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A patient is brought to the emergency department by her brother, who reports that the patient became very agitated and started hallucinating. Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The brother states that the patient is taking paroxetine for depression. Which of the following would the nurse most likely suspect?
- A. Neuroleptic malignant syndrome
- B. Acute dystonic reaction
- C. Serotonin syndrome
- D. Hypothyroidism
Correct Answer: C
Rationale: Paroxetine, an SSRI, can cause serotonin syndrome, characterized by agitation, hallucinations, tachycardia, incoordination, vomiting, and diarrhea, especially if combined with other serotonergic agents. Neuroleptic malignant syndrome and dystonic reactions are linked to antipsychotics, and hypothyroidism presents differently.
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A nursing instructor is teaching a class on the pharmacodynamics of psychiatric medications. The instructor determines that additional teaching is needed when the students identify which of the following as a site of action?
- A. Receptor
- B. Ion channels
- C. Neurotransmitters
- D. Enzymes
Correct Answer: C
Rationale: Pharmacodynamics involves how drugs act on the body, typically at receptors, ion channels, or enzymes. Neurotransmitters are chemicals that transmit signals, not sites of drug action, indicating a need for further teaching.
The nurse observes an older adult patient who has been taking antipsychotic medications for 8 months. The patient is smacking her lips and blinking her eyes rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?
- A. Ask if the patient has been experiencing side effects.
- B. Contact the patient?s physician for a different medication order.
- C. Document the patient?s symptoms of tardive dyskinesia.
- D. Instruct the patient to begin tapering off the medication.
Correct Answer: C
Rationale: Lip smacking, rapid blinking, and tongue protrusion indicate tardive dyskinesia, a serious side effect of long-term antipsychotic use. Documenting these symptoms is the most appropriate initial action to ensure accurate reporting and prompt physician review. Asking about side effects is vague, contacting the physician follows documentation, and tapering is premature without medical orders.
A patient is experiencing hallucinations and delusions. The nurse would expect the physician to order which class of drug?
- A. Mood stabilizer
- B. Antipsychotic
- C. Antianxiety agent
- D. Stimulant
Correct Answer: B
Rationale: Hallucinations and delusions are hallmark symptoms of psychosis, treated primarily with antipsychotics. Mood stabilizers address bipolar disorder, antianxiety agents treat anxiety, and stimulants are used for ADHD, not psychosis.
A patient is prescribed medication for a psychiatric disorder. After 3 days, the patient tells the nurse that he or she has been constipated. Which instruction would the nurse give the patient?
- A. You need to eat more high-protein foods such as meat and peanut butter.
- B. You need to eat more fruits and vegetables and drink more water.
- C. Ask your psychiatrist to prescribe a stool softener for you.
- D. This side effect should disappear within a week or so.
Correct Answer: B
Rationale: Constipation, a common side effect of psychiatric medications, can be managed by increasing dietary fiber (fruits and vegetables) and hydration (water). High-protein foods may worsen constipation, a stool softener may be premature without dietary changes, and waiting for resolution dismisses the patient?s discomfort.
The nurse is reviewing the medical records of several patients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a patient at greater risk for tardive dyskinesia?
- A. Male gender
- B. Age 30 to 45 years
- C. History of depression
- D. Short duration of treatment
Correct Answer: None
Rationale: Tardive dyskinesia risk factors include older age, female gender, longer treatment duration, and certain conditions, not depression. None of the options (male gender, age 30?45, depression, short duration) are primary risk factors, suggesting a possible test error, but none apply.