The client who is recovering from schizophrenia has just seen the ...

[Sportsfan2111]

The client who is recovering from schizophrenia has just seen the psychiatrist and tells the nurse that the Olanzapine (Zyprexa) is being reduced from 20 mg to 15 mg.
 
  This client asks the nurse why the Olanzapine is just not discontinued since the client has not had a hallucination for two months. Which nursing response to the client is correct? 1. I will check your serum level to see if it was too high and the reason for the reduction.
  2. This medication is gradually reduced and continued to prevent a relapse.
  3. I think that you should call your psychiatrist and ask to discontinue the Olanzapine.
  4. The 20 mg of Olanzapine is above the recommended dose and was reduced due to the risk of toxicity.

Question 2

A client with a history of physical and sexual abuse by her husband is admitted to the hospital for treatment of vaginal lacerations. While hospitalized, the client expresses concerns to the nurse about her safety when she returns home.
 
  The first priority for the nurse is to: 1. Offer to contact outpatient services if the client promises that she will not return home after her discharge.
  2. Encourage the client to take charge of her situation.
  3. Make it clear to the client that her husband needs to see a therapist.
  4. Assist the client to devise a safety or escape plan.

[Kdiggy]

Answer to Question 1

2
Rationale: Antipsychotic medications are gradually reduced after maximum clinical improvement has been obtained. The dosage range of Olanzapine is between 520 mg. Serum levels for antipsychotic medications are not routinely checked. It would be premature to discontinue the medication for at least three to six months following an acute episode.

Answer to Question 2

4
Rationale: A victim of abuse by a partner should have a safety plan. This is the highest priority because the client's physical and/or mental health is in danger. The nurse should not assume that the client will be able to control her partner, and suggesting that the client tell the abusive partner to see a therapist could escalate the abuse. Encouraging a client to take charge is a very general suggestion. The client needs specific tools to develop a safety plan. It may not be safe or feasible for the client to leave home right away, and resources should not be withheld if a client is unable to promise to leave home.