Nokea
The nurse in the physician's office is instructing an adult about taking penicillin V potassium (Pen-Vee-K) qid. When should the nurse tell him to take the medicine?
- A. With meals and at bedtime
- B. Once a day at 10:00 a.m.
- C. On an empty stomach at six-hour intervals
- D. With orange juice at four-hour intervals
Correct Answer: C
Rationale: Penicillin V potassium should be taken on an empty stomach at six-hour intervals to optimize absorption.
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The nurse is preparing to administer the initial dose of an antibiotic in the emergency department. Which interventions should the nurse implement? Select all that apply.
- A. Assess for drug allergies.
- B. Collect needed specimens for culture.
- C. Check the client's armband.
- D. Ask the client his or her birthday.
- E. Draw peak and trough levels.
Correct Answer: A,B,C
Rationale: Allergy assessment prevents reactions, cultures guide therapy, and armband ensures identity. Birthday is redundant, and peak/trough levels are post-administration.
The client with arthritis is self-medicating with aspirin, a nonsteroidal anti-inflammatory medication. Which complication should the nurse discuss with the client?
- A. Tinnitus.
- B. Diarrhea.
- C. Tetany.
- D. Paresthesia.
Correct Answer: A
Rationale: High-dose aspirin can cause tinnitus, an early sign of salicylate toxicity, requiring education. Diarrhea, tetany, or paresthesia are less common.
The elderly male client is admitted for acute severe diverticulitis. He has been taking Xanax, a benzodiazepine, for nervousness three (3) to four (4) times a day prn for six (6) years. Which intervention should the nurse implement first?
- A. Prepare to administer an intravenous antianxiety medication.
- B. Notify the HCP to obtain an order for the client's Xanax prn.
- C. Explain Xanax causes addiction and he should quit taking it.
- D. Assess for signs/symptoms of medication withdrawal.
Correct Answer: D
Rationale: Long-term Xanax use risks dependence; assessing withdrawal (e.g., agitation, seizures) is the priority during acute illness to guide safe management.
The client is complaining of incisional pain. Which intervention should the nurse implement first?
- A. Administer the pain medication STAT.
- B. Determine when the last pain medication was given.
- C. Assess the client's pulse and blood pressure.
- D. Teach the client distraction techniques to address pain.
Correct Answer: B
Rationale: Determining the last dose ensures safe timing and avoids overdose, the first step in pain management per nursing process.
The client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) is receiving the aminoglycoside antibiotic vancomycin. Peak and trough levels are ordered for the dose the nurse is administering. Which priority intervention should the nurse implement?
- A. Ask the client if he has had any diarrhea.
- B. Monitor the aminoglycoside peak level.
- C. Determine if the trough level has been drawn.
- D. Check the client's culture and sensitivity report.
Correct Answer: C
Rationale: Trough levels must be drawn before the next vancomycin dose to ensure therapeutic levels and avoid toxicity; this is the priority. Diarrhea, peak levels, or culture reports are secondary.