A nurse is providing teaching to a client about the adverse effects of sertraline. Which of the following adverse effects should the nurse include?
Metallic taste in the mouth
Excessive sweating
Increased urinary frequency
Dry cough
The Correct Answer is B
A. Incorrect. A metallic taste in the mouth is not a common adverse effect of sertraline.
B. Correct. Excessive sweating (diaphoresis) is a potential adverse effect of sertraline and other selective serotonin reuptake inhibitors (SSRIs).
C. Incorrect. Increased urinary frequency is not commonly associated with sertraline.
D. Incorrect. A dry cough is not a known adverse effect of sertraline.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Correct. Beneficence refers to the ethical principle of doing good and taking actions that promote the well-being and best interests of the client. Sitting with the client to provide comfort aligns with this principle.
B. Incorrect. Autonomy relates to respecting the client's right to make decisions about their own care and treatment.
C. Incorrect. Fidelity pertains to keeping promises and maintaining trust in the nurse-client relationship.
D. Incorrect. Veracity involves truthfulness and honesty in communication with clients, particularly in providing accurate information about their care and condition.
Correct Answer is A
Explanation
The correct answer is Choice A.
Choice A rationale: “What are the voices telling you?” This is the priority response because it directly addresses the client’s immediate concern. The nurse is acknowledging the client’s experience and seeking to understand more about it. This can help the nurse assess the potential for harm to the client or others, as the voices may be instructing the client to engage in dangerous behaviors.
Choice B rationale: “Have you taken your medication today?” While medication adherence is important in managing schizophrenia, this response does not address the client’s immediate concern about hearing voices. It may also come across as dismissive of the client’s experience.
Choice C rationale: “I realize the voices are real to you, but I don’t hear anything.” This response validates the client’s experience, but it does not gather further information about what the voices are saying, which is crucial for assessing safety.
Choice D rationale: “How long have you been hearing the voices?” While this question is relevant for understanding the client’s history and the progression of their illness, it is not the priority response. The immediate concern should be what the voices are saying to assess for potential harm.
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