Chapter 49: Antipsychotics

Chapter 49: Antipsychotics

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. The primary care nurse practitioner (NP) is performing a physical examination on a patient who has been taking mesoridazine (Serentil) for several weeks to treat schizophrenia. The patient is exhibiting rhythmic movements of the face and jaw. The NP should be concerned that the patient may:

ANS:  D

Tardive dyskinesia, or abnormal involuntary movements characterized by rhythmic involuntary movements of the tongue, face, mouth, or jaw, may be progressive and irreversible. This condition can occur with all antipsychotics, especially the first-generation antipsychotics. Increasing the dose may increase the symptoms. Thioridazine is another first-generation antipsychotic with a similar adverse-effect profile. Neuroleptic malignant syndrome occurs weeks after initiation and is characterized by fever, catatonia, muscle rigidity, and autonomic instability.

DIF:    Cognitive Level: Applying (Application)                           REF:   552

2. A patient with a recent diagnosis of schizophrenia is taking thioridazine (Mellaril) to treat psychotic symptoms. The patient’s family member is concerned that the patient continues to have little interest in activities and has difficulty beginning even simple tasks. The primary care NP should contact the patient’s psychiatrist to discuss changing to:

ANS:  B

First-generation antipsychotics treat positive but not negative symptoms associated with psychotic states. This patient exhibits negative symptoms and should be treated with a second-generation antipsychotic, such as risperidone. The other three drugs are first-generation antipsychotics.

DIF:    Cognitive Level: Applying (Application)                           REF:   552

3. A 22-year-old male patient who has dropped out of college has increasingly disorganized behavior and delusional thinking. His parents report that he lives at home and has no desire to find a job or help around the house. The primary care NP has ruled out organic causes and has referred the patient to a psychiatrist for treatment. To prepare for the referral visit, the NP should:

ANS:  D

Before antipsychotic drugs are initiated, baseline laboratory tests, including LFTs, CBC, ECG, and urinalysis, should be performed. Serum lipids and hemoglobin A_1c may be ordered if the patient has risk factors for diabetes or metabolic syndrome.

DIF:    Cognitive Level: Applying (Application)                           REF:   554

4. A patient who is newly diagnosed with schizophrenia is overweight and has a positive family history for type 2 diabetes mellitus. The primary care NP should consider initiating antipsychotic therapy with:

ANS:  A

Many antipsychotics increase the risk of metabolic syndrome in patients. Ziprasidone does not have effects on weight. The other agents all increase the risk of weight gain and metabolic syndrome.

DIF:    Cognitive Level: Applying (Application)                           REF:   564