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A nurse is caring for a client with schizophrenia. The physician has prescribed olanzapine in a disintegrating tablet form for the client. Which of the following points should the nurse include in the teaching plan for the client?
- A. Remove the tablet with dry hands.
- B. Take the tablet with a full glass of water.
- C. Add extra salt to food.
- D. Avoid tea or coffee.
Correct Answer: A
Rationale: The nurse should instruct the client to remove the olanzapine tablet with dry hands and place the entire tablet in his or her mouth. Wet or damp hands may cause the medication to begin disintegrating prior to entering the client's mouth. There is no need to add extra salt to food. The client is required to take orally disintegrating olanzapine, so there is no need to take any fluid with the drug. Also, there is no need to avoid tea or coffee.
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A nurse would assess a client treated with an antipsychotic medication for which of the following behaviors if the antipsychotic medication was stopped? Select all that apply.
- A. Hallucinations
- B. Anhedonia
- C. Delusions
- D. Dystonia
- E. Flattened affect
Correct Answer: A,B,C,E
Rationale: Antipsychotic medications help control symptoms associated with psychotic disorders such as hallucinations, delusions, disorganized speech, behavior disturbances, social withdrawal, flattened affect, and anhedonia. Dystonia would be noted as an adverse reaction with antipsychotic drugs.
The caregiver of a client who is started on antipsychotic drug therapy asks the nurse when the client's symptoms will improve. Which response by the nurse would be most appropriate?
- A. You should notice an improvement in the next day or two.'
- B. It might take about 6 weeks or so before the drug is most effective.'
- C. There's no way to tell but usually it takes about a week.'
- D. Look for movements of his face, mouth, or jaw and that's the sign.'
Correct Answer: B
Rationale: Antipsychotics take time to produce the optimal effect, sometimes 6 to 10 weeks. Evidence of tongue, facial, or mouth movements suggest tardive dyskinesia, a late-appearing reaction that requires discontinuation of the drug.
When teaching a client who is to receive antipsychotic therapy, the nurse would include which of the following as a common skin reaction that might occur when initiating therapy? Select all that apply.
- A. Urticaria
- B. Stevens-Johnson syndrome
- C. Photosensitivity
- D. Hyperpigmentation
- E. Toxic epidermal necrolysis
Correct Answer: A,C
Rationale: Urticaria and photosensitivity are common skin reactions a nurse should warn a client about when the client is initiated on antipsychotic therapy.
After teaching a group of nursing students about antipsychotic drugs, the instructor determines that the teaching was successful when the students identify aripiprazole (Abilify) as exerting its effect on which of the following in the brain? Select all that apply.
- A. Serotonin
- B. Dopamine
- C. Norepinephrine
- D. Muscarinic
- E. Nicotinic
Correct Answer: A,B
Rationale: Atypical antipsychotic drugs like aripiprazole (Abilify) are thought to act on serotonin and dopamine receptors in the brain. The conventional, or first-generation, antipsychotics (FGAs) work to diminish the positive symptoms by blocking dopamine transmission.
A client is receiving antipsychotic therapy. As part of the client's plan of care, the nurse assesses the client for possible adverse reactions. Which of the following would lead the nurse to suspect that the client is experiencing extrapyramidal effects? Select all that apply.
- A. Mask-like facial appearance
- B. Increased motor activity
- C. Facial grimacing
- D. Delusions
- E. Flat affect
Correct Answer: A,B,C
Rationale: Manifestations of extrapyramidal syndrome include Parkinson-like symptoms-fine tremors, muscle rigidity, mask-like appearance of the face, slowness of movement, slurred speech, and unsteady gait; akathisia - extreme restlessness and increased motor activity; and dystonia - facial grimacing and twisting of the neck into unnatural positions. Delusions and flat affect are manifestations associated with schizophrenia.