Nursing Knowledge: The nursing assessment of a patient indicates positive signs for Neuroleptic Malignant Syndrome (NMS). Select all that apply.
Low suspicion of anyone on antipsychotics.
Cramps, tremors, delirium, agitation and seizure
Muscular rigidity, Severe hypotension, or hypertension and tachycardia
Low creatine phosphokinase (CPK) and Low Leukocytosis.
Correct Answer : B,C
Choice A reason: NMS occurs in patients taking antipsychotics, particularly dopamine antagonists. Low suspicion of anyone on antipsychotics is incorrect because NMS is directly linked to antipsychotic use.
Choice B reason: Neurological symptoms such as tremors, delirium, agitation, and seizures are hallmark signs of NMS. These reflect dopamine blockade and autonomic instability.
Choice C reason: Muscular rigidity, autonomic instability (hypotension or hypertension), and tachycardia are classic features of NMS. These symptoms are critical for diagnosis and require immediate intervention.
Choice D reason: NMS is associated with elevated creatine phosphokinase (CPK) due to muscle breakdown and leukocytosis from systemic stress. Low levels would not be consistent with NMS.
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Related Questions
Correct Answer is B
Explanation
Choice A reason: The nuclear family arrangement is common in Western cultures but not universally preferred. In many Asian cultures, extended family living is valued for support, caregiving, and cultural continuity.
Choice B reason: Extended family living arrangements are common in many cultures, including Asian families. Grandparents often play a vital role in childrearing, passing down traditions, and providing emotional and financial support. This arrangement reflects cultural norms rather than dysfunction.
Choice C reason: Diffused boundaries imply unhealthy enmeshment or lack of autonomy between family subsystems. In this case, the grandparents’ presence is culturally normative, not evidence of boundary diffusion.
Choice D reason: Separation between subsystems is not necessarily expected in cultures where extended family living is the norm. The grandparents’ involvement does not indicate dysfunction but rather cultural practice.
Correct Answer is C
Explanation
Choice A reason: Restlessness is not a common side effect of St. John’s wort. While mood changes can occur, this herbal remedy is more associated with photosensitivity than agitation.
Choice B reason: Hirsutism, or excessive hair growth, is unrelated to St. John’s wort use. This side effect is more commonly linked to hormonal imbalances or certain medications, not herbal antidepressants.
Choice C reason: Photosensitivity is a well-documented adverse effect of St. John’s wort. The herb increases sensitivity to sunlight, leading to skin reactions such as rashes or burns. Clients taking this remedy should be advised to use sun protection and avoid prolonged sun exposure.
Choice D reason: Insomnia can occur with some antidepressants, but it is not a primary side effect of St. John’s wort. The herb’s most notable adverse effect is its impact on skin sensitivity to light.
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