A nurse is assessing a client who has schizophrenia which has been treated with fluphenazine for several years.
Which of the following findings should the nurse document as manifestations of tardive dyskinesia (TD)?.
Twisting tongue movements.
Shuffling gait.
Sudden onset of high fever.
Constant tapping of feet when sitting.
The Correct Answer is A
Choice A rationale:
Twisting tongue movements are a common symptom of tardive dyskinesia (TD), a side effect of long-term use of antipsychotic medications like fluphenazine.
Choice B rationale:
Shuffling gait is more commonly associated with Parkinson’s disease and certain antipsychotic medications can cause Parkinson-like symptoms, but it is not a characteristic of TD2.
Choice C rationale:
Sudden onset of high fever is not associated with TD. It could be a sign of a serious condition like neuroleptic malignant syndrome, which requires immediate medical attention.
Choice D rationale:
Constant tapping of feet when sitting could be a sign of restlessness or akathisia, another potential side effect of antipsychotic medications, but it is not a specific sign of TD2.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Flooding therapy is not typically used for somatic symptom disorder.
Choice B rationale:
Telling a client that their pain is not real can invalidate their experience and is not a recommended approach for somatic symptom disorder.
Choice C rationale:
Providing reassurance to the client is a recommended approach when all tests are normal and there are no identified risk factors.
Choice D rationale:
Encouraging the client to request invasive cardiac testing is not typically recommended when all tests are normal and there are no identified risk factors.
Correct Answer is A
Explanation
Choice A rationale:
The client is displaying manifestations of lithium toxicity, which includes ataxia and blurred vision. Therefore, the nurse should withhold the medication.
Choice B rationale:
Administering the next dose as prescribed could potentially exacerbate the client’s symptoms and increase the risk of further toxicity.
Choice C rationale:
Propranolol is not typically used in the management of lithium toxicity.
Choice D rationale:
Levothyroxine is used to treat hypothyroidism and is not relevant in this context.
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