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 D
Explanation
a. Hypoglycaemia can occur, but it is not as immediately life-threatening as cardiac dysrhythmia.
b. Endocrine imbalance and amenorrhea are significant but not usually immediately life-threatening.
c. Cold intolerance due to decreased metabolism is uncomfortable but not immediately life-threatening.
d. Cardiac dysrhythmias are a major health complication of anorexia nervosa due to electrolyte imbalances, particularly hypokalaemia, which can lead to cardiac arrest. This is a life-threatening condition that needs to be monitored closely.
Correct Answer is D
Explanation
a. Focused conversations on various foods: While a healthy relationship with food is a treatment goal, focusing excessively on food during therapy sessions might indicate continued preoccupation, not necessarily a positive change.
b. Is able to binge eat without purging: This might seem positive on the surface, but it doesn't address the underlying problem of binge eating. The goal is to develop healthy eating habits and reduce both bingeing and purging behaviors.
c. Gained ten pounds in one week: Rapid weight gain is unlikely to be a healthy or sustainable outcome in bulimia nervosa treatment. It's important to focus on healthy weight management alongside addressing the core eating disorder behaviors.
d. Demonstrated healthy coping mechanisms that decreased anxiety (Correct): Bulimia nervosa involves recurrent episodes of binge eating followed by purging behaviors. Recovery involves developing healthy coping mechanisms to manage anxiety and reduce the urge to binge or purge. This is a key indicator of progress.
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