A nurse can anticipate anticholinergic side effects are likely when a patient is taking:

risperidone (Risperdal)

lithium (Lithobid)

buspirone (Buspar)

fluphenazine (Prolixin)

Answer and Explanation

The Correct Answer is D

A. Risperidone (Risperdal):

Risperidone is an atypical antipsychotic and generally has a lower propensity for causing anticholinergic side effects compared to typical antipsychotics.

B. Lithium (Lithobid):

Lithium is a mood stabilizer used primarily for bipolar disorder and does not typically cause anticholinergic side effects.

C. Buspirone (Buspar):

Buspirone is an anxiolytic medication and does not have significant anticholinergic properties. It tends to have fewer side effects compared to other medications used for anxiety.

D. Fluphenazine (Prolixin):

Fluphenazine is a typical antipsychotic medication and belongs to the phenothiazine class, which is known to have notable anticholinergic effects. These effects can include dry mouth, constipation, blurred vision, urinary retention, and cognitive impairment.

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Correct Answer is A

Explanation

A. WBC count 3,300/mm³.

Clozapine, an atypical antipsychotic medication, is associated with a risk of agranulocytosis, which is a severe reduction in white blood cell (WBC) count. A WBC count of 3,300/mm³ is significantly below the normal range, and it indicates a contraindication to the use of clozapine.

B. Asthma:

Asthma is not a contraindication to clozapine. However, it is important to monitor respiratory function as antipsychotic medications can have side effects related to respiratory function.

C. Hypertension:

Hypertension alone is not a contraindication to clozapine. Clozapine can, however, be associated with some cardiovascular side effects, so blood pressure should be monitored regularly.

D. Fasting blood glucose 120 mg/dL:

An elevated fasting blood glucose level is not a contraindication to clozapine. However, it is important to monitor metabolic parameters as antipsychotic medications, including clozapine, can be associated with metabolic side effects.

A. The voices are telling me to harm myself B. I hear Voices C. I see birds flying in the room D. The voices don't stop and continue all day

Correct Answer is A

Explanation

A. The voices are telling me to harm myself: This statement indicates command hallucinations with a potential for harm. It suggests that the patient is receiving directives to harm themselves, which poses an immediate safety concern. Implementing safety measures, such as close monitoring, removal of harmful objects, and involving appropriate professionals, is essential to protect the patient from self-harm.

B. I hear voices: While hearing voices (auditory hallucinations) is a symptom that requires assessment and intervention, the nature of the voices is crucial in determining the level of risk. This statement, on its own, does not provide information about the content or potential harm associated with the voices.

C. I see birds flying in the room: This statement describes a visual hallucination, which, while potentially distressing, does not necessarily pose an immediate safety risk to the patient or others. Visual hallucinations may be less likely to necessitate immediate safety measures compared to command hallucinations.

D. The voices don't stop and continue all day: This statement suggests persistent auditory hallucinations, but without information about the content of the voices, it does not specifically indicate a risk of harm. While it may be distressing for the patient, the urgency for safety measures depends on the nature of the auditory content.

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A nurse can anticipate anticholinergic side effects are likely when a patient is taking:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a client who has a new prescription for clozapine for the treatment of schizophrenia. Which of the following findings indicates a contraindication to clozapine?

Correct Answer is A

Explanation

Which hallucination necessitates the nurse to implement safety measures? The patient says.

Correct Answer is A

Explanation

A withdrawn client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being implicated in this behavior?

A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive workup in an emergency department reveals no pathology. Which medical diagnosis is suspected, and what nursing diagnosis takes priority?

A nurse is completing an assessment of a client. Which of the following information should the nurse anticipate the provider will use in the diagnosis of a mental health disorder?

A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client?

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During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior?

A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100-ml bottle. The label reads 20 mg/5mL.. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense?