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Psychiatric Nursing 6th Edition Keltner Bostrom McGuinness Test Bank

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Psychiatric Nursing 6th Edition Keltner Bostrom McGuinness Test Bank

ISBN-13: 978-0323069519

ISBN-10: 0323069517

 

Description

Psychiatric Nursing 6th Edition Keltner Bostrom McGuinness Test Bank

ISBN-13: 978-0323069519

ISBN-10: 0323069517

 

 

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Below you will find some free nursing test bank questions from this test bank:

 

Keltner: Psychiatric Nursing, 6th Edition

 

Chapter 18: Antipsychotic Drugs

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient receiving a traditional high-potency antipsychotic medication should be closely monitored for:
a.adrenergic effects.
b.extrapyramidal side effects.
c.anticholinergic side effects.
d.changes in pain perception.

 

ANS: B

High-potency antipsychotics are more likely to cause extrapyramidal side effects (EPSEs) than low-potency antipsychotics. The other effects are not related to potency classification.

 

DIF:   Cognitive level: Application         REF:  163

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A patient receives a traditional low-potency antipsychotic medication. The nurse should assess closely for:
a.urinary frequency.
b.urinary retention.
c.hypertension.
d.diarrhea.

 

ANS: B

Low-potency antipsychotics tend to cause anticholinergic side effects. Urinary retention and other anticholinergic effects are important findings for which the nurse should be alert. The other effects would not be expected.

 

DIF:   Cognitive level: Application         REF:  163

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A patient with schizophrenia has taken thiothixene (Navane) 5 mg/day for 4 years with good symptom control. Today, the patient is admitted with paranoia and auditory hallucinations. The nurse should determine if the patient’s symptoms are related to:
a.not taking the drug as prescribed.
b.activation of serotonin receptors.
c.development of tolerance to the drug.
d.an expected illness-exacerbation cycle.

 

ANS: A

When a patient does not respond to a drug, or when symptoms reappear after a good response to the drug, the nurse should assess for compliance. Is the patient taking the drug? Is the patient taking less of the drug than ordered? The other options are less relevant or of no value.

 

DIF:   Cognitive level: Application         REF:  167

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. When assessing for a positive outcome to drug therapy with fluphenazine (Prolixin), the nurse would look primarily for improvement in:
a.hallucinations.
b.range of affect.
c.personal hygiene.
d.social interactions.

 

ANS: A

Fluphenazine, a typical antipsychotic, will produce improvement in the positive symptoms associated with schizophrenia, such as hallucinations. Less improvement is expected in negative symptoms such as affect, activity, and grooming.

 

DIF:   Cognitive level: Application         REF:  165                TOP:  Nursing process: Evaluation

MSC: NCLEX: Psychosocial Integrity

 

  1. A patient with schizophrenia tells the clinic nurse, “I stopped taking my antipsychotic medication 2 days ago.” Previously, the patient was compliant and had good symptom control. What assessment finding would the nurse expect at this visit?
a.Mood instability
b.Paranoid delusions
c.No evidence of symptoms
d.Mental clouding and confusion

 

ANS: C

Antipsychotic drugs accumulate in fatty tissue and are released slowly. This explains why symptoms might still be controlled for several days after discontinuing the drug.

 

DIF:   Cognitive level: Analysis              REF:  165-166

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A patient is diagnosed with neuroleptic malignant syndrome. Which medication from the patient’s pharmacologic profile most likely led to this problem?
a.Divalproex sodium (Depakote)
b.Amitriptyline (Elavil)
c.Haloperidol (Haldol)
d.Paroxetine (Paxil)

 

ANS: C

Neuroleptic malignant syndrome is more likely to occur in patients taking traditional high-potency antipsychotic drugs. The distracters are not antipsychotic drugs.

 

DIF:   Cognitive level: Analysis              REF:  168

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. During a psychiatric emergency, a patient is given a traditional antipsychotic drug IM and placed in seclusion. Over the next 2 hours, concerns for safety and physiologic stability require that the patient be carefully monitored for:
a.tardive dyskinesia.
b.gastrointestinal hyperactivity.
c.drug-induced parkinsonian movements.
d.orthostatic hypotension and cardiac arrhythmias.

 

ANS: D

Hypotension is the major antiadrenergic effect of antipsychotic drugs. It is related to the blocking of alpha-1 receptors on peripheral blood vessels, preventing the vessels from constricting automatically to positional changes. Hypotension is frequently noted following IM administration and is of concern because it relates to patient safety and injury from falls. Cardiac arrhythmias may also occur, jeopardizing the patient’s physiologic stability. Drug-induced parkinsonism and tardive dyskinesia develop over time.

 

DIF:   Cognitive level: Application         REF:  167-168

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. During a psychiatric emergency, a patient is given a traditional antipsychotic drug IM and placed in seclusion. Over the next 2 hours, which aspect of physical assessment is most important?
a.Blood pressure, pulse, and respirations
b.Urinary output
c.AIMS scale
d.Temperature

 

ANS: A

A traditional antipsychotic medication administered IM might produce the marked antiadrenergic side effect of hypotension, thus making blood pressure an important assessment. It may also precipitate cardiac arrhythmias, so monitoring pulse and respirations is important. Decreased urinary output is related to anticholinergic side effects and would not be a priority assessment during the first 2 hours. The AIMS scale assesses for tardive dyskinesia, a late complication of antipsychotic therapy. Temperature assessment is relevant if assessing for neuroleptic malignant syndrome, a complication that develops after several doses of antipsychotic medication.

 

DIF:   Cognitive level: Application         REF:  167-168

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. After an unsuccessful trial with fluphenazine (Prolixin), a patient’s medication was changed to trifluoperazine (Stelazine). Three months later, the patient is still hallucinating and delusional. What is the most likely explanation for the persistent symptoms?
a.Trifluoperazine (Stelazine) is a low-potency antipsychotic, and the patient might need higher doses.
b.The patient has not taken trifluoperazine (Stelazine) long enough to decrease symptoms significantly.
c.Delusions and hallucinations are negative symptoms of schizophrenia that do not respond to traditional antipsychotic medications.
d.Both fluphenazine (Prolixin) and trifluoperazine (Stelazine) are traditional antipsychotics, and the patient does not respond well to this class of drug.

 

ANS: D

When a trial of a drug produces little change in symptoms and a new drug is to be prescribed, the best plan is to use a drug of another class, because the response to a drug of the first class will usually be poor. The other options are misleading.

 

DIF:   Cognitive level: Analysis              REF:  163 | 165-166

TOP:  Nursing process: Evaluation          MSC: NCLEX: Physiological Integrity

 

  1. Thioridazine (Mellaril) is prescribed for a 72-year-old patient with a psychiatric disorder. It is most critical for the nurse to obtain information about preexisting:
a.cataracts.
b.heart disease.
c.diabetes mellitus.
d.chronic bronchitis.

 

ANS: B

The anticholinergic and antiadrenergic effects of this drug might produce reflex tachycardia and/ or arrhythmias. Individuals with known heart disease must be carefully evaluated before and during therapy.

 

DIF:   Cognitive level: Analysis              REF:  163 | 166-167

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A 67-year-old patient with serious and persistent schizophrenia takes thioridazine (Mellaril). Regarding potential side effects of this drug, which nursing diagnosis should be considered for the plan of care? Risk for:
a.deficient fluid volume related to urinary frequency.
b.decreased cardiac output related to reflex tachycardia.
c.ineffective thermoregulation related to excessive sweating.
d.ineffective tissue perfusion related to peripheral vasoconstriction.

 

ANS: B

The antiadrenergic effects of antipsychotic medication produce orthostatic hypotension and reflex tachycardia to compensate for the orthostatic hypotension. This effect is especially likely in older adults. Cardiac insufficiency might be the result of reflex tachycardia. The other diagnoses are not applicable.

 

DIF:   Cognitive level: Analysis              REF:  163 | 166-167

TOP:  Nursing process: Analysis             MSC: NCLEX: Physiological Integrity

 

  1. When a patient begins a traditional antipsychotic medication, the nurse should assess carefully for extrapyramidal side effects, particularly:
a.akathisia.
b.mydriasis.
c.hypotension.
d.constipation.

 

ANS: A

It is estimated that more than 25% of all patients receiving antipsychotic medication experience akathisia, a subjective feeling of restlessness and jitteriness and a desire to stand or walk. Akathisia typically manifests itself early in treatment. The other options are not considered EPSEs.

 

DIF:   Cognitive level: Comprehension   REF:  168

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A patient who takes haloperidol (Haldol) 10 mg/day PO developed restlessness, agitation, and an inability to sit still. The nurse then administered a PRN dose of haloperidol 5 mg IM. One hour later, the patient’s symptoms were worse. What is the most likely explanation?
a.The PRN medication has not yet taken effect.
b.The patient needs an additional PRN dose of haloperidol to control the rising agitation.
c.The patient was experiencing akathisia, which worsened after receiving the PRN medication.
d.The nurse should consider an adjunctive dose of an antianxiety drug such as lorazepam (Ativan).

 

ANS: C

Akathisia is characterized by subjective feelings of restlessness accompanied by the inability to sit still and the need to pace. It is an extrapyramidal side effect of antipsychotic medication, made more intense by higher doses of medication and use of PRN doses. It is unnecessary to change to a more sedating drug. The addition of an antianxiety drug is unnecessary.

 

DIF:   Cognitive level: Analysis              REF:  168                TOP:  Nursing process: Evaluation

MSC: NCLEX: Physiological Integrity

 

  1. The patient receiving antipsychotic medication who should be most carefully monitored for development of neuroleptic malignant syndrome is the individual who:
a.has a history of hypothermia.
b.has an elevated serum prolactin level.
c.is beginning treatment with a high-potency drug.
d.has taken antipsychotics for more than 6 months.

 

ANS: C

Neuroleptic malignant syndrome is more common among patients receiving high-potency drugs. NMS is associated with hyperthermia and occurs within the first 3 to 9 days of administration. Prolactin levels and NMS are not causally related.

 

DIF:   Cognitive level: Application         REF:  168-169

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. An adult with schizophrenia was started on clozapine (Clozaril) 4 days ago. At 2100 today, the patient’s vital signs are T 101° F; P 143; R 20; BP 100/60. What is the nurse’s best action regarding the 2100 dose of clozapine?
a.Recognize the alterations in vital signs as typical for early therapy, and administer the medication.
b.Hold the medication and notify the health care provider.
c.Give the drug and continue to monitor vital signs q4h.
d.Postpone the dose until vital signs are normal.

 

ANS: B

Clozapine might cause agranulocytosis, a potentially fatal illness. Any symptoms or signs of infection raise suspicion and call for investigation of white cell differential counts. Clozapine should be withheld until the white blood cell (WBC) count and absolute neutrophil count (ANC) are known. Administering the drug has the potential for further lowering the WBC count and ANC.

 

DIF:   Cognitive level: Analysis              REF:  168 | 173-174

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. Which third-generation antipsychotic medication acts by stabilizing the dopamine system?
a.Aripiprazole (Abilify)
b.Ziprasicone (Geodon)
c.Quetiapine (Seroquel)
d.Risperidone (Risperdal)

 

ANS: A

Aripiprazole is novel in action. It acts by stabilizing the dopamine system through partial agonism of dopamine D2 and 5-HT2. The other drugs are atypical antipsychotics, which have other modes of action that produce therapeutic effects.

 

DIF:   Cognitive level: Comprehension   REF:  175

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A patient in the emergency room is highly agitated and psychotic. The nurse can anticipate that the combination of drugs to be ordered will be:
a.haloperidol (Haldol) and lorazepam (Ativan).
b.clozapine (Clozaril) and benztropine (Cogentin).
c.carbamazepine (Tegretol) and fluphenazine (Prolixin).
d.chlorpromazine (Thorazine) and bromocriptine (Parlodel).

 

ANS: A

Haloperidol is a high-potency drug often given because it causes fewer anticholinergic effects. It is compatible with lorazepam, a benzodiazepine, used for anxiety reduction. Clozapine is expensive and has few EPSEs, but would not initially be combined with benztropine. Chlorpromazine would be a viable choice, but bromocriptine is given only for NMS. Fluphenazine is a viable choice, but carbamazepine is not a first-line drug.

 

DIF:   Cognitive level: Application         REF:  72

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A patient is being switched to clozapine (Clozaril) from therapy using a traditional antipsychotic. The patient asks, “What’s the advantage of the new drug?” Select the nurse’s best response.
a.“It is much less expensive.”
b.“It has a lower risk for seizure activity.”
c.“It is sometimes effective when other drugs fail.”
d.“It has a lower risk for causing blood abnormalities.”

 

ANS: C

Clozapine is often effective against refractory schizophrenia. The distracters are incorrect statements.

 

DIF:   Cognitive level: Application         REF:  173

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. Which drug would a nurse expect to produce a favorable response for both positive and negative symptoms?
a.Haloperidol (Haldol)
b.Risperidone (Risperdal)
c.Fluphenazine (Prolixin)
d.Trifluoperazine (Stelazine)

 

ANS: B

Risperidone is an atypical antipsychotic. It has proven to be effective in managing both positive and negative symptoms of schizophrenia in many patients. The other drugs are traditional antipsychotics, all of which are more effective against positive symptoms.

 

DIF:   Cognitive level: Application         REF:  172

TOP:  Nursing process: Outcome Identification

MSC: NCLEX: Physiological Integrity

 

  1. A patient has taken a traditional antipsychotic medication for several years. The nurse observes involuntary tongue movements and lip smacking. The nurse should:
a.notify the health care provider.
b.administer PRN doses of an anticholinergic drug.
c.offer a reward when the patient stops these motions.
d.counsel the patient that the movements are annoying to others.

 

ANS: A

These symptoms suggest the presence of tardive dyskinesia and should be reported to the health care provider, who will probably discontinue the drug or change to an atypical drug. The movements are involuntary. Tardive dyskinesia does not respond to anticholinergics.

 

DIF:   Cognitive level: Application         REF:  168

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A patient who takes a traditional antipsychotic medication says, “I feel shaky and very warm.” The patient is diaphoretic. The nurse should further assess for what complication?
a.Acute dystonia
b.Tardive dyskinesia
c.Drug-induced parkinsonism
d.Neuroleptic malignant syndrome (NMS)

 

ANS: D

NMS is a relatively rare but serious reaction to antipsychotic therapy. It is characterized by muscle rigidity, fever, sweating, autonomic instability, altered levels of consciousness, and possible death. The data given in the scenario are not consistent with other options.

 

DIF:   Cognitive level: Application         REF:  168

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. A patient who takes a traditional antipsychotic medication says, “I feel shaky and very warm.” The patient is diaphoretic. What is the nurse’s best first action?
a.Take the patient’s vital signs.
b.Position the patient in the semi-Fowlers position.
c.Begin oxygen by nasal cannula at 2 L/min.
d.Place the patient on one-to-one supervision.

 

ANS: A

The signs and symptoms suggest that the patient might be experiencing neuroleptic malignant syndrome. The first action would be to check vital signs. NMS produces elevated temperature, BP fluctuations, and irregular heart rate in addition to muscle rigidity and altered levels of consciousness.

 

DIF:   Cognitive level: Application         REF:  168

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A patient who takes a traditional antipsychotic medication says, “I feel shaky and very warm.” The patient is diaphoretic. The nurse anticipates that the health care provider will prescribe:
a.olanzapine (Zyprexa).
b.dantrolene (Dantrium).
c.benztropine (Cogentin).
d.chlorpromazine (Thorazine).

 

ANS: B

Dantrolene is a drug of choice for treating NMS. It is a direct-acting skeletal muscle relaxant that will be administered for 8 to 12 days after improvement.

 

DIF:   Cognitive level: Analysis              REF:  168

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A nurse reviews laboratory reports for a patient who has taken clozapine (Clozaril) for one year. Which value would prompt the nurse to notify the health care provider of the need to suspend treatment? The total white count and granulocyte count are:
a.2900/mm3 and 1450/mm3.
b.3500/mm3 and 1850/mm3.
c.4000/mm3 and 2000/mm3.
d.4500/mm3 and 2500/mm3.

 

ANS: A

These values indicate that leukopenia is present. Agranulocytosis is a sometimes fatal side effect of clozapine. The other values are above baseline.

 

DIF:   Cognitive level: Application         REF:  168

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A nurse cares for four patients with schizophrenia who are receiving antipsychotic medication. Which patient will receive the nurse’s priority attention? The patient:
a.with diaphoresis and a temperature of 104°F.
b.who reports feelings of neck and shoulder stiffness.
c.who reports auditory hallucinations of church bells clanging loudly.
d.who chants, “I am the messiah, delivered to earth from the heavens above.”

 

ANS: A

These findings indicate neuroleptic malignant syndrome, a serious adverse reaction to antipsychotic medication. The other findings may be significant, but are a lesser priority.

 

DIF:   Cognitive level: Analysis              REF:  168

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A patient is to be discharged on a maintenance dose of a high-potency antipsychotic medication. Which remark indicates that discharge teaching about the medication was effective?
a.“I will be able to have a few glasses of wine.”
b.“I have to use sun block when I go to the beach.”
c.“It is important for me to dress warmly in all seasons.”
d.“If I miss a dose, I will take an extra one the next day.”

 

ANS: B

The patient understands that antipsychotics cause photosensitivity and sunburn with minimal exposure to the sun. The other remarks suggest that the patient does not understand the additive effects of the antipsychotics and other CNS depressants, and does not understand what to do in the event of a missed dose.

 

DIF:   Cognitive level: Application         REF:  171                TOP:  Nursing process: Evaluation

MSC: NCLEX: Physiological Integrity

 

  1. A 60-year-old female patient who has taken traditional antipsychotic medication for 20 years should be screened for:
a.osteoporosis.
b.metabolic syndrome.
c.polycystic ovary disease.
d.neuroleptic malignant syndrome.

 

ANS: A

Traditional antipsychotic medications increase prolactin levels, placing patients at risk for development of osteoporosis. Atypical antipsychotics increase the risk for metabolic syndrome. Screening for NMS and polycystic ovary disease are not indicated.

 

DIF:   Cognitive level: Application         REF:  169

TOP:  Nursing process: Assessment        MSC: NCLEX: Physiological Integrity

 

  1. Which information should the nurse include in the teaching plan for a patient receiving clozapine (Clozaril)?
a.“Abstain from using tobacco products.”
b.“Increase your daily carbohydrate intake.”
c.“Notify your health care provider if you start drooling.”
d.“You will need monthly electrocardiographic tracings done.”

 

ANS: A

Use of tobacco products speeds metabolism of clozapine in the liver, reducing the clozapine level and diminishing its effectiveness in reducing symptoms. Increasing carbohydrate intake is contraindicated because of the possibility of developing metabolic syndrome. Drooling is a common side effect. Monthly electrocardiographic tracings are unnecessary, but annual or semiannual tracings might be suggested, because arrhythmia development is possible.

 

DIF:   Cognitive level: Application         REF:  173

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. Patient teaching for individuals taking risperidone (Risperdal) should include: Select all that apply.
a.measures to prevent episodes of orthostatic hypotension.
b.strategies to maintain fluid and electrolyte balance.
c.importance of determining monthly WBC.
d.dietary management to avoid weight gain.
e.self-monitoring for facial tics.

 

ANS: A, D

Risperidone causes orthostatic hypotension, sedation, and appetite stimulation. When taken in moderate doses, its favorable side effect profile suggests that teaching regarding EPSEs and tardive dyskinesia can be minimal. Fluid and electrolyte imbalance and agranulocytosis are not usual side effects.

 

DIF:   Cognitive level: Application         REF:  174

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. A patient has received several doses of low-potency antipsychotic medication. The patient stands, sways, and then grasps the table for support and sits down again. What are the nurse’s best actions? Select all that apply.
a.Distract the patient with activity.
b.Ask the patient, “Do you feel dizzy?”
c.Assess the patient’s sitting and standing BPs.
d.Continue observing the patient from a distance.
e.Administer a PRN dose of diphenhydramine (Benadryl).

 

ANS: B, C

The behaviors described suggest that the patient is experiencing orthostatic hypotension, a common problem when low-potency antipsychotic medications are being administered. The nurse should ask the patient about this sensation. Taking the BP while the patient is seated and standing is a method for determining the presence of orthostatic hypotension. If the systolic BP decreases by 10 to 25 mm Hg and diastolic BP decreases by 5 to 10 mm Hg, the finding is considered positive for orthostatic hypotension. The other options would not be particularly helpful in confirming or treating hypotension.

 

DIF:   Cognitive level: Application         REF:  167

TOP:  Nursing process: Implementation  MSC: NCLEX: Physiological Integrity

 

  1. When comparing major differences between traditional and atypical antipsychotic drugs, which statements are correct? Select all that apply.
a.Traditional antipsychotic drugs produce more extrapyramidal effects.
b.Traditional antipsychotic drugs are more likely to produce weight gain.
c.Traditional antipsychotic drugs alter dopamine and serotonin transmission.
d.Atypical medications have a greater therapeutic effect on both positive and negative symptoms.
e.Atypical medications are more likely to cause tardive dyskinesia.

 

ANS: A, D

Traditional antipsychotics have a higher incidence of extrapyramidal side effects and tardive dyskinesia. Atypical antipsychotics are more likely to produce weight gain and alter dopamine and serotonin transmission.

 

DIF:   Cognitive level: Analysis              REF:  166-172         TOP:  Nursing process: Evaluation

MSC: NCLEX: Physiological Integrity