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CHAPTER 31

PSYCHOPARMACOLOGY

WHAT YOU NEED TO KNOW

There are certain psychotropic drugs you must know about in detail and others youshould recognize on the NCLEX-RN. The test writers want to make sure you know themajor classifications, side effects, and indications for drug. They want you to know theproper methods of drug administration and the importance of educating your client aboutmedications. We think the following information is most likely to appear on your exam.But first, a little review.

1. Review the five rights of medication administration:A. ____________________________

B. ____________________________ C. ____________________________ D. ____________________________ E. ____________________________

Remember the following points about medication administration: You need a written order from a provider to administer any medication. Client education pertaining to medications is vital. If you withhold a medication because of a side effect, you must notify the

provider.

ANTIPSYCHOTIC AGENTS

The following tables summarize the most important aspects of antipsychotic medications:

Class Other Nomenclature Indication Main EffectsAntipsychotic agents Major tranquilizers

Neuroleptic drugsAntischizophrenicdrugs

SchizophreniaPsychoticdisordersTourettessyndrome

Organic mentaldisorders

Treatment of psychoticsymptoms:thought disorders,perceptual

disturbances,hostility,agitation, anxiety,control of ticsand vocalutterances; can beused incombination with

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analgesics of painmanagement

Summary of Antipsychotic Medication

Classification Generic Name(Trade Name)

Adult DailyDosageRange

Therapeutic Notes

Phenothiazines Chlorpromazine(Thorazine)

30-2000 mg Potent hypotensive effect

Thioridazine(Mellaril)

150-800 mg May cause retinitispigmentosa in doses above800 mg

Mesoridazine(Serentil)

30-400 mg

Perphenazine

(Trilafon)

12-64 mg

Trifluoperazine(Stelazine)

2-40 mg

Fluphenazine(Prolixin)

1-40 mg Available in long actingform; may be used inclients with a history of noncompliance

Thioxanthenes Thiothixene(Navane)

8-30 mg

Butyrophenone Haloperidol(Haldol)

1-100 mg Available in long actingform; may be used in

clients with a history of noncompliance

Dihydroindolone Molindone(Moban)

15-225 mg

Dibenzoxazepine Loxapine(Loxitane)

20-250 mg

Dibenzodiazepine Clozpine (Clozaril) 300-900 mg Increased risk for agranulocytosis; higher incidence of seizuresreported

Benzisoxazole Risperidone

(Risperidal)

2-6 mg

Thienobenzodiazepine Olanzapine(xyprexa)

5-20 mg Weight gain

Antipsychotic drugs have a high incidence of troublesome side effects. The nurse mustbe aware of these potential side effects, make ongoing assessments of a clientscondition, and intervene to alleviate or minimize these symptoms.

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Common Side Effects of Antipsychotics

Nursing Process Related to Side Effects of Antipsychotic Drugs

Adverse Reaction Assessment/Evaluation InterventionsAnticholinergic Symptoms

Dry mouth Subjective statementDry, cracked lips

Encourage frequent sips of water, good oral hygiene,chew sugarless gum,artificial saliva preparations

Blurred vision Subjective statementUse antipsychotic drugswith caution in clients withglaucoma

Reassure client of transientnature of blurred vision.

Retinitis pigmentosa Impaired acuity, pigmentarydeposits on retina onophthalmic exam

Stop or change drug.Mellaril (thioridazine)should never be given indoses greater than 800 mg.

Urinary retention or hesitancy

Subjective complaintPercuss bladder for distention.Observe for symptoms of infection.Review history for underlying causes

Instruct client to report anydifficulty urinating.Record intake and outputWithhold medicationpending medical evaluation.

Constipation Subjective complaintRecord bowel movements.Observe for abdominaldistentionAssess for pain

Encourage diet high infiber.Increase fluid intake andincrease exerciseDiscuss possibility of stoolsoftener with provider.

Paralytic ileus Auscultate for bowelsounds. Assess for pain

Withhold medicationpending medical evaluation

Sedation Complaints of fatigue,sleepinessIncreased number of hours

asleepReaction time slowedDecreased dexterity inperforming tasks

Client teaching regardingneed to restrict driving or operation of machinery

while feeling sedated.Promote environmentalsafety; prevent falls due tolethargy

Orthostatic hypotension Complaints of palpitations,dizziness, syncope,decreased blood pressure

Instruct client to rise slowlyfrom a lying or sittingposition.Take blood pressure lying

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Get a baseline sitting andstanding blood pressurewhen antipsychoticmedication is initiated

and standing; if more than20 mm drop in pressure,withhold dose, take bloodpressure again, and if nochange, notify provider

prior to giving dose.Tachycardia Review history of cardiacdisease, concurrentmedications for other hypotensives

Notify provider for pulseabove 120 b.p.m.

Dermatologic Effects

Skin rash Observe for maculopapular rash involving most of thebody

Hold medication dose,notify provider.Treat symptoms.

Photosensitivity Sunburn on exposed areasof the skin

Instruct the client to wear protective sunscreens,clothing and sunglasses, andto limit exposure time in thesun.

Hormonal EffectsDecreased libidoFailure to achieve orgasm

Subjective complaints Explain that this may betransient.Notify provider: drug maybe stopped, decreased or changed.

Amenorrhea Serum test for pregnancy if indicated.

Explain that this isreversible.Instruct client not todiscontinue the use of birthcontrol as ovulation iscontinuing and pregnancy ispossible

Weight gain Baseline and periodicweights

Encourage proper diet andexercise.

Extrapyramidal EffectsDystonia (involuntarymuscular movements of face, arms, legs, and neck)

Observe client closelyduring acute treatment.Check tendons for cogwheel jerkiness.

Teach client to recognizeonset of dystonicsymptoms.Respond to symptoms of dystonia immediately,pursue does reductionand/or antiparkinsoniandrug order.Severe dystonic reactionsmay be treated withdiphendyhramine (Bendryl)

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25-100 mg or benztropine(Cogentin) mg IM IV.

Oculogyric crisis(uncontrolled rolling back of the eyes)

Observe client closely.Side effect may becomepsychiatric emergency as it

can be a precursor tomuscular/respiratorycollapse

Notify provider.Prepare to administer antiparkinsonian drug; may

be given IM or IV.Anticipate need for respiratory / emergencysupport PRN.

Akinesia (muscular weakness and fatigue likesymptoms)

Subjective complaints of muscle weakness, lethargy

Pursue dose reductionand/or administer antiparkinsonian drug.

Akathesia (restlessness,fidgeting, pacing beyondthe conscious control of theclient)

Insomnia, pacing, constantmovement

Pursue does reductionand/or administer antiparkinsonian drug.

Pseudoparkinsonism(mimics symptoms of parkinsonism)

Observe for tremor,shuffling gait, drooling,rigidity.

Pursue dose reductionand/or administer antiparkinsonian drug

Tardive dyskinesia(characterized by bizarrefacial and tonguemovements, stiff neck,difficulty swallowing)

Observe for changes in gaitand facial and extremitiymovements. Be aware forisk factors: elderlyfemales, extended treatmenton high dose antipsychoticdrugs

Notify provider immediately if signs areobserved.

Antipsychotic may bediscontinued or changed.

Neuroleptic malignant

syndrome (NMS):(characterized by muscular rigidity, hyperthermia,altered consciousness, andautonomic dysfunction)

Regular monitor vital signs

of clients takingantipsychotic medication.

Be alert to signs of possibledevelopment of neurolepticmalignant syndrome:elevated temperature,severe extrapyramidalrigidity, diaphoresis,tachycardia, or an alteredlevel of consciousness

Withhold antipsychotic

medication until discussionwith provider.

Monitor vital signs.

Initiate supportive measuresto lower temperature.

Monitor electrolytes andintake and output.

Other EffectsReduced seizure threshold History of seizures Closely observe client witha history of seizures

Agranulocytosis Periodic complete bloodcountsObserve clients for bruising,bleeding, mouth sores,lethargy.

Stop medication if redblood count is below 3000mm or if granulocytes fallbelow 1500 mm.

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ANTIPARKINSONIAN AGENTS

Because antiparkinsonian agents are often administered to control the extrapyramidal side

effects of antipsychotic medications, well now focus on this classification of drugs.

Class Other Nomenclature Indication Main EffectsAntiparkinsonianagents

Anti-extrapyramidalagents

Treatment of sideeffects of antipsychoticmedications

Decrease in sideeffects of blurredvision, dry mouth,tremors, shufflinggait, musclespasms or rigidity,and restlessness

SIDE EFFECTS OF THE ANTIPARKINSONIAN DRUGS

Side effects of the antiparkinsonian drugs are most often associated with high dosages inmiddle-aged and young adults; the elderly may experience side effects with moderate or even low doses.

Potential side effects of antiparkinsonian drugs include constipation, urinary retention,paralysis of bowel or bladder, lethargy, blurred vision, dry mouth, dilated pupils,confusion, tachycardia, decreased sweating, elevated temperature, dizziness,gastrointestinal disturbances, and dry, flushed skin.

Assign each of the following side effects to the correct definition:

2. ___ Irreversible side effect of antipsychoticmedication causing a syndrome characterized bybizarre facial and tongue movements, stiff neck,and difficulty swallowing.3. ___ Potentially fatal blood disorder in whichthe clients white blood cells drop to dangerouslylow levels. Associated with antipsychoticmedications, in particular clozapine (Clozaril).

4. ___ Involuntary movement or spasms of theface, arms, legs, and neck; usually an acute sideeffect of antipsychotic medication.5. ___ Uncontrollable upward or rolling back movement of the eyes; may occur as anextrapyramidal side effect of antipsychotic drugs.6. ___ Rare but potentially fatal complication of treatment with neuroleptic drugs. Symptoms

A. agranulocytosisB. akathisiaC. dystoniaD. neurolepticmalignant syndromeE. oculogyriccrisis

F. pseudopark insonismG. tardivedyskinesia

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include severe muscle rigidity, high fever,tachycardia, fluctuating blood pressure,diaphoresis, and rapid deterioration of mentalstatus into stupor and coma7. ___ Sensation of restlessness or a feeling of

the need to move; shifting from one foot to theother. An extrapyramidal side effect of antipsychotic medications.8. ___ Symptoms of drooling, shuffling gait,tremor and rigidity, mask-like face, pill-rolling of the fingers, and cogwheel rigidity that may occur early in treatment with antipsychotic medications.

ANTIANXIETY AGENTS

Class Other

Nomenclature

Purpose Main Effects

Antianxietyagents

Minor tranquilizersAnxiolytic drugs

To treat anxiety, panic,phobias, insomnia, obsessive-compulsive disorders, posttraumatic stress disordersSome benzodiazepines maybe used as muscle relaxantsand anticonvulsants

Buspirone has beenused to treatpsychoticsymptoms.Decrease in anxiety.Increase in sleepDecrease in nervoussystem activationDecrease in skeletalspasms

Producesanticonvulsantactivity

SUMMARY OF COMMONLY USED ANTIANXIETY DRUGS

Chemical Group Generic Name(Trade Name)

Daily Dosage Range

Antihistamines Hydroxyzine (Vistaril, Atarax) 100-400 mgBenzodiazepines Alprazolam (Xanax)

Chlordiazepoxide (Librium)Clonazepam (Klonopin)Diazepam (Valium)Lorazepam (Ativan)Temazepam (RestorilTriazolam (Halcion)

0.75-4 mg

10-100 mg1.5-10 mg7.5-60 mg2-9 mg15-30 mg0.125-0.5 mg

Miscellaneous Buspirone (BuSpar) 15-60 mg

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Side Effect Nursing ImplicationDrowsiness, confusion, and lethargy Instruct client not to drive or operate

dangerous machinery while takingmedication.

Orthostatic hypotension Monitor vital signs; instruct client to

change positions slowly.Nausea and vomiting Advise that this medication may be takenwith meals

Dry mouth Frequent sips of water, sugarless gum, or candy

Potentiates the effects of other C.N.S.depressants

Instruct client to avoid alcohol and to check with provider before taking other medications.

Blood dyscrasias Symptoms of sore throat, fever, malaise,easy bruising, or unusual bleeding shouldbe reported to the provider immediately.

Paradoxical excitement Report to provider immediately.Tolerance Instruct clients on long-term therapy not to

discontinue drug abruptlyLiver dysfunction Symptoms of nausea, upper abdominal

pain, jaundice, fever, rash; monitor liver function tests.

Remember, antianxiety drugs: Should not be taken with other C.N.S. depressants Are strictly contraindicated in clients with narrow-angle glaucoma, shock, or

coma, and during pregnancy or lactation May exacerbate depression

BENZODIAZEPINES

DURATION OF ACTION OF BENZODIAZEPINES

Benzodiazepine Withdrawal Syndrome Withdrawal from benzodiazepines begins within 12 to 48 hours after the last dose. Withdrawal may last from 12 to 48 hours. Some symptoms persist for weeks. Medication dosages must be reduced gradually to avoid the possibility of seizures. Symptoms of withdrawal include anxiety, agitation, tremors, insomnia, dizziness,

headaches, tinnitus, blurred vision, diarrhea, hypotension, hyperthermia,neuromuscular irritability, psychosis, and seizures.

BUSPIRONE

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BuSpar (buspirone) lacks the anticonvulsant and muscle relaxant properties of thebenzodiazepines, causes minimal sedation, and has a lower interactive effect with other C.N.S. depressants. Headache, dizziness, nervousness, and lightheadedness are commonside effects of BuSpar.

ANTIDPRESSANTS

Class OtherNomenclature


AntidepressantAgents

Mood elevatorsEnergizers

To treat dysthymia,major depressionwith melancholia or psychoticsymptoms,depression

associated withorganic disease,bipolar disorder,dual diagnoses

Decrease depressivesymptoms, improvemood, improvesleep, increaseability to experiencepleasure, decrease

psychomotor retardation

Summary of Common Antidepressant MedicationsClassification Generic Name

(Trade Name)Daily Dose Range

Tricyclics Amitriptyline (Elavil)Desipramine (norpramin)Doxepin hydrochloride (Sinequan)

Imipramine (Tofranil)Nortriptyline (Pamelor)

20-300 mg25-200 mg25-300 mg

30-300 mg50-150 mgMonoamine oxidase (MAO)inhibitors

Isocarboxazid (Marplan)Phenelzine sulfate (Nardil)Tranylcypromine sulfate (Parnate)

10-30 mg15-75 mg10-30 mg

Selective reuptakeinhibitors (SSRIs)

Fluoxetine (Prozac)Paroxetine (Paxil)Sertraline (Zoloft)

40-80 mg10-50 mg50-200 mg

Miscellaneous Bupropion (Wellbutrin)Trazodone (D esyrel)

300-450 mg200-600 mg

Here are a few things you should keep in mind about antidepressants for the NCLEX-RN: Antidepressants affect the actions of norepinephrine, dopamine, or serotonin in

the brain. Response time to the antidepressants varies, but in general it takes from 2 to 3

weeks to see therapeutic effects. SSRIs are generally seen as the first line of treatment because of their lower side

effect profile and decreased potential for overdose.

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Tricyclic and tetracyclic antidepressants have anticholinergic side effects: drymouth, blurred vision, constipation, urinary hesitancy, orthostatis hypotension,and drowsiness.

Adverse effects include exacerbation of psychosis and cardiac arrhythmias.

MAO INHIBITORS

MAO inhibitors are not considered the first line for treatment of depression because of their more serious and potentially life-threatening side effects.

The most serious side effect of the MAO inhibitors is the hypertensive crisis, which isconsidered a medical emergency with potential for producing intracranial hemorrhage or death. The MAO inhibitors produce hypertension in combination with foods that aretyramine-rich. (Clients taking MAO inhibitors should avoid the tyramine-rich foodslisted below.) Several medications are also contraindicated in combination with the

MAO inhibitors.

Symptoms of Hypertensive Crisis General Nursing InterventionsHeadachesElevated blood pressurePalpitations and chest painSweatingNausea/vomitingFever Neck stiffnessPhotophobia

Nosebleed

Hold next MAO inhibitor dose.Monitor vital signsCooling techniques for fever Maintain hydration/electrolyte balance.

In order to avoid a hypertensive crisis, a client taking MAO inhibitors must consult hisprovider before taking any over-the-counter medication or any other prescriptionmedication.

Foods to Avoid Include: Use in Moderation:Aged or mature cheese (e.g., cheddar,parmesan)Aged protein and fermented foods (e.g., salami,sausage)

Broad beansPickled herring; beef or chicken liversBeer, red wineYeast or protein extracts (Marmite, Oxo,Bovril)YogurtOver-ripe fruit

Soy sauceChocolateCaffeine drinks

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THERAPEUTIC USES Moderate to severe depression: Use of MAO inhibitors is indicated for depressed

patients who are unresponsive or allergic to tricyclic antidepressants or whoexperience strong anxiety.

Treatment of hypersomnia.

Treatment of phobic states.

ANTIMANIC AGENTS OR MOOD STABILIZERS

Class OtherNomenclature


Antimanic agents Mood stabilizer To treat bipolar disorder, mania,depression, or schizoaffective

disorder

Stabilization of mood, decrease inand prevention of manic episodes,

decrease indepression

LITHIUM CARBONATE

Lithium carbonate is the drug of choice of acute manic symptoms, as well as for prophylactic treatment of cyclical mood swings. Lithiums mode of action is not known,but it takes 7-10 days for the medication to work. During that time, antipsychotic drugsare often used to control the acute symptoms of mania until lithium takes effect. Serumlithium blood levels are used to titrate the dose, with therapeutic levels ranging from 0.5to 1.5 mEq/L. Dose stabilization usually takes 1 year.

ANTICONVULSANTS

The second line of treatment for mood stabilization I bipolar disorder is anticonvulsants.These drugs are usually prescribed for those who do not respond to lithium or for whomlithium may be contraindicated.

Anticonvulsant Drugs to Treat Bipolar DisorderDrug Daily 1 Dose / Therapeutic

Blood Level

Side Effects

Carbemazapine (Tegretol) 300-1,200 mgserum level of 6-12 mg/L

Skin rash, sore throat, low-grade fever, mucosalulceration, ataxia, vertigo,nausea, vomiting,hepatotoxicity, benign

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(Depakene / Depakote) serum level of 50-125mcg/ml

diarrhea, tremor, sedation,ataxia

Clonazepam (Klonapin) 4-24 mg Ataxia, drowsiness,increased salivation

Lamotrigine (Hamictal) 200-500 mg Dizziness, sedation,

headache, diplopia, ataxia,rash occurs in about 10% of all cases

CHAPTER 31: EXERCISE ANSWERS

1. Review the five rights of medication administration: client, dose, drug, route, andtime.

2. G tardive dyskinesia - Irreversible side effect of antipsychotic medication causing asyndrome characterized by bizarre facial and tongue movements, stiff neck, and

difficulty swallowing.3. A agranulocytosis - Potentially fatal blood disorder in which the clients white bloodcells drop to dangerously low levels. Associated with antipsychotic medications, inparticular clozapine (Clozaril).

4. C dystonia - Involuntary movement or spasms of the face, arms, legs, and neck;usually an acute side effect of antipsychotic medication.

5. E oculogyric crisis - Uncontrollable upward or rolling back movement of the eyes;may occur as an extrapyramidal side effect of antipsychotic drugs.

6. D neuroleptic malignant syndrome - Rare but potentially fatal complication of treatment with neuroleptic drugs. Symptoms include severe muscle rigidity, highfever, tachycardia, fluctuating blood pressure, diaphoresis, and rapid deterioration of

mental status into stupor and coma7. B akathisia - Sensation of restlessness or a feeling of the need to move; shiftingfrom one foot to the other. An extrapyramidal side effect of antipsychoticmedications.

8. F pseudoparkinsonism - Symptoms of drooling, shuffling gait, tremor and rigidity,mask-like face, pill-rolling of the fingers, and cogwheel rigidity that may occur earlyin treatment with antipsychotic medications.

CHAPTER 31: NCLEX-RN STYLE QUESTIONS

1. A nurse is conducting an in-service program on psychotropic medications for

other staff nurses. In discussing the mechanism of action (MOA) for benzodiazepinesversus nonbenzodiazepines, the nurse needs to emphasize that thenonbenzodiazepines

(1) have a decreased risk of dependency.(2) Cause central nervous system depression(3) Are categorized as a controlled substance(4) Active -aminobutyric acid (GABA).

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2. A client who has schizoaffectie disorder has been taking haloperidol (Haldol) for several months. Recently, lithium (Lithane) was added to the medication regime.The nurse in the outpatient program should carefully monitor which of the followingdue to the combination of these two drugs?

(1) Decreased need to sleep and a surge of energy(2) Increased appetite and a weight gain of 5 pounds.(3) Fluctuating level of consciousness, confusion, disorientation.(4) Complaints of flue-like symptoms, including a temperature of 100 oF

3. A client who is diagnosed with obsessive compulsive disorder is takingclomipramine (Anafranil). The nurse is aware that the most common side effects of this drug are

(1) insomnia and weakness.

(2) Incontinence and muscle twitching.(3) Urinary retention and fatigue.(4) Memory loss and depressed appetite.

4. A psychiatric client is receiving temazepam (Restoril). The client tells the nurse,Im feeling dizzy, and I cant think right. What would be an appropriate responseby the nurse?

(1) Try to get some rest and you will feel better.(2) That is because youre not eating. With the medication youre taking you

must eat to feel better.(3) The dizziness and confusion you are experiencing are more common side

effects of the drugs you are taking.(4) Dont worry, the dizziness will go away in a few days.

5. .A client is prescribed haloperidol (Haldol) 10 mg po hs. In teaching the clientabout self-administration, for which of the following side effects should the nurseemphasize that the client seek immediate medical attention?

(1) drowsiness(2) increase urine output(3) metallic taste and diarrhea(4) restlessness and muscle spasms

6. A client has been very despondent, withdrawn, and apathetic for about 6 months.Recently, the client began to attend an outpatient clinic for treatment of depressivedisorder. Fluoxetine (HCL) Prozac) is prescribed, and after 3 days the client showsimprovement. What is the most appropriate nursing intervention at this time?

(1) assess the clients knowledge about the medication

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(2) encourage the client to interact with other clients.(3) Discuss long-term plans for discharge and follow-up(4) Evaluate the potential for self-destructive behaviors

7. In evaluating a clients compliancy to lithium therapy, the nurse would assess an

improved clinical response and a therapeutic lithium level of

(1) 0.3-0.5 mEq/L(2) 0.5-0.7 mEq/L(3) 1.0-1.2 mEq/L(4) 1.5-1.8 mEq/L

8. A client has been attending th partial hospitalization program for several weeks.Clozapine (Clozaril) 100 mg po tid is prescribed. Today the client did not come for aschedule appointment and when the nurse telephoned the client, it was stated that hehad a fever and sore throat. The nurse interprets these complaints as the client

experiencing(1) allergic reaction(2) agranulocytosis.(3) Conversion disorder.(4) Serotonin syndrome

9. A client is receiving fluphenazine (Prolixin). During a scheduled appointment tothe outpatient unit, the client complains of an inability to sit sill and a need to pace.The nurse, in evaluating this client, expects that he may be experiencing

(1) akathisia(2) akinesia(3) anticholinergic crisis(4) another episode of his psychiatric symptoms.

10. A client has just been place on haloperidol (Haldol) for a psychosis. When doingan assessment, the nurse finds that the client is displaying tongue thrusting and jerkymovements of the extremities. The client asks why this is happening. The nursesbest response is

(1) You have developed Huntingtons chorea, which is a side effect of thedrug youre taking.

(2) Youre having extrapyramidal side effects.(3) Youre having tardive dyskinesia, which is a side effect of the drug

youre taking.(4) Youre having akathesia, which is a side effect of the drug youre

taking.

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CHAPTER 31: NCLEX-RN STYLE ANSWERS

1. (1) CORRECT There is no indication that physical or psychologicaldependence develops with the nonbenzodiazepine class of drugs.

(2) ELIMINATE True of the benzodiazepine class of drugs.(3) ELIMINATE True of the benzodiazepine class of drugs.(4) ELIMINATE True of the benzodiazepine class of drugs.

CATEGORY 08 PHARMACOLOGICAL AND PARENTERAL THERAPIES

2. (3) CORRECT Potential encephalopathic syndrome can occur with thiscombination.

(1) ELIMINATE More characteristic of a manic episode(2) ELIMINATE Not applicable.(4) ELIMINATE More characteristic of agranulocytosis


3. (3) CORRECT These are side effects of Anafranil. Other side effects aredry mouth, dizziness, seizures, and sexual dysfunction.

(1) ELIMINATE Not the most common side effects of Anafranil.(2) ELIMINATE Not the most common side effects of Anafranil.(3) ELIMINATE Not the most common side effects of Anafranil.


4. (3) CORRECT Dizziness, confusion, drowsiness, and euphoria arecommon side effects of Restoril

(1) ELIMINATE This response ignores the concerns the client has expressed.(2) ELIMINATE The symptoms expressed by the client have nothing to do

with food intake.(4) ELIMINATE This response ignores the concerns the client has expressed.


5. (4) CORRECT These are characteristics of the extrapyramidal reactions(akathesia and dystonias) for which the client should beadministered a stat dose of an anticholinergic medication.

(1) ELIMINATE Drowsiness may occur when initially taking haloperidol.The client should be informed about postural changes andtaking the scheduled doses at bedtime. It does not requireimmediate medical attention.

(2) ELIMINATE Increased urine output is not associated with Haldol.(3) ELIMINATE Metallic taste and diarrhea are not associated with Haldol.

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6. (4) CORRECT Antidepressant therapy may take 1-6 weeks for the client todemonstrate an improvement and reduction of suicidalbehaviors.

(1) POSSIBLE This should be done, but only after the risk of suicide hasbeen evaluated.(2) POSSIBLE This is not the most appropriate nursing intervention at this

time(3) POSSIBLE This would be done at a later date.

CATEGORY 06 PYSCHOSOCIAL ADAPTATION

7. (3) CORRECT An improved clinical response usually corresponds withthis therapeutic range

(1) ELIMINATE Not an appropriate level.

(2) ELIMINATE Not an appropriate level.(4) ELIMINATE Not an appropriate level.


8. (2) CORRECT A side effect of Clozaril is agranulocytosis.(1) ELIMINATE Signs of allergy include rash, hives, and a lump in the

throat(3) ELIMINATE A conversion disorder occurs when a client manifests

symptoms of an illness, but with this medication thesymptoms indicate a severe adverse effect.

(4) ELIMINATE The symptoms described do not relate to serotoninsyndrome.


9. (1) CORRECT This is a subjective feeling of restlessness and agitation dueto the antipsychotic medication

(2) ELIMINATE This is a slowing or absence of movement often associatedwith pseudoparkinsonism

(3) ELIMINATE Not applicable.(4) ELIMINATE The complaints are specific and relate directly to the client

receiving the antipsychotic medication.


10. (3) CORRECT Tardive dyskinesia is an unwanted and disfiguring sideeffect that occurs in some people who take neuroleptics.

(1) ELIMINATE The client has not developed Huntingtons chorea(2) ELIMINATE These are not extrapyramidal side effects.

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(4) ELIMINATE This is not akathesia.


Reference: Princeton Review

part xvi

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