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The client diagnosed with bipolar disorder has been taking valproic acid (Depakote), an anticonvulsant, for four (4) months. Which assessment data would warrant the medication being discontinued?
- A. The client's eyes are yellow.
- B. The client has mood swings.
- C. The client's BP is 164/94.
- D. The client's serum level is 75 mcg/mL.
Correct Answer: A
Rationale: Yellow eyes suggest hepatotoxicity, a serious valproic acid side effect, warranting discontinuation. Mood swings, hypertension, or normal levels are less critical.
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The nurse is caring for a client with schizophrenia who has been treated with quetiapine (Seroquel) for 1 month. Today the client is increasingly agitated and complains of muscle stiffness. Which of these findings should be reported to the health care provider?
- A. Elevated temperature and sweating
- B. Decreased pulse and blood pressure
- C. Mental confusion and general weakness
- D. Muscle spasms and seizures
Correct Answer: A
Rationale: Elevated temperature and sweating. Neuroleptic malignant syndrome (NMS) is a rare disorder that can occur as a side effect of antipsychotic medications. It is characterized by muscular rigidity, tachycardia, hyperthermia, sweating, altered consciousness, autonomic dysfunction, and increase in CPK. This is a life-threatening complication.
The client diagnosed with multiple sclerosis (MS) is receiving Lioresal (baclofen), a muscle relaxant. Which information should the nurse teach the client/family?
- A. The importance of tapering off medication when discontinuing medication.
- B. Baclofen may cause diarrhea, so the client should take antidiarrheal medication.
- C. The client should not be allowed to drive alone while taking this medication.
- D. The need for follow-up visits to obtain a monthly white blood cell count.
Correct Answer: A
Rationale: Baclofen requires tapering to prevent withdrawal symptoms, like seizures, per FDA warnings. Diarrhea, driving, or WBC counts are not primary concerns.
The nurse is administering diltiazem (Cardizem) to a client. Prior to administration, it is important for the nurse to assess which parameter?
- A. Temperature
- B. Blood pressure
- C. Vision
- D. Bowel sounds
Correct Answer: B
Rationale: Blood pressure. Diltiazem (Cardizem) is a calcium channel blocker that causes systemic vasodilation resulting in decreased blood pressure.
The client is diagnosed with pernicious anemia. Which health-care provider order should the nurse anticipate in treating this condition?
- A. Subcutaneous iron dextran.
- B. Intramuscular vitamin B12.
- C. Intravenous folic acid.
- D. Oral thiamine medication.
Correct Answer: B
Rationale: Pernicious anemia results from B12 deficiency; IM B12 is standard treatment due to absorption issues. Iron, folic acid, or thiamine do not address the primary cause.
The client who has had a kidney transplant tells the nurse he has been taking St. John's wort, an herb, for depression. Which action should the nurse take first?
- A. Praise the client for taking the initiative to treat the depression.
- B. Remain nonjudgmental about the client's alternative treatments.
- C. Refer the client to a psychologist for counseling for depression.
- D. Instruct the client to quit taking the medication immediately.
Correct Answer: D
Rationale: St. John’s wort induces CYP3A4, reducing immunosuppressant efficacy (e.g., cyclosporine), risking transplant rejection. Stopping it is the priority.