Nursing Elites

1. The RN is preparing to administer a prescribed dose of haloperidol (Haldol) to a client with schizophrenia. The client begins to exhibit muscle rigidity, fever, and altered mental status. What action should the RN take first?

• A. Administer the haloperidol as prescribed.
• B. Monitor the client's vital signs closely.
• C. Hold the medication and notify the healthcare provider.
• D. Give the client an antipyretic for the fever.

Correct answer: C

Rationale: Muscle rigidity, fever, and altered mental status are symptoms of neuroleptic malignant syndrome (NMS), a potentially life-threatening reaction to antipsychotic medications. The RN should hold the medication and notify the healthcare provider immediately. Option A is incorrect because administering more of the medication can worsen the symptoms. Option B is not the first priority when the client is experiencing symptoms of NMS. Option D is incorrect as addressing the fever alone does not address the underlying issue of NMS caused by haloperidol.

2. An elderly client was prescribed Ativan 1 mg three times a day to help calm her anxiety after her husband's death. The next day the client calls her daughter asking when she is picking her up to go to the graveside. The client says she has been walking up and down the driveway for the past hour waiting for her daughter. Noting the client's agitation, hyperactivity, and insistence, the daughter calls the nurse to report her mother's behavior. What should the nurse suspect?

• A. The client is manic and may need a sleeping pill
• B. The client is experiencing a medication interaction and should go to the ED
• C. The client is experiencing a paradoxical reaction to the Ativan and should stop the new medication immediately
• D. The client is overcome by grief and probably needs an antidepressant

Correct answer: C

Rationale: A paradoxical reaction to Ativan, where the drug causes opposite effects such as increased agitation and hyperactivity, should prompt immediate cessation of the medication. In this scenario, the client was prescribed Ativan to help calm her anxiety, but instead, she is displaying symptoms of increased agitation and hyperactivity, indicating a paradoxical reaction. Choice A is incorrect because the symptoms described do not align with mania. Choice B is incorrect as there is no mention of a medication interaction. Choice D is incorrect as the symptoms are more indicative of a paradoxical reaction rather than overwhelming grief.

3. A female client in an acute care facility has been on antipsychotic medications for the past three days. Her psychotic behaviors have decreased and she has had no adverse reactions. On the fourth day, the client's blood pressure increases, she becomes pale and febrile, and demonstrates muscular rigidity. What action should the nurse initiate?

• A. Place the client on seizure precautions and monitor her frequently.
• B. Take the client's vital signs and notify the physician immediately.
• C. Describe the symptoms to the charge nurse and document them in the client's record.
• D. No action is required at this time as these are known side effects of her medications.

Correct answer: B

Rationale: The correct action for the nurse to initiate is to take the client's vital signs and notify the physician immediately. These symptoms may indicate neuroleptic malignant syndrome, a rare but life-threatening reaction to antipsychotic medications, requiring immediate medical attention. Placing the client on seizure precautions and monitoring her frequently (Choice A) is not the most appropriate action in this situation. Describing the symptoms to the charge nurse and documenting them in the client's record (Choice C) delays prompt medical intervention. Choosing not to take any action (Choice D) is dangerous as the symptoms described suggest a serious condition that needs urgent evaluation and treatment.

4. 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.

5. The nurse observes a client who is admitted to the mental health unit and identifies that the client is talking continuously, using words that rhyme but that have no context or relationship with one topic to the next in the conversation. This client's behavior and thought processes are consistent with which syndrome?

• A. Dementia
• B. Depression
• C. Schizophrenia
• D. Chronic brain syndrome

Correct answer: C

Rationale: The client is demonstrating symptoms of schizophrenia, such as disorganized speech that may include word salad (a type of communication that mixes real and imaginary words in no logical order), incoherent speech, and clanging (rhyming). Dementia (Choice A) is characterized by memory loss and cognitive decline, not by disorganized speech. Depression (Choice B) typically presents with persistent feelings of sadness and loss of interest, not disorganized speech. Chronic brain syndrome (Choice D) is a vague term and does not specifically describe the symptoms mentioned in the scenario.

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