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The nurse completed teaching for the client who will be receiving TPN at home. Which client statement indicates that further teaching is needed?
- A. My refrigerator is big enough to store several bags of parenteral solution.
- B. I will keep my cellular phone with me at all times to use in an emergency.
- C. I plan to use the main floor bedroom; it'll be best with the infusion pump.
- D. I'll sit at the table to remove the IV catheter cap to attach the IV tubing.
Correct Answer: D
Rationale: A: Several total nutrient solution bags are kept on hand and require refrigeration. B: A telephone is necessary for contacting home health personnel, arranging for supply deliveries, and calling emergency services. C: The TPN is delivered through an infusion pump, which can limit the client's mobility. D: The central catheter lumen is capped with a needleless port. The IV infusion tubing is connected to the insertion site cap and not removed to administer the TPN solution. Caps are changed every 3 to 7 days during dressing changes, with the client in a flat position. An air embolus can occur if the cap is removed while the client is in a sitting position.
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The home care nurse is observing the child with asthma self-administer a dose of albuterol via a metered-dose inhaler with a spacer. Within a short time, the child begins to wheeze loudly. What should the nurse do?
- A. Reassure the parent that this usually only occurs with the initial dose.
- B. Notify the HCP; wheezing may indicate paradoxical bronchospasms.
- C. Consult with the HCP to have the child's medication dosage increased.
- D. Reassess the technique; eye contact with albuterol can cause wheezing.
Correct Answer: B
Rationale: A: Reassuring the parent is an inappropriate action; the wheezing is not a normal reaction. There is no indication that this is an initial dose. B: The client's wheezing suggests paradoxical bronchospasms, which can occur with excessive use of adrenergic bronchodilators such as albuterol (Proventil). The medication should be withheld and the HCP notified. C: A paradoxical bronchospasm can occur from excessive use, so the dosage should not be increased. D: Contact with the eyes can cause eye irritation, not wheezing.
The nurse is caring for a group of clients all in need of pain medication. The nurse has determined the most appropriate pain medication for each client based on the client's level of pain. Prioritize the order that the nurse should plan to administer the pain medications, beginning with the most potent analgesic for the client with the most severe pain.
- A. Ketorolac 10 mg oral
- B. Fentanyl 0.1 mg IV bolus per patient-controlled analgesia (PCA)
- C. Hydromorphone 5 mg oral
- D. Morphine sulfate 4 mg IV
- E. Propoxyphene 65 mg oral
Correct Answer: B,D,C,A,E
Rationale: B: Fentanyl 0.1 mg IV bolus per PCA. Fentanyl (Sublimaze), the most potent of the medications, is an opioid narcotic analgesic that binds to opiate receptors in the CNS, altering the response to and perception of pain. A dose of 0.1 to 0.2 mg is equivalent to 10 mg of morphine sulfate. D: Morphine sulfate 4 mg IV. Morphine sulfate is also an opioid analgesic. This dose is IV and would be fast-acting. C: Hydromorphone 5 mg oral. Hydromorphone (Dilaudid), another opioid analgesic, would be next in priority. The oral dosing of this medication would indicate that the client's pain is less severe than the client receiving fentanyl or morphine sulfate. Hydromorphone 7.5 mg oral is an equianalgesic dose to 30 mg of oral morphine or 10 mg parenteral morphine. A: Ketorolac 10 mg oral. Ketorolac (Toradol) is an NSAID and nonopioid analgesic that inhibits prostaglandin synthesis, producing peripherally mediated analgesia. E: Propoxyphene 65 mg oral. Propoxyphene (Darvon) should be given last. It binds to opiate receptors in the CNS but is used in treating mild to moderate pain. It has analgesic effects similar to acetaminophen's.
The nurse is educating the client concerning the possible side effects of a newly prescribed traditional antipsychotic medication. Which client statement reflects a need for further education regarding the side effects of this classification of medication?
- A. I need to get up from bed slowly so I will not get dizzy.
- B. The medication can cause constipation, so I need to eat fiber.
- C. I may need a sleeping pill because insomnia is a possible side effect.
- D. I can't risk gaining weight, so I will need to add some exercise to my routine.
Correct Answer: C
Rationale: Drowsiness, not insomnia, is a common side effect of traditional antipsychotics, indicating a need for further teaching.
The nurse is developing a teaching plan for the client prescribed nortriptyline. Which self-care aspects should be included to minimize medication side effects and prevent injury? Select all that apply.
- A. Avoid eating processed meats, cheeses, and wines.
- B. Suck on candy or ice chips to keep your mouth moist.
- C. Run water in the bathroom to stimulate urination if needed.
- D. Increase fluid and fiber in the diet to prevent constipation.
- E. Avoid driving until vision is completely clear to prevent injury.
- F. Increase exposure to sunlight to facilitate vitamin D absorption.
Correct Answer: B,C,D,E
Rationale: Nortriptyline (Pamelor) causes dry mouth, urinary retention, constipation, and blurred vision. Sucking on candy, running water to stimulate urination, increasing fluid and fiber, and avoiding driving until vision is clear are appropriate.
Ciprofloxacin is prescribed for the client to treat a UTI. Which information should the nurse stress when teaching the client about the medication?
- A. Avoid taking ciprofloxacin with dairy products such as milk or yogurt.
- B. Treat diarrhea, a side effect of ciprofloxacin, with bismuth subsalicylate.
- C. Avoid fennel because it will increase the absorption of the ciprofloxacin.
- D. Take dietary calcium tablets one hour before or two hours after ciprofloxacin.
Correct Answer: A
Rationale: A: Ciprofloxacin (Cipro) is a fluoroquinolone antibiotic. Milk or yogurt decreases its absorption and should be avoided. B: Bismuth subsalicylate decreases the absorption of ciprofloxacin and should be avoided. C: Fennel will decrease, not increase, the absorption of the ciprofloxacin. D: Dietary calcium can be taken at any time; it is unaffected by ciprofloxacin.