Unit 5 Pharm Chapter 22

Question 1

The nurse just administered chlorpromazine to a client by intramuscular injection. The nurse should instruct the client to:

A) stay in bed for the next half hour.

B) expect urinary urgency for the next few hours.

C) perform deep breathing and coughing exercises.

D) report any new onset of chest pain promptly.

Answer 1

A) stay in bed for the next half hour.

Rationale:After administering parenteral forms of antipsychotic agents, the nurse should keep the client recumbent in bed for approximately 30 minutes to reduce the risk of orthostatic hypotension. Urinary urgency and chest pain are not anticipated adverse effects, so would not need to be addressed. There is no obvious need for the client to perform deep breathing and coughing exercises.

Question 2

Mania is characterized by extreme overactivity and excitement.

A) FALSE

B) TRUE

Answer 2

B) TRUE

Rationale:Mania is characterized by periods of extreme overactivity and excitement (at the opposite pole from depression) and occurs in individuals with bipolar disorder who experience a period of depression followed by a period of mania. The cause of mania is not understood, but it is thought to be an overstimulation of certain neurons in the brain.

Question 3

The nurse determines the client may be displaying extrapyramidal effects on the basis of what assessment findings? Select all that apply.

A) The client’s gait is uncoordinated.

B) The client has an aversion to bright lights.

C) The client has been experiencing insomnia and early morning awakening.

D) The client exhibits hand tremors.

E) The client has had uncharacteristic verbal outbursts.

Answer 3

A) The client’s gait is uncoordinated.
D)The client exhibits hand tremors.

Rationale:Ataxia, parkinsonism, and tremors are signs and symptoms of extrapyramidal effects. Insomnia and photophobia are adverse effects of typical antipsychotic medications but are not indicative of extrapyramidal effects. Verbal outbursts are unlikely to be related to drug therapy.

Question 4

A client has a serum lithium level of 2.2 mEq/L. The nurse should expect to assess what symptoms? Select all that apply.

A) Seizures

B) Hypotension

C) Hyperreflexia

D) Full body rash

E) Epistaxis

Answer 4

A) Seizures
B) Hypotension
C) Hyperreflexia

Rationale:Hypotension, hyperreflexia, and seizures would be noted with a serum lithium level between 2.0 and 2.5 mEq/L. Rash and epistaxis are not associated with lithium toxicity.

Question 5

A client with schizophrenia will exhibit fluctuations in mood swings from depression to mania.

A) FALSE

B) TRUE

Answer 5

A) FALSE

Rationale:Schizophrenia is characterized by hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Bipolar disorder involves extremes of depression followed by hyperactivity and excitement (mania).

Question 6

A 14-year client with symptoms of psychosis has been prescribed pimozide 0.05 mg/kg PO at bedtime. The client weighs 154 lbs. How many milligrams of pimozide should the client be administered?
____________mg

Answer 6

3.5mg

Rationale:The client’s weight in kilograms is 70 kg (154 ÷ 2.2). The prescription is for 0.05 mg/kg, and 0.05 × 70 = 3.5 mg.

Question 7

During periods of dehydration, the client is at risk for lower serum lithium levels.

A) FALSE

B) TRUE

Answer 7

A) FALSE

Rationale:During periods of sodium depletion or dehydration, the kidney reabsorbs more lithium into the serum, often leading to toxic levels.

Question 8

A nurse is reviewing a bipolar client’s serum lithium level, which is 1.8 mEq/L. What is the nurse’s best action?

A) Facilitate a transfer to the intensive care unit.

B) Inform the prescriber and perform a focused respiratory assessment.

C) Inform the prescriber and monitor for GI and CNS effects.

D) Contact the prescriber and request a supplementary dose of lithium.

Answer 8

C) Inform the prescriber and monitor for GI and CNS effects.

Rationale:Therapeutic serum lithium levels range from 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic but would be unlikely to warrant admission to intensive care. The nurse should report the finding and assess for common adverse effects of toxicity, which include GI and CNS effects more often than respiratory effects.

Question 9

A client taking lithium receives haloperidol. What data should indicate to the nurse that the client is experiencing encephalopathic syndrome? Select all that apply.

A) The client’s white cell count is greatly elevated.

B) The client is uncharacteristically disoriented.

C) The client is much weaker than normal.

D) The client’s hands are tremulous when at rest.

E) The client’s random blood glucose level is 145 mg/dL (8.0 mmol/L).

Answer 9

A) The client’s white cell count is greatly elevated.
B) The client is uncharacteristically disoriented.
C) The client is much weaker than normal.
D) The client’s hands are tremulous when at rest.

Rationale:A lithium–haloperidol combination may result in an encephalopathic syndrome, consisting of weakness, lethargy, confusion, tremors, extrapyramidal symptoms, leukocytosis, and irreversible brain damage. Glucose levels are not affected by encephalopathic syndrome.

Question 10

While caring for a client receiving antipsychotic therapy, the nurse observes cogwheel rigidity, tremors, and drooling. The nurse interprets this as what?

A) Akathisia

B) Pseudoparkinsonism

C) Tardive dyskinesia

D) Dystonia

Answer 10

B) Pseudoparkinsonism

Rationale:Pseudoparkinsonism is manifested by muscle tremors, cogwheel rigidity, drooling, shuffling gait, and slow movements. Tardive dyskinesia involves abnormal muscle movements such as lip smacking, tongue darting, chewing movements, and slow aimless arm and leg movements. Dystonia is manifested by spasms of the tongues, neck, back, and legs.

Question 11

The nurse is providing drug teaching for a client newly prescribed a typical antipsychotic medication. What teaching points will the nurse include while talking with this client? Select all that apply.

A) Spending time outside in the sunshine will improve your mood.

B) Inform all health providers of the medications you take.

C) Never drink alcohol while taking this medication.

D) Increased appetite can cause obesity, so take care to eat a healthy diet.

E) Avoid use of the herb evening primrose.

Answer 11

B) Inform all health providers of the medications you take.
C) Never drink alcohol while taking this medication.
E) Avoid use of the herb evening primrose.

Rationale:The herb primrose can worsen symptoms and increase hyperexcitability, so it should be avoided. There are several drugs that are contraindicated including beta-blockers and anticholinergics, so the client should be sure to consult with the provider or pharmacist before taking any over-the-counter or newly prescribed medications. Alcohol is contraindicated because it worsens CNS effects of the drug. Decreased appetite or anorexia is more likely that an increase in appetite, so the client should be taught how to increase calorie intake. Photophobia is a common adverse effect, so client should be taught to avoid sunlight or wear dark glasses.

Question 12

A nurse is planning the care of a client who has been diagnosed with schizophrenia and who will begin treatment with a typical antipsychotic. The nurse should identify what nursing diagnosis?

A) Risk for imbalanced body temperature related to hypothalamic suppression

B) Risk for injury related to central nervous system depression

C) Risk for impaired liver function related to hepatotoxicity

D) Bowel incontinence related to gastrointestinal adverse effects

Answer 12

B) Risk for injury related to central nervous system depression

Rationale:Typical antipsychotics cause significant sedation, which creates a risk for injury. These drugs are not severely hepatotoxic and are not linked to bowel incontinence. Thermoregulatory disruptions are similarly unlikely.

Question 13

A client’s medication regimen includes lithium. What assessment finding would suggest a therapeutic effect?

A) The client refrains from aggressive or violent outbursts.

B) The client denies audio or visual hallucinations.

C) The client denies severe depressive or manic episodes.

D) The client states that he or she now have purpose and direction in life.

Answer 13

C) The client denies severe depressive or manic episodes.

Rationale:Lithium is used to treat bipolar disorder, which is characterized by manic and depressive episodes. Lithium is intended to interrupt this cycle. Hallucinations, violence, and hopelessness are not core characteristics of bipolar disorder.

Question 14

What client is being treated with a typical antipsychotic?

A) A client with schizophrenia who received paliperidone 6 mg PO daily

B) An agitated client who was given haloperidol during acute psychosis

C) A client whose thought disorder requires clozapine 25 mg PO b.i.d.

D) A client who recently began taking ziprasidone

Answer 14

B) An agitated client who was given haloperidol during acute psychosis

Rationale:Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.

Question 15

What assessment finding should lead the nurse to suspect that a client receiving antipsychotic therapy is developing tardive dyskinesia?

A) Lip smacking

B) Disorientation

C) Urinary incontinence

D) Abnormal eye movements

Answer 15

A) Lip smacking

Rationale:Lip smacking is associated with tardive dyskinesia. Abnormal eye movements are associated with dystonia. Tardive dyskinesia is not associated with disorientation or urinary incontinence.

Question 16

Typical antipsychotics block dopamine receptors.

A) FALSE

B) TRUE

Answer 16

B) TRUE

Rationale:The antipsychotic drugs, which are essentially dopamine receptor blockers, are used to treat disorders that involve thought processes.

Question 17

The development of diabetes mellitus is associated with the use of typical antipsychotics.

A) FALSE

B) TRUE

Answer 17

A) FALSE

Rationale:All of the atypical antipsychotics include a warning that there is a risk for the development of diabetes mellitus when these drugs are used.

Question 18

The nurse is caring for a client who is prescribed haloperidol long term. What assessment should the nurse prioritize?

A) Monitoring the client’s white cell differential

B) Assessment of the client’s skin integrity

C) Monitoring the client’s CD4 T-cell count

D) Assessment for involuntary movements

Answer 18

D) Assessment for involuntary movements

Rationale:Haloperidol is associated with the greatest increased risk of extrapyramidal adverse effects. Leukopenia is less common, and there is no obvious threat to skin integrity. The client’s T-cell levels will not be affected

Question 19

The client has been taking an atypical antipsychotic medication for several years. During annual physical examinations, what assessment best addresses a likely adverse effect?

A) Assessment of passive range of motion

B) Blood pressure

C) Electrocardiogram

D) Fasting blood glucose level

Answer 19

D) Fasting blood glucose level

Rationale:Clients taking atypical antipsychotic drugs are at increased risk of developing diabetes and should be regularly screened. Clients taking typical antipsychotics are at risk for prolonged QT intervals, but this is less likely with atypical antipsychotics. Hypotension, specifically orthostatic hypotension, is a potential adverse effect of typical antipsychotic medications. Passive range of motion is unlikely to be affected.

Question 20

A client who is being treated with a typical antipsychotic reports frequent nasal congestion are urinary hesitation. To what should the nurse most likely attribute these symptoms?

A) Neuroleptic malignant syndrome

B) Tardive dyskinesia

C) Extrapyramidal symptoms

D) Anticholinergic effects

Answer 20

D) Anticholinergic effects

Rationale:Nasal congestion and urinary hesitation are manifestations of anticholinergic effects. Neuroleptic malignant syndrome primarily affects the CNS. Tardive dyskinesia involves involuntary movements. Extrapyramidal symptoms are movement related.

Question 21

A client who takes lithium for the treatment of bipolar disorder has been experiencing occasional constipation. What should the nurse teach the client about safely managing this problem?

A) Avoid taking psyllium supplements.

B) Occasional constipation is inevitable during lithium therapy.

C) Avoid foods that are high in soluble fiber.

D) Do not take OTC stool softeners under any circumstances.

Answer 21

A) Avoid taking psyllium supplements.

Rationale:Patients being treated with lithium should be encouraged not to use the herbal therapy psyllium, which is used to treat constipation and to lower cholesterol levels. If this agent is combined with lithium, the absorption of the lithium may be blocked, and the patient will not receive therapeutic levels. There is no need to avoid soluble fiber, and OTC stool softeners are likely safe, with the approval of the healthcare provider. The nurse should not teach the client that constipation must be accepted as inevitable.

Question 22

The nurse is caring for a client who has bipolar disorder and who receives lithium therapy. When reviewing the client’s medication administration record, what drug would cause an increase in the client’s risk of lithium toxicity?

A) Vitamin B12

B) Indomethacin

C) Levothyroxine

D) Calcium carbonate

Answer 22

B) Indomethacin

Rationale:Indomethacin and lithium, when combined, increase the risk of lithium toxicity. Psyllium interferes with the absorption of lithium leading to nontherapeutic levels. Antacids, like calcium carbonate, when combined with lithium, lead to a decrease in lithium effectiveness. Levothyroxine and vitamins would not be contraindicated.