A schizophrenic client with delusions tells the nurse, “There is a man wearing a red coat who’s out to get me.” The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be the best response?
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Solution
“This subject seems to be troubling you. Let’s walk to the activity room.”
Option A: This remark distracts the client from the delusion by engaging the client in a less threatening or more comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the false belief.
Options B, C, and D: The other options focus on the content of the delusion rather than the meaning, feeling, or intent that it provokes.
For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take?
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Solution
Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.
Option B: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client’s fluid volume further, raising blood pressure even higher.
A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?
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Solution
Tremors, shuffling gait, and mask-like face
Option C: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and “pill rolling.”
Option A: Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting.
Option B: An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency.
Option D: Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.
A schizophrenic client states, “I hear the voice of King Tut.” Which response by the nurse would be most therapeutic?
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Solution
“I don’t hear the voice, but I know you hear what sounds like a voice.”
Option A: This response states reality about the client’s hallucination.
Options B, C, and D: The other options are judgmental, flippant, or dismissive.
Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction?
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Solution
diphenhydramine (Benadryl)
Option B: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition.
Options A and C: Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it.
Option D: Midazolam would make this client drowsy.
A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:
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Solution
hallucination.
Option D: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination.
Option A: Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli.
Option B: Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren’t clearly linked to one another.
Option C: Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.
Most antipsychotic medications exert which of following effects on the central nervous system (CNS)?
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Solution
Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine.
Option C: The exact mechanism of antipsychotic medication action is unknown, but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine.
Options A, B, and D: They don’t sedate the CNS by stimulating serotonin, and they don’t stimulate neurotransmitter action or acetylcholine release.
A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by:
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Solution
activating dopamine receptors in the CNS.
Option D: Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are caused by a low level of dopamine.
Option A: Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity.
Options B and C: They don’t affect norepinephrine or acetylcholine.
Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by:
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Solution
blocking the cholinergic activity in the central nervous system (CNS).
Option B: This is the action of Cogentin.
Option A: Anxiety doesn’t cause extrapyramidal effects.
Option C: Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects.
Option D: Benztropine doesn’t increase norepinephrine in the CNS.
The nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia. The client’s husband expresses concern over whether his wife will continue to take her daily prescribed medication. The nurse should inform him that:
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Solution
his wife can be given a long-acting medication that is administered every 1 to 4 weeks.
Option C: Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic.
Option A: A client has the right to refuse medication, but this issue isn’t the focus of discussion at this time.
Option B: Medication should never be hidden in food or drink to trick the client into taking it; besides destroying the client’s trust, doing so would place the client at risk for overmedication or undermedication because the amount administered is hard to determine.
Option D: Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic.