Nursing Elites

1. Escitalopram is prescribed for a 16-year-old adolescent client who is clinically depressed. Five days later, the parent tells the practical nurse (PN) that the drug is not working because their child is not feeling any better. Which explanation should the PN provide?

• A. It takes 1 to 4 weeks for antidepressant medications to become effective.
• B. The dosage may need to be increased; I will contact your health care provider.
• C. Depression is difficult to treat with drugs alone. Therapy sessions would enhance their effectiveness.
• D. Based on your child's response to this drug, the health care provider is reviewing your medication regimen.

Correct answer: A

Rationale: Antidepressant medications typically require 1 to 4 weeks to reach their full therapeutic effect. It is crucial to educate the family that during the initial week of treatment, the child may experience heightened anxiety. Therefore, it is important to wait for the medication to take its full course before assessing its effectiveness.

2. A client is admitted to a long-term care facility, and the nurse and a new employee are conducting medication reconciliation. The nurse notes that oxybutynin has been prescribed. The nurse realizes the new employee understands the drug's effect if the new employee explains that this medication is prescribed to treat which condition?

• A. Pain
• B. Depression
• C. Overactive bladder
• D. Chronic anxiety

Correct answer: C

Rationale: The correct answer is C: Overactive bladder. Oxybutynin is prescribed to treat overactive bladder by reducing muscle spasms of the bladder. It is classified as an anticholinergic medication. Choices A, B, and D are incorrect. Oxycodone is an opioid used for pain management. Bupropion is an antidepressant used to treat depression. Buspirone is an anxiolytic used to manage anxiety disorders.

3. A client with chronic pain is prescribed oxycodone. What instruction should the practical nurse (PN) include in the client's teaching plan?

• A. Take the medication with meals to avoid gastrointestinal upset.
• B. Avoid taking the medication with alcohol.
• C. Increase fluid intake to avoid constipation.
• D. Report any signs of respiratory depression to the healthcare provider.

Correct answer: B

Rationale: The correct answer is to instruct the client to avoid taking oxycodone with alcohol. Mixing oxycodone with alcohol can lead to serious side effects, including respiratory depression. Taking the medication with meals may not always be necessary, and instructions about fluid intake to avoid constipation are important but not the priority when considering the immediate risks associated with oxycodone. While reporting signs of respiratory depression is crucial, preventing it by avoiding alcohol is key in the client's safety.

4. A client with chronic kidney disease is prescribed ferric citrate. The nurse should monitor for which potential side effect?

• A. Constipation
• B. Diarrhea
• C. Nausea
• D. Hyperphosphatemia

Correct answer: A

Rationale: When a client with chronic kidney disease is prescribed ferric citrate, the nurse should monitor for constipation as a potential side effect. Ferric citrate can lead to constipation due to its effects on the gastrointestinal system, causing a decrease in bowel movements. It is essential for the nurse to assess and manage constipation promptly to prevent complications and ensure the client's comfort and well-being. Monitoring bowel movements, providing adequate hydration, and recommending dietary interventions can help alleviate constipation in clients taking ferric citrate. Diarrhea, nausea, and hyperphosphatemia are not typically associated with the use of ferric citrate in clients with chronic kidney disease.

5. A client is prescribed phenobarbital 100 mg daily for the treatment of seizures. Which statement made by the client indicates an accurate understanding of the medication phenobarbital?

• A. I will take my medicine at 10 PM before retiring to bed.
• B. The medication will turn the color of my urine to a pink color.
• C. I should not eat or drink anything for at least 2 hours before taking my medicine.
• D. In the event a seizure occurs in the middle of the day, I need to take an extra dose of my medicine.

Correct answer: A

Rationale: The correct answer is A. Phenobarbital should be taken at the same time every day to maintain blood levels and enhance compliance. Common side effects of phenobarbital include drowsiness, lethargy, dizziness, and nausea; therefore, it is best to take it before bedtime to minimize these effects and improve sleep quality. Choice B is incorrect because phenobarbital does not affect the color of urine. Choice C is incorrect because there is no need to fast before taking phenobarbital. Choice D is incorrect because taking extra doses without healthcare provider guidance can lead to overdose and adverse effects.

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