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?

A. Premenstrual dysphoric disorder (PMDD): While PMDD is a severe form of premenstrual syndrome (PMS) that can cause mood disturbances, irritability, and depression, it is typically cyclical and the symptoms resolve after menstruation begins. Although PMDD can increase the risk of suicidal thoughts or behaviors during the luteal phase, it is generally not considered to carry the same long-term risk for suicide as major depressive disorder.

B. Seasonal affective disorder (SAD): SAD is a type of depression that occurs at specific times of the year, usually in the winter months when there is less sunlight. While it can cause significant depressive symptoms, it is typically treated with light therapy or other interventions and generally has a lower risk for suicide compared to other types of depression, such as major depressive disorder.

C. Major depressive disorder (MDD): This is the most significant risk factor for suicide. Individuals with MDD often experience severe, persistent feelings of hopelessness, worthlessness, and sadness, which can lead to suicidal ideation. The risk is particularly high in individuals with chronic or recurrent episodes of major depression, especially if there are additional factors like previous suicide attempts, substance abuse, or a lack of social support.

D. Persistent depressive disorder (PDD), also known as dysthymia: This is a long-term form of depression that lasts for at least two years. While the symptoms can significantly impair functioning and cause distress, the intensity of the depressive episodes is generally less severe than in major depressive disorder. Although it still carries a risk for suicide, it is not as high as the risk associated with MDD.

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.