D449 Psychology and Mental Health - Set 2 - Part 3

Correct Answer: Checking orthostatic blood pressure readings

Option b is correct because first-generation antipsychotics like chlorpromazine commonly cause orthostatic hypotension that can lead to falls and injury, making blood pressure monitoring with position changes a high priority immediately after administration. Option a is incorrect because involuntary facial movements associated with tardive dyskinesia develop after prolonged antipsychotic use over weeks to months, not within thirty minutes of the first dose, making this assessment premature at this timepoint. Option c is incorrect because fasting blood glucose monitoring is primarily associated with second-generation antipsychotics and their metabolic syndrome risk, and it is not the most immediate concern thirty minutes after administering a first-generation medication. Option d is incorrect because weekly body weight changes are a longer-term monitoring parameter more associated with second-generation antipsychotics, and cannot be meaningfully assessed thirty minutes after the first d

Correct Answer: Implementing seizure precautions at bedside

Option a is correct because first-generation antipsychotics like thioridazine carry an increased risk of seizures, and patients with preexisting seizure disorders require standing seizure precautions to ensure rapid intervention if a seizure occurs. Option b is incorrect because restricting oral fluid intake is not related to seizure prevention with antipsychotic medications and could actually be harmful by contributing to dehydration, which may worsen medication side effects and overall patient well-being. Option c is incorrect because continuous bilateral wrist restraints are not appropriate standing seizure precautions and would violate patient rights, as restraints require specific criteria for use and are reserved for situations of immediate danger to self or others. Option d is incorrect because prophylactic benztropine addresses extrapyramidal symptoms rather than seizure risk, and administering it without evidence of movement disorders exposes the patient to unnecessary anticho

Correct Answer: Life-threatening blood cell count drops can occur

Option d is correct because clozapine carries a unique risk of agranulocytosis, a potentially fatal decrease in white blood cells that impairs the immune system, requiring mandatory regular blood count monitoring throughout the entire course of treatment. Option a is incorrect because rapid hepatic enzyme elevation is not the primary reason for mandatory clozapine blood monitoring; the critical concern is agranulocytosis, which specifically affects white blood cell production and can lead to fatal immunosuppression. Option b is incorrect because clozapine monitoring focuses on white blood cell counts for agranulocytosis risk rather than maintaining narrow serum drug levels, which is a monitoring concern more associated with medications like lithium for bipolar disorder. Option c is incorrect because predictable renal function decline is associated with lithium therapy requiring BUN and creatinine monitoring, whereas clozapine's mandatory blood monitoring specifically targets the d

Correct Answer: Teaching slow position changes when rising

Option c is correct because orthostatic hypotension is a common side effect of antipsychotic medications including risperidone, and teaching patients to change positions slowly helps prevent dangerous blood pressure drops that can cause dizziness and falls. Option a is incorrect because discontinuing an antipsychotic medication without prescriber approval is outside the nurse's scope of practice and could lead to dangerous symptom rebound, while orthostatic hypotension can be safely managed through positional change education. Option b is incorrect because intravenous fluid bolus is an acute intervention for significant hemodynamic instability, not the appropriate response to expected medication-related orthostatic hypotension that can be managed with slower position changes during daily activities. Option d is incorrect because restricting a patient to complete bed rest eliminates functional independence and creates additional risks such as blood clots and muscle deconditioning,

Correct Answer: Drug-induced parkinsonism signs

Option b is correct because shuffling gait, masklike facial expression, and resting tremor are hallmark features of drug-induced parkinsonism, an extrapyramidal side effect that mimics Parkinson's disease symptoms caused by dopamine blockade from antipsychotics. Option a is incorrect because anticholinergic toxicity presents with dry mouth, urinary retention, constipation, and blurred vision rather than the movement-related symptoms of shuffling gait, masklike face, and resting tremor described in this assessment. Option c is incorrect because tardive dyskinesia manifests as involuntary rhythmic movements of the tongue, lips, and jaw rather than the parkinsonian triad of shuffling gait, masklike facial expression, and resting tremor observed in this patient. Option d is incorrect because neuroleptic malignant syndrome presents with severe muscle rigidity, high fever, altered consciousness, and autonomic instability, which is a more acute and life-threatening presentation than the

Correct Answer: Monitor closely for new suicidal statements

Option a is correct because SSRIs increase the risk of suicidal thoughts and behaviors in adolescents, especially during the first few weeks, and families must be educated to closely monitor for any new expressions of self-harm or suicidal ideation. Option b is incorrect because telling families to expect immediate daily mood improvement is inaccurate and sets unrealistic expectations, since SSRIs require two or more weeks to reach therapeutic effectiveness and improvement occurs gradually over time. Option c is incorrect because restricting physical activity is counterproductive for treating adolescent depression, as exercise is an evidence-based intervention that naturally improves mood and should be encouraged alongside medication therapy for optimal outcomes. Option d is incorrect because appetite changes can be a normal side effect of SSRI medications and do not warrant immediate discontinuation, as abruptly stopping an antidepressant without prescriber guidance can cause withdraw

Correct Answer: Validate concern while explaining relapse risk

Option d is correct because validating the patient's weight concern builds therapeutic rapport while educating about the risk of symptom return when antipsychotics are discontinued, as patients off medications can revert to their pre-medication symptomatic state. Option a is incorrect because agreeing that weight gain justifies stopping medication without prescriber involvement ignores the serious risk of psychotic symptom relapse, and medication changes should always be discussed with the treatment team before implementation. Option b is incorrect because dismissing the patient's weight gain concern damages the therapeutic relationship and ignores a legitimate quality-of-life issue that, if unaddressed, will likely continue driving medication noncompliance and subsequent symptom recurrence. Option c is incorrect because lecturing about noncompliance is a non-therapeutic communication approach that creates defensiveness, damages rapport, and fails to address the underlying co

Correct Answer: Continue taking it to manage movement symptoms

Option c is correct because benztropine must be taken consistently as prescribed to maintain the dopamine-acetylcholine balance in the brain and effectively manage the extrapyramidal movement symptoms caused by haloperidol's dopamine-blocking action. Option a is incorrect because benztropine is not indicated for chest pain, which requires immediate medical evaluation for cardiac causes, and taking benztropine for chest pain could delay life-saving treatment while failing to address movement symptom management. Option b is incorrect because benztropine does not replace haloperidol; these medications serve complementary purposes where haloperidol treats psychotic symptoms and benztropine manages the movement side effects that haloperidol can cause during treatment. Option d is incorrect because mixing any medication with alcohol is dangerous and contraindicated, and benztropine should be taken as prescribed with water, as alcohol can potentiate sedation and increase the risk of seri

Correct Answer: Avoid St. John's Wort due to interaction risk

Option b is correct because St. John's Wort is a serotonin-enhancing herbal supplement that when combined with SSRIs like paroxetine significantly increases the risk of developing life-threatening serotonin syndrome through excessive serotonergic activity. Option a is incorrect because not all vitamin supplements are completely safe when taken with SSRIs, and making this blanket statement could lead the patient to unknowingly take serotonin-enhancing supplements that dangerously interact with their prescribed antidepressant. Option c is incorrect because calcium supplements do not enhance SSRI medication effects, and providing this inaccurate information fails to address the critical safety teaching about avoiding serotonin-enhancing supplements that can cause dangerous drug interactions. Option d is incorrect because some herbal teas and supplements can significantly impact medications through pharmacological interactions, and stating they have no impact provides false reassuranc

Correct Answer: Emphasize diet and glucose monitoring importance

Option a is correct because olanzapine carries significant metabolic syndrome risks including hyperglycemia and weight gain, and patients with family histories of diabetes need comprehensive education on healthy dietary habits and regular glucose monitoring. Option b is incorrect because recommending immediate discontinuation of a newly prescribed antipsychotic without clinical justification would leave psychotic symptoms untreated, and metabolic risks can be managed through monitoring and lifestyle modifications while continuing treatment. Option c is incorrect because focusing solely on psychotic symptom management while ignoring metabolic concerns is dangerous for a patient with diabetes risk factors, as unmonitored hyperglycemia and weight gain can lead to serious long-term health complications. Option d is incorrect because suggesting a patient ignore metabolic concerns while taking a medication known to cause hyperglycemia and weight gain is negligent, especially given this patie