Nokea
The management of nausea as a side effect of lithium carbonate (Eskalith) includes instructing the patient to take the medication:
- A. after meals
- B. between meals
- C. with a carbonated beverage
- D. with a large glass of water
Correct Answer: A
Rationale: Taking lithium after meals reduces gastrointestinal irritation, including nausea, by buffering its absorption.
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Which statement by a patient with bulimia nervosa indicates a need for further education?
- A. I understand that purging can damage my body in the long term.
- B. I feel better after purging, but I know it's not a healthy behavior.
- C. I believe I can control my eating and purging behaviors without help.
- D. I know I need therapy to address my unhealthy relationship with food.
Correct Answer: C
Rationale: Rationale:
Choice C indicates a need for further education because it suggests the patient believes they can manage bulimia without help. Patients with bulimia often require professional intervention for successful treatment. Choices A, B, and D acknowledge the need for therapy, understanding of long-term consequences, and recognition of unhealthy behaviors, respectively.
The spouse of a man being treated with sertraline (Zoloft) calls to report that he had a grand mal seizure. Prior to the seizure, he had seemed confused and his forehead felt hot. The man does not have a seizure-disorder history. Which action should the nurse direct the spouse to take?
- A. Monitor the patient and notify the clinic if there are more seizures.
- B. Hold all medications and call 911 for transportation to the hospital.
- C. Hold tonight's sertraline and encourage him to drink more fluids.
- D. Administer an antipyretic drug to lower his fever and prevent seizures.
Correct Answer: B
Rationale: Step 1: The man had a grand mal seizure, confusion, and a hot forehead, which are signs of serotonin syndrome, a serious side effect of sertraline.
Step 2: The nurse should direct the spouse to hold all medications to prevent further serotonin syndrome symptoms.
Step 3: Calling 911 for immediate transportation to the hospital is crucial for prompt evaluation and treatment of the seizure and serotonin syndrome.
Step 4: This action ensures the man receives appropriate medical care to address the seizure and manage the potential serotonin syndrome.
Summary:
- Choice A is incorrect as monitoring the patient at home is not sufficient for a serious medical emergency like serotonin syndrome.
- Choice C is incorrect as simply holding tonight's sertraline and encouraging fluids does not address the immediate need for medical intervention.
- Choice D is incorrect as administering an antipyretic drug does not address the underlying cause of the seizure and confusion, which is serotonin syndrome.
A client who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia developed tardive dyskinesia as evidenced by tongue thrusting and chewing motions. The physician discontinued the chlorpromazine and prescribed Seroquel (quetiapine). As a result of this change, the nurse should carefully monitor for:
- A. Development of pseudoparkinsonism
- B. Development of dystonic reactions
- C. Improvement in tardive dyskinesia
- D. Worsening of anticholinergic symptoms
Correct Answer: C
Rationale: The correct answer is C: Improvement in tardive dyskinesia. Tardive dyskinesia is a side effect of long-term antipsychotic use, such as chlorpromazine. Quetiapine (Seroquel) is a second-generation antipsychotic with a lower risk of causing tardive dyskinesia. By discontinuing chlorpromazine and switching to quetiapine, the client is less likely to experience worsening of tardive dyskinesia symptoms. Monitoring for improvement in tardive dyskinesia is essential in this situation.
Choices A, B, and D are incorrect:
A: Development of pseudoparkinsonism is less likely with quetiapine compared to first-generation antipsychotics like chlorpromazine.
B: Dystonic reactions are acute side effects and are not typically associated with switching to quetiapine.
D: Anticholinergic symptoms are not directly related to tardive dyskinesia
An elderly client was well until 12 hours ago, when she reported to her family that during the evening she saw strange faces peering in her windows and in the middle of the night awakened to see a man standing at the foot of her bed. She admits to being very frightened. She is presently pacing and somewhat agitated in the examining room. The client's family reports that the client has recently been to the doctor, who made some medication changes, although they are unsure what the changes were. Which nursing intervention should the nurse implement at the time of this client's admission?
- A. Interact with the client on an adult to child level.
- B. Place the client in a safe, nonstimulating environment.
- C. Ask client why she thinks someone would be trying to frighten her.
- D. Explain to the family that the client will be restrained for her own good.
Correct Answer: B
Rationale: The correct answer is B: Place the client in a safe, nonstimulating environment. This is the most appropriate nursing intervention because the client is experiencing hallucinations and agitation, which could be due to the recent medication changes. Placing the client in a safe, calm environment can help reduce stimulation and provide a sense of security. This intervention addresses the client's immediate needs by ensuring her safety and promoting a sense of comfort.
Incorrect answers:
A: Interact with the client on an adult to child level - This is not appropriate as it does not address the client's current state of distress and could potentially worsen the situation.
C: Ask client why she thinks someone would be trying to frighten her - This is not the priority at this time, as the client is experiencing hallucinations and agitation that need to be managed first.
D: Explain to the family that the client will be restrained for her own good - Restraints should only be used as a last resort and should not be considered
The physician prescribes haloperidol (Haldol), a first-generation antipsychotic drug, for a patient with schizophrenia who displays delusions, hallucinations, apathy, and social isolation. Which symptoms should most be monitored to evaluate the expected improvement from this medication?
- A. Talking to himself, belief that others will harm him
- B. Flat affect, avoidance of social activities, poor hygiene
- C. Loss of interest in recreational activities, alogia
- D. Impaired eye contact, needs help to complete tasks
Correct Answer: A
Rationale: The correct answer is A because the symptoms of delusions and hallucinations are key indicators of improvement in schizophrenia with antipsychotic treatment. These symptoms directly relate to the patient's perception of reality and are core features of the disorder. Monitoring these symptoms provides objective evidence of the medication's effectiveness in addressing the patient's psychotic symptoms.
Choices B, C, and D are incorrect because they mainly indicate negative symptoms of schizophrenia, such as flat affect, social withdrawal, and cognitive deficits. While monitoring these symptoms is important for assessing overall functioning and quality of life, they are not the primary target of improvement with antipsychotic medications. Symptoms like delusions and hallucinations are considered primary targets for evaluating the efficacy of antipsychotic treatment in schizophrenia.