A patient with schizophrenia who has received chlorpromazine ...

[Mr.Thesaxman]

A patient with schizophrenia who has received chlorpromazine (Thorazine) 200 mg PO four times daily for 4 weeks has symptoms of a shuffling, propulsive gait, a masklike face, and drooling.
 
  Which nursing response would be most appropriate? Select all that apply. a. Advise the patient to be patient, since these side effects are only temporary.
  b. Seek a physician order for a PRN IM antiparkinsonian medication.
  c. Suggest carrying a towel to catch any drool, and initiate fall precautions.
  d. Administer PRN trihexyphenidyl (Artane) PO to suppress the side effects.
  e. Suggest administering half the medicine in the morning and half at bedtime.
  f. Encourage the patient to be more physically active and facially expressive.

Question 2

The client, an 80-year-old widow, complains of being unable to sleep through the night. The caregiver explains that
 
  1. this is a normal change of aging.
  2. this is an abnormal change of aging.
  3. she should get out of bed when she cannot sleep.
  4. she should take a sleeping pill 30 minutes before retiring.

[Kedrick2014]

Answer to Question 1

B, C
Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson's disease. It is not a side effect that one tends to adjust to; it tends to persist and can become marked. Appropriate responses include adjunctive antiparkinsonian medications such as benztropine (Cogentin), which should be given IM because of impaired swallowing ability (as evidenced by the patient's drooling). Addressing elements individually, as in instituting fall precautions owing to the impaired gait and suggesting wearing a towel so that the patient can frequently wipe accumulating drool and avert soiling his clothing, are also helpful. Administering PRN trihexyphenidyl (Artane) PO would be acceptable only if the patient did not exhibit impaired swallowing. Altering when or how the medication is administered would be helpful for issues such as sedation but not pseudoparkinsonism. Changes in motor activity seen in pseudoparkinsonism cannot be countered by increasing physical activity or trying to be more facially expressive.

Answer to Question 2

1
Changes in eating and sleeping patterns take place as one ages.