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A client with peptic ulcer disease is prescribed ranitidine (Zantac). Which statement by the client indicates the need for further teaching?
- A. I will take this medication at bedtime.
- B. I need to avoid smoking while taking this medication.
- C. I should take this medication with meals.
- D. This medication will help reduce stomach acid.
Correct Answer: C
Rationale: Rationale:
C is the correct answer. Ranitidine is usually taken on an empty stomach to maximize its effectiveness in reducing stomach acid production. Therefore, taking it with meals would decrease its efficacy. A, B, and D are incorrect because taking ranitidine at bedtime is common practice, smoking can worsen ulcer symptoms, and ranitidine does indeed reduce stomach acid.
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A patient with chronic heart failure is prescribed furosemide. What is the primary action of this medication?
- A. Increase cardiac output
- B. Reduce fluid retention
- C. Decrease heart rate
- D. Lower blood pressure
Correct Answer: B
Rationale: The correct answer is B: Reduce fluid retention. Furosemide is a loop diuretic that works by increasing urine production, leading to the removal of excess fluid and sodium from the body. This helps reduce fluid volume overload in conditions like heart failure. Choice A is incorrect because while reducing fluid retention may indirectly improve cardiac output by reducing preload, furosemide itself does not directly increase cardiac output. Choice C is incorrect as furosemide does not have a direct effect on heart rate. Choice D is incorrect because while furosemide may lower blood pressure as a result of reducing fluid volume, its primary action is to reduce fluid retention, not specifically lower blood pressure.
What is the primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of deep vein thrombosis (DVT)?
- A. No need for regular INR monitoring
- B. Lower risk of bleeding
- C. Fewer dietary restrictions
- D. Longer half-life
Correct Answer: A
Rationale: The primary advantage of prescribing rivaroxaban over warfarin for a patient with a history of DVT is the absence of regular INR monitoring required with rivaroxaban. This is because rivaroxaban is a direct oral anticoagulant with more predictable pharmacokinetics, eliminating the need for monitoring. Regular INR monitoring is necessary with warfarin to ensure the drug is within the therapeutic range, which can be burdensome for patients and healthcare providers. The other choices are incorrect as they do not directly address the primary advantage of rivaroxaban over warfarin for this specific patient population.
What should be monitored to evaluate the effectiveness of enoxaparin in a patient with deep vein thrombosis (DVT)?
- A. Prothrombin time (PT)
- B. Partial thromboplastin time (PTT)
- C. International normalized ratio (INR)
- D. Platelet count
Correct Answer: C
Rationale: Rationale:
1. Enoxaparin is a low molecular weight heparin that primarily affects the intrinsic pathway of coagulation.
2. INR is used to monitor the effectiveness of anticoagulants affecting the intrinsic pathway.
3. Monitoring INR helps ensure the patient is within the therapeutic range to prevent clotting without excessive bleeding.
4. PT and PTT primarily evaluate the extrinsic and intrinsic pathways, respectively, not specific to enoxaparin.
5. Platelet count is not directly related to monitoring the effectiveness of enoxaparin in treating DVT.
A patient with type 2 diabetes is prescribed metformin. What instruction should the nurse provide regarding this medication?
- A. Take the medication on an empty stomach.
- B. Monitor for signs of hypoglycemia.
- C. Take the medication with meals.
- D. Increase intake of simple carbohydrates.
Correct Answer: C
Rationale: Step-by-step rationale for choice C:
1. Metformin can cause gastrointestinal side effects.
2. Taking it with meals helps reduce stomach upset.
3. It also helps in better absorption and effectiveness.
4. Therefore, the nurse should instruct the patient to take metformin with meals.
Summary of other choices:
A: Taking on an empty stomach can worsen gastrointestinal side effects.
B: Metformin doesn't typically cause hypoglycemia.
D: Increasing simple carbohydrates can counteract the effects of metformin.
When assessing a male client who is receiving a unit of packed red blood cells (PRBCs), the nurse notes that the infusion was started 30 minutes ago, and 50 ml of blood is left to be infused. The client's vital signs are within normal limits. He reports feeling 'out of breath' but denies any other complaints. What action should the nurse take at this time?
- A. Administer a PRN prescription for diphenhydramine (Benadryl).
- B. Start the normal saline attached to the Y-tubing at the same rate.
- C. Decrease the intravenous flow rate of the PRBC transfusion.
- D. Ask the respiratory therapist to administer PRN albuterol (Ventolin).
Correct Answer: C
Rationale: The correct action for the nurse to take in this situation is to decrease the intravenous flow rate of the PRBC transfusion. The client is showing early signs of a transfusion reaction, as evidenced by feeling 'out of breath'. By decreasing the flow rate of the transfusion, the nurse can slow down the rate at which the remaining blood is infused, potentially preventing a more severe reaction. Administering diphenhydramine or albuterol would not address the underlying issue of a potential transfusion reaction. Starting normal saline at the same rate may exacerbate the client's symptoms and is not indicated in this scenario.