A nurse is preparing to administer fluphenazine 7.5 mg PO daily to a client who has schizophrenia.

Available is fluphenazine elixir 2.5 mg/5 mL. How many mL should the nurse administer?

The nurse should anticipate prescriptions for methadone as well as group therapy.

Rationale for correct answers

Methadone is a long-acting opioid agonist used in medication-assisted treatment (MAT) for heroin withdrawal and opioid dependence. Given the client’s history of heroin use and symptoms suggestive of withdrawal, methadone can alleviate withdrawal symptoms while preventing cravings and relapse.

Group therapy is a key component of substance use disorder treatment, providing peer support, relapse prevention strategies, and coping mechanisms. The client has already expressed willingness to participate in outpatient therapy and identified cravings as a challenge, making group therapy beneficial for sustained recovery.

Rationale for incorrect Response 1 options

• Disulfiram: Used for alcohol dependence, but this client does not report alcohol use.
• Naltrexone: Used to prevent opioid or alcohol relapse but does not treat withdrawal symptoms, making methadone a better choice during acute withdrawal.
• Lorazepam: A benzodiazepine used for alcohol withdrawal and anxiety, but it is not first-line for opioid or methamphetamine withdrawal.

Rationale for incorrect Response 2 options

• Electroconvulsive therapy: Primarily used for severe depression or treatment-resistant mood disorders, not substance use disorder management.
• Antidepressant medication: The client has no history of depression or psychiatric disorders, making behavioral therapies a better fit for recovery.
• Antipsychotic medication: No psychotic symptoms such as delusions or hallucinations are reported, so antipsychotics are not indicated.

Choice A rationale

Assisting the client with evaluating their coping mechanisms is a helpful strategy for preventing future panic attacks and managing anxiety in the long term. However, during an acute panic attack, the client's ability to think rationally and evaluate their coping skills is significantly impaired. The immediate focus should be on reducing overwhelming stimuli.

Choice B rationale

Exploring with the client what precipitates an attack is crucial for identifying triggers and developing preventative strategies. However, during an active panic attack, the client is experiencing intense anxiety and may not be able to effectively process or articulate potential triggers. This intervention is more appropriate for periods between attacks.

Choice C rationale

Minimizing environmental stimuli is a key intervention during a panic attack. Panic attacks involve a surge of intense fear and anxiety, often accompanied by sensory overload. Reducing noise, bright lights, and excessive activity in the immediate surroundings can help decrease the client's distress and promote a sense of calm and safety.

Choice D rationale

Encouraging the client to set goals is a therapeutic strategy aimed at promoting a sense of control and accomplishment, which can be beneficial for overall mental health and managing anxiety in the long term. However, during an acute panic attack, the client is likely overwhelmed and unable to focus on goal setting. The immediate priority is to reduce their acute anxiety.