A nurse is reinforcing teaching with a client who has a history of depression about a new prescription for fluoxetine.
Which statement by the client indicates understanding of the teaching?

“I will increase my water intake up to 8 glasses a day.”

“I may experience sedation and sleepiness.”

“I will notice an improvement in my sex drive.”

“I should expect to feel better within 3 to 4 days.”

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Increased water intake is not a specific teaching point for fluoxetine. While general hydration is important for overall health, it's not directly related to the medication's effectiveness or side effects.

Fluoxetine is not known to cause dehydration or require fluid intake beyond typical recommendations.

Focusing on water intake could potentially distract from more relevant education about the medication.

Choice B rationale:

Sedation and sleepiness are common side effects of fluoxetine, especially during the initial weeks of treatment.

It's important for the client to be aware of these potential side effects so they can make necessary adjustments to their activities, such as avoiding driving or operating machinery if drowsy.

Understanding that these side effects are expected can also help with adherence to treatment, as clients may be less likely to discontinue the medication if they know that the side effects are likely to subside over time.

Choice C rationale:

Fluoxetine can sometimes cause sexual side effects, such as decreased libido or difficulty achieving orgasm.

It's important for the client to be aware of this potential side effect, but it's not accurate to say that they will definitely notice an improvement in their sex drive.

Sexual side effects can be distressing and may impact treatment adherence, so open communication with the healthcare provider is essential if these issues arise.

Choice D rationale:

Fluoxetine can take several weeks, typically 4-6 weeks, to fully exert its therapeutic effects.

Expecting to feel better within 3-4 days could lead to disappointment and frustration if symptom improvement isn't immediately noticeable.

It's important for the client to understand that patience is needed while the medication takes effect.

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Correct Answer is A

Explanation

Choice A rationale:

Pseudoparkinsonism is an extrapyramidal side effect (EPSE) of antipsychotic medications, particularly first-generation antipsychotics (FGAs) like haloperidol, that closely resembles the symptoms of Parkinson's disease. It's characterized by:

Stooped posture: A forward-leaning posture, often with rounded shoulders and a head that is bent forward.

Shuffling gait: Small, slow steps with reduced arm swing, often described as a "shuffling" or "dragging" walk.

Rigidity: Increased muscle stiffness throughout the body, leading to resistance to movement and a feeling of tightness.

Bradykinesia: Slowness of movement, both in initiating and completing actions.

Tremor: Involuntary shaking, often most noticeable in the hands, but can also affect the arms, legs, head, or jaw.

Masked facies: A decreased facial expression, often described as a "flat" or "expressionless" face.

Mechanism of pseudoparkinsonism:

Haloperidol primarily blocks dopamine D2 receptors in the nigrostriatal pathway of the brain.

Dopamine plays a crucial role in motor control, and its blockade in this pathway leads to a disruption in the balance of dopamine and acetylcholine, another neurotransmitter involved in movement.

This imbalance results in the characteristic symptoms of pseudoparkinsonism.

Risk factors for pseudoparkinsonism:

Older age

Female sex

Higher doses of antipsychotic medication

Prolonged use of antipsychotic medication

History of Parkinson's disease or other movement disorders

Presence of other EPSEs

Management of pseudoparkinsonism:

Dose reduction: If possible, the dose of the antipsychotic medication may be reduced.

Switching to a different antipsychotic: Some antipsychotics, such as second-generation antipsychotics (SGAs), have a lower risk of causing EPSEs.

Anticholinergic medications: These medications can help to counteract the effects of dopamine blockade on the acetylcholine system, but they can have their own side effects, such as dry mouth, constipation, and urinary retention.

Amantadine: This medication can also be used to treat pseudoparkinsonism, but it has the potential to cause side effects such as insomnia, anxiety, and livedo reticularis (a mottled skin rash).

A. Hgb 11g/dL B. Potassium 2.8 mEq/L C. C. Serum chloride 96 mEq/L D. Serum amylase 240 units/L

Correct Answer is B

Explanation

Choice A rationale:

Hemoglobin (Hgb) of 11 g/dL is slightly below the normal range for adult females (12-16 g/dL) but is not considered a critical value.

It may indicate mild anemia, which is common in bulimia nervosa due to factors such as poor nutrition and blood loss from self-induced vomiting. However, it would not typically be the most urgent finding requiring immediate intervention.

Choice B rationale:

Potassium of 2.8 mEq/L is significantly below the normal range (3.5-5.0 mEq/L) and is considered a critical value, indicating severe hypokalemia.

Hypokalemia is a potentially life-threatening electrolyte imbalance that can lead to cardiac arrhythmias, muscle weakness, respiratory failure, and even death.

It is a common complication of bulimia nervosa due to excessive vomiting and/or laxative abuse, which can lead to significant potassium loss.

Therefore, this finding would be the nurse's priority, necessitating immediate intervention to correct the hypokalemia and prevent potentially life-threatening complications.

Choice C rationale:

Serum chloride of 96 mEq/L is slightly below the normal range (98-106 mEq/L) but is not considered a critical value.

It may be associated with hypokalemia, as chloride and potassium are often lost together in conditions like bulimia nervosa.

However, it would not typically be the most urgent finding requiring immediate intervention.

Choice D rationale:

Serum amylase of 240 units/L is elevated above the normal range (30-110 units/L) but is not considered a critical value.

It may indicate inflammation of the pancreas (pancreatitis), which can be a complication of bulimia nervosa due to recurrent vomiting and/or alcohol abuse.

However, it would not typically be the most urgent finding requiring immediate intervention, especially in comparison to severe hypokalemia.

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A nurse is reinforcing teaching with a client who has a history of depression about a new prescription for fluoxetine. Which statement by the client indicates understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has schizophrenia and is taking haloperidol. The nurse observes that the client has developed a stooped posture and shuffling gait. The nurse should document these findings as which of the following extrapyramidal side effects of haloperidol?

Correct Answer is A

Explanation

A nurse is reviewing the admission laboratory values for a client who has a history of bulimia nervosa. Which of the following findings is the nurse’s priority?

Correct Answer is B

Explanation

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A nurse is reinforcing teaching with a client who has a history of depression about a new prescription for fluoxetine.
Which statement by the client indicates understanding of the teaching?