A client who has been taking duloxetine for several months reports there has been little improvement in symptoms. The healthcare provider changes the prescription to phenelzine. Which action should the nurse take?
Assess the client for suicidal ideation.
Confirm the date the client last took duloxetine.
Evaluate if the client has taken phenelzine previously.
Review the foods the client typically eats.
The Correct Answer is B
A. Assessing the client for suicidal ideation is always an important safety measure when managing depression, particularly after changes in antidepressant therapy. However, in this scenario, the immediate priority is preventing a potentially dangerous drug interaction between duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), and phenelzine, a monoamine oxidase inhibitor (MAOI). Suicidal ideation assessment is ongoing but not the first critical action in this specific context.
B. Confirming the date the client last took duloxetine is correct. Phenelzine, an MAOI, has significant interactions with other antidepressants, particularly SNRIs like duloxetine. Administering phenelzine too soon after duloxetine can lead to serotonin syndrome, a potentially life-threatening condition characterized by agitation, confusion, hyperthermia, and autonomic instability. Confirming the last dose ensures an adequate washout period before initiating phenelzine and prevents dangerous interactions.
C. Evaluating if the client has taken phenelzine previously is useful for understanding past responses and tolerance, but it does not address the immediate safety concern related to drug interactions with the current therapy. This assessment is secondary to confirming the timing of the last duloxetine dose.
D. Reviewing the foods the client typically eats is important once the client is taking an MAOI because dietary tyramine restrictions are necessary to prevent hypertensive crises. However, this is not the immediate priority action at the time of medication change. Food restrictions should be addressed after confirming a safe transition period from duloxetine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Initiating bilateral intermittent sequential pneumatic compression devices is used for venous thromboembolism (VTE) prevention, but this is not the immediate priority during acute stroke management. Early focus should be on airway, perfusion, and diagnostic evaluation.
B. Raising the head of the bed to 30 degrees while keeping the head and neck in neutral alignment is the correct immediate intervention. This position helps reduce intracranial pressure and promotes venous drainage from the brain while maintaining cerebral perfusion. Neutral alignment prevents obstruction of blood flow to the affected brain area. This is a key component of acute stroke care while awaiting imaging.
C. Obtaining a focused history regarding recent bleeding or anticoagulant use is important before administering treatments such as thrombolytic therapy, but it does not take priority over stabilizing the client and preparing for the CT scan. It can be completed simultaneously with other interventions.
D. Maintaining elevated positioning of the dependent joints on the affected side is part of later nursing care to prevent contractures and promote circulation, but it is not part of the immediate management in the acute stroke scenario.
Correct Answer is C
Explanation
A. A fasting serum glucose of 140 mg/dL is above the normal reference range (74–106 mg/dL) and indicates hyperglycemia. This finding aligns with the client’s report of intermittent elevated blood glucose and reflects ongoing diabetes management concerns, but it is expected in the context of poorly controlled type 2 diabetes and does not necessarily indicate an acute complication.
B. A WBC of 11,000/mm³ is slightly above the reference range (5,000–10,000/mm³). Mild leukocytosis can occur due to infection, stress, or inflammation. While it warrants observation, it is not as immediately concerning as significant renal function changes.
C. A BUN of 26 mg/dL is elevated above the reference range of 10–20 mg/dL. This suggests possible impaired kidney function, which is particularly important in a client with long-standing diabetes, as chronic hyperglycemia can lead to diabetic nephropathy. Further assessment is required, including evaluation of creatinine, glomerular filtration rate (GFR), hydration status, and medication review, because renal impairment can have serious consequences.
D. A potassium level of 3.5 mEq/L is at the lower end of the reference range (3.5–5 mEq/L) but is still considered normal. No immediate intervention is required unless trends show a downward pattern or the client has symptoms of hypokalemia.
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