The nurse reviews the client's test results.

 

For each potential provider's prescription, click to specify if the potential prescription is expected or unexpected for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

A. Blurred vision: Blurred vision is a possible side effect of many antipsychotic medications, including ziprasidone, but it is not a contraindication. It should be monitored and reported if persistent, but it does not prevent the use of the medication.

B. History of cholelithiasis: A history of gallstones (cholelithiasis) is not a contraindication for ziprasidone. While metabolic changes and weight gain may be monitored with long-term antipsychotic use, prior cholelithiasis does not pose an acute risk that would prevent prescribing ziprasidone.

C. Fine hand tremors: Fine tremors may be associated with underlying neurological or metabolic conditions, or could be an early extrapyramidal symptom, but they are not an absolute contraindication for ziprasidone. The nurse should monitor for worsening movement disorders during therapy.

D. History of prolonged QT interval: Ziprasidone is contraindicated in clients with a history of prolonged QT interval because it can further prolong cardiac repolarization, increasing the risk of torsades de pointes and sudden cardiac death. Baseline and ongoing ECG monitoring is essential for safety, and use in this population should be avoided.

Rationale for correct choices

• a chest x-ray: A chest x-ray is essential to assess for pulmonary infections such as tuberculosis or pneumonia, especially in clients presenting with a prolonged productive cough, hemoptysis (blood-tinged sputum), night sweats, low-grade fever, and weight loss. Imaging allows visualization of lung infiltrates, cavitations, or other abnormalities that guide diagnosis and treatment.

• a sputum culture: A sputum culture is necessary to identify the causative organism of the productive cough and hemoptysis. Culturing the sputum confirms whether Mycobacterium tuberculosis or another pathogen is present, guiding appropriate antimicrobial therapy. It also allows drug-susceptibility testing if TB is detected, which is critical for selecting treatment.

Rationale for incorrect choices

• pulmonary function test: Pulmonary function tests assess lung capacity and airflow obstruction, typically used for chronic respiratory conditions like asthma or COPD. They do not provide information about infectious causes of acute cough or hemoptysis and are not indicated for initial evaluation in this case.

• a nasopharyngeal swab: Nasopharyngeal swabs are mainly used to detect viral respiratory infections such as influenza or COVID-19. While the client has a cough, the presence of hemoptysis, weight loss, and night sweats suggests a bacterial or mycobacterial infection rather than a viral illness, making this test less relevant.

• a blood culture: Blood cultures are indicated if systemic infection or sepsis is suspected. The client’s vital signs are stable, and there are no signs of systemic bacterial infection, such as hypotension or tachycardia consistent with sepsis. Therefore, blood cultures are not immediately necessary for this presentation.