Nokea
A patient is experiencing mucositis (stomatitis) after receiving chemotherapy. Which symptomatic treatments will be appropriate? (Select all that apply.)
- A. Frequent mouth rinses
- B. Antiemetics
- C. Topical anesthetics
- D. Stress reduction
Correct Answer: A
Rationale: Mucositis, or stomatitis, is a painful inflammation of the mucous membranes caused by chemotherapy. Frequent mouth rinses with saline or baking soda solutions help keep the mouth clean and promote healing. Topical anesthetics, such as lidocaine, can provide pain relief. Stress reduction techniques, such as relaxation or mindfulness, may help manage the discomfort associated with mucositis. Antiemetics are used to control nausea and vomiting, which are not directly related to mucositis. Antibiotics are only necessary if there is a secondary infection, which is not mentioned in this scenario.
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A child was brought to the emergency room complaining of right upper quadrant abdominal pain, nausea, and vomiting. Upon the interview of the nurse to the mother, the client has been taking a long-
- A. Which of the following medications should be readily available?
- B. naltrexone (ReVi
- C. urea (Ureaphil)
- D. acetylcysteine (Mucomyst)
Correct Answer: A
Rationale: The presentation of right upper quadrant abdominal pain, nausea, and vomiting in a child with a history of taking a long-acting formulation of valproic acid (Depakene) is concerning for valproic acid overdose. Valproic acid toxicity can lead to liver damage, which may present with symptoms such as abdominal pain, nausea, and vomiting. In cases of valproic acid overdose, acetylcysteine (Mucomyst) is commonly used as a treatment to help prevent or reduce liver damage by replenishing glutathione stores and acting as a reactive oxygen species scavenger. Therefore, acetylcysteine should be readily available in this scenario to initiate prompt treatment and potentially prevent severe liver injury.
For the patient taking acetaminophen, what should the nurse do? (Select all that apply.)
- A. Monitor routine liver enzyme tests.
- B. Encourage the patient to check package labels of over-the-counter drugs to avoid overdosing.
- C. Report side effects immediately, as toxicity can cause severe hepatic damage.
- D. Teach the female patient that oral contraceptives can increase the effect of acetaminophen.
Correct Answer: D
Rationale: Acetaminophen is metabolized in the liver, and excessive doses can lead to hepatotoxicity. Routine monitoring of liver enzymes is essential to detect early signs of liver damage. Patients should also be educated to check the acetaminophen content in over-the-counter medications to avoid accidental overdose. Reporting side effects promptly is crucial, as acetaminophen toxicity can cause severe and potentially fatal liver damage. While oral contraceptives can affect drug metabolism, they do not significantly increase the effects of acetaminophen. Therefore, the correct actions are to monitor liver enzymes, educate about over-the-counter medications, and report side effects.
Which drug concentration is appropriate to administer in an order for epinephrine 0.3 mg IM to treat a severe allergic reaction in an adult patient?
- A. 1:10,000
- B. 0.736111111
- C. 0.111111111
- D. 1:10
Correct Answer: B
Rationale: The appropriate concentration for epinephrine 0.3 mg IM in an adult for a severe allergic reaction is 1:1000. This concentration is used for intramuscular administration, while 1:10,000 (A) is used for intravenous administration in cardiac arrest. Concentrations of 1:100 (C) and 1:10 (D) are not standard for this purpose.
An injection of penicillin into a penicillin-sensitized person may lead to death due to:
- A. absence of histamine
- B. a Shwartzman's reaction
- C. release of enzymes from polymorphonuclear leukocytes
- D. constriction of bronchioli and drop in blood pressure
Correct Answer: B
Rationale: A Shwartzman's reaction is a severe inflammatory response that occurs when a person who has previously been sensitized to penicillin is re-exposed to the drug. This exaggerated response can lead to widespread activation of inflammatory mediators and is characterized by endotoxin-induced intravascular coagulation. This can result in a cascade of events leading to tissue damage, organ failure, and potentially death. It is different from a typical allergic reaction mediated by histamine release or constriction of bronchioli and drop in blood pressure. Additionally, the release of enzymes from polymorphonuclear leukocytes is not directly related to the fatal outcome of a penicillin injection in a sensitized individual.
The patient accidentally takes too much of the prescribed warfarin (Coumadin) and is readmitted to the hospital with bleeding. Which drug can the nurse anticipates administrating?
- A. Protamine sulfate
- B. Alteplase (Activase, Cathflo Activas
- D. Reteplase (Retavas
Correct Answer: D
Rationale: Warfarin, also known as Coumadin, is an anticoagulant medication that works by inhibiting the production of clotting factors in the liver, specifically factors II, VII, IX, and X. In the event of warfarin overdose, which can lead to excessive bleeding, the antidote is vitamin K. Vitamin K promotes the production of these clotting factors and helps reverse the effects of warfarin. Therefore, in this situation, the nurse can anticipate administering vitamin K to the patient to help stop the bleeding caused by the excess warfarin in the system.