NURS 241 Exam 1 Questions With Complete Solutions
*Acute Dystonia* Correct Answers Develops within the first
few days of therapy; often within hours of the first dose
Severe spasm of the muscles of the tongue, face, neck, or back.
Laryngeal dystonia can cause respiratory distress
Treated with benztropine and diphenhydramine. Symptoms
resolve in minutes.
*Akathisia* Correct Answers -*Inability to sit still*
-the most common extrapyramidal symptom of the neuroleptic
medications
Treated with beta blockers, benzodiazepines, and anticholinergic
drugs or switching to a low potency FGA
*Calcium Treatment Nugget* Correct Answers -Oral
replacement is usually calcium carbonate
-*Beta blockers (atenolol) can interfere with calcium: space out
these meds (hours)!*
-IV replacement is usually Calcium chloride (best in shock) or
calcium gluconate (less corrosive to veins)
-*Give CAREFULLY! Have the pt on a cardiac monitor, and
check VS!*
*Chlorpromazine: FGA: Low Potency* Correct Answers
Route: PO, IM, IV. If oral, only 30% is absorbed. Other methods
are preferred. Renal excretion.
,Adverse Effects: Sedation, orthostatic hypotension, and
anticholinergic effects (dry mouth, blurred vision, urinary
retention photophobia, constipation, tachycardia), EPS (lower
risk because this is a low potency drug), Tardive Dyskinesia,
lowers the seizure threshold so seizure precautions, prolonged
QT interval, rare *agranulocytosis and neoplasmic malignant
syndrome*
Drug Interactions: can intensify reactions to CNS depressants
and anticholinergic drugs
Preparations/Dosage/Administration: Tablets (10, 25, 50, 100,
200 mg), Injection solution 25 mg/mL
*ORAL THERAPY INITIAL DOSAGE: 25 mg TID, gradually
increase until symptoms are controlled. Maintenance dose is 400
mg/day
PARENTERAL THERAPY INITIAL DOSAGE: 25-50 mg;
increase gradually to max 400 mg q 4-6 hours*
*Haloperidol: FGA: High Potency* Correct Answers Route:
PO, IM. Oral availability is 60%. Hepatic metabolism is
extensive; excreted in the urine.
Adverse Effects: Early EPS, TD, prolonged QT interval
(dysrhythmias; especially when given IV or high doses)
*Dosage: 6-40 mg for schizophrenia
Oral 0.5-2 mg BID or TID initially
IV/IM 2-5 mg can be repeated q 1 hour at 4-8 hour intervals*
,*Magnesium Treatment Nugget* Correct Answers *May lower
neuropathic pain: consider this for post surgical patients such as
masectomy; Mg can also improve sleep and cognition: boosting
Mg improves memory*
*Maximum Potassium IV Rate* Correct Answers *20mEq per
hour*
Safety concern if it is any higher
*Neuroleptic Malignant Syndrome* Correct Answers Rare but
serious; If pt is experiencing high fever and EPS severely this
should be suspected. Take patient off off antipsychotic
IMMEADIATELY
Symptoms: "lead pipe" ridgity, sudden high fever, sweating,
autonomic instability, dysrhythmias, seizures, coma. Most
common with high potency FGAs
If continuing therapy 1) wait 2 weeks before resuming 2) lowest
effective dose should be used 3) Avoid high potency agents
(more common with them)
*Parkinsonism* Correct Answers bradykinesia, mask-like
faces, rigidity, shuffling gait, drooling, tremors, cog wheeling
Treated with benztropine, diphenhydramine, amantadine
temporarily until resolution or switch to SGA
*Potassium Treatment Nugget* Correct Answers *Replace 20-
60 mEq gradually over 24 hours; if administered too quickly
, arrhythmia can occur. It can burn veins, so we dilute it with a
mainline IV and run slowly
*Schizophrenia Risk Factors* Correct Answers -Season of
birth (late winter/early spring)
-Growing up in an urban environment
-Stressful life events
-Cannabis use
-Sibling with disease
-Pregnancy and birth complications (hypoxia, greater paternal
age)
-Viral infection
-Malnutrition
-Maternal Diabetes
-Familial hx of mood disorder
-Later age of onset
-Female Gender
-Abrupt onset of symptoms following precipitating factor
-Low socioeconomic status
*Sodium Treatment Nugget* Correct Answers *Don't raise
sodium levels more than 10 mEq/L in 24 hours.* i.e. going from
130 to 140 within 24 hours. *This can cause LIFE
THREATENING cerebral edema or even paralysis*. Continue
to stay on top of labs, VS, mental status and orders
*Tardive Dyskinesia* Correct Answers *Earliest Sign is slow,
worm like movement of the tongue*
Symptoms: writhing worm like movements of tongue and face,
lip-smacking, tongue thrusts.
*Acute Dystonia* Correct Answers Develops within the first
few days of therapy; often within hours of the first dose
Severe spasm of the muscles of the tongue, face, neck, or back.
Laryngeal dystonia can cause respiratory distress
Treated with benztropine and diphenhydramine. Symptoms
resolve in minutes.
*Akathisia* Correct Answers -*Inability to sit still*
-the most common extrapyramidal symptom of the neuroleptic
medications
Treated with beta blockers, benzodiazepines, and anticholinergic
drugs or switching to a low potency FGA
*Calcium Treatment Nugget* Correct Answers -Oral
replacement is usually calcium carbonate
-*Beta blockers (atenolol) can interfere with calcium: space out
these meds (hours)!*
-IV replacement is usually Calcium chloride (best in shock) or
calcium gluconate (less corrosive to veins)
-*Give CAREFULLY! Have the pt on a cardiac monitor, and
check VS!*
*Chlorpromazine: FGA: Low Potency* Correct Answers
Route: PO, IM, IV. If oral, only 30% is absorbed. Other methods
are preferred. Renal excretion.
,Adverse Effects: Sedation, orthostatic hypotension, and
anticholinergic effects (dry mouth, blurred vision, urinary
retention photophobia, constipation, tachycardia), EPS (lower
risk because this is a low potency drug), Tardive Dyskinesia,
lowers the seizure threshold so seizure precautions, prolonged
QT interval, rare *agranulocytosis and neoplasmic malignant
syndrome*
Drug Interactions: can intensify reactions to CNS depressants
and anticholinergic drugs
Preparations/Dosage/Administration: Tablets (10, 25, 50, 100,
200 mg), Injection solution 25 mg/mL
*ORAL THERAPY INITIAL DOSAGE: 25 mg TID, gradually
increase until symptoms are controlled. Maintenance dose is 400
mg/day
PARENTERAL THERAPY INITIAL DOSAGE: 25-50 mg;
increase gradually to max 400 mg q 4-6 hours*
*Haloperidol: FGA: High Potency* Correct Answers Route:
PO, IM. Oral availability is 60%. Hepatic metabolism is
extensive; excreted in the urine.
Adverse Effects: Early EPS, TD, prolonged QT interval
(dysrhythmias; especially when given IV or high doses)
*Dosage: 6-40 mg for schizophrenia
Oral 0.5-2 mg BID or TID initially
IV/IM 2-5 mg can be repeated q 1 hour at 4-8 hour intervals*
,*Magnesium Treatment Nugget* Correct Answers *May lower
neuropathic pain: consider this for post surgical patients such as
masectomy; Mg can also improve sleep and cognition: boosting
Mg improves memory*
*Maximum Potassium IV Rate* Correct Answers *20mEq per
hour*
Safety concern if it is any higher
*Neuroleptic Malignant Syndrome* Correct Answers Rare but
serious; If pt is experiencing high fever and EPS severely this
should be suspected. Take patient off off antipsychotic
IMMEADIATELY
Symptoms: "lead pipe" ridgity, sudden high fever, sweating,
autonomic instability, dysrhythmias, seizures, coma. Most
common with high potency FGAs
If continuing therapy 1) wait 2 weeks before resuming 2) lowest
effective dose should be used 3) Avoid high potency agents
(more common with them)
*Parkinsonism* Correct Answers bradykinesia, mask-like
faces, rigidity, shuffling gait, drooling, tremors, cog wheeling
Treated with benztropine, diphenhydramine, amantadine
temporarily until resolution or switch to SGA
*Potassium Treatment Nugget* Correct Answers *Replace 20-
60 mEq gradually over 24 hours; if administered too quickly
, arrhythmia can occur. It can burn veins, so we dilute it with a
mainline IV and run slowly
*Schizophrenia Risk Factors* Correct Answers -Season of
birth (late winter/early spring)
-Growing up in an urban environment
-Stressful life events
-Cannabis use
-Sibling with disease
-Pregnancy and birth complications (hypoxia, greater paternal
age)
-Viral infection
-Malnutrition
-Maternal Diabetes
-Familial hx of mood disorder
-Later age of onset
-Female Gender
-Abrupt onset of symptoms following precipitating factor
-Low socioeconomic status
*Sodium Treatment Nugget* Correct Answers *Don't raise
sodium levels more than 10 mEq/L in 24 hours.* i.e. going from
130 to 140 within 24 hours. *This can cause LIFE
THREATENING cerebral edema or even paralysis*. Continue
to stay on top of labs, VS, mental status and orders
*Tardive Dyskinesia* Correct Answers *Earliest Sign is slow,
worm like movement of the tongue*
Symptoms: writhing worm like movements of tongue and face,
lip-smacking, tongue thrusts.
