Quiz 5: Nursing care Of The Client With Special Health Needs: Psychosis

1. The patient taking pemoline (Cylert) should have _ tests done periodically to monitor for adverse side effects.

Cylert is a CNS stimulant used to treat ADHD. Potential side effects include insomnia, anorexia, aplastic anemia, physical and psychological dependence, and seizures. Aplastic anemia is a deficiency in red blood cells due to decreased production in bone marrow. Liver function tests are done to detect breakdown products of hemoglobin into bile.

Explanation

Cylert is a CNS stimulant used to treat ADHD. Potential side effects include insomnia, anorexia, aplastic anemia, physical and psychological dependence, and seizures. Aplastic anemia is a deficiency in red blood cells due to decreased production in bone marrow. Liver function tests are done to detect breakdown products of hemoglobin into bile.

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2. Many clients taking medication for treatment of schizophrenia experience conditions which contribute to ________________ with treatment. These conditions include intolerance of life-long requirement for medication and a perception that medication is no longer required after the client starts to feel better.

The inability to tolerate a daily requirement for medication with significant side effects for the rest of one's life and the perception that medication is generally not beneficial are basic reasons for medication noncompliance. Be aware that these two issues may be experienced by the client in a variety of ways.

Explanation

The inability to tolerate a daily requirement for medication with significant side effects for the rest of one's life and the perception that medication is generally not beneficial are basic reasons for medication noncompliance. Be aware that these two issues may be experienced by the client in a variety of ways.

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3. ___________________________, photosensitivity, and sedation are all potential side effects of the phenothiazine antipsychotic medications.

Thorazine, Prolixin, and Mellaril are examples of phenothiazine antipsychotic medications.

Explanation

Thorazine, Prolixin, and Mellaril are examples of phenothiazine antipsychotic medications.

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4. A client with schizophrenia has been started on medication therapy with quetipine fumarate (Seroquel). The nurse determines that the client is experiencing the intended effects of the medication if which of the following client behaviors is observed?

Decreased appetite and food intake

Taking sips of water for dry mouth

Presence of fixed stare

Absence of delusional statements

Seroquel is an atypical antipsychotic medication that is used to treat symptoms such as hallucinations, delusions, and altered thought processes. These symptoms are characteristic of psychosis and should decrease with effective treatment. Fixed stare (option 3) and dry mouth (option 2) are side effects of therapy. If you focus on the client's diagnosis and the medication, you may recall that Seroquel is an antipsychotic medication effective against positive symptoms of schizophrenia,like delusions.

Explanation

Seroquel is an atypical antipsychotic medication that is used to treat symptoms such as hallucinations, delusions, and altered thought processes. These symptoms are characteristic of psychosis and should decrease with effective treatment. Fixed stare (option 3) and dry mouth (option 2) are side effects of therapy. If you focus on the client's diagnosis and the medication, you may recall that Seroquel is an antipsychotic medication effective against positive symptoms of schizophrenia,like delusions.

5. Barbiturates and sedative hypnotics are used for short-term treatment of insomnia or for sedation to relieve anxiety, tension, and apprehension. All of the following medications are sedative hypnotics except for:

Choral hydrate (Somnote)

Ramelteon (Rozerem)

Dextroamphetamine sulfate (Dexedrine)

Zolpidem (Ambien)

Dextroamphetamine sulfate (Dexedrine) is a central nervous system stimulant, a medication effective in controlling attention deficit hyperactivity disorder.

Explanation

Dextroamphetamine sulfate (Dexedrine) is a central nervous system stimulant, a medication effective in controlling attention deficit hyperactivity disorder.

6. A nurse has been caring for a hospitalized client who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication?

Platelet count

Cholesterol level

White blood cell count

Blood urea nitrogen

Clozapine is associated with hematologic reactions like agranulocytosis (lack of nuetrophils, eosinophils and bsaophils, the granulocytic white blood cells) and mild leucopenia (abnormal decrease in WBCs to

Explanation

Clozapine is associated with hematologic reactions like agranulocytosis (lack of nuetrophils, eosinophils and bsaophils, the granulocytic white blood cells) and mild leucopenia (abnormal decrease in WBCs to

7. All of the following are mood-stabilizers and atypical antipsychotic medications with the exception of:

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Carbamazepine (Tegretol)

Carbamazepine (Tegretol) is a mood stabilizer and anticonvulsant. All mood stabilizers affect cellular transport mechanisms and enhanced serotonin or gamma-aminobutyric acid (GABA) functioning. Both serotonin and GABA are neurotransmitters associated with mood. Tegretol is most frequently used to treat epilepsy and bipolar disorder. Other off-label uses of Tegretol include treatment of trigeminal neuralgia, ADHD, and schizophrenia.

Explanation

Carbamazepine (Tegretol) is a mood stabilizer and anticonvulsant. All mood stabilizers affect cellular transport mechanisms and enhanced serotonin or gamma-aminobutyric acid (GABA) functioning. Both serotonin and GABA are neurotransmitters associated with mood. Tegretol is most frequently used to treat epilepsy and bipolar disorder. Other off-label uses of Tegretol include treatment of trigeminal neuralgia, ADHD, and schizophrenia.

8. A client is receiving a daily dose of oral fluphenazine (Prolixin). The nurse would teach the client to do which of the following to minimize common side effects of this medication?

Have blood pressure checked once a week.

Monitor pulse daily

Eat snacks at midmorning and bedtime.

Use hard, sour candy or sugarless gum.

Fluphenazine is classified as a phenothiazine antipsychotic medication. Dry mouth is a common side effect. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Hypotension and hypertension are rare side effects of oral fluphenazine. Fluphenazine does not affect the pulse. Weight gain is a common side effect, and frequent snacks will worsen the problem. The strategic words are “oral” and “minimize common side effects.” Eliminate options 1 and 2 because they are assessments rather than interventions, and as such, they cannot “minimize” a side effect.

Explanation

Fluphenazine is classified as a phenothiazine antipsychotic medication. Dry mouth is a common side effect. Frequent mouth rinsing with water, sucking on hard candy, and chewing sugarless gum will alleviate this common side effect. Hypotension and hypertension are rare side effects of oral fluphenazine. Fluphenazine does not affect the pulse. Weight gain is a common side effect, and frequent snacks will worsen the problem. The strategic words are “oral” and “minimize common side effects.” Eliminate options 1 and 2 because they are assessments rather than interventions, and as such, they cannot “minimize” a side effect.

9. The most common side effects of central nervous system stimulants include: (Select all that apply)

Tachycardia

Anorexia and weight loss

Allergic reactions

Headache

Dizziness and agitation

CNS stimulants which increase agitation and activity in adults, may produce a calming (paradoxical) effect in children and increase the ability to pay attention and respond to environmental stimuli appropriately. However, stimulation is possible and may be dose related; therefore, additional stimulants like caffeine and chocolate should be avoided. Allergic reactions and headache are common side effects of barbiturates and anxiolytic medications, respectively.

Explanation

CNS stimulants which increase agitation and activity in adults, may produce a calming (paradoxical) effect in children and increase the ability to pay attention and respond to environmental stimuli appropriately. However, stimulation is possible and may be dose related; therefore, additional stimulants like caffeine and chocolate should be avoided. Allergic reactions and headache are common side effects of barbiturates and anxiolytic medications, respectively.

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10. Select from the following statements the descriptions which apply to phenothiazine antipsychotic medications; (Select all that apply)

Antipsychotics affect dopamine receptors in the brain, thereby reducing the psychotic symptoms.

Typical antipsychotics are more effective for positive symptoms of schizophrenia, such as hallucinations, aggression, and delusions.

(a) & (d) are true statements that can be found in the Silvestric NCLEX Review text on page 982. Neuroleptic malignant syndrome is an uncommon and life-threatening side effect of antipsychotic therapy. It is true however that NMS symptoms (high fever, muscle rigidity progressing to coma) tend to appear after initiating therapy or when combinations of medications are used. The extrapyramidal side effects such as Parkinson's-like symptoms, rigidity, and abnormal or involuntary movements of the eyes, body and extremities, are common but reversible side effects. Symptoms of tardive dyskinesia are considered irreversible extra-pyramidal side effects.

Explanation

(a) & (d) are true statements that can be found in the Silvestric NCLEX Review text on page 982. Neuroleptic malignant syndrome is an uncommon and life-threatening side effect of antipsychotic therapy. It is true however that NMS symptoms (high fever, muscle rigidity progressing to coma) tend to appear after initiating therapy or when combinations of medications are used. The extrapyramidal side effects such as Parkinson's-like symptoms, rigidity, and abnormal or involuntary movements of the eyes, body and extremities, are common but reversible side effects. Symptoms of tardive dyskinesia are considered irreversible extra-pyramidal side effects.

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Quiz 5: Nursing care Of The Client With Special Health Needs: Psychosis

1. The patient taking pemoline (Cylert) should have ____________ _____________ tests done periodically to monitor for adverse side effects.

2.

What first name or nickname would you like us to use?

3. ___________________________, photosensitivity, and sedation are all potential side effects of the phenothiazine antipsychotic medications.

4. A client with schizophrenia has been started on medication therapy with quetipine fumarate (Seroquel). The nurse determines that the client is experiencing the intended effects of the medication if which of the following client behaviors is observed?

5. Barbiturates and sedative hypnotics are used for short-term treatment of insomnia or for sedation to relieve anxiety, tension, and apprehension. All of the following medications are sedative hypnotics except for:

7. All of the following are mood-stabilizers and atypical antipsychotic medications with the exception of:

8. A client is receiving a daily dose of oral fluphenazine (Prolixin). The nurse would teach the client to do which of the following to minimize common side effects of this medication?

9. The most common side effects of central nervous system stimulants include: (Select all that apply)

10. Select from the following statements the descriptions which apply to phenothiazine antipsychotic medications; (Select all that apply)

1. The patient taking pemoline (Cylert) should have _ tests done periodically to monitor for adverse side effects.