An aging client diagnosed with schizophrenia disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate?
"Make sure you concentrate on taking slow, deep, cleansing breaths."
"Wear sunscreen and try to avoid midday sun exposure."
"Watch your diet and try to engage in some regular physical activity."
"Rise slowly when you change position from lying to sitting or sitting to standing."
The Correct Answer is D
a. While taking slow, deep breaths can help with relaxation and possibly with managing anxiety or panic attacks, it is not directly addressing the combined side effects of these medications.
b. Wearing sunscreen and avoiding midday sun exposure is important to prevent photosensitivity reactions caused by some antipsychotics, but it is not related to the combined effects of antipsychotics and beta-blockers.
c. Watching diet and engaging in physical activity are generally good health practices but do not specifically address the combined side effects of these medications.
d. "Rise slowly when you change position from lying to sitting or sitting to standing." Both antipsychotics and beta-adrenergic blocking agents can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions. This can lead to dizziness, lightheadedness, or even fainting. Advising the client to rise slowly helps to prevent these effects and ensures the client’s safety
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a. "I can make that promise to you based on nurse-client privilege." Nurse-client confidentiality is important, but it doesn't apply to threats of violence. The nurse has a duty to protect the client and others.
b. "Those kinds of thoughts will make your hospitalization longer." While true, this response doesn't directly address the safety concern and might be perceived as judgmental.
c. "I cannot promise that. Confidentiality does not include plans to hurt others." This is a clear and honest statement. It explains the limitations of confidentiality and prioritizes safety.
d. "You should share this thought with your psychiatrist." While encouraging the client to talk to a psychiatrist is a good suggestion, it doesn't directly address the confidentiality issue or the immediate threat.
Correct Answer is B
Explanation
a. "You need to understand there are no voices": Denying the client's experience can be invalidating and unhelpful.
b. What are the voices telling you to do? (Correct)A key principle in responding to someone experiencing auditory hallucinations is to validate their experience and ask open-ended questions. This helps the client feel heard and allows the nurse to assess the severity of the situation and potential safety risks.
c. What do you think is causing you to hear the voices? While exploring the cause of hallucinations can be part of therapy, in the immediate situation, focusing on what the voices are saying and assessing safety is more important.
d. "You need to tell the forces to leave you alone": This is confrontational and doesn't acknowledge the client's fear. It might also reinforce the belief in the voices having power.
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