Test bank for Stahl’s Essential Psychopharmacology 4th edition

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Test bank for Stahl’s Essential Psychopharmacology 4th edition

Chapter 5 Antipsychotic agents
MULTIPLE CHOICE

1. The nurse is assessing a patient who is complaining of hearing voices. What is this
patient experiencing?
a. Delusions
b. Flight of ideas
c. Disorganized thinking
d. Hallucinations
ANS: D
Hallucinations are false sensory perceptions that are experienced without an external
stimulus but seem real to the patient. Auditory hallucinations are prominent in a
schizophrenic patients. Additional sensory hallucinations include those of touch, sight,
smell, and body sensation. Delusions are false beliefs that persist despite evidence to
the contrary. Flight of ideas is characterized by rapid changes in thought from one
topic to another. Disorganized thinking is commonly associated with psychoses and
consists of a flight of ideas during which the individual jumps from one idea or topic
to another.

2. A patient with schizophrenia has been nonadherent with his home medication
regimen. He requires frequent admissions to the intensive psychiatric unit for
treatment of acute psychotic episodes. Which medication regimen would be
appropriate for this patient?
a. Daily home nursing visits to administer the prescribed oral medication
b. Continuous inpatient hospitalization for medication therapy
c. Administration of depot antipsychotic medication
d. Subcutaneous medication administration
ANS: C
Depot antipsychotic medications are long-acting injections that may be used with
noncompliant patients and may assist in avoiding repeated hospital admissions. Daily
home nursing visits are not an efficient way to ensure medication compliance.
Continuous inpatient hospitalization is not an efficient way to ensure medication
compliance. Subcutaneous medication administration is not an option for this patient.

3. What is the most common cause of nonadherence to antipsychotic pharmacologic
treatment?
a. Expense
b. Increased symptoms of chemical dependency

c. Extrapyramidal effects
d. Inability of the patient to understand the need to take medications
ANS: C
Extrapyramidal effects are the most common reason for nonadherence to
antipsychotic therapy. The four categories of extrapyramidal effects are dystonic
reactions, pseudoparkinsonism, akathisia, and tardive dyskinesia. Although expense
may be a concern, it is not the most common reason for noncompliance. Chemical
dependency is not a feature of therapy with antipsychotic drugs. Although knowledge
deficit is a concern, it is not the most common reason for noncompliance.

4. Which type of adverse effects is present when a patient displays prolonged tonic
contractions of the tongue, oculogyric crisis, and torticollis?
a. Dystonic reactions
b. Pseudoparkinsonism
c. Akathisia
d. Tardive dyskinesia
ANS: A
Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is
taking antipsychotic agents. Dystonias are spasmodic movements of muscle groups
such as tongue protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms
(trismus), or neck torsion (torticollis). Pseudoparkinsonism is characterized by tremors
and rigidity. Akathisia is characterized by subjective feelings of anxiety and
restlessness, accompanied by pacing and the inability to remain in one place for
extended periods. Tardive dyskinesia is characterized by persistent involuntary
hyperkinetic movements.

5. The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly
blood tests for the first 6 months of treatment to monitor for which potential
complication?
a. Agranulocytosis
b. Vitamin deficiencies
c. Clotting abnormalities
d. Polycythemia
ANS: A
The use of clozapine requires baseline and weekly white blood cell (WBC) counts
because of the high incidence of agranulocytosis. Clozapine does not cause vitamin
deficiencies. Clozapine does not interfere with clotting abilities. Clozapine does not
affect red blood cell volume.

6. A male patient becomes verbally aggressive and insists the nurse is poisoning him
as she attempts to administer haloperidol (Haldol). Which action will the nurse take?                                                 a. Support the patient’s decision to refuse the medication.
b. Discreetly ask an assistant to put the medication in the patient’s food.
c. Firmly redirect the patient to take the medication.
d. Speak privately with the patient and reinforce medication action.
ANS: C
During episodes of acute psychosis, the patient is out of touch with reality and often
does not understand the need for medication to stabilize his or her condition. Target
symptoms such as agitation, suspicion, and paranoia are common. Healthcare
providers must be supportive yet firm in their expectations. An open and direct
manner in handling highly suspicious patients is critical. Delusions should
not be supported. The patient is not competent to determine his need for medication. It
is dishonest to hide medication in a patient’s food and destroys a trusting relationship.
Reasoning with the patient is unlikely to change his mind; he needs external structure
for making decisions when he is aggressive and paranoid.

7. Which statement is true regarding the adverse effects associated with antipsychotic
medications?
a. Tardive dyskinesia is a common, reversible condition.
b.Painful dystonic reactions can occur in the first 72 hours of initiation of
therapy.
c. Neuroleptic malignant syndrome (NMS) is a common adverse effect.
d. Pseudoparkinsonian symptoms can cause Parkinson’s disease.
ANS: B
Approximately 90% of all dystonic reactions occur in the first 72 hours of
antipsychotic therapy. These symptoms are often frightening and painful. Tardive
dyskinesia is present in 20% to 25% of patients and may become irreversible. NMS is
not a common adverse effect. Pseudoparkinsonism is not related to Parkinson’s’
disease.

8. To what does the potency of an antipsychotic medication refer?
a. Severity of adverse effects associated with the drug
b. Length of time that it takes to reach a therapeutic blood level of the drug
c. Milligram doses used for the medication
d. Effectiveness of the drug in alleviating psychotic behavior
ANS: C
Low and high potency refers only to the milligram doses used for the medications and
does not suggest any difference in effectiveness. Potency is not related to the severity of
adverse effects or the onset of action. Potency does not refer to effectiveness.

9. Dystonic reactions, pseudo-parkinsonism, akathisia, and tardive dyskinesia are types
of which effect?
a. Extrapyramidal symptoms
b. Allergic reactions
c. Idiosyncratic reactions
d. Therapeutic responses
ANS: A
There are four categories of extrapyramidal symptoms: dystonic reactions,
pseudoparkinsonism, akathisia, and tardive dyskinesia. These are not allergic
reactions, idiosyncratic reactions, or therapeutic responses.

10. Which is an appropriate nursing intervention for a patient who has recently been
prescribed clozapine (Clozaril)?
a. Assess for signs and symptoms of hypoglycemia.
b. Encourage a low-fiber diet.
c. Measure the patient’s waist circumference.
d. Monitor for insomnia.
ANS: C
Waist circumference baseline measurement is appropriate because of the weight gain
and onset of diabetes with the use of these medications. Hypoglycemia and insomnia do
not occur with this medication. A low-fiber diet is not appropriate.