Nursing Elites

1. A client with a diagnosis of schizophrenia is prescribed clozapine. The nurse should monitor the client for which potential side effect?

• A. Agranulocytosis
• B. Dry mouth
• C. Weight gain
• D. Hypersalivation

Correct answer: A

Rationale: The correct answer is Agranulocytosis. Clozapine is known to potentially cause agranulocytosis, a serious condition characterized by a dangerously low white blood cell count. Monitoring white blood cell counts is crucial to detect this side effect early and prevent complications. Choices B, C, and D are incorrect because dry mouth, weight gain, and hypersalivation are not typically associated with clozapine use. While dry mouth can be a common side effect of some antipsychotic medications, it is not specifically linked to clozapine. Weight gain can occur with certain antipsychotics, but clozapine is more commonly associated with metabolic side effects. Hypersalivation is not a common side effect of clozapine.

2. A client with a diagnosis of generalized anxiety disorder is prescribed fluvoxamine. The nurse should instruct the client that this medication may have which potential side effect?

• A. Drowsiness
• B. Dry mouth
• C. Insomnia
• D. Headache

Correct answer: A

Rationale: The correct answer is A: Drowsiness. Fluvoxamine is known to cause drowsiness as a potential side effect. Patients should be advised to avoid activities like driving that require alertness until they understand how the medication affects them. Dry mouth, insomnia, and headache are potential side effects of other medications used for anxiety disorders but are not typically associated with fluvoxamine.

3. What instructions should the PN reinforce with the client regarding the newly prescribed medications isosorbide dinitrate and hydrochlorothiazide?

• A. Instruct the client to use a soft bristle toothbrush.
• B. Instruct the client to slowly rise from a sitting or lying down position.
• C. Instruct the client to elevate their legs above the level of their heart.
• D. Instruct the client to limit the amount of fiber in their diet.

Correct answer: B

Rationale: The correct instruction for the client is to slowly rise from a sitting or lying down position. Isosorbide dinitrate, a nitrate, and hydrochlorothiazide, a diuretic, can both cause hypotension. When used together, their additive effects can further lower blood pressure, leading to orthostatic hypotension. Instructing the client to change positions slowly helps prevent a sudden drop in blood pressure, reducing the risk of dizziness or falls. Choices A, C, and D are incorrect because they do not directly address the potential side effect of hypotension associated with the prescribed medications. Using a soft bristle toothbrush, elevating legs above the heart level, or limiting fiber intake are not specific instructions to mitigate the risk of orthostatic hypotension.

4. A client with severe depression is prescribed sertraline. Which statement by the client indicates the need for further teaching?

• A. I can stop taking this medication once I feel better.
• B. It may take 1 to 4 weeks to notice improvement in symptoms.
• C. I should avoid alcohol while taking this medication.
• D. I should take this medication in the morning with food.

Correct answer: A

Rationale: The correct answer is A. Clients should not stop taking sertraline abruptly once they feel better without consulting their healthcare provider. It is important to complete the full course of treatment as prescribed to prevent a relapse of symptoms. Stopping the medication suddenly can lead to withdrawal symptoms and may worsen the condition. Choice B is correct because sertraline may take 1 to 4 weeks to show noticeable improvement in symptoms. Choice C is correct as alcohol should be avoided while taking sertraline due to the increased risk of side effects. Choice D is also correct as taking sertraline in the morning with food can help reduce gastrointestinal side effects.

5. What is the primary nursing intervention that the practical nurse should perform before administering ampicillin to a client diagnosed with a urinary tract infection?

• A. Obtain a clean-catch urine specimen.
• B. Assess the urine pH for acidity.
• C. Insert an indwelling catheter.
• D. Assess for complaints of dysuria.

Correct answer: A

Rationale: The correct answer is to obtain a clean-catch urine specimen. Before administering ampicillin to a client with a urinary tract infection, it is crucial to collect a urine specimen to determine the causative organism and evaluate the effectiveness of pharmacological therapy. Assessing the urine pH for acidity (choice B) is not the primary intervention needed before administering ampicillin. Inserting an indwelling catheter (choice C) is invasive and not necessary unless indicated for specific reasons. Assessing for complaints of dysuria (choice D) is important but does not take precedence over obtaining a urine specimen for proper diagnosis and treatment.

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