Forty-eight hours after starting haloperidol, the client is observed standing by the nurse’s station with his neck arched sharply backward. The nurse recognizes that the client:
Is having pseudo-Parkinsonian side effects and needs to have his medication adjusted.
Is experiencing temporary side effects that usually disappear after several days.
Needs to have the dosage increased because of psychotic behavior that is increasing.
Needs immediate treatment and is experiencing an acute dystonic reaction to the drug.
The Correct Answer is D
Choice A Reason:
Pseudo-Parkinsonian side effects, also known as drug-induced parkinsonism, can occur with the use of antipsychotic medications like haloperidol. These side effects include symptoms such as rigidity, bradykinesia, tremor, and postural instability. However, the description of the client’s neck arched sharply backward is more indicative of an acute dystonic reaction rather than pseudo-Parkinsonian side effects. Pseudo-Parkinsonian symptoms typically develop more gradually and do not present with such dramatic posturing.
Choice B Reason:
While some side effects of haloperidol can be temporary and may disappear after several days, the acute dystonic reaction described in the scenario requires immediate intervention. Acute dystonic reactions are characterized by sudden, severe muscle contractions that can be painful and potentially dangerous if they involve the airway. Therefore, it is crucial to address this reaction promptly rather than waiting for it to resolve on its own.
Choice C Reason:
Increasing the dosage of haloperidol in response to the described symptoms would likely exacerbate the situation. The client’s symptoms are not indicative of worsening psychotic behavior but rather an adverse reaction to the medication. Increasing the dosage could lead to more severe side effects and complications. The appropriate response is to treat the acute dystonic reaction and reassess the medication regimen.
Choice D Reason:
An acute dystonic reaction is a known side effect of antipsychotic medications like haloperidol. It involves sudden, severe muscle contractions, often affecting the neck, face, and back. This reaction can be distressing and requires immediate treatment with anticholinergic medications such as benztropine or diphenhydramine. Prompt intervention can relieve the symptoms and prevent further complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Clozapine is known to cause agranulocytosis, a potentially life-threatening condition where the white blood cell count drops significantly, leading to a higher risk of infection. Patients on clozapine must have regular blood tests to monitor their white blood cell count. Any signs of infection, such as fever, sore throat, or flu-like symptoms, should be reported to a physician immediately as they could indicate agranulocytosis.
Choice B Reason:
A decrease in hallucinations is generally a positive sign indicating that the medication is working effectively. It is not a reason to call the physician immediately. Instead, this should be discussed during regular follow-up appointments to assess the overall effectiveness of the treatment.
Choice C Reason:
While a decrease in appetite can be a side effect of clozapine, it is not typically an emergency unless it leads to significant weight loss or malnutrition. This should be monitored and discussed with the physician during regular visits. If the decrease in appetite is severe or persistent, it may warrant a call to the physician, but it is not as urgent as signs of infection.
Choice D Reason:
Insomnia can occur with clozapine use, but it is usually managed with adjustments to the medication regimen or additional treatments for sleep. While it is important to address insomnia, it does not require immediate medical attention unless it severely impacts the patient’s well-being.
Correct Answer is B
Explanation
Choice A Reason:
Clonazepam is to be used for long-term therapy in conjunction with buspirone.
This statement is incorrect. Clonazepam, a benzodiazepine, is typically used for short-term relief of anxiety symptoms due to its potential for dependence and tolerance1. Long-term use of benzodiazepines is generally avoided in favor of medications like buspirone, which do not carry the same risks of dependence.
Choice B Reason:
Clonazepam is to be used short-term until the buspirone takes full effect.
This is the correct response. Buspirone takes several weeks to achieve its full therapeutic effect. During this period, clonazepam may be used to manage acute anxiety symptoms. Once buspirone reaches its full effect, clonazepam can be tapered off to avoid long-term use and potential dependence.
Choice C Reason:
Buspirone should be taken as needed until clonazepam takes full effect.
This statement is incorrect. Buspirone is not intended for as-needed use; it must be taken consistently to maintain stable blood levels and achieve its therapeutic effect. Clonazepam, on the other hand, is used for short-term relief and should not be relied upon for long-term management of anxiety.
Choice D Reason:
Tolerance could result with long-term use of buspirone.
This statement is incorrect. Unlike benzodiazepines, buspirone does not typically cause tolerance or dependence with long-term use. It is considered a safer option for chronic management of anxiety disorders.
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