Nokea
The nurse is teaching the client newly started on propranolol for acute situational anxiety disorder. In addition to treating the client's anxiety, the nurse should inform the client that propranolol's use is effective in treating which associated problem?
- A. Bradycardia
- B. Hand tremors
- C. Muscle spasms
- D. Hypertensive crisis
Correct Answer: B
Rationale: Propranolol (Inderal), a beta blocker, has been shown to be effective in ameliorating the somatic symptoms of anxiety such as hand tremor.
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Trimethoprim-sulfamethoxazole is prescribed for the child who develops a UTI. What information should the nurse address when teaching the parents about administering the medication? Select all that apply.
- A. Weigh the child daily in the morning.
- B. Take the child's temperature once daily.
- C. Encourage the child to drink plenty of fluids.
- D. Administer the medication at the prescribed times.
- E. If a rash occurs, report this immediately to the HCP.
Correct Answer: C,D,E
Rationale: A: Weighing is unnecessary; it is important with medications that affect fluid balance, but not with an antibiotic. B: Monitoring temperature would be important to evaluate the effectiveness of antipyretic medications. C: Fluids should be increased to dilute bacterial toxins and increase urinary output. D: The medication should be given in the exact amount at the times directed to maintain a therapeutic blood level. If the therapeutic blood level falls, organisms can build a resistance to the medication. E: Trimethoprim-sulfamethoxazole (Bactrim) is a sulfonamide antibiotic. A rash can indicate an allergy to sulfonamides.
The HCP prescribes 1200 mL of TPN solution to be administered over 24 hours for the homebound client. The home health nurse should instruct the client to set the infusion pump to deliver how many mL per hour?
Correct Answer: 50
Rationale: To calculate the infusion rate, divide the total volume by the total time: 1200 mL/ 24 hours = 50 mL per hour. The nurse should instruct the client to set the infusion pump to deliver 50 mL per hour.
The client with CRF receives a sodium polystyrene sulfonate enema. Which finding indicates that the medication is achieving the desired therapeutic effect?
- A. Returns of dark-colored stool
- B. Able to retain solution for 1 hour
- C. Verbalizes relief of constipation
- D. Serum potassium level 4.0 mEq/L
Correct Answer: D
Rationale: A: Although sodium polystyrene sulfonate may be administered as an enema and stool may return, the purpose of the medication is to lower serum potassium levels and not to empty the bowel. B: The client should be encouraged to retain the enema solution for as long as possible so that sodium ions can be exchanged for potassium ions in the intestine, but its retention for this length of time does not indicate its effectiveness in lowering the serum potassium level. C: The client may be constipated prior to receiving the enema, but this is not the purpose of a sodium polystyrene sulfonate enema. D: Sodium polystyrene sulfonate exchanges sodium ions for potassium ions in the intestine and is administered when the client has hyperkalemia. A normal serum potassium level of 4.0 mEq/L indicates that the medication is achieving its desired therapeutic effect.
The client's dose of mirtazapine was increased from 15 to 30 mg at bedtime two days ago. When the nurse is preparing to administer mirtazapine, the client reports having insomnia, irritability, and panic attacks. What should the nurse do next?
- A. Document the symptoms, hold the dose, and notify the HCP.
- B. Telephone the HCP to request a pm sedative to help the client sleep.
- C. Have the client participate in a card game with other clients on the unit.
- D. Reassure the client that these symptoms will subside after taking this dose.
Correct Answer: A
Rationale: Mirtazapine (Remeron) is an antidepressant. Adverse effects include insomnia, irritability, panic attacks, and suicidal ideation. A change in medication may be needed rather than a dosage increase.
The nurse is assessing an 18-month-old. Which of these statements made by the parent or caregiver would require follow-up?
- A. I'm worried that my child is not using two-word phrases yet.
- B. My child has recently taken a few steps but does not seem stable when standing.
- C. My child seems to have developed separation anxiety when I leave.
- D. I'm letting my child use a spoon to eat.
Correct Answer: B
Rationale: Around 12 months of age, children should have taken their first steps and stand well. If a child hasn't made progress by 18 months old, a physical therapy evaluation may be necessary. At 18 months, the child should be using a spoon to eat. However, two-word phrases are not expected until 2 years. Separation anxiety is expected between 6 and 18 months.