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A client taking mirtazapine is disheartened about a 20 lb (9 kg) weight gain over the past 3 months. The client tells the nurse, "I stopped taking my mirtazapine 15 days ago. I do not want to get depressed again, but I feel awful about my weight." Which response by the nurse is most appropriate? a) "I hear how difficult this is for you and will help you approach your health care provider about it." b) "Look at all the positive things that have happened to you since you started mirtazapine." c) "Your depression is much better now, so your medication is helping you." d) "Focusing on diet and exercise alone should control your weight."
"I hear how difficult this is for you and will help you approach your health care provider about it." Explanation: The nurse should express concern for the client and offer to help the client speak with the HCP, which will lend support to the client's concerns. The client who has stopped the medication must be taken seriously because medication noncompliance could result in a recurrence of symptoms of depression. Telling the client to focus on diet and exercise ignores the client's feelings and subtly implies the weight gain is the client's fault. Pointing out that the medication has helped and that positive things have happened since the depression lifted may be true, but it does not address the client's current feelings or needs.
An elderly client hospitalized 4 days ago for treatment of acute respiratory distress has become confused and disoriented. The client has been picking invisible items off blankets and has been yelling at the daughter who is not in the room. The family tells the nurse that the client has been treated for anxiety with alprazolam for years, but alprazolam is not on the current medication list. Which safety measures should be implemented? Select all that apply. a) The daughter should not visit until the client is better. b) A prescription should be obtained to help with the hallucinations. c) The client's medical and mental status will be evaluated frequently and treated as needed. d) The client will be placed on withdrawal precautions and treatment started immediately. e) The client will be placed in soft restraints.
• The client will be placed on withdrawal precautions and treatment started immediately. • A prescription should be obtained to help with the hallucinations. • The client's medical and mental status will be evaluated frequently and treated as needed. Explanation: Especially in the elderly, alprazolam withdrawal requires immediate and aggressive treatment. Hallucinations are frightening for the client and family. Changes in medical and mental status can occur quickly in the elderly and the client must be monitored closely. Restraints are not indicated for the client and would likely aggravate the confusion and agitation. There is no need to restrict the daughter from visiting at this point
Which of the following instructions should the nurse give to the parents of an 8-year-old child with asthma who is being switched from parenteral steroid therapy to a daily dose of oral prednisone? a) "Administer the dose before bedtime to minimize adverse effects." b) "Have the child take the dose with meals to prevent gastric irritation." c) "Give the medication according to the child's response." d) "Make sure to give the pill intact to maintain the enteric coating."
"Have the child take the dose with meals to prevent gastric irritation." Explanation: Prednisone causes severe gastric upset. Therefore, it should be given with food. It is recommended that the daily dose be given in the morning before 9 a.m. (0900) Given at this time, the medication will suppress adrenal cortex activity less, which may reduce the risk of hypothalamic-pituitary-adrenal--axis suppression. The drug must be given as prescribed and not titrated to response. If the drug has been given over a long period, abrupt cessation can cause serious side effects. Because the pills are not enteric coated, they may be crushed and mixed with food if the child has difficulty swallowing them.
Which statement by a client who has been taking buspirone as prescribed for 2 days indicates the need for further teaching? a) "I may not feel better for 7 to 10 days." b) "The drug does not cause physical dependence." c) "This medication will help my tight, aching muscles." d) "I can take the medication with food."
"This medication will help my tight, aching muscles." Explanation: Buspirone, a nonbenzodiazepine anxiolytic, is particularly effective in treating the cognitive symptoms of anxiety, such as worry, apprehension, difficulty with concentration, and irritability. Buspirone is not effective for the somatic symptoms of anxiety (muscle tension). Therapeutic effects may be experienced in 7 to 10 days, with full effects occurring in 3 to 4 weeks. This drug is not known to cause physical or psychological dependence. It can be taken with food or small meals to reduce gastrointestinal upset.
The health care provider (HCP) prescribes ampicillin 100 mg/kg/dose for a newly admitted neonate. The neonate weighs 1,350 g. How many milligrams should the nurse administer? Record your answer using a whole number.
135 Explanation: The recommended dose of ampicillin for a neonate is 100 mg/kg/dose. First, determine the neonate's weight in kilograms, and then multiply the kilograms by 100 mg. The nurse should use this formula: 1,000 g = 1 kg 1,350 g = 1.35 kg 100 mg × 1.35 kg = 135 mg/kg
A client returns to the room from the postanesthesia care unit after undergoing a right hemicolectomy. The health care provider orders 1 L of dextrose 5% in half-normal saline solution to infuse at 125 ml/hour. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Round your answer to the nearest whole number. (For example: 62)
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Which statement should be included when teaching clients about monoamine oxidase (MAO) inhibitors? a) Don't take an MAO inhibitor with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). b) Avoid strenuous activity because of the drug's cardiac effects. c) Have blood levels screened weekly for leukopenia. d) Don't take any prescribed or over-the-counter medications without consulting a physician and pharmacist.
Don't take any prescribed or over-the-counter medications without consulting a physician and pharmacist. Explanation: When combined with a number of drugs MAO inhibitors can cause life-threatening hypertensive crisis. It's imperative that a client using MAO inhibitors check with his physician and pharmacist before taking any other medications. Activity limitations are unnecessary. Blood disorders aren't a common problem with MAO inhibitors. Aspirin and NSAIDs are safe to take with MAO inhibitors.
A nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is: a) diphenhydramine. b) benztropine. c) haloperidol. d) propranolol.
benztropine. Explanation: Benztropine, trihexyphenidyl, or amantadine are ordered for treatment of Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.
At what time should the blood be drawn in relation to the administration of the IV dose of gentamicin sulfate? a) just before the administration of the next IV dose b) 3 hours before the administration of the next IV dose c) 2 hours before the administration of the next IV dose d) 4 hours before the administration of the next IV dose
just before the administration of the next IV dose Explanation: To determine how low the gentamicin serum level drops between doses, the trough serum level should be drawn just before the administration of the next IV dose of gentamicin sulfate.
When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which laboratory value? a) serum potassium b) serum calcium c) serum creatinine d) serum sodium
serum creatinine Explanation: It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibiotic because of the potential of this type of drug to cause acute tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels.
