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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
Answer: (B, C, D, E)
Rationale:
A) Damp dressing: A damp dressing around the IV site is typically indicative of a leaking IV or infiltration, where fluid escapes from the vein into the surrounding tissue. This finding is not directly related to phlebitis, which is inflammation of the vein.
B) Warmth at insertion site: Warmth at the insertion site is a common sign of phlebitis. The inflammation of the vein causes increased blood flow to the area, leading to localized warmth. This symptom is a key indicator that the IV site may be irritated or infected.
C) Streak formation: Streak formation, often seen as a red line running along the vein above the IV site, is a classic sign of phlebitis. It indicates inflammation and irritation spreading along the vein, which can occur due to the presence of the IV catheter.
D) Throbbing: Throbbing pain or discomfort at the IV site is another sign of phlebitis. The inflammation of the vein can cause pain that may be constant or increase with movement or palpation, indicating irritation or potential damage to the vessel.
E) Erythema: Erythema, or redness at the IV site, is a hallmark sign of phlebitis. The inflammation results in redness around the insertion area, which may spread along the vein, further indicating the presence of irritation or infection at the site.
Correct Answer is B
Explanation
B. Shake the container vigorously:
This is the correct action. Phenytoin suspension tends to settle over time, leading to non-uniform distribution of the medication in the suspension. Therefore, shaking the container vigorously before administering each dose ensures proper dispersion of the medication and helps maintain consistent drug concentration, thus promoting therapeutic efficacy.
A. Check the child's blood pressure:
Checking the child's blood pressure is not directly related to the administration of phenytoin suspension. Monitoring blood pressure may be indicated in certain clinical situations or with certain medications, but it is not specifically required before administering phenytoin suspension.
C. Be sure the child has not eaten within the hour:
While it's important to consider food-drug interactions with certain medications, such as those affected by food intake, there are no specific dietary restrictions associated with phenytoin suspension administration. Therefore, checking whether the child has eaten within the hour is not a necessary step before administering phenytoin suspension.
D. Perform mouth care:
Performing mouth care is not directly related to the administration of phenytoin suspension. However, oral hygiene is important for overall health, especially in children who may have difficulty performing adequate mouth care independently. While mouth care should be encouraged, it is not specifically required before administering phenytoin suspension.
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