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A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of
- A. Extrapyramidal side effects
- B. Loss of voluntary muscle control
- C. Posturing
- D. Tardive dyskinesia
Correct Answer: D
Rationale: These behaviors are classic signs of tardive dyskinesia, a syndrome of permanent involuntary movements commonly caused by long-term use of conventional antipsychotic drugs.
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Which of the following medications rarely causes extrapyramidal side effects (EPS)?
- A. Ziprasidone (Geodon)
- B. Chlorpromazine (Thorazine)
- C. Haloperidol (Haldol)
- D. Fluphenazine (Prolixin)
Correct Answer: A
Rationale: Atypical antipsychotics like ziprasidone rarely cause EPS compared to first-generation antipsychotics like chlorpromazine, haloperidol, and fluphenazine.
A patient with bipolar disorder asks the nurse, 'Why did I get this illness? I don't want to be sick.' The nurse would best respond with,
- A. People who develop mental illnesses often had very traumatic childhood experiences.
- B. There is some evidence that contracting a virus during childhood can cause mental disorders.
- C. Sometimes people with mental illness have an overactive immune system.
- D. We don't fully understand the cause, but mental illnesses do seem to run in families.
Correct Answer: D
Rationale: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Traumatic childhood experiences, viral infections, and immune system activity may contribute to mental illness in genetically predisposed individuals, but these are not definitive causes.
When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic?
- A. This is a good medication! It will be effective within 20 minutes of the first dose.
- B. You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication.
- C. It will probably take months for the medication to work. In the meantime, you should work on improving your attitude.
- D. If you believe it will work, then it will. You have to have faith!
Correct Answer: B
Rationale: SSRIs typically take 2-3 weeks to show effectiveness, with gradual symptom improvement that may be subtle initially, requiring continued adherence.
A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol).
- A. Get a stat order for a serum drug level.
- B. Hold the client's medication until the symptoms subside.
- C. Place an urgent call to the client's physician.
- D. Give a PRN dose of benztropine (Cogentin).
Correct Answer: D
Rationale: The client is experiencing an acute dystonic reaction, common with high-potency antipsychotics like haloperidol. Immediate treatment with an anticholinergic like benztropine provides rapid relief.
A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially?
- A. Instruct the client to stop the medication for a few days to see if the nausea goes away.
- B. Reassure the client that this is an expected side effect that will improve with time.
- C. Suggest that the client take the medication with food.
- D. Tell the client to contact the physician for a change in medication.
Correct Answer: C
Rationale: Taking SSRIs like paroxetine with food usually eliminates nausea, making this the initial recommended action.