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A nurse is preparing to administer a dose of lamotrigine to a 35-year-old male client in an outpatient mental health clinic.

Exhibits

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.

Answer and Explanation

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.

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Correct Answer is B

Explanation

Choice A rationale

Directly contradicting the client's hallucination by stating "I'm using a syringe to obtain your blood, not a snake" dismisses their experience and does not address their fear or distress. This can erode trust and make the client feel unheard.

Choice B rationale

Acknowledging the client's perception ("I don't see a snake") while validating their feelings ("that must be scary for you") is a therapeutic response. It shows empathy and helps the client feel understood without confirming the hallucination as real.

Choice C rationale

Telling the client "You must be mistaken. Snakes cannot be in the clinic" is dismissive and invalidates their sensory experience. Hallucinations are real to the person experiencing them, and denying their reality can be counterproductive.

Choice D rationale

Stating "Your provider requires this blood specimen" provides a factual explanation for the procedure but does not address the client's immediate fear and anxiety related to the hallucination. It prioritizes the task over the client's emotional state. .

A. Blood glucose level B. WBC count C. Temperature D. Blood pressure

Correct Answer is ["A","B","C"]

Explanation

Choice A rationale: Blood glucose level

A blood glucose level of 200 mg/dL is elevated, suggesting possible hyperglycemia. Clozapine, an atypical antipsychotic, can cause metabolic effects, including insulin resistance, leading to diabetes. This warrants further evaluation by the provider to determine if glucose monitoring or treatment adjustments are needed.

Choice B rationale: WBC count

A WBC count of 4,800/mm³ is low, which is concerning because clozapine can cause agranulocytosis, a severe condition where white blood cells drop significantly, increasing the risk of infection. Since the client is on clozapine, the provider must be informed to assess the need for additional lab monitoring or medication adjustments.

Choice C rationale: Temperature

A temperature of 37.8°C (100.0°F) may indicate a mild fever, which is concerning in the context of a low WBC count. Since clozapine increases infection risk due to potential agranulocytosis, this temperature should be reported to rule out an underlying infection.

Choice D rationale: Blood pressure

A blood pressure of 110/68 mm Hg is within the normal range and does not warrant immediate intervention. It is not concerning in this case.

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Naxlex Comprehensive Predictor Exams

A nurse in a mental health facility is collecting a blood specimen from a client.The client is hallucinating and states, "That looks like a snake, and it won't let it take all of my blood.”. Which of the following responses should the nurse make?

Correct Answer is B

Explanation

A nurse is reviewing the medical record of a 50-year-old male client who has schizophrenia in an inpatient mental health facility Exhibits Which of the following findings should the nurse report to the provider? (Select all that apply.)

Correct Answer is ["A","B","C"]

Explanation

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