A nurse is assessing a client who has schizophrenia prior to administering the client's next dose of clozapine. Which of the following findings should the nurse report to the provider?

Diaphoresis

Fever

Polyuria

Diarrhea

Answer and Explanation

The Correct Answer is B

A. Diaphoresis: Diaphoresis, or excessive sweating, is a common side effect of clozapine and may not necessarily indicate a need for immediate intervention. However, it should be documented and monitored for any changes.
B. Fever: Fever can be a sign of infection, which is a serious concern in clients taking clozapine due to the risk of agranulocytosis, a potentially life-threatening side effect characterized by a severe decrease in white blood cell count. Any signs of infection, including fever, should be reported promptly to the provider for further evaluation and management.
C. Polyuria: Polyuria, or excessive urination, is not typically associated with clozapine use and may be indicative of other underlying issues such as diabetes mellitus or diabetes insipidus. While it should be assessed and managed appropriately, it is not specifically related to clozapine administration and may not require immediate reporting to the provider.
D. Diarrhea: Diarrhea is a common gastrointestinal side effect of clozapine and may occur due to its effects on the gastrointestinal system. While persistent or severe diarrhea should be monitored and managed, it is not typically considered a serious adverse reaction that requires immediate reporting to the provider unless it is accompanied by other concerning symptoms.

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Correct Answer is A

Explanation

A. Veracity: Veracity refers to the ethical principle of truthfulness or honesty. By informing the client about the potential adverse effects of transcranial magnetic stimulation (TMS) and reassuring them that it should not affect their memory, the nurse is demonstrating truthfulness and providing accurate information to the client.
B. Fidelity: Fidelity pertains to the ethical principle of faithfulness or honoring commitments and promises made to clients. While important, fidelity is not directly demonstrated in this scenario.
C. Beneficence: Beneficence involves the ethical principle of doing good or acting in the best interest of the client to promote their well-being. While providing information about the potential adverse effects of TMS is aligned with beneficence, the specific action described in the scenario focuses more on truthfulness (veracity).
D. Autonomy: Autonomy refers to the ethical principle of respecting the client's right to make their own decisions and choices regarding their healthcare. While autonomy is important in healthcare decision-making, it is not directly demonstrated in this scenario, as the nurse is providing information rather than facilitating the client's decision-making process.

A. Tell the client to gently stroke their lower abdomen. B. Turn on the faucets in the client's sink. C. Pour cool water over the client's perineum. D. Instruct the client to lean slightly backward.

Correct Answer is B

Explanation

Answer: B. Turn on the faucets in the client's sink.

Rationale:

A. Tell the client to gently stroke their lower abdomen:
Stroking the abdomen may promote some sensory stimulation, but it is not a well-supported or commonly used intervention to stimulate voiding reflexes in clients having difficulty urinating on bed rest.

B. Turn on the faucets in the client's sink:
The sound of running water is a non-invasive, evidence-based method known to trigger the urge to urinate by stimulating the micturition reflex. This auditory cue can help relax pelvic muscles and facilitate urination, especially in clients struggling to void while in bed.

C. Pour cool water over the client's perineum:
Pouring cool water may not effectively stimulate urination and may cause discomfort. If water is used to promote voiding, it should be warm, not cool, to relax the perineal muscles and increase the likelihood of voiding.

D. Instruct the client to lean slightly backward:
Leaning backward can misalign the urethra and bladder, making voiding more difficult, especially for a female client in a supine or semi-recumbent position. A forward-leaning posture, if possible, is more anatomically favorable to aid urination.

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A nurse is assessing a client who has schizophrenia prior to administering the client's next dose of clozapine. Which of the following findings should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A nurse is caring for a female client who requires bed rest and reports difficulty urinating into a bedpan. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

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