A nurse is caring for an adolescent client who is receiving carbamazepine for partial seizure disorder. Which of the following statements by the client's parent is the nurse's priority?
"He has so many new bruises on his body."
"He says his mouth is always dry."
"He says he feels sick to his stomach after taking this medication."
"He takes a 2-hour nap every day after school."
The Correct Answer is A
A. "He has so many new bruises on his body."
This statement raises concerns about potential adverse effects of carbamazepine, such as hematologic effects like thrombocytopenia, which could manifest as bruising. Given the potential seriousness of this issue, it should be the nurse's priority to further assess and address.
B. "He says his mouth is always dry."
Dry mouth (xerostomia) is a common side effect of carbamazepine, but it is generally not as concerning as other potential adverse effects such as hematologic issues or liver toxicity.
C. "He says he feels sick to his stomach after taking this medication."
Gastrointestinal side effects, including nausea, are common with carbamazepine but are typically not as urgent or serious as other potential adverse effects.
D. "He takes a 2-hour nap every day after school."
While changes in sleep patterns can be important to monitor, especially in adolescents, it is not as urgent as addressing potential adverse effects such as bruising.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Bleeding: While haloperidol can cause side effects such as orthostatic hypotension and sedation, it is not typically associated with bleeding as a common adverse effect.
B. Pancreatitis: Pancreatitis is not a common adverse effect of haloperidol. However, it can cause gastrointestinal side effects such as constipation, nausea, and vomiting.
C. Cataracts: Haloperidol is not known to cause cataracts. However, long-term use of antipsychotic medications, including haloperidol, may increase the risk of developing metabolic side effects such as weight gain, dyslipidemia, and hyperglycemia, which can contribute to conditions like diabetes and potentially increase the risk of cataracts.
D. Dysrhythmias: Haloperidol can prolong the QT interval on an electrocardiogram (ECG), leading to an increased risk of dysrhythmias, including torsades de pointes. This risk is particularly important in clients with preexisting cardiovascular conditions or those taking other medications that can prolong the QT interval. Therefore, nurses should monitor clients receiving haloperidol for signs of dysrhythmias, including palpitations, dizziness, and syncope, and promptly report any abnormalities to the healthcare provider.
Correct Answer is ["8"]
Explanation
To calculate the flow rate in drops per minute (gtt/min), we first need to find the total number of drops (gtt) that will be infused over 3 hours and then divide by the total infusion time in minutes.
Given: Volume to infuse = 150 mL
Infusion time = 3 hours
Drop factor = 10 gtt/mL
First, let's find the total number of drops for the entire infusion:
Total drops = Volume × Drop factor
Total drops = 150 mL × 10 gtt/mL = 1500 drops
Now, let's find the infusion time in minutes: Infusion time (in minutes) = 3 hours × 60 minutes/hour = 180 minutes
Finally, let's calculate the flow rate:
Flow rate (gtt/min) = Total drops / Infusion time
Flow rate = 1500 drops / 180 minutes ≈ 8.33 gtt/min
Rounded to the nearest whole number, the nurse should set the manual IV infusion to deliver approximately 8 gtt/min.
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