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During a home visit, the nurse assesses a client with Alzheimer's disease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take?
- A. Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed.
- B. Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
- C. Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's safety.
- D. Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's insomnia.
Correct Answer: B
Rationale: Insomnia is a common, often temporary side effect of rivastigmine. Explaining this reassures the caregiver. Rivastigmine is for cognition, not sleep, and withholding or increasing the dose is inappropriate without provider guidance.
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A male client who has been taking a high dose of a nonsteroidal antiinflammatory drug (NSAID) comes to the clinic reporting gastric pain and blood in his stool. The healthcare provider discontinues the NSAIDs and prescribes esomeprazole. Which information should the nurse include in this client's teaching plan?
- A. Once pain subsides, NSAID therapy can be resumed.
- B. Resume a diet that consists of milk, cream, and bland foods.
- C. Notify the healthcare provider of the passage of black stools.
- D. Call the clinic if diarrhea or headache occur when taking esomeprazole.
Correct Answer: C
Rationale: Black stools indicate potential gastrointestinal bleeding, a serious NSAID complication, requiring immediate provider notification. Resuming NSAIDs risks further damage, bland diets are outdated, and diarrhea/headache are less urgent.
Which instruction should the nurse include when teaching a client about self-administration of a bulk-forming laxative?
- A. Avoid the intake of dairy products while using the medication.
- B. Remain upright for thirty minutes following drug administration.
- C. Take the medication one hour after meals and other medications.
- D. Follow medication administration with an additional glass of water.
Correct Answer: D
Rationale: Bulk-forming laxatives require ample water to prevent choking and ensure efficacy. Dairy avoidance, staying upright, or specific post-meal timing are not necessary.
The healthcare provider prescribes enoxaparin sodium 80 mg SUBQ twice daily. The nurse is preparing a preloaded 1 mL syringe labeled, 'Enoxaparin sodium injection, USP 60 mg/0.6 mL.' How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)
Correct Answer: 0.8
Rationale: Desired dose = 80 mg, Concentration = 60 mg/0.6 mL = 100 mg/mL. Volume = 80 mg / 100 mg/mL = 0.8 mL.
A client who is receiving pregabalin for fibromyalgia complains of tremors in the hands. Which action should the nurse implement?
- A. Notify the healthcare provider.
- B. Administer a PRN dose of an antianxiety drug.
- C. Obtain orthostatic blood pressure readings.
- D. Collect a capillary glucose level.
Correct Answer: A
Rationale: Tremors are a potential side effect of pregabalin, warranting notification of the healthcare provider for possible dose adjustment. Antianxiety drugs, blood pressure readings, or glucose levels are not directly related to addressing pregabalin-induced tremors.
A client with a history of anaphylactic reaction to penicillin receives a prescription for cephalexin 500 mg PO twice daily. Which action should the nurse take?
- A. Administer the medication as prescribed.
- B. Monitor the client for a rash or hives.
- C. Contact the healthcare provider.
- D. Give with prescribed antihistamine.
Correct Answer: B
Rationale: Cephalexin may cause cross-reactivity in penicillin-allergic clients, so monitoring for allergic reactions like rash or hives is critical. Administering without monitoring, contacting the provider immediately, or giving antihistamines prophylactically are less appropriate.