A 40-year-old woman began taking risperidone (Risperdal) for symptoms of schizoaffective disorder 3 days ago, and today she feels restless. She is pacing around and is unable to remain still. Which action should the PMHNP perform first?
Discontinue the risperidone and give the patient a low dose of clonazepam (Klonopin)
Continue the risperidone and start the patient on sertraline (Zoloft)
Discontinue the risperidone and give a dose of propranolol (Inderal)
Continue the risperidone and give the patient a low dose of clonazepam (Klonopin)
The Correct Answer is D
Choice A reason: Discontinuing risperidone immediately may not be necessary unless symptoms are severe or unmanageable. Clonazepam can help with akathisia, but abrupt discontinuation of antipsychotics may destabilize the patient’s psychiatric condition.
Choice B reason: Sertraline is an SSRI used for depression and anxiety, not for treating akathisia. Introducing it at this point would not address the patient’s restlessness and may complicate the clinical picture.
Choice C reason: Propranolol is effective for akathisia, but discontinuing risperidone prematurely may not be warranted. A better initial approach is to manage the side effect while continuing the antipsychotic, unless symptoms are intolerable.
Choice D reason: Akathisia is a common side effect of risperidone, especially early in treatment. Clonazepam, a benzodiazepine, can help reduce restlessness and agitation. Continuing risperidone while managing the side effect is appropriate unless symptoms worsen or persist. This approach balances symptom control with psychiatric stability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Cerebral edema is a rare but serious complication associated more with rapid shifts in osmolality, such as in dialysis disequilibrium syndrome. It is not the most common or significant complication of routine intermittent hemodialysis.
Choice B reason: Arrhythmias can occur due to electrolyte imbalances during dialysis, particularly with potassium shifts. However, they are less frequent and not as consistently observed as hypotension.
Choice C reason: Hypotension is the most frequent and significant complication of intermittent hemodialysis. It results from rapid fluid removal, autonomic dysfunction, or impaired cardiac output. It can lead to dizziness, nausea, cramps, and even syncope, making it a critical concern during dialysis sessions.
Choice D reason: Hypertension is a chronic issue in patients with kidney disease, but it is not a direct complication of the dialysis procedure itself. In fact, dialysis often helps manage fluid overload and blood pressure.
Correct Answer is D
Explanation
Choice A reason: Bipolar disorder with psychotic features requires the presence of manic or depressive episodes that meet full diagnostic criteria, with psychotic symptoms occurring exclusively during mood episodes. This patient’s psychosis is chronic and independent of mood symptoms, which rules out bipolar disorder.
Choice B reason: Schizoaffective disorder requires mood episodes (either depressive or manic) that meet full diagnostic criteria and occur concurrently with psychotic symptoms. Additionally, psychotic symptoms must persist for at least two weeks in the absence of mood symptoms. Since the depressive symptoms in this case do not meet criteria for major depression, schizoaffective disorder is not appropriate.
Choice C reason: Schizophreniform disorder is diagnosed when schizophrenia-like symptoms persist for more than one month but less than six months. This patient has had symptoms for four years, which exceeds the time frame for this diagnosis.
Choice D reason: Schizophrenia with unspecified depressive disorder is the most accurate diagnosis. The patient has a chronic course of schizophrenia and has experienced depressive symptoms that do not meet full criteria for major depressive disorder. This combination fits the clinical picture.
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