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The parent of the adolescent taking chlordiazepoxide for the past 2 months telephones the nurse requesting to have the dose increased. The parent states, “Chlordiazepoxide is being given as directed, but my child's anxiety is increasing.†Which should be the nurse's best interpretation of this situation?
- A. The client may be developing tolerance to chlordiazepoxide and needs the dose reevaluated.
- B. The client may be skipping drug doses when not anxious and now needs the dose doubled.
- C. The client is becoming resistant to the drug effects, and an alternative medication is needed.
- D. The client's anxiety may be hormone-related, and larger doses of chlordiazepoxide are needed.
Correct Answer: A
Rationale: The client is describing tolerance, a sign of dependence, to chlordiazepoxide (Librium), and the dose needs reevaluation.
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The client is placed on lorazepam for short-term treatment of anxiety. Which instruction by the nurse is most important with lorazepam use?
- A. Take a second tablet if your anxiety is not being adequately relieved.
- B. If lorazepam is less effective after a few weeks, notify your provider.
- C. Avoid caffeinated foods and beverages, including tea and chocolate.
- D. If you are experiencing drowsiness or dizziness, notify your provider.
Correct Answer: B
Rationale: Lorazepam (Ativan) is a benzodiazepine anxiolytic and sedative-hypnotic medication. If it is less effective after a few weeks, the client may be developing a tolerance to lorazepam, and the HCP should be notified of this.
The LPN is caring for a 9 month-old infant. Which of these behaviors exhibited by the child warrants further investigation?
- A. She prefers crawling and is making no attempt to walk.
- B. She seems distressed with new adults.
- C. She does not respond to her own name.
- D. She only babbles "mama" and "dada."
Correct Answer: C
Rationale: By 9 months, children should be babbling simple words and crawling, and they should recognize and respond to their own name. They may begin attempting to walk or may just be starting to attempt to pull themselves up to stand. Strangers often produce fear or anxiety in infants this age.
The client is receiving fludrocortisone for treatment of adrenocortical insufficiency. The nurse is evaluating the client's serum laboratory values for adverse effects of the medication. Place an X in the column indicated for the laboratory values that the nurse should specifically review to evaluate the adverse effects of fludrocortisone. Select all that apply.
- A. Glucose
- B. TSH
- C. Potassium
- D. Platelets
- E. FreeT4
- F. Calcium
Correct Answer: A,C,D,F
Rationale: Adverse effects of fludrocortisone (Florinef) include hyperglycemia, hypokalemia, hypocalcemia, and thrombocytopenia. The nurse should review serum glucose, potassium, calcium, and platelet counts. Thyroid hormones of TSH and free T4, although abnormal, are unaffected by fludrocortisone administration.
The nurse is teaching the 14-year-old who is being given captopril for the first time. Which explanation would be most appropriate?
- A. Captopril will help to control your asthma.
- B. Captopril will help to control your heart rate.
- C. Captopril will help to control your blood sugar.
- D. Captopril will help to control your blood pressure.
Correct Answer: D
Rationale: A: Captopril does not have any effect on asthma. B: While HR may slow in response to lowered BP, this is not the desired effect for which captopril is given. C: Captopril does not have any effect on blood sugar. D: Captopril (Capoten) is an ACE inhibitor and is indicated for the treatment of hypertension in children.
The adolescent, who is receiving morphine sulfate via PCA, has itching. Which medication listed on the client's MAR should the nurse plan to administer to relieve the itching?
- A. Diazepam
- B. Diphenhydramine
- C. Naloxone hydrochloride
- D. Butenafine hydrochloride
Correct Answer: B
Rationale: A: Diazepam (Valium) acts on the CNS to produce sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity. B: Diphenhydramine (Benadryl) is an antihistamine that blocks histamine release by competing for the histamine receptors. C: Naloxone (Narcan) is a narcotic antagonist that reverses the effects of opiates. D: Butenafine (Mentax) is an antifungal antibiotic used to treat tinea pedis, tinea corporis, and tinea cruris.