Nokea
The nurse is caring for a client who has been prescribed prednisone. Which of the following statements, if made by the nurse, would be correct?
- A. This medication may make you gain weight.
- B. It is best to take this medication in the morning with food.
- C. If you have pain, it is okay to take ibuprofen.
- D. Your blood pressure may decrease while taking this medication.
- E. You may experience mood changes while on this medicine.
Correct Answer: A, B, E
Rationale: Prednisone can cause weight gain, should be taken in the morning with food to reduce GI upset, and may cause mood changes. Ibuprofen should be avoided due to increased GI risk, and prednisone may increase, not decrease, blood pressure.
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The following scenario applies to the next 1 items
The nurse is caring for a 23-year-old male in the psychiatry clinic
Item 1 of 1
History and Physical
Chief Complaint – 23-year-old male presents with his mother, who insists, 'he needs some help; all he does is work and play video games and doesn't socialize with anyone.'
History of Present Illness – 23-year-old Caucasian male presents with his mother with reports of his asociality starting to impact his life. He reports that while in high school, he had a degree of anxiety about socializing with his peers. He thought that as the years passed, it would get better.
He states his anxiety has declined, but he gets paranoid around individuals because they may want to 'do him wrong.' He cannot point to an example of maleficence caused by his friends. He states he doesn't have a problem with his self-esteem, but sometimes social situations are avoided because 'I can see ahead into the future, and I want to avoid people who can bring me harm through their negative energy.' The client reports that he spends his time playing video games, stating he likes games that are fantasy related because 'they take me a while.' He states he has a strong interest in tarot card readings, and for his close friends, he does provide readings. He did offer the examiner a tarot card reading. His interest in tarot cards came from his self-described ability to interpret the spirits of individuals and their auras.
He states that occasionally, he will browse social media and identify a quote or lyric that he feels 'was directed towards me.' The client is employed as an overnight hotel clerk, and his highest level of education is a high school diploma. The client has never been married and has no children. His last relationship was seven years ago, which was brief. He identifies himself as heterosexual. He has a distant criminal history of petty theft and identity theft. No history of violent crimes. He has never been incarcerated. He denies drinking alcohol. However, he does smoke marijuana 2-3x a week. He lives in the basement with his Mother and declines to move out because he has no plans.
Medical History – No past medical history, no past psychiatric history. The client has never been hospitalized—no family history of psychiatric illness.
Mental Status Examination – Alert and fully oriented; Fair concentration; No psychomotor retardation or agitation; Cooperative behavior; Adequately groomed; unkept hair that is bright green in color. He has multiple facial piercings (nose, eyebrow, lip). Speech is at a normal rate with a slightly increased volume Affect is bright, and he describes his mood as 'okay.' Denies suicidal or homicidal ideations. Intact insight and judgment
Complete the sentence below by choosing from the list of options. The client is at highest risk of developing ___ as evidenced by the client's ___
- A. antisocial personality disorder
- B. bipolar disorder
- C. schizotypal personality disorder
- D. dependent personality disorder
- E. illogical thought content
- F. criminal history
- G. self-esteem
Correct Answer: C, E
Rationale: The client's paranoia, magical thinking (tarot cards, auras), and social avoidance suggest schizotypal personality disorder, evidenced by illogical thought content.
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question?
- A. Levothyroxine for a client with a myxedema coma
- B. Hydrochlorothiazide for a client with hyperparathyroidism
- C. Hydrocortisone for a client with adrenal insufficiency
- D. Regular insulin for a client with diabetic ketoacidosis
Correct Answer: B
Rationale: Hydrochlorothiazide can worsen hypercalcemia in hyperparathyroidism and should be questioned.
The nurse is teaching a group of nursing students about the five rights of delegation. The nurse is correct to include that this involves the right
- A. intention
- B. alternative
- C. assessment
- D. task
Correct Answer: D
Rationale: The five rights of delegation include the right task, ensuring appropriate delegation.
The following scenario applies to the next 1 items
The case manager is reviewing the medical record of a client with schizophrenia
Item 1 of 1
Progress Notes
Discharge Summary
0900: Third involuntary admission in the past six months. The client was admitted four days ago because of florid psychosis. During the stay, the client was stabilized with their prescribed aripiprazole. Once stabilized, the client reported nonadherence to aripiprazole because they 'forget.' It is documented that the client also missed two follow-up appointments for some unknown reason. The client was prescribed aripiprazole oral disintegrating tablet (ODT) to optimize adherence versus tablets. Provided two refills and a follow-up appointment at discharge. Thorough counseling was provided regarding the dosing schedule. Considering the client's repeated nonadherence, there is a high probability of readmission. Will consult case management for follow-up.
Orders
0815:
• discharge client home
• case management consultation for repeated readmissions
• arrange outpatient follow-up appointment prior to discharge
• give morning dose of aripiprazole prior to discharge
• discharge with a prescription for aripiprazole 15 mg ODT daily
The case manager reviews the physician's progress notes and orders. Select the actions the case manager should take to reduce the client's risk of readmission.
- A. perform a post discharge follow-up phone call
- B. recommend the client be prescribed a long acting injectable antipsychotic
- C. review the client's advanced directives
- D. assess the client's social determinants of health
- E. arrange for more frequent follow-up appointments
Correct Answer: A, B, D, E
Rationale: Follow-up calls, long-acting injectable antipsychotics, assessing social determinants, and frequent appointments address nonadherence and reduce readmission risk.
The nurse is caring for a client who has developed retinal detachment. Which of the following actions should the nurse take first?
- A. Instruct the client to restrict activity
- B. Establish a vascular access device
- C. Review the client's current medications
- D. Educate the client about topical eye ointments
Correct Answer: A
Rationale: Restricting activity is the first priority to prevent further retinal damage.