A nurse is caring for a client who has schizophrenia and is taking an antipsychotic medication. Which of the following screening tools should the nurse use to identify tardive dyskinesia?

Patient Health questionnaire 9

Mental Status Examination

Brief Psychiatric Rating Scale

Abnormal Involuntary Movement Scale

Answer and Explanation

The Correct Answer is D

A.   Incorrect. The Patient Health questionnaire is used to assess depression severity.
B.   Incorrect. The Mental Status Examination assesses cognitive function and psychiatric symptoms.
C.   Incorrect. The Brief Psychiatric Rating Scale assesses psychiatric symptoms but not specifically tardive dyskinesia.
D.   Correct. The Abnormal Involuntary Movement Scale (AIMS. is specifically designed to screen for and assess the severity of tardive dyskinesia, which is a movement disorder associated with antipsychotic medications.

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Correct Answer is B

Explanation

A. Incorrect. Plaster casts are not waterproof and can become weakened if exposed to moisture, so showering with the cast is generally not recommended.
B. Correct. Elevating the extremity can help reduce swelling and promote comfort after the cast is applied.
C. Incorrect. Using a hair dryer inside the cast can cause burns and is not recommended for relieving itching.
D. Incorrect. Keeping the cast covered is not necessary, and covering it can trap moisture, potentially causing skin problems.

A. Apply the restraint under the client's clothes. B. Place the client in a sitting position. C. Tie the restraint to the railing of the client's bed. D. Ensure the restraint is placed across the client's chest.

Correct Answer is B

Explanation

A.Restraints should never be applied directly on the skin or under clothing, as this can cause irritation, pressure injuries, and make it difficult for the nurse to assess skin integrity. Restraints should be placed over the client's clothing to reduce friction and protect the skin.

B.Positioning the client in a sitting or semi-Fowler's position is preferred as it promotes comfort, minimizes the risk of aspiration, and allows the nurse to monitor the client's airway, breathing, and circulation more effectively. Lying flat can increase discomfort and respiratory difficulty, especially if the client is aggressive or agitated.

C.Restraints should never be tied to movable parts, like bed rails, as this could result in injury if the bed rail is moved up or down. Restraints should be tied to a non-movable part of the bed frame to ensure stability and prevent accidental tightening or loosening that could harm the client.

D.A belt restraint should be placed across the client’s waist or hips, not the chest, as a chest restraint can impede respiratory function, especially in an aggressive client who may be physically exerting themselves. The restraint should secure the client’s lower body to prevent them from standing or moving excessively, while still allowing safe breathing and circulation.

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A nurse is caring for a client who has schizophrenia and is taking an antipsychotic medication. Which of the following screening tools should the nurse use to identify tardive dyskinesia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

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Correct Answer is B

Explanation

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