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The adolescent, who is receiving morphine sulfate via PCA, has itching. Which medication listed on the client's MAR should the nurse plan to administer to relieve the itching?
- A. Diazepam
- B. Diphenhydramine
- C. Naloxone hydrochloride
- D. Butenafine hydrochloride
Correct Answer: B
Rationale: A: Diazepam (Valium) acts on the CNS to produce sedation, hypnosis, skeletal muscle relaxation, and anticonvulsant activity. B: Diphenhydramine (Benadryl) is an antihistamine that blocks histamine release by competing for the histamine receptors. C: Naloxone (Narcan) is a narcotic antagonist that reverses the effects of opiates. D: Butenafine (Mentax) is an antifungal antibiotic used to treat tinea pedis, tinea corporis, and tinea cruris.
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A client with stress incontinence should be advised:
- A. to purchase absorbent undergarments.
- B. that Kegel exercises might help.
- C. that effective surgical treatments are nonexistent.
- D. that behavioral therapy is ineffective.
Correct Answer: B
Rationale: Kegel exercises, tightening and releasing the pelvic floor muscles, might improve stress incontinence. Choice A is not an appropriate treatment for stress incontinence. Several effective surgical treatments exist. Lifestyle and dietary modifications can also be helpful.
The 9-year-old with SLE is receiving large doses of prednisolone. Which laboratory finding should the nurse recognize as an untoward effect of the medication?
- A. Total bilirubin of 4 mg/dL
- B. WBC count of 18,000/mm3
- C. Serum sodium of 130 mEq/L
- D. Random glucose of 130 mg/dL
Correct Answer: B
Rationale: A: The liver is not affected by prednisolone use, so an increased total bilirubin of 4 mg/dL is not related to the use of the drug. Normal total bilirubin in a 9-year-old should be less than 2 mg/dL. B: A WBC count of 18,000/mm3 may indicate an infection, an untoward effect of prednisolone (Omnipred). Prednisolone, a corticosteroid used to reduce inflammation, may increase the risk of infection. The normal WBC in a 9-year-old is 4500-11,100/mm3. C: Prednisolone has been associated with the adverse effect of hypokalemia, but not hyponatremia. Normal serum sodium is 135-145 mEq/L. D: Although corticosteroids may have the effect of increasing blood glucose, a random glucose of 130 mg/dL is not abnormal.
The client taking glyburide 5 mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client's fingerstick blood sugar result is 56 mg/dL. Which question is most important for the nurse to ask the client?
- A. How many grams of protein do you normally eat?
- B. What time did you eat your dinner last night?
- C. How often do you check your blood sugar level?
- D. What was your alcohol intake like this past week?
Correct Answer: D
Rationale: A: Carbohydrate intake, not protein, is more important to consider in diabetic clients in relation to blood sugar levels. B: Glyburide once daily dose is taken with breakfast, so asking the client about dinner is not consistent with drug administration. C: Asking the client frequency of checking blood sugar levels will not help determine the possible causes of the client's symptoms. D: Alcohol use while taking sulfonylureas such as glyburide (DiaBeta, Micronase) can cause a disulfiram-like reaction, manifested by abdominal cramps, nausea, headache, flushing, and hypoglycemia.
While the nurse is completing the assessment of the child with Reye's syndrome, the parent states that multiple OTC medications were given before hospitalization to treat the child's influenza symptoms. Which medication stated by the parent is most important for the nurse to report to the HCP?
- A. Acetaminophen
- B. Bismuth subsalicylate
- C. Pseudoephedrine
- D. Diphenhydramine
Correct Answer: B
Rationale: A: Acetaminophen (Tylenol) is an aspirin-free analgesic and antipyretic. B: Although the etiology of Reye's syndrome is unknown, the condition typically occurs after a viral illness, such as influenza, and is associated with aspirin (acetylsalicylic acid) use during the illness. Bismuth subsalicylate (Pepto-Bismol) contains aspirin. C: Pseudoephedrine (Sudafed) is an allergy and/or cold remedy used for nasal drying and decongestion. This does not contain aspirin. D: Diphenhydramine (Benadryl) is an antihistamine. This does not contain aspirin.
The LPN is caring for a client taking Lipitor (Atorvastatin). Which of these statements would indicate that the client may need reinforced teaching?
- A. I take my Lipitor with a glass of milk after my breakfast.
- B. I take my Lipitor and wait 30 minutes before taking my other medications.
- C. I take my Lipitor 30 minutes after I eat something.
- D. I take my Lipitor and my other morning medications with my grapefruit juice at breakfast.
Correct Answer: D
Rationale: Grapefruit juice should be avoided when taking Lipitor. Grapefruit juice blocks the enzymes needed to breakdown the drug, which leads to excessive amounts of the drug in the body.