A nurse is teaching a client who has rapid cycling bipolar disorder and a new prescription for carbamazepine. Which of the following information should the nurse include in the teaching? (Select all that apply.)

A. Blood tests will be done weekly during the first several months of treatment.

B. You should not drink alcohol while taking this medication.

C. You will be more alert while taking this medication.

D. Refrain from taking Monoamine oxidase inhibitor medications for several days after starting this treatment.

A, B, E

Correct Answers:
A. “Blood tests will be done weekly during the first several months of treatment.”
B. “You should not drink alcohol while taking this medication.”
E. “Do not abruptly discontinue this medication.”

Carbamazepine causes an elevation in liver enzymes, which can cause carbamazepine or other medications to be metabolized at a faster rate. The client should avoid alcohol or taking other sedatives while taking carbamazepine. Carbamazepine can cause dizziness and sedation. The client should follow a tapering schedule as directed by the provider when discontinuing carbamazepine.

Incorrect Answers:
C. Drowsiness is an adverse effect of carbamazepine. The client should avoid activities that require alertness, such as driving until the client has determined how the medication affects the ability for alertness.
D. The client should not take Monoamine oxidase inhibitor (MAOI) medications with or within 14 days of taking carbamazepine.

Vital Concept: Carbamazepine is considered to be more effective than lithium for clients who have rapid cycling bipolar disorder. However, there are significant side effects of the medication. A client who is going to take carbamazepine must be given very specific oral and written instructions before starting the medication.

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A. Keep a time log for what was done during the hours worked

B. Complete each task before beginning another activity

C . Ask for additional assistance when necessary to complete tasks

D. Set daily goals with the establishment of priorities

CORRECT ANSWER

A. Keep a time log for what was done during the hours worked

The first step in planning for time management is to establish what tasks were done and when they were completed. This provides a baseline for needed changes in any activities and time use log. The key words in this question are “time management,” “most effective,” and “initial development.” Remember the first step in the nursing process is data collection – this applies to both caring for clients and developing management skills.

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1. Explore for further identification about the nature of the problem

2. Assure the staff nurse that the complaint will be investigated

3. Write down potential solutions to the problems today by shift’s end

4. Add this concern to the agenda of the next unit meeting

1.Explore for further identification about the nature of the problem
Correct Answer

Helping staff manage conflict is part of the charge nurse’s role. It is appropriate to work with the LPN in order to work out problems with minimal intervention from administration when possible. Further definition of the problem and associated issues would be a first step. The nursing process can be used to collect more data before plans or interventions are made.

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A. Lecture the client on the importance of having advance directives.

B. Advance directives are not appropriate for this client due to the client’s age.

C. Refer this issue to the client’s health care provider.

D. Inform the charge nurse to offer information about advance directives.

Answer

D. Inform the charge nurse to offer information about advance directives.
Correct Response

For every admission, the nurse should check if the client has advance directives and if yes, that a copy of the current advance directive is in the medical record. If there are none, the nurse should inform the appropriate interdisciplinary team member to provide information to the client. In most health care settings, nurses, social services, case managers or the spiritual support team can educate clients on advance directives, including helping them complete an advance directive. Every adult client should have advance directives. The client is 27-years-old and is therefore considered an adult.

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1. A client with an IV of normal saline infusing at 125 ml per hour complaining of slight swelling at the IV insertion site.

2. A client 3 days post right knee replacement complaining of right calf pain with movement.

3. A client with a respiratory rate of 24 and an oxygen saturation of 94% on room air.

4. A client 12 hours after a hysterectomy complaining of nausea.

ANSWER

Strategy: Determine the most unstable client.

(1) assess site for client’s comfort and to prevent complications associated with IV infusion, probable DVT takes priority

(2) CORRECT—assessment for possible DVT should be performed and reported to the physician immediately

(3) respiratory status is stable at present

(4) administer antiemetics; client with calf pain takes priority

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A. Take the medication with juice

B. Take the medication before going to bed

C. Avoid exposure to sunlight when taking the medication

D. Take propylthiouracil (PTU) after taking Lugol solution

Correct Answer: A. 
Take the medication with juice
 

The thyroid gland absorbs dietary iodine, found in many foods, combines it with the amino acid tyrosine, and converts it into thyroid hormones thyroxine (T4) and triiodothyronine (T3). Although iodine is necessary for synthesis of thyroid hormone in individuals with normal thyroid function, it inhibits synthesis and release of thyroid hormone in individuals with hyperthyroidism.

Lugol solution is a solution of potassium iodide and iodine that is given prior to a thyroidectomy. The client should be instructed to take 5-7 drops 3 times a day for 10 days before the surgery. In clients who are hyperthyroid, the iodine will inhibit synthesis of thyroid hormone and secretion into the circulation while decreasing the size and vascularity of the gland to reduce the risk of complications of surgery. The solution has a bitter taste and should be given with juice. Lugol solution is also used for treatment of thyroid storm and for short-term treatment of hyperthyroidism. It should not be taken after PTU, methimazole, or radioactive iodine.

Incorrect Answers:
B. Lugol solution drops are taken 3 times a day.

C. Photosensitivity does not occur with Lugol solution.

D. PTU, methimazole, or radioactive iodine should not be taken after Lugol solution.

Vital Concept:
Lugol solution, a potassium iodide-iodine solution, inhibits synthesis and release of thyroid hormone in individuals with hyperthyroidism. It is prescribed for individuals with hyperthyroidism for ten days prior to thyroidectomy, to decrease serum levels of thyroid hormone and reduce the size and vascularity of the thyroid gland. It is also used in conjunction with other medications to treat thyroid storm.

 
References:
Ignatavicius DD, et al. (2017). Medical-surgical Nursing: Patient-centered Collaborative Care. Philadelphia, PA: WB Saunders Co.

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Answer in the comment section.

A. Packed red blood cells

B. Cryoprecipitate

C. Platelets

D. Whole blood

Correct Answer: B. 
Cryoprecipitate
 

The liver produces most coagulation factors, except factor VIII and factor XIII A-subunit. Individuals with liver disease are at risk of decreased synthesis due to decreased production capacity. Some clients may also have vitamin K deficiency. Vitamin K is necessary for the production of clotting factors II, VII, IX, and X. In individuals with hemorrhage and liver failure, cryoprecipitate or fresh frozen plasma is administered to provide clotting factors. Cryoprecipitate provides VIII, XIII, and fibrinogen. It is infused through a sterile infusion set with a filter. Side effects can include allergic reactions and febrile reactions. ABO compatibility testing is recommended, but Rh factor testing is unnecessary. Cryoprecipitate is stored frozen and thawed in a water bath for 15 minutes.

Incorrect Answers:
A. Packed red blood cells are given to increase hemoglobin and hematocrit.

C. Platelets play a small role in abnormalities of hemostasis in some individuals with liver disease, but low levels of coagulation factors are the primary underlying abnormality and can be corrected with cryoprecipitate or fresh frozen plasma. Platelet counts may be normal in some individuals with chronic liver disease. Others may have mild thrombocytopenia that doesn’t impact hemostasis. Clients with infection, uremia, and other conditions concurrent with liver failure may have reduced platelet dysfunction.

D. Whole blood is not used when components are available. Whole blood transfusion is associated with a higher rate of complications, including volume overload.

Vital Concept:
Liver failure results in decreased synthesis of clotting factors and increased risk of hemorrhage. Cirrhosis also results in esophageal varices, a common cause of upper GI bleeding. When treating an upper GI bleed in clients with liver disease, clotting factors can be replaced by administration of cryoprecipitate or fresh frozen plasma.

 
References:
Ignatavicius DD, et al. (2017). Medical-surgical Nursing: Patient-centered Collaborative Care. Philadelphia, PA: WB Saunders Co.
Peer Comparison
A
32%
B
33%
C
19%
D
16%
Difficulty level:
Hard

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A) Antibiotic therapy for 10 days

B) Teach client isometric exercises for legs

C) Assess movement and sensation of extremities

D) Assist to stand up at bedside within the first 24 hours

Post your answer in the comment section.

Correct Answer is (C)

C: Assess movement and sensation of extremities. Following corrective surgery for scoliosis, neurological status requires special attention and assessment, especially that of the extremities

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 A) administer pain medication

 B) suction excessive tracheobronchial secretions

 C) assist client to turn, deep breathe and cough

 D) monitor oxygen saturation

Post your answer in the comment section.

Correct Answer is (B)

B: suction excessive tracheobronchial secretions. Suctioning the copious tracheobronchial secretions present in post-thoracic surgery clients maintains an open airway which is always the priority nursing intervention.

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1. Have the surgeon speak with the client.

2. Ask the client to discuss the concerns.

3. Continue to prep the client for surgery.

4. Immediately stop the surgical procedure.

Post your answer in the comment section

CORRECT ANSWER (4)

1. This surgeon should speak with the client,

but the first intervention is to stop the 

procedure.

2. Asking the client to discuss concerns should

be done, but the first intervention is to stop

the procedure.

3. Continuing to prep the client for the surgery

can be done, but is inappropriate when the

client no longer is giving consent.

4. Stopping the surgical procedure is the first intervention for the nurse to implement.

Content – Medical/Surgical: Integrated Processes –

Nursing Process: Implementation: Client Needs – 

Physiological Integrity: Reduction of Risk Potential: 

Cognitive Level – Application

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