An acutely violent patient with schizophrenia receives several ...

[Ebrown]

An acutely violent patient with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position;
 
  the lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated?
 
  a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.
  b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient.
  c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time.
  d. Administer atropine sulfate 2 mg subcut from the PRN medication administration record.

Question 2

Which symptoms are expected for a patient with disorganized schizophrenia?
 
  a. Extremes of motor activity, from excitement to stupor
  b. Social withdrawal and ineffective communication
  c. Severe anxiety with ritualistic behavior
  d. Highly suspicious, delusional behavior

[Sophiapenny]

Answer to Question 1

ANS: A
Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore oral medication is not an option. Medication should be administered immediately; therefore the intramuscular route is best. In this case, the best option given is diphenhydramine.

Answer to Question 2

ANS: B
Patients with disorganized schizophrenia demonstrate the most regressed and socially impaired behaviors of the schizophrenias. Communication is often incoherent, with silly giggling and loose associations predominating. Highly suspicious, delusional behavior relates more to paranoid schizophrenia. Extremes of motor activity, from excitement to stupor, relates to catatonic schizophrenia. Severe anxiety and ritualistic behaviors relate to obsessive-compulsive disorder.