The nurse is told that the client most likely has the diagnosis ...

[jasdeep_brar]

The nurse is told that the client most likely has the diagnosis of obsessive-compulsive disorder. The nurse is not sure of the assessment data and behaviors that accompany this disorder.
 
  Which action would be most appropriate for the nurse to take? 1. Document all subjective and objective data provided by the client.
  2. Ask the primary health provider to identify needed subjective and objective assessment data.
  3. Research obsessive-compulsive disorder in the medical dictionary.
  4. Consult the Diagnostic and Statistical Manual of Mental Disorders for diagnostic criteria.

Question 2

A client hospitalized for psychotic symptoms including auditory hallucinations and delusions of reference is prescribed a medication with a strong dopamine blocking action.
 
  The nurse teaches the client to recognize which symptom as a possible side effect of the medication? 1. Muscle stiffness
  2. Constipation
  3. Orthostatic intolerance
  4. Dry mouth

[Ashley I]

Answer to Question 1

4
Rationale: The Diagnostic and Statistical Manual of Mental Disorders provides diagnostic criteria that all members of the health care team will use in the diagnosis process and will serve as a resource for assessment and analysis of data. While communication with the primary care provider is appropriate, knowledge of the DSM is expected in a graduate nurse and this choice does not reflect an application of basic knowledge. A medical dictionary is not specific enough for diagnostic purposes. Documentation of all subjective and objective data is not appropriate and will confuse relevant from irrelevant data.

Answer to Question 2

1
Rationale: Dopamine is found in the basal ganglia and is responsible for control of complex movement. When these dopamine receptors are blocked, the client may experience muscle stiffness. A dry mouth and constipation are due to anticholinergic effects. Orthostatic intolerance is due to an antiadrenergic effect.