Nokea
The mother asks the nurse why the anticonvulsant valproic acid is being prescribed for her adolescent who is beginning therapy for control of aggressive behaviors. The nurse's response is based on the fact that valproic acid is helpful in reducing manic and impulsive behavior by what mechanism of action?
- A. Block the effects of dopamine at the postsynaptic neuron
- B. Enhance the reuptake of norepinephrine and serotonin in the CNS
- C. Alter sodium channels in the neurons, thus decreasing nerve impulse transmission
- D. Increase gamma-aminobutyric acid (GABA) levels to inhibit CNS neurotransmission
Correct Answer: D
Rationale: Valproic acid (Depakote) increases levels of GABA, an inhibitory neurotransmitter in the CNS.
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Nursing care for a client undergoing chemotherapy includes assessment for signs of bone marrow depression. Which finding accounts for some of the symptoms related to bone marrow depression?
- A. erythrocytosis
- B. leukocytosis
- C. polycythemia
- D. thrombocytopenia
Correct Answer: D
Rationale: Thrombocytopenia is an abnormal decrease in the number of platelets, which results in bleeding tendencies. Erythrocytosis is an abnormal increase in the number of circulating red blood cells. Leukocytosis is an increase in the number of white blood cells in the blood. Polycythemia is also an excess of red blood cells and is a synonym for erythrocytosis. With chemotherapy there is a decrease in red and white blood cells, not an increase.
A client who is newly diagnosed with Parkinson's disease and beginning medication therapy asks the nurse, 'How soon will I see improvement?' The nurse's best response is:
- A. That varies from client to client
- B. You should discuss that with your physician
- C. You should notice a difference in a few days
- D. It might take several weeks before you notice improvement
Correct Answer: D
Rationale: Parkinson's medications often take several weeks to show improvement, as they gradually adjust neurotransmitter levels to manage symptoms.
The client calls a clinic to renew the prescription for insulin being administered subcutaneously via an insulin pump. Which insulin type, if prescribed by the HCP, should the nurse question?
- A. Insulin lispro
- B. Insulin aspart
- C. Insulin glulisine
- D. Insulin glargine
Correct Answer: D
Rationale: A: Lispro (Humalog) is a rapid-acting human insulin analog that can be delivered via an insulin pump. B: Aspart (NovoLog) is a rapid-acting human insulin analog that can be delivered via an insulin pump. C: Glulisine (Apidra) is a rapid-acting human insulin analog that can be delivered via an insulin pump. D: The nurse should question if glargine (Lantus) is prescribed. Glargine is long-duration insulin not suited for delivery by an infusion pump.
An LPN is taking care of an elderly client who experiences the effects of Sundowner's Syndrome almost every evening. Which of these interventions implemented by the nurse would be the most helpful?
- A. Place a nightlight in the client's room.
- B. Administer the PRN sedative prescribed by the attending physician.
- C. Remind the client the things and people they are seeing are not real and that they are safe.
- D. Turn on the TV or radio to a station the client enjoys.
Correct Answer: A
Rationale: A nightlight will help reorient the client to his or her surroundings in the evening and nighttime hours. It is best not to challenge the reality of a client experiencing Sundowner's Syndrome, and sedatives may make the effects of the syndrome worse. Every effort should be made to keep the client's room calm, quiet, and peaceful, so noise should be kept to a minimum.
The client with COPD is prescribed salmeterol diskus inhaler and fluticasone Rotadisk inhaler. Which instruction should the nurse include to prevent the client from developing oropharyngeal candidiasis?
- A. Drink a glass of water before taking your medications.
- B. Rinse your mouth after using your inhaler medications.
- C. Wait at least one minute before taking the next medication.
- D. Close your mouth tightly around the inhaler mouthpiece.
Correct Answer: B
Rationale: A: Drinking fluids before inhaler use may moisten the mouth, but it does not prevent oropharyngeal candidiasis. B: Oropharyngeal candidiasis is a yeast infection that occurs in the mouth due to destruction of the normal flora with the use of a glucocorticoid inhaler (fluticasone [Advair]). The nurse should instruct the client to rinse the mouth after using the glucocorticoid inhaler to prevent its occurrence. C: For best effectiveness, the client should wait 5 minutes between medications, but this has no effect on prevention of oropharyngeal candidiasis. D: This describes the correct technique for using an inhaler but does not reduce the risk of developing oropharyngeal candidiasis.