Nokea
The nurse is reinforcing teaching with a client who has a prescription for sertraline for the treatment of depression. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. I can discontinue the medication as soon as I start feeling better
- B. I should avoid eating aged cheeses, cured meats, or pickled foods
- C. I should expect to feel better within 2 to 3 days after starting this medication
- D. I will report any thoughts of self-harm to my health care provider
Correct Answer: D
Rationale: Reporting self-harm thoughts is critical, as sertraline may increase suicide risk initially. Discontinuing abruptly risks relapse, food restrictions apply to MAOIs, and benefits take weeks, not days.
You may also like to solve these questions
The nurse is caring for several 70 to 80 year-old clients on bed rest. What is the most important measure to prevent skin breakdown?
- A. Massage legs frequently
- B. Frequent turning
- C. Moisten skin with lotions
- D. Apply moist heat to reddened areas
Correct Answer: B
Rationale: Frequent turning. Frequent turning will prevent skin breakdown by relieving prolonged pressure on any one area.
A 4-month-old infant is being treated for talipes equinovarus (clubfoot). The nurse should include which of the following in the priority teaching plan for the parents?
- A. Monitor respiratory rate
- B. Monitor intake and output every hour
- C. Assist the client to breathe into a paper bag
- D. Prepare to administer oxygen by mask
Correct Answer: C
Rationale: Assisting the client to breathe into a paper bag addresses hyperventilation caused by aspirin toxicity, which can lead to respiratory alkalosis in the initial stages.
An adult is receiving cancer chemotherapy. Metoclopramide (Reglan) is also prescribed. The client asks why she is getting Reglan. How should the nurse respond?
- A. Reglan helps to prevent bleeding that may occur as a side effect of your other medications.'
- B. Reglan helps to prevent any nausea and vomiting that may occur as a side effect of your other medications.'
- C. Reglan increases the effectiveness of the cancer chemotherapeutic agents.'
- D. Reglan helps to control pain associated with your disease.'
Correct Answer: B
Rationale: Metoclopramide is an antiemetic, prescribed to prevent nausea and vomiting, common chemotherapy side effects, improving patient comfort.
The client has an IV in place when he returns for surgery. While examining the IV site, the licensed practical nurse notices pallor, coolness, and edema. The nurse is aware that these are signs of:
- A. Infiltration
- B. Infection
- C. Thrombus formation
- D. Sclerosing of the vein
Correct Answer: A
Rationale: Pallor, coolness, and edema at an IV site indicate infiltration, where IV fluid leaks into surrounding tissue. Infection shows redness and warmth, thrombus formation may cause pain and redness, and sclerosing involves vein hardening, not edema.
The orthopedic health care provider instructs a client with a fractured right femur, who has been non-weight bearing for the past 5 weeks, to progress to full-weight bearing on the right leg. Which advanced crutch gait that most closely resembles normal walking should the nurse reinforce when teaching the client?
- A. 2-point gait
- B. 3-point gait
- C. 4-point gait
- D. 5-point gait
Correct Answer: A
Rationale: The 2-point gait mimics normal walking, alternating crutch and opposite leg, suitable for full-weight bearing. 3-point is for non-weight bearing, 4-point is slower, and 5-point does not exist.