A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately?
Dry mouth and urinary retention
Akinesia and insomnia
Sore throat, fever, and malaise
Akathisia and hypersalivation
The Correct Answer is C
A. Dry mouth and urinary retention: These symptoms are not typically associated with the side effects of clozapine. Dry mouth is a common side effect of many antipsychotic medications, but urinary retention is not a typical side effect of clozapine.
B. Akinesia and insomnia: Akinesia (lack of movement) is not a common side effect of clozapine. Insomnia can occur with various antipsychotic medications but does not typically warrant immediate intervention unless severe or persistent.
C. Sore throat, fever, and malaise: These symptoms can indicate a potentially serious side effect known as agranulocytosis, which is a significant reduction in white blood cell count. Clozapine is associated with an increased risk of agranulocytosis. If a client experiences symptoms such as sore throat, fever, or malaise, it may indicate a severe drop in white blood cell count, and immediate medical attention is necessary.
D. Akathisia and hypersalivation: Akathisia (restlessness) is a known side effect of antipsychotic medications, but it is not typically associated with immediate severe medical risks. Hypersalivation is a common side effect but does not usually require immediate intervention unless severe.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment): This statement is inaccurate. There is substantial evidence supporting the interaction between nature (biology and genetics) and nurture (environment) in the development of mental health conditions, including depression.
B. Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors: This is the correct answer. It acknowledges the role of medications in addressing chemical imbalances but also emphasizes the importance of environmental and interpersonal factors in influencing biological factors. This response aligns with a biopsychosocial model of understanding mental health.
C. Because biological factors are the sole cause of depression, medications will improve your mood: This statement oversimplifies the complex etiology of depression. Depression is a multifactorial condition influenced by biological, psychological, and environmental factors. Medications may be part of the treatment, but they are not the sole solution.
D. Environmental factors have been shown to exert the most influence in the development of depression: This statement is also incorrect. Depression is influenced by a combination of biological, psychological, and environmental factors. No single factor is solely responsible for the development of depression.
Correct Answer is A
Explanation
A. Maintain consistency of care by open communication to avoid staff manipulation: This is the correct answer. Borderline personality disorder (BPD) clients may engage in splitting behaviors, which involve polarized views of staff as either all good or all bad. Maintaining consistency of care and open communication can help prevent manipulation and ensure fair and transparent interactions.
B. Maintain unit order by the application of autocratic leadership: Autocratic leadership, characterized by a top-down approach with limited input from others, may not be the most effective strategy in this situation. It may lead to resistance from clients and potentially escalate the conflict.
C. Allow the clients to apply the democratic process when developing unit rules: While democratic processes are generally beneficial, allowing clients to unreasonably demand modifications of unit rules without considering the overall impact on the therapeutic environment may not be appropriate. It's important to balance client involvement with maintaining a structured and therapeutic milieu.
D. Allow the client spokesperson to verbalize concerns during a unit staff meeting: While it's important to provide a platform for clients to express concerns, allowing a spokesperson to verbalize concerns during a staff meeting should be done in a manner that maintains order and follows the therapeutic goals of the unit. It should not involve unreasonably demanding modifications without a careful consideration of the impact on the overall treatment milieu.
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