Nokea
A patient receiving risperidone reports severe muscle stiffness at 10:30 am. By noon, the patient is diaphoretic, drooling, and has difficulty swallowing. By 4:00 pm, vital signs are body temperature, 102.8°F; pulse, 110 beats/min; respirations, 26 breaths per minute; and blood pressure, 150/90 mm Hg. Select the nurse's best analysis and action.
- A. Agranulocytosis. Institute reverse isolation.
- B. Tardive dyskinesia. Withhold the next dose of medication.
- C. Cholestatic jaundice. Begin a high-protein, low-fat diet.
- D. Neuroleptic malignant syndrome. Immediately notify the health care provider.
Correct Answer: D
Rationale: Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in this scenario are not consistent with the medical problems listed in the incorrect options.
You may also like to solve these questions
When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, 'I stopped taking those pills. I didn't like how it made me feel.' What likely side effects did the patient experience?
- A. Sedation and muscle stiffness
- B. Sweating, nausea, and diarrhea
- C. Mild fever, sore throat, and skin rash
- D. Headache, watery eyes, and runny nose
Correct Answer: A
Rationale: Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance. The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient.
Which patient diagnosed with schizophrenia would be expected to have the lowest level of overall functioning?
- A. 39 years old; paranoid ideation since age 35 years
- B. 32 years old; isolated episodes of catatonia since age 24 years; stable for 3 years
- C. 19 years old; diagnosed with schizophreniform disorder 6 months ago
- D. 40 years old; frequent relapses since age 18; often does not take medication as prescribed
Correct Answer: D
Rationale: The 40-year-old patient who has been diagnosed with schizophrenia since 18 years of age could logically be expected to have the lowest overall level suivre of functioning secondary to deterioration associated with frequent relapses. The 39-year-old patient who has had paranoid ideation since 35 years of age could be expected to have a higher-level because schizophrenia of short duration may be less impairing than other types. The patient who has had episodes of catatonia since the age of 24 years has been stable for more than 3 years, suggesting a higher functional ability. The 19-year-old patient diagnosed with schizophreniform disorder has been ill for only 6 months, and disability is likely to be minimal.
The family members of a patient newly diagnosed with schizophrenia state that they do not understand what has caused the illness. The nurse's response should be based on which models?
- A. Neurobiological
- B. Environmental
- C. Family theory
- D. Genetic
- E. Stress
Correct Answer: A,D
Rationale: Compelling evidence exists that schizophrenia is a neurological disorder probably related to neurochemical abnormalities, neuroanatomical disruption of brain circuits, and genetic vulnerability. Stress and family disruption may contribute but are not considered etiological factors. Environmental factors are not recognized as causative variables in schizophrenia.
An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol. Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position; the lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated?
- A. Administer diphenhydramine 50 mg IM from the PRN medication administration record.
- B. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient.
- C. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time.
- D. Administer atropine sulfate 2 mg subcutaneously from the PRN medication administration record.
Correct Answer: A
Rationale: Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately; therefore, the intramuscular route is best. In this case, the best option given is diphenhydramine.
A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, 'I saw two doctors talking in the hall. They were plotting to kill me.' The nurse may correctly assess this as what classic behavior?
- A. Echolalia
- B. An idea of reference
- C. A delusion of infidelity
- D. An auditory hallucination
Correct Answer: B
Rationale: Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.