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The nurse applies a fentanyl transdermal patch to the client for the first time. Shortly after application, the client is experiencing pain. Which nursing action is most appropriate?
- A. Remove the transdermal patch and apply a new one.
- B. Administer a short-acting opioid analgesic medication.
- C. Rub the transdermal patch to enhance drug absorption.
- D. Call the HCP to request a higher-dosed fentanyl patch.
Correct Answer: B
Rationale: A: Removing the patch is unnecessary; effective analgesia may take 12 to 24 hours. B: The nurse should administer a short-acting opioid analgesic. When the first fentanyl (Duragesic) transdermal patch is applied, effective analgesia may take 12 to 24 hours because absorption is slow. C: Transdermal patches should not be rubbed to enhance absorption; it can cause the delivery of the medication to fluctuate. D: It is premature to request a higher dose of fentanyl.
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The client calls a clinic 2 weeks after taking oral carbidopa-levodopa, stating that the medication has been ineffective in controlling the symptoms of PD. What nursing action is most important?
- A. Review how to correctly take the carbidopa-levodopa.
- B. Contact the HCP to address a change in the dose.
- C. Reinforce that it may take 1 to 2 months to see effects.
- D. Reinforce eating a diet high in protein and vitamin B6.
Correct Answer: C
Rationale: A: Reviewing the method for taking carbidopa-levodopa, including foods to avoid, may be important, but option C is most important. More information is needed to determine whether the client is taking it correctly. B: A dosage change is unnecessary because it has been only two weeks since the client started carbidopa-levodopa. C: With oral administration of carbidopa-levodopa (Sinemet), it usually takes 1 to 2 months before an effect is noted, although in some cases it may require up to 6 months. D: A high-protein diet can slow or prevent absorption of carbidopa-levodopa. Vitamin B6 increases the action of decarboxylases that destroy levodopa in the body's periphery, reducing the effects of carbidopa-levodopa. Foods high in pyridoxine should be avoided.
The nurse is teaching the parent of the 3-year-old being treated with vincristine sulfate for Wilms' tumor. The nurse should inform the parents to immediately notify the HCP of which most significant adverse effect?
- A. The child develops diarrhea.
- B. The child's hair begins to fall out.
- C. The child develops dysphagia and paresthesia.
- D. The child has signs or symptoms of depression.
Correct Answer: C
Rationale: A: Both diarrhea and severe constipation are adverse effects of vincristine, and prophylactic treatment is implemented at the beginning of therapy to decrease the potential of these occurring. B: Hair loss is a common adverse reaction to the medication and is reversible. C: Dysphagia and paresthesia are CNS adverse effects from vincristine sulfate (Oncovin). The nurse should teach the parent to notify the HCP immediately if these occur. D: Three-year-olds may not show signs or symptoms of depression. If present, the signs and symptoms should be distinguished as being associated with the neoplastic disease itself or as side effects of the medication.
Which statement best describes electrolytes in intracellular and extracellular fluid?
- A. There is a greater concentration of sodium in extracellular fluid and potassium in intracellular fluid
- B. There is an equal concentration of sodium and potassium in extracellular fluid
- C. There is a greater concentration of potassium in extracellular fluid and sodium in intracellular fluid
- D. There is an equal concentration of sodium and potassium between intracellular and extracellular fluid
Correct Answer: A
Rationale: There is a greater concentration of sodium in extracellular fluid and potassium in intracellular fluid, maintaining cellular function and fluid balance.
The nurse is developing the plan of care for the 7-year-old with encopresis who has been started on lactulose. Which outcome would be most appropriate for the nurse to establish?
- A. 2-pound weight gain
- B. Nighttime continence
- C. Blood glucose 70-110 mg/dL
- D. Normal bowel movement daily
Correct Answer: D
Rationale: A: Weight gain is not expected with an osmotic laxative. B: Nighttime continence is not expected to be altered by an osmotic laxative. C: Blood glucose is not expected to be altered by an osmotic laxative. D: Lactulose (Constulose) is an osmotic laxative used in treating encopresis to prevent constipation; the nurse should establish an outcome of a normal daily bowel movement.
The client taking carbamazepine XR for seizure control reports that pieces of the medication are being passed into the stool. Which action by the nurse is most important?
- A. Report this to the health care provider.
- B. Reassure the client that this is normal.
- C. Collect the stool for laboratory analysis.
- D. Document the findings in the medical record.
Correct Answer: B
Rationale: A: It is inappropriate to report an expected finding to the HCP. B: Carbamazepine XR (Tegretol XR) is a sustained-release medication with a coating that is not absorbed but is excreted in feces and may be visible in stool. The nurse should reassure the client that this is normal. C: Collecting the stool for laboratory analysis is not necessary because the coating is not absorbed but excreted in the stool. D: The nurse should document the client teaching but usually would not document the presence of the coating in the client's stool.