Psychotic Disorders
Which neurotransmitter imbalance is directly associated with psychotic disorders?
A. Elevated norepinephrine
B. Altered dopamine and serotonin
C. Increased acetylcholine
D. Decreased histamine
Answer: B
Rationale: Psychotic disorders involve abnormal dopamine and serotonin transmission.
Which group includes phenothiazines and non-phenothiazines?
A. Second-generation antipsychotics
B. First-generation antipsychotics
C. Atypical antipsychotics
D. Serotonin modulators
Answer: B
Rationale: FGAs consist of phenothiazines and non-phenothiazines.
What is the primary MOA of first-generation antipsychotics?
A. Block serotonin receptors
B. Block dopamine receptors
C. Increase dopamine release
D. Inhibit glutamate
Answer: B. Block dopamine receptors
Rationale: FGAs block postsynaptic dopamine receptors.
Which adverse effect may be irreversible?
A. Dystonia
B. Drug-induced parkinsonism
C. Akathisia
D. Tardive dyskinesia
Answer: D
Rationale: Tardive dyskinesia (a side effect of FGAs) may be irreversible.
Phenothiazine: chlorpromazine (Thorazine): Non-phenothiazine: haloperidol (Haldol)
When administering haloperidol IM, which nursing action is appropriate?
A. Use ventrogluteal site
B. Massage injection site
C. Administer subcutaneously
D. Have the client walk immediately afterward
Answer: A
Rationale: IM haloperidol should be given in the ventrogluteal muscle with the patient lying down afterward.
Which findings represent negative symptoms?
A. Avolition
B. Hallucinations
C. Poor hygiene
D. Blunted emotional expression
E. Confused speech
Answer: A, C, D
Rationale: Negative symptoms include avolition, poor hygiene, and diminished emotional expression.
Also...
Anhedonia
Poor social skills
Alogia
Asociality
Which antipsychotic is classified as a low-potency first-generation antipsychotic?
A. Haloperidol
B. Loxapine
C. Chlorpromazine
D. Perphenazine
Answer: C. Chlorpromazine
Also thioridazine
What is the MOA of second-generation antipsychotics?
A. Stimulate dopamine release
B. Block dopamine and serotonin receptors
C. Increase serotonin only
D. Activate GABA receptors
Answer: B. Block dopamine and serotonin receptors
Rationale: SGAs act on both dopamine and serotonin pathways.
Which findings are associated with Neuroleptic Malignant Syndrome? SATA
A. Fever
B. Rigid muscles
C. Tachycardia
D. Altered mental status
E. Hypotonia
Answer: A, B, C, D
Rationale: NMS includes fever, rigidity, altered mental status, tachycardia, and hypertension.
Which assessments are required before starting antipsychotic therapy? SATA
A. EKG
B. CBC
C. Fasting blood glucose
D. Lipid panel
E. Serum magnesium
Answer: A, B, C, D
Rationale: Baseline EKG and routine labs including CBC, glucose, and lipids are required.
Psychotic disorder symptoms must be present for how long to diagnose schizophrenia?
A. 1 month
B. 3 months
C. 6 months
D. 1 year
Answer: C
Rationale: Diagnosis requires symptoms for at least 6 months.
A patient taking haloperidol develops dystonia and akathisia.
These adverse effects are typical of:
A. Atypical antipsychotics
B. Low-potency FGAs
C. Mood stabilizers
D. High-potency FGAs
Answer: D
Rationale: High-potency FGAs are more likely to cause EPS, including dystonia and akathisia.
Which of the following antipsychotics block both dopamine and serotonin receptors?
A. Clozapine
B. Quetiapine
C. Risperidone
D. Haloperidol
Answer: A, B, C
Rationale: SGAs block dopamine and serotonin; haloperidol (FGA) only blocks dopamine.
Older adults with dementia taking antipsychotics have an increased risk for:
A. Kidney injury
B. Liver damage
C. Death
D. Thyroid dysfunction
Answer: C
Rationale: Antipsychotics carry a BBW for increased mortality in dementia-related psychosis.
FGA - r/o death with dementia-related psychosis
SGA (Clozapine) - r/o death with hyperglycemia
Therapeutic effects of second-generation antipsychotics typically appear in:
A. 1 week
B. 2 weeks
C. Approximately 6 weeks
D. Immediately
Answer: C
Rationale: SGAs take around 6 weeks for therapeutic effect.
A patient presents with hallucinations, delusions, and movement disturbances.
Which type of symptoms are these?
A. Negative
B. Positive
C. Cognitive
D. Affective
Answer: B
Rationale: Hallucinations, delusions, and movement disorders are positive symptoms.
Which medication is a phenothiazine?
A. Loxapine
B. Clozapine
C. Chlorpromazine
D. Aripiprazole
Answer: C
Rationale: Chlorpromazine is a phenothiazine antipsychotic.
Which statement describes the effect of dopamine blockade by FGAs?
A. Improves serotonin-mediated mood
B. Prevents metabolic syndrome
C. Increases risk for sedation only
D. Reduces psychotic symptoms
Answer: D
Rationale: Dopamine blockade reduces psychotic symptoms.
Clozapine carries a boxed warning for which serious condition?
A. Agranulocytosis
B. Hypertension
C. Seizure disorders only
D. Acute kidney injury
Answer: A
Rationale: Clozapine can cause fatal agranulocytosis.
Which patient statement indicates a need for further teaching about antipsychotic medication administration?
A. “I will lie down for a while after receiving the injection so I don’t get dizzy.”
B. “I know my dose might be adjusted during treatment, and the provider will tell me when that happens.”
C. “I should avoid letting this medication touch my skin because it can cause irritation.”
D. “I can take this medicine on an empty stomach if I prefer.”
Answer: D
Rationale:
Nursing implications include:
IM haloperidol requires the patient to lie down after injection to prevent orthostatic hypotension.
Doses often change and must be provider-directed.
Oral forms should be taken with food to avoid GI upset.
FGAs may cause contact dermatitis with skin exposure.
Negative symptoms are associated with which neurotransmitter change?
A. High dopamine
B. Low serotonin
C. High serotonin
D. Low glutamate
Answer: B
Rationale: Low serotonin contributes to negative symptom development.
Which of the following medications is correctly matched to its antipsychotic classification?
A. Risperidone — first-generation antipsychotic
B. Haloperidol — non-phenothiazine first-generation antipsychotic
C. Clozapine — high-potency first-generation antipsychotic
D. Chlorpromazine — second-generation antipsychotic
Correct Answer: B
Rationale:
Haloperidol is listed as a non-phenothiazine FGA and is a high-potency first-generation antipsychotic.
Risperidone and clozapine are second-generation (atypical) antipsychotics.
Chlorpromazine is a phenothiazine first-generation antipsychotic, not an SGA.
Which statement best explains the mechanism of action of atypical antipsychotics?
A. They selectively block dopamine receptors only, resulting in a higher risk of EPS.
B. They block dopamine and serotonin receptors, improving both positive and negative symptoms.
C. They enhance serotonin levels while inhibiting acetylcholine to reduce negative symptoms.
D. They reduce glutamate activity, which decreases hallucinations and delusions.
Correct Answer: B
Rationale:
Second-generation (atypical) antipsychotics block both dopamine and serotonin receptors. This dual action results in better treatment of positive and negative symptoms with milder adverse effects compared to FGAs.
Which antipsychotic is noted for causing increased prolactin levels?
A. Clozapine
B. Quetiapine
C. Risperidone
D. Aripiprazole
Answer: C. Risperidone
A patient taking an SGA develops weight gain and high blood glucose.
These findings indicate which effect?
A. Extrapyramidal Symptoms (EPS)
B. Metabolic effects
C. Neuroleptic Malignant Syndrome
D. Hematologic toxicity
Answer: B
Rationale: SGAs may cause weight gain and hyperglycemia.