Nokea
A nurse is providing teaching for a school-age child and his parents regarding a new prescription for risperidone. Which of the following statements by the parent indicates an understanding of the teaching?
- A. I will provide a low sodium diet for my son
- B. I will make sure my son takes the last dose of the day by 4 PM
- C. I should expect my son to develop hand tremors
- D. I should contact my doctor if my son urinates excessively
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Risperidone is known to cause sedation, so giving the last dose early can help minimize sleep disturbance.
2. Taking the last dose by 4 PM reduces the risk of insomnia or disrupted sleep patterns.
3. This statement shows the parent understands the importance of timing to optimize the medication's effects.
4. The other choices are incorrect because they do not directly relate to the appropriate use of risperidone.
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A nurse is evaluating the medication response of a client who takes naltrexone for the treatment of alcohol use disorder. The nurse should identify that which of the following is a therapeutic effect of this medication.
- A. Blocks aldehyde dehydrogenase
- B. Prevents the anxiety of abstinence
- C. Reduces substance craving
- D. Decreases the likelihood of seizures
Correct Answer: C
Rationale: The correct answer is C: Reduces substance craving. Naltrexone is an opioid receptor antagonist that helps reduce the craving for alcohol by blocking the euphoric effects associated with alcohol consumption. This medication does not block aldehyde dehydrogenase (choice A), which is involved in alcohol metabolism. It also does not prevent the anxiety of abstinence (choice B) or decrease the likelihood of seizures (choice D). Naltrexone specifically targets reducing the desire to drink, making choice C the most appropriate therapeutic effect in this scenario.
A nurse is reviewing the laboratory results on an adolescent who has anorexia nervosa. Which of the following findings should the nurse expect?
- A. Blood glucose 100 mg/dL
- B. T4 11 mcg/dL
- C. Potassium 3.7 mEq/L
- D. Hgb 10 g/dL
Correct Answer: D
Rationale: The correct answer is D: Hgb 10 g/dL. In an adolescent with anorexia nervosa, low hemoglobin (Hgb) levels are expected due to malnutrition and inadequate intake of essential nutrients. Anorexia nervosa can lead to a deficiency in essential nutrients such as iron, which can result in anemia and low Hgb levels. This is a common finding in individuals with anorexia nervosa.
Blood glucose of 100 mg/dL (choice A) is within the normal range and not specific to anorexia nervosa. T4 of 11 mcg/dL (choice B) is also within the normal range and not typically affected by anorexia nervosa. Potassium of 3.7 mEq/L (choice C) is within the normal range and not a common finding in anorexia nervosa. Therefore, the correct answer is D as it is a common laboratory finding associated with anorexia nervosa.
A nurse is caring for a client who has major depressive disorder and is prescribed sertraline. Which of the following instructions should the nurse provide?
- A. Take the medication at bedtime
- B. Expect results within 1 to 2 days
- C. Avoid consuming grapefruit juice
- D. Stop taking the medication once symptoms improve
Correct Answer: C
Rationale: The correct answer is C: Avoid consuming grapefruit juice. Grapefruit juice can interact with sertraline, leading to increased levels of the medication in the bloodstream, potentially causing side effects or toxicity. It is essential for the nurse to instruct the client to avoid grapefruit juice to ensure the safe and effective use of sertraline. Taking the medication at bedtime (choice A) is not specifically necessary for sertraline. Expecting results within 1 to 2 days (choice B) is incorrect as antidepressants like sertraline typically take weeks to show full effects. Stopping the medication once symptoms improve (choice D) can be dangerous as abruptly discontinuing an antidepressant can lead to withdrawal symptoms or a relapse of depression.
A nurse is assessing a client who has opioid intoxication. Which of the following findings should the nurse expect?
- A. Pinpoint pupils
- B. Hyperreflexia
- C. Increased respiratory rate
- D. Dilated pupils
Correct Answer: A
Rationale: The correct answer is A: Pinpoint pupils. Opioid intoxication causes miosis, resulting in constricted or pinpoint pupils. This occurs due to the suppression of the sympathetic nervous system. Hyperreflexia (B) is not typically associated with opioid intoxication; it is more common in conditions like spinal cord injury. Opioids depress the respiratory system, leading to decreased respiratory rate (C), not increased. Dilated pupils (D) are more indicative of stimulant intoxication, such as amphetamines.
A nurse in an inpatient mental health facility is planning care for a client who has schizophrenia and is experiencing delusions. Which of the following interventions should the nurse include?
- A. Encourage the client to focus on reality-based topics
- B. Agree with the client’s delusional beliefs
- C. Discuss the delusions in detail
- D. Provide frequent reassurance about safety
Correct Answer: A
Rationale: The correct answer is A: Encourage the client to focus on reality-based topics. This intervention is appropriate because it helps the client ground themselves in reality and potentially reduce the intensity of their delusions. By redirecting the client's focus to reality-based topics, the nurse can help them challenge and eventually overcome their delusions. Choices B, C, and D are incorrect. Agreeing with delusional beliefs can reinforce them, discussing delusions in detail may exacerbate them, and providing frequent reassurance about safety may not address the underlying issue of delusions.