Nokea
The nurse is caring for a client who is receiving valproic acid. What clinical manifestation should the nurse periodically monitor for?
- A. Hepatotoxicity
- B. Hypertensive crisis
- C. Orthostatic hypotension
- D. Hyper alertness
Correct Answer: A
Rationale: The nurse should closely monitor a client on valproic acid, Depakote or Depakene, for hepatotoxicity. Frequent liver function tests and serum ammonia concentrations may be ordered. When a monoamine oxidase inhibitor is mixed with foods containing tyramine, clients are likely to develop a potentially fatal hypertensive crisis, not when taking valproic acid. Risk for orthostatic hypotension from psychotropic drugs is increased in older adults because of decreased functioning of the blood pressure-regulating mechanism. Some clients administered valproic acid experience sedation and ataxia.
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The nurse is completing a plan of care for a client on lithium therapy to manage bipolar symptoms. Which nursing intervention(s) will be included? Select all that apply.
- A. Monitor for symptoms of nausea, vomiting, muscle weakness, and lack of coordination.
- B. Increase fluid intake to 5000 mL/day.
- C. Limit sodium intake daily.
- D. Monitor kidney and liver functioning.
- E. Instruct client that it may take up to 6 weeks to reach therapeutic level.
- F. Monitor intake and output.
Correct Answer: A,B,D,F
Rationale: The nurse is correct to place in the plan of care interventions that include monitoring for symptoms of lithium toxicity, increasing fluid intake to maintain fluid balance, monitoring kidney and liver function, and monitoring intake and output. Salt intake is important to regulate lithium levels in the body. A therapeutic lithium level is accomplished in a few days to a week.
The nurse is admitting a client to a mental health clinic following a recent suicide attempt and hospitalization. In assessing the client's status, which question is most helpful?
- A. How are you currently feeling?
- B. What made you decide to commit suicide?
- C. Do you have a suicide plan or thoughts of harming yourself?
- D. What method did you choose for your suicide attempt?
Correct Answer: C
Rationale: In assessing the client's status, it is best to evaluate suicide risk factors. A client who is at the highest risk for suicide is the client who verbalizes a desire to end life and has a plan. The other questions are relevant but not the best question for gaining essential information.
The nurse is caring for a middle-aged client prescribed a selective serotonin reuptake inhibitor (SSRI). Which side effect of medication therapy leads to the most common cause of noncompliance?
- A. Hypertension
- B. Dizziness
- C. Hallucinations
- D. Sexual dysfunction
Correct Answer: D
Rationale: When taking a selective serotonin reuptake inhibitor, the nurse must instruct on the most common side effect, which is sexual dysfunction. Unfortunately, sexual dysfunction (reduced desire for sex, erectile and ejaculatory dysfunction, and the inability to orgasm) is a frequent and undesirable side effect that leads to noncompliance in medication regimen. The other side effects are not associated with use of SSRIs.
The nurse is providing teaching to a client starting monoamine oxidase inhibitor (MAOI) drug therapy. Which over-the-counter medications should the nurse instruct the client to avoid?
- A. Cold and allergy medications
- B. Antiulcer medications
- C. Multivitamins
- D. Laxatives
Correct Answer: A
Rationale: The nurse is correct to place cold and allergy medications on a clinical reference guide of over-the-counter medications to avoid. These preparations may have a drug-drug interaction. The client can use over-the-counter antiulcer medications, multivitamins, and laxatives per physician instruction.
What is an example of sub-acute symptoms that may be observed in the older adult who may be depressed?
- A. Weight gain
- B. Lack of energy
- C. Memory loss
- D. Increased sleep
Correct Answer: B
Rationale: The examples of sub-acute symptoms that may be observed in the older adult who may be depressed are loss of appetite, trouble sleeping, lack of energy, and weight loss.