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A nurse is reviewing the medical record of a client who has a new prescription for celecoxib to treat osteoarthritis. Which of the following should the nurse recognize as a contraindication for this medication?
- A. Concurrent use of chondroitin
- B. Concurrent use of calcium supplements
- C. Penicillin allergy
- D. Sulfonamide allergy
Correct Answer: D
Rationale: The correct answer is D: Sulfonamide allergy. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that belongs to the sulfonamide class of medications. Patients with a known allergy to sulfonamides are at an increased risk of developing an allergic reaction to celecoxib. It is important for the nurse to recognize this contraindication to prevent potential serious adverse reactions such as anaphylaxis.
A: Concurrent use of chondroitin - This is not a contraindication for celecoxib as there is no known significant interaction between chondroitin and celecoxib.
B: Concurrent use of calcium supplements - Calcium supplements do not interact with celecoxib and are not a contraindication for its use.
C: Penicillin allergy - Penicillin allergy is not related to celecoxib use as they are different classes of medications with distinct mechanisms of action.
In summary, the correct answer is D because
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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
Vital Signs
Laboratory Results
0800:
Client is admitted with a 3-day history of abdominal cramps and diarrhea of 4 to 5 liquid stools per day.
Client was taking amoxicillin/clavulanate 875 mg PO every 12 hr for 10 days for a respiratory tract infection. Antibiotics completed 7 days ago.
Bilateral breath sounds clear and present throughout.
Abdomen soft, distended with hyperactive bowel sounds audible in all 4 quadrants.
Stool is watery and contains mucous. Stool sent for culture.
The nurse should first address the client's ___ followed by the client's ___. (Options: Hgb level, Blood pressure, temperature, Hct level, abdominal findings, potassium level)
- A. Hgb level
- B. Blood pressure
- C. temperature
- D. Hct level
- E. abdominal findings
- F. potassium level
Correct Answer: B,F
Rationale: Action to Take: B, F; Potential Condition: Hypovolemia; Parameter to Monitor: Blood Pressure, Potassium Level.
Rationale:
1. Blood pressure should be addressed first to assess perfusion status and hemodynamic stability.
2. Potassium level should be monitored next due to potential electrolyte imbalances in hypovolemia.
3. Hgb, Hct, and abdominal findings are important but secondary to addressing perfusion and electrolyte balance.
4. Temperature is not typically the initial concern in hypovolemia.
A nurse is preparing to administer regular and NPH insulin to a client. Which of the following actions should the nurse take?
- A. Withdraw the NPH insulin last.
- B. Mix the medications in a 3-mL syringe.
- C. Administer the medications in two separate syringes.
- D. Inject air into the regular vial first.
Correct Answer: A
Rationale: The correct answer is A: Withdraw the NPH insulin last. This is because regular insulin is a clear solution and should be withdrawn first to prevent contamination with the cloudy NPH insulin. Mixing the medications in a 3-mL syringe (B) is not recommended as it may alter the effectiveness of the insulin. Administering the medications in two separate syringes (C) is important to avoid mixing them prior to administration. Injecting air into the regular vial first (D) is unnecessary and not a standard practice.
A nurse is preparing to administer vaccines to an 11-year-old child who is up to date on immunizations. Which of the following vaccines should the nurse plan to administer?
- A. Quadrivalent human papillomavirus
- B. Rotavirus
- C. Pneumococcal conjugate
- D. Hepatitis B
Correct Answer: A
Rationale: The correct answer is A: Quadrivalent human papillomavirus vaccine. At age 11, the child should receive the HPV vaccine as part of routine immunization. HPV vaccination is recommended for both males and females at this age to prevent HPV-related cancers and diseases. The other options are not typically given to a child who is up to date on immunizations at age 11. Rotavirus vaccine is usually given in infancy, pneumococcal conjugate vaccine is given earlier in childhood, and hepatitis B vaccine is typically administered shortly after birth and during infancy. Therefore, the HPV vaccine is the appropriate choice for this scenario.
A nurse is preparing to administer 0800 medications to a client. The medication administration record (MAR) states 'phenobarbital' and the medication the pharmacy supplied is pentobarbital. Which of the following actions should the nurse take?
- A. Check the client's MAR to see what the client received the day before
- B. Ask the client what medication she took yesterday.
- C. Ask the client if she has any allergies.
- D. Check the prescription in the client's medical record.
Correct Answer: D
Rationale: The correct answer is D: Check the prescription in the client's medical record. This is the appropriate action for the nurse to take because it ensures that the medication being administered matches the prescription ordered by the healthcare provider. By verifying the prescription in the client's medical record, the nurse can confirm if pentobarbital is indeed the correct medication prescribed for the client. Checking the MAR alone may not provide the necessary information about the prescribed medication. Asking the client about previous medications or allergies (choices A, B, C) may not be reliable sources of information regarding the specific prescription. Therefore, option D is the most appropriate and logical course of action in this situation.