Choice A reason: Tetracycline HCl can make the skin more sensitive to sunlight and increase the risk of sunburn. Therefore, the client should avoid exposure to direct sunlight and use sunscreen or protective clothing while taking the drug.

Choice B reason: Orange juice is acidic and can decrease the absorption of tetracycline HCl in the GI tract. Therefore, the client should not take the drug with orange juice or other acidic beverages.

Choice C reason: Serum drug levels are not routinely monitored for tetracycline HCl, as there is no established therapeutic range or toxicity level for this drug. Therefore, the client does not need to return to the clinic weekly to obtain serum drug levels.

Choice D reason: Milk and antacids can bind to tetracycline HCl and reduce its effectiveness. Therefore, the client should not take the drug with milk or antacids or within 2 hours of consuming them.

Choice A reason: Risedronate is a bisphosphonate that is used to treat osteoporosis by inhibiting bone resorption. It should be taken on an empty stomach with a full glass of water at least 30 minutes before any other food, beverage, or medication. This is because food, milk, and antacids can interfere with the absorption of risedronate and reduce its effectiveness.

Choice B reason: Milk contains calcium, which can bind to risedronate and prevent its absorption. Therefore, the client should not drink milk with or within 2 hours of taking risedronate.

Choice C reason: Withholding the medication until the client's breakfast tray is available is not appropriate, as it would delay the administration of risedronate and disrupt the dosing schedule. The client should take risedronate as soon as possible after waking up and before eating anything.

Choice D reason: Consulting with a pharmacist about scheduling the dose one hour after the client eats is not necessary, as risedronate should be taken at least 30 minutes before any food or beverage. Taking risedronate one hour after eating may not ensure adequate absorption of the drug.

Choice A reason: Recent use of other antidepressants is important to know, as duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that can interact with other antidepressants, especially monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs). However, this information is not as important as liver function laboratory results, as duloxetine can cause hepatotoxicity in some clients.

Choice B reason: Weight change in the last month is relevant to monitor, as duloxetine can cause weight loss or gain in some clients. However, this information is not as important as liver function laboratory results, as duloxetine can cause liver damage in some clients.

Choice C reason: Family history of mental illness is useful to assess, as duloxetine may be more effective or less effective in clients with certain genetic factors. However, this information is not as important as liver function laboratory results, as duloxetine can cause liver failure in some clients.

Choice D reason: Liver function laboratory results are most important to obtain, as duloxetine is metabolized by the liver and can cause hepatotoxicity in some clients. The nurse should monitor the client's liver enzymes and bilirubin levels before and during treatment with duloxetine and report any signs of liver impairment, such as jaundice, dark urine, abdominal pain, or fatigue.

Choice A reason: Checking the client's capillary glucose level is not relevant to this finding, as acetaminophen does not affect blood glucose levels. The yellow color of the skin may indicate jaundice, which is a sign of liver damage caused by acetaminophen overdose or toxicity.

Choice B reason: Advising the client to reduce the medication dose is not sufficient to address this finding, as acetaminophen can cause irreversible liver damage if taken in excess or for prolonged periods. The client may need immediate medical attention and treatment with an antidote such as N-acetylcysteine.

Choice C reason: Reporting the finding to the healthcare provider is the appropriate action to take, as the yellow color of the skin may indicate jaundice, which is a sign of liver failure caused by acetaminophen overdose or toxicity. The healthcare provider can order further tests and interventions to assess and treat the client's condition.

Choice D reason: Using a pulse oximeter to assess oxygen saturation is not related to this finding, as acetaminophen does not affect oxygen levels. The yellow color of the skin may indicate jaundice, which is a sign of liver dysfunction caused by acetaminophen overdose or toxicity.

Choice A reason: Holding the calcitriol but administering the calcium carbonate as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.

Choice B reason: Holding the calcium carbonate, but administering the calcitriol as scheduled is not appropriate, as calcitriol alone can also raise the serum calcium level and cause hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization.

Choice C reason: Holding both medications until contacting the healthcare provider is the appropriate action to take, as the client's total calcium level is above the normal range of 9 to 10.5 mg/dL or 2.25 to 2.62 mmol/L and indicates hypercalcemia. Hypercalcemia can cause symptoms such as nausea, vomiting, constipation, confusion, lethargy, muscle weakness, cardiac arrhythmias, and kidney stones. The healthcare provider can adjust the dose or frequency of the medications or prescribe other treatments to lower the serum calcium level.

Choice D reason: Administering both prescribed medications as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.

Choice A reason: Monitoring for signs of sodium and fluid retention is not relevant to this situation, as broad spectrum antibiotics do not affect sodium or fluid balance. Sodium and fluid retention may be caused by other conditions such as heart failure, kidney disease, or liver disease.

Choice B reason: Obtaining wound and blood specimens for culture and sensitivity is most important before administering the first dose of a broad spectrum antibiotic, as this can help identify the specific type and strain of bacteria causing the infection and determine which antibiotic is most effective against it. Broad spectrum antibiotics are effective against a wide range of bacteria, but they may also kill beneficial bacteria and increase the risk of resistance or superinfection.

Choice C reason: Obtaining a complete blood count and serum electrolytes is not necessary before administering the first dose of a broad spectrum antibiotic, as these tests do not provide information about the type or severity of infection. A complete blood count may show an elevated white blood cell count or other changes in response to infection, but it does not identify the causative organism. Serum electrolytes may show abnormalities due to dehydration, vomiting, diarrhea, or other factors, but they do not indicate infection.

Choice D reason: Performing irrigation and topical antibiotic application to wound area is not sufficient before administering the first dose of a broad spectrum antibiotic, as this may not reach all sites of infection or eradicate all bacteria. Irrigation and topical antibiotic application may help clean and prevent further contamination of wound area, but they do not replace systemic antibiotic therapy.

Choice A reason: Encouraging an increase in oral intake is not necessary in this situation, as dark urine is not a sign of dehydration or fluid imbalance. Dark urine may be caused by certain foods, medications, or medical conditions, but it does not indicate a need for more fluids.

Choice B reason: Measuring the client's urinary output is not relevant to this situation, as dark urine is not a sign of urinary retention or obstruction. Urinary output may vary depending on fluid intake, activity level, or other factors, but it does not reflect urine color.

Choice C reason: Explaining that color change is normal is the appropriate action to take, as dark urine is a common and harmless side effect of carbidopa/levodopa, which is a combination drug used to treat Parkinson's disease by increasing dopamine levels in the brain. Carbidopa/levodopa can cause urine to turn brown, black, or red, but this does not affect the function or health of the kidneys or bladder.

Choice D reason: Obtaining a specimen for a urine culture is not necessary in this situation, as dark urine is not a sign of infection or inflammation. A urine culture may be indicated if the client has symptoms such as fever, pain, burning, frequency, or urgency, but it does not diagnose urine color

Choice A reason: Nausea and diarrhea are possible side effects of ginkgo biloba, but they are not as serious or common as the risk of bleeding caused by the interaction with aspirin and non-steroidal anti-inflammatory drugs. Therefore, this information is not as important as choice c.

Choice B reason: Anxiety and headaches are not associated with the use of ginkgo biloba, but rather with the underlying condition of multiple sclerosis. Therefore, this information is not relevant or accurate for this client.

Choice C reason: Aspirin and non-steroidal anti-inflammatory drugs interact with ginkgo biloba, as both substances have antiplatelet effects that can increase the risk of bleeding. Therefore, this information is most important for the nurse to include in the teaching plan for this client, as the client should avoid taking these drugs while using ginkgo biloba or inform the healthcare provider if they are prescribed.

Choice D reason: Ginkgo biloba use should be limited and not taken during pregnancy, as there is insufficient evidence about its safety and efficacy for pregnant women. However, this information is not as important as choice c, as the client may not be pregnant or planning to become pregnant.

Choice A reason: Determining when the last dose was administered is important to ensure safe and effective pain management, but it is not the first action that the nurse should implement. The nurse should first assess the client's pain level and intensity before deciding on the appropriate dose and frequency of pain medication.

Choice B reason: Encouraging the client to use diversional thoughts to manage pain is a non-pharmacological intervention that can help reduce pain perception and anxiety, but it is not sufficient to address severe or acute pain. The nurse should first assess the client's pain level and intensity before suggesting any complementary or alternative therapies.

Choice C reason: Asking the client to rate the current level of pain using a pain scale is the first action that the nurse should implement, as it can help quantify and communicate the client's pain experience and guide the nurse's decision on pain medication. The nurse should use a valid and reliable pain scale that is appropriate for the client's age, cognitive ability, and language preference.

Choice D reason: Reviewing the history for a past use of recreational drugs is relevant to assess the client's risk of addiction or tolerance to pain medication, but it is not the first action that the nurse should implement. The nurse should first assess the client's pain level and intensity before considering any factors that may influence pain management.

Choice A reason: Notifying the healthcare provider of the carbamazepine level is not necessary, as 8.4 mg/L (35.6 mcmol/L) is within

the normal range of 4 to 12 mg/L (16.9 to 50.8 mcmol/L). The healthcare provider may adjust

the dose based on other factors such as clinical response, seizure frequency, or adverse effects,

but not based on this level alone.

Choice B reason: Administering the carbamazepine as prescribed is the appropriate action to take, as 8.4 mg/L (35.6 mcmol/L) is within

the normal range of 4 to 12 mg/L (16.9 to 50.8 mcmol/L). The nurse should follow the prescribed

dose and schedule of carbamazepine to maintain a therapeutic level and prevent seizures.

Choice C reason: Assessing the client for side effects of carbamazepine is important, as carbamazepine can cause adverse effects such as drowsiness, dizziness, nausea, rash, or blood dyscrasias. However, this action is not related to the carbamazepine level, as side effects can occur at any level and may not correlate with the serum concentration. The nurse should monitor the client for side effects regardless of the carbamazepine level.

Choice D reason: Withholding this dose of carbamazepine is not appropriate, as 8.4 mg/L (35.6 mcmol/L) is withinthe normal range of 4 to 12 mg/L (16.9 to 50.8 mcmol/L). Withholding the dose may cause a drop in the serum concentration and increase the risk of seizures. The nurse should administer the carbamazepine as prescribed unless instructed otherwise by the healthcare provider.