A. Applying pressure to the IV site can cause further damage to the tissue and is not recommended. Pressure can exacerbate the infiltration and cause more discomfort to the patient.
B. Elevating the extremity helps reduce swelling and facilitates fluid reabsorption.

This position also reduces pain and further leakage of the infiltrated fluid.

C. Flushing the IV catheter is not appropriate as it can increase infiltration. This action would introduce more fluid into the surrounding tissue, worsening the condition.
D. Slowing the infusion rate does not address the infiltration and can exacerbate the problem. The infusion should be stopped immediately, not just slowed down.

A. Probiotics do not typically interact with warfarin. They generally affect gut health and are not known to have significant effects on blood clotting mechanisms.
B. Coenzyme Q10 has minimal effects on warfarin metabolism. It is mainly involved in cellular energy production and does not significantly alter coagulation.
C. Valerian primarily affects the central nervous system and has no significant interaction with warfarin. It is mainly used for its sedative properties and does not interfere with blood thinning.
D. Ginkgo biloba can increase the risk of bleeding when taken with warfarin due to its antiplatelet effects. This supplement inhibits platelet aggregation, which can significantly enhance the anticoagulant effects of warfarin, raising the risk of hemorrhage.

A. Doxycycline can increase sensitivity to sunlight, leading to a higher risk of sunburn. Advising the client to avoid the sun or use sun protection helps prevent this adverse effect.
B. Antibiotics like doxycycline can reduce the effectiveness of combined oral contraceptives. Using an alternate form of birth control ensures continued contraceptive protection while on the antibiotic.

C. While headaches and blurred vision can be side effects of doxycycline, they are not among the most common side effects that need to be emphasized during teaching.
D. Constipation is not a common side effect of doxycycline. Common side effects include gastrointestinal upset such as nausea, diarrhea, and esophageal irritation.
E. Doxycycline should not be taken with dairy products as calcium can interfere with its absorption, reducing the effectiveness of the medication. The client should be advised to take it with a full glass of water and to avoid dairy close to the time of taking the medication.

A. There is no specific requirement to administer within 20 minutes as long as proper technique is used. The mixture should be administered promptly, but the exact timing is not critical within this short period.
B. The short-acting insulin should be drawn into the syringe first to prevent contamination. Drawing NPH insulin first can contaminate the short-acting insulin with the intermediate-acting insulin's cloudy appearance.

C. Injecting air into the vial to withdraw the short-acting insulin first is the correct technique. This prevents the risk of contaminating the clear short-acting insulin with the cloudy NPH insulin.
D. Using two separate syringes is not necessary for mixing insulins and can complicate administration. Mixing in one syringe ensures correct dosing and simplifies the injection process.

A. Calculation: 3 mL/min × 60 min/hr × 2 hr = 360 mL, accurately reflecting the infusion rate over the two-hour period.
B. Calculation: 3 mL/min × 60 min/hr × 2 hr = 360 mL, accurately reflecting the infusion rate over the two-hour period.
C. Calculation: 3 mL/min × 60 min/hr × 2 hr = 360 mL, accurately reflecting the infusion rate over the two-hour period.

D. Calculation: 3 mL/min × 60 min/hr × 2 hr = 360 mL, accurately reflecting the infusion rate over the two-hour period.

A. A firm-bristle toothbrush can cause further irritation and trauma to the already sensitive and lesioned oral mucosa. A soft-bristle toothbrush is recommended instead. This statement indicates a misunderstanding of proper oral care in the context of stomatitis.
B. Methotrexate can cause folic acid deficiency, and taking folic acid supplements is often recommended to mitigate some side effects of methotrexate, including oral mucositis. Avoiding folic acid supplements is not correct in this context and indicates a misunderstanding of the appropriate use of supplements.
C. Saline rinses help to keep the mouth clean and can soothe mucosal irritation and lesions associated with stomatitis. This indicates effective teaching as it is a recommended intervention for managing stomatitis.

D. Alcohol can irritate the oral mucosa and exacerbate stomatitis. Avoiding alcohol helps prevent further irritation and promotes healing, indicating the client understood the teaching.
E. Consuming soft or semisolid foods can reduce irritation and trauma to the oral mucosa, which is important for clients with stomatitis. This shows that the client has understood and can implement dietary modifications to manage their condition.

A. Oxycodone does not primarily inhibit prostaglandin synthesis. This action is more characteristic of nonsteroidal anti-inflammatory drugs (NSAIDs).
B. Blocking sodium channels is not the main mechanism of oxycodone. This effect is more relevant to local anesthetics, not opioids like oxycodone.
C. Oxycodone causes central nervous system depression, leading to a decreased respiratory rate. It acts on the brainstem respiratory centers, which can slow down breathing and even lead to respiratory arrest in high doses.

D. Oxycodone's primary effect is not on cranial artery vasodilation. Its main effects are analgesia and central nervous system depression, which includes respiratory depression.

A. Antacids can interfere with the absorption of ferrous sulfate, reducing its effectiveness. The client should avoid taking antacids concurrently with the iron supplement.
B. Black stools are a common and expected side effect of taking iron supplements. This is generally not a cause for concern and does not require notifying the provider unless accompanied by other symptoms such as pain or blood in the stool.

C. Liquid forms of iron supplements can stain teeth. Rinsing the mouth after taking the medication can help prevent this staining. Even if taking a tablet, this practice can be a good habit to avoid any residual taste.
D. Vitamin C, which is present in orange juice, can enhance the absorption of iron from the gastrointestinal tract, making the iron supplement more effective.
E. Iron supplements are best absorbed on an empty stomach. However, if the client experiences gastrointestinal upset, it can be taken with a small amount of food, but avoiding dairy products and antacids is important.

Nurses' Notes Day 1:

Client is seen by provider for routine follow-up after being started on axcarbazepine 150mg PO twice a day, last week. Client reports no nausea, headache, dizziness, or ataxia. Provider increased oxcarbazepine to 300 mg PO twice a day. Client is to return for a follow-up in 2 weeks.

Day 14:

Client returns for follow-up after increasing oxcarbazepine dosage. Client reports starting to have mild headaches earlier this week. Also states, "Yesterday I was very nauseated and threw up before breakfast." When talking to client they have difficulty remembering the times they are taking their axcarbazepine. Client reports using oral contraceptives as the only means of birth control.

Laboratory Results Day 14

Hct 40% (37% to 47%)

Hgb 13g/dL (12 to 16g/dL)

Sodium 124 mEq/L (136 to 145 mEq/L) Vitals Signs

Day 14:

Temperature 36.3°C (97.4° F)

Heart rate 86/min

Rationale:

The patient's follow-up findings on Day 14, particularly the reported symptoms and laboratory results, suggest potential side effects from the increased dosage of oxcarbazepine. Common side effects of oxcarbazepine include dizziness, nausea, and vomiting. The patient's symptoms of mild headaches and nausea, along with difficulty remembering medication times, could be indicative of these side effects. Additionally, the sodium level of 124 mEq/L is below the normal range (136 to 145 mEq/L), indicating hyponatremia, which is a known side effect of oxcarbazepine and can be serious.

Hyponatremia can cause symptoms such as nausea, vomiting, exhaustion, and dizziness, aligning with the patient's reported condition. These findings warrant immediate medical attention to assess the need for adjusting the medication dosage or considering alternative treatments.

A. Levodopa/Carbidopa can cause nausea, and taking it with food can help mitigate this side effect. However, it's important to avoid high-protein meals which can interfere with the medication's absorption.
B. Levodopa/Carbidopa can cause orthostatic hypotension, leading to dizziness or light-headedness when standing up quickly. Advising the client to rise slowly can help prevent falls.
C. This is a potential side effect, but it is not as immediate or common as other side effects. It can occur with prolonged use and higher doses.
D. High-protein meals can interfere with the absorption of Levodopa, making it less effective. Clients should be advised to avoid high-protein meals close to the time they take their medication.
E. Vivid dreams or nightmares are a known side effect of Levodopa/Carbidopa. This is consistent with the client's report of having trouble sleeping due to nightmares.
F. Levodopa can cause urine to become darker, not lighter. This is not typically a cause for concern but is a side effect clients should be aware of.