The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient?
A) Risk for infection
B) Establish suicide precautions
C) Disturbed thought processes related to central nervous system (CNS) effects of medication
D) Dysfunctional Family Processes
C
Feedback:
Nursing diagnoses related to SSRI therapy might include: Disturbed thought processes related to central nervous system effects because adverse effects of SSRIs include headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures. There would be no reason to expect the patient is at increased risk for infection, there is not enough information known about the patient's family to know if processes are dysfunctional. Establishing suicide precautions is an intervention and not a nursing diagnosis.
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a. Nausea and dyspnea b. Severe constipation c. Headache and intense hunger d. Pain in the joints
A patient with acute respiratory distress syndrome (ARDS) requires mechanical ventilation but is at risk for barotrauma due to decreased lung compliance. Which mode of ventilation should the nurse use with this patient?
A) Pressure support ventilation mode B) Synchronized intermittent mandatory ventilation mode C) Pressure-controlled ventilation mode D) Assist-control mode
Nurses realize the importance of family relationships in the life of a patient with anorexia nervosa. As a nurse, you would expect which of the following attitudes or behaviors in the parents of an adolescent with anorexia nervosa?
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The nurse suspects clubfoot in the newborn. It is appropriate to:
1. Adduct the foot and listen for a click. 2. Move the foot to midline and determine resistance. 3. Extend the foot and observe for pain. 4. Stimulate the sole of the foot.