Nokea
The severely depressed client tells the nurse, “I don't need these antidepressants; they're too expensive! I'm going to use St. John's wort instead.†Which is the most appropriate response by the nurse?
- A. It would be a safe alternative, especially if you need to watch your finances.
- B. What about taking St. John's wort and an antidepressant for greater effectiveness?
- C. St. John's wort may cost less, but it has not been shown to improve severe depression.
- D. I have some information showing the effective use of St. John's wort. Let's go over it.
Correct Answer: C
Rationale: St. John's wort has not been clinically proven effective for severe depression.
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The client taking glyburide 5 mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client's fingerstick blood sugar result is 56 mg/dL. Which question is most important for the nurse to ask the client?
- A. How many grams of protein do you normally eat?
- B. What time did you eat your dinner last night?
- C. How often do you check your blood sugar level?
- D. What was your alcohol intake like this past week?
Correct Answer: D
Rationale: A: Carbohydrate intake, not protein, is more important to consider in diabetic clients in relation to blood sugar levels. B: Glyburide once daily dose is taken with breakfast, so asking the client about dinner is not consistent with drug administration. C: Asking the client frequency of checking blood sugar levels will not help determine the possible causes of the client's symptoms. D: Alcohol use while taking sulfonylureas such as glyburide (DiaBeta, Micronase) can cause a disulfiram-like reaction, manifested by abdominal cramps, nausea, headache, flushing, and hypoglycemia.
The nurse receives an order to administer phenytoin through the client's J-tube. The order instructs that tube feedings are stopped at least an hour prior to administering the medication and an hour after medication is administered. Which of the following considerations may be a reason to discuss this order with the physician?
- A. The client has a history of Type II diabetes.
- B. The client is on a continuous tube-feeding regimen.
- C. The client is on fluid-restriction.
- D. The pharmacy has provided phenytoin in tablet form.
Correct Answer: B
Rationale: For a client on a continuous tube-feeding regimen, stopping tube feedings for two hours to administer this medication may compromise the client's nutritional status.
The nurse is assessing the 13-year-old who has been taking somatropin recombinant. Which findings should the nurse report to an HCP?
- A. Erythematous palmar rash
- B. Blood pressure of 122/74 mm Hg
- C. Random blood glucose of 158 mg/dL
- D. X-ray report noting epiphyseal closure
Correct Answer: D
Rationale: A: Erythematous palmar rash is not associated with the use of GH. B: BP of 122/74 in a 13-year-old is considered normal. C: Although GH use may be associated with blood glucose changes, a random blood glucose of 158 mg/dL is normal. D: Somatropin (Genotropin) recombinant is an injectable GH indicated for children with a deficiency of the hormone. It cannot be given once the epiphyses have closed. The nurse should notify the HCP.
One day postoperative, the client complains of dyspnea, and his respiratory rate (RR) is 35, slightly labored, and there are no breath sounds in the lower-right base. The nurse should suspect:
- A. Cor pulmonale
- B. Atelectasis
- C. Pulmonary embolus
- D. Cardiac tamponade
Correct Answer: B
Rationale: No breath sounds in the lower-right base postoperative suggest atelectasis, a lung collapse common after surgery, causing dyspnea and tachypnea.
The nurse is preparing to administer medications at 1700 to multiple clients with GI problems. Which medication should be the nurse's priority when the meal trays are due to arrive at 1700?
- A. Misoprostol
- B. Famotidine
- C. Cimetidine
- D. Bisacodyl
Correct Answer: A
Rationale: A: The nurse's priority should be to administer misoprostol (Cytotec), a gastric protectant, first because it should be taken with meals to minimize diarrhea. B: Famcomputers (Pepcid), a histamine receptor agonist, should be taken after meals. C: Cimetidine (Tagamet HB), a histamine receptor agonist, should be taken after meals. D: Bisacodyl (Dulcolax), a laxative, should be taken at least one hour after meals.