A nurse is assessing a client who has depression and takes phenelzine. The client reports eating pepperoni pizza while out on a pass during lunchtime. Which of the following assessments should the nurse perform?
Oxygen saturation
Blood pressure
Pupil response
Bowel sounds
The Correct Answer is B
Phenelzine is a monoamine oxidase inhibitor (MAOI) that can cause a hypertensive crisis if taken with foods that contain tyramine, such as pepperoni pizza. The nurse should assess the client's blood pressure to monitor for signs of hypertension, such as headache, chest pain, or blurred vision.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The nurse should respect the client's autonomy and inform them of their right to refuse treatment, even if it is against medical advice. The nurse should also explore the reasons for the refusal and provide information and support as needed. The other options are not appropriate as they do not respect the client's decision or may violate their privacy.
Correct Answer is B
Explanation
The nurse should collaborate with the client to set realistic and achievable goals for weight gain and recovery. This can help increase the client's sense of control and motivation. The other options are not appropriate because they do not involve the client in the decision-making process, and they may increase the client's resistance or anxiety.
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