Author Question: A patient with schizophrenia is acutely disturbed and violent. After several doses of haloperidol ... (Read 33 times)

DelorasTo · **on:** Jul 19, 2018

A patient with schizophrenia is acutely disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position;

the lower jaw is thrust forward, and the patient is drooling. Which problem is most likely?

a. Acute dystonic reaction
b. Tardive dyskinesia
c. Waxy flexibility
d. Akathisia

Question 2

A newly admitted patient with schizophrenia says, The voices are bothering me. They yell and tell me I'm bad. I have got to get away from them. Select the nurse's most helpful reply.

a. Do you hear the voices often?
b. Do you have a plan for getting away from the voices?
c. I'll stay with you. Focus on what we are talking about, not the voices.
d. Forget the voices, and ask some other patients to play cards with you.

connor417 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: A
Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back; opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies that require immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis; it appears after prolonged treatment. Waxy flexibility is a symptom observed in catatonic schizophrenia. Akathisia is evidenced by internal and external restlessness, pacing, and fidgeting.

Answer to Question 2

ANS: C
Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to get away from the voices is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients.