Difficulty: Medium
Average Score: 69%
Simulated
Passage / Scenario
The nurse in the behavioral health clinic is caring for a 48-year-old male client.ÔÇó Diagnostic Results
Diagnostic, Result ,Reference Range
Calcium, 10.5 mg/di (2.75mmol/I), 9.0-10.5 mg/dL (2.25-2.75 mmol/L)
Chloride, 99 mEq/1 (99 mmol/l), 98 to 106 mEq/L (98 to 106 mmol/l)
Creatinine, 0.9 mg/dI (79.6mcmol/L), 0.6 to 1.2 mg/di (53-106 mcmol/L)
Potassium, 3.8 mEq/1 (3.8, mmol/D), 3.5-5.0 mEq/L (3.5-5.0 mmol/L)
Sodium,137 mEq/1 (137mmol/l), 135 to 145 mEq/1 (135 to 145 mmol/I)
Blood urea nitrogen,12 mg/di (4.2mmol/I), 10-20 mg/dL (3.6-7.1 mmol/L)
Fasting glucose ,202 mg/dL (11.2mmol/L), 70-110 mg/dL (4-6 mmol/L)
White blood cell, 11,000/mm3 (11 × 109 /L), 5,000-10,000/mm 3 (5-10 × 109 /L)
Hemoglobin (Hgb), 15 g/dL (150 g/L), Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L)
Hematocrit (Hct), 45% (0.47), Male: 42%-52% (0.42-0.52) Female: 37%-47% (0.37-0.47)
Lithium level, 0.4 mEg/L , 0.6-1.2 mEg/L
ÔÇó NursesÔÇÖ Notes
1230: Client presents for a follow-up appointment. He reports 100% adherence with prescribed ziprasidone. Two weeks ago, he was prescribed lithium, for which he reports a mild thirst. This thirst is causing him to go to the bathroom more frequently overnight. He reports that he recently got a second job to save for a vacation. On assessment, the client is alert and completely oriented. He had a logical thought process. Lung sounds clear bilaterally, and peripheral pulses were 2+. Skin is warm, dry, and normal for ethnicity. Rapid eye blinking and persistent chewing motions in his mouth despite not eating any food or gum. He reports that this started two weeks ago. Current weight is 128 kg (282 pounds). Current BMI is 26kg/m2. Previous weight one month ago was 126 kg (277 pounds). The most recent hospitalization was one month ago for a manic episode. Laboratory data reviewed.
The nurse is determining the risks associated with the clientÔÇÖs current condition. Based on the clientÔÇÖs presentation, which of the following issues is the client at risk of developing? Select all that apply.
Correct answer
D,E
Rationale
The client is demonstrating manifestations consistent with tardive dyskinesia (TD). While further standardized testing is necessary (Abnormal Involuntary Movement Scale [AIMS]), the client is having involuntary facial movements consistent with TD. TD typically results from prolonged use of antipsychotics and may become irreversible if not addressed. The clientÔÇÖs symptoms began two weeks ago and should be promptly evaluated to prevent progression.Type two diabetes mellitus is a concern because the fasting plasma glucose is 202 mg/dL, which is well above the normal range. Additionally, the clientÔÇÖs BMI is elevated, which is another risk factor for diabetes mellitus, type two. Diabetes mellitus type one is not associated with antipsychotic use and typically has a different pathophysiology, involving autoimmune destruction of pancreatic beta cells, which is unlikely in this adult client. Serotonin syndrome is linked to serotonergic medications, such as SSRIs or MAOIs, which the client is not currently taking. Akathisia typically presents with observable motor restlessness, such as pacing, inability to sit still, or constantly shifting positions. The client in this case appears calm, with no reported or observed signs of restlessness or agitation. Instead, the noted abnormal movements (eye blinking and chewing) align more with tardive dyskinesia, which is a distinct type of extrapyramidal symptom and not the same as akathisia.