A client is prescribed alprazolam for acute anxiety. What client history should cause a nurse to question this order?

A personality disorder.

Hypertension.

Alcohol use disorder.

Schizophrenia.

Answer and Explanation

The Correct Answer is C

Choice A Reason
While a personality disorder can present challenges in managing medications due to the complexity of the psychiatric condition, it is not typically a contraindication for the use of alprazolam. However, caution is advised as the dynamics of personality disorders can affect medication adherence and response.

Choice B Reason
Hypertension is not a direct contraindication for alprazolam. However, since alprazolam can sometimes cause changes in blood pressure, it is important for the nurse to monitor the client's blood pressure and consult with the physician if there are concerns.

Choice C Reason
Alcohol use disorder is a significant concern when prescribing alprazolam. Alprazolam is a benzodiazepine, and concurrent use with substances like alcohol can increase the risk of respiratory depression, sedation, and misuse or addiction. Therefore, a history of alcohol use disorder should prompt the nurse to question the order and discuss alternative treatments with the physician.

Choice D Reason
Schizophrenia itself is not a contraindication for the use of alprazolam, but it is essential to consider the overall treatment plan for the client. Alprazolam is not a primary treatment for schizophrenia and is used for anxiety management. The nurse should ensure that the use of alprazolam does not interfere with the treatment of schizophrenia.

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Correct Answer is C

Explanation

Choice A reason:
Mandated activities are part of a therapeutic milieu, but they are not the primary element that contributes to the stability of a client with schizophrenia. While these activities provide a routine, they do not encompass the comprehensive support system that structured programming offers.

Choice B reason:
Visitor restrictions can be a component of a therapeutic milieu, particularly in inpatient settings, to ensure a safe and controlled environment. However, this is not typically what is missing in the home environment that leads to decompensation.

Choice C reason:
Structured programming is a key element of the therapeutic milieu that provides a stable and predictable environment, which is often lacking at home. This structure includes scheduled therapy sessions, social interactions, and activities that are designed to improve coping skills and social functioning. The consistency and predictability of structured programming can significantly benefit individuals with schizophrenia, helping them maintain functional stability.

Choice D reason:
Peer pressure is not a therapeutic aspect of the milieu. In fact, peer pressure can sometimes be negative. However, positive peer interactions and support are important in a therapeutic setting, as they can provide encouragement and a sense of community.

A. "Please share the joke with me." B. "You're laughing. Tell me what's happening." C. "Why are you laughing?" D. "I don't think I said anything funny."

Correct Answer is B

Explanation

Choice A Reason:
Asking the client to share the joke may imply that the nurse believes the client is laughing at a joke, which may not be the case. It's important to recognize that uncontrollable laughter can be a symptom of schizophrenia and not necessarily a response to humor.

Choice B Reason:
This response is open-ended and nonjudgmental, inviting the client to explain their behavior without making assumptions. It allows the client to share their experience, which could be related to an internal stimulus such as a hallucination or simply a response they cannot control.

Choice C Reason:
Asking "Why are you laughing?" could be perceived as confrontational or accusatory. It might make the client feel defensive or misunderstood, especially if the laughter is a symptom of their condition and not something they are doing voluntarily.

Choice D Reason:
Saying "I don't think I said anything funny" focuses on the nurse's perspective rather than the client's experience. It could inadvertently dismiss the client's behavior as inappropriate or unjustified, which is not supportive in a therapeutic relationship.

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A client is prescribed alprazolam for acute anxiety. What client history should cause a nurse to question this order?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client diagnosed with schizophrenia functions well during hospitalization but decompensates after discharge. What does the therapeutic milieu provide that may be missing in the home environment?

Correct Answer is C

Explanation

The nurse is sitting with a client diagnosed with schizophrenia, who starts to laugh uncontrollably, although the nurse has not said anything funny. The nurse should say:

Correct Answer is B

Explanation

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