TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 31-35
Chapter 31: Antipsychotic Agents and Their Use in
Schizophrenia
MULTIPLE CHOICE
1. A patient with schizophrenia has been taking an antipsychotic drug for several days. The
nurse enters the patient’s room to administer a dose of haloperidol (Haldol) and finds the
patient having facial spasms. The patient’s head is thrust back, and the patient is unable to
speak. What will the nurse do?
a. Administer the haloperidol as ordered.
b. Discuss increasing the haloperidol dose with the provider.
c. Request an order to give diphenhydramine.
d. Request an order to give levodopa.
ANS: C
An early reaction to antipsychotic drugs is acute dystonia. Initial treatment consists of
an anticholinergic medication, such as diphenhydramine. Administering more
antipsychotic medication would increase the symptoms and could be life threatening.
Levodopa is not given for extrapyramidal symptoms, because it could counteract the
beneficial effects of antipsychotic treatment.
DIF: Cognitive Level: Application REF: First-Generation (Conventional)
Antipsychotics | Extrapyramidal Symptoms | Acute Dystonia | Parkinsonism
TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
2. A patient who is taking an antipsychotic drug for schizophrenia comes to the clinic for
evaluation. The nurse observes that the patient has a shuffling gait and tremors and is
drooling. The nurse will ask the patient’s provider about which course of action?
a. Administering a direct dopamine antagonist
b. Giving an anticholinergic medication
c. Increasing the dose of the antipsychotic drug
d. Stopping the antipsychotic drug
ANS: B
The patient is showing signs of parkinsonism, an extrapyramidal effect associated
with antipsychotic medications. Anticholinergic medications are indicated. A direct
dopamine antagonist would counter the effects of the antipsychotic and remove any
, beneficial effect it has. Increasing the dose of the antipsychotic medication would
only worsen the extrapyramidal symptoms. Stopping the antipsychotic medication
would cause the symptoms of schizophrenia to worsen.
DIF: Cognitive Level: Application REF: First-Generation (Conventional)
Antipsychotics | Extrapyramidal Symptoms | Acute Dystonia | Parkinsonism
TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. A patient taking a first-generation antipsychotic (FGA) medication develops severe
parkinsonism and is treated with amantadine (Symmetrel). The amantadine is withdrawn
2 months later, and the parkinsonism returns. The nurse will expect the provider to:
a. give anticholinergic medications.
b. make a diagnosis of idiopathic parkinsonism.
c. resume the amantadine indefinitely.
d. try a second-generation antipsychotic (SGA).
ANS: D
Neuroleptic-induced parkinsonism is treated with some of the same drugs used for
idiopathic parkinsonism, such as amantadine. If parkinsonism is severe, switching to
an SGA may help, because the risk of parkinsonism is much lower with these drugs.
An anticholinergic medication may be used initially. A recurrence of parkinsonism
when the drug is withdrawn does not indicate idiopathic parkinsonism. These drugs
should not be used indefinitely.
DIF: Cognitive Level: Application REF: First-Generation (Conventional)
Antipsychotics | Extrapyramidal Symptoms | Acute Dystonia | Parkinsonism
TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
4. A nurse and a nursing student are discussing the plan of care for a patient with
schizophrenia. The patient, who has been taking a high-potency FGA for 2 months, has
become restless and constantly needs to be in motion. Which statement by the student
indicates a need for further education?
a. “Anticholinergic medications may help control these symptoms.”
b. “Because this may be an exacerbation of psychosis, the provider may increase the
dose of the FGA.”
c. “The provider may try a low-potency FGA instead of the high-potency FGA.”
d. “This patient may need to take a benzodiazepine or a beta blocker.”
ANS: B
The patient is showing signs of akathisia, which can resemble an exacerbation of
psychosis. If the two are confused and the provider orders more of the FGA, the
symptoms may actually increase. Anticholinergic medications may be used, a low-
potency FGA may be ordered, or a benzodiazepine or beta blocker may be prescribed.
DIF: Cognitive Level: Application REF: First-Generation (Conventional)
5. A patient is taking an FGA for schizophrenia. The nurse notes that the patient has trouble
speaking and chewing and observes slow, wormlike movements of the patient’s tongue.
The nurse recognizes which adverse effect in this patient?
a. Acute dystonia
b. Akathisia
c. Parkinsonism
d. Tardive dyskinesia
ANS: D
Tardive dyskinesia can occur in patients during long-term therapy with FGAs. This
patient shows signs of this adverse effect. Acute dystonia is characterized by severe
spasm of muscles in the face, tongue, neck, or back and by opisthotonus. Akathisia is
characterized by constant motion. Parkinsonism is characterized by bradykinesia,
drooling, tremor, rigidity, and a shuffling gait.
DIF: Cognitive Level: Analysis REF: First-Generation (Conventional)
Antipsychotics | Extrapyramidal Symptoms | Acute Dystonia | Parkinsonism |
Akathisia | Tardive Dyskinesia TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
6. A nurse provides teaching for a patient about to begin taking a first-generation
antipsychotic drug for schizophrenia. Which statement by the patient indicates a need for
further teaching about side effects of these drugs?
a. “Anticholinergic effects are uncommon with this medication.”
b. “I may experience gynecomastia and galactorrhea.”
c. “I may feel lightheaded or dizzy and should sit or lie down if this occurs.”
d. “Sedation may occur initially, but will subside in 1 to 2 weeks.”
ANS: A
Anticholinergic effects are common with FGAs, so this statement indicates a need for
further teaching. Neuroendocrine effects, orthostatic hypertension, and sedation can
occur with FGAs.
DIF: Cognitive Level: Application REF: First-Generation (Conventional)
Antipsychotics | Other Adverse Effects | Anticholinergic Effects | Orthostatic |
Hypotension | Sedation | Neuroendocrine Effects TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
7. A patient with schizophrenia shows suicidal behaviors, and the provider orders clozapine
(Clozaril). The nurse teaches the family about the medication and its side effects. Which
, statement by a family member indicates a need for further teaching about this drug?
a. “Blood counts are necessary for several weeks after discontinuation of the drug.”
b. “Fever, sore throat, and sores in the mouth should be reported immediately.”
c. “If the ANC is less than 3000, the drug will be discontinued permanently.”
d. “Use of this drug requires weekly evaluation of blood work.”
ANS: C
Clozapine can cause agranulocytosis. If the absolute neutrophil count (ANC) drops
below 1000/mcL, the drug must be discontinued permanently. Blood counts must be
evaluated weekly, and this evaluation should be continued for several weeks after
withdrawal of the drug. Fever, sore throat, and mouth ulcers are symptoms of
agranulocytosis and should be reported immediately.
DIF: Cognitive Level: Application REF: Second-Generation (Atypical)
Antipsychotics | Clozapine | Adverse Effects and Interactions |
Agranulocytosis TOP: Nursing Process: Assessment MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
8. A patient with schizophrenia receives a dose of risperidone (Risperdal Consta) IM. The
nurse teaching this patient about this medication will make which statement?
a. “You will experience therapeutic levels of this drug in 1 to 2 weeks.”
b. “You will need injections of this drug every 6 weeks.”
c. “You will need to take an oral antipsychotic drug for 3 weeks.”
d. “You probably will not have extrapyramidal symptoms with this drug.”
ANS: C
Risperidone given intramuscularly is a depot preparation used for long-term therapy.
Significant release of the drug does not occur until 2 to 3 weeks after injection;
therefore, patients must take an oral antipsychotic medication until drug levels are
raised. Therapeutic levels are reached 4 to 6 weeks after injection. Patients need
injections every 2 weeks. With IM dosing, the incidence of extrapyramidal symptoms
is substantial.
DIF: Cognitive Level: Application REF: Other Second-Generation
Antipsychotics | Risperidone | Adverse Effects | Preparations, Dosage, and
Administration TOP: Nursing Process: Planning MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
9. A patient with schizophrenia has been taking an oral FGA for 1 week. The patient has
been taking the drug daily in two divided doses. The individual complains of daytime
drowsiness. The patient’s family reports a decrease in the person’s hostility and anxiety
but states that the patient remains antisocial with disordered thinking. What will the nurse
tell the patient and the family?
a. An increased dose of the drug may be needed.
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