A nurse is caring for a client in a clinic.
For each body system below, click to specify the adverse effect that the nurse should include in the teaching. Choose the most likely response for the dropdown(s) in the table below by choosing from the lists of options.
|
Body System |
Common Adverse Effects |
|
Head, eyes, ears, nose, and throat (HEENT) |
_____
|
|
Cardiovascular |
_____
|
|
Genitourinary |
_____
|
|
Gastrointestinal |
_____
|
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C","dropdown-group-3":"B","dropdown-group-4":"A"}
Rationale:
• HEENT – Dry mouth: SSRIs such as sertraline commonly cause dry mouth due to anticholinergic effects and altered salivary secretion. Clients may notice difficulty swallowing, increased thirst, or altered taste. Education should include strategies to manage dry mouth, such as frequent sips of water, sugar-free gum, or saliva substitutes.
• Cardiovascular – Tachycardia: Sertraline may increase sympathetic nervous system activity, leading to mild tachycardia. Clients should monitor heart rate and report palpitations, lightheadedness, or other cardiovascular changes. Although usually mild, monitoring is important for those with underlying heart conditions.
• Genitourinary – Urinary retention: SSRIs can interfere with detrusor muscle function and bladder emptying, leading to urinary retention in some clients. Teaching includes observing for difficulty urinating, straining, or reduced urine output, and reporting persistent problems to the provider.
• Gastrointestinal – Diarrhea: Gastrointestinal upset is common when starting SSRIs, including diarrhea, nausea, and abdominal cramping. This occurs due to increased serotonin in the gut. Patients should be advised to maintain hydration and report severe or persistent symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Gather supplies for a client's dressing change after removing the old dressing: This approach is inefficient and can lead to delays in care. Effective time management involves preparing all necessary supplies beforehand to minimize interruptions and ensure a smooth workflow.
B. Complete activities for one client before moving to the next client: Organizing care around each client and completing all required interventions in one visit promotes efficiency, reduces the risk of missed tasks, and allows better prioritization of nursing responsibilities.
C. Document assessment findings and interventions after providing care for a group of clients: Delaying documentation increases the risk of forgetting important details and can compromise patient safety. Timely documentation is essential for accurate communication and continuity of care.
D. Delay cleaning personal work area until the end of the shift: Maintaining an organized and clean work environment throughout the shift prevents clutter, reduces errors, and supports efficient care delivery. Postponing cleaning can hinder workflow and time management.
Correct Answer is D
Explanation
A. Boiled eggs: While eggs contain some iron, the iron is nonheme and not highly absorbable. Eggs do not contain vitamin C, which is necessary to enhance nonheme iron absorption.
B. Mixed nuts: Nuts provide nonheme iron but lack significant vitamin C, so consuming them alone does not significantly improve absorption. They are beneficial for iron intake but not for enhancing absorption.
C. Cheddar cheese: Dairy products contain very little iron and can actually inhibit nonheme iron absorption when consumed with iron-rich foods, making them a less effective choice for enhancing iron uptake.
D. Orange slices: Vitamin C in oranges significantly enhances the absorption of nonheme iron from plant-based sources. Consuming foods rich in vitamin C alongside iron-rich plant foods is an effective strategy for clients following a vegetarian diet.
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