Nursing Elites

1. An outpatient clinic that has been receiving haloperidol (Haldol) for 2 days develops muscular rigidity, altered consciousness, a temperature of 103, and trouble breathing on day 3. The LPN/LVN interprets these findings as indicating which of the following?

• A. Neuroleptic Malignant Syndrome
• B. Tardive dyskinesia
• C. Extrapyramidal adverse effects
• D. Drug-induced parkinsonism

Correct answer: A

Rationale: Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition characterized by hyperthermia, muscle rigidity, altered consciousness, and autonomic dysregulation. It is a rare but serious side effect of antipsychotic medications like haloperidol (Haldol). NMS requires immediate intervention, including discontinuation of the offending medication and supportive care. Tardive dyskinesia (Choice B) is a different condition characterized by involuntary movements of the face and extremities that can occur with long-term antipsychotic use. Extrapyramidal adverse effects (Choice C) encompass a range of movement disorders like dystonia, akathisia, and parkinsonism that can result from antipsychotic medications, but they do not present with hyperthermia and altered consciousness as in NMS. Drug-induced parkinsonism (Choice D) is a form of parkinsonism caused by certain medications, but it typically presents with symptoms similar to Parkinson's disease, such as tremor, bradykinesia, and rigidity, without the severe hyperthermia and autonomic dysregulation seen in NMS.

2. A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone (Risperdal). When the client walks to the nurse's station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?

• A. Medicate the client with the prescribed antipsychotic thioridazine (Mellaril).
• B. Offer the client a prescribed physical therapy hot pack for muscle spasms.
• C. Direct the client to occupational therapy to distract him from somatic complaints.
• D. Administer the prescribed anticholinergic benztropine (Cogentin) for dystonia.

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to administer the prescribed anticholinergic benztropine (Cogentin) for dystonia. Dystonia can be a side effect of antipsychotic medications like risperidone, leading to involuntary muscle contractions and abnormal postures. Benztropine is an anticholinergic medication commonly used to treat dystonia. Choices A, B, and C are incorrect because thioridazine is not the appropriate medication in this case, a hot pack would not address the underlying issue of dystonia, and occupational therapy is not the primary intervention for addressing acute dystonic reactions.

3. A client who has just been sexually assaulted is calm and quiet. The nurse analyzes this behavior as indicating which defense mechanism?

• A. Denial
• B. Projection
• C. Rationalization
• D. Intellectualization

Correct answer: A

Rationale: The correct answer is A: Denial. In this situation, the client's calm and quiet demeanor after a traumatic event like sexual assault may indicate denial, a defense mechanism where the individual refuses to acknowledge the reality of the distressing event. Choice B, Projection, involves attributing one's thoughts or feelings to others. Choice C, Rationalization, is a defense mechanism where logical reasoning is used to justify behaviors or feelings. Choice D, Intellectualization, is a defense mechanism where excessive reasoning or logic is used to avoid uncomfortable emotions.

4. At the first meeting of a group of older adults at a daycare center for the elderly, the LPN/LVN asks one of the members what kinds of things she would like to do with the group. The older woman shrugs her shoulders and says, 'You tell me, you're the leader.' What is the best response for the nurse to make?

• A. Yes, I am the leader today. Would you like to be the leader tomorrow?
• B. Yes, I will be leading this group. What would you like to accomplish during this time?
• C. Yes, I have been assigned to be the leader of this group. I will be here for the next six weeks.
• D. Yes, I am the leader. You seem angry about not being the leader yourself.

Correct answer: B

Rationale: The best response for the nurse is choice B: 'Yes, I will be leading this group. What would you like to accomplish during this time?' This response acknowledges the member's comment and encourages her to share her interests, promoting engagement and active participation in group activities. Choice A is not as inclusive and may not foster collaboration within the group. Choice C focuses more on the nurse's assignment rather than addressing the member's input. Choice D assumes emotions that were not expressed by the group member and does not encourage open communication.

5. A male employee who is assessed weekly in the employee clinic for blood pressure because of a history of hypertension tells the nurse that he is so upset with one of his co-workers that he would like to shoot him. What action should the nurse take first?

• A. Determine if the client has a weapon available for use.
• B. Inform the health care provider of the threat to harm a co-worker.
• C. Notify security of the client's intention to harm a co-worker.
• D. Have the employee escorted to a mental health facility.

Correct answer: A

Rationale: Determining if the client has access to a weapon is critical for immediate safety and to prevent potential harm.

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