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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Establish a new routine for the child to follow while in the facility. - Preschoolers thrive on routines and familiarity, especially in unfamiliar environments like acute care facilities. Therefore, it's essential for the nurse to maintain the child's existing routine as much as possible to provide a sense of security and stability.
B. Encourage the child to play with toys such as a pounding board. - Encouraging play with age-appropriate toys helps promote normalcy, reduce anxiety, and facilitate coping for preschoolers during their hospital stay. Toys like a pounding board provide opportunities for physical activity and engagement, which can help distract and entertain the child.
C. Use medical terminology when discussing procedures with the child. - Preschoolers have limited understanding of complex medical terminology. Using simple, age-appropriate language helps the child better comprehend what is happening, reducing fear and anxiety. Therefore, it's important for the nurse to avoid medical jargon and use language the child can understand.
D. Perform the morning assessments when the parent is not in the room. - Preschoolers often feel more comfortable and secure when their parents are present, especially in unfamiliar environments like hospitals. Performing assessments in the presence of the parent helps maintain the child's sense of security and allows the parent to participate in the child's care and provide comfort and support.
Correct Answer is D
Explanation
A. "I can expect my eyelids to be bruised after this procedure": Bruising of the eyelids is not a common expectation following cataract removal surgery. While mild redness or irritation may occur, significant bruising is not typical.
B. "I will see dark spots in my vision after this procedure": Seeing dark spots in vision after cataract removal surgery is not expected. The purpose of cataract surgery is to improve vision by removing the cloudy lens and replacing it with a clear artificial lens. Dark spots in vision may indicate complications such as retinal detachment, which should be promptly reported to the healthcare provider.
C. "I will receive general anesthesia for this procedure": Cataract removal surgery typically does not require general anesthesia. Instead, it is commonly performed under local anesthesia with sedation. General anesthesia is reserved for more complex or high-risk procedures. Therefore, this statement indicates a misunderstanding of the anesthesia type for cataract surgery.
D. "I know the provider will replace the lens in my eyes during this procedure": This statement indicates an accurate understanding of the cataract removal procedure. During cataract surgery, the cloudy natural lens of the eye is removed and replaced with an artificial intraocular lens (IOL) to restore vision. This is the primary goal of the surgery, and the statement reflects the client's understanding of the procedure.
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