Nokea
The nurse receives an order to administer phenytoin through the client's J-tube. The order instructs that tube feedings are stopped at least an hour prior to administering the medication and an hour after medication is administered. Which of the following considerations may be a reason to discuss this order with the physician?
- A. The client has a history of Type II diabetes.
- B. The client is on a continuous tube-feeding regimen.
- C. The client is on fluid-restriction.
- D. The pharmacy has provided phenytoin in tablet form.
Correct Answer: B
Rationale: For a client on a continuous tube-feeding regimen, stopping tube feedings for two hours to administer this medication may compromise the client's nutritional status.
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The nurse is discussing the prescribed atypical antipsychotic medication therapy with the client with schizophrenia. What information should the nurse include in this discussion? Select all that apply.
- A. Atypical antipsychotic medications will affect the client's hallucinations and inappropriate emotional responses.
- B. Atypical antipsychotic medications are prescribed after other medications have proven ineffective in treating symptoms.
- C. The greatest concern with taking atypical antipsychotic medications is that they produce extrapyramidal side effects.
- D. Regular laboratory appointments will need to be scheduled to monitor the client's blood glucose levels.
- E. The client may experience an increase in appetite and weight gain when taking an atypical antipsychotic medication.
Correct Answer: A,D,E
Rationale: Atypical antipsychotics target hallucinations and emotional responses, require blood glucose monitoring, and may cause increased appetite and weight gain.
The LPN is caring for a client taking Lipitor (Atorvastatin). Which of these statements would indicate that the client may need reinforced teaching?
- A. I take my Lipitor with a glass of milk after my breakfast.
- B. I take my Lipitor and wait 30 minutes before taking my other medications.
- C. I take my Lipitor 30 minutes after I eat something.
- D. I take my Lipitor and my other morning medications with my grapefruit juice at breakfast.
Correct Answer: D
Rationale: Grapefruit juice should be avoided when taking Lipitor. Grapefruit juice blocks the enzymes needed to breakdown the drug, which leads to excessive amounts of the drug in the body.
The LPN is on a home visit with a client taking Amiodarone. Which of these statements would indicate that the client understands the potential drug side effects.
- A. It is normal if I have numbing or tingling in my feet.
- B. I need to make sure I wear sunblock when going outdoors.
- C. I need to take supplemental vitamin B12.
- D. I should avoid eating leafy vegetables.
Correct Answer: B
Rationale: Amiodarone can cause increased photosensitivity, so the client should ensure that he or she wears protection.
The LPN has been asked to help a client taking Risperdal with activities of daily living in the morning. Which of these tasks is most likely to be potentially impacted by this medication?
- A. eating breakfast
- B. drinking fluids
- C. getting out of bed to use the bathroom
- D. brushing teeth
Correct Answer: C
Rationale: Risperdal can cause orthostatic hypotension, so, to prevent a fall, care should be taken when changing positions.
The nurse is administering Phenobarbital 300 mg IV to the child weighing 18 kg who is in status epilepticus. Which actions should the nurse take to safely administer the medication? Select all that apply.
- A. Administer the phenobarbital over 20 minutes.
- B. Monitor the IV site for signs of extravasation.
- C. Dilute the phenobarbital dose in 10 mL D5W.
- D. Administer the phenobarbital via IV piggyback.
- E. Identify incompatible medications or solutions being infused.
- F. Inject the phenobarbital over 10 minutes in the port closest to the child.
Correct Answer: B,E,F
Rationale: A: This dose of phenobarbital should be administered as an IV-push medication over 10 minutes; administering it over 20 minutes will delay the medication's effects to treat status epilepticus. B: Whenever IV medications are being administered by any route, the site should be evaluated for irritation and extravasation. An extravasation of phenobarbital (Luminal) may cause necrotic tissue changes that necessitate skin grafting. C: Phenobarbital, if diluted, should be mixed with sterile water for injection and not D5W. D: Phenobarbital should be prepared for direct IV administration and not as an IV piggyback because this would delay the child's receiving the medication to terminate the seizure. E: When administering IV medications, identification of medications or solutions that would be incompatible with that medication must occur so that the tubing can be flushed to ensure that crystallization does not occur in the IV tubing. F: Phenobarbital should be administered no faster than 1 mg/kg/min, with a maximum of 30 mg over 1 minute in infants and children.