What should the nurse plan to teach as a priority for a client who is taking a benzodiazepine daily for anxiety?

The potential for dependence and tolerance

It should be taken first thing in the morning with food

The importance of discontinuing immediately if addiction is suspected

Increased caffeine consumption will increase the effectiveness

Answer and Explanation

The Correct Answer is A

Choice A reason: Benzodiazepines enhance GABA activity, leading to rapid anxiety relief but with a high risk of tolerance and dependence. Teaching about this risk is critical to ensure the client understands the need for medical supervision, potential withdrawal symptoms, and strategies to prevent misuse or long-term dependency.

Choice B reason: Taking benzodiazepines with food may reduce gastrointestinal upset, but the timing is not critical for efficacy. This instruction is less urgent than addressing dependence, as benzodiazepines are effective regardless of meal timing, and the primary concern is their addictive potential.

Choice C reason: Discontinuing benzodiazepines abruptly can cause severe withdrawal symptoms, including seizures, due to their effect on GABA receptors. This is dangerous advice, as gradual tapering under medical supervision is required, making this choice incorrect and less critical than teaching about dependence risks.

Choice D reason: Increased caffeine consumption can counteract benzodiazepine effects by stimulating the central nervous system, potentially worsening anxiety. This is incorrect advice, as it could reduce the medication’s efficacy and exacerbate symptoms, making it less relevant than educating about dependence and tolerance risks.

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Correct Answer is C

Explanation

Choice A reason: Serotonin syndrome involves fever, agitation, and hyperreflexia due to excessive serotonin, typically from SSRIs or MAOIs, not antipsychotics like risperidone. Muscle stiffness and shuffling gait are not characteristic, making this an incorrect cause of the symptoms.

Choice B reason: Neuroleptic malignant syndrome causes severe muscle rigidity, fever, and autonomic instability due to dopamine blockade by antipsychotics. While possible with risperidone, the client’s mild symptoms (stiffness, shuffling gait) are more consistent with extrapyramidal effects than this severe condition.

Choice C reason: Extrapyramidal symptoms, caused by risperidone’s dopamine D2 receptor blockade, include muscle stiffness and shuffling gait (parkinsonism). These occur due to disrupted basal ganglia function, mimicking Parkinson’s disease, and are common with antipsychotics, making this the most likely cause.

Choice D reason: Tardive dyskinesia involves involuntary movements like grimacing or lip smacking, typically after long-term antipsychotic use. Muscle stiffness and shuffling gait are not characteristic, as these are parkinsonian symptoms, making this less likely than extrapyramidal symptoms.

A. Increased sleep B. Suicidal ideations C. Emotional changes D. Increased socialization

Correct Answer is B

Explanation

Choice A reason: Increased sleep may occur with sertraline due to its sedative effects, but it is not the priority assessment. Early in treatment, SSRIs can increase energy before mood improvement, heightening suicide risk, making suicidal ideation a more urgent concern.

Choice B reason: Sertraline, an SSRI, can initially increase energy in severe depression before fully improving mood, potentially increasing suicide risk. Assessing suicidal ideation is the priority to ensure safety, as this risk is highest early in treatment, requiring immediate intervention if present.

Choice C reason: Emotional changes are expected with sertraline as it improves mood over weeks. However, this is less urgent than assessing suicidal ideation, which poses an immediate safety risk, especially in severe depression during the early phase of SSRI treatment.

Choice D reason: Increased socialization may indicate improved depressive symptoms but is a secondary outcome. The priority is assessing suicidal ideation, as SSRIs can paradoxically increase suicide risk early in treatment due to improved energy without full mood stabilization, requiring vigilant monitoring.

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What should the nurse plan to teach as a priority for a client who is taking a benzodiazepine daily for anxiety?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with schizophrenia is prescribed risperidone. The nurse observes muscle stiffness and a shuffling gait. What is the most likely cause of these symptoms?

Correct Answer is C

Explanation

The client has been diagnosed with severe depression and prescribed sertraline (Zoloft). Which assessment of the client by the nurse is a priority after initiation of the medication?

Correct Answer is B

Explanation

What should the nurse plan to teach as a priority for a client who is taking a benzodiazepine daily for anxiety?

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