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A patient is scheduled to receive chemotherapy drugs that will cause myelosuppression. Which action by the nurse will be most important?
- A. Monitor for a change in temperature.
- B. Evaluate gastrointestinal function.
- C. Assess for evidence of cardiac compromise.
- D. Question the patient about changes in sense of taste.
Correct Answer: A
Rationale: Myelosuppression, a common side effect of chemotherapy, leads to a decrease in white blood cells, red blood cells, and platelets. A drop in white blood cells, particularly neutrophils, increases the risk of infection. Monitoring for a change in temperature is critical because fever is often the first sign of infection in neutropenic patients. Early detection allows for prompt intervention, such as administering antibiotics, to prevent life-threatening complications. While gastrointestinal function, cardiac compromise, and changes in taste are important to assess, they are not as immediately life-threatening as an undetected infection in a myelosuppressed patient.
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The nurse is teaching a patient about taking aspirin. Which are important points to include? (Select all that apply.)
- A. Advise the patient to avoid alcohol while taking aspirin.
- B. Instruct the patient to take aspirin before meals on an empty stomach.
- C. Instruct the patient to inform the dentist of the aspirin dosage before having dental work.
- D. Instruct the patient to inform the surgeon of the aspirin dosage before having surgery.
Correct Answer: D
Rationale: Aspirin is an antiplatelet agent that can increase the risk of bleeding, especially when combined with alcohol or during invasive procedures like dental work or surgery. Patients should avoid alcohol to reduce the risk of gastrointestinal bleeding. Additionally, informing healthcare providers about aspirin use is crucial to prevent excessive bleeding during procedures. Taking aspirin on an empty stomach is not recommended, as it can increase the risk of gastric irritation. Therefore, the correct teaching points are to avoid alcohol, inform the dentist, and inform the surgeon about aspirin use.
A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect?
- A. Drowsiness
- B. Nystagmus
- C. Dry mouth
- D. Convulsions
Correct Answer: D
Rationale: Lidocaine is a local anesthetic that can have systemic effects if levels become toxic. Continuous infusion of lidocaine can lead to lidocaine toxicity, which can manifest as adverse effects including convulsions, altered mental status, confusion, seizures, and cardiac arrhythmias. Monitoring for signs of lidocaine toxicity, such as convulsions, is crucial when a patient is receiving continuous lidocaine infusion. It is important for the nurse to closely monitor the patient's neurological status and vital signs to promptly recognize and manage any adverse effects.
The nurse is caring for a young patient with a closed head injury who has an intracranial pressure of 35 (normal <20) and serum osmolality of 330 mOsm/kg. The nurse would anticipate which action?
- A. Administration of mannitol
- B. Withholding mannitol at this time, but taking other measures to reduce intracranial pressure
- C. Administration of sodium nitroprusside
- D. Taking no action at this time because the patient has a serum osmolality of 330, which will offset the effects of the elevated intracranial pressure
Correct Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure (ICP) by drawing fluid out of the brain tissue. However, it should be used cautiously in patients with elevated serum osmolality, as it can exacerbate hyperosmolality and lead to renal failure or other complications. In this case, the patient's serum osmolality is already high (330 mOsm/kg), so mannitol should be withheld, and other measures to reduce ICP, such as elevating the head of the bed, maintaining proper oxygenation, and avoiding hypercapnia, should be prioritized. Sodium nitroprusside (C) is used for hypertension, not ICP, and taking no action (D) is inappropriate given the elevated ICP.
Basis for pharmacotherapeutics
- A. Selective action of drugs with regard to diagnosis, preventive and treatment of disease
- B. Bioavailability of drugs
- C. Biologic half-life of drugs
- D. Renal clearance and elimination of drugs
Correct Answer: A
Rationale: The basis for pharmacotherapeutics lies in the selective action of drugs with regard to the diagnosis, prevention, and treatment of diseases. Pharmacotherapeutics involves the use of drugs to manage diseases and improve health outcomes. Drugs are carefully selected based on their mechanism of action, efficacy, safety profile, and suitability for a specific condition. The goal is to achieve optimal therapeutic effects while minimizing potential adverse effects. By understanding the selective action of drugs in targeting specific pathways or processes in the body, healthcare providers can customize treatment regimens to individual patients and achieve the best possible outcomes.
What should you monitor when given a patient Clopidogrel?
- A. Signs of thrombotic thrombolytic purpura
- B. Bleeding during therapy
- C. CBC with differential and platelet count
- D. All the above
Correct Answer: D
Rationale: When monitoring a patient on Clopidogrel therapy, it is important to monitor for signs of thrombotic thrombolytic purpura (TTP), bleeding during therapy, and changes in blood counts. Clopidogrel is an antiplatelet medication that works by preventing platelets from sticking together and forming clots. Monitoring for signs of TTP is necessary as clopidogrel has been associated with an increased risk of TTP in some patients. Additionally, monitoring for bleeding is crucial as clopidogrel, like other antiplatelet medications, can increase the risk of bleeding complications. Monitoring a complete blood count (CBC) with differential and platelet count allows healthcare providers to assess the patient's blood cell levels and ensure that the medication is not causing any adverse effects on blood counts. Therefore, monitoring all of the above parameters is essential to ensure the safety and efficacy of clopidogrel therapy.