The nurse is caring for a client with a history of depression who is prescribed a selective serotonin reuptake inhibitor (SSRI). Which side effect should the nurse monitor for?

Sexual dysfunction

Hypotension

Hyperglycemia

Peripheral edema

Answer and Explanation

The Correct Answer is A

Choice A reason: Sexual dysfunction is a common SSRI side effect, as increased serotonin inhibits sexual arousal and orgasm. Monitoring is critical, as it affects adherence in depression treatment, requiring dose adjustments or alternative therapies, making it the priority side effect to assess.

Choice B reason: Hypotension is less common with SSRIs, though orthostatic changes may occur. Sexual dysfunction is more frequent, impacting quality of life and treatment adherence in depression, making it the priority to monitor, as it directly affects patient compliance and outcomes.

Choice C reason: Hyperglycemia is not a typical SSRI side effect, though metabolic changes are rare. Sexual dysfunction is a prevalent issue, reducing adherence in depression treatment, making it the priority to monitor, as it significantly impacts patient satisfaction and therapy continuation.

Choice D reason: Peripheral edema is rare with SSRIs, which primarily affect serotonin pathways. Sexual dysfunction is a common side effect, compromising adherence in depression management, making it the priority to monitor, as it directly influences treatment success and patient well-being.

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Correct Answer is A

Explanation

Choice A reason: Avoiding alcohol is critical with phenytoin, as it increases seizure risk and alters drug metabolism, reducing efficacy or causing toxicity. Alcohol’s CNS depressant effects exacerbate epilepsy, making this the priority teaching point to ensure seizure control and medication safety.

Choice B reason: Increasing calcium intake is unrelated to phenytoin or epilepsy management. While phenytoin may affect bone health long-term, alcohol avoidance is more urgent, as it directly impacts seizure control and drug pharmacokinetics, making it the priority teaching focus.

Choice C reason: Limiting physical activity is unnecessary for epilepsy unless seizures are poorly controlled. Alcohol avoidance is critical, as it lowers the seizure threshold and interferes with phenytoin metabolism, posing immediate risks to seizure control, making it the primary teaching point.

Choice D reason: Reducing fluid intake is irrelevant to phenytoin or epilepsy. Proper hydration supports health, but alcohol avoidance is the priority, as it directly affects seizure risk and phenytoin’s effectiveness, ensuring therapeutic levels and preventing breakthrough seizures in epilepsy management.

A. Obtain arterial blood gases B. Suction to clear secretions from airway C. Offer a prescribed PRN analgesia D. Administer a prescribed antipyretic

Correct Answer is B

Explanation

Choice A reason: Arterial blood gases assess oxygenation and acid-base balance, critical for diagnosing respiratory distress severity. However, this diagnostic measure does not immediately relieve airway obstruction. Clearing secretions is prioritized to restore ventilation, as hypoxia can rapidly cause tissue damage or cardiac arrest in acute respiratory distress.

Choice B reason: Suctioning removes airway secretions, directly addressing breathing difficulty. Secretions obstruct airways, reducing oxygen delivery to alveoli and impairing gas exchange. Immediate suctioning restores patency, enhances ventilation, and prevents hypoxia, making it the priority intervention to stabilize the client’s respiratory function in acute distress.

Choice C reason: PRN analgesia addresses pain, which is not indicated as the primary issue. Pain relief does not resolve airway obstruction or improve breathing. Administering analgesia prematurely could mask respiratory symptoms, delaying critical airway management and potentially worsening hypoxia by neglecting the underlying obstruction.

Choice D reason: An antipyretic reduces fever, improving comfort but not addressing breathing difficulty. Fever is secondary, and treating it does not restore airway patency or oxygenation. Airway management is prioritized in respiratory distress to prevent hypoxia and ensure effective gas exchange before managing fever symptoms.

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The nurse is caring for a client with a history of depression who is prescribed a selective serotonin reuptake inhibitor (SSRI). Which side effect should the nurse monitor for?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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