Nokea
The client with epilepsy is prescribed carbamazepine (Tegretol), an anticonvulsant. Which discharge instruction should the nurse include in the teaching?
- A. Wear SPF 15 sunscreen when outside.
- B. Obtain regular serum drug levels.
- C. Be sure to floss teeth daily.
- D. Instruct the client to take tub baths only.
Correct Answer: B
Rationale: Carbamazepine requires serum level monitoring to ensure therapeutic range and avoid toxicity. Sunscreen, flossing, or baths are less relevant.
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An adult client who has been taking furosemide (Lasix) 40 mg PO every day for several weeks is complaining of muscle weakness and lethargy. Which test will be of greatest value in assessing the client's condition?
- A. Serum electrolytes
- B. Urinalysis
- C. Serum creatinine
- D. Five-hour glucose tolerance test
Correct Answer: A
Rationale: Furosemide can cause hypokalemia, leading to muscle weakness and lethargy; serum electrolytes assess potassium levels.
The female client with Trichomonas vaginalis is prescribed metronidazole (Flagyl), an antibacterial medication. Which statement indicates the client does not understand the discharge teaching?
- A. I will not be able to drink any alcohol while taking this drug.
- B. My boyfriend will need to take this same medication.
- C. I cannot transmit the disease through oral sex.
- D. I must make sure I take all the pills no matter how I feel.
Correct Answer: C
Rationale: Trichomonas can be transmitted via oral sex; this statement shows misunderstanding. Alcohol avoidance, partner treatment, and full course completion are correct.
In providing care for a client with pain from a sickle cell crisis, which one of the following medication orders for pain control should be questioned by the nurse?
- A. Demerol
- B. Morphine
- C. Methadone
- D. Codeine
Correct Answer: A
Rationale: Demerol. Meperidine is not recommended in clients with sickle cell disease. Normeperidine, a metabolite of meperidine, is a central nervous system stimulant that produces anxiety, tremors, myoclonus, and generalized seizures when it accumulates with repetitive dosing. Clients with sickle cell disease are particularly at risk for normeperidine-induced seizures.
An adult client is on call for the operating room. The preoperative medication order is for meperidine HCl (Demerol) 100 mg IM and atropine 0.4 mg IM. The operating room calls at 11:00 A.M. and requests that the client be medicated. The nurse notes that the client last received meperidine for pain at 10:00 A.M. What is the most appropriate action for the nurse to take?
- A. Give the preoperative medication as ordered
- B. Give half the dose of meperidine and all of the atropine
- C. Check with the anesthesiologist before administering the medication
- D. Withhold both the meperidine and the atropine
Correct Answer: C
Rationale: Recent meperidine administration increases the risk of respiratory depression. Consulting the anesthesiologist ensures safe dosing.
The client diagnosed with status asthmaticus is prescribed intravenous aminophylline, a bronchodilator. Which assessment data would warrant immediate intervention?
- A. The theophylline level is 12 mcg/mL.
- B. The client has expiratory wheezing.
- C. The client complains of muscle twitching.
- D. The client is refusing to eat the meal.
Correct Answer: C
Rationale: Muscle twitching indicates theophylline toxicity, requiring immediate intervention. Normal levels (10–20 mcg/mL), wheezing, or meal refusal are expected or less urgent.