Nokea
You are caring for a patient who is preoperative and is NPO. The patient takes carbamazepine (Tegretol), 200 mg PO BID for a seizure disorder. Which of the following actions should you take?
- A. Give the oral dose of carbamazepine with a sip of water.
- B. Give carbamazepine IV.
- C. Withhold the carbamazepine.
- D. Administer half the usual morning dose of carbamazepine.
Correct Answer: A
Rationale: It is important to continue the oral carbamazepine to maintain therapeutic blood levels and to prevent seizure activity. You should notify the anesthesiologist and should give the patient the carbamazepine with a sip of water. Carbamazepine is not available IV. Withholding the carbamazepine may reduce the therapeutic blood level and cause seizure activity. Administering a reduced dose of carbamazepine may reduce the therapeutic blood level and cause seizure activity.
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The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make?
- A. Why are you crying? The medication will help the disease.
- B. You seem upset. I will sit down and we can talk for awhile.
- C. Multiple sclerosis is a disease that has good times and bad times.
- D. I will have the chaplain come and stay with you for a while.
Correct Answer: B
Rationale: Acknowledging the client's emotions and offering support is the most therapeutic response, as it validates their feelings and provides comfort.
The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client:
- A. You will need to accept the necessity for a quiet and inactive lifestyle.
- B. Keep active, use stress reduction strategies, and avoid fatigue.
- C. Follow good health habits to change the course of the disease.
- D. Practice using the mechanical aids that you will need when future disabilities arise.
Correct Answer: B
Rationale: Encouraging activity, stress reduction, and fatigue management is essential for maintaining quality of life in MS. A completely inactive lifestyle is not recommended.
During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient?
- A. Mobility
- B. Nutrition
- C. Respiratory function
- D. Verbal communication
Correct Answer: C
Rationale: Respiratory function is critical in myasthenic crisis
The nurse is providing post-procedure care for a patient recovering from a lumbar puncture. Which order should the nurse anticipate for this patient?
- A. Keep the patient NPO for 4 hours.
- B. Have the patient lie flat for 6 hours.
- C. Monitor the patient's pedal pulses every 4 hours.
- D. Keep the head of the bed elevated 30 degrees for 8 hours.
Correct Answer: B
Rationale: After a lumbar puncture, the patient should lie flat for 6 to 8 hours to prevent cerebrospinal fluid leakage and reduce the risk of a spinal headache. Monitoring pedal pulses or elevating the head of the bed is not necessary. Proper post-procedure care minimizes complications.
The following signs occur in ipsilateral interruption of the cervical sympathetic trunk:
- A. enophthalmos
- B. ptosis
- C. vasodilatation in the skin of the face
- D. All above
Correct Answer: D
Rationale: Interruption of the cervical sympathetic trunk leads to Horner's syndrome, characterized by ipsilateral ptosis (drooping eyelid), miosis (pupil constriction), and anhidrosis (lack of sweating). Enophthalmos (sunken eye) and vasodilatation in the facial skin may also occur due to loss of sympathetic tone.