The client is prescribed phenelzine (Nardil). The client tells the nurse that they consumed two glasses of Chianti (red) wine at lunchtime. What is the nurse's priority action?
Discuss how food can increase the symptoms of depression
Arrange for admittance to the psychiatric unit
Discuss the effects of wine on the action of antidepressants
Assess the client's blood pressure
The Correct Answer is D
Explanation:
A. Discussing how food can increase the symptoms of depression is not the priority in this situation; the immediate concern is the interaction between phenelzine and wine.
B. Admitting the client to the psychiatric unit is not necessary based solely on the consumption of wine with phenelzine; assessing the client's condition is the priority.
C. Discussing the effects of wine on the action of antidepressants is important, but assessing the client's current status takes precedence.
D. Assessing the client's blood pressure is the priority action because phenelzine is an MAOI, and consuming wine while taking MAOIs can lead to a hypertensive crisis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Hearing loss is not a common adverse effect of phenelzine (Nardil).
B. Orthostatic hypotension is a common adverse effect of phenelzine due to its monoamine oxidase inhibitor (MAOI) activity, leading to decreased blood pressure upon standing.
C. Weight loss is not a common adverse effect of phenelzine and may be more indicative of other factors or conditions.
D. Gastrointestinal bleeding is not a common adverse effect of phenelzine.
Correct Answer is D
Explanation
A. Nitroglycerin typically causes vasodilation and can lower blood pressure, rather than causing hypertension.
B. Diuresis, or increased urine production, is not a common adverse effect of nitroglycerin.
C. Nitroglycerin may cause a slight decrease in heart rate (bradycardia), but headache is a more common adverse effect.
D. Headache is the most common adverse effect of nitroglycerin, especially when first starting the medication or with dosage adjustments, due to vasodilation of blood vessels, including those in the head.
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