Walkthrough: Pharmacological and Parenteral Therapies Q11 – NCLEX-RN®

00:00 The nurse is caring for a client taking clozapine. They're exhibiting severe muscular rigidity, temperature of, wow, 39.2 or 102.5 Fahrenheit, pulse rate of 125 and extreme tremors of the hands. Based on these symptoms, which is the priority nursing intervention? Okay, we know this is priority, that means we could have more than 1 correct answer, but let's go back through because, don't let these crazy things throw you off. Stick to your system, be consistent. So in this stem, you want to go back to the first sentence. The nurse is caring for a client who is taking clozapine. Now, that's a medication. You may or may not recall that. If you don't just tell yourself "Hey, let's look for a pattern or some clues in the stem, we'll also look in the answer choices." Now, they are exhibiting, look at that, severe muscle rigidity. That's an assessment. You always have to ask yourself "Is that normal or abnormal?" Very clearly this is not normal. Right? So severe muscle rigidity; temperature that is high, that's a number and it's very high; pulse rate of 125, that's high and extreme tremors of the hands. Okay, so put all these things together. This kind of like sounds a reaction with that extreme muscle rigidity. That sounding like a problem from a psych medication, CNS medication, so it's kind of sounding like something you may have heard of before but I'm not ready to say it yet because I want to see if you can remember what it is. So, I'm looking for what based on these symptoms they're seeing can I put together this patient's variables. Right? They have clozapine and all these assessment things. What do I recognize is is it a problem, is it normal? I think we've already established. It's not normal. But is it a problem? Is it life threatening? This is what they're testing you on. So, you can have 4 option choices. Go ahead and write down number 1, number 2, number 3, number 4, just the numbers and I want you to think through each one of these things what would be the priority nursing intervention, the most important thing that you do for this particular patient in this particular setting to keep them safe.

02:27 Okay, so pause the video, work through the question on your own, then restart the video we'll walk through it together but don't cheat. Make sure you claim and answer before you come back and always say why you're eliminating or keeping an answer. So, see you in a couple of minutes.

02:50 Hey, welcome back. So we've got some really strange symptoms going on here. Right? Extreme muscle rigidity doesn't happen with very many things, but it does happen with neuroleptic malignant syndrome. Now, clozapine is not typically a drug that you will think of this first off, but you should think of it more things like the first generation antipsychotics like haloperidol but this one can cause neuroleptic malignant syndrome and they were queuing you with the severe muscular rigidity. Now, that might also do things like he has an arched back and things seem really stiff.

03:27 They may not use that kind of formal language, they might just describe to you what the patient looks like. So keep your mind open to that, you're always asking "Hey, what's the connection to that muscle thing and the medication?" Now, we look at our answer choices, we got 4 and I'm not feeling like starting at the top, I can always start another place or I can start the one that I think is the most obvious to get rid of but I'm looking for what's the priority nursing intervention.

03:56 They're asking if I recognize is this neuroleptic malignant syndrome. So, number 4, assist the client to slowly contract the upper extremities. That's not happening with severe muscular rigidity. So number 4 you are out. Now, what about number 2? Apply ice packs to bring down the temperature. Now, for this particular patient in this particular setting, does that keep them the safest? If I have someone in neuroleptic malignant syndrome is if I can only do one thing, would it be ice packs to bring the temperature down? No. There is going to be a lower temperature when they pass on. So, 2 is out. We're not going to do that again.

04:40 So, now I've got 1 and 3. Well, beta blockers don't fix neuroleptic malignant syndrome. They may be tempted to pick that answer because the heart rate's 125 it would bring the heart rate down but it's just like the ice packs. The ice packs would likely bring the temperature down somewhat but that's not a problem, it's not the source of our problem. And since number 3 is what we would give to treat neuroleptic malignant syndrome, number 3 is the priority. So, keep that in mind. If that was a knowledge thing you did know, add some notes to your notebook. Did you recognize that clozapine can cause neuroleptic malignant syndrome? Did you know that without dantrolene when someone's in neuroleptic malignant syndrome, now that really stiff muscle rigidity and everything is firing up. If they don't get treated, it could cause their death. So, those are some fun facts although it's not super fun if you're experiencing it, that you want to have done in your notebooks so you recognize this. Because this is a life-threatening reaction to medication, it does have a higher probability of being on the NCLEX.

05:48 Since the NCLEX and nursing school exams are all about safety, this is something that could threaten a patient's life. So, you have a chance of seeing it. Nobody knows for sure the exact medications that will be on the NCLEX so don't buy into that when somebody tells you they do, but any medication that can knock out an organ or can cause a death, that's something NCLEX would be very interested and you recognizing the adverse effect. So jot some notes down, think about what you need to have in mind. If you want another review of antipsychotics, check out our pharmacology review, we've got that on much more detail in our review.