A client calls the outpatient clinic after

A client calls the outpatient clinic after starting on lamotrigine (Lamictal) three days ago. The client reports developing a rash overnight and asks the nurse about stopping the medication. Which response by the nurse is most appropriate? “This is an expected reaction with this medication. If the rash gets worse, call back and we will schedule an appointment with your provider.” “Stop the medication and I will contact your provider. We will get you in for an appointment today.” “Have you had rashes before when you start on new medications? Just continue the medication and see if it resolves. Call back if it gets worse.” “Tell me more about the rash. I do not think it is anything to worry about but I can schedule you for an appointment later this week.” A client is taking the following medications: perphenazine (Trilafon) 4mg PO TID valproic acid (Depakote) 500mg PO BID benztropine (Cogentin) 1mg PO/IM PRN q 4hours for dystonia trazadone 50mg PO PRN QHS for insomnia Which assessment by the nurse indicates the need to administer the benztropine (Cogentin)? The client states, “I think I am getting a rash, and the nurse notes irritated/reddened areas on the client’s torso. The client is having increased auditory hallucinations and states, “The voices tell me to hurt myself.” The client is experiencing stiffness and tightness in the neck muscles and reports, “I cannot move my neck.” The client reports “I feel so depressed. I wish I would feel better, and isolates in room refusing groups. The nurse is working with a client in restraints for the first time after starting a new job on an inpatient psychiatric unit. Which statements by the nurse indicate an understanding of restraint use in the mental health setting? Select all that apply. “All restraints need to be removed immediately when the client viciously pulls on the restraints.” “Restraints are indicated only for imminent risk of harm to self or others.” “Restraint orders are time limited and PRN restraint orders are not permitted.” “Restraints are an important part of the treatment plan for individuals with self-harm behavior.” “Restraints are discontinued as soon as it is safe to do so.” “Debriefing with the client is necessary after any use of restraints.” A client is about to start fluoxetine (Prozac) therapy with 20 mg PO every morning. Which of the following statement by the nurse would be most relevant when educating this “Call the prescriber if you develop abnormally enlarged breasts.” “Take the medication with breakfast if you start experiencing nausea. “Cover vour pillow with a towel at night if drooling bothers you.” “Make sure to take your pulse before getting out of bed in the morning.” The nurse is assessing a client who is prescribed olanzapine (Zyprexa). The client experienced significant weight gain of 20 pounds over a 3 month period and now has a BMI 35. What other indicators would the nurse review to evaluate the client for metabolic syndrome? Select all that apply. Lipid profile History of smoking Blood pressure Waist circumference Hemoglobin A1C or fasting glucose Kidney function tests the client is brought to the ED by police after yelling at pedestrians on the street outside of Harborview. The client was stating, “I will kill you. I don’t care if I get arrested. I am going to kill myself anyway.” The client has a thin and malnourished appearance and declines food and fluid in the ED stating, “I know you are trying to poison me.” The nurse recognizes which reasons to initiate a referral for potential involuntary treatment for this client? Select all that apply. The client is trespassing parts of public property. The client is a danger to self. The client is disruptive to the community. The client is not adherent with prescribed medications. The client is gravely disabled and not able to meet basic needs. The client is a danger to others. In shift report, the off-going nurse states, “The client has been experiencing an increase in positive symptoms of schizophrenia.” Which symptoms would the nurse expect t observe in the client? Select all that apply. Social withdrawal and isolation Flat affect Hallucinations Bizarre and disorganized conversation Inability to feel pleasure Delusional thought content Which client would the nurse assess as being at highest risk for a life threatening hypertensive crisis? A client who is prescribed tranylcypromine (Parnate) and takes Robitussin for a cold. A client prescribed diazepam (Valium) and goes out for drinks with friends. A client who is prescribed buspirone (BuSpar) and takes propranolol (Inderal) for social anxiety. A client who is prescribed nortriptyline (Pamelor) and drinks coffee. A client is scheduled for ECT treatment the next morning. Which situation would result in the nurse questioning the validity of the informed consent? The client is not oriented to place and time and asks the nurse, “What kind of place is this and why am I here?” The client has been recently exhibiting signs of paranoia and is reluctant to eat food provided on the unit. The client was observed discussing ECT with her spouse and asked the spouse, “Do you think this is safe?” before signing the consent form. The client is 72 years old and has been severely depressed since the death of her spouse 3 months ago. A client with a long history of alcoholism recently has been diagnosed with Wernicke-Korsakoff syndrome. Which symptom should the nurse expect to assess? Gastroesophageal reflux disorder Signs and symptoms of congestive heart failure A sudden onset of muscle pain Loss of memory A client has been taking citalopram (Celexa) for 2 weeks. The client had been frighly suicidal and now tells the nurse, “You don’t have to worry about me anymore. I feel better now and the staff can stop watching me all the time.” Which intervention by the nurse takes priority for this client? The nurse praises the client for progress in the recovery process and improved mood. The nurse suggests the client use journaling to track changes in mood and thought process. The nurse engages the client in medication teaching due to the client’s increased ability to concentrate. The nurse recommends to the team to increase the level of monitoring related to suicide risk for this client. A nurse is providing medication education to a client taking alprazolam (Xanax). Which statements suggest that more teaching is needed? Select all that apply. “It is normal to need an extra dose of this medication when things are stressful.” “I should not just stop taking this medication without speaking to my provider.” “This medication can make me drowsy, so I shouldn’t do anything requiring clear eyesight for a while.” “I don’t have to worry about getting addicted to this medication.” “Although I should cut back on how many beers I drink, it’s still okay to drink a couple.” “When I feel anxious, I will just take more medication until I feel better.” The nurse is teaching the student about relevant laboratory tests with medications for the treatment of Bipolar Disorder. Following the teaching, the student recognizes that which laboratory tests are routinely indicated for a client prescribed valproic acid (Depakote)? Select all that apply. Liver function tests Thyroid-stimulating hormone (TSH) Fasting blood glucose Platelet count Serum Depakote level Absolute neutrophil count (ANC) The nurse is assessing a client and suspects that the client has a diagnosis of Cluster A personality disorder. Which data would lead the nurse to this assessment? Select all that apply. The client states, “I let others make decisions for me,” and avoids responsibility. The client describes feeling different and more important than others with easily shifting mood. The client reports having a “sixth sense” and states, “People avoid me and think I am strange.” The client reports difficulty understanding the emotions of others leading to difficulty working with others. The client presents as tense and aloof and avoids interactions with others reporting, “I can read hidden meanings. A client is prescribed clomipramine (Anafranil). Which side effects would the nurse assess for with this medication? Orthostatic hypotension and constipation Excessive salivation and dysuria Polyuria and coarse hand tremors Unusual bleeding and bruising SCIENCE HEALTH SCIENCE NURSING NURS 1060

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