A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects?

Dystonia

Tardive dyskinesia

Parkinsonism

Akathisia

Answer and Explanation

The Correct Answer is B

A. Dystonia - Dystonia presents as sustained or intermittent muscle contractions causing abnormal, often repetitive, movements or postures. It is an acute extrapyramidal side effect of antipsychotic medications like chlorpromazine but typically manifests as sudden-onset muscle spasms rather than involuntary movements of the tongue and face.

B. Tardive dyskinesia - Tardive dyskinesia is a late-appearing movement disorder characterized by involuntary, repetitive movements of the face, tongue, and limbs. It is associated with long-term use of antipsychotic medications like chlorpromazine and typically develops after months to years of treatment.

C. Parkinsonism - Parkinsonism resembles Parkinson's disease and is characterized by symptoms such as tremor, rigidity, bradykinesia, and postural instability. While antipsychotic medications can cause Parkinsonism as an adverse effect, it usually presents with symptoms different from those described in the scenario.

D. Akathisia - Akathisia is characterized by an inner feeling of restlessness and the urge to move, often accompanied by pacing and inability to sit still. It is an acute extrapyramidal side effect of antipsychotic medications but does not manifest as involuntary movements of the tongue and face as described in the scenario.

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Correct Answer is ["20"]

Explanation

To calculate the dose of midazolam to administer, we need to convert the client's weight from pounds to kilograms, and then multiply by the dose per kilogram.

Given: Client weight = 220 lb

Dose of midazolam = 0.2 mg/kg

First, let's convert the client's weight from pounds to kilograms:

1 lb ≈ 0.453592 kg (approximately 0.45 kg, for simplicity)

Client weight in kilograms ≈ 220 lb × 0.45 kg/lb ≈ 99 kg

Now, let's calculate the dose of midazolam:

Dose = Weight (in kg) × Dose per kg Dose ≈ 99 kg × 0.2 mg/kg = 19.8 mg

Rounded to the nearest whole number, the nurse should administer approximately 20 mg of midazolam.

A. A pretreatment electroencephalogram (EEG) will be done. B. High serum sodium levels can cause toxic levels of valproate. C. Thyroid function tests should be performed every 6 months. D. Liver function tests must be monitored.

Correct Answer is D

Explanation

A. A pretreatment electroencephalogram (EEG) is not typically required before starting valproate therapy. EEGs may be used in the diagnosis and management of seizure disorders, but they are not a standard part of valproate therapy initiation.

B. High serum sodium levels are not associated with toxic levels of valproate. Instead, valproate can cause hyperammonemia, especially in individuals with urea cycle disorders.

C. Thyroid function tests are not typically required specifically for valproate therapy. However, valproate may interfere with thyroid hormone levels, so thyroid function tests might be ordered if there are symptoms of thyroid dysfunction.

D. Monitoring liver function tests is essential when taking valproate because the medication can cause hepatotoxicity. Clients should have baseline liver function tests before starting valproate, followed by regular monitoring throughout treatment. If liver function test results indicate liver damage, the healthcare provider may adjust the dosage or discontinue the medication. Therefore, this is the correct instruction to provide to the client starting valproate therapy.

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A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer midazolam 0.2 mg/kg via IV bolus now. The client weighs 220 lb. How many mg should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["20"]

Explanation

A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

Correct Answer is D

Explanation

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