Nokea
A young adult, 20 years old, who is hospitalized for the first time with schizophrenia, is receiving chlorpromazine (Thorazine) 75 mg PO tid. The client is to go home for a weekend pass. Which statement that the client makes indicates a need for nursing intervention?
- A. I won't drink any alcohol this weekend.
- B. It will be good to taste home-cooked food again.
- C. We plan to go dancing.
- D. I'm looking forward to a relaxing weekend at the beach.
Correct Answer: C
Rationale: Chlorpromazine causes orthostatic hypotension and photosensitivity. Dancing may exacerbate hypotension, requiring caution and education.
You may also like to solve these questions
The client diagnosed with chronic obstructive pulmonary disease is being discharged and is prescribed the steroid prednisone. Which scientific rationale supports why the nurse instructs the client to taper off the medication?
- A. The pituitary gland must adjust to the decreasing dose.
- B. The beta cells of the pancreas have to start secreting insulin.
- C. This will allow the adrenal gland time to start functioning.
- D. The thyroid gland will have to start producing cortisol.
Correct Answer: C
Rationale: Prednisone suppresses adrenal cortisol production; tapering allows adrenal glands to resume function, preventing adrenal crisis.
The client complains of leg cramps at night. Which medication should the nurse anticipate the HCP ordering to help relieve the leg cramps?
- A. Quinine, an antimalarial.
- B. Soma, a muscle relaxant.
- C. Ambien, a sedative-hypnotic.
- D. Darvon, an opioid analgesic.
Correct Answer: A
Rationale: Quinine is historically used for nocturnal leg cramps, though off-label due to risks. Muscle relaxants, sedatives, or opioids are less specific.
An 80 year-old client is admitted with a diagnosis of malnutrition. In addition to physical assessments, which of the following lab tests should be closely monitored?
- A. Urine protein
- B. Urine creatinine
- C. Serum calcium
- D. Serum albumin
Correct Answer: D
Rationale: Serum albumin. Serum albumin is a valuable indicator of protein deficiency and, later, nutritional status in adults. A normal reading for an elder's serum albumin is between 3.0-5.0 g/dl.
The client in end-stage renal disease is a Jehovah's Witness. The HCP orders erythropoietin (Epogen), a biologic response modifier, subcutaneously for anemia. Which action should the nurse take?
- A. Question this order because of the client's religion.
- B. Encourage the client to talk to his or her minister.
- C. Administer the medication subcutaneously as ordered.
- D. Obtain the informed consent prior to administering.
Correct Answer: C
Rationale: Epogen is synthetic, not blood-derived, so it’s acceptable for Jehovah’s Witnesses. Administer as ordered; questioning, minister consultation, or consent are unnecessary.
A client is receiving digitalis. The nurse should instruct the client to report which of the following side effects?
- A. Nausea, vomiting, fatigue
- B. Rash, dyspnea, edema
- C. Polyuria, thirst, dry skin
Correct Answer: A
Rationale: Nausea, vomiting, fatigue. Side effects of digitalis toxicity include fatigue, nausea, vomiting, anorexia, and bradycardia. Digitalis inhibits the sodium potassium ATPase, which makes more calcium available for contractile proteins, resulting in increased cardiac output.