What nursing interventions are appropriate for a client starting clonazepam? Select all that apply.
Assist the client to the bathroom.
Have an opioid agonist at the bedside.
Provide oral care at least twice a day.
Assess mental status regularly.
Monitor calcium levels.
Screen for orthostatic hypotension.
Correct Answer : A,D,F
Choice A rationale
Assisting the client to the bathroom is appropriate as clonazepam can cause dizziness and unsteadiness, increasing the risk of falls.
Choice B rationale
Having an opioid agonist at the bedside is not necessary for a client starting clonazepam. Clonazepam is a benzodiazepine, not an opioid.
Choice C rationale
Providing oral care at least twice a day is generally good practice for all patients, but it’s not specifically related to clonazepam use.
Choice D rationale
Assessing mental status regularly is crucial as clonazepam can cause changes in mood and behavior.
Choice E rationale
Monitoring calcium levels is not typically required for a client starting clonazepam.
Choice F rationale
Screening for orthostatic hypotension is important as clonazepam can lower blood pressure, leading to dizziness and fainting when the client stands up.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["18"]
Explanation
Step 1 is to calculate the infusion rate. The prescription is for heparin 900 units/hr IV. The IV bag contains heparin 25,000 units in 500 mL of 0.45% normal saline.
So, the calculation would be (900 units ÷ 25,000 units) × 500 mL = 18 mL/hr.
Correct Answer is ["A","B","E"]
Explanation
E.
Choice A rationale
Removing resuscitation equipment from the room is a standard practice before allowing family members to view the body after an unsuccessful resuscitation. This helps to create a more peaceful and less distressing environment for the family. It also respects the dignity of the deceased and allows the family to focus on their loved one, rather than the medical interventions that were attempted.
Choice B rationale
Placing a small pillow under the head is a common practice in preparing the body for viewing by the family. This helps to position the body in a natural and peaceful manner, which can be comforting for the family. It also respects the dignity of the deceased.
Choice E rationale
Gently closing the eyes is another common practice in preparing the body for viewing by the family. This helps to give the appearance of peaceful rest, which can be comforting for the family. It also respects the dignity of the deceased.
Choice C rationale
Taking out dentures and placing them in a labeled cup is not a standard practice in preparing the body for viewing by the family. Dentures, if present, are usually left in place to maintain the natural appearance of the face.
Choice D rationale
Applying a body shroud is not a common practice in preparing the body for viewing by the family. The use of a body shroud may vary based on cultural or religious preferences, but it is not a standard procedure in many healthcare settings.
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