A nurse is preparing to administer a dose of lamotrigine to a 35-year-old male client in an outpatient mental health clinic.
Click to highlight the information from the drug reference that supports the decision to withhold the lamotrigine.
Drug Reference for Highlighting:
Lamotrigine Classification: Anticonvulsant. Indications: Bipolar disorder maintenance, epilepsy. Contraindications/Precautions: Impaired renal function, impaired hepatic function. Adverse Reactions/Side Effects: Common: Headache, dizziness, diplopia. Rare: Stevens-Johnson syndrome, Drug reaction with eosinophilia and systemic symptoms (DRESS). Interactions: Carbamazepine, phenobarbital, oral contraceptives, valproic acid. Route/Dosage: 25 mg PO daily. Data Collection: Monitor for mood changes and suicidal ideation. Monitor for seizure activity, blood dyscrasias. Monitor for alterations in hepatic and renal function, temperature, rash. Implementation: Can be administered with or without meals. Taper dosage gradually when beginning and discontinuing. Do not abruptly discontinue.
Rare: Stevens-Johnson syndrome, Drug reaction with eosinophilia and systemic symptoms (DRESS)
Interactions: Carbamazepine, phenobarbital, oral contraceptives, valproic acid.
Route/Dosage: 25 mg PO daily.
Implementation: Can be administered with or without meals. Taper dosage gradually when beginning and discontinuing.
Contraindications/Precautions: Impaired renal function, impaired hepatic function.
Monitor for alterations in hepatic and renal function, temperature, rash.
The Correct Answer is ["A","F"]
The information from the drug reference that supports the decision to withhold lamotrigine includes:
- Rare: Stevens-Johnson syndrome, Drug reaction with eosinophilia and systemic symptoms (DRESS).
- Monitor for alterations in hepatic and renal function, temperature, rash.
The presence of a red rash and petechiae on the client’s trunk and abdomen raises concern for a potential serious adverse reaction, such as Stevens-Johnson syndrome or DRESS, which are rare but severe. Since lamotrigine carries a risk for these potentially life-threatening conditions, withholding the medication until further evaluation by the healthcare provider is the appropriate course of action. Monitoring for worsening skin reactions and systemic symptoms remains crucial in determining the safest approach for the client’s treatment plan.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Respecting the client's autonomy is paramount in nursing practice. If a client explicitly states they do not want visitors, the nurse should communicate this directly to the sibling. This upholds the client's right to make decisions about their care and interactions.
Choice B rationale
While the provider may be involved in the client's overall care, directly referring the sibling regarding visitation preferences bypasses the nurse's role in communicating the client's wishes. The nurse has a responsibility to act on the client's stated preferences.
Choice C rationale
Encouraging the client to see the sibling might undermine the client's expressed wishes and feelings. The nurse should first respect the client's decision and explore the reasons behind it before suggesting a visit.
Choice D rationale
Arranging a visit in the dayroom without the client's consent disregards their autonomy and right to privacy. The client has the right to decide who they interact with and where those interactions occur.
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale
Access to firearms in the home significantly increases the risk of suicide because firearms are highly lethal and provide a quick and often impulsive means of ending one's life. The availability of a firearm reduces the time between suicidal ideation and action, making intervention more difficult.
Choice B rationale
A sibling history of suicide can increase an individual's risk due to potential genetic predispositions to mental health disorders or learned behaviors and coping mechanisms within the family. However, it is not as direct or immediate a risk factor as other factors.
Choice C rationale
Being currently unmarried can be a contributing factor to social isolation and lack of support, which are risk factors for suicide. However, marital status alone is not a strong predictor of suicide risk, as many unmarried individuals have strong social networks, and married individuals can still experience isolation.
Choice D rationale
Expressing feelings of hopelessness is a critical warning sign for suicide. Hopelessness is a state of despair where an individual believes their situation will never improve, leading to a sense of futility and a higher likelihood of considering suicide as an escape.
Choice E rationale
A recent significant loss, such as the death of a loved one, a job loss, or the end of a significant relationship, can trigger intense emotional distress and increase vulnerability to suicidal ideation, especially if the individual lacks adequate coping mechanisms or social support. .
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