Nokea
A client is prescribed clozapine. The nurse instructs the client on the need for weekly laboratory testing for which of the following?
- A. Serum lithium
- B. WBC count
- C. Blood glucose
- D. pH level
Correct Answer: B
Rationale: Use of the drug clozapine has been associated with severe agranulocytosis (i.e., decreased white blood cells), so weekly WBC count tests are scheduled. Serum lithium tests are taken for clients who have been administered lithium, not clozapine. There is no need to check blood glucose or pH level.
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A nurse is required to administer an antipsychotic agent parenterally. After administering the drug, the nurse would ensure that the client remains lying down for which time frame?
- A. 15 minutes
- B. 30 minutes
- C. 45 minutes
- D. 60 minutes
Correct Answer: B
Rationale: After administering an antipsychotic agent parenterally, the nurse would ensure that the client remains lying down for about 30 minutes.
A nurse caring for a client receiving clozapine (Clozaril) needs to be mindful of the symptoms that indicate bone marrow suppression. Assessment of which of the following would lead the nurse to suspect that the client is experiencing bone marrow suppression? Select all that apply.
- A. Hypertension
- B. Sore throat
- C. Fever
- D. Chills
- E. Weakness
Correct Answer: B,C,D,E
Rationale: Symptoms that indicate bone marrow suppression include lethargy, weakness, fever, sore throat, malaise, mucous membrane ulceration, and 'flu-like' complaints.
A client is receiving antipsychotic therapy. As part of the client's plan of care, the nurse assesses the client for possible adverse reactions. Which of the following would lead the nurse to suspect that the client is experiencing extrapyramidal effects? Select all that apply.
- A. Mask-like facial appearance
- B. Increased motor activity
- C. Facial grimacing
- D. Delusions
- E. Flat affect
Correct Answer: A,B,C
Rationale: Manifestations of extrapyramidal syndrome include Parkinson-like symptoms-fine tremors, muscle rigidity, mask-like appearance of the face, slowness of movement, slurred speech, and unsteady gait; akathisia - extreme restlessness and increased motor activity; and dystonia - facial grimacing and twisting of the neck into unnatural positions. Delusions and flat affect are manifestations associated with schizophrenia.
A nurse observes rhythmic, involuntary facial movements in a client who has been receiving antipsychotic drugs. The client also makes chewing movements and, at times, his tongue protrudes. The nurse interprets these findings as which of the following?
- A. Stevens-Johnson syndrome
- B. Neuropeptic malignant syndrome
- C. Tardive dyskinesia
- D. Extrapyramidal syndrome
Correct Answer: C
Rationale: Tardive dyskinesia is characterized by rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities. The tongue may protrude, and there may be chewing movements, puckering of the mouth, and facial grimacing. Extrapyramidal syndrome (EPS), neuroleptic malignant syndrome (NMS), and Stevens-Johnson syndrome do not cause rhythmic, involuntary facial movements.
A nurse is caring for a client with schizophrenia. The physician has prescribed olanzapine in a disintegrating tablet form for the client. Which of the following points should the nurse include in the teaching plan for the client?
- A. Remove the tablet with dry hands.
- B. Take the tablet with a full glass of water.
- C. Add extra salt to food.
- D. Avoid tea or coffee.
Correct Answer: A
Rationale: The nurse should instruct the client to remove the olanzapine tablet with dry hands and place the entire tablet in his or her mouth. Wet or damp hands may cause the medication to begin disintegrating prior to entering the client's mouth. There is no need to add extra salt to food. The client is required to take orally disintegrating olanzapine, so there is no need to take any fluid with the drug. Also, there is no need to avoid tea or coffee.