NR 546 MIDTERM EXAM - COMPLETE QUESTIONS AND DETAILED
SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Carla is a 35-year-old woman that is currently taking
olanzapine for her diagnosed schizophrenia. She has gained 30
pounds in the last 6 months and her waist circumference is 37
inches. She requests a change in medications. Which of the
following medications is less associated with weight gain?
Answer:
aripiprazole
-associated with the lowest risk weight gain.
Question 2: Alex is a returning client who reports leaking fluid from
his nipples. Which of the following is most likely responsible for
these undesirable side effects?
Answer:
Risperidone
-highest risk for galactorrhea, due to hyperprolactinemia.
Question 3: Prescribing Considerations (antipsychotics)
Answer:
-Start with lowest dose, eval tolerance, then titrate dose
-no evidence that high antipsychotic doses are more effective than standard doses
-Dose adjustments should be made after two weeks of taking medication
-Establish efficacy and an effective med dose before switching to a long-acting
injectable (LAI). Dose of LAI will be same as the effective oral dose.
-Most antipsychotic side effects and adverse effects are dose-related.
,Question 4: When prescribing, document the _____________ at
every visit.
Answer:
targeted symptoms, response, and any adverse effects
Question 5: Many persons with schizophrenia are treated
successfully in an ______________, though some clients may
require ________________ for initial treatment and subsequent
treatment of psychotic episodes
Answer:
outpatient setting, inpatient hospitalizations
Question 6: Why begin with monotherapy? (antipsychotics)
Answer:
The use of multiple antipsychotics can increase the risk of QT prolongation.
-Combinations considered only after single med have provided inadequate
response.
Question 7: If antipsychotics switched too quickly
Answer:
can develop agitation, activation, insomnia, and experience withdrawal
-due to the binding differences in each medication subcategory
*Cross titration over several days to weeks is required to prevent side effects
Question 8: Clients are more likely to experience side effects when
changing from a medication in one ___________ to a medication in
another ____________
Answer:
, subcategory, subcategory
(ex: pine to done)
Question 9: Special considerations: Pregnancy (antipsychotics)
Answer:
-Risk of withdrawal symptoms in the newborn: extrapyramidal symptoms may be
present at delivery.
-atypical antipsychotics appear more harmful than typical antipsychotics due to
increased risk of gestational metabolic complications, increased gestational age
weight, and increased birth weight.
-Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and quetiapine, especially in
the third trimester
Question 10: Special considerations: breast feeding
(antipsychotics)
Answer:
All antipsychotics are assumed to be secreted in breast milk.
-recommended drug is discontinued or the infant bottle feeds.
Question 11: Special considerations: Older Adult (antipsychotics)
Answer:
2019 American Geriatric Society (AGS) Beers Criteria recommendations:
Avoid the use of haloperidol, ziprasidone, and olanzapine due to an increased risk of
cerebrovascular accident (CVA), cognitive decline, and death in persons with
dementia and with dementia-related psychosis.
Question 12: Special consideration: children (antipsychotics)
Answer:
, Black box warnings:
-Aripiprazole: Increased risk of suicide in children.
-Quetiapine: Increased risk of suicidal ideation and suicidal behavior in
adolescents/young adults during the initial 1-2 months of treatment
Question 13: Special considerations: caution (antipsychotics)
Answer:
-Olanzapine - exercise caution in suspected alcohol withdrawal, stimulant
intoxication, or anticholinergic intoxication
-High and repeated doses of amphetamines or cocaine can mimic positive
symptoms of paranoid schizophrenia
Question 14: Legal issues/considerations when prescribing
antipsychotics
Answer:
informed consent
-required due to serious side effects
Question 15: Challenges -psychosis can be an obstacle -provide
education before obtaining a signature in outpatient setting
Contingency planning -establish a plan with client and family for
emergencies -designate a mental healthcare proxy if possible
Prescribing Pearls
Answer:
-Use the lowest effective dose and slow dosage titration.
-Avoid agents with anticholinergic properties.
-Avoid combining benzodiazepines with intramuscular olanzapine due to an
increased risk of sudden death.
-Avoid the combination of intramuscular benzodiazepines with clozapine due to a
risk of respiratory failure.
SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Carla is a 35-year-old woman that is currently taking
olanzapine for her diagnosed schizophrenia. She has gained 30
pounds in the last 6 months and her waist circumference is 37
inches. She requests a change in medications. Which of the
following medications is less associated with weight gain?
Answer:
aripiprazole
-associated with the lowest risk weight gain.
Question 2: Alex is a returning client who reports leaking fluid from
his nipples. Which of the following is most likely responsible for
these undesirable side effects?
Answer:
Risperidone
-highest risk for galactorrhea, due to hyperprolactinemia.
Question 3: Prescribing Considerations (antipsychotics)
Answer:
-Start with lowest dose, eval tolerance, then titrate dose
-no evidence that high antipsychotic doses are more effective than standard doses
-Dose adjustments should be made after two weeks of taking medication
-Establish efficacy and an effective med dose before switching to a long-acting
injectable (LAI). Dose of LAI will be same as the effective oral dose.
-Most antipsychotic side effects and adverse effects are dose-related.
,Question 4: When prescribing, document the _____________ at
every visit.
Answer:
targeted symptoms, response, and any adverse effects
Question 5: Many persons with schizophrenia are treated
successfully in an ______________, though some clients may
require ________________ for initial treatment and subsequent
treatment of psychotic episodes
Answer:
outpatient setting, inpatient hospitalizations
Question 6: Why begin with monotherapy? (antipsychotics)
Answer:
The use of multiple antipsychotics can increase the risk of QT prolongation.
-Combinations considered only after single med have provided inadequate
response.
Question 7: If antipsychotics switched too quickly
Answer:
can develop agitation, activation, insomnia, and experience withdrawal
-due to the binding differences in each medication subcategory
*Cross titration over several days to weeks is required to prevent side effects
Question 8: Clients are more likely to experience side effects when
changing from a medication in one ___________ to a medication in
another ____________
Answer:
, subcategory, subcategory
(ex: pine to done)
Question 9: Special considerations: Pregnancy (antipsychotics)
Answer:
-Risk of withdrawal symptoms in the newborn: extrapyramidal symptoms may be
present at delivery.
-atypical antipsychotics appear more harmful than typical antipsychotics due to
increased risk of gestational metabolic complications, increased gestational age
weight, and increased birth weight.
-Avoid Clozapine, Ziprasidone, olanzapine, risperidone, and quetiapine, especially in
the third trimester
Question 10: Special considerations: breast feeding
(antipsychotics)
Answer:
All antipsychotics are assumed to be secreted in breast milk.
-recommended drug is discontinued or the infant bottle feeds.
Question 11: Special considerations: Older Adult (antipsychotics)
Answer:
2019 American Geriatric Society (AGS) Beers Criteria recommendations:
Avoid the use of haloperidol, ziprasidone, and olanzapine due to an increased risk of
cerebrovascular accident (CVA), cognitive decline, and death in persons with
dementia and with dementia-related psychosis.
Question 12: Special consideration: children (antipsychotics)
Answer:
, Black box warnings:
-Aripiprazole: Increased risk of suicide in children.
-Quetiapine: Increased risk of suicidal ideation and suicidal behavior in
adolescents/young adults during the initial 1-2 months of treatment
Question 13: Special considerations: caution (antipsychotics)
Answer:
-Olanzapine - exercise caution in suspected alcohol withdrawal, stimulant
intoxication, or anticholinergic intoxication
-High and repeated doses of amphetamines or cocaine can mimic positive
symptoms of paranoid schizophrenia
Question 14: Legal issues/considerations when prescribing
antipsychotics
Answer:
informed consent
-required due to serious side effects
Question 15: Challenges -psychosis can be an obstacle -provide
education before obtaining a signature in outpatient setting
Contingency planning -establish a plan with client and family for
emergencies -designate a mental healthcare proxy if possible
Prescribing Pearls
Answer:
-Use the lowest effective dose and slow dosage titration.
-Avoid agents with anticholinergic properties.
-Avoid combining benzodiazepines with intramuscular olanzapine due to an
increased risk of sudden death.
-Avoid the combination of intramuscular benzodiazepines with clozapine due to a
risk of respiratory failure.
