A nurse in a mental health clinic is caring for a client who has bipolar disorder and a prescription for an antipsychotic medication. The provider and nursing staff suspect the client is not adhering to his medication therapy. Which of the following interventions should the staff use to encourage the client's adherence? (Select all that apply.)
Rotate staff that administer the medications.
Engage the client in conversation following medication administration.
Use sustained-release forms.
Provide for once-daily dosing.
Perform mouth checks following the administration of the medication.
Correct Answer : B,C,D,E
A. Rotating the staff who administer medications is generally counterproductive for a client with bipolar disorder or suspected non-adherence. Consistency in the nursing staff helps build a therapeutic alliance and trust, which are foundational for successful medication management. Frequent changes in personnel can lead to confusion, increased suspicion, and a lack of accountability in the nurse-client relationship.
B. Engaging the client in conversation immediately following the administration of medication is a subtle but effective clinical intervention. This strategy ensures the client has swallowed the medication by requiring vocalization, which prevents the client from "cheeking" or hiding the dose in the buccal cavity. It provides a non-confrontational method to verify ingestion while maintaining a positive and social therapeutic environment.
C. The use of sustained-release forms or long-acting injectable antipsychotics significantly improves adherence by reducing the frequency of administration. These formulations maintain a stable therapeutic serum concentration over a longer period, which is especially beneficial for clients who struggle with daily regimens. Reducing the burden of medication management minimizes the risk of relapse associated with missed doses.
D. Providing for once-daily dosing is a scientifically proven strategy to enhance medication compliance by simplifying the treatment schedule. Complexity in drug regimens is a primary barrier to adherence, particularly in psychiatric populations where cognitive symptoms may be present. A single daily dose is easier for the client to incorporate into a routine, thereby increasing the likelihood of long-term therapy maintenance.
E. Performing mouth checks following the administration of medication is a direct nursing intervention used to confirm that the client has truly swallowed the dose. This process involves a respectful but thorough inspection of the oral cavity, including under the tongue and along the gum lines. It is a standard safety protocol in mental health settings to ensure the delivery of prescribed psychiatric treatment.
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Related Questions
Correct Answer is B
Explanation
A. Insert the needle slowly and gently.
This statement is generally true for most injection techniques, including the Z-track method. Slow and gentle insertion helps minimize discomfort for the client and allows for better control over the needle's placement. However, the specific speed of insertion may vary depending on the nurse's technique and the client's skin condition.
B. Pull the skin 1.3 cm (1/2 inch) to the side.
This statement is correct. The Z-track technique involves pulling the skin laterally (to the side) by approximately 1.3 cm (1/2 inch) before inserting the needle. This lateral displacement of the skin creates a zigzag pathway for the medication, which helps prevent leakage or tracking of the medication along the injection site.
C. Aspirate for 5 to 10 seconds.
Aspiration, or pulling back on the plunger of the syringe after needle insertion, is not typically recommended for intramuscular injections, including those using the Z-track method. Aspiration may increase the risk of tissue trauma or damage to blood vessels. Since the Z-track technique is designed to minimize medication leakage into the subcutaneous tissue, aspiration is usually unnecessary.
D. Use a 45° angle of insertion.
The angle of insertion for the Z-track technique is typically 90 degrees (perpendicular) to the skin surface rather than 45 degrees. This angle allows for proper depth penetration into the muscle and ensures adequate delivery of the medication into the muscle tissue.
Correct Answer is B
Explanation
A. Dilute the medication with sterile water before injecting: Phenytoin should not be diluted before administration because it may cause precipitation or crystallization of the drug, leading to potential adverse effects such as tissue irritation or embolism.
B. Administer the medication over 1 min: Phenytoin should be administered slowly over 1 to 2 minutes to reduce the risk of adverse effects such as hypotension or cardiac arrhythmias. Rapid infusion can lead to cardiovascular collapse.
C. Slow the injection if the medication crystallizes: If the medication crystallizes, the nurse should stop the injection immediately and flush the IV line with normal saline. However, preventing crystallization by administering the medication slowly over the recommended time is preferable.
D. Follow the IV injection with sterile water: Following the IV injection with sterile water is not a standard practice for administering phenytoin. Instead, the nurse should follow institutional guidelines for flushing the IV line after medication administration, typically with normal saline.
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