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A client diagnosed with bipolar disease is receiving a maintenance dosage of lithium carbonate. His wife calls the community mental health nurse to report that her husband is displaying mild aggression and poor judgment. Which intervention is appropriate?
- A. administer an extra dose of lithium carbonate
- B. take client to the closest emergency department
- C. measure lithium blood level
- D. arrange for hemodialysis
Correct Answer: C
Rationale: Mild aggression and poor judgment may indicate lithium toxicity or subtherapeutic levels, requiring a blood level check to guide management.
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The nurse is reviewing a client's morning medication orders. Which of the following orders would prompt the nurse to call the health care provider for order clarification?
- A. famotidine 20 mg PO BID
- B. haloperidol 15 mg IM q4h prn
- C. lithium carbonate 300 mg PO TID
- D. amoxicillin 500 mg PO q12h X 7 days
Correct Answer: B
Rationale: Haloperidol 15 mg IM q4h prn is a high dose, risking extrapyramidal side effects, and requires clarification. Famotidine (A), lithium (C), and amoxicillin (D) doses are standard.
The nurse is working in the mental health unit and is educating a group of student nurses about atypical antipsychotics. Which statement by one of the student nurses requires further teaching about this class of drugs?
- A. These drugs can cause bradycardia.
- B. This class of drugs can cause diabetes.
- C. Weight gain and obesity are side effects of these drugs.
- D. Rarely, neuroleptic malignant syndrome can occur and may be fatal.
Correct Answer: A
Rationale: Atypical antipsychotics are associated with tachycardia, not bradycardia, requiring further teaching. Diabetes, weight gain, and neuroleptic malignant syndrome are known risks.
The nurse is teaching a group of student nurses about drug safety. Keeping in mind Joint Commission guidelines, which of the following does the nurse teach the students? Select all that apply.
- A. Do not abbreviate drug names.
- B. Use daily instead of QD, Q.D., or q.d.
- C. Rectum can be abbreviated PR, R, or Per Rec.
- D. Use OD to indicate right eye for eye medications.
- E. Use the letter u to indicate units, such as with insulin.
Correct Answer: A,B
Rationale: Joint Commission guidelines prohibit abbreviating drug names (A) and QD (B) to prevent errors. PR is acceptable (C is incorrect), OD is unsafe for eyes (D), and ‘u' for units (E) risks confusion with zero.
The nurse is providing discharge teaching to a client who has been prescribed prednisone. The nurse instructs the client to report which symptom to the health care provider?
- A. increased appetite
- B. anxiety or confusion
- C. strong, bounding pulses
- D. weight gain of 3 pounds
Correct Answer: B
Rationale: Anxiety or confusion may indicate corticosteroid-induced psychosis or mood changes, which require prompt reporting. Increased appetite and minor weight gain are common, and bounding pulses are not typical.