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A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be
- A. Increasing the amount of serotonin and norepinephrine in the brain.
- B. Decreasing the amount of an enzyme that breaks down neurotransmitters.
- C. Normalizing the levels of serotonin, norepinephrine, and dopamine.
- D. Blocking dopamine receptors in the brain.
Correct Answer: D
Rationale: The major action of all antipsychotics, including olanzapine, is to block dopamine receptors in the brain, which helps control psychotic symptoms.
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Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia?
- A. Opisthotonus
- B. Oculogyric crisis
- C. Torticollis
- D. Pseudoparkinsonism
Correct Answer: B
Rationale: Oculogyric crisis is the term for the eye rolling back in a locked position, a manifestation of acute dystonia.
The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan?
- A. Drink plenty of fruit juice.
- B. Developing an exercise program is important.
- C. Increase foods high in fiber.
- D. Laxatives can be used as needed.
- E. Use sunscreen when outdoors.
- F. For missed doses, take double the dose at the next scheduled time.
Correct Answer: B,C,E
Rationale: Exercise and high-fiber foods help prevent constipation, and sunscreen is recommended due to photosensitivity. Fruit juice may contribute to weight gain, laxatives should be avoided, and doubling doses is incorrect.
A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol).
- A. Get a stat order for a serum drug level.
- B. Hold the client's medication until the symptoms subside.
- C. Place an urgent call to the client's physician.
- D. Give a PRN dose of benztropine (Cogentin).
Correct Answer: D
Rationale: The client is experiencing an acute dystonic reaction, common with high-potency antipsychotics like haloperidol. Immediate treatment with an anticholinergic like benztropine provides rapid relief.
Which of the following medications rarely causes extrapyramidal side effects (EPS)?
- A. Ziprasidone (Geodon)
- B. Chlorpromazine (Thorazine)
- C. Haloperidol (Haldol)
- D. Fluphenazine (Prolixin)
Correct Answer: A
Rationale: Atypical antipsychotics like ziprasidone rarely cause EPS compared to first-generation antipsychotics like chlorpromazine, haloperidol, and fluphenazine.
A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports
- A. Feeling sleepy and less energetic.
- B. Weight gain of 7 pounds in the last month.
- C. Minimum mood swings.
- D. Increased feelings of self-worth.
Correct Answer: C
Rationale: Mood-stabilizing drugs like lithium aim to minimize mood swings in bipolar disorder. Weight gain and lethargy may occur but are not indicators of appropriate dosing, and inflated self-worth is a symptom that should diminish with treatment.