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A female client with multiple sclerosis reports having less fatigue and improved memory since she began using the herbal supplement, ginkgo biloba. What is the most important information for the nurse to include in the teaching plan for this client?
- A. Nausea and diarrhea can occur when using this supplement.
- B. Ginkgo biloba use should be limited and not taken during pregnancy.
- C. Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo.
- D. Anxiety and headaches increase with the use of ginkgo biloba.
Correct Answer: C
Rationale: Ginkgo biloba increases bleeding risk, especially with aspirin/NSAIDs (C), a critical interaction for safety. Nausea/diarrhea (A) and anxiety/headaches (D) are less severe. Pregnancy restrictions (B) are relevant but secondary unless applicable.
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A patient with chemotherapy-induced nausea has been prescribed metoclopramide. What adverse effect should the nurse report?
- A. Diarrhea.
- B. Unusual irritability.
- C. Nausea.
- D. Involuntary movements.
Correct Answer: D
Rationale: This question is identical to Question 5. Involuntary movements (D), such as tardive dyskinesia, are a serious metoclopramide side effect, requiring immediate reporting. Diarrhea (A) and irritability (B) are less severe. Nausea (C) is the treated condition. Note: Duplicate question; consider removing.
Which nursing action has the highest priority when administering a dose of codeine with acetaminophen to a client?
- A. Instruct the client to request assistance when ambulating to the bathroom.
- B. Administer a stool softener/laxative at the same time as the analgesic.
- C. Tell the client to notify the nurse if the pain is not relieved.
- D. Advise the client that the medication should start to work in about 30 minutes.
Correct Answer: A
Rationale: Codeine, an opioid, causes drowsiness and dizziness, increasing fall risk. Instructing the client to request assistance when ambulating (A) is the highest priority for safety. Stool softeners (B) address constipation but are secondary. Notifying about unrelieved pain (C) and onset time (D) are important but not immediate safety concerns.
A nurse is caring for a client diagnosed with stage 4 cancer who has a prescription for a subcutaneous morphine sulfate patch for pain. The client is short of breath and difficult to arouse. During a head-to-toe assessment, the nurse finds four patches on the client’s body. What should be the nurse’s first action?
- A. Administer a narcotic reversal drug.
- B. Apply an oxygen face mask.
- C. Remove the morphine patches.
- D. Monitor the client’s blood pressure.
Correct Answer: C
Rationale: Four morphine patches suggest overdose, causing respiratory depression and sedation. Removing the patches (C) stops further absorption. Naloxone (A) or oxygen (B) may follow, but removal is first. Blood pressure monitoring (D) is secondary.
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.
A patient with peptic ulcer disease has been prescribed cimetidine. Which statement made by the patient indicates the need for further instruction by the nurse?
- A. Decrease cigarette use to a pack per day.
- B. Notify the healthcare provider of lethargy.
- C. Take the medication an hour after antacids.
- D. Monitor for any signs of sexual dysfunction.
Correct Answer: C
Rationale: Cimetidine should be taken with meals or immediately after, not 1 hour after antacids (C), which interferes with absorption. Reducing smoking (A) is insufficient; cessation is ideal. Lethargy (B) and sexual dysfunction (D) are valid monitoring points.