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At discharge, the nurse documents that the client taking lithium has an accurate understanding of self-care. On which client statement should the nurse base this judgment?
- A. I need to have my blood lithium level checked every 2 weeks.
- B. I should take my lithium on an empty stomach for best absorption.
- C. I know I need to restrict foods high in sugar while I'm taking lithium.
- D. I need to eat foods containing sodium and drink 2 to 3 liters of fluid daily.
Correct Answer: D
Rationale: The client must consume adequate dietary sodium and 2500 to 3000 mL of fluid per day to prevent dehydration leading to lithium toxicity.
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The client taking sertraline for treatment of depression for the past 11 months reports feeling much better and wishes to discontinue the medication. Which is the nurse's most appropriate response?
- A. The medication will have to be reduced gradually to prevent undesirable symptoms.
- B. You should not stop the medication without talking to your health care provider first.
- C. It appears that the medication has worked very well. It should be safe to discontinue its use.
- D. You should take this medication indefinitely to prevent recurrence of depressive symptoms.
Correct Answer: A
Rationale: Sertraline (Zoloft) is an SSRI antidepressant. Stopping these abruptly can cause withdrawal symptoms. The dose should be reduced gradually.
The LPN is about to give 100 mg Lopressor (metoprolol) to a client. Before administering the drug, he takes the patient's vitals, which are as follows: Pulse: 58, Blood Pressure: 90/62, Respirations: 18/minute. What action should the LPN take?
- A. Give the client half the prescribed dose and report the findings to the RN on duty.
- B. Give the client double the dose and report the findings to the RN on duty.
- C. Administer the drug and report the findings to the RN on duty.
- D. Hold the drug and report the findings to the RN on duty.
Correct Answer: D
Rationale: Lopressor is given to treat hypertension, and a pulse of 58 and a blood pressure of 90/62 are considered low. To prevent the client from bottoming out, the drug should be held and the findings reported to the RN, who should consult with the attending physician. LPNs should never adjust client dosing, as that is outside of their scope of practice.
The nurse is concerned that the adolescent may be developing a side effect of methotrexate. Which test or exam results should the nurse review prior to administration?
- A. Folic acid level
- B. Serum electrolytes
- C. Complete blood count
- D. Activated partial prothrombin time
Correct Answer: C
Rationale: A: Although methotrexate is a folic acid antagonist, it does not alter serum levels. B: Methotrexate has no effect on electrolytes. C: An adverse effect of methotrexate (Trexall) is aplastic anemia; thus, the nurse should review the CBC results before administration. D: Methotrexate has no effect on coagulation.
A nurse working a surgical unit, notices a patient is experiencing SOB, calf pain, and warmth over the posterior calf. All of these may indicate which of the following medical conditions?
- A. Patient may have a DVT.
- B. Patient may be exhibiting signs of dermatitis.
- C. Patient may be in the late phases of CHF.
- D. Patient may be experiencing anxiety after surgery.
Correct Answer: A
Rationale: All of these factors (SOB, calf pain, and warmth) indicate a deep vein thrombosis (DVT), which can be a postoperative complication.
The client is taking metolazone and diltiazem for treatment of hypertension. Which statement made by the client to the nurse indicates further teaching is needed?
- A. I eat foods high in potassium to prevent the development of hypokalemia.
- B. Metolazone makes me urinate more, so I take my last dose at suppertime.
- C. I took my medication at breakfast with eggs, toast, grapefruit juice, and milk.
- D. Ibuprofen affects my urine output, so I prefer to take acetaminophen for pain.
Correct Answer: C
Rationale: A: Consuming foods daily that are high in potassium is recommended. Thiazide diuretics such as metolazone (Zaroxolyn) can result in hypokalemia. B: The diuretic metolazone (Zaroxolyn) should not be taken at bedtime to avoid nocturia and the subsequent loss of sleep. C: The client should not consume grapefruit juice because it inhibits the metabolism of diltiazem (Cardizem) and can cause toxicity. This client statement indicates the need for further teaching. D: NSAIDs such as ibuprofen (Advil, Motrin) can decrease the diuretic and antihypertensive effects of thiazide diuretics.