A nurse on a mental health unit observes a diagnosed schizophrenic patient on antipsychotics having an impaired gait and uncontrollable tremors. The nurse should recognize that which of the following adverse effects may be occurring?
Tardive dyskinesia.
Acute dystonia.
Pseudoparkinsonism.
Neuroleptic malignant syndrome.
The Correct Answer is C
The correct answer is choice C. Pseudoparkinsonism.
Choice A rationale:
Tardive dyskinesia is a long-term side effect of antipsychotic medications characterized by repetitive, involuntary movements, often around the mouth, such as lip-smacking, tongue protrusion, and chewing movements. It does not typically present with impaired gait and tremors.
Choice B rationale:
Acute dystonia involves sudden, severe muscle contractions, often affecting the neck, face, and back. Symptoms include twisting movements and abnormal postures, but it does not usually cause impaired gait and tremors.
Choice C rationale:
Pseudoparkinsonism is an adverse effect of antipsychotic medications that mimics the symptoms of Parkinson’s disease, including bradykinesia (slowness of movement), rigidity, tremors, and postural instability. The impaired gait and uncontrollable tremors observed by the nurse are characteristic signs of pseudoparkinsonism.
Choice D rationale:
Neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotic medications. It presents with symptoms such as high fever, muscle rigidity, altered mental status, and autonomic dysfunction (e.g., unstable blood pressure, sweating). It does not typically present with impaired gait and tremors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
The correct answer is Choice A, Choice B, Choice D, Choice E.
Choice A rationale: Offering specific privileges for sustained weight gain acts as positive reinforcement, motivating the client to adhere to the treatment plan. It supports behavior change and helps in gradually restoring a healthy weight, vital in anorexia nervosa management.
Choice B rationale: Monitoring the client's weight daily allows for accurate tracking of progress and ensures timely intervention if weight loss continues. It helps the healthcare team make necessary adjustments to the treatment plan to meet nutritional and therapeutic goals.
Choice C rationale: Allowing the client to choose their meals can lead to poor nutritional choices due to their distorted perception of body image and fear of gaining weight. Structured meal plans are essential to ensure balanced nutrition and recovery in anorexia nervosa.
Choice D rationale: Providing the client with small meals frequently helps in preventing overwhelming feelings during meals and reduces the risk of refeeding syndrome. This approach promotes consistent nutritional intake and supports gradual weight gain.
Choice E rationale: Staying with the client during meals and for 1 hour afterward prevents purging behaviors and provides emotional support. It also ensures the client consumes the prescribed food, facilitating adherence to the nutritional plan and promoting recovery.
Correct Answer is A
Explanation
Choice A rationale:
This statement requires intervention by the charge nurse. The nurse is making a judgmental suggestion to the client about how they should approach their marital issues. The nurse's role is to provide support, empathy, and open-ended questions that allow the client to explore their feelings and thoughts. Making a directive statement like this can be perceived as controlling and dismissive of the client's feelings.
Choice B rationale:
Relationship difficulties being stressful and requiring effort to resolve is an appropriate and empathetic response from the nurse. This acknowledges the client's struggles and offers validation without imposing a particular solution.
Choice C rationale:
Developing a plan for communication is a constructive approach that helps the client address their concerns. This response is within the nurse's scope of practice and promotes problem-solving and effective communication between partners.
Choice D rationale:
Encouraging the client to share more about their concerns regarding their marriage is a therapeutic response. It shows active listening and facilitates the client's exploration of their feelings, which is an essential aspect of the nursing role in a therapeutic relationship.
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