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A home health nurse is visiting a client who has heart failure and a prescription for furosemide. The nurse identifies that the client has gained 2.5 kg (5 lb.) since the last visit 2 days ago. Which of the following actions should the nurse take first?
- A. Encourage the client to dangle the legs while sitting in a chair
- B. Teach the client about foods low in sodium
- C. Determine medication adherence by the client
- D. Notify the provider of the client's weight gain
Correct Answer: D
Rationale: The correct answer is D: Notify the provider of the client's weight gain. This is the first action the nurse should take because sudden weight gain in a client with heart failure could indicate fluid retention, which may worsen the client's condition. By notifying the provider, the nurse can ensure timely intervention to adjust the medication or treatment plan. Encouraging leg dangling (A) may help with circulation but does not address the immediate concern of weight gain. Teaching about low-sodium foods (B) is important for long-term management but not the priority at this moment. Determining medication adherence (C) is important but should come after addressing the immediate weight gain issue.
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A nurse is caring for a client who has breast cancer and reports pain. 1 hr after administration of prescribed morphine 10 mg IV. Which of the following medications should the nurse expect to administer?
- A. Naloxone IV
- B. Morphine tablet
- C. Lidocaine patch
- D. Fentanyl transmucosal
Correct Answer: D
Rationale: The correct answer is D: Fentanyl transmucosal. Fentanyl is a potent opioid used for severe pain, and transmucosal administration provides rapid relief. Naloxone (A) is an opioid antagonist used to reverse opioid overdose, not for pain management. Morphine tablet (B) is not indicated for immediate relief after IV morphine. Lidocaine patch (C) is used for localized pain, not post-IV opioid pain control. Therefore, fentanyl transmucosal (D) is the most appropriate choice for rapid pain relief in this scenario.
A nurse is providing teaching to a client who has a new prescription for enoxaparin. Which of the following medications for pain relief should the nurse include in the teaching that can be taken concurrently with enoxaparin?
- A. Ibuprofen
- B. Naproxen sodium
- C. Acetaminophen
- D. Aspirin
Correct Answer: C
Rationale: Rationale: Acetaminophen is the correct choice because it does not have an antiplatelet effect like aspirin, ibuprofen, and naproxen sodium. Enoxaparin is an anticoagulant that works by preventing blood clots, so it is safer to take acetaminophen for pain relief as it does not increase the risk of bleeding. Aspirin, ibuprofen, and naproxen sodium can increase the risk of bleeding when taken with enoxaparin due to their antiplatelet effects. Therefore, acetaminophen is the safest option for pain relief while on enoxaparin therapy.
A nurse is reviewing the list of current medications for a client who is to start a prescription for carbamazepine. The nurse should identify that which of the following medications interacts with carbamazepine?
- A. Nicotine transdermal system
- B. Diphenhydramine
- C. Estrogen-progestin combination
- D. Beclomethasone
Correct Answer: C
Rationale: The correct answer is C: Estrogen-progestin combination. Carbamazepine can decrease the effectiveness of estrogen-containing medications, including estrogen-progestin combinations, by increasing their metabolism. This can lead to reduced contraceptive efficacy and breakthrough bleeding.
Nicotine transdermal system (choice A) does not have a significant interaction with carbamazepine. Diphenhydramine (choice B) is an antihistamine and does not interact with carbamazepine. Beclomethasone (choice D) is a corticosteroid and does not have a significant interaction with carbamazepine.
A nurse is teaching a guardian of a school-age child who has a new prescription for a fluticasone metered-dose inhaler. Which of the following information should the nurse include in the teaching? (SATA)
- A. Soak the inhaler in water after use.
- B. Have your child take one inhalation as needed for shortness of breath.
- C. Shake the device prior to administration.
- D. A spacer will make it easier to use the device.
Correct Answer: C,D,E
Rationale: Correct Answer: C, D, E
Rationale:
C: Shake the device prior to administration - Shaking the inhaler ensures proper mixing of the medication for effective delivery to the lungs.
D: A spacer will make it easier to use the device - A spacer helps improve medication delivery by ensuring more of the medication reaches the lungs rather than the mouth or throat.
E: - Additional information may include the importance of proper inhaler technique, how to clean the device, how to monitor for side effects, and when to seek medical help.
Incorrect Choices:
A: Soak the inhaler in water after use - Soaking the inhaler in water can damage the device and affect the medication's effectiveness.
B: Have your child take one inhalation as needed for shortness of breath - The prescription likely specifies a specific dosing regimen that should be followed, rather than using the inhaler as needed.
A nurse is reviewing the laboratory results of a client who is taking amitriptyline. Which of the following laboratory values should the nurse report to the provider?
- A. Total bilirubin 1.5 mg/dL
- B. Potassium 4.2 mEq/L
- C. Hct 0.44%
- D. WBC count 5
Correct Answer: A
Rationale: The correct answer is A. Total bilirubin levels should be reported because amitriptyline can cause hepatotoxicity. Elevated bilirubin could indicate liver damage. Option B, potassium level, is not typically affected by amitriptyline. Option C, hematocrit, and option D, WBC count, are not directly related to amitriptyline use. Options E, F, and G are not provided. In summary, the nurse should report elevated total bilirubin levels due to potential hepatotoxicity from amitriptyline.