Chapter 22: Antipsychotics and Anxiolytics

Chapter 22: Antipsychotics and Anxiolytics

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75 mg BID to treat schizophrenia. A family member tells the nurse that the patient’s agitation, hallucinations, and delusional symptoms have improved, but the patient continues to withdraw from social interaction and won’t bathe unless reminded to do so. The nurse will tell the family member that

a.	all symptoms will eventually resolve over time with this medication.
b.	the patient may need an increased dose of the antipsychotic medication.
c.	these results may indicate that the patient does not have schizophrenia.
d.	they should consider discussing adding another medication.

 

 

ANS:   D

Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely that the negative symptoms will improve over time with this medication. Increasing the dose will not improve control of negative symptoms. This patient exhibits signs of schizophrenia.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 281

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Psychosocial Integrity

 

2. The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect?

a.	Acute dystonia
b.	Akathisia
c.	Pseudoparkinsonism
d.	Tardive dyskinesia

 

 

ANS:   A

Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities.

 

DIF:    Cognitive Level: Understanding (Comprehension)               REF:    p. 285

TOP:    Nursing Process: Assessment/Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has schizophrenia. The patient has been taking this medication twice daily for 15 months. The nurse notes smacking lip movements and involuntary movements of all extremities. Which action by the nurse is correct?

a.	Administer the medication as ordered to treat these symptoms of psychosis.
b.	Hold the dose and notify the provider of these medication adverse effects.
c.	Request an order for an anticholinergic medication such as benztropine (Cogentin).
d.	Suggest that the provider increase the dose to 125 mg twice daily.

 

 

ANS:   B

Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities and is a serious adverse effect of antipsychotic medications. The provider should be notified, so the drug can be stopped and a different medication ordered. These are not symptoms of psychosis. Anticholinergic medications are used to combat acute dystonia. Increasing the dose of this medication would only exacerbate these adverse effects.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 282

TOP:    Nursing Process: Assessment/Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action?

a.	Contact the provider to discuss changing to benztropine (Cogentin).
b.	Notify the provider of these symptoms and request an order for lorazepam (Ativan).
c.	Question the patient about adherence to the drug regimen.
d.	Recognize these signs of a serious adverse drug reaction and notify the provider.

 

 

ANS:   B

The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug. Benztropine is an anticholinergic used to combat acute dystonia side effects. These are not signs of psychosis, so it is not necessary to question whether or not the patient is taking the medication. These side effects are not as serious as those with tardive dyskinesia.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 281

TOP:    Nursing Process: Assessment/Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies