Medications For Psychotic Disoders

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Medications For Psychotic Disoders - Quiz


Questions and Answers
  • 1. 

    A nurse is giving instructions to a client taking risperidone.  The nurse advise the client to which of the following?

    • A. 

      Take it on an empty stomach.

    • B. 

      Change position slowly.

    • C. 

      Get a daily source of sunlight.

    • D. 

      Discontinue medication once the symptoms went away.

    Correct Answer
    B. Change position slowly.
    Explanation
    Risperidone can cause orthostatic hypotension.

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  • 2. 

    A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue.  The nurse determines that the client is experiencing?

    • A. 

      Hypertensive crisis

    • B. 

      Parkinsonism

    • C. 

      Tardive dyskinesia

    • D. 

      Neuroleptic malignant syndrome

    Correct Answer
    C. Tardive dyskinesia
    Explanation
    TD is characterized by uncontrollable involuntary movements of the body (especially of the face, lips, mouth, tongue, arms, and legs)

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  • 3. 

    A client with schizophrenia has been started on medication therapy with clozapine.  A nurse assesses the results of which lab study to monitor for adverse effect related to this medication?

    • A. 

      White blood cell

    • B. 

      Platelet count

    • C. 

      Liver function studies

    • D. 

      Random blood sugar

    Correct Answer
    A. White blood cell
    Explanation
    Agranulocytosis may be experienced by the client taking clozapine.

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  • 4. 

    A nurse is assessing a client who is currently taking perphenazine.  Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? ​Select all that apply.

    • A. 

      Decreased level of consciousness

    • B. 

      Drooling

    • C. 

      Involuntary arm movements

    • D. 

      Urinary Retention

    • E. 

      Continual pacing

    Correct Answer(s)
    B. Drooling
    C. Involuntary arm movements
    E. Continual pacing
    Explanation
    The nurse should identify drooling, involuntary arm movements, and continual pacing as extrapyramidal symptoms (EPS) in a client taking perphenazine. EPS are a side effect of antipsychotic medications, such as perphenazine, and can include abnormal movements and behaviors. Drooling can be a result of decreased muscle control in the mouth and throat. Involuntary arm movements, such as tremors or jerking, can be a sign of EPS. Continual pacing, or restlessness and constant movement, can also be a manifestation of EPS. Decreased level of consciousness and urinary retention are not typically associated with EPS.

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  • 5. 

    A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone.  Which of the following client statements indicates understanding of the teaching?

    • A. 

      "I will be able to stop the medication as soon as I feel better."

    • B. 

      "If I feel drowsy during the day, I will stop taking this medication and call my provider."

    • C. 

      "I will be careful not to gain too much weight while taking this medication."

    • D. 

      "This medication is highly addictive and must be withdrawn slowly."

    Correct Answer
    C. "I will be careful not to gain too much weight while taking this medication."
    Explanation
    Has a high risk for significant weight gain

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  • 6. 

    A nurse is caring for a schizophrenia patient that takes haloperidol and notices the patient is having manifestations of pseudoparkinsonism.  What is the nurse's priority intervention?

    • A. 

      Discontinue the medication and notify the provider

    • B. 

      Treat with benztropine

    • C. 

      Implement interventions to reduce the risk for falling

    • D. 

      Administer antipyretics

    Correct Answer
    B. Treat with benztropine
    Explanation
    Benztropine is an antiparkinsonian agent

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  • 7. 

    A client is about to be discharged with a prescription for haloperidol, 10mg PO twice per day.  During a discharge teaching session, the nurse should provide which instruction to the client?

    • A. 

      Take the medication 1 hour before a meal

    • B. 

      Decrease the dosage if signs of illness decrease

    • C. 

      Apply a sunscreen before being exposed to the sun

    • D. 

      Increase the dosage up to 50 mg twice per day if signs of illness don't decrease

    Correct Answer
    C. Apply a sunscreen before being exposed to the sun
    Explanation
    Haloperidol can cause photosensitivity and precipitate severe sunburn

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  • 8. 

    Which of the following is one of the advantages of the newer antipsychotic medication risperidone?

    • A. 

      The absence of anticholinergic effects

    • B. 

      A lower incidence of extrapyramidal effects

    • C. 

      Photosensitivity and sedation

    • D. 

      No incidence of neuroleptic malignant syndrome

    Correct Answer
    B. A lower incidence of extrapyramidal effects
    Explanation
    Lower incidence of EPS, does produce anticholinergic effects and NMS effects. Photosensitivity isn't an advantage.

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  • 9. 

    A client with schizophrenia is receiving antipsychotic medication.  Which nursing diagnosis may be appropriate for this client? 

    • A. 

      Ineffective protection r/t blood dyscrasias

    • B. 

      Urinary frequency r/t adverse effects of antipsychotic medication

    • C. 

      Risk for injury r/t severely decreased level of consciousness

    • D. 

      Risk for injury r/t electrolyte disturbances

    Correct Answer
    A. Ineffective protection r/t blood dyscrasias
    Explanation
    Antipsychotic medications mat cause neutropenia and granulocytopenia (life threatening blood dyscrasias)

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  • 10. 

    A client with persistent, severe schizophrenia has been treated with typical antipsychotics for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion.  What is another name for this extrapyramidal symptom?

    • A. 

      Dystonia

    • B. 

      Akathisia

    • C. 

      Pseudoparkinsonism

    • D. 

      Tardive dyskinesia

    Correct Answer
    D. Tardive dyskinesia
    Explanation
    Tardive dyskinesia is a movement disorder characterized by involuntary, repetitive movements of the tongue, lips, face, and other body parts. It is a common extrapyramidal symptom that can occur as a side effect of long-term use of antipsychotic medications, especially typical antipsychotics. The garbled speech in this client is a result of the rhythmic tongue protrusion caused by tardive dyskinesia.

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  • 11. 

    Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine?

    • A. 

      Monthly blood tests will be necessary

    • B. 

      Report a sore throat, fever, or malaise to the physician immediately

    • C. 

      Blood pressure must be monitored for hypertension

    • D. 

      Stop the medication when symptoms subside

    Correct Answer
    B. Report a sore throat, fever, or malaise to the physician immediately
    Explanation
    Sore throat, fever, and malaise are indications of an infection caused by agranulocytosis. WBC counts are necessary WEEKLY

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  • 12. 

    Important teaching for clients receiving antipsychotic medication such as haloperidol includes which of the following instructions?  Select all that apply.

    • A. 

      Use sunscreen because of photosensitivity

    • B. 

      Take the antipsychotic medication with food

    • C. 

      Have routine blood tests to determine levels of medication

    • D. 

      Abstain from eating aged cheese

    • E. 

      Instruct client to take a bedtime to avoid daytime sleepiness

    Correct Answer(s)
    A. Use sunscreen because of photosensitivity
    B. Take the antipsychotic medication with food
    E. Instruct client to take a bedtime to avoid daytime sleepiness
    Explanation
    Clients receiving antipsychotic medication such as haloperidol should be instructed to use sunscreen because these medications can increase photosensitivity. They should also be advised to take the medication with food to minimize gastrointestinal side effects. Routine blood tests are necessary to determine the levels of medication in the client's system and ensure therapeutic effectiveness. Abstaining from eating aged cheese is not specifically related to antipsychotic medication. Instructing the client to take the medication at bedtime rather than during the day can help avoid daytime sleepiness, which is a common side effect of antipsychotic medication.

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  • 13. 

    Positive symptoms of schizophrenia include which of the following?

    • A. 

      Hallucinations, delusions, and disorganized thinking

    • B. 

      Somatic delusions, echolalia, and a flat affect

    • C. 

      Waxy flexibility, alogia, and apathy

    • D. 

      Flat affect, avolition, and anhedonia

    Correct Answer
    A. Hallucinations, delusions, and disorganized thinking
    Explanation
    Positive symptoms of schizophrenia refer to the presence of abnormal behaviors or experiences that are not typically seen in healthy individuals. Hallucinations, delusions, and disorganized thinking are all examples of positive symptoms. Hallucinations are sensory experiences that are not based in reality, such as hearing voices or seeing things that are not there. Delusions are false beliefs that are not based in reality, such as believing that one is being followed or that one has special powers. Disorganized thinking refers to difficulties in organizing thoughts and expressing them coherently. These symptoms are characteristic of schizophrenia and are considered positive symptoms because they represent an excess or distortion of normal functioning.

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  • 14. 

    A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate IM.  Three days later, the client has muscle contractions that contort the neck.  This client is exhibiting which extrapyramidal reaction?

    • A. 

      Dystonia

    • B. 

      Akinesia

    • C. 

      Akathisia

    • D. 

      Tardive dyskinesia

    Correct Answer
    A. Dystonia
    Explanation
    The client is exhibiting dystonia, which is characterized by muscle contractions that cause abnormal postures or twisting movements. This extrapyramidal reaction is a known side effect of fluphenazine decanoate, an antipsychotic medication commonly used to treat schizophrenia. Dystonia can affect various muscle groups, including the neck, and can cause discomfort and pain. It is important to monitor and manage extrapyramidal reactions promptly to ensure the client's well-being and to adjust the medication regimen if necessary.

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  • 15. 

    Hormonal effects of the antipsychotic medications include which of the following?

    • A. 

      Retrograde ejaculation and gynecomastia

    • B. 

      Dysmenorrhea and increased vaginal bleeding

    • C. 

      Polydipsia and dysmenorrhea

    • D. 

      Akinesia and dysphasia

    Correct Answer
    A. Retrograde ejaculation and gynecomastia
    Explanation
    Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications.

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  • 16. 

    Yesterday, a client with schizophrenia began treatment with haloperidol.  Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms.  What should the nurse do?

    • A. 

      Assume that the client is posturing

    • B. 

      Tell the client to lie down and relax

    • C. 

      Evaluate the client for adverse reactions to haloperidol

    • D. 

      Put the client on the list for physician to see tomorrow

    Correct Answer
    C. Evaluate the client for adverse reactions to haloperidol
    Explanation
    The client's symptoms of holding the head to one side and complaining of neck and jaw spasms are indicative of dystonia, which is a possible adverse reaction to haloperidol. Therefore, the nurse should evaluate the client for adverse reactions to haloperidol. This is important to ensure the client's safety and to determine if any interventions or adjustments to the medication are needed.

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  • 17. 

    Important teaching for  client receiving risperidone would include advising the client to:

    • A. 

      Double the dose if missed to maintain a therapeutic level

    • B. 

      Be sure to take the drug with a meal because it's very irritating to the stomach

    • C. 

      Discontinue the drug if the client reports weight gain

    • D. 

      Notify the physician if the client notices an increase in bruising

    Correct Answer
    D. Notify the physician if the client notices an increase in bruising
    Explanation
    Increase in bruising may indicate blood dyscrasias

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  • 18. 

    A client begins clozapine therapy after several other antipsychotic agents fail to relieve her psychotic symptoms.  The nurse instructs her return for weekly WBC counts to assess for which adverse reaction?

    • A. 

      Hepatitis

    • B. 

      Neuroleptic Malignant Syndrome

    • C. 

      Agranulocytosis

    • D. 

      Orthostatic Hypotension

    Correct Answer
    C. Agranulocytosis
    Explanation
    The nurse instructs the client to return for weekly WBC counts to assess for agranulocytosis. Agranulocytosis is a potentially life-threatening adverse reaction associated with clozapine therapy. It is characterized by a severe decrease in white blood cells (WBCs), specifically granulocytes, which are important for fighting off infections. Monitoring WBC counts is important to detect agranulocytosis early and prevent serious complications such as infections.

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  • 19. 

    How do you manage the psychopharmacologic side effect of dry mouth? ​Select all that apply.

    • A. 

      Sugarless candy or gum

    • B. 

      Sipping on water

    • C. 

      Eating food high in fiber

    • D. 

      Regular exercise

    Correct Answer(s)
    A. Sugarless candy or gum
    B. Sipping on water
    Explanation
    Sugarless candy or gum and sipping on water are both effective ways to manage the psychopharmacologic side effect of dry mouth. Sugarless candy or gum stimulates saliva production, providing relief from dry mouth. Sipping on water helps to keep the mouth moist and hydrated, reducing the discomfort caused by dry mouth.

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  • 20. 

    How do you manage psychopharmacologic side effects of constipation? Select all that apply.

    • A. 

      Increase fluid intake

    • B. 

      Eating food high in fiber

    • C. 

      Sugarless candy or gum

    • D. 

      Increase physical exercise

    Correct Answer(s)
    A. Increase fluid intake
    B. Eating food high in fiber
    D. Increase physical exercise
    Explanation
    Increasing fluid intake, eating food high in fiber, and increasing physical exercise are all effective ways to manage the psychopharmacologic side effect of constipation. These strategies help to promote regular bowel movements and prevent or alleviate constipation. Increasing fluid intake helps to soften the stool and make it easier to pass. Eating food high in fiber adds bulk to the stool and promotes regular bowel movements. Increasing physical exercise helps to stimulate the muscles in the digestive tract, promoting bowel movements. Sugarless candy or gum, however, does not have a direct impact on managing constipation and is not an effective strategy for this specific side effect.

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  • 21. 

    What are the symptoms of neuroleptic malignant syndrome? Select all that apply.

    • A. 

      Weight gain

    • B. 

      High body temperature

    • C. 

      Akathisia

    • D. 

      BP fluctuations

    • E. 

      Tachycardia

    • F. 

      Dry mouth

    Correct Answer(s)
    B. High body temperature
    D. BP fluctuations
    E. Tachycardia
    Explanation
    Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening condition that can occur as a side effect of certain medications used to treat mental disorders. The symptoms of NMS include high body temperature (hyperthermia), fluctuations in blood pressure (BP), and tachycardia (rapid heartbeat). Weight gain, akathisia (restlessness), and dry mouth are not typically associated with NMS.

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  • 22. 

    Sheila who has been on a low-potency antipsychotic for 2 weeks has shown minimal response.  The most probable explanation is:

    • A. 

      The client probably has refractory illness

    • B. 

      The client needs a stronger medication

    • C. 

      It is too early to see a full therapeutic response

    • D. 

      The client is not taking the medication

    Correct Answer
    C. It is too early to see a full therapeutic response
    Explanation
    The initial response may be seen 1-2 days after initiation of treatment, it takes 6-8 weeks to see a full therapeutic response.

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  • 23. 

    A patient is receiving a traditional antipsychotic agent complains that she is gaining weight.  The nurse would:

    • A. 

      Be aware this is probably delusional thinking because these agents cause weight loss

    • B. 

      Encourage the client to follow a healthy diet to help maintain her weight

    • C. 

      Discuss to switch to a high-potency agent so the weight gain will not be a problem

    • D. 

      Establish a contract with the client to carefully follow her high-calorie diet

    Correct Answer
    B. Encourage the client to follow a healthy diet to help maintain her weight
    Explanation
    These agents have a known side effect of weight gain.

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  • 24. 

    Neurological adverse effect associated with antipsychotic drug use; occurs late in therapy:

    • A. 

      Akathisia

    • B. 

      Dystonia

    • C. 

      Tardive dyskinesia

    • D. 

      All of the above

    Correct Answer
    C. Tardive dyskinesia
    Explanation
    Tardive dyskinesia is a neurological adverse effect that is associated with the long-term use of antipsychotic drugs. It is characterized by involuntary movements of the face, tongue, and limbs. Unlike akathisia and dystonia, which can occur early in therapy, tardive dyskinesia typically develops after prolonged exposure to antipsychotics. This condition is often irreversible and can be socially and psychologically distressing for patients. Therefore, it is important to monitor patients on long-term antipsychotic therapy for signs of tardive dyskinesia and consider alternative treatment options if necessary.

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  • 25. 

    A patient has recently been prescribed fluphenazine.  Before discharge the nurse must teach the patient about the neuroendocrine effects of the medication.  What manifestations would the nurse teach the client to report to the provider if they occur?

    • A. 

      Gynescomastia

    • B. 

      High fever

    • C. 

      Weight gain

    • D. 

      Menstrual irregularities

    • E. 

      Diaphoresis

    Correct Answer(s)
    A. Gynescomastia
    C. Weight gain
    D. Menstrual irregularities
    Explanation
    The nurse would teach the patient to report the manifestations of gynescomastia, weight gain, and menstrual irregularities to the provider if they occur. This is because fluphenazine, an antipsychotic medication, can cause these neuroendocrine effects. Gynescomastia refers to the enlargement of breast tissue in males, weight gain is a common side effect of antipsychotics, and menstrual irregularities can occur in females. It is important for the patient to report these symptoms to the provider for further evaluation and management.

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  • 26. 

    What test is done to screen for the presence of EPS?

    • A. 

      Snellen chart

    • B. 

      Abnormal Involuntary Movement Scale (AIMS)

    • C. 

      Vagus nerve stimulation

    • D. 

      Physical Assessment

    Correct Answer
    B. Abnormal Involuntary Movement Scale (AIMS)
    Explanation
    The correct answer is Abnormal Involuntary Movement Scale (AIMS). AIMS is a test used to screen for the presence of extrapyramidal symptoms (EPS), which are movement disorders caused by certain medications. This test assesses the presence and severity of abnormal movements, such as tremors, rigidity, and dyskinesias. By administering the AIMS, healthcare professionals can determine if EPS is present and adjust the medication regimen accordingly. The Snellen chart is used to assess visual acuity, vagus nerve stimulation is a treatment for epilepsy and depression, and physical assessment is a general term for evaluating a patient's overall health.

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  • 27. 

    A woman, 68 years of age, presents with blunted affect; she seems indifferent to her surroundings and says that she has no sense of pleasure in life.  She complains that she hears voices and fears that she is about to be killed.  She is admitted to the acute psychiatric ward where she is given an antipsychotic--Drug A.  After treatment, her hallucinations and paranoia resolve, but she complains that she has a tremor and cannot move about quickly.  After a change in her medication to Drug B, all of her symptoms improved.  She does not need to have weekly blood tests.  Which one of the following pairs most likely corresponds to Drug A and Drug B?

    • A. 

      Fluphenazine, Clozapine

    • B. 

      Risperidone, Sertraline

    • C. 

      Thioridazine, Clozapine

    • D. 

      Haloperidol, Olanzapine

    • E. 

      Quetiapine, Paroxetine

    Correct Answer
    D. Haloperidol, Olanzapine
    Explanation
    The patient's symptoms of blunted affect, indifference to surroundings, lack of pleasure, and hallucinations are consistent with schizophrenia. The initial treatment with Drug A, Haloperidol, effectively resolved her hallucinations and paranoia. However, it caused a side effect of tremor and impaired movement. Therefore, the medication was changed to Drug B, Olanzapine, which improved all of her symptoms without the need for weekly blood tests. This suggests that Haloperidol and Olanzapine are the most likely corresponding medications.

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  • 28. 

    A patient who has been taking chlorpromazine for the last 5 days.  She lets the nurse know that she feels dizzy every time she stands up.  The nurse would teach the patient:

    • A. 

      If this occurs just keep standing until the dizziness goes away

    • B. 

      If this occurs just bend down and touch your toes to promote circulation

    • C. 

      If this occurs just sit or lie down and stand up slowly

    • D. 

      If this occurs notify your provider

    Correct Answer
    C. If this occurs just sit or lie down and stand up slowly
    Explanation
    The patient's dizziness when standing up is likely a side effect of chlorpromazine, which can cause orthostatic hypotension. Orthostatic hypotension is a drop in blood pressure that occurs when standing up from a sitting or lying position. To prevent dizziness and falls, the nurse would teach the patient to sit or lie down and stand up slowly, allowing their body time to adjust to the change in position.

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  • 29. 

    Contraindications/precautions of first generation (typical) antipsychotics are?

    • A. 

      Client in coma

    • B. 

      Client who has Parkinson's disease

    • C. 

      Client who has an STD

    • D. 

      Client who is bipolar

    • E. 

      Client who has liver damage

    • F. 

      Client with severe hypotension

    • G. 

      Elderly client with dementia

    • H. 

      Client who takes oral contraceptives

    Correct Answer(s)
    A. Client in coma
    B. Client who has Parkinson's disease
    E. Client who has liver damage
    F. Client with severe hypotension
    G. Elderly client with dementia
    Explanation
    The contraindications/precautions of first generation (typical) antipsychotics include clients in a coma, clients with Parkinson's disease, clients with liver damage, clients with severe hypotension, and elderly clients with dementia. These conditions can be worsened by the use of first generation antipsychotics and may lead to adverse reactions or complications. It is important to consider these contraindications/precautions when prescribing or administering these medications to ensure the safety and well-being of the client.

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  • 30. 

    A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect.  The nurse should anticipate a prescription of which of the following medications?

    • A. 

      Chlorpromazine

    • B. 

      Haloperidol

    • C. 

      Thiothixene

    • D. 

      Risperidone

    Correct Answer
    D. Risperidone
    Explanation
    Secind-generation antipsychotics, such as risperidone, are effective in treating negative symptoms of schizophrenia, such as lack of grooming and flat affect.

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