A patient on the psychiatric unit took his first dose of chlorpromazine last night. The following morning, he approaches the nursing station complaining of severe spasms in his neck and back. The psych nurse informs the provider, and can expect an order for which medication?

A) Paroxetine hydrochloride: Paroxetine is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class and is typically used to treat depression, anxiety, and certain other mood disorders. It is not the appropriate medication for managing acute aggression or violence in a client with paranoid schizophrenia, as it doesn't address psychotic symptoms or acute agitation.

B) Haloperidol: Haloperidol is an antipsychotic medication that is often used to manage acute episodes of aggression and psychosis in individuals with schizophrenia. It is especially effective for controlling agitation and violent behavior. As the client has paranoid schizophrenia and is displaying acute violence, haloperidol is the most appropriate medication to address these symptoms.

C) Lithium carbonate: Lithium is primarily used to treat bipolar disorder, specifically for managing mood swings and preventing manic episodes. It is not indicated for managing acute agitation or violent behavior in schizophrenia and would not be the first choice in this scenario.

D) Propranolol: Propranolol is a beta-blocker, typically used to manage hypertension, anxiety, or certain heart conditions. While it can help with anxiety or physical symptoms of agitation (such as tremors), it does not address the underlying psychosis or violent behaviors in a client with paranoid schizophrenia. Therefore, it would not be the most appropriate choice for this acute situation.

A) Administer PRN medication for agitation: Administering PRN medication may be necessary if the client’s agitation becomes unmanageable, but it is important to first attempt non-pharmacological interventions, such as reducing stimuli, before resorting to medication. This approach helps in managing the client's agitation in a more holistic manner and avoids over-reliance on medication.

B) Request a prescription for physical restraints: Restraints should be considered a last resort and only after less restrictive interventions, like reducing stimuli or verbal de-escalation techniques, have been attempted. Restraints can escalate aggression and increase the risk of harm, so they should not be the first intervention in managing agitation.

C) Place the client in seclusion: Seclusion should only be used as a last resort when other methods have failed, and the client poses a risk to themselves or others. It is a restrictive intervention that can have negative psychological effects, so it is better to try less intrusive measures first, such as reducing environmental stimuli.

D) Attempt to reduce environmental stimuli: Reducing environmental stimuli is a non-invasive, first-line intervention for managing agitation. It helps decrease overwhelming sensory input and can calm the client down. This approach involves creating a quieter, more controlled environment, which can assist in de-escalating the situation before more drastic measures are needed.