A nurse is assessing a client who has schizophrenia and is taking aripiprazole. The nurse should notify the provider of which of the following findings?
Insomnia
Muscle stiffness
Weight gain of 5 lb in 1 month
Constipation
The Correct Answer is B
A. Insomnia While insomnia can be a side effect of aripiprazole, it is generally not a reason to notify the provider unless it becomes severe or chronic. Other interventions can be tried to manage sleep disturbances.
B. Muscle stiffness This is a concerning symptom, as it may indicate extrapyramidal symptoms (EPS), such as akathisia or dystonia, which are serious side effects of antipsychotic medications like aripiprazole. Muscle stiffness may also indicate neuroleptic malignant syndrome (NMS), a life-threatening condition that requires immediate medical attention. Therefore, this finding should be promptly reported to the provider.
C. Weight gain of 5 lb in 1 month Weight gain can occur with many antipsychotic medications, but a gain of 5 pounds over one month is generally not alarming unless it becomes more significant over time. The nurse should monitor the client for further weight changes, but it is not an urgent concern in this instance.
D. Constipation is a common side effect of many medications, including antipsychotics like aripiprazole. While it should be addressed to prevent complications (such as impaction), it does not require urgent intervention unless the symptoms become severe or result in bowel obstruction.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Olanzapine, an antipsychotic medication, can cause serious side effects such as sedation, orthostatic hypotension, and even respiratory depression. Therefore, it is important to monitor the client for at least 3 hours after the injection to observe for any adverse reactions, especially given the potential for prolonged effects from the intramuscular injection.
B. If a client reports hallucinations, the nurse should assess the client’s mental state and the effectiveness of the current treatment but should not withhold medication like olanzapine, as it is intended to manage symptoms of schizophrenia, including hallucinations. The nurse should instead consult with the provider about adjusting the treatment.
C. Olanzapine can cause sedation and drowsiness rather than difficulty sleeping, particularly after an intramuscular injection. Therefore, instructing the client to expect difficulty sleeping would not be an accurate expectation.
D. Olanzapine should be administered into the ventrogluteal or vastus lateralis muscle, not the deltoid muscle, due to the volume of the injection and to avoid complications. The deltoid muscle is not recommended for large-volume IM injections.
Correct Answer is C
Explanation
A. Fluoxetine, like other SSRIs, commonly causes sexual dysfunction, including decreased libido, not improvement.
B. Fluoxetine can cause insomnia, so it is typically taken in the morning, not at bedtime.
C. A skin rash may indicate a serious reaction such as Stevens-Johnson syndrome or an allergic response. Clients should be instructed to notify their provider immediately if a rash develops.
D. SSRIs like fluoxetine typically take 2 to 4 weeks or longer to begin improving depressive symptoms. Expecting relief in 3 to 4 days is unrealistic and may lead to nonadherence.
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