Create
Learn
Share

PSYCHIATRIC CARE part three

rename
xelehila's version from 2015-09-30 00:49

Section

11. Which neurotransmitter is MOST affected by antipsychotic agents?

 

a. dopamine
b. epinephrine
c. histamine
d. serotonin

 

ANS: A
Dopamine is the neurotransmitter most affected by antipsychotic agents. Specifically, all antipsychotics block dopamine receptor D2. Illnesses such as schizophrenia (and perhaps other psychoses) involve excessive activation of dopamine receptor D2, and antipsychotics seek to alleviate the illness by blocking such activation. Clozapine also has an effect on dopamine receptors D1 and D4.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Non-Antipsychotic Drugs Commonly Used in the Treatment of Psychosis

 

12. When an antipsychotic medication is administered orally in pill form that is swallowed intact, the clinical effects are noted within:

 

a. 5 to 10 minutes
b. 15 to 30 minutes
c. 40 to 55 minutes
d. 60 minutes or longer

 

ANS: D
The clinical effects of antipsychotics are noted within 60 minutes or longer when the medication is taken orally. Oral absorption can take between 1 and 4 hours. The absorption process may be decreased by foods, coffee, smoking, and other drugs.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Dose/Administration

 

13. Absorption of liquid antipsychotic medication compared to the absorption of the same antipsychotic medication in pill form is:

 

a. often somewhat faster with the liquid than with the pills
b. slightly slower in liquid form compared to pill form
c. much slower with the liquid form of the medication
d. nearly always approximately the same length of time

 

ANS: A
Absorption of liquid antipsychotic medication is often somewhat faster than the same antipsychotic in pill form. Both forms of oral absorption can take between 1 and 4 hours. The absorption process may be decreased by foods, coffee, smoking, and other drugs.

 

PTS: 1 DIF: Analysis REF: Antipsychotic Drugs| Dose/Administration

 

14. Parenteral administration of antipsychotic medications:

 

a. avoids first pass metabolism
b. demonstrates variable absorption
c. has lower brain bioavailability
d. has slower clinical effectiveness

 

ANS: A
Parenteral administration of antipsychotic medications avoids first pass metabolism. As a result of this, medications administered parenterally work faster and have greater clinical effect, due to higher brain bioactivity. In the case of medications not administered parenterally, many times they are rapidly metabolized by the liver before reaching the bloodstream.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Dose/Administration

 

15. A nurse teaches a new client about the route of administration used for a single dose of antipsychotic medication to produce a sustained action over 2 to 3 weeks. The client has correctly learned that this would require taking the medication in the form of:

 

a. capsules
b. injections
c. liquids
d. pills

 

ANS: B
Antipsychotics formulated to have a long duration of action are administered only by injection. They are manufactured by dissolving the drug in sesame seed oil. The sesame seed oil slows the diffusion of the drug and significantly delays absorption.

 

PTS: 1 DIF: Application REF: Antipsychotic Drugs| Dose/Administration

 

16. One way of classifying antipsychotic medications is into short-acting and long-acting preparations. Which of the following antipsychotic medications is a long-acting preparation?

 

a. haloperidol decanoate (Haldol Decanoate)
b. chlorpromazine (Thorazine)
c. thioridazine (Mellaril)
d. clozapine (Clozaril)

 

ANS: A
Haloperidol decanoate is a long-acting preparation of antipsychotic medication. Another first-generation antipsychotic formulated for long duration of action is fluphenazine decanoate. Both of these drugs, as well as all other antipsychotics formulated for long duration of action, are administered by injection only.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Dose/Administration

 

17. Which brain receptors do the ÒclassicalÓ first-generation antipsychotic medications influence most?

 

a. acetylcholine
b. dopamine
c. histamine
d. serotonin

 

ANS: B
First-generation antipsychotic medication influences the dopamine brain receptors the most. Specifically, all antipsychotics block dopamine receptor D2. Illnesses such as schizophrenia (and perhaps other psychoses) involve excessive activation of dopamine receptor D2, and antipsychotics seek to alleviate the illness by blocking such activation. Clozapine also has an effect on dopamine receptors D1 and D4.

 

PTS: 1 DIF: Application
REF: Antipsychotic Drugs| Non-Antipsychotic Drugs Commonly Used in the Treatment of Psychosis

 

18. When comparing the enhanced effectiveness of clozapine with the ÒclassicalÓ first-generation antipsychotic medications, the wider range of action produced by clozapine may be because it:

 

a. is extremely potent at dopamine-2 receptors without causing side effects at other sites
b. does not have an affinity for dopamine receptors
c. affects dopamine receptors 1 and 4 as well as several other neurotransmitter systems
d. is long-acting over several weeks following a single injection

 

ANS: C
Clozapine's wider range of action may be the result of the medication's effects on dopamine receptors D1 and D4 and several other transmitters. In addition, clozapine blocks dopamine receptor D2, which all other antipsychotics block as well. Illnesses such as schizophrenia (and perhaps other psychoses) involve excessive activation of dopamine receptor D2, and antipsychotics seek to alleviate the illness by blocking such activation.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Non-Antipsychotic Drugs Commonly Used in the Treatment of Psychosis

 

19. When teaching clients about the newer, ÒatypicalÓ antipsychotic medications, the nurse evaluates whether the clients have correctly learned that as a group these medications:

 

a. are not all alike in how they work and which side effects they produce
b. are newer, more receptor-site-selective versions of the older ÒclassicalÓ antipsychotics
c. are cheaper to purchase than the older ÒclassicalÓ antipsychotics
d. are all virtually free of serious adverse effects when taken correctly

 

ANS: A
Atypical (also known as Òsecond generationÓ) antipsychotic medications are not uniform in how they work or what side effects they produce. The atypical antipsychotics have differing and often fewer side effects than the first-generation (also known as ÒclassicalÓ) antipsychotic medications. In addition, they are often significantly more costly.

 

PTS: 1 DIF: Analysis REF: Antipsychotic Drugs| Grouping by Chemical Class

 

20. A nurse is working with a client who is obese and who has been stabilized on a regular dose of a ÒclassicalÓ first-generation antipsychotic medication. The client severely restricts caloric intake over several weeks to quickly lose weight. The nurse understands that the medication dosage may need to be:

 

a. increased because of increased body metabolic rate
b. lowered because of the medicationÕs affinity for fatty tissues
c. left at the same dose, as weight change does not affect metabolism of this medication
d. left at the same dose because this medication is very water soluble

 

ANS: B
Because of the medication's affinity for fatty tissues, the medication dosage may need to be lowered for an obese client experiencing rapid weight loss. First-generation antipsychotics tend to have a chemical structure that lacks polar regions. As a result, the drugs are not water soluble and have an affinity for fatty tissues in the body such as the lung, brain, and adipose stores. For this reason a thinner person may require a lower dosage than a fatter person, because the thinner personÕs body does not have as much fatty tissue.

 

PTS: 1 DIF: Analysis
REF: Antipsychotic Drugs| Non-Antipsychotic Drugs Commonly Used in the Treatment of Psychosis

 

21. The major characteristic of antipsychotic medications is that they produce:

 

a. active sedative effects
b. decreased tolerance to pain
c. dependence and addiction rapidly
d. indifference to stressful stimuli

 

ANS: D
The major characteristic of antipsychotic medications is that they produce an indifference to stressful stimuli. This is most likely due to the fact that all antipsychotics bind to the brain's dopamine receptors. However, although there is an indifference to both internal and external stimuli, the drugs have relatively little sedative effects and do not inhibit pain response.

 

PTS: 1 DIF: Comprehension REF: Antipsychotic Drugs

 

22. You are the nurse caring for a client who is psychotic and has been diagnosed with a mood disorder. Which of the following is a drug that is not an antipsychotic but is often ordered by the provider to aid in managing psychosis in clients with mood disorders?

 

a. Ritalin
b. Reserpine
c. lithium
d. phenobarbital

 

ANS: C
Lithium, while not an antipsychotic, is often prescribed to clients who are psychotic and have mood disorders. However, care must be taken when a client is also taking an antipsychotic medication. Although rare, lithium and antipsychotics can interact in a manner that results in profound neurological impairment. As a result, the client taking both drugs must be closely monitored for any signs of neurological disorders.

 

PTS: 1 DIF: Analysis REF: Antipsychotic Drugs| Drug Interactions

 

23. Which of the following newest antipsychotic drugs has been publicized as having the greatest risk for severe agranulocytosis and severe bone marrow depression and requires carefully controlled laboratory monitoring?

 

a. clozapine (Clozaril)
b. risperidone (Risperdal)
c. olanzapine (Zyprexa)
d. quetiapine (Seroquel)

 

ANS: A
Clozapine has been publicized as having the greatest risk for severe agranulocytosis and severe bone marrow depression. 1% to 2% of persons taking clozapine develop bone marrow suppressions. For this reason, safe use of clozapine requires weekly monitoring of the individual's white blood cell count for the first 6 months of therapy.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Adverse Effects

 

24. Interaction between antipsychotic medications and which of the following drugs is particularly problematic because it may inhibit the metabolism of antipsychotics?

 

a. caffeine
b. chlorpromazine
c. cimetidine
d. epinephrine

 

ANS: C
Cimetidine has a problematic interaction with antipsychotic medications because it may inhibit metabolism of antipsychotics. This can result in increased levels of the drug in the body and increased effects. Tagamet is the brand name of cimetidine, and can be purchased over the counter. It is used to treat dyspepsia.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Nursing Alert: Tagamet and Antipsychotics

 

25. Interactions between antipsychotic medications and some cardiac drugs containing epinephrine may cause which of the following side effects or adverse effects to occur?

 

a. decreased absorption of the medication
b. severe hypotensive complications
c. toxic levels of antipsychotics
d. worsening of psychosis

 

ANS: B
Interactions between some antipsychotics and some cardiac drugs containing epinephrine may cause severe hypotensive complications. Specifically, antipsychotic medications of the phenothiazine family (such as Thorazine) are prone to this interaction.

 

PTS: 1 DIF: Comprehension
REF: Antipsychotic Drugs| Nursing Alert: Epinephrine and Thorazine

 

26. A client being started on antipsychotic medication has recently delivered her first child and wishes to breast-feed the infant. The nurse correctly instructs the client that breast-feeding while taking antipsychotic medications is:

 

a. not contraindicated because the motherÕs liver metabolizes medications for the infant
b. contraindicated because these medications block proper absorption of the milk
c. not contraindicated because these medications are not harmful to an infant
d. contraindicated because these medications are excreted in breast milk

 

ANS: D
Breast-feeding while taking antipsychotic medication is contraindicated since the medication is excreted through the breast milk and passed on to the child. However, there are no particular known contraindications regarding the use of antipsychotics during pregnancy. Clinicians do try to minimize the dosage during pregnancy and avoid administering the medication early in the pregnancy and close to the delivery time.

 

PTS: 1 DIF: Analysis
REF: Antipsychotic Drugs| Use During Pregnancy/Lactation

 

27. One of the most troublesome adverse effects of the ÒatypicalÓ antipsychotic medications is:

 

a. hypertensive crisis
b. tardive dyskinesia
c. weight gain
d. anticholinergic delirium

 

ANS: C
Weight gain is one of the most troublesome adverse effects of ÒatypicalÓ second-generation antipsychotics. In addition, there is also an increased risk of metabolic syndrome, diabetes, and enhanced cardiovascular risk. All of these complications are directly linked to each other.