Chapter 27: Antipsychotics and Anxiolytics Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 27: Antipsychotics and Anxiolytics

Test Bank

MULTIPLE CHOICE

1. A client is to receive a dose of fluphenazine hydrochloride (Prolixin) by intramuscular injection. What is the most important nursing intervention related to the injection?

a.

Massage the site vigorously after injection.

b.

Administer the drug using Z-tracking.

c.

Avoid rotating the injection sites.

d.

Select a 22- to 23-gauge needle.

ANS: B

This medication is very viscous and requires Z-track, deep IM injection to avoid muscle irritation.

DIF: Cognitive Level: Application REF: pp. 384-385

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Psychosocial Integrity

2. The client has been diagnosed with schizophrenia and is exhibiting a loss of function and motivation. The nurse recognizes that these symptoms are categorized as:

a.

positive.

b.

paranoiac.

c.

negative.

d.

incoherent.

ANS: C

Negative symptoms are manifested as the inability to initiate voluntary motor function. The others are considered positive symptoms.

DIF: Cognitive Level: Application REF: p. 382

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. What is a common side effect for which the nurse must monitor during administration of both phenothiazine and non-phenothiazine medications?

a.

Hypertension

b.

Renal failure

c.

Increase in number of white blood cells

d.

Extrapyramidal symptoms

ANS: D

These medications are known for their extrapyramidal symptoms.

DIF: Cognitive Level: Comprehension REF: p. 386

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client is to be treated with Prolixin. The highest priority nursing intervention related to the clients vital signs is to monitor for:

a.

bradycardia.

b.

hypertension.

c.

hypotension.

d.

tachypnea.

ANS: C

The phenothiazine groups major side effect is hypotension.

DIF: Cognitive Level: Application REF: p. 385

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A client has been taking a phenothiazine for 1 week. She contacts the crisis intervention clinic because she is still having symptoms. The nurses response is based on the premise that the desired effects usually take _____ to manifest.

a.

1 week

b.

1 to 3 weeks

c.

3 to 6 weeks

d.

3 to 5 months

ANS: C

The client may feel some effect in 7 to 10 days, but generally it takes 6 weeks for the medication to take full effect.

DIF: Cognitive Level: Application REF: pp. 383-384

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. Extrapyramidal symptoms are a side effect of perphenazine (Trilafon). The nurse should assess and observe for which sign of akathisia?

a.

Restlessness and constant moving about

b.

Facial grimacing

c.

Chewing motion

d.

Involuntary eye movement

ANS: A

Akathisia is described as restless, agitated movement.

DIF: Cognitive Level: Application REF: p. 390

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. Client teaching is important when antipsychotics are taken after discharge from the hospital. Nursing instruction should include giving which information to the client and family?

a.

Therapeutic effect should occur in 2 to 3 days with maximum effect in 1 week.

b.

The drugs should not be discontinued without consulting a healthcare provider.

c.

Taking barbiturates in small dosages with the drug is usually permissible.

d.

Rapid change in position has little effect on dizziness or blood pressure.

ANS: B

Antipsychotic medications affect symptoms while they are used. If they are stopped, the symptoms will recur.

DIF: Cognitive Level: Application REF: p. 394

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A client is ordered to receive chlordiazepoxide (Librium) for severe anxiety. The nurse monitors for which symptoms of severe anxiety or panic attack?

a.

Dyspnea and heart palpitations

b.

Trembling, shaking, and gastrointestinal upset

c.

Dizziness and anorexia

d.

Drowsiness and blurred vision

ANS: A

Dyspnea and heart palpitations are symptoms of severe anxiety; also experienced is chest pain, dizziness, or faintness.

DIF: Cognitive Level: Application REF: p. 392

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A client is experiencing severe EPS effects. In addition to administering a lower dose of the antipsychotic agents, the nurse would anticipate administering a medication in which category?

a.

Cholinergics

b.

Anticholinergics

c.

Antidepressants

d.

Dopamine agonists

ANS: B

Anticholinergics, such as benztropine (Cogentin), are used to decrease the EPS effects associated with antipsychotic medications.

DIF: Cognitive Level: Application REF: pp. 382-383

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A client is taking an anxiolytic agent secondary to grief-related anxiety. The client questions the nurse about abruptly discontinuing these agents. The nurses response is based on the knowledge that, when discontinuing these medications:

a.

the dosage must be tapered to avoid withdrawal.

b.

the client must be evaluated for hyperglycemia.

c.

hangover syndrome must be planned for.

d.

blood levels must be monitored.

ANS: A

Discontinuing anxiolytic agents abruptly may lead to withdrawal symptoms.

DIF: Cognitive Level: Application REF: p. 394

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client is ordered to receive diazepam (Valium). The nurse is teaching the client about her medication. Which information would be included in the teaching plan?

a.

The medication causes high levels of energy and activity.

b.

The medication is effective in aiding clients with suicidal ideations.

c.

The medication may be taken concurrently with other benzodiazepines.

d.

The client may develop tolerance after prolonged use.

ANS: D

Patients may become tolerant to Valium.

DIF: Cognitive Level: Application REF: p. 394

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A client is brought to the emergency department unconscious. The clients spouse tells the nurse that the client was found in bed with an empty pill bottle nearby. The clients spouse believes that there were 20 to 25 diazepam (Valium) pills in the bottle. What represents an appropriate nursing priority?

a.

Administer an emetic agent followed by activated charcoal.

b.

Lavage the stomach using a nasogastric tube.

c.

Prepare the client for emergency surgery.

d.

Monitor the client because there is no antidote.

ANS: B

Because the client is unconscious, this is the correct course of action.

DIF: Cognitive Level: Application REF: p. 394

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A client is ordered to receive fluphenazine (Prolixin) to manage the psychotic symptoms of schizophrenia. The nurse assesses for which signs of anticholinergic effects?

a.

Bradycardia and orthostatic hypotension

b.

Diarrhea and tachycardia

c.

Urinary retention and dry mouth

d.

Constipation and hypertension

ANS: C

Urinary retention and dry mouth are the side effects of anticholinergics.

DIF: Cognitive Level: Application REF: pp. 383-384

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A client is receiving an antipsychotic agent. Which laboratory result is of most concern?

a.

Serum sodium level of 138 mEq/L

b.

Blood glucose level of 100 mg/dl

c.

White blood cell count of 6000/mm3

d.

Serum medication level below normal limits

ANS: D

A serum medication level below normal limits is a concern because subtherapeutic levels may allow for breakthrough psychotic symptoms.

DIF: Cognitive Level: Application REF: pp. 383-384

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The client has been placed on Ativan. The nurse is planning a client instructional session. Which herbal preparation should the nurse emphasize that the client avoid taking with Ativan?

a.

Kava kava

b.

St. Johns wort

c.

Ginseng

d.

Ginger

ANS: A

Kava kava in combination with Ativan will increase the sedation effects of the Ativan.

DIF: Cognitive Level: Application REF: p. 392

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The client has been placed on Risperdal. He complains to the nurse of experiencing headaches. The highest priority action on the part of the nurse is to recognize that this is a(n) ________ the medication and call the physician.

a.

adverse reaction to

b.

expected side effect of

c.

life-threatening reaction to

d.

anaphylactic reaction to

ANS: B

Headaches are an expected side effect of treatment with Risperdal.

DIF: Cognitive Level: Application REF: p. 389

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The client is an older adult who has been placed on Librium. The nurse recognizes that the dose of the drug _____ for this client.

a.

is contraindicated

b.

should be increased

c.

should be decreased

d.

will not change

ANS: C

The dose of Librium should be decreased for an older adult.

DIF: Cognitive Level: Application REF: p. 393

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is preparing a dose of Mellaril. What is the highest priority intervention for the nurse while preparing the dose?

a.

Draw up the dosage of the liquid in an oral syringe.

b.

Use a 21-gauge needle to administer the injection.

c.

Start a new IV site before administering the drug.

d.

Avoid spilling the liquid on exposed skin.

ANS: D

If Mellaril is allowed to come in contact with exposed skin, contact dermatitis can result.

DIF: Cognitive Level: Application REF: pp. 387-388

TOP: Nursing Process: Intervention

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The client is known to have overdosed on a benzodiazepine medication. The nurse anticipates that which medication will most likely be ordered?

a.

Tranxene

b.

Romazicon

c.

BuSpar

d.

Librium

ANS: B

Romazicon is considered to be the benzodiazepine antagonist.

DIF: Cognitive Level: Application REF: p. 393

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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