Nokea
Which of the following is an inappropriate item to include in planning care for a severely neutropenic client?
- A. Transfuse netrophils (granulocytes) to prevent infection.
- B. Exclude raw vegetables from the diet.
- C. Avoid administering rectal suppositories.
- D. Prohibit vases of fresh flowers and plants in the client's room.
Correct Answer: A
Rationale: Granulocyte transfusion is not indicated to prevent infection. Produced in the bone marrow, granulocytes normally comprise 70% of all WBCs. They are subdivided into three types based on staining properties: neutrophils, eosinophils, and basophils. They can be beneficial in a selected population of infected, severely granulocytopenic clients (less than 500/mm3) who do not respond to antibiotic therapy and who are expected to experience prolonged suppression of granulocyte production.
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The client is taking metolazone and diltiazem for treatment of hypertension. Which statement made by the client to the nurse indicates further teaching is needed?
- A. I eat foods high in potassium to prevent the development of hypokalemia.
- B. Metolazone makes me urinate more, so I take my last dose at suppertime.
- C. I took my medication at breakfast with eggs, toast, grapefruit juice, and milk.
- D. Ibuprofen affects my urine output, so I prefer to take acetaminophen for pain.
Correct Answer: C
Rationale: A: Consuming foods daily that are high in potassium is recommended. Thiazide diuretics such as metolazone (Zaroxolyn) can result in hypokalemia. B: The diuretic metolazone (Zaroxolyn) should not be taken at bedtime to avoid nocturia and the subsequent loss of sleep. C: The client should not consume grapefruit juice because it inhibits the metabolism of diltiazem (Cardizem) and can cause toxicity. This client statement indicates the need for further teaching. D: NSAIDs such as ibuprofen (Advil, Motrin) can decrease the diuretic and antihypertensive effects of thiazide diuretics.
The hospitalized adult is having difficulty falling and staying asleep. The nurse consults standing orders, which have medications included in the table illustrated. Which hypnotic medication should the nurse administer to effectively help the client sleep soundly throughout the night?
- A. Zaleplon
- B. Triazolam
- C. Flurazepam
- D. Eszopiclone
Correct Answer: B
Rationale: Triazolam (Halcion) has a later peak and longer duration, helping the client fall and stay asleep longer.
The nurse administers risperidone to the client experiencing hallucinations. Which physiological disorder should the nurse assess for considering the risk of developing this disorder as a side effect of risperidone?
- A. Asthma
- B. Hypertension
- C. Crohn's disease
- D. Diabetes mellitus
Correct Answer: D
Rationale: Risperidone (Risperdal) increases the risk of diabetes, especially in the first few months of therapy.
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.
Which of the following diseases or conditions is least likely to be associated with increased potential for bleeding?
- A. metastatic liver cancer
- B. gram-negative septicemia
- C. pernicious anemia
- D. iron-deficiency anemia
Correct Answer: C
Rationale: Pernicious anemia results from vitamin B12 deficiency due to lack of intrinsic factor. This can result from inadequate dietary intake, faulty absorption from the GI tract due to a lack of secretion of intrinsic factor normally produced by gastric mucosal cells and certain disorders of the small intestine that impair absorption. The nurse should instruct the client in the need for lifelong replacement of vitamin B12, as well as the need for folic acid, rest, diet, and support.