A nurse needs to administer haloperidol IM at a dose of 5 mg. The medication available is haloperidol injection 10 mg/mL. How many mL should the nurse administer?
0.5 mL
2 mL
0.25 mL
1 mL
The Correct Answer is A
Choice A reason: To calculate the correct volume, the nurse uses the standard formula: Desired dose (5 mg) divided by the dose on hand (10 mg) multiplied by the volume (1 mL). Therefore, 5 divided by 10 equals 0.5. Administering 0.5 mL provides exactly the 5 mg prescribed.
Choice B reason: Administering 2 mL would result in the patient receiving 20 mg of haloperidol. This is four times the prescribed dose and could lead to severe extrapyramidal side effects, acute dystonia, or neuroleptic malignant syndrome, representing a significant and dangerous medication administration error by the nurse.
Choice C reason: A volume of 0.25 mL would only deliver 2.5 mg of the medication. This sub-therapeutic dose would likely be ineffective in managing the patient's acute psychiatric symptoms or agitation, failing to meet the clinical objectives established by the prescribing healthcare provider's original medication order.
Choice D reason: Administering 1 mL would deliver 10 mg of haloperidol, which is double the intended 5 mg dose. Overdosing a patient on high-potency antipsychotics increases the risk of cardiac complications, such as QTc prolongation, and requires immediate reporting and monitoring for adverse neurological reactions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This description refers to humanistic or psychodynamic therapy, which focuses on self-actualization and insight into past behaviors to drive change. While developing self-awareness is a component of overall mental health, it does not describe the specific behavioral desensitization mechanics that define prolonged exposure therapy for PTSD.
Choice B reason: This accurately describes Eye Movement Desensitization and Reprocessing (EMDR) therapy, not prolonged exposure therapy. EMDR uses bilateral stimulation, such as guided eye movements or tapping, to help the brain reprocess traumatic memories. While both are used for PTSD, they are distinct therapeutic modalities with different procedural protocols.
Choice C reason: Prolonged exposure therapy is a form of cognitive-behavioral therapy that utilizes "in vivo" and "imaginal" exposure. By repeatedly and safely facing the trauma-related stimuli that the client has been avoiding, the process of emotional processing occurs, leading to a reduction in the conditioned fear response and associated symptoms.
Choice D reason: This describes the fundamental premise of standard Cognitive Behavioral Therapy (CBT). While prolonged exposure is a subset of CBT, this broad definition focuses on cognitive restructuring. Prolonged exposure is more specific, focusing on the behavioral extinction of fear through direct confrontation with the trauma memory and related triggers.
Correct Answer is C
Explanation
Choice A reason: Engaging a severely agitated client in a group therapy session is contraindicated and potentially dangerous. High levels of stimulation and the presence of other patients can exacerbate the client's psychosis and agitation, leading to an increased risk of physical aggression or injury to the client and others in the therapeutic environment.
Choice B reason: While monitoring vital signs is an important nursing responsibility, recommending rest alone is insufficient for a client experiencing sudden severe agitation. Agitation in a psychotic client often requires active pharmacological intervention to ensure safety and prevent the escalation of behavioral dysregulation that could lead to physical restraint or seclusion.
Choice C reason: Administering prescribed benzodiazepines, such as lorazepam, is the standard medical intervention for acute agitation. These medications enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in rapid anxiolysis and sedation. This helps to stabilize the client quickly and reduce the risk of violent outbursts.
Choice D reason: Instructing a client to use deep breathing exercises is a useful technique for mild anxiety but is generally ineffective during a state of severe, sudden agitation or active psychosis. The client’s cognitive processing and ability to follow complex verbal instructions are significantly impaired during an acute episode, necessitating a more direct pharmacological approach.
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