Review Practice Exercise 2

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Practice Exercise 2

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Total Questions : 7

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Question 1:

A patient who is taking an antipsychotic agent develops extrapyramidal symptoms. Which of these symptoms, if observed by the nurse, would indicate the presence of extrapyramidal effects? Select all that apply.

A. Tongue protrusion B. Pressured speech C. Neck torsions D. Seizures E. Shuffling gait F. Pacing or rocking G. Frequent blinking H. Jaw spasms I. Mask-like expression

Answer and Explanation

Choice A:

Tongue protrusion: A hallmark of tardive dyskinesia, a late-onset EPS, reflecting involuntary movements of the tongue and mouth.

Choice B:

Pressured speech: This is more characteristic of mania or psychosis, not EPS, and is not related to medication-induced movement disorders.

Choice C:

Neck torsions: Represent dystonic reactions, an acute form of EPS causing painful, involuntary muscle contractions.

Choice D:

Seizures: Not typically a manifestation of EPS; seizures are a separate neurological concern that may arise from other causes or medications.

Choice E:

Shuffling gait: Reflects pseudo-parkinsonism, an EPS characterized by slowed movements, stooped posture, and reduced arm swing.

Choice F:

Pacing or rocking: Indicative of akathisia, an EPS that manifests as inner restlessness and repetitive movements.

Choice G:

Frequent blinking: This is not a specific EPS sign; may be benign or related to anxiety.

Choice H:

Jaw spasms: Another form of dystonia, involving sudden, involuntary contraction of jaw muscles.

Choice I:

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Question 2:

A patient appears to have had an overdose of phenothiazines. The nurse anticipates that which intervention(s) may be used to treat phenothiazine overdose? Select all that apply.

A. Gastric lavage B. Adequate hydration C. Maintaining an airway D. Fluphenazine (Prolixin) E. Risperidone (Risperdal) F. Activated charcoal administration

Answer and Explanation

Choice A:

Gastric lavage: Gastric lavage may be performed soon after ingestion to remove unabsorbed drug from the stomach, reducing systemic toxicity. It is most effective within the first hour of ingestion.

Choice B:

Adequate hydration: Hydration helps maintain blood pressure, support renal function, and facilitate drug elimination. This is essential in cases of hypotension or when high doses of phenothiazines have been ingested.

Choice C:

Maintaining an airway: Phenothiazine overdose can lead to CNS depression and respiratory compromise. Ensuring a patent airway and supporting ventilation are critical nursing priorities.

Choice D:

Fluphenazine (Prolixin): Administering another antipsychotic is not appropriate and could worsen toxicity. Management focuses on supportive care, not adding additional dopamine blockade.

Choice E:

Risperidone (Risperdal): Similarly, adding another antipsychotic is contraindicated during an overdose. It does not reverse toxicity and may compound CNS depression

Choice F:

Activated charcoal administration: Activated charcoal binds the drug in the gastrointestinal tract, limiting absorption into the bloodstream, and is a common intervention for oral overdoses.Rationale for incorrect answer:

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Question 3:

A nurse observes a patient with involuntary lip-smacking and tongue movements after chronic haloperidol use. What is the most likely condition?

A. Akathisia B. Tardive dyskinesia C. Acute dystonia D. Neuroleptic malignant syndrome

Answer and Explanation

Choice A:

AkathisiaInvolves restlessness, pacing, or an inability to remain still, rather than involuntary facial movements. It typically occurs within days to weeks of starting antipsychotics.

Choice B:

Tardive dyskinesiaChronic antipsychotic use, especially with haloperidol, can lead to lip-smacking, tongue protrusion, and grimacing. Early detection is critical, as these movements may become permanent without intervention.Rationale for incorrect answers:

Choice C:

Acute dystoniaCharacterized by sudden, severe muscle contractions, often affecting the neck, face, or back, occurring hours to days after starting therapy, not after chronic use.

Choice D:

Neuroleptic malignant syndrome (NMS)
A rare, life-threatening reaction to antipsychotics, presenting with hyperthermia, muscle rigidity, altered mental status, and autonomic instability, not isolated facial movements.

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Question 4:

A patient develops severe rigidity, high fever, and altered mental status after starting chlorpromazine. What is the nurse’s priority action?

A. Monitor vital signs before the next dose B. Administer an anticholinergic C. Encourage frequent ambulation D. Notify the provider immediately

Answer and Explanation

Choice A:

Monitor vital signs before the next dose: Monitoring alone is insufficient in NMS, as the condition requires immediate medical intervention. Delaying action can be fatal.

Choice B:

Administer an anticholinergic: Anticholinergics treat extrapyramidal symptoms, not the systemic complications of NMS. This would not address the critical, life-threatening effects.

Choice C:

Encourage frequent ambulation: While mobility may prevent minor complications in psychiatric patients, ambulation does not treat NMS and could worsen the patient’s condition due to extreme rigidity and instability.

Choice D:

Notify the provider immediately: This is the priority action. Prompt medical management may include discontinuation of the antipsychotic, supportive care (hydration, cooling measures), and possible pharmacologic treatment such as dantrolene or bromocriptine to reduce muscle rigidity and hyperthermia.Rationale for incorrect answers:

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Question 5:

Which pathway is primarily targeted by first-generation antipsychotics to reduce hallucinations and delusions?

A. Nigrostriatal B. Mesolimbic C. Mesocortical D. Tuberoinfundibular

Answer and Explanation

Choice A:

Nigrostriatal: This pathway regulates movement. Dopamine blockade here is responsible for extrapyramidal symptoms (EPS), not the reduction of hallucinations or delusions.

Choice B:

Mesolimbic: Dopamine hyperactivity in this pathway contributes to positive psychotic symptoms. FGAs effectively reduce hallucinations and delusions by dampening this overactive dopaminergic signaling.Rationale for incorrect answers:

Choice C:

Mesocortical: This pathway is involved in cognition and negative symptoms. Dopamine blockade here may worsen negative symptoms such as apathy or social withdrawal.

Choice D:

Tuberoinfundibular: This pathway regulates prolactin secretion. Blockade can lead to hyperprolactinemia, resulting in galactorrhea, amenorrhea, or sexual dysfunction, but it does not target positive psychotic symptoms.

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Question 6:

A patient initiated on chlorpromazine is at risk for which common cardiovascular side effect that the nurse should monitor for?

A. Hypertension B. Bradycardia C. Orthostatic hypotension D. Tachycardia

Answer and Explanation

Choice A:

Hypertension: Chlorpromazine primarily causes hypotension rather than elevated blood pressure due to its peripheral alpha-adrenergic blockade, making hypertension an unlikely side effect.

Choice B:

Bradycardia: While heart rate changes can occur, reflex tachycardia is more typical as a compensatory response to hypotension, rather than bradycardia.

Choice C:

Orthostatic hypotension: This is the most clinically significant cardiovascular effect. Alpha-1 blockade causes blood pooling in lower extremities when standing, decreasing cerebral perfusion and resulting in dizziness, lightheadedness, or syncope. Older adults or patients on concurrent antihypertensives are particularly vulnerable, making vital signs and safety monitoring essential.Rationale for incorrect answers:

Choice D:

Tachycardia: May occur as a compensatory response to hypotension, but it is secondary and not the primary concern when initiating therapy.

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Question 7:

A nurse observes a patient with involuntary lip-smacking and tongue movements after chronic haloperidol use. What is the most likely condition?

A. Akathisia B. Tardive dyskinesia C. Acute dystonia D. Neuroleptic malignant syndrome

Answer and Explanation

Choice A:

Akathisia: Involves inner restlessness and pacing, not the involuntary facial and tongue movements seen here. It usually appears within days to weeks of starting therapy.

Choice B:

Tardive dyskinesia: Occurs after chronic antipsychotic use, typically months to years, with persistent, involuntary movements of the face, tongue, and extremities. The symptoms may be irreversible, making early identification critical.Rationale for incorrect answers:

Choice C:

Acute dystonia: Presents as sustained muscle contractions, often affecting the neck, eyes, or back, and typically appears within hours to days of starting therapy, not after chronic use.

Choice D:

Neuroleptic malignant syndrome: Manifests with fever, rigidity, autonomic instability, and altered mental status, which is acute and life-threatening, not characterized by repetitive oral movements.

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