Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who has major depression and a new prescription for citalopram.
Which of the following adverse effects is the priority for the nurse to report to the provider?
A. Weight loss.
While weight changes can be concerning, they are not typically life-threatening and can occur as a common side effect of antidepressants, including citalopram. Monitoring is important, but it does not require immediate reporting.
B. Confusion.
This is the priority to report because confusion can indicate a serious reaction to the medication, such as serotonin syndrome, especially if it occurs in conjunction with other symptoms like agitation, hallucinations, or rapid heart rate. Confusion can also signal worsening mental status, which is critical for someone with major depression.
C. Bruxism.
This refers to teeth grinding, which can occur with certain antidepressants. While it should be monitored and possibly addressed with interventions, it is generally not an immediate concern compared to confusion.
D. Insomnia.
Sleep disturbances can be a side effect of citalopram and may need adjustment of treatment or recommendations for sleep hygiene, but they are not as urgent as confusion.
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Pharmacology 2019 Proctored Exam. Take the full exam now
Full Explanation
a. While weight changes can be concerning, they are not typically life-threatening and can occur as a common side effect of antidepressants, including citalopram. Monitoring is important, but it does not require immediate reporting.
b. This is the priority to report because confusion can indicate a serious reaction to the medication, such as serotonin syndrome, especially if it occurs in conjunction with other symptoms like agitation, hallucinations, or rapid heart rate. Confusion can also signal worsening mental status, which is critical for someone with major depression.
c. This refers to teeth grinding, which can occur with certain antidepressants. While it should be monitored and possibly addressed with interventions, it is generally not an immediate concern compared to confusion.
d. Sleep disturbances can be a side effect of citalopram and may need adjustment of treatment or recommendations for sleep hygiene, but they are not as urgent as confusion.
Similar Questions
A nurse is reviewing the medical record of a client who has sinusitis and a new prescription for cefuroxime.
Which of the following client information is the priority for the nurse to report to the provider?
A. The client has a BUN level of 18 mg/dL.
Choice A is wrong because the client has a BUN level of 18 mg/dL, which is within the normal range of 7 to 20 mg/dL. This does not indicate any renal impairment or adverse reaction to cefuroxime.
B. The client reports a history of nausea with cefuroxime.
Choice B is wrong because the client reports a history of nausea with cefuroxime, which is a common side effect of this drug. The nurse should instruct the client to take cefuroxime with food to reduce nausea, but this is not a priority to report to the provider.
C. The client has a history of a severe penicillin allergy.
This is the priority for the nurse to report to the provider because cefuroxime is a cephalosporin antibiotic that can cause serious or life-threatening allergic reactions in people who are allergic to penicillin.The nurse should not administer cefuroxime to this client until the provider is notified and an alternative antibiotic is prescribed.
D. The client takes an aspirin daily.
Choice D is wrong because the client takes an aspirin daily, which does not interact with cefuroxime. The nurse should monitor the client for any signs of bleeding or bruising while taking aspirin, but this is not a priority to report to the provider.
Full Explanation
This is the priority for the nurse to report to the provider because cefuroxime is a cephalosporin antibiotic that can cause serious or life-threatening allergic reactions in people who are allergic to penicillin. The nurse should not administer cefuroxime to this client until the provider is notified and an alternative antibiotic is prescribed.
Choice A is wrong because the client has a BUN level of 18 mg/dL, which is within the normal range of 7 to 20 mg/dL.
This does not indicate any renal impairment or adverse reaction to cefuroxime.
Choice B is wrong because the client reports a history of nausea with cefuroxime, which is a common side effect of this drug.
The nurse should instruct the client to take cefuroxime with food to reduce nausea, but this is not a priority to report to the provider.
Choice D is wrong because the client takes aspirin daily, which does not interact with cefuroxime.
The nurse should monitor the client for any signs of bleeding or bruising while taking aspirin, but this is not a priority to report to the provider.
A nurse is caring for a client who has a prescription for total parental nutrition (TPN).
Which of the following routes of administration should the nurse use?
A. Midline catheter.
Choice A is wrong because a midline catheter is a type of peripheral catheter that can only be used for solutions with low or moderate osmolarity, not for TPN.
B. Central venous access device.
This is because TPN solutions are concentrated and can cause thrombosis of peripheral veins, so a central venous catheter is usually required. TPN should only be used when the intestine is unavailable or unable to absorb nutrients.
C. Subcutaneous.
Choice C is wrong because subcutaneous administration is not a route for delivering TPN, which requires intravenous infusion.
D. Intraosseous.
Choice D is wrong because intraosseous administration is an emergency route for delivering fluids and drugs when intravenous access is not available, not for TPN.
Full Explanation
This is because TPN solutions are concentrated and can cause thrombosis of peripheral veins, so a central venous catheter is usually required. TPN should only be used when the intestine is unavailable or unable to absorb nutrients.
Choice A is wrong because a midline catheter is a type of peripheral catheter that can only be used for solutions with low or moderate osmolarity, not for TPN.
Choice C is wrong because subcutaneous administration is not a route for delivering TPN, which requires intravenous infusion.
Choice D is wrong because intraosseous administration is an emergency route for delivering fluids and drugs when intravenous access is not available, not for TPN.
A nurse recently administered filgrastim intravenously to a client who has cancer and is receiving cytotoxic chemotherapy.
For which of the following data, discovered after the medication was administered, should the nurse file an incident report?
A. The client had chemotherapy 12 hr before the medication was administered.
Administering filgrastim 12 hours after chemotherapy does not typically require an incident report. Filgrastim is often given at least 24 hours after chemotherapy to avoid the risk of increasing the toxicity of the chemotherapy agents. While the timing is closer than recommended, it does not necessarily constitute an error unless specific instructions for the timing were provided by the prescribing physician.
B. The medication vial sat at room temperature for 2 hr before it was administered.
The medication vial sitting at room temperature for 2 hours before administration does not require an incident report. Filgrastim can be left out at room temperature for up to 24 hours before use. This is within the safe handling guidelines for the medication.
C. The client’s absolute neutrophil count was 2,500/mm3 before the medication was administered.
An absolute neutrophil count (ANC) of 2,500/mm³ is within the normal range, which is typically 1,500-8,000/mm³. Filgrastim is used to increase neutrophil counts in patients with low ANC due to chemotherapy. Since the ANC was not low before administration, this would not necessitate an incident report, although it may prompt a review of the necessity of the medication.
D. The nurse flushed the client’s IV line with dextrose 5% in water before and after the medication was administered.
Flushing the client's IV line with dextrose 5% in water before and after the medication was administered is not the standard procedure and could potentially lead to medication errors or adverse effects. Filgrastim should be diluted in glucose 5% in water for intravenous infusion, but not used to flush the line. This deviation from the standard protocol is what necessitates an incident report.
Full Explanation
The correct answer is d
Choice A reason:
Administering filgrastim 12 hours after chemotherapy does not typically require an incident report. Filgrastim is often given at least 24 hours after chemotherapy to avoid the risk of increasing the toxicity of the chemotherapy agents. While the timing is closer than recommended, it does not necessarily constitute an error unless specific instructions for the timing were provided by the prescribing physician.
Choice B reason:
The medication vial sitting at room temperature for 2 hours before administration does not require an incident report. Filgrastim can be left out at room temperature for up to 24 hours before use. This is within the safe handling guidelines for the medication.
Choice C reason:
An absolute neutrophil count (ANC) of 2,500/mm³ is within the normal range, which is typically 1,500-8,000/mm³. Filgrastim is used to increase neutrophil counts in patients with low ANC due to chemotherapy. Since the ANC was not low before administration, this would not necessitate an incident report, although it may prompt a review of the necessity of the medication.
Choice D reason:
Flushing the client's IV line with dextrose 5% in water before and after the medication was administered is not the standard procedure and could potentially lead to medication errors or adverse effects. Filgrastim should be diluted in glucose 5% in water for intravenous infusion, but not used to flush the line. This deviation from the standard protocol is what necessitates an incident report.