A client received maintenance doses of trifluoperazine ...

[dmcintosh]

A client received maintenance doses of trifluoperazine (Stelazine) 30 mg po daily for 1.5 years. The
  clinic nurse notes the client is grimacing and seems to be constantly smacking her lips.
 
  Her neck and
  shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of
  a. agranulocytosis.
  b. tardive dyskinesia.
  c. Tourette's syndrome.
  d. anticholinergic effects.

Question 2

The nurse caring for a 72-year-old client admitted for treatment of depression notes that the
  physician's order to begin therapy with an antidepressant calls for a dose greater than the usual adult
  dose. The nurse should
 
  a. consult a drug reference.
  b. implement the order.
  c. give the usual adult dose.
  d. hold the medication and consult the physician.

[lauravaras]

Answer to Question 1

B
Tardive dyskinesia is a neuroleptic-induced condition involving the face, trunk, and limbs.
Involuntary movements such as tongue thrusting; licking; blowing; irregular movements of the arms,
neck, and shoulders; rocking; hip jerks; and pelvic thrusts are seen. These symptoms are frequently
not reversible even when the drug is discontinued. The scenario does not present evidence consistent
with the other disorders mentioned. Option A: Agranulocytosis is a blood disorder. Option C:
Tourette's syndrome is a condition in which tics are present. Option D: Anticholinergic effects
include dry mouth, blurred vision, flushing, constipation, and dry eyes.

Answer to Question 2

ANS: D
The dose of antidepressants for elderly clients is often less than the usual adult dose. The nurse
should withhold the medication and consult the physician who wrote the order. The nurse's duty is
to intervene and protect the client. Option A is unnecessary because the nurse already knows the
dose is excessive. Option B is negligent. Option C: A nurse without prescriptive privileges cannot
change the dose.