Nokea
A nurse is reinforcing teaching with a client who has a new prescription for prednisone to treat rheumatoid arthritis. Which of the following statements should indicate to the nurse that the client understands the teaching?
- A. I should watch for weight loss.
- B. I should increase the sodium in my diet.
- C. I will take this medication on an empty stomach.
- D. I will report a sore throat to my provider.
Correct Answer: D
Rationale: The correct answer is D: "I will report a sore throat to my provider." This is the correct answer because prednisone can suppress the immune system, increasing the risk of infections like thrush or sore throat. Reporting these symptoms promptly is crucial to prevent complications.
Choice A is incorrect because prednisone can actually cause weight gain. Choice B is incorrect because prednisone can lead to fluid retention, so increasing sodium intake is not recommended. Choice C is incorrect because prednisone should be taken with food to reduce stomach upset.
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Nurses' Notes
Plan of Care
Provider Prescriptions
Vital Signs
6 months ago:
The client was diagnosed with epilepsy during childhood. The client reports not having seizures for 2 years. The client has weaned off all seizure medications. The client was informed to return to the office for a follow-up in 6 months and to call the office if seizure activity resumes.
Today:
The client reports having a seizure this morning. Provider aware and new prescription obtained.
Click to highlight the findings that require immediate follow-up as contraindications to the prescribed prescription (phenytoin).
- A. Client reports having three to four alcoholic beverages a couple times per week.
- B. Last bowel movement was 3 days ago
- C. Last menstrual period was 3 months ago
- D. Client takes diazepam as needed for anxiety.
Correct Answer: A,C
Rationale: First, Step 1: The prescribed medication is phenytoin, an antiepileptic drug. Step 2: Alcohol consumption can interact with phenytoin, causing increased sedation and affecting liver function. Therefore, client reporting alcohol intake requires immediate follow-up. Step 3: (0,0,1,0) Phenytoin can also affect menstrual cycles, so the client's last menstrual period being 3 months ago is a potential contraindication that needs follow-up. Step 4: (0,1,0,0) Last bowel movement being 3 days ago is not directly related to phenytoin use. Step 5: (0,0,0,1) Diazepam for anxiety is not a direct contraindication to phenytoin use. Therefore, choices A and C are correct as they indicate potential issues requiring immediate attention, while choices B and D do not
A nurse is preparing to administer an IM injection to a client who has gonorrhea. Which of the following actions should the nurse take?
- A. Use the Z-track technique to administer the medication.
- B. Administer the medication with a 27-gauge 1/2-inch needle.
- C. Inject the medication at least 5 cm (2 in) from the umbilicus.
- D. Give the medication without aspirating prior to injection.
Correct Answer: A
Rationale: The correct answer is A: Use the Z-track technique to administer the medication. This technique helps prevent leakage of the medication into surrounding tissues by sealing the medication in the muscle. The Z-track method involves pulling the skin laterally before injecting the medication, then releasing the skin after the injection. This creates a zig-zag path that closes after the needle is withdrawn, reducing the risk of irritation or staining at the injection site. Choice B is incorrect because the needle size for IM injections in adults is typically 22-25 gauge and 1-1.5 inches long. Choice C is incorrect as IM injections should be administered at least 2.5 cm (1 inch) away from the umbilicus. Choice D is incorrect because aspiration (pulling back on the plunger to check for blood return) is not recommended for IM injections due to the risk of tissue trauma.
A nurse is caring for a client who started taking amitriptyline 6 days ago. The client reports that the medication is not helping. Which of the following responses should the nurse make?
- A. I will ask your provider to increase the dose of the medication.
- B. You will need to take this medication on an empty stomach for it to be more effective.
- C. You will need to wait a couple of weeks to feel the therapeutic effect of the medication.
- D. I will inform your provider so they can prescribe a different medication.
Correct Answer: C
Rationale: The correct response is C: "You will need to wait a couple of weeks to feel the therapeutic effect of the medication." Amitriptyline, a tricyclic antidepressant, typically takes 2-4 weeks to start showing its full therapeutic effects. It is important for the nurse to educate the client about the delayed onset of action to manage expectations. Option A is incorrect because increasing the dose prematurely can lead to adverse effects. Option B is incorrect as taking it on an empty stomach is not necessary for its efficacy. Option D is incorrect as switching medications without giving the current one a fair trial may not be appropriate.
A nurse is reinforcing discharge teaching with a client who has a prescription for rifampin for the treatment of tuberculosis (TB). Which of the following instructions should the nurse include in the teaching?
- A. Take the medication on an empty stomach.
- B. Discontinue the medication if your saliva turns orange.
- C. Return for another TB skin test in 3 months.
- D. You will need to take this medication for 1 week.
Correct Answer: A
Rationale: The correct answer is A: Take the medication on an empty stomach. Rifampin is best absorbed when taken on an empty stomach, usually 1 hour before or 2 hours after meals. This maximizes its effectiveness in treating TB. Choice B is incorrect because discoloration of body fluids (including saliva) is a known side effect of rifampin and does not indicate the need to discontinue the medication. Choice C is incorrect because the client should not return for another TB skin test in 3 months unless specifically instructed by the healthcare provider. Choice D is incorrect because treatment for TB usually lasts for several months, not just 1 week.
A nurse is administering the first dose of ramipril to a client who has hypertension. The client reports feeling dizzy and lightheaded. Which of the following should the nurse administer?
- A. 15 g of carbohydrates
- B. Naloxone
- C. Diphenhydramine
- D. Fluid bolus
Correct Answer: D
Rationale: The correct answer is D: Fluid bolus. The client is experiencing symptoms of hypotension, a common side effect of ramipril. Administering a fluid bolus helps increase blood volume, improving blood pressure and alleviating dizziness and lightheadedness. It is important to address the underlying cause of the symptoms. Choices A, B, and C are not appropriate in this situation as they do not address the hypotension caused by ramipril. Administering carbohydrates (A) is irrelevant, naloxone (B) is used for opioid overdose, and diphenhydramine (C) is an antihistamine and not indicated for hypotension.