Nokea
Cyclosporine and methotrexate are prescribed for the client with severe rheumatoid arthritis. What information should the nurse address when teaching the client? Select all that apply.
- A. Drink grapefruit juice to enhance the medication effects.
- B. Drink plenty of fluids to prevent becoming dehydrated.
- C. Avoid use of St. John's wort, echinacea, and melatonin.
- D. These medications are administered weekly by injection.
- E. Methotrexate and cyclosporine suppress the immune system.
Correct Answer: B,C,E
Rationale: A: Grapefruit juice should be avoided because it can increase the concentration of cyclosporine. B: Adequate hydration minimizes the risk of adverse effects. C: St. John's wort decreases cyclosporine levels. Echinacea and melatonin interact with cyclosporine to alter immunosuppression. D: Methotrexate and cyclosporine can be taken orally instead of by injection. It is incorrect that both medications are taken weekly. Only methotrexate is taken weekly, whereas cyclosporine is usually taken twice daily. E: Methotrexate and cyclosporine both have immunosuppressive effects.
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New medications are prescribed for the client taking lithium. Which medication, if prescribed, should the nurse question with the HCP?
- A. Isosorbide dinitrate by mouth tid
- B. Prednisone 20 mg by mouth daily
- C. Furosemide 80 mg by mouth daily
- D. Insulin aspart 2 units subcut with meals
Correct Answer: C
Rationale: Furosemide (Lasix) is a loop diuretic that promotes sodium loss and lithium retention, increasing serum lithium levels and risk of toxicity.
The unresponsive client with DM is admitted to the ED with a serum glucose level of 35 mg/dL. Which medication should the nurse plan to administer?
- A. Exenatide
- B. Pramlintide
- C. Miglitol
- D. Glucagon
Correct Answer: D
Rationale: A: Exenatide (Byetta), a synthetic incretin mimetic, is used as an adjunct in type 2 diabetes to decrease blood glucose levels. B: Pramlintide (Symlin) lowers postprandial glucose levels by slowing gastric emptying. C: Miglitol (Glyset), an alpha-glucosidase inhibitor, lowers postprandial serum glucose levels. D: The nurse should plan to administer glucagon (GlucaGen). Glucagon, administered intramuscularly, intravenously, or subcutaneously, is used in unconscious clients with diabetes to reverse severe hypoglycemia from insulin overdose. Normal serum glucose is 70 to 110 mg/dL.
The nurse is receiving a report from an ER nurse about a client. Which of the following statements requires additional follow-up?
- A. The client said they have been taking aspirin, but I'm not sure for how long or how much.
- B. The client frequently takes antacids, but they have not taken any in the last three days.
- C. The client stopped taking ibuprofen after developing gastric ulcers.
- D. The client takes Antabuse and has stopped using mouthwash.
Correct Answer: A
Rationale: Aspirin can have an impact on the patient's bleeding risk, so the amount and frequency is important to know. Antacids can change the gastric pH and impact medication absorption, so the nurse should note when they are last taken. Ibuprofen can cause or exacerbate gastric ulcers. Clients who take Antabuse should avoid alcohol in all forms, including avoiding over-the-counter cough medication and mouthwash.
A client had a colostomy done one day ago. Which of the following is an abnormal finding when assessing the stoma?
- A. Mild edema
- B. Minimal bleeding
- C. Rose color
- D. Dark red color
Correct Answer: D
Rationale: A dark red stoma indicates inadequate blood supply, an abnormal finding requiring intervention. Mild edema, minimal bleeding, and rose color are normal postoperative findings.
The nurse is preparing to administer a pm dose of benztropine to the client with worsening akathisia. The client's medication record lists benztropine 0.5 mg IM q4h pm. The vial contains 1 mg/mL. How many milliliters of the medication should the nurse administer?
Correct Answer: 0.5
Rationale: Calculation: 0.5 mg/ 1 mg/mL = 0.5 mL.