A nurse is preparing to administer diphenhydramine 50 mg PO every 6 hr to a client who has acute dystonia. The available medication is diphenhydramine 25 mg tablets.

How many tablets should the nurse administer per dose?

Choice A: Giving opinion: While sharing your opinions might seem helpful, it can actually shut down communication and make the patient feel judged or invalidated. Therapeutic communication focuses on understanding the patient's perspective, not imposing your own views.

Choice B: Asking why: Asking "why" can often come across as accusatory or judgmental, putting the patient on the defensive and hindering open communication. Instead, use open-ended s or clarifying statements to encourage the patient to elaborate on their feelings and experiences.

Choice C: Silence: In some situations, silence can be a powerful tool. It can provide a safe space for the patient to process their emotions, gather their thoughts, or initiate conversation themselves. However, be sure to use silence actively, paying close attention to nonverbal cues and ensuring the patient feels comfortable with the pause.

Choice D: Change the subject: While there may be times when it's appropriate to redirect the conversation, abruptly changing the subject can leave the patient feeling unheard and dismissed. It's important to acknowledge the patient's concerns and validate their feelings before moving on to another topic.

Choice E: Reflecting: Reflecting involves rephrasing the patient's words or statements in a way that acknowledges and emphasizes their emotions and experiences. This helps the patient feel heard and understood, promoting trust and openness in the communication. For example, if a patient says "I feel so alone," you could reflect by saying "It sounds like you're feeling isolated and disconnected."

Choice F: Clarification: Clarifying statements are a helpful way to ensure you understand the patient correctly. This can involve repeating parts of what they said, summarizing their message, or asking for specific details. For example, if a patient says "I just can't take it anymore," you could clarify by saying "You mentioned you're feeling overwhelmed. Can you tell me more about what's been difficult for you?"

By utilizing techniques like silence, reflecting, and clarification, nurses can create a safe and supportive environment for their patients in the mental health unit, fostering therapeutic communication that promotes healing and recovery.

Rationale:

Choice A is incorrect. Alprazolam does not have any known dietary interactions with aged cheeses. This information is specific to monoamine oxidase inhibitors (MAOIs), not benzodiazepines like alprazolam.

Choice B is incorrect. While some benzodiazepines can have side effects like drowsiness or dizziness that might indirectly affect blood pressure, alprazolam itself is not known to directly cause an increase in blood pressure.

Choice D is incorrect. Doubling the next dose of medication if a dose is missed is dangerous and can lead to overdose and increased risk of serious side effects. The client should be instructed to contact their doctor if they miss a dose.

Choice C is correct. Alprazolam is a pregnancy category D medication, meaning it has positive evidence of fetal risk. Studies have shown an increased risk of birth defects, including cleft lip and palate, in babies exposed to alprazolam during pregnancy. Therefore, it is crucial for women of childbearing age to use a reliable form of contraception while taking alprazolam to prevent unintended pregnancy and potential harm to the fetus.

Additional teaching points for the nurse:

The nurse should inform the client about the specific risks associated with alprazolam during pregnancy and the importance of discussing alternative treatment options if pregnancy is desired.

The nurse should emphasize the importance of using a reliable form of contraception that is effective both during and after treatment with alprazolam, as the medication can remain in the system for some time after the last dose.

The nurse should provide the client with resources on contraception and reproductive health, and encourage her to talk to her doctor about any s or concerns she may have.