Nokea
The client in end-stage renal disease is a Jehovah's Witness. The HCP orders erythropoietin (Epogen), a biologic response modifier, subcutaneously for anemia. Which action should the nurse take?
- A. Question this order because of the client's religion.
- B. Encourage the client to talk to his or her minister.
- C. Administer the medication subcutaneously as ordered.
- D. Obtain the informed consent prior to administering.
Correct Answer: C
Rationale: Epogen is synthetic, not blood-derived, so it’s acceptable for Jehovah’s Witnesses. Administer as ordered; questioning, minister consultation, or consent are unnecessary.
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The HCP ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with a myocardial infarction. Which statement best explains the rationale for administering this medication to this client?
- A. It will help prevent the development of congestive heart failure.
- B. This medication will help decrease the client's blood pressure.
- C. ACE inhibitors increase the contractility of the heart muscle.
- D. They will help decrease the development of atherosclerosis.
Correct Answer: A
Rationale: ACE inhibitors reduce afterload and prevent ventricular remodeling, lowering CHF risk post-MI, per ACC/AHA guidelines. BP, contractility, or atherosclerosis are secondary.
An adult client is seen in the clinic, and sulfisoxazole (Gantrisin) is prescribed. Which information is most appropriate for the nurse to include in the teaching?
- A. Limit your fluid intake to four glasses a day.
- B. If it upsets your stomach, try taking it with an antacid.
- C. Avoid going out in the sun while taking this drug.
- D. Take the tablets with orange juice or milk.
Correct Answer: C
Rationale: Sulfisoxazole causes photosensitivity; avoiding sun exposure is critical to prevent skin reactions.
A newly admitted client has a diagnosis of depression. She complains of 'twitching muscles' and a 'racing heart', and states she stopped taking Zoloft a few days ago because it was not helping her depression. Instead, she began to take her partner's Parnate. The nurse should immediately assess for which of these adverse reactions?
- A. Pulmonary edema
- B. Atrial fibrillation
- C. Mental status changes
- D. Muscle weakness
Correct Answer: C
Rationale: Mental status changes. Use of serotonergic agents may result in Serotonin Syndrome with confusion, nausea, palpitations, increased muscle tone with twitching muscles, and agitation. Serotonin syndrome is most often reported in patients taking 2 or more medications that increase CNS serotonin levels by different mechanisms. The most common drug combinations associated with serotonin syndrome involve the MAOIs, SSRIs, and the tricyclic antidepressants.
The nurse is teaching a group of women in a community clinic about prevention of osteoporosis. Which of the following over-the-counter medications should the nurse recognize as having the most elemental calcium per tablet?
- A. Calcium chloride
- B. Calcium citrate
- C. Calcium gluconate
- D. Calcium carbonate
Correct Answer: D
Rationale: Calcium carbonate. Calcium carbonate contains 400 mg of elemental calcium in 1 gram of calcium carbonate.
The client in the intensive care department has a nasogastric tube for continuous feedings. The nurse is preparing to administer nifedipine (Procardia XL) via the N/G tube. Which procedure should the nurse follow?
- A. Crush the medication and dissolve it in water.
- B. Administer and flush the N/G tube with cranberry juice.
- C. Give the medication orally with pudding.
- D. Do not administer the medication and notify the HCP.
Correct Answer: D
Rationale: Procardia XL is extended-release and cannot be crushed or given via NG tube; HCP notification is needed for an alternative form.