A client on an antipsychotic medication develops a high fever, unstable blood pressure, and mus-cle rigidity. Her next dose of medication is due. The nurse should:
1. Administer the medication and take the vital signs again
2. Give a lower dose of the medication and take the blood pressure
3. Prepare to give the prn anticholinergic, benztropine (Cogentin)
4. Hold the medication and call the client's doctor immediately
ANS: 4
These symptoms could be related to neuroleptic malignant syndrome (NMS), and the nurse should hold the medication and contact the doctor.
You might also like to view...
HIPAA and the American Recovery and Reinvestment Act of 2009 specify that personal health records must be protected. Nurses can protect client privacy by
1. Whispering when discussing clients in the elevator 2. Placing flow sheets on the client's bed 3. Not posting clients' names where they can be viewed by visitors 4. Sharing passwords with floating nurses
The nurse present at the delivery is reporting to the nurse who will be caring for the neonate after birth. What information might be included for an infant who had thick meconium in the amniotic fluid?
a. The infant needed vigorous stimulation immediately after birth to initiate crying. b. An IV was started immediately after birth to treat dehydration. c. There was no meconium below the vocal cords when they were visualized. d. The parents spent an hour bonding with the baby after birth.
Examples of a primary level of violence prevention include (select all that apply):
a. well-lit parking lots. b. critical incident debriefing. c. de-escalation training for all staff. d. metal detectors at hospital entrances. e. posting security guards in the main lobby.
The nurse receives laboratory reports on a client and notes that the potassium level is 5.6 mEq/L. The nurse contacts the physician for consultation. What type of intervention is this?
1. nurse-initiated intervention 2. physician-initiated intervention 3. indirect care intervention 4. direct care intervention