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A female patient who follows a vegetarian diet has recently been prescribed warfarin. She mentions that she consumes leafy green vegetables daily. What should be the nurse’s response?
- A. Praise the patient for her healthy lifestyle and encourage her to maintain her current dietary habits.
- B. Assure the patient that her dietary choices will enhance the effectiveness of the medication in preventing blood clots.
- C. Inform the patient that her healthcare provider needs to be informed about her current diet.
- D. Recommend that the patient substitutes the leafy vegetables with a protein source like nuts or beans.
Correct Answer: C
Rationale: Leafy greens, high in vitamin K, can reduce warfarin’s anticoagulant effect. Informing the provider (C) ensures dose adjustment. Praising (A) or assuring enhanced efficacy (B) ignores the interaction. Substituting vegetables (D) is unnecessary with proper monitoring.
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A patient who is taking albendazole reports experiencing fatigue, nausea, and dark urine. The nurse observes a yellowing of the patient’s skin and sclera. Which laboratory result should the nurse review?
- A. Thyroid function test.
- B. Liver function test.
- C. Renal function panel.
- D. Basic metabolic panel.
Correct Answer: B
Rationale: Albendazole can cause hepatotoxicity, indicated by fatigue, nausea, dark urine, and jaundice. Reviewing liver function tests (B) assesses damage. Thyroid (A), renal (C), and metabolic panels (D) are unrelated to these symptoms.
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.
A client reports confusion and blurred vision after receiving a dose of glipizide. What should the nurse do?
- A. Administer glucagon intramuscularly.
- B. Measure the client’s vital signs.
- C. Obtain a fingerstick blood glucose.
- D. Perform a neurological exam.
Correct Answer: C
Rationale: Glipizide, a sulfonylurea, can cause hypoglycemia, presenting as confusion and blurred vision. Checking blood glucose (C) confirms the cause. Glucagon (A) treats severe hypoglycemia, not confirmed yet. Vital signs (B) and neurological exams (D) are secondary.
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.
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.