Celia with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?
-
Solution
Opioid withdrawal
Option D: The symptoms listed are specific to opioid withdrawal.
Option A: Alcohol withdrawal would show elevated vital signs.
Option B: There is no real withdrawal from cannabis.
Option C: Symptoms of cocaine withdrawal include depression, anxiety, and agitation.
Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client’s physical health, the nurse should plan to:
-
Solution
Monitor vital signs, serum electrolyte levels, and acid-base balance.
Option C: An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital signs, serum electrolyte level, and acid-base balance is crucial.
Option A: This may worsen anxiety.
Option B: This is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal.
Option D: This would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.
Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client’s physical health, the nurse should plan to:
-
Solution
This medication may initially cause tiredness, which should become less bothersome over time.
Option D: Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops.
Option A: Antidepressants aren’t habit forming and don’t cause physical or psychological dependence. However, after a long course of high-dose therapy, the dosage should be decreased gradually to avoid mild withdrawal symptoms.
Option B: Serious adverse effects, although rare, include myocardial infarction, heart failure, and tachycardia.
Option C: Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic antidepressant.
Isabel with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that:
-
Solution
Impaired communication.
Option B: Signs of advancement to the middle stage of Alzheimer’s disease include exacerbated cognitive impairment with obvious personality changes and impaired communication, such as inappropriate conversation, actions, and responses.
Options A and C: Initially, memory impairment may be the only cognitive deficit in a client with Alzheimer’s disease. During the early stage of this disease, subtle personality changes may also be present. However, other than occasional irritable outbursts and lack of spontaneity, the client is usually cooperative and exhibits socially appropriate behavior.
Option D: During the late stage, the client can’t perform self-care activities and may become mute.
Edward, a 66-year-old client with slight memory impairment and poor concentration, is diagnosed with primary degenerative dementia of the Alzheimer’s type. Early signs of this dementia include subtle personality changes and withdrawal from social interactions. To assess for progression to the middle stage of Alzheimer’s disease, the nurse should observe the client for:
-
Solution
It’s characterized by an acute onset and lasts hours to a number of days
Option D: Delirium has an acute onset and typically can last from several hours to several days.
Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement about delirium is true?
-
Solution
Sodium
Option B: Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and should drink adequate amounts of fluid each day.
Options A, C, and D: The other electrolytes are important for normal body functions but sodium is most important to the absorption of lithium.
What herbal medication for depression, widely used in Europe, is now being prescribed in the United States?
-
Solution
St. John’s wort
Option C: St. John’s wort has been found to have serotonin-elevating properties, similar to prescription antidepressants.
Option A: Ginkgo biloba is prescribed to enhance mental acuity.
Option B: Echinacea has immune-stimulating properties.
Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine.
After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What is the usual minimum dose of activated charcoal?
-
Solution
30 g mixed in 250 ml of water
Option C: The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the drug or chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses less than this will be ineffective; doses greater than this can increase the risk of adverse reactions, although toxicity doesn’t occur with activated charcoal, even at the maximum dose.
Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tiffany suspects:
-
Solution
Dysthymic disorder.
Option D: Dysthymic disorder is marked by feelings of depression lasting at least 2 years, accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, and hopelessness. These symptoms may be relatively continuous or separated by intervening periods of normal mood that last a few days to a few weeks.
Option A: Cyclothymic disorder is a chronic mood disturbance of at least 2 years’ duration marked by numerous periods of depression and hypomania.
Option B: Atypical affective disorder is characterized by manic signs and symptoms.
Option C: Major depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities, with signs and symptoms recurring for at least 2 weeks.
Which nursing intervention would be most appropriate if a male client develops orthostatic hypotension while taking amitriptyline (Elavil)?
-
Solution
Advising the client to sit up for 1 minute before getting out of bed.
Option B: To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed.
Option A: Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy.
Option C: In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant.
Option D: Orthostatic hypotension disappears only when the drug is discontinued.