A nurse is caring for a client who requires a crisis intervention for acute anxiety. Which of the following actions should be the nurse's highest priority?
Protecting the client from injury
Identifying the client's coping skills
Ensuring that the client feels safe
Determining the cause of the client's anxiety.
The Correct Answer is A
Choice A rationale:
Protecting the client from injury is the highest priority nursing action in this scenario. Here's a detailed rationale explaining the importance of this action:
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["2"]
Explanation
Step 1: Identify the required dose of lithium, which is 300 mg.
Step 2: Identify the available dose of lithium carbonate, which is 150 mg per capsule.
Step 3: Calculate the number of capsules needed using the formula: Number of capsules = Required dose ÷ Available dose.
Numberofcapsules=300 mg150 mg/capsule
\(Number\ of\ capsules = {300\ mg \over 150\ mg/capsule}\)
Step 4: Solve the equation.
Numberofcapsules=2 capsulesNumberofcapsules=2capsules
So, the nurse should administer 2 capsules per dose to achieve the required lithium dose of 300 mg.
Correct Answer is ["A","D"]
Explanation
Choice A rationale: Fluoxetine, also known as Prozac, is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. One of the common side effects of fluoxetine is a decreased interest in sexual intercourse. This can manifest as a decreased sex drive, difficulty in achieving an orgasm, or inability to have or keep an erection. It’s important for patients to be aware of this potential side effect so they can discuss it with their healthcare provider if it becomes a concern.
Choice B rationale: While fluoxetine is an effective treatment for depressive disorders, it does not typically cause an improvement in depressive symptoms in 2 to 3 days. In fact, it may take several weeks before patients begin to feel the full benefits of fluoxetine. Some people may even feel worse before they start to feel better. This is because it takes some time for fluoxetine to adjust the chemical balance in the brain.
Choice C rationale: Drooling is not typically associated with the use of fluoxetine. While fluoxetine can have many side effects, drooling is not commonly reported. If a patient experiences this side effect, it may be due to another medication or a different medical condition. It’s always important to discuss any new or unusual symptoms with a healthcare provider.
Choice D rationale: Loss of appetite is another potential side effect of fluoxetine. This can lead to weight loss in some patients. While this may be desirable for some, it can also lead to malnutrition and other health problems if not properly managed. Patients should be advised to monitor their weight and dietary intake while taking fluoxetine, and to discuss any concerns with their healthcare provider.
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