The nurse is assessing a client diagnosed with schizophrenia, who has been prescribed Haloperidol for the past year. On assessment, the nurse notices that the client is demonstrating bizarre facial and tongue movements. What is the priority nursing intervention?
Administer the 6mg Benztropine orally with a full glass of water on an empty stomach.
Ask the healthcare provider to increase the dose of Haloperidol to assist with the side effect.
Hold the dose of Haloperidol and notify the healthcare provider.
Explain to the client that the side effects should diminish in one to two weeks.
The Correct Answer is C
a. Administer the 6mg Benztropine orally with a full glass of water on an empty stomach: Benztropine is an anticholinergic medication used to manage the extrapyramidal side effects (EPS) of antipsychotics. However, it's important to consult the healthcare provider before administering any additional medications.
b. Ask the healthcare provider to increase the dose of Haloperidol to assist with the side effect: Increasing the dose of Haloperidol might worsen the tardive dyskinesia symptoms.
c. Hold the dose of Haloperidol and notify the healthcare provider. (Correct) Haloperidol is an antipsychotic medication with a known side effect of tardive dyskinesia, which manifests as involuntary facial and body movements. Stopping the medication and informing the provider is crucial to determine the best course of action, which might involve dose adjustment or switching medications
d. Explain to the client that the side effects should diminish in one to two weeks: Tardive dyskinesia can be a persistent side effect, and reassurance without addressing the medication is not helpful.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a. Can stop taking this medication abruptly without serious complications: Abruptly stopping diazepam, especially after long-term use, can lead to withdrawal symptoms like anxiety, seizures, and insomnia.
b. Will need scheduled blood work in order to monitor for toxic levels of this drug: While monitoring might be necessary in some cases, it's not typical for everyone on diazepam.
c. Will not drink alcohol while taking this medication. (Correct) Diazepam is a central nervous system depressant. Alcohol has similar effects, and combining them can significantly increase the risk of drowsiness, impaired coordination, and respiratory depression. Understanding this interaction is crucial for safe medication use.
d. Will have to take this medication for the rest of my life: The duration of diazepam therapy depends on the individual and the condition being treated.
Correct Answer is A
Explanation
a. "You feel that your mother does not want you to come back home?" This response uses reflection, a therapeutic communication technique, to encourage the client to express and explore their feelings further.
b. "It's quite common for clients to feel that way after a lengthy hospitalization." While this normalizes the client's feelings, it might dismiss the client's unique emotional experience and does not invite further exploration.
c. "Why don't you talk to your mother? You may find out she doesn't feel that way." This response provides a solution but does not address the client's current emotional state or encourage them to express their feelings.
d. "Your mother seems like an understanding person. I'll help you approach her." This response makes an assumption about the mother and shifts the focus away from the client’s feelings.
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