A nurse is caring for a client who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication?

A. Rotating the staff who administer medications is generally counterproductive for a client with bipolar disorder or suspected non-adherence. Consistency in the nursing staff helps build a therapeutic alliance and trust, which are foundational for successful medication management. Frequent changes in personnel can lead to confusion, increased suspicion, and a lack of accountability in the nurse-client relationship.

B. Engaging the client in conversation immediately following the administration of medication is a subtle but effective clinical intervention. This strategy ensures the client has swallowed the medication by requiring vocalization, which prevents the client from "cheeking" or hiding the dose in the buccal cavity. It provides a non-confrontational method to verify ingestion while maintaining a positive and social therapeutic environment.

C. The use of sustained-release forms or long-acting injectable antipsychotics significantly improves adherence by reducing the frequency of administration. These formulations maintain a stable therapeutic serum concentration over a longer period, which is especially beneficial for clients who struggle with daily regimens. Reducing the burden of medication management minimizes the risk of relapse associated with missed doses.

D. Providing for once-daily dosing is a scientifically proven strategy to enhance medication compliance by simplifying the treatment schedule. Complexity in drug regimens is a primary barrier to adherence, particularly in psychiatric populations where cognitive symptoms may be present. A single daily dose is easier for the client to incorporate into a routine, thereby increasing the likelihood of long-term therapy maintenance.

E. Performing mouth checks following the administration of medication is a direct nursing intervention used to confirm that the client has truly swallowed the dose. This process involves a respectful but thorough inspection of the oral cavity, including under the tongue and along the gum lines. It is a standard safety protocol in mental health settings to ensure the delivery of prescribed psychiatric treatment.

To calculate the volume of chlorpromazine to administer per dose, we'll use the formula:

Volume(mL)=Totaldoseneeded(mg)/Concentrationofthemedication(mg/mL)

Given: Total dose needed per dose = 50 mg

Concentration of chlorpromazine injection = 25 mg/mL

Substituting the given values into the formula:

Volume(mL)=50 mg/25 mg/mL

Volume(mL)=2 mL

Rounded to the nearest whole number, the nurse should administer 2 mL of chlorpromazine per dose.