A client with schizophrenia is seen in the Emergency Department ...

[dejastew]

A client with schizophrenia is seen in the Emergency Department in an acutely agitated state due to threatening auditory hallucinations.
 
  The client's medical record indicates he has had severe dystonic reactions to parenteral admin-istration of typical antipsychotic medication. The nurse can anticipate that the physician will or-der:
  1. Ziprasidone (Geodon) IM
  2. Fluphenazine (Prolixin) decanoate
  3. Clozapine (Clozaril) IM
  4. Paroxetine (Paxil) IM

Question 2

A client whose schizophrenia has been refractory to treatment with other medications has been placed on clozapine (Clozaril). The priority discharge teaching should include:
 
  1. Keep salt intake the same from day to day
  2. Maintain a tyramine-free daily diet
  3. Report for weekly blood tests for CBC level
  4. Use sun-blocking agents when out of doors

[whitcassie]

Answer to Question 1

ANS: 1
This atypical antipsychotic comes in an injectable form and is effective in controlling agitated and assaultive behaviors. Option 2 is a typical antipsychotic. Option 3 is used only for refractory schizophrenia. Option 4 is an SSRI.

Answer to Question 2

ANS: 3
Clozaril has the potential to cause agranulocytosis; hence, the need for weekly blood draws for CBCs for the first 6 months of therapy and every other week after that point. The other options are not relevant to Clozaril therapy. Option 1 refers to lithium therapy, option 2 to MAOI thera-py, and option 4 to phenothiazine therapy.