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When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect?
- A. Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane).
- B. Chew sugarless gum or use sugarless hard candy to moisten your mouth.
- C. Increase the amount of sleep you get, and try to take frequent rest breaks.
- D. Wear elastic support hose, drink adequate fluids, and change position slowly.
Correct Answer: D
Rationale: The correct answer is D because wearing elastic support hose, drinking adequate fluids, and changing positions slowly can help prevent postural hypotension associated with antipsychotic medications. Elastic support hose can improve blood circulation and prevent blood pooling in the legs. Adequate fluid intake can help maintain blood volume and blood pressure. Changing positions slowly can prevent sudden drops in blood pressure upon standing.
Choice A (anticholinergic drug) is incorrect as it may worsen symptoms of schizophrenia. Choice B (sugarless gum or candy) is unrelated to postural hypotension. Choice C (increasing sleep and rest breaks) may help with fatigue but does not address postural hypotension directly.
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A new nurse asks, 'My elderly patient has Lewy body disease. What should I do about assessing for pain?' Select the best response from the nurse manager.
- A. Ask the patients family if they think the patient is experiencing pain.'
- B. Use a visual analog scale to help the patient determine the presence and severity of pain.'
- C. There are special scales for assessing patients with dementia. Lets review how to use them.'
- D. The perception of pain is diminished by this type of dementia. Focus your assessment on the patients mental status.'
Correct Answer: C
Rationale: Lewy body disease is a form of dementia. There are special scales to assess the presence and severity of pain in patients with dementia. The Pain Assessment in Advanced Dementia Scale evaluates breathing, negative vocalizations, body language, and consolability. A patient with dementia would be unable to use a visual analog scale. The family may be able to help the nurse gain perspective about the pain, but this strategy alone is inadequate. The other distracters are myths.
A PET scan involves the injection of
- A. radioactive sugar
- B. iodine
- C. metal particles
- D. xenon gas
Correct Answer: A
Rationale: PET scans use radioactive glucose (sugar) to measure brain activity, aiding in diagnosing mental disorders.
A client who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia developed tardive dyskinesia as evidenced by tongue thrusting and chewing motions. The physician discontinued the chlorpromazine and prescribed Seroquel (quetiapine). As a result of this change, the nurse should carefully monitor for:
- A. Development of pseudoparkinsonism
- B. Development of dystonic reactions
- C. Improvement in tardive dyskinesia
- D. Worsening of anticholinergic symptoms
Correct Answer: C
Rationale: The correct answer is C: Improvement in tardive dyskinesia. Tardive dyskinesia is a side effect of long-term antipsychotic use, such as chlorpromazine. Quetiapine (Seroquel) is a second-generation antipsychotic with a lower risk of causing tardive dyskinesia. By discontinuing chlorpromazine and switching to quetiapine, the client is less likely to experience worsening of tardive dyskinesia symptoms. Monitoring for improvement in tardive dyskinesia is essential in this situation.
Choices A, B, and D are incorrect:
A: Development of pseudoparkinsonism is less likely with quetiapine compared to first-generation antipsychotics like chlorpromazine.
B: Dystonic reactions are acute side effects and are not typically associated with switching to quetiapine.
D: Anticholinergic symptoms are not directly related to tardive dyskinesia
An elderly client was well until 12 hours ago, when she reported to her family that during the evening she saw strange faces peering in her windows and in the middle of the night awakened to see a man standing at the foot of her bed. She admits to being very frightened. She is presently pacing and somewhat agitated in the examining room. The client's family reports that the client has recently been to the doctor, who made some medication changes, although they are unsure what the changes were. Which nursing intervention should the nurse implement at the time of this client's admission?
- A. Interact with the client on an adult to child level.
- B. Place the client in a safe, nonstimulating environment.
- C. Ask client why she thinks someone would be trying to frighten her.
- D. Explain to the family that the client will be restrained for her own good.
Correct Answer: B
Rationale: The correct answer is B: Place the client in a safe, nonstimulating environment. This is the most appropriate nursing intervention because the client is experiencing hallucinations and agitation, which could be due to the recent medication changes. Placing the client in a safe, calm environment can help reduce stimulation and provide a sense of security. This intervention addresses the client's immediate needs by ensuring her safety and promoting a sense of comfort.
Incorrect answers:
A: Interact with the client on an adult to child level - This is not appropriate as it does not address the client's current state of distress and could potentially worsen the situation.
C: Ask client why she thinks someone would be trying to frighten her - This is not the priority at this time, as the client is experiencing hallucinations and agitation that need to be managed first.
D: Explain to the family that the client will be restrained for her own good - Restraints should only be used as a last resort and should not be considered
A client is admitted to a day hospital following an episode in which he purchased a gun to use while standing guard over his property to prevent a neighbor from erecting a boundary fence. His wife describes him as distrustful of the motives of others and often interpreting others' motives as threats. She mentions that one time he accused her of having an affair with a neighbor with whom she chatted occasionally. The care plan will list the priority outcome as 'Client will:
- A. admit his action was excessive based on the circumstance.
- B. write the neighbor a letter of apology.
- C. demonstrate trust in the nurse.
- D. identify positive role models.'
Correct Answer: C
Rationale: The correct answer is C: demonstrate trust in the nurse. This is the priority outcome because the client's lack of trust and tendency to perceive threats need to be addressed first. By demonstrating trust in the nurse, the client can begin to develop a therapeutic relationship, which is essential for addressing his distrustful behavior and interpreting threats. This outcome focuses on building rapport and establishing a foundation for therapeutic interventions.
Choice A is incorrect because admitting his action was excessive may not address the underlying issues of distrust and misinterpretation of motives. Choice B is incorrect as it does not address the client's core issues and may not be appropriate in this context. Choice D is also incorrect as identifying positive role models is not a priority when the client's trust and perception issues need immediate attention.