NCLEX-RN
NCLEX RN Psychiatric Questions Questions
Extract:
The emergency department (ED) nurse is caring for a 56-year-old male client
• Nurses' Notes
1056: 56-year-old male presents to the ED with his wife after she found him tremulous, talking incoherently to various pieces of furniture, and disoriented. She stated that two nights ago, he was in a rage and got rid of a medication bottle because he was tired of feeling 'numb.' The wife is unsure what medications he discarded, but he has been acting irritable and confused since, with bouts of anxiety and panic. On assessment, the client's breathing is unlabored, and he has clear lung sounds. Skin is warm and pink in tone; pulses 2+ and regular. Capillary refill is 3 seconds. The client is alert, irritable, and confused. Pupils are equal, round, and reactive to light. Vital signs: T 98° F (36.7° C), P 92, RR 19, BP 142/76. The client has a medical history of generalized anxiety disorder, polysubstance use, major depressive disorder, chronic back pain, hypertension, duodenal ulcer, and low testosterone.
• Current Medications
• omeprazole 20 mg by mouth daily
• fluvoxamine 100 mg by mouth daily
• oxycodone extended-release (ER) 10 mg by mouth daily
• multivitamin 1 tablet by mouth daily
• clonidine 0.1 mg by mouth daily
• propranolol 10 mg by mouth daily
• alprazolam 1 mg by mouth twice daily
• testosterone cypionate 200 mg intramuscular (IM) every two weeks
Question 1 of 5
Complete the sentence below by choosing from the list of options.The client is demonstrating signs and symptoms consistent with-----------------
Correct Answer: D
Rationale: The client's current medications indicate he is taking alprazolam, and his irritability, disorientation, high blood pressure, and anxiety suggest benzodiazepine withdrawal.
Benzodiazepine intoxication leads to a client developing confusion, bradycardia, sedation, and ataxia.
Serotonin syndrome is unlikely because the case study suggested that the client got rid of pills that would put the client in a withdrawal. Serotonin syndrome would be if the client took too much of a serotonergic, such as their prescribed fluvoxamine. While the manifestations overlap with serotonin syndrome, it is not plausible, considering this condition is caused by too much - not too little.
Opioid intoxication is unlikely. While the client does take extended-release oxycodone, opioid intoxication would cause more psychomotor retardation, decreased respirations, and pinpoint pupils. None of the client's manifestations support this finding.
The client self-discontinuing his medication without taper is the cause of the withdrawal symptoms. When benzodiazepines are discontinued, they should be tapered.
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