Nokea
The client with tonsillar cancer is receiving filgrastim. Prior to administering the next dose of filgrastim, the nurse notes that the client's absolute neutrophil count is 11,000/mm3. What is the nurse's best action?
- A. Administer filgrastim as prescribed.
- B. Place the client on neutropenic precautions.
- C. Notify the HCP to question giving filgrastim.
- D. Apply gown, gloves, and mask to enter the room.
Correct Answer: C
Rationale: A: Unnecessary doses can cause leukocytosis (WBCs above 100,000/mm3), an adverse effect of filgrastim. B: A normal neutrophil count is greater than 2000/mm3. Neutropenic precautions and protective wear are unnecessary because the filgrastim has been effective in increasing the neutrophil count. C: Filgrastim (Neupogen) is a granulocyte colony-stimulating factor for treatment of neutropenia. Filgrastim is usually discontinued when the absolute neutrophil count reaches 10,000/mm3. D: A high-efficiency particulate air (HEPA) or N95 mask rather than a regular mask should be worn if the client is severely neutropenic (less than 100/mm3).
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The nurse is initiating an IV infusion of lactated Ringer's (LR) for the client in shock. What is the purpose of LR for this client?
- A. Increase fluid volume and urinary output
- B. Draw water from the cells into the blood vessels
- C. Provide dextrose and nutrients to prevent cellular death
- D. Replace potassium and magnesium for cardiac stabilization
Correct Answer: A
Rationale: A: LR is an isotonic crystalloid solution containing multiple electrolytes in approximately the same concentration as plasma. It enters the cells from the blood, provides fluids, and increases urinary output. B: A hypertonic solution draws fluid from the cells into the vascular compartment; LR is isotonic. C: LR alone does not contain dextrose. Formulations with dextrose are available. D: Magnesium is not a component of LR.
The 30-year-old has been taking olanzapine for the past 5 years for the treatment of schizophrenia. The client, who has a positive family history of DM, is now overweight but is not showing signs of hyperglycemia. When the client asks about the next steps for treatment, how should the nurse respond?
- A. You'll be started on an oral hyperglycemic agent.
- B. I will be teaching you how to self-administer insulin.
- C. You'll need to have a fasting blood glucose level drawn.
- D. Olanzapine will be discontinued and another drug started.
Correct Answer: C
Rationale: Due to the risk of hyperglycemia with olanzapine (Zyprexa), blood glucose testing is needed to determine if medication therapy is indicated.
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.
The client has been successful at controlling gastroesophageal reflux symptoms without prescription medications. Which OTC medication should the nurse explore whether the client is taking for symptom control?
- A. Aspirin once a day
- B. Famotidine
- C. Ibuprofen
- D. Desloratadine
Correct Answer: B
Rationale: A: Aspirin increases gastric acid secretion and may worsen symptoms. B: The nurse should explore whether the client is taking famotidine (Pepcid) for symptom control. Famotidine blocks histamine-2 receptors on parietal cells, thus decreasing gastric acid production. C: NSAIDs, such as ibuprofen (Motrin), do not reduce gastric acid. D: Desloratadine (Clarinex) blocks only histamine-1 receptors and is not effective against histamine-2 receptors.
The nurse is assessing the client. Which findings indicate that the client may be experiencing physical changes from long-term use of prednisone? Select all that apply.
- A. Weight gain
- B. Increased muscle mass
- C. Fragile skin
- D. Acne vulgaris
- E. Alopecia
Correct Answer: A,C,D
Rationale: A: Weight gain and muscle atrophy are body changes that may occur with long-term glucocorticoid therapy. B: Muscle wasting (not increased muscle mass) is a side effect of prednisone. C: Fragile skin is a possible body change that may occur with long-term glucocorticoid therapy. D: Acne vulgaris may occur with long-term glucocorticoid therapy. E: Hirsutism (not alopecia) is a side effect of prednisone.