NR-326 Mental Health Nursing - Set 3 - Part 3

Correct Answer: It may persist even after the drug stops

Tardive dyskinesia arrives late and often stays, sometimes permanently, once receptors have been blocked for years. Pseudoparkinsonism instead clears when the dose falls or an anticholinergic is added, which makes early detection everything. Option a is incorrect because early onset describes pseudoparkinsonism, which typically appears in the first weeks. Six years of exposure before the movements began points the nurse toward the late syndrome instead. Option b is incorrect because anticholinergic drugs make these oral movements worse rather than better. Benztropine helps the rigid, tremulous client, so ordering it here would deepen the very problem under assessment. Option c is incorrect because stiffness and slowed movement belong to the parkinsonian syndrome, and this client has normal tone. The described movements are extra and involuntary, not missing and effortful.

Correct Answer: Anticholinergic drugs make these movements worse

Blocking acetylcholine helps dystonia and parkinsonian stiffness, but the same drug intensifies tardive movements. The right steps are a movement scale, provider notification and a discussion about lowering or changing the antipsychotic. Option a is incorrect because rapid relief describes what happens when benztropine breaks an acute dystonic spasm. Late oral movements follow a different mechanism and do not melt away after a single dose. Option c is incorrect because the drug comes in oral and injectable forms, with injection reserved for emergencies such as laryngeal spasm. Route was never the flaw in the graduate nurse's suggestion. Option d is incorrect because too little medication would allow symptoms to return, not create involuntary chewing and tongue movement. Raising the dose here adds receptor blockade and accelerates the damage already underway.

Correct Answer: Sit near the box for about thirty minutes each morning

A ten thousand lux box filtered for ultraviolet light is used for roughly thirty minutes soon after waking, with the eyes open but not fixed on the source. Response appears within a week or two. Option a is incorrect because evening exposure pushes the body clock the wrong way and commonly causes agitation or trouble falling asleep. Morning timing soon after waking is what the prescription specifies. Option b is incorrect because looking straight at the panel invites eyestrain and headache without adding benefit. Clients keep their eyes open and work or read nearby while the light reaches them indirectly. Option d is incorrect because stopping early invites the symptoms to return before the season ends. Daily sessions continue through the darker months, and the nurse also screens for a swing into elevated mood.

Correct Answer: Urinary retention and lethal cardiac toxicity in overdose

Tricyclic blockade of muscarinic receptors worsens outlet obstruction, and sodium channel blockade in the heart makes even a small excess lethal. Both risks land hard on this particular client, so the order deserves review. Option a is incorrect because appetite loss and seizure threshold reduction describe bupropion. Amitriptyline does the reverse on weight through histamine blockade, adding pounds rather than taking them off. Option c is incorrect because low sodium and bruising belong with the serotonin reuptake inhibitors, which impair platelet aggregation. Those problems would argue for avoiding a different class, not the tricyclic in front of the nurse. Option d is incorrect because thyroid and renal decline are long term lithium concerns tracked with periodic blood work. Neither develops from a tricyclic, so neither would justify stopping this prescription.

Correct Answer: Have the client hold the drug and call the provider

Any new rash on lamotrigine is treated as possible Stevens Johnson syndrome, and the drug is stopped at once while the provider evaluates. Rapid titration drives this reaction, so waiting is never safe. Option b is incorrect because an antihistamine treats itching while the reaction underneath keeps advancing. Comfort measures cannot substitute for stopping a drug that can strip mucous membranes and skin. Option c is incorrect because watchful waiting is precisely the error that turns a treatable rash into a medical emergency. Fever alongside the rash makes the situation more worrying, not less. Option d is incorrect because lotion belongs to routine dermatitis care, and this presentation is neither routine nor dermatitis. Advising it also keeps the client at home when review is needed within hours.

Correct Answer: "I will put on headphones and listen to my music."

Engaging attention outside the self reduces the intensity of voices, so music through headphones, humming, or talking with someone are strategies the client can start alone. Isolation and passive waiting do the opposite. Option a is incorrect because withdrawing into a dark empty room removes the external input that competes with the voices. Solitude and low stimulation of this kind usually make hallucinations louder, not quieter. Option b is incorrect because debating with the voices keeps the client locked onto them and raises the anxiety that amplifies them. Telling the voices to stop is brief; arguing for agreement is not. Option c is incorrect because passive waiting gives the client no active tool and leaves him alone with the experience. Coping skills are meant to be used deliberately, not endured until something changes.

Correct Answer: "Once the symptoms fade we can put the pills away."

Symptom relief proves the drug is working, not that it is finished. Stopping when the client feels well is the commonest route back to relapse, and abrupt cessation can bring rebound symptoms. Option a is incorrect because a family alert to fever is doing exactly what the nurse hoped. Temperature elevation with rigidity signals neuroleptic malignant syndrome, and prompt calling saves lives in that emergency. Option c is incorrect because watching for muscle stiffness reflects sound understanding of motor side effects. Reporting rigidity early lets the team treat dystonia or parkinsonism before the client is harmed. Option d is incorrect because keeping laboratory appointments is exactly the commitment these medications demand. Weight, glucose, lipids and, for some agents, blood counts guide every decision about continuing the prescription safely.

Correct Answer: Sit at the edge before standing slowly

Blocking alpha one receptors keeps vessels from tightening when a client stands, so blood pools in the legs. Dangling at the bedside and rising slowly gives circulation the seconds it needs. Option b is incorrect because skipping doses on the client's own judgement destabilises treatment and invites relapse. Postural drops are managed by changing how the client moves, not by rationing the prescription. Option c is incorrect because reduced intake shrinks circulating volume and makes the pressure drop steeper. Adequate fluid supports perfusion, so restricting it moves this client closer to a fall. Option d is incorrect because lying down after the symptom starts is a reaction rather than a safeguard. By then the client may already have fallen, and prevention is what this teaching needs to accomplish.

Correct Answer: Tardive dyskinesia from prolonged exposure

Repetitive involuntary movements of the lips, tongue and jaw appearing after years of dopamine blockade describe tardive dyskinesia. The late onset separates it from every other extrapyramidal syndrome, and the movements may prove permanent. Option a is incorrect because dystonia strikes within hours to days of a first dose or a dose increase, producing a sudden sustained spasm of the neck, jaw or eyes rather than slow rhythmic oral movements. Option b is incorrect because akathisia is a felt state, an inner restlessness that drives pacing and constant motion of the whole body. Nothing about it involves stereotyped movement confined to the mouth. Option d is incorrect because pseudoparkinsonism shows as cogwheel rigidity, resting tremor, shuffling gait and a mask-like face within the first weeks. Benztropine relieves that picture but makes oral dyskinesia worse.

Correct Answer: A shift toward weight gain and hyperglycemia

Second generation agents drive weight gain, insulin resistance and rising lipids, with olanzapine among the worst. Tracking weight, fasting glucose and lipids catches diabetes and heart disease before either becomes established. Option a is incorrect because orthostatic drops do occur, yet they are caught with lying and standing blood pressures at the bedside. No laboratory panel is drawn to detect a postural fall. Option b is incorrect because prolactin trouble shows up as missed periods, breast discharge or sexual difficulty, and the nurse finds it by asking. Risperidone and paliperidone raise it far more than olanzapine. Option c is incorrect because neutrophil surveillance is required for clozapine, not for olanzapine. Weight, glucose and lipid tracking answers a metabolic question, while a blood count answers an infection risk question.