The practical nurse (PN) is caring for a client receiving a prescription for paroxetine who suddenly exhibits restlessness, tachycardia, fever, and elevated blood pressure. Which action should the PN implement first?

Withhold the next dose and contact the healthcare provider

Obtain a cooling blanket from the hospital central supply department

Take the client to a quiet area and provide reassurance

Administer a PRN prescription for benzodiazepine and acetaminophen

Answer and Explanation

The Correct Answer is A

Choice A reason: Restlessness, tachycardia, fever, and hypertension suggest serotonin syndrome, a life-threatening paroxetine side effect due to excessive serotonin. Withholding the dose and contacting the provider prevents further serotonin accumulation, allowing urgent assessment and intervention to stabilize the client’s neurological and cardiovascular status.

Choice B reason: A cooling blanket addresses fever but is not the first action for serotonin syndrome. Withholding paroxetine and consulting the provider are critical to stop the syndrome’s progression, as fever is a symptom, not the cause, making this choice secondary to halting the drug.

Choice C reason: Taking the client to a quiet area may reduce stimulation but does not address serotonin syndrome’s physiological cause. Paroxetine’s serotonin excess drives symptoms, requiring drug cessation and medical intervention, not just reassurance, as this condition can rapidly worsen, making this choice inadequate.

Choice D reason: Administering benzodiazepine and acetaminophen is premature without provider guidance, as serotonin syndrome requires specific treatments, like cyproheptadine. Paroxetine must be stopped first, and the provider consulted to confirm diagnosis and manage symptoms, making this choice unsafe and reactive.

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Correct Answer is B

Explanation

Choice A reason: Explaining the medication’s purpose is important but does not address the inappropriate bedtime dosing. Diuretics increase urination, causing nocturia and sleep disruption. Administering as scheduled without review risks client discomfort, making this choice less appropriate than verifying timing.

Choice B reason: Reviewing the prescription with the charge nurse is critical, as bedtime diuretic administration causes nocturia, disrupting sleep. Diuretics, like hydrochlorothiazide, increase urine production, and morning dosing aligns with daily activity, minimizing nighttime disturbance, ensuring safe and effective administration timing.

Choice C reason: Withholding the medication until the next day delays treatment, risking conditions like edema or hypertension. Consulting the charge nurse allows timely clarification of dosing time, ensuring therapeutic benefits without sleep disruption, making this choice overly cautious and unnecessary.

Choice D reason: Administering the diuretic early without confirmation violates protocol, as the prescription specifies bedtime. Unilateral changes risk errors, and morning dosing requires provider approval. Reviewing with the charge nurse is safer, ensuring alignment with clinical intent while addressing sleep concerns.

A. Observe the client’s ability to easily and quickly open the pill box B. Explain the need to store the medication in the original container C. Remind the client to obtain a fresh supply of pills every 30 days D. Assist in clearly labeling the pill container with directions for use

Correct Answer is B

Explanation

Choice A reason: Observing the client’s ability to open the pill box ensures accessibility but does not address nitroglycerin’s stability. Nitroglycerin degrades when exposed to air, light, or plastic, reducing potency. The original container is critical for maintaining efficacy, making this choice secondary.

Choice B reason: Nitroglycerin must be stored in its original amber glass container to protect it from light, air, and moisture, which degrade its potency. Plastic pill boxes allow exposure, reducing effectiveness for angina relief. Explaining this ensures the client maintains the drug’s therapeutic integrity.

Choice C reason: Reminding the client to refresh nitroglycerin every 30 days is relevant due to its short shelf life, but the priority is proper storage. Without the original container, even fresh pills lose potency, making this choice less critical than ensuring correct storage conditions.

Choice D reason: Labeling the pill box improves usability but does not address nitroglycerin’s stability. Plastic containers expose the drug to air and light, reducing efficacy. Proper storage in the original container is more critical to ensure the drug remains effective for emergency use.

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The practical nurse (PN) is caring for a client receiving a prescription for paroxetine who suddenly exhibits restlessness, tachycardia, fever, and elevated blood pressure. Which action should the PN implement first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

At the start of the shift, the practical nurse (PN) reviews a client’s medication administration record and notes that a client has a new prescription for a diuretic to be administered at bedtime. Which action should the PN take?

Correct Answer is B

Explanation

Sublingual nitroglycerin is prescribed PRN for an older adult female client with a history of chest pain. The client shows the practical nurse (PN) a plastic pill box that she purchased so the medication can always be readily available in her purse. Which action should the PN take?

Correct Answer is B

Explanation

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