Health Promo + Pharm # 3

The nurse provides care for a client receiving doxycycline. The nurse is concerned if the client makes which statements? (Select all that apply.)

- "Currently I have a thick vaginal discharge. " - "I take the medication at 10:30 AM and 10:30 PM. " - "I take an antacid immediately before going to bed. " CORRECT— Doxcycline is an antibiotic, which can increase the risk for superinfection. Vaginal discharge may indicate a superinfection, which requires immediate treatment. CORRECT— Medication is taken at regular intervals around the clock, but should not be taken within 1 hour of bedtime because it may cause esophageal irritation. The nurse should find out what time the client usually goes to bed. CORRECT— The client should not take antacids within 1 -3 hours of taking doxcycline to avoid absorption interference.

The nurse provides care to a client receiving topiramate. For which client statement will the nurse intervene?

- "I use oral contraceptives. " Topiramate is an anticonvulsant. Non-hormonal contraceptives should be used when taking topiramate. The efficacy of combined oral contraceptives is diminished in clients taking anti-epileptic drugs. The client and partner should be informed about using other methods of birth control, such as a condom, when taking these medications. The client should drink 2000 to 3000 mL of fluid daily to prevent kidney stones. Topiramate may cause orthostatic hypotension. Changing positions slowly is an appropriate action. Topiramate should be discontinued if ocular symptoms occur. If left untreated, ocular changes may lead to blindness.

A client diagnosed with leukemia has a platelet count of 100×103/µL (100×109/L). The client will receive a platelet transfusion. The novice nurse reviews the transfusion plan with the nurse preceptor. Which statement, made by the novice nurse, requires the nurse preceptor to intervene?

- "I will be sure to have a standard transfusion set ready before I call the blood bank." This requires an intervention. All equipment should be ready before blood products are requested from the blood bank. However, a standard blood transfusion set (Y-tubing) is not used for platelet administration because the filter traps the platelets, and there is increased adherence of platelets to the lumen of the longer tubing. An administration set particularly designed for platelets must be used, as it has a smaller filter and shorter tubing. Amphotericin B is an antifungal agent often given to clients diagnosed with leukemia, but it can cause severe allergic reactions. This makes it difficult to distinguish whether a reaction is caused by the medication or the transfusion. This and other medications capable of causing allergic reactions should not be administered immediately before, during, or after a transfusion. At least 1 hour should pass after the transfusion before the amphotericin is administered again.

A client is being discharged after a liver transplant with cyclosporine oral solution as one of the prescribed medications. Which statement made by the client indicates further teaching is necessary?

- "I will mix the cyclosporine in a glass of grapefruit juice." Grapefruit juice and cyclosporine should not be taken together because the juice causes the bioavailability of cyclosporine to increase by 20 to 200%. It is even advised by some that no drinking of grapefruit juice should occur when a patient is on this drug. The medication is always mixed in glass, not plastic, and with a room temperature liquid, such as orange or apple juice.

The client is to begin treatment with metformin. Which client statement requires immediate intervention by the nurse?

- "I will take the medication when I first get up and just before I go to bed." The client should take metformin with meals to reduce the side effects of the medication. Side effects may include nausea, vomiting, anorexia, and abdominal cramps. Bitter or metallic tastes and abdominal cramps are two common side effects of this medication. These side effects are less likely if the client takes the medication with meals.

The nurse teaches a client newly diagnosed with latent tuberculosis (TB). Which statement by the client indicates that further teaching is needed?

- "I'm glad I don't have to take any medication." The client with latent tuberculosis (TB) has no symptoms, cannot spread TB bacteria.However, the client with latent TB requires treatment to prevent active TB disease. Treatment for latent TB is less rigorous and usually requires only one drug (isoniazid or rifampin) because fewer bacteria are present. Standard treatment for latent TB is 9 months of daily isoniazid.

The nurse provides discharge instructions to a client with a central venous access device (CVAD) for continued treatment of osteomyelitis. Which client statements require further instruction by the nurse?

- "If the dressing over this catheter gets loose, I'll tape it back down." - "If the catheter starts to fall out, I will gently reinsert it." - "I'll put all these supplies in the trash as soon as I'm done with them." CORRECT - The client must be instructed to call the home health nurse if the sterile dressing becomes loose, damp, or soiled. CORRECT - The client should be instructed to apply pressure with sterile gauze if the catheter becomes dislodged and to avoid reinserting it. CORRECT - The client should be instructed on the proper disposal of sharps and contaminated items. All intravenous therapy trash should be treated as a potential biohazard and should not be placed with regular household trash.

The nurse instructs a client about the correct way to take an oral contraceptive. Which client statement indicates that teaching was effective?

- "The pill is most effective if I take it at the same time each day." Hormone levels may decrease and ovulation may occur if the pill is not taken at the same time daily. The client should take the medication with a meal or at bedtime to serve as a reminder. This statement indicates that client teaching was effective. If a pill is missed, it should be taken as soon as the client remembers. The client should not wait until the next day when the next scheduled dose is due to take the missed pill. If two pills are missed, the client should use a barrier method of birth control for the rest of the month.

A client experiencing regular contractions reports "water breaking. " Which action does the nurse take first?

- Auscultate the fetal heart rate. The priority is assessment of fetal well-being. This is completed by auscultating the fetal heart rate. This heart rate should range from 120 to 160 beats per minute. A heart rate above 160 beats per minute is an early sign of fetal hypoxia. A heart rate below 110 beats per minute is a later sign of fetal hypoxia, which could be caused by prolapse of the umbilical cord.

The nurse presents information to staff regarding anatomic changes that occur shortly after birth to facilitate a newborn's adaptation to extrauterine life. Which anatomic changes are included by the nurse in the teaching session?

- Decrease in pulmonary vascular resistance. - Closure of the foramen ovale. - Closure of the ductus arteriosus. - Closure of the ductus venosus.

The nurse assesses a client who gave birth to a baby 10 hours ago. Which findings are expected for this client? (Select all that apply.)

- Elevated white blood cells (WBC) level. - Pulse oximetry reading of 96%. - Elevated neutrophils. - Temperature of 100.4°F (38°C).

The nurse obtains a history on a middle-age adult client who has come in for a gynecological examination. The client shares with the nurse that having intercourse is painful. Which action does the nurse take first?

- Explore the client's personal menstrual history. The client is probably experiencing dyspareunia caused by perimenopause or menopause. The nurse should assess the client's menstrual status before determining the appropriate course of action.

The nurse provides care to a client who sustained severe crush injuries of both legs during a motor vehicle crash. The client is diagnosed with rhabdomyolysis. The nurse anticipates the health care provider will prescribe which intervention for the client?

- Mannitol. Administration of mannitol, an osmotic diuretic, is an appropriate intervention for the client diagnosed with rhabdomyolysis. Rhabdomyolysis is characterized by the release of massive quantities of myoglobin from damaged muscle cells, as well as the release of intracellular potassium (K +) due to cell lysis. Mannitol is administered to promote excretion of substances, including myoglobin and potassium. The nurse gives the client with rhabdomyolysis mannitol to reduce edema and compartment syndrome as a result of crush injuries. To monitor effectiveness, the nurse anticipates an increased urine output (in crush injury, a urine output of 300 mL or more is recommended, and volumes of up to 12 liters/24 hours may be required). In rhabdomyolysis, intravenous hydration coupled with diuresis is thought to decrease the risk of myoglobin-associated acute tubular damage and acute kidney injury.

A client comes to the clinic reporting muscle weakness, breathlessness, and bone pain. The nurse notes that the client takes phenytoin 100 mg three times a day. When providing nutritional counseling, which food grouping best meets this client's needs?

- Milk, cantaloupe, kale. Anticonvulsants can cause folate and vitamin D deficiencies. The client has symptoms reflective of anemia and bone resorption. Folate deficiency can cause anemia. Good sources of folate are green leafy vegetables, legumes, tomatoes, and various fruits such as oranges and cantaloupe. Good sources of vitamin D include fortified milk. Because vitamin D promotes calcium absorption, foods rich in this vitamin (e.g., kale) are also recommended.

The nurse provides care for a client receiving lithium carbonate 300 mg orally three times per day. Which clinical manifestations will the nurse identify as early indications of toxicity? (Select all that apply.)

- Nausea and vomiting. - Slurred speech. - Muscle weakness. INCORRECT - A coarse hand tremor is an advanced sign of toxicity. Other indications include persistent GI upset, mental confusion, and poor coordination. INCORRECT - Defective, uncoordinated muscle movements indicate a severe toxicity.

The nurse instructs the parent of a toddler about appropriate foods for a 2-year-old. Which suggestion is most important for the nurse to make?

- Provide the child with finger foods. The toddler is working to develop autonomy in this stage. Finger foods offer the child the necessary independence for this stage. It is the parents' responsibility to offer a variety of nutritionally sound foods.The toddler needs carbohydrates for energy. The nurse should recommend a balanced diet. Because toddlers eat small amounts of food, it is important to offer nutritionally sound snacks frequently.

The parent of a toddler asks the pediatric clinic nurse, "Do you have any suggestions for what I can say to get my child to go to bed without a fuss?" Which suggestion by the nurse is best?

- Say to your toddler, "After we read this story, it will be time for sleep." This statement avoids asking the toddler's permission to go to sleep. It sets clear and reasonable limits and allows time for adjustment. Having a clear routine builds trust when the parent follows through. Bedtime is paired with an enjoyable, calming activity and provides a ritual, which will cue the toddler that it is time to sleep.

A client requests information on nonpharmacologic methods of birth control. In planning the client's care, which method is most effective and needs to be included when providing education?

- Symptothermal method. The symptothermal method combines cervical mucus evaluation and basal body temperature evaluation. Any time a method of birth control can be used in combination with another, the rate of effectiveness increases. Therefore, this method is the most effective.

The nurse is called to a neighbor's house during a snowstorm. The neighbor states she is in her 40th week of gestation with her second baby, and has been having contractions for several hours. The woman has been unable to obtain assistance because the roads are impassable. Which statement most concerns the nurse?

- The woman asks for help to go to the bathroom. This indicates that the woman may be entering the transition phase, which occurs when the cervix is 8-10 cm dilated with complete effacement. Symptoms of the transition stage include increased pressure in pelvis, which causes an intense desire to urinate. The nurse should immediately assess the client's cervix and prepare for emergent delivery.

The nurse manager on the oncology unit makes rounds during the day shift. Which observation by the manager requires an immediate intervention?

- Using a marking pen, the nurse labels an IV fluid bag with the date and time the IV was initiated and the nurse's initials. A marking pen should not be used to label an IV bag, especially directly on the plastic IV bag. Ink can penetrate the plastic and diffuse into the solution, posing a risk to the client. Labeling should be done on a label or tape using a regular pen and then placed on the IV bag. Not --> Wearing gloves, the nurse firmly seals all four edges of the sterile gauze dressing at an IV catheter insertion site with tape. No intervention is required. While most facilities use transparent dressings over IV insertion sites, some continue to use gauze dressings. The nurse should follow the procedures adopted by the facility.

The nurse provides care for infants in the pediatric clinic. When teaching parents about developmental milestones, in which order does the nurse present the information?

First, the infant loses the doll's eye reflex at 2 to 3 months of age and can follow a moving object briefly. At about 4 months of age, the infant begins drooling as the gums swell and teeth erupt. The infant responds to name by 6 to 8 months of age. The infant will take deliberate steps when held up or after pulling self up to a standing position at 9 to 10 months of age. Lastly, an infant will pick up bite-size pieces of cereal at 11 months and deliberately put them in the mouth.