1
Which symptom is most characteristic of neuroleptic malignant syndrome (NMS)?
Tremors relieved by benztropine
Restlessness and pacing
Drooling and shuffling gait
Muscle rigidity with high fever
-Muscle rigidity with high fever
Explanation:
NMS presents with severe muscle rigidity, hyperthermia, autonomic instability, and altered mental status.
This EPS causes involuntary upward eye deviation and a painfully stiff neck.
Parkinsonism
Acute dystonia
Akathesia
Tardive dyskinesia
Acute dystonia
This term describes speech that shifts rapidly from one unrelated topic to another.
Flight of ideas
Common in mania due to accelerated thought processes.
This term describes a false sensory perception without external stimuli.
Hallucination
Reason: Hallucinations involve perception without actual sensory input.
A client says, “You can’t keep me here. I’m not crazy.” They are involuntary. What should the nurse do?
Explain criteria for involuntary admission and their right to appeal .
Transparency reduces fear and increases cooperation.
This medication requires routine WBC monitoring due to the risk of agranulocytosis.
clozapine
This antipsychotic is known for causing significant weight gain and metabolic syndrome.
Olanzapine
Olanzapine has one of the highest risks for weight gain, hyperlipidemia, and insulin resistance.
This is the first nursing action when a client says, “I don’t want to live anymore.”
Ask directly about suicidal intent
Reason: Direct assessment determines immediate safety risk.
This therapeutic communication technique helps clients explore feelings without leading them.
open ended questions
A client becomes verbally abusive during medication administration. What is the best response?
Set limits: “I will talk with you when you speak respectfully.”
Limits protect staff and model appropriate communication.
This antipsychotic is famous for causing hyperprolactinemia, leading to galactorrhea and menstrual changes.
Risperidone
This life‑threatening reaction to antipsychotics features lead rigidity, hyperthermia, and autonomic instability.
Tardive dyskinesia
Serotonin syndrome
Neuroleptic malignant syndrome
Neuroleptic malignant syndrome
Explanation:
NMS is a rare but dangerous reaction to dopamine‑blocking medications
This defense mechanism involves unconsciously blocking distressing thoughts from awareness.
Repression
Reason: Repression keeps painful memories out of conscious awareness.
A client yells, “You can’t tell me what to do!” after being asked to lower their voice. What is the best limit‑setting response?
“You may express your feelings, but you cannot yell at others.”
Clear, respectful limits define acceptable behavior without shaming.
A client with a history of violence begins pacing rapidly. What is the best early intervention?
Offer a quiet room or space to reduce stimulation and monitor closely.
Early removal from triggers prevents escalation.
This antipsychotic carries the highest risk for tardive dyskinesia due to strong dopamine blockade.
Haloperidol
Reason: First‑generation antipsychotics have the strongest D2 blockade, increasing TD risk.
This medication is known for causing orthostatic hypotension due to strong alpha‑1 blockade.
Clozapine
Reason: Clozapine leads to vasodilation and blood pressure drops.
This part of the Mental Status Exam describes how a client expresses emotion, not what they say they feel.
Affect
Reason: Affect is the observable emotional expression; mood is the client’s stated feeling.
A client with depression refuses to get out of bed for group therapy. What is the best nursing action?
Use gentle encouragement and assist with small, achievable steps
Behavioral activation improves depressive symptoms.
A client repeatedly enters other clients’ rooms despite redirection. What is the best limit‑setting approach?
State the rule and consequence clearly and consistently
Consistency reinforces boundaries and reduces confusion.
This antipsychotic is least likely to cause metabolic syndrome.
Abilify
Aripiprazole is a partial dopamine agonist with lower weight‑gain and metabolic risk.
This mood stabilizer becomes toxic when sodium levels drop or dehydration occurs.
Lithium
Reason: Lithium and sodium compete in the kidneys; low sodium increases lithium retention and toxicity.
A client in alcohol withdrawal has tremors, sweating, and agitation. What is the priority intervention?
Administer prescribed benzodiazepines
Reason: Benzos prevent seizures and delirium tremens.
check CIWA protocol
A client with severe depression says, “I gave my sister my favorite necklace. I won’t need it anymore.” What should the nurse do first?
Assess for suicidal intent and plan
Giving away possessions is a warning sign of suicide preparation.
A client is escalating and staff are gathering nearby. What is the nurse’s best action when communicating with the patient?
Have only one staff member speak while others remain visible
Multiple voices increase confusion and agitation.