A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone. When the client walks to the nurse's station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?
Administer the prescribed anticholinergic benztropine for dystonia.
Offer the client a prescribed physical therapy hot pack for muscle spasms.
Direct the client to occupational therapy to distract him from somatic complaints.
Medicate the client with the prescribed antipsychotic thioridazine.
The Correct Answer is A
A. The client's symptoms, including a laterally contracted position and perception of body contortion, suggest acute dystonia, a known side effect of antipsychotic medications like risperidone. Administering an anticholinergic such as benztropine can help alleviate these symptoms.
B. Offering a hot pack for muscle spasms may provide some relief for generalized muscle discomfort but would not specifically address the dystonic reaction.
C. Directing the client to occupational therapy may be beneficial for overall treatment but does not address the immediate need to alleviate acute dystonic symptoms.
D. Thioridazine is an antipsychotic medication but is not typically used as a first-line treatment for acute dystonia. Administering benztropine, an anticholinergic, would be more appropriate for dystonia associated with risperidone use.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
Social withdrawal: This is a common symptom as individuals may avoid social interactions and isolate themselves due to ongoing distress.
Prepared by Brandel
B) Exaggerated startle response: Individuals may have an increased startle reflex following trauma, which can persist over time.
C) Intrusive thoughts: These are unwanted and distressing thoughts related to the trauma that can continue to affect the individual.
D) Avoidance of places associated with the assault: This behavior is a protective mechanism to prevent re-experiencing the traumatic event.
E) Overeating: Overeating is not a characteristic sequalae of rape trauma. F) Hallucinations: Hallucinations are not typically associated with long-term symptoms of rape trauma syndrome. Hallucinations can occur in severe cases, particularly if there are co-occurring mental health disorders such as PTSD.
Correct Answer is C
Explanation
A. While the loss of a significant other can be a risk factor for suicide, retired older males may have developed coping mechanisms over time that could mitigate the risk.
B. While working in a pediatric emergency department can be stressful, it does not necessarily indicate a higher risk for suicide compared to other factors such as personal life stressors or mental health issues.
C. Adolescents experiencing significant life changes such as parental divorce are at increased risk for suicide due to the emotional upheaval and lack of coping skills typical of this age group.
D. While being a single working mother with three preschool-aged children can be stressful, it does not inherently indicate a higher risk for suicide compared to other factors such as social support, coping mechanisms, and mental health status.

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