Comprehensive exams for Mental Health Q 80



The nurse is administering a psychotropic drug to an elderly client who has a history of benign prostatic hypertrophy. It is most important for the nurse to teach this client to:
  
     A. Add fiber to his diet.
     B. Exercise on a regular basis.
     C. Report incomplete bladder emptying.
     D. Take the prescribed dose at bedtime.
    
    

Correct Answer: C. Report incomplete bladder emptying

Urinary retention is a common anticholinergic side effect of psychotic medications, and the client with benign prostatic hypertrophy would have increased risk for this problem. First-generation antipsychotics (FGAs) are associated with significant extrapyramidal side effects. Anticholinergic adverse effects like dry mouth, constipation, urinary retention are common with low potency dopamine receptor antagonists like chlorpromazine, thioridazine.

Option A: Neuroleptic malignant syndrome is a rare but fatal adverse effect that can occur at any time during treatment with FGAs. The onset of symptoms is over 24 to 72 hours with increased temperature, severe muscular rigidity, confusion, agitation, elevation in white blood cell count, elevated creatinine phosphokinase concentrations, elevated liver enzymes, myoglobinuria, and acute renal failure.
Option B: Adding fiber to one’s diet and exercising regularly are measures to counteract another anticholinergic effect, constipation. Second-generation antipsychotics (SGAs) have a decreased risk of extrapyramidal side effects as compared to first-generation antipsychotics. SGAs are associated with significant weight gain and the development of metabolic syndrome.
Option D: Depending on the specific medication and how it is prescribed, taking the medication at night may or may not be important. However, it would have nothing to do with urinary retention in this client. The FDA recommends monitoring personal and family history of diabetes mellitus, dyslipidemia, weight, and height, waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile for all patients.