MENTAL DISORDERS QUESTIONS WITH RATIONAL ANSWERS

A physician starts a client on the Antipsychotic medication haloperidol (Haldol). The nurse is aware that this medication has extrapyramidal adverse effects. Which measures should the nurse take during haloperidol administration? Select all that apply. 1. Review subcutaneous injection technique. 2. Closely monitor vital signs, especially temperature. 3. Provide the client with the opportunity to pace. 4. Monitor blood glucose levels. 5. Provide the client with hard candy. 6. Monitor for signs and symptoms of urticaria. Answer: 2, 3, 5. Neuroleptic malignant syndrome is a life-threatening extrapyramidal adverse effect of antipsychotic medications such as haloperidol. It’s associated with a rapid increase in temperature. The most common extrapyramidal adverse effect, akathisia, is a form of psychomotor restlessness that can usually be relieved by pacing. Haloperidol and the anticholinergic medications that are provided to alleviate its extrapyramidal effects can result in dry mouth. Providing the client with hard candy to suck on can help alleviate this problem. Haloperidol isn’t given subcutaneously and doesn’t affect blood glucose levels. Urticaria isn’t usually associated with haloperidol administration. A male client approaches the nurse and says “Hey cutie, can you take me outside for a smoke?” The nurse is aware that the client isn’t supposed to go out to smoke for another 15 minutes. Which response by the nurse is most therapeutic? 1. “Sure, I’m not busy right now.” 2. “You can ask the technician. I’m busy right now.” 3. “You’ll be able to smoke in 15 minutes. Calling me cutie is disrespectful.” 4. “You know the rules. It isn’t time yet for you to go out to smoke.” Answer: 3. The client’s behavior indicates that he has difficulty adhering to limits and respecting boundaries. The nurse must place limits on the client’s manipulative behavior. Taking the client outside to smoke is inappropriate because the nurse is allowing the client to manipulate her. Referring the client to the technician is incorrect because the nurse isn’t addressing the client’s manipulative behavior. Offering an abrupt response, such as “You know the rules,” may cause the client to act defensively. A client tells the nurse that he never disagrees with anyone and that he has loved everyone he’s ever known. What would be the nurse’s best response to this client? 1. “How do you manage to do that?” 2. “That’s hard to believe. Most people couldn’t do that.” 3. “What do you do with your feelings of dissatisfaction or anger?” 4. “How did you come to adopt such a way of life?” Answer: 4 . Inquiring about the client’s way of life allows for further exploration of the message he’s trying to convey. Asking him how he’s managed to do that has too narrow a focus and doesn’t permit maximal exploration of the client’s experience. Expressing disbelief is incorrect because the client could misinterpret it as a challenge and become even more defensive. Asking about feelings of dissatisfaction or anger is incorrect because the nurse shouldn’t identify the client’s feelings for him. A nurse is working with a client who has just stimulated her anger by using a condescending tone of voice. Which response by the nurse is most therapeutic? 1. “I feel angry when I hear that tone of voice.” 2. “You make me so angry when you talk to me that way.” 3. “Are you trying to make me angry?” 4. “Why do you use that condescending tone of voice with me?” Answer: 1. This response allows the nurse to provide feedback without making the client responsible for the nurse’s reaction. Stating that the client makes you angry is accusatory and blocks communication. “Are you trying to make me angry” is a challenging remark that can lead to power struggles, lowers the client’s self-esteem, and blocks opportunities for open communication. Avoid “why” questions such as “Why do you use that condescending tone of voice with me” because these questions put the client on the defensive. A client on the unit tells the nurse that his wife’s nagging really gets on his nerves. He asks the nurse if she’ll talk with his wife about her nagging during their family session tomorrow afternoon. Which response is the most therapeutic? 1. “Tell me more specifically about her complaints” 2. “Can you think why she might nag you so much?” 3. “I’ll help you think about how to bring this up yourself tomorrow.” 4. “Why do you want me to initiate this discussion in tomorrow’s session rather than you?” Answer: 3. The client needs to learn how to communicate directly with his wife about her behavior. The nurse’s assistance will enable him to practice a new skill and will communicate the nurse’s confidence in his ability to confront this situation directly. Asking about the wife’s specific complaints or reasons for nagging inappropriately directs attention