A nurse is collecting data from a client who is taking chlorpromazine. Which of the following findings should the nurse identify as extrapyramidal symptoms (EPS)? (Select all that apply.)

Impaired gait

Fidgeting behavior

Muscle contractions of the neck

Fluctuating vital signs

Sexual dysfunction

Answer and Explanation

Correct Answer : A,C

A.   Impaired gait is a classic extrapyramidal symptom, which includes issues like dystonia or bradykinesia.
B.   Fidgeting behavior is more related to anxiety or restlessness rather than EPS.
C.   Muscle contractions of the neck, known as torticollis, are common signs of EPS caused by antipsychotic medications such as chlorpromazine.
D.   Fluctuating vital signs are not directly linked to EPS but may indicate another underlying issue.
E.   Sexual dysfunction is a side effect of chlorpromazine but not classified as an EPS.

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Correct Answer is A

Explanation

A. Acknowledge the client’s delusion while gently redirecting them to the necessary activity (group
therapy). This approach maintains engagement without directly confronting the delusion.
B. Ignoring the delusion and focusing only on group therapy may cause the client to feel unheard or dismissed.
C. Dismissing the delusion is not therapeutic and could undermine trust.
D. Asking "why" could challenge the delusion, leading to defensiveness rather than productive conversation.

A. Assign the client to a private room. B. Tuck bedcovers over client's hands and arms. C. Remove all utensils from the client's meal trays. D. Inspect the client's personal belongings.

Correct Answer is D

Explanation

A. Assigning a private room may increase isolation, which is not conducive to a therapeutic environment.
B. Tucking bedcovers over the client’s hands and arms could be a restrictive action, not appropriate for
suicide prevention.
C. Removing utensils is not necessary unless the client has direct access to harmful objects.
D. Inspecting personal belongings ensures that the client does not have items that could be used for self-harm, which is a key suicide precaution.

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A nurse is collecting data from a client who is taking chlorpromazine. Which of the following findings should the nurse identify as extrapyramidal symptoms (EPS)? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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