A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? (Select all that apply.)

Fine hand tremors and pill rolling

Urinary retention and constipation

Facial grimacing and eye blinking

Involuntary pelvic rocking and hip thrusting movements

Tongue thrusting and lip-smacking:

Answer and Explanation

Correct Answer : C,E

Fine hand tremors and pill rolling are not indicative of tardive dyskinesia. These symptoms are more commonly associated with other neurological or movement disorders.

B. Urinary retention and constipation:

Urinary retention and constipation are not symptoms of tardive dyskinesia. These symptoms are more related to anticholinergic effects of certain medications.

C. Facial grimacing and eye blinking:

Facial grimacing and repetitive, involuntary movements such as eye blinking are characteristic of tardive dyskinesia. These abnormal movements of the face and eyes are commonly seen in individuals who have been on long-term antipsychotic medications, especially older ones like haloperidol.

D. Involuntary pelvic rocking and hip thrusting movements:

Involuntary pelvic rocking and hip thrusting movements are not typical symptoms of tardive dyskinesia. These types of movements are less associated with antipsychotic-induced movement disorders.

E. Tongue thrusting and lip-smacking:

Tongue thrusting and lip-smacking are classic symptoms of tardive dyskinesia. These repetitive, involuntary movements involving the mouth and tongue are often observed in individuals who have been on antipsychotic medications for an extended period of time.

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Correct Answer is B

Explanation

Gabapentin and phenytoin are not directly associated with causing vitamin B deficiencies. However, certain antiseizure medications could potentially affect nutrient absorption over time.

B) A client who has chronic alcohol use disorder.

Explanation:

Chronic alcohol use disorder can lead to a deficiency in several B vitamins, particularly vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), vitamin B9 (folate), and vitamin B12 (cobalamin). Alcohol interferes with the absorption and utilization of these vitamins in the body, and individuals with alcohol use disorder are often at risk for malnutrition and vitamin deficiencies.

C) A client who takes heparin to prevent deep vein thrombosis:

Heparin is an anticoagulant and does not directly impact the absorption or utilization of vitamin B.

D) A client who has asthma:

Asthma itself does not significantly increase the risk of vitamin B deficiencies. Vitamin B deficiencies are more commonly associated with factors like malnutrition, certain medical conditions, or medications that impact absorption, as seen in chronic alcohol use disorder.

A. The partner has placed locks at the top of the doors leading to the outside. B. The partner has hired a house cleaner. C. The partner has lost 20 lb in the past 2 months. D. The partner redirects the client when the client is frustrated.

Correct Answer is C

Explanation

A. The partner has placed locks at the top of the doors leading to the outside:

Explanation: Placing locks at the top of doors leading outside is a safety measure to prevent the person with Alzheimer's disease from wandering or getting lost. While this does show that the partner is taking proactive steps to ensure the client's safety, it is not necessarily indicative of caregiver role strain.

B. The partner has hired a house cleaner:

Explanation: Hiring a house cleaner can be a sign of caregiver role strain. Caregivers often become overwhelmed with the responsibilities of caring for a person with Alzheimer's disease, and hiring help for household tasks can be an indication that they are finding it challenging to manage everything on their own.

C. The partner has lost 20 lb in the past 2 months:

Explanation: Rapid weight loss can be a sign of caregiver stress or burnout. The emotional and physical demands of caring for a loved one with Alzheimer's disease can lead to neglect of one's own well-being, including proper nutrition and self-care.

D. The partner redirects the client when the client is frustrated:

Explanation: While redirecting the client when they're frustrated shows that the partner is using appropriate strategies to manage challenging behaviors associated with Alzheimer's disease, this observation doesn't necessarily indicate caregiver role strain.

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A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a group of clients. The nurse should recognize which of the following clients is at risk for a vitamin B, deficiency.

Correct Answer is B

Explanation

A nurse is making a home visit to a client who has Alzheimer's disease and the client's partner. Which of the following observations indicates to the nurse that the partner is experiencing caregiver role strain?

Correct Answer is C

Explanation

A nurse is providing a community health education class about suicide prevention. Which of the following should the nurse identify as risk factors for suicide? (Select all that apply).

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