Exam (Elaborations) Ati Nclex Rationales (Nclex Uworld Review) -2020

Clozapine is an atypical antipsychotic medication used to treat schizophrenia that has not responded to standard, more traditional treatment. Clozapine is associated with a risk for agranulocytosis and is therefore used only in clients with treatment-resistant schizophrenia. must have their WBC and ANC monitored regularly throughout the course of therapy (initially once every week). the health care provider (HCP) immediately if fever or a sore throat develops, as this may indicate an underlying infection from neutropenia. also cause metabolic syndrome (weight gain, hyperlipidemia, insulin resistance/diabetes) and seizures. • Weight gain—a baseline height, weight, and waist circumference should be obtained, and a BMI can be calculated • Hyperglycemia—symptoms of hyperglycemia (eg, increased thirst and urination, weakness, increased blood glucose) should be monitored • Dyslipidemia—a lipid profile should be obtained A hemorrhagic stroke occurs when a blood vessel ruptures in the brain and causes bleeding into the brain tissue or subarachnoid space. Seizure activity may occur due to increased intracranial pressure (ICP) (Option 3). During the acute phase, a client may develop dysphagia. To prevent aspiration, the client must remain NPO until a swallow function screen reveals no deficits (Option 4). The nurse should perform neurological assessments (eg, level of consciousness, pupillary response) at regular intervals and report any acute changes (Option 5). Preventing activities that increase ICP or blood pressure will minimize further bleeding. The nurse should: • Reduce stimulation, maintain a quiet and dimly lit environment, limit visitors • Administer stool softeners to reduce strain during bowel movements (Option 1) • Reduce exertion, maintain strict bed rest, assist with activities of daily living • Maintain head in midline position to improve jugular venous return to the heart Sulfonylureas (eg, glyburide) stimulate insulin release via the pancreas and carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended by the Beers Criteria. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin)Giving oral medications to infants requires specialized techniques for safe administration. A plastic, disposable oral syringe can be used for accurate dosing and ease of delivery (Option 4). Oral medication should be administered with the infant in a semi-reclining position, which is similar to the feeding position (Option 3). This position promotes comfort, prevents aspiration, and may be better controlled by the nurse if the infant resists the medication. Liquid medications administered by oral syringe should be directed toward the back and inside of the infant's cheek (Option 2). The medication should be dispensed slowly in small amounts, allowing the infant to swallow between squirts to prevent aspiration. (Option 1) Medications are never mixed in a bottle of infant formula as this can affect the taste and the infant may then refuse the formula in the future. In addition, if the infant does not complete the full feed, underdosing will occur. (Option 5) Pinching the nose shut during medication administration may cause aspiration. The infant's mouth should be opened by applying gentle pressure to the chin or cheeks. Educational objective: Disposable oral syringes are the preferred tool to administer oral medications to infants. Infants should be held in a semi-reclining position, and medications should be given slowly in small amounts directed toward the back and inside of the cheek.