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A client with atrial fibrillation has been prescribed dabigatran. What instruction should the nurse include in this client’s teaching plan?
- A. Eliminate spinach and other green vegetables from the diet.
- B. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
- C. Continue to obtain scheduled laboratory bleeding tests.
- D. Keep an antidote available in case of hemorrhage.
Correct Answer: B
Rationale: Dabigatran increases bleeding risk; avoiding NSAIDs (B) reduces this risk. Spinach (A) affects warfarin, not dabigatran. Routine bleeding tests (C) aren’t required for dabigatran. Antidotes (D) like idarucizumab are hospital-administered, not kept at home.
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A patient with type 1 diabetes mellitus has been prescribed a glucagon emergency kit for home use. When should the nurse instruct the patient and family that glucagon needs to be administered?
- A. Before meals to prevent hyperglycemia.
- B. When signs of severe hypoglycemia occur.
- C. When unable to eat during sick days.
- D. At the onset of signs of diabetic ketoacidosis.
Correct Answer: B
Rationale: Glucagon treats severe hypoglycemia (B) by mobilizing liver glucose stores. It’s not for preventing hyperglycemia (A), sick-day management (C), or diabetic ketoacidosis (D), which requires insulin and medical intervention.
A client with chemotherapy-induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report?
- A. Diarrhea.
- B. Unusual irritability.
- C. Nausea.
- D. Involuntary movements.
Correct Answer: D
Rationale: Involuntary movements (D), such as tardive dyskinesia, are a serious, potentially irreversible side effect of metoclopramide, requiring immediate reporting. Diarrhea (A) and irritability (B) are less severe. Nausea (C) is the treated condition, not an adverse effect.
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.
A patient in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system to manage asthma. This system delivers an inhaled powdered form of these combined medications. What instruction should the nurse provide to this patient’s caregivers?
- A. Instruct the patient to exhale rapidly into the mouthpiece when using the discus.
- B. Explain that the patient should not use the discus more than twice daily.
- C. Inform that patients using the discus may experience a decrease in blood pressure.
- D. Suggest offering the discus to the patient for use during an acute asthma attack.
Correct Answer: B
Rationale: Fluticasone/salmeterol is a maintenance therapy, used twice daily (B). Exhaling into the mouthpiece (A) is incorrect; inhalation is required. Hypotension (C) isn’t a common side effect. It’s not for acute attacks (D), which require rescue inhalers.
The nurse is preparing to administer a scheduled dose of labetalol orally to a client with hypertension. The client’s vital signs are temperature 99° F (37.2 C), heart rate 48 beats/minute, respirations 16 breaths/minute, and blood pressure (BP) 150/90 mm Hg. What action should the nurse take?
- A. Withhold the scheduled dose and notify the healthcare provider.
- B. Administer the dose and monitor the client’s BP regularly.
- C. Assess for orthostatic hypotension before administering the dose.
- D. Apply a telemetry monitor before administering the dose.
Correct Answer: A
Rationale: Labetalol, a beta-blocker, can worsen bradycardia (heart rate 48 bpm). Withholding the dose and notifying the provider (A) is safest. Administering (B) risks exacerbating bradycardia. Orthostatic hypotension assessment (C) and telemetry (D) are secondary.