Nokea
The client's dose of mirtazapine was increased from 15 to 30 mg at bedtime two days ago. When the nurse is preparing to administer mirtazapine, the client reports having insomnia, irritability, and panic attacks. What should the nurse do next?
- A. Document the symptoms, hold the dose, and notify the HCP.
- B. Telephone the HCP to request a pm sedative to help the client sleep.
- C. Have the client participate in a card game with other clients on the unit.
- D. Reassure the client that these symptoms will subside after taking this dose.
Correct Answer: A
Rationale: Mirtazapine (Remeron) is an antidepressant. Adverse effects include insomnia, irritability, panic attacks, and suicidal ideation. A change in medication may be needed rather than a dosage increase.
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Which of these medications has the least risk of causing tinnitus?
- A. Aspirin
- B. Lasix
- C. Gentamicin
- D. Fluoxetine
Correct Answer: D
Rationale: Gentamicin, Lasix, and Aspirin are all ototoxic drugs that have a potential side effect of causing tinnitus, a ringing in the ear. Fluoxetine, an SSRI, is not typically associated with tinnitus.
New medications are prescribed for the client taking lithium. Which medication, if prescribed, should the nurse question with the HCP?
- A. Isosorbide dinitrate by mouth tid
- B. Prednisone 20 mg by mouth daily
- C. Furosemide 80 mg by mouth daily
- D. Insulin aspart 2 units subcut with meals
Correct Answer: C
Rationale: Furosemide (Lasix) is a loop diuretic that promotes sodium loss and lithium retention, increasing serum lithium levels and risk of toxicity.
The HCP prescribed a dose of acetaminophen according to weight recommendations for the child weighing 48 lb. The package insert states that the recommended dose is 15 mg per kg. What dose should the nurse administer?
Correct Answer: 327
Rationale: First change 48 lb into kilograms (48 / 2.2 = 21.8 kg). Next determine the dose (21.8 kg x 15 = 327 mg). The child should receive 327 mg of acetaminophen (Tylenol).
The nurse evaluates that pancrelipase is having the optimal intended benefit for the client with CF. Which assessment finding prompted the nurse's conclusion?
- A. The client lost 4 pounds in 1 month.
- B. The client no longer has heartburn.
- C. The client has increased steatorrhea.
- D. The client has improved nutritional status.
Correct Answer: D
Rationale: A: Weight gain, not weight loss, is an intended effect. B: Pancrelipase is not used to treat abdominal heartburn. C: Pancrelipase reduces the amount of fatty stools (steatorrhea). D: Pancrelipase (Pancreaze) is a pancreatic enzyme used in clients with deficient exocrine pancreatic secretions, CF, chronic pancreatitis, or steatorrhea from malabsorption syndrome. Because it aids digestion, the nutritional status should be improved.
An LPN is tasked with checking the narcotic count on a medical surgical unit. Which statement by the LPN requires further investigation?
- A. I need a witness when I waste the leftover narcotics in the client's PCA pump.
- B. I am going to check the facility's policy for how to dispose of this controlled substance.
- C. I left the narcotics box unlocked after confirming the beginning of shift count was correct.
- D. The end of shift narcotics count is incorrect and needs to be reported.
Correct Answer: C
Rationale: Narcotics should be locked and kept in a secure place during the shift.