Chapter 29: Psychopharmacological Treatment
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 D2 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.
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.
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,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.
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.
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
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, 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.
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.
7. A severely depressed patient has been prescribed clomipramine (Anafranil). For which
medication side effects should the patient be monitored?
a. Excess salivation and drooling
b. Muscle rigidity and restlessness
c. Polyuria and coarse hand tremors
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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 D2 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.
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.
HTTPS://PASINGGRADES.COM/
,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.
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.
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
HTTPS://PASINGGRADES.COM/
, 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.
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.
7. A severely depressed patient has been prescribed clomipramine (Anafranil). For which
medication side effects should the patient be monitored?
a. Excess salivation and drooling
b. Muscle rigidity and restlessness
c. Polyuria and coarse hand tremors
HTTPS://PASINGGRADES.COM/
