Answers Graded A+
A nurse is admitting a client who has major
depressive disorder and a new prescription for A. An adolescent family member who questions
tranylcypromine. Which of the following over-the- parental authority
counter medications that the client reports taking B. A family with three generations in the same
should alert the nurse to a potential adverse household
reaction? C. Older children who are responsible for their
younger siblings
A. Lansoprazole D. Two adults and their children from prior
B. Naproxen relationships in the same household -
C. Magnesium hydroxide ANSWERS - C. Older children who are
D. Phenylephrine - ANSWERS - D. responsible for their younger siblings
Phenyleprine
This is an example of enmeshed boundaries in
Clients who are taking tranylcypromine, an MAOI which there are no distinctions between the roles
antidepressant, should not take phenylephrine of family members
and other over-the-counter medications for sinus
congestion, colds, or allergies due to their
actions on the sympathetic nervous system, A nurse is assessing a client who had major
which can result in severe hypertension depressive disorder and has been receiving
amitriptyline for 1 week. Which of the following
outcomes should the nurse expect?
A nurse on a mental health unit observes a client
who has acute mania hit another client. Which of A. Rapid improvement in affect within 30 to 60
the following actions should the nurse take first? min after taking the medication
B. Greater risk of attempting suicide as affect and
A. Call the provider to obtain an immediate energy improve
prescription for restraint. C. Onset of frequent, loose stools
B. Prepare to administer benzodiazepine IM. D. Development of physiologic dependence on
C. Call for a team of staff members to help with the medication - ANSWERS - B. Greater
the situation. risk of attempting suicide as affect and energy
D. Check the client who was hit for injuries. - improve
ANSWERS - C. Call for a team of staff
members to help with the situation The nurse shoud identify that an initial response
to amitriptyline can develop in 1 week. For a
The greatest risk is injury to the client and others. client who has major depressive disorder with
Therefore, the first action the nurse should take suicidal ideation, the energy to carry out a plan is
is to call for assistance to prevent further injury to increased after 1 week of treatment.
themselves or others.
A nurse is teaching a newly licensed nurse about
A nurse is assessing a family's dynamics during nursing care plans for clients who have
a counseling session. The nurse should depressive disorders. Which of the following
recognize which of the following findings as an statements by the newly licensed nurse indicates
indication of a boundary issue? an understanding of the teaching?
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