Chapter 16: Anxiolytic and Hypnotic Drugs
MULTIPLE CHOICE
1. The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75
mg BID to treat schizophrenia. A family member tells the nurse that the patients agitation,
hallucinations, and delusional symptoms have improved, but the patient continues to withdraw
from social interaction and wont bathe unless reminded to do so. The nurse will tell the family
member that
a. all symptoms will eventually resolve over time with this medication.
b. the patient may need an increased dose of the antipsychotic medication.
c. these results may indicate that the patient does not have schizophrenia.
d. they should consider discussing adding another medication.
ANS: D
Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive
symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely
that the negative symptoms will improve over time with this medication. Increasing the dose
will not improve control of negative symptoms. This patient exhibits signs of schizophrenia.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 373
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity
2. The nurse is assessing a young adult patient with schizophrenia who recently began taking
fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with
grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect?
a. Acute dystonia
b. Akathisia
c. Pseudoparkinsonism
d. Tardive dyskinesia
ANS: A
Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle
spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia
is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is
characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive
dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and
involuntary movement of the body and extremities.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 375
TOP: NURSING PROCESS: Assessment/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has
schizophrenia. The patient has been taking this medication twice daily for 15 months. The
, nurse notes smacking lip movements and involuntary movements of all extremities. Which
action by the nurse is correct?
a. Administer the medication as ordered to treat these symptoms of psychosis.
b. Hold the dose and notify the provider of these medication adverse effects.
c. Request an order for an anticholinergic medication such as benztropine (Cogentin).
d. Suggest that the provider increase the dose to 125 mg twice daily.
ANS: B
Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and
involuntary movement of the body and extremities and is a serious adverse effect of
antipsychotic medications. The provider should be notified, so the drug can be stopped and a
different medication ordered. These are not symptoms of psychosis. Anticholinergic
medications are used to combat acute dystonia. Increasing the dose of this medication would
only exacerbate these adverse effects.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 375
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and
fidgety and is pacing around the room. The nurse caring for this patient will perform which
action?
a. Contact the provider to discuss changing to benztropine (Cogentin).
b. Notify the provider of these symptoms and request an order for lorazepam (Ativan).
c. Question the patient about adherence to the drug regimen.
d. Recognize these signs of a serious adverse drug reaction and notify the provider. ANS: B
The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug.
Benztropine is an anticholinergic used to combat acute dystonia side effects. These are not
signs of psychosis, so it is not necessary to question whether or not the patient is taking the
medication. These side effects are not as serious as those with tardive dyskinesia.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 375
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. A patient arrives in the emergency department with dehydration. The patient reports taking
fluphenazine (Prolixin) to treat schizophrenia. The nurse notes rigid muscles and an altered
mental status. The patient has a temperature of 103.6 F, a heart rate of 98 beats per minute, and
a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication?
a. Dantrolene (Dantrium)
b. Haloperidol (Haldol)
c. Propranolol (Inderal)
d. Tetrabenazine (Xenazine)
ANS: A
MULTIPLE CHOICE
1. The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75
mg BID to treat schizophrenia. A family member tells the nurse that the patients agitation,
hallucinations, and delusional symptoms have improved, but the patient continues to withdraw
from social interaction and wont bathe unless reminded to do so. The nurse will tell the family
member that
a. all symptoms will eventually resolve over time with this medication.
b. the patient may need an increased dose of the antipsychotic medication.
c. these results may indicate that the patient does not have schizophrenia.
d. they should consider discussing adding another medication.
ANS: D
Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive
symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely
that the negative symptoms will improve over time with this medication. Increasing the dose
will not improve control of negative symptoms. This patient exhibits signs of schizophrenia.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 373
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Psychosocial Integrity
2. The nurse is assessing a young adult patient with schizophrenia who recently began taking
fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with
grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect?
a. Acute dystonia
b. Akathisia
c. Pseudoparkinsonism
d. Tardive dyskinesia
ANS: A
Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle
spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia
is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is
characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive
dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and
involuntary movement of the body and extremities.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 375
TOP: NURSING PROCESS: Assessment/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has
schizophrenia. The patient has been taking this medication twice daily for 15 months. The
, nurse notes smacking lip movements and involuntary movements of all extremities. Which
action by the nurse is correct?
a. Administer the medication as ordered to treat these symptoms of psychosis.
b. Hold the dose and notify the provider of these medication adverse effects.
c. Request an order for an anticholinergic medication such as benztropine (Cogentin).
d. Suggest that the provider increase the dose to 125 mg twice daily.
ANS: B
Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and
involuntary movement of the body and extremities and is a serious adverse effect of
antipsychotic medications. The provider should be notified, so the drug can be stopped and a
different medication ordered. These are not symptoms of psychosis. Anticholinergic
medications are used to combat acute dystonia. Increasing the dose of this medication would
only exacerbate these adverse effects.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 375
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and
fidgety and is pacing around the room. The nurse caring for this patient will perform which
action?
a. Contact the provider to discuss changing to benztropine (Cogentin).
b. Notify the provider of these symptoms and request an order for lorazepam (Ativan).
c. Question the patient about adherence to the drug regimen.
d. Recognize these signs of a serious adverse drug reaction and notify the provider. ANS: B
The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug.
Benztropine is an anticholinergic used to combat acute dystonia side effects. These are not
signs of psychosis, so it is not necessary to question whether or not the patient is taking the
medication. These side effects are not as serious as those with tardive dyskinesia.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 375
TOP: NURSING PROCESS: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. A patient arrives in the emergency department with dehydration. The patient reports taking
fluphenazine (Prolixin) to treat schizophrenia. The nurse notes rigid muscles and an altered
mental status. The patient has a temperature of 103.6 F, a heart rate of 98 beats per minute, and
a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication?
a. Dantrolene (Dantrium)
b. Haloperidol (Haldol)
c. Propranolol (Inderal)
d. Tetrabenazine (Xenazine)
ANS: A
