A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?
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Solution
Granulocytopenia
Option C: Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly.
Options A, B, D: Hepatitis, infection, and systemic dermatitis aren’t adverse reactions of clozapine therapy.
A client with borderline personality disorder becomes angry when he is told that today’s psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client’s anger?
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Solution
“You had to wait. Can we talk about how this is making you feel right now?”
Option C: This response may diffuse the client’s anger by helping to maintain a therapeutic relationship and addressing the client’s feelings.
Option A: This wouldn’t address the client’s anger.
Option B: This is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client’s misconceptions.
Option D: The nurse can’t promise that a delay will never occur again because such matters are outside the nurse’s control.
A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client’s arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting:
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Solution
waxy flexibility.
Option C: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them.
Option A: Clients with dependency problems may demonstrate suggestibility, a response pattern in which one easily agrees to the ideas and suggestions of others rather than making independent judgments.
Options B and D: Negativity (for example, resistance to being moved or being asked to cooperate) and retardation (slowed movement) also occur in catatonic clients.
Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:
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Solution
notify the physician if the client notices an increase in bruising.
Option D: Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important.
Option A: Don’t double the dose.
Options B and C: This drug doesn’t irritate the stomach, and weight gain isn’t a problem.
A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect?
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Solution
amantadine (Symmetrel)
Option B: An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism;
Option A: Phenytoin is used to treat seizure activity.
Options C and D: diphenhydramine or benztropine may be used to control other extrapyramidal effects.
Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
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Solution
Evaluate the client for adverse reactions to haloperidol.
Option C: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly.
Option A: Although posturing may occur in clients with schizophrenia, it isn’t the same as neck and jaw spasms.
Option B: Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms.
Option D: When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.
An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used for this client to treat:
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Solution
psychosis.
Option C: By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation.
Options A and B: Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients.
Option D: Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.
A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?
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Solution
Avolition
Option D: Avolition refers to impairment in the ability to initiate goal-directed activity.
Option A: Word salad is when a group of words are put together in a random fashion without logical connection.
Option B: Tangential is where a person never gets to the point of the communication.
Option C: Perseveration is when a person repeats the same word or idea in response to different questions.
Hormonal effects of the antipsychotic medications include which of the following?
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Solution
Retrograde ejaculation and gynecomastia
Option A: Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible.
Options C and D: Polydipsia, akinesia, and dysphasia aren’t hormonal effects.
A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction?
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Solution
Dystonia
Option A: Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs.
Option B: Akinesia refers to decreased or absent movement;
Option C: Akathisia, to restlessness or inability to sit still; and
Option D: Tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.