A nurse is teaching a client who has a new prescription for sertralihe to treat depression. For which of the following findings should the nurse instruct the client to monitor and report immediately as indicating serotonin syndrome?
Insomnia
Constipation
Dry mouth
Excessive sweating
The Correct Answer is D
A. Insomnia: While insomnia can be a side effect of sertraline, it is not typically associated with serotonin syndrome. However, if the insomnia is severe or accompanied by other symptoms of serotonin syndrome, it should be reported to the healthcare provider.
B. Constipation: Constipation is a common side effect of sertraline but is not indicative of serotonin syndrome. It is important to monitor for constipation and manage it appropriately but not as an indicator of serotonin syndrome.
C. Dry mouth: Dry mouth is another common side effect of sertraline but is not specific to serotonin syndrome. While uncomfortable, it does not typically require immediate reporting unless severe or accompanied by other concerning symptoms.
D. Excessive sweating: Excessive sweating, also known as diaphoresis, is a hallmark symptom of serotonin syndrome. It is a significant indicator of serotonin toxicity and should be reported immediately to the healthcare provider for further evaluation and management.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Contact precautions are used for infections transmitted by direct or indirect contact with the client or their environment. Examples include MRSA, C. difficile, and other multidrug-resistant organisms.
B. Airborne precautions are used for infections transmitted by small droplets that remain suspended in the air and can be inhaled. Examples include tuberculosis (TB), measles, and chickenpox (varicella).
C. Protective environment precautions are typically used for clients with compromised immune systems, such as those undergoing stem cell transplants, to protect them from environmental pathogens.
D. Droplet precautions are used for infections transmitted by large respiratory droplets that can travel up to approximately 3 feet. Examples include bacterial meningitis, influenza, and pertussis. Therefore, the nurse should initiate droplet precautions for the school-age child with bacterial meningitis.
Correct Answer is B
Explanation
A. "I will position the shoulder harness straps 3 inches above my baby's shoulders.": The shoulder harness straps should be positioned at or below the baby's shoulders, not above them, to ensure proper restraint in the event of a crash. Placing the straps too high can increase the risk of injury to the baby.
B. "I will position my baby at a 45-degree angle in the car seat.": This statement indicates an understanding of proper car seat positioning for a newborn. Newborns should be positioned at a 45-degree angle in a rear-facing car seat to keep the airway open and prevent head flopping, which can restrict breathing. This angle helps to keep the baby's head from falling forward and blocking the airway.
C. "I will turn the car seat forward-facing when my baby is 1 year old.": It is recommended to keep infants in a rear-facing car seat until they reach the maximum weight or height limit specified by the car seat manufacturer, typically around 2 years of age. Turning the car seat forward-facing prematurely increases the risk of injury to the baby's head, neck, and spine in the event of a crash.
D. "I will place the retainer clip on my baby's upper abdomen.": The retainer clip, also known as the chest clip, should be positioned at armpit level to properly secure the harness straps over the baby's shoulders. Placing the clip on the baby's upper abdomen can result in improper restraint and increase the risk of injury in a crash.
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