are more likely to produce weight gain and alter dopamine and serotonin
transmission

8
.

fl
.

fi
.