Nursing implications of the administration of haloperidol (Haldol) to a client exhibiting psychotic behavior include which of the following? Select all that apply.
Take 1 hour before or 2 hours after antacids.
The incidence of EPS is high.
It is therapeutic if ordered on an as-needed (PRN) basis.
Haldol is contraindicated in Parkinson’s disease, seizure disorders, alcoholism, and severe mental depression.
Crush the sustained-release form for easier swallowing.
Correct Answer : A,B,D
When administering haloperidol (Haldol) to a client with psychotic behavior, the nurse must be vigilant for specific precautions due to the drug’s high risk of extrapyramidal symptoms (EPS) and other significant side effects. Understanding safe administration timing, contraindications, and monitoring needs helps prevent complications and promotes therapeutic outcomes.
Rationale for correct answer:
A. Take 1 hour before or 2 hours after antacids. Antacids can reduce the absorption of haloperidol, potentially decreasing therapeutic effects. Separating administration times ensures optimal drug bioavailability.
B. The incidence of EPS is high. Haloperidol is a high-potency first-generation antipsychotic, and its strong dopamine blockade in the basal ganglia makes EPS symptoms—such as dystonia, akathisia, and pseudo-parkinsonism—more likely. Early detection allows prompt intervention.
D. Haldol is contraindicated in Parkinson’s disease, seizure disorders, alcoholism, and severe mental depression. Dopamine blockade can worsen Parkinson’s disease symptoms, lower seizure threshold, and exacerbate CNS depression, making these conditions unsafe for use.
Rationale for incorrect answer:
C. It is therapeutic if ordered on an as-needed (PRN) basis. PRN dosing is generally not recommended for maintenance therapy in psychotic disorders because steady plasma levels are essential for symptom control. Inconsistent use increases relapse risk.
E. Crush the sustained-release form for easier swallowing. Sustained-release tablets should not be crushed, as doing so alters the pharmacokinetics and may lead to rapid release, toxicity, or loss of prolonged effect.
Take-home points:
- Haloperidol carries a high EPS risk, requiring close monitoring.
- Administration timing in relation to antacids is essential for drug absorption.
- Know contraindications to avoid worsening underlying health conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Clozapine is a second-generation (atypical) antipsychotic reserved for treatment-resistant schizophrenia when other antipsychotics have failed. It has a superior efficacy for reducing both positive and some negative symptoms, but carries a risk of agranulocytosis, requiring strict and regular monitoring of white blood cell (WBC) and absolute neutrophil counts. Nurses must educate patients on signs of infection and ensure adherence to blood monitoring schedules to safely use this medication.
Rationale for correct answer:
B. Clozapine: Reserved for patients unresponsive to other antipsychotics; the risk of agranulocytosis necessitates weekly WBC monitoring initially, then biweekly/monthly, making monitoring and patient education essential.
Rationale for incorrect answers:
A. Risperidone: Effective for schizophrenia but not the first choice for treatment-resistant cases and does not require the same intensive hematologic monitoring.
C. Olanzapine: Effective for positive and negative symptoms but less potent than clozapine for treatment-resistant cases and does not carry the same severe risk of blood dyscrasias.
D. Ziprasidone: Less effective for treatment-resistant schizophrenia and mainly monitored for cardiac effects (QT prolongation) rather than hematologic complications.
Take-home points:
- Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia.
- Strict hematologic monitoring is mandatory to detect agranulocytosis early.
- Patient education on infection signs and adherence to blood tests is crucial for safe therapy.
Correct Answer is ["D","E"]
Explanation
Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed to treat psychotic disorders, including schizophrenia and bipolar disorder. These medications work by blocking dopamine and serotonin receptors, which helps reduce both positive and negative symptoms of psychosis while generally causing fewer extrapyramidal symptoms compared to first-generation antipsychotics. Nurses must monitor clients for therapeutic effects, metabolic changes, and other adverse reactions when administering these drugs.
Rationale for correct answer:
A. clozapine (Clozaril): Clozapine is a second-generation antipsychotic that blocks dopamine and serotonin receptors. It is effective for treatment-resistant schizophrenia and helps reduce hallucinations and delusions. Monitoring for agranulocytosis is essential.
D. olanzapine (Zyprexa): Atypical antipsychotic that acts on dopamine and serotonin receptors, helping reduce psychotic symptoms and improve mood. Metabolic monitoring is required due to risks of weight gain, diabetes, and dyslipidemia.
E. aripiprazole (Abilify): Atypical antipsychotic with a partial dopamine agonist effect, useful for schizophrenia, bipolar disorder, and as an adjunct in depression. It has a lower risk of EPS but still requires monitoring for akathisia and metabolic changes.
Rationale for incorrect answer:
B. fluphenazine (Prolixin): This is a first-generation antipsychotic. It primarily blocks dopamine and is associated with a higher risk of extrapyramidal symptoms and tardive dyskinesia, making it distinct from atypical antipsychotics.
C. haloperidol (Haldol): Also a first-generation antipsychotic, haloperidol is potent for positive symptoms of psychosis but carries a significant risk of EPS and neuroleptic malignant syndrome, unlike atypical agents.
Take-home points:
- Atypical antipsychotics treat both positive and negative symptoms of psychosis while generally causing fewer motor side effects.
- Metabolic monitoring is essential due to risks of weight gain, hyperglycemia, and dyslipidemia.
- First-generation antipsychotics (fluphenazine, haloperidol) primarily target dopamine and have a higher risk of extrapyramidal side effects.
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