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A client has a new prescription for zolpidem, a hypnotic. The client tells the home health nurse that he plans to take a dose of the medication during the day because he is exhausted and needs to take a short afternoon nap prior to an evening activity in his home. Which action should the nurse take?
- A. Explain that the client needs to allow for sleep time of at least two hours.
- B. Advise the client to take the medication with the noon meal.
- C. Encourage the client to wait until bedtime to take the medication.
- D. Remind the client to drink plenty of fluids when taking the medication.
Correct Answer: C
Rationale: Zolpidem, a sedative-hypnotic, should be taken at bedtime (C) to avoid daytime drowsiness and fall risk. Two hours of sleep (A) is insufficient for safe clearance. Taking with meals (B) reduces efficacy. Fluid intake (D) is unrelated to zolpidem’s administration.
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Before administering the evening dose of carbamazepine, the nurse notes that the patient’s morning carbamazepine level was 84 mcg/mL. What action should the nurse take?
- A. Notify the healthcare provider of the carbamazepine level.
- B. Administer the carbamazepine as prescribed.
- C. Withhold this dose of the carbamazepine.
- D. Assess the patient for side effects of carbamazepine.
Correct Answer: A
Rationale: Carbamazepine’s therapeutic range is 4-12 mcg/mL; 84 mcg/mL (A) indicates toxicity risk, requiring provider notification. Administering (B) or withholding (C) without consultation is unsafe. Assessing side effects (D) is secondary to reporting.
A client in the surgical recovery area asks the nurse to bring the largest possible dose of pain medication available. Which action should the nurse implement first?
- A. Determine when the last dose was administered.
- B. Review the history for past use of recreational drugs.
- C. Ask the client to rate the current level of pain using a pain scale.
- D. Encourage the client to use diversional thoughts to manage pain.
Correct Answer: C
Rationale: Assessing the client’s pain level using a pain scale (C) is the first step to quantify pain and guide appropriate dosing. Determining the last dose (A) and reviewing drug history (B) are secondary. Diversional thoughts (D) are a non-pharmacological adjunct, not the priority.
The nurse initiates an infusion of piperacillin-tazobactam for a client with a urinary tract infection. Five minutes into the infusion, the client reports not feeling well. Which client manifestation should the nurse identify as a reason to stop the infusion?
- A. Hypertension.
- B. Scratchy throat.
- C. Bradycardia.
- D. Pupillary constriction.
Correct Answer: B
Rationale: A scratchy throat (B) may indicate an allergic reaction, potentially anaphylaxis, requiring immediate cessation of the piperacillin-tazobactam infusion and assessment. Hypertension (A), bradycardia (C), and pupillary constriction (D) are not typical signs of an allergic response to this antibiotic.
When administering medications to a group of patients, which patient should the nurse closely monitor for the development of acute kidney injury (AKI)?
- A. Patient on Vancomycin.
- B. Patient on Sucralfate.
- C. Patient on Lorazepam.
- D. Patient on Digoxin.
Correct Answer: A
Rationale: Vancomycin (A) is nephrotoxic and requires monitoring for AKI, especially with high doses or prolonged use. Sucralfate (B) protects the stomach, not kidneys. Lorazepam (C) and digoxin (D) have minimal renal toxicity risks.
Which intervention is most important for the nurse to implement for a client who is receiving insulin lispro?
- A. Assess for hypoglycemia between meals.
- B. Check blood glucose levels every six hours.
- C. Provide meals at the same time this insulin is given.
- D. Keep an oral liquid or glucose source available.
Correct Answer: C
Rationale: Insulin lispro, a rapid-acting insulin, peaks quickly and should be given with meals (C) to match food intake and prevent hypoglycemia. Assessing for hypoglycemia (A) and keeping glucose sources (D) are important but secondary. Six-hour glucose checks (B) are too infrequent.