A client has been recently started on phenelzine, a monoamine oxidase inhibitor (MAOI) for depression.
Which statement indicates that the client requires further educational reinforcement about the medication?

I will avoid excessive amounts of cheese and caffeine.

My spouse will just have to put up with any new irritability.

I will change positions slowly, as dizziness may occur.

My spouse will check my blood pressure if I experience a headache.

Answer and Explanation

The Correct Answer is B

My spouse will just have to put up with any new irritability. This statement indicates that the client requires further educational reinforcement about the medication because phenelzine is an antidepressant that should improve the mood and reduce irritability. The client may also need to be assessed for possible adverse effects of phenelzine, such as agitation, insomnia, or hypomania.

Choice A is wrong because it is a correct statement. Phenelzine is a monoamine oxidase inhibitor (MAOI) that can interact with foods that contain tyramine, such as cheese and caffeine, and cause a hypertensive crisis.

The client should avoid excessive amounts of these foods while taking phenelzine.

Choice C is wrong because it is also a correct statement. Phenelzine can cause orthostatic hypotension, which is a drop in blood pressure when changing positions.

The client should change positions slowly, as dizziness may occur.

Choice D is wrong because it is partially correct. Phenelzine can cause headaches, which may be a sign of a hypertensive crisis.

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Correct Answer is D

Explanation

A back massage is a type of cutaneous stimulation that can help reduce pain by activating the gate control theory of pain. Cutaneous stimulation is a non-pharmacological intervention that can be delegated to unlicensed assistive personnel (UAP) or nursing assistive personnel (NAP) under the supervision of a registered nurse.

Choice A is wrong because assessing pain status requires critical thinking and clinical judgment, which are skills that only registered nurses have. Pain assessment is not a task that can be delegated to UAP/NAP.

Choice B is wrong because administering a placebo is a type of pharmacological intervention that involves giving a substance that has no therapeutic effect. Placebos are unethical and ineffective for pain management and should not be used by any health care provider.

Choice C is wrong because reviewing a pain diary involves evaluating the patient’s response to pain interventions and adjusting the plan of care accordingly. This is a complex task that requires nursing knowledge and skills and cannot be delegated to UAP/NAP.

A. Saturate dressing thoroughly with saline before removing the dressing. B. Remove the dressing from the wound and place in a bag for contaminated items. C. Use the old dressing to debride any tissue that is adhered to the wound. D. Reinsert the drain if removed with the dressing and let the surgeon know.

Correct Answer is B

Explanation

This is the appropriate action because it prevents the spread of infection and maintains a clean environment.

The nurse should also wear gloves and dispose of the bag properly.

Choice A is wrong because saturating the dressing with saline before removing it can cause maceration of the skin and increase the risk of infection. The dressing should be removed gently and carefully, and if it is adhered to the wound, small amounts of sterile saline can be used to loosen it.

Choice C is wrong because using the old dressing to debride any tissue that is adhered to the wound can cause trauma, bleeding, and pain. The nurse should use sterile forceps or cotton- tipped applicators to gently press moistened gauze into the wound surfaces.

Choice D is wrong because reinserting the drain if removed with the dressing can cause injury and infection. The nurse should notify the surgeon immediately if the drain is accidentally removed.

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A client has been recently started on phenelzine, a monoamine oxidase inhibitor (MAOI) for depression. Which statement indicates that the client requires further educational reinforcement about the medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is attempting to use non-pharmacological treatment for pain control. Which treatment could the nurse delegate to the UAP?

Correct Answer is D

Explanation

Which action is appropriate for a nurse to remove a soiled wound dressing?

Correct Answer is B

Explanation

Which amount of urine production should the nurse evaluate as adequate output for a typical adult client?

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Which intervention should the nurse include while caring for a client who has been diaphoretic for the past six hours?

A client has been recently started on phenelzine, a monoamine oxidase inhibitor (MAOI) for depression.
Which statement indicates that the client requires further educational reinforcement about the medication?