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The nurse is observing the certified nursing assistant caring for a client who is taking Thorazine (chloropromazine) for psychosis. Which action by the nursing assistant indicates a need for further teaching? A. The nursing assistant offers the client a magazine to read. B. The nursing assistant stands on the client's dominant side during ambulation. C. The nursing assistant asks the client if he wants to take a walk. D. The nursing assistant allows the client to have hard candy.

Short Answer

Expert verified
Answer: Allowing the client to have hard candy.

Step by step solution

01

Understanding Thorazine

Thorazine (chloropromazine) is an antipsychotic medication used to treat psychotic disorders such as schizophrenia. This medication can cause side effects such as drowsiness, dizziness, and low blood pressure which might cause orthostatic hypotension (a sudden drop in blood pressure upon standing).
02

Option A: Offering a Magazine to Read

There is nothing wrong with offering a magazine to read, as it can keep the client occupied and engaged without causing any potential side effects due to Thorazine. Thus, this action is appropriate.
03

Option B: Standing on the Dominant Side during Ambulation

Standing on the client's dominant side during ambulation is essential as the client might experience dizziness due to the effects of Thorazine. The nursing assistant should be on the client's dominant side to provide support if the client experiences dizziness or difficulty ambulating. Thus, this action is appropriate.
04

Option C: Asking the Client if They Want to Take a Walk

Asking the client if they want to take a walk can be beneficial to their overall health and well-being. However, the nursing assistant should ensure that the client is stable and not experiencing dizziness or any adverse side effects from the medication. If the client is stable and willing, encouraging ambulation is appropriate. Thus, this action is appropriate.
05

Option D: Allowing the Client to Have Hard Candy

Thorazine can cause a condition called "dry mouth," making it uncomfortable for the client. Allowing the client to have hard candy can help alleviate this side effect and provide them with some comfort. However, it is essential to monitor the client closely while consuming the hard candy as there is a potential risk of choking. Thus, this action indicates a need for further teaching. In conclusion, the correct answer is Option D, as allowing the client to have hard candy can pose a risk of choking and requires further teaching on how to assist the client safely.

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Key Concepts

These are the key concepts you need to understand to accurately answer the question.

Antipsychotic Medication Side Effects
Thorazine (chloropromazine), as a typical antipsychotic medication, comes with a spectrum of side effects that both healthcare providers and patients should be aware of. Being well-informed about these adverse reactions is critical for safe administration and observation.

Common side effects include sedation, dizziness, and orthostatic hypotension—a sudden drop in blood pressure when standing up which can increase the risk of falls. There are also extrapyramidal symptoms such as tremors or stiffness, and anticholinergic effects like dry mouth and constipation. More severe concerns may involve tardive dyskinesia, characterized by repetitive, involuntary movements, usually of the jaw and lips.

Moreover, Thorazine can affect the body's ability to regulate temperature, making patients more susceptible to heat stroke or hypothermia. It can also lead to increased photosensitivity, so protecting against sun exposure is essential. Due to these potential side effects, nursing staff, especially CNAs, should be vigilant in monitoring their patients for any new or worsening symptoms.
Certified Nursing Assistant Training
Certified Nursing Assistants (CNAs) play a fundamental role in patient care, working under the supervision of nurses to provide high-quality care to patients. Training for CNAs covers a broad range of topics from patient rights and communication to infection control and safety procedures.

A crucial element of their education involves understanding how to support patients taking medications like Thorazine. This includes recognizing side effects, knowing when to report changes in patient conditions, and learning proper procedures to assist with mobility and daily living activities. For instance, when assisting a patient who is on antipsychotic medications, CNAs should learn the importance of monitoring for side effects like dizziness or sedation, which could affect a patient's ability to safely ambulate.
Psychotic Disorders Management
Managing psychotic disorders often requires a multifaceted approach including medication such as antipsychotics, therapy, and lifestyle changes. In the context of nursing, medication management forms a significant part of the treatment for conditions like schizophrenia.

Medications like Thorazine help by adjusting the balance of neurotransmitters in the brain, which can alleviate symptoms such as delusions, hallucinations, and disorganized thinking. Nurses must ensure medication compliance, assess for therapeutic effectiveness, and monitor for potential side effects. Communication, patient education, psychoeducation for families, as well as engagement in meaningful activities, complement the medication therapy to provide a holistic care plan.
NCLEX-PN Exam Preparation
Preparing for the NCLEX-PN exam, which prospective Licensed Practical Nurses must pass to practice, involves understanding a wide array of topics, including pharmacology, patient care, and safety. Antipsychotic medications and their management, like Thorazine, are common subjects in this exam.

Test-takers should be familiar with Thorazine's uses, side effects, contraindications, and nursing implications. They must know how to monitor patients on this medication, recognize adverse effects, and understand how to intervene appropriately. Case studies and questions about medications like Thorazine often appear on exams, designed to test the practical nursing knowledge that will be applicable in real patient-care scenarios.

Comprehensive study guides, practice exams, and courses are available to aid in NCLEX-PN preparation, covering the indispensable knowledge a practical nurse should grasp for safe and effective patient care.

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