1. A male client with schizophrenia who is taking fluphenazine decanoate (Prolixin
decanoate) is being discharged in the morning. A repeat dose of medication is scheduled
for 20 days after discharge. The client tells the nurse that he is going on vacation in the
Bahamas and will return in 18 ...
1 a male client with schizophrenia who is taking fluphenazine decanoate prolixin decanoate is being discharged in the morning a repeat dose of medication is scheduled for 20 days after discharge
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1. A male client with schizophrenia who is taking fluphenazine decanoate (Prolixin
decanoate) is being discharged in the morning. A repeat dose of medication is scheduled
for 20 days after discharge. The client tells the nurse that he is going on vacation in the
Bahamas and will return in 18 days. Which statement by the client indicates a need for
health teaching?
A) When I return from my tropical island vacation, I will go to the clinic to get my
Prolixin injection.
B) While I am on vacation and when I return, I will not eat or drink anything that
contains alcohol.
C) I will notify the healthcare provider if I have a sore throat or flu-like symptoms.
D) I will continue to take my benztropine mesylate (Cogentin) every day.
Photosensitivity is a side effect of Prolixin and a vacation in the Bahamas (with its
tropical island climate) increases the client's chance of experiencing this side effect. He
should be instructed to avoid direct sun (A) and wear sunscreen. (B, C, and D) indicate
accurate knowledge. Alcohol acts synergistically with Prolixin (B). (C) lists signs of
agranulocytosis, which is also a side effect of Prolixin. In order to avoid extrapyramidal
symptoms (EPS), anticholinergic drugs, such as Cogentin, are often prescribed
prophylactically with Prolixin.
2. A male client is admitted to the mental health unit because he was feeling depressed
about the loss of his wife and job. The client has a history of alcohol dependency and
admits that he was drinking alcohol 12 hours ago. Vital signs are: temperature, 100° F,
pulse 100, and BP 142/100. The nurse plans to give the client lorazepam (Ativan) based
on which priority nursing diagnosis?
A) Risk for injury related to suicidal ideation.
B) Risk for injury related to alcohol detoxification.
C) Knowledge deficit related to ineffective coping.
D) Health seeking behaviors related to personal crisis.
The most important nursing diagnosis is related to alcohol detoxification (B) because the
client has elevated vital signs, a sign of alcohol detoxification. Maintaining client safety
related to (A) should be addressed after giving the client Ativan for elevated vital signs
secondary to alcohol withdrawal. (C and D) can be addressed when immediate needs for
safety are met.
5. A client who is being treated with lithium carbonate for bipolar disorder develops
diarrhea, vomiting, and drowsiness. What action should the nurse take?
A) Notify the healthcare provider immediately and prepare for administration of an
antidote.
B) Notify the healthcare provider of the symptoms prior to the next administration of the
drug.
C) Record the symptoms as normal side effects and continue administration of the
prescribed dosage.
,13. Which diet selection by a client who is depressed and taking the MAO inhibitor
tranylcypromine sulfate (Parnate) indicates to the nurse that the client understands the
dietary restrictions imposed by this medication regimen?
A) Hamburger, French fries, and chocolate milkshake.
B) Liver and onions, broccoli, and decaffeinated coffee.
C) Pepperoni and cheese pizza, tossed salad, and a soft drink.
D) Roast beef, baked potato with butter, and iced tea.
Only (D) contains no tyramine. Tyramine in foods interacts with MAOI in the body
causing a hypertensive crisis which is life-threatening, and Parnate is classified as an
MAOI antidepressant. Some items in (A, B, and C) contain tyramine and would not be
permitted for a client taking Parnate.
18. Based on non-compliance with the medication regimen, an adult client with a medical
diagnosis of substance abuse and schizophrenia was recently switched from oral
fluphenazine HCl (Prolixin) to IM fluphenazine decanoate (Prolixin Decanoate). What is
most important to teach the client and family about this change in medication regimen?
A) Signs and symptoms of extrapyramidal effects (EPS).
B) Information about substance abuse and schizophrenia.
C) The effects of alcohol and drug interaction.
D) The availability of support groups for those with dual diagnoses.
Alcohol enhances the EPS side effects of Prolixin. The half-life of Prolixin PO is 8 hours,
whereas the half-life of the Prolixin Decanoate IM is 2 to 4 weeks. That means the side
effects of drinking alcohol are far more severe when the client drinks alcohol after taking
the long-acting Prolixin Decanoate IM. (A, B, and D) provide valuable information and
should be included in the client/family teaching, but they do not have the priority of (C).
50. A client who is known to abuse drugs is admitted to the psychiatric unit. Which
medication should the nurse anticipate administering to a client who is exhibiting
benzodiazepine withdrawal symptoms?
A) Perphenazine (Trilafon).
B) Diphenhydramine (Benadryl).
C) Chlordiazepoxide (Librium).
D) Isocarboxazid (Marplan).
Librium (C), an antianxiety drug, as well as other benzodiazepines, are used in titrated
doses to reduce the severity of abrupt benzodiazepine withdrawal. (A) is an antipsychotic
agent. (B) is an antihistamine and antianxiety drug. (D) is an MAO inhibitor.
Correct Answer(s): C
56. When preparing a teaching plan for a client who is to be discharged with a
prescription for lithium carbonate (Lithonate), it is most important for the nurse to
include which instruction?
A) It may take 3 to 4 weeks to achieve therapeutic effects.
, 59. The nurse is preparing to administer phenelzine sulfate (Nardil) to a client on the
psychiatric unit. Which complaint related to administration of this drug should the nurse
expect this client to make?
A) My mouth feels like cotton.
B) That stuff gives me indigestion.
C) This pill gives me diarrhea.
D) My urine looks pink.
A dry mouth (A) is an anticholinergic effect that is an expected side effect of MAO
inhibitors such as phenelzine sulfate (Nardil). (B, C, and D) are not expected side effects
of this medication.
Correct Answer(s): A
61. A 46-year-old female client has been on antipsychotic neuroleptics for the past three
days. She has had a decrease in psychotic behavior and appears to be responding well to
the medication. On the fourth day, the client's blood pressure increases, she becomes pale
and febrile, and demonstrates muscular rigidity. Which action should the nurse initiate?
A) Place the client on seizure precautions and monitor carefully.
B) Immediately transfer the client to ICU.
C) Describe the symptoms to the charge nurse and record on the client's chart.
D) No action is required at this time as these are known side effects of such drugs.
These symptoms are descriptive of neuroleptic malignant syndrome (NMS) which is an
extremely serious/life threatening reaction to neuroleptic drugs (B). The major symptoms
of this syndrome are fever, rigidity, autonomic instability, and encephalopathy.
Respiratory failure, cardiovascular collapse, arrhythmias, and/or renal failure can result in
death. This is an EMERGENCY situation, and the client requires immediate critical care.
Seizure precautions (A) are not indicated in this situation. (C and D) do not consider the
seriousness of the situation.
63. The nurse should hold the next scheduled dose of a client's haloperidol (Haldol) based
on which assessment finding(s)?
A) Dizziness when standing.
B) Shuffling gait and hand tremors.
C) Urinary retention.
D) Fever of 102° F.
A fever (D) may indicate neuroleptic malignant syndrome (NMS), a potentially fatal
complication of antipsychotics. The healthcare provider should be contacted before
administering the next dose of Haldol. (A, B, and C) are all adverse effects of Haldol
which can be managed.
*A client who has been taking the prescribed dose of zolpidem (Ambien) for 5 days
returns to the clinic for a follow-up visit. When interviewing the client, the nurse
identifies that the medication has been effective when the client says:
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