Chapter 22: Antipsychotic Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. The nurse is caring for a client diagnosed with HIV. The nurse should question a new order for clozapine due to which currently prescribed drug? a. Immunologics b. Anticholinergics c. Opioids d. Anticoagulants Answer: A Rationale: Immunological agents are used to treat HIV. It is contraindicated to give a client with bone marrow suppression clozapine. The concomitant use of clozapine and immunological drugs can increase the severity of bone marrow suppression. The use of anticholinergics in combination with antipsychotics can increase the risk of tardive dyskinesia and psychotic symptoms. Opioids and anticoagulants are not associated with interactions involving antipsychotic drugs. Question Format: Multiple Choice Chapter: 22 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 270, Interactions 2. The nurse is conducting an ongoing assessment of a client who is prescribed loxapine. Which finding is most likely attributable to this medication? a. Hypertension b. Skin dryness c. Dry mouth d. Bradycardia Answer: C Rationale: Antipsychotics such as loxapine may cause adverse effects of dry mouth, drowsiness, akathisia, EPS, headache, and orthostatic hypotension. Antipsychotics are contraindicated in clients with severe hypertension. Bradycardia can be a sign of hypertensive crisis, which is an adverse effect of MAOIs. Skin dryness is a recognized adverse effect to clofazimine, a drug used to treat M. leprae. Question Format: Multiple Choice Chapter: 22 Learning Objective: 2 Cognitive Level: Remember Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 275, Summary Drug Table 3. A client who has been receiving treatment for psychosis presents to the clinic for follow up. On assessment, the nurse discovers the client is currently displaying rhythmic, involuntary facial movements to include chewing-like movements and tongue protrusion. The nurse interprets these findings as an indication of which disorder? a. Stevens–Johnson syndrome b. Neuroleptic malignant syndrome c. Tardive dyskinesia d. Extrapyramidal syndrome Answer: C Rationale: Tardive dyskinesia is irreversible and characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome (EPS), neuroleptic malignant syndrome (NMS), and Stevens–Johnson syndrome (SJS) do not cause rhythmic, involuntary facial movements. SJS is a hypersensitivity reaction to various antibiotics and presents with fever, cough, muscle aches and pains, headaches, and lesions on the skin, mucous membranes, and eyes. NMS is a combination of extrapyramidal syndrome, hyperthermia, and autonomic disturbance. It is similar to TD with muscle rigidity, altered mental status, and autonomic system problems; however, it is a reversible reaction to TCAs. EPS is related to conventional antipsychotics with Parkinson-like symptoms, akathisia, and dystonia. The effects diminish with a reduction in dosage. Question Format: Multiple Choice Chapter: 22 Learning Objective: 1 Cognitive Level: Analyze Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 269, Tardive Dyskinesia 4. A nurse is preparing a teaching plan for a client with schizophrenia who is prescribed olanzapine in a disintegrating tablet form. Which instruction should the nurse include in the teaching? a. Remove the tablet with dry hands. b. Take the tablet with a full glass of water. c. Add extra salt to food. d. Avoid tea or coffee. Answer: A Rationale: The nurse should instruct the client to remove the olanzapine tablet with dry hands and place the entire tablet in their mouth. Wet or damp hands may cause the medication to begin disintegrating prior to entering the client's mouth. There is no need to add extra salt to food. The client is required to take orally disintegrating olanzapine, so there is no need to take any fluid with the drug. Also, there is no need to avoid tea or coffee. Question Format: Multiple Choice Chapter: 22 Learning Objective: 4 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Teaching/Learning Reference: p. 273, Educating the Client and Family 5. The nurse is teaching a client and caregiver about the antipsychotic medication which has been prescribed. The nurse determines the teaching is successful when they correctly choose which reaction should be reported immediately to the health care provider? a. Orthostatic hypotension b. Dry mouth c. Rigidity d. Drowsiness Answer: C Rationale: The nurse should immediately report to the primary health care provider the following: rigidity, restlessness, inability to sit still, muscle spasms, mask-like expression, tremors, drooling, or involuntary rhythmic movements of the face, mouth, or extremities. Dry mouth, episodes of orthostatic hypotension, and drowsiness are reactions that are considered normal during drug therapy and need not be reported unless severe. Question Format: Multiple Choice Chapter: 22 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 273, Educating the Client and Family 6. The nurse is preparing to teach a client with psychosis about clozapine. The nurse will point out the importance of which weekly laboratory test to this client? a. Serum lithium b. WBC count c. Blood glucose d. pH level