NCLEX: Physiological Integrity
Chapter 25: Psychopharmacology
Test Bank
MULTIPLE CHOICE
1. The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics:
a.Remain in the system longer
b.Act more quickly to reduce delusions
c.Produce fewer extrapyramidal effects
d.Are risk free for neuroleptic malignant syndrome (NMS)
ANS: C
Atypical antipsychotics produce less D 2 blockade; thus movement disorders are less of a problem. No evidence suggests that the medication remains in the system longer nor that it acts more quickly
to reduce delusions. The atypicals are not risk free for NMS.
DIF: Cognitive Level: Application REF: Page 567
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a:
a.30 mm Hg decrease in blood pressure reading
b.Respiratory rate of 24 respirations per minute
c.Temperature reading of 104° F
d.Pulse rate of 70 beats per minute
ANS: C
Increased temperature is the cardinal sign of NMS. This BP is not a significant feature of NMS. There are no significant findings to support the options related to respirations or pulse rate.
DIF: Cognitive Level: Application REF: Page 570 TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would
the nurse assess as the likely cause of these symptoms?
a.Decreased dopamine at receptor sites
b.Blockade of histamine
c.Cholinergic blockade
d.Adrenergic blocking
ANS: C
Fluphenazine administration produces blockade of cholinergic receptors giving rise to anticholinergic effects, such as dry mouth, blurred vision, and constipation.
DIF: Cognitive Level: Application REF: Page 566
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)?
a.Grimacing and lip smacking
b.Falling asleep in the chair and refusing to eat lunch
c.Experiencing muscle rigidity and tremors
d.Having excessive salivation and drooling
ANS: A
TD manifests as abnormal movements of voluntary muscle groups after a prolonged period of dopamine blockade. Movements may affect any muscle group, but muscles of the face, mouth, tongue, and digits are commonly affected. Falling asleep is reflective of the sedative effect of these medications. Muscle rigidity and drooling reflect EPS caused from imbalance between dopamine and acetylcholine.
DIF: Cognitive Level: Application REF: Page 570
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed oral haloperidol (Haldol), which intervention would promote medication compliance?
a.Instructing the patient to have friends monitor his medications
b.Beginning administration of haloperidol (Haldol) decanoate
c.Writing instructions in detail for the patient to follow
d.Changing haloperidol to an atypical antipsychotic
ANS: B
Haloperidol decanoate is a depot medication, given intramuscularly every 2 to 4 weeks. It is unknown whether the patient has a support system. The patient probably received education, including written instructions prior to discharge. Changing to another classification of medication would not necessarily improve compliance.
DIF: Cognitive Level: Application REF: Page 572
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. When asked how tricyclic antidepressants affect neurotransmitter activity, the nurse should respond that they:
a.Decrease available dopamine.
b.Increase availability of norepinephrine and serotonin.
c.Make available increased amounts of monoamine oxidase.
d.Increase the effects of the chemical gamma-aminobutyric acid.
ANS: B
Tricyclic antidepressants block neurotransmitter uptake, increasing the amounts of norepinephrine and serotonin available. Decreasing dopamine is the action of typical antipsychotic medication. Increasing monoamine oxidase is not the action of tricyclics. Benzodiazepines, not tricyclics, increase the effects of GABA.
DIF: Cognitive Level: Application REF: Page 578
TOP: Nursing Process: Implementation
Chapter 25: Psychopharmacology
Test Bank
MULTIPLE CHOICE
1. The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics:
a.Remain in the system longer
b.Act more quickly to reduce delusions
c.Produce fewer extrapyramidal effects
d.Are risk free for neuroleptic malignant syndrome (NMS)
ANS: C
Atypical antipsychotics produce less D 2 blockade; thus movement disorders are less of a problem. No evidence suggests that the medication remains in the system longer nor that it acts more quickly
to reduce delusions. The atypicals are not risk free for NMS.
DIF: Cognitive Level: Application REF: Page 567
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a:
a.30 mm Hg decrease in blood pressure reading
b.Respiratory rate of 24 respirations per minute
c.Temperature reading of 104° F
d.Pulse rate of 70 beats per minute
ANS: C
Increased temperature is the cardinal sign of NMS. This BP is not a significant feature of NMS. There are no significant findings to support the options related to respirations or pulse rate.
DIF: Cognitive Level: Application REF: Page 570 TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would
the nurse assess as the likely cause of these symptoms?
a.Decreased dopamine at receptor sites
b.Blockade of histamine
c.Cholinergic blockade
d.Adrenergic blocking
ANS: C
Fluphenazine administration produces blockade of cholinergic receptors giving rise to anticholinergic effects, such as dry mouth, blurred vision, and constipation.
DIF: Cognitive Level: Application REF: Page 566
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. Which behavior displayed by a patient receiving a typical antipsychotic medication would be assessed as displaying behaviors characteristic of tardive dyskinesia (TD)?
a.Grimacing and lip smacking
b.Falling asleep in the chair and refusing to eat lunch
c.Experiencing muscle rigidity and tremors
d.Having excessive salivation and drooling
ANS: A
TD manifests as abnormal movements of voluntary muscle groups after a prolonged period of dopamine blockade. Movements may affect any muscle group, but muscles of the face, mouth, tongue, and digits are commonly affected. Falling asleep is reflective of the sedative effect of these medications. Muscle rigidity and drooling reflect EPS caused from imbalance between dopamine and acetylcholine.
DIF: Cognitive Level: Application REF: Page 570
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed oral haloperidol (Haldol), which intervention would promote medication compliance?
a.Instructing the patient to have friends monitor his medications
b.Beginning administration of haloperidol (Haldol) decanoate
c.Writing instructions in detail for the patient to follow
d.Changing haloperidol to an atypical antipsychotic
ANS: B
Haloperidol decanoate is a depot medication, given intramuscularly every 2 to 4 weeks. It is unknown whether the patient has a support system. The patient probably received education, including written instructions prior to discharge. Changing to another classification of medication would not necessarily improve compliance.
DIF: Cognitive Level: Application REF: Page 572
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. When asked how tricyclic antidepressants affect neurotransmitter activity, the nurse should respond that they:
a.Decrease available dopamine.
b.Increase availability of norepinephrine and serotonin.
c.Make available increased amounts of monoamine oxidase.
d.Increase the effects of the chemical gamma-aminobutyric acid.
ANS: B
Tricyclic antidepressants block neurotransmitter uptake, increasing the amounts of norepinephrine and serotonin available. Decreasing dopamine is the action of typical antipsychotic medication. Increasing monoamine oxidase is not the action of tricyclics. Benzodiazepines, not tricyclics, increase the effects of GABA.
DIF: Cognitive Level: Application REF: Page 578
TOP: Nursing Process: Implementation
