A client has a new prescription for zolpidem, a hypnotic. The client tells the home health nurse that he plans to take a dose of the medication during the day because he is exhausted and needs to take a short afternoon nap prior to an evening activity in his home. Which action should the nurse take?

Encourage the client to wait until bedtime to take the medication.

Remind the client to drink plenty of fluids when taking the medication.

Advise the client to take the medication with the noon meal.

Explain that the client needs to allow for sleep time of at least two hours.

Answer and Explanation

The Correct Answer is A

Choice A reason: Zolpidem is a hypnotic drug that induces sleep by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. Zolpidem is used to treat insomnia, or difficulty falling asleep or staying asleep. Zolpidem should be taken only at bedtime, when the client is ready to go to sleep and can devote at least seven to eight hours for uninterrupted sleep. Taking zolpidem during the day can cause excessive sedation, drowsiness, confusion, memory loss, and impaired coordination. Therefore, the nurse should encourage the client to wait until bedtime to take the medication and avoid daytime naps.

Choice B reason: Reminding the client to drink plenty of fluids when taking the medication is not an action that the nurse should take in this situation, but rather a general recommendation that applies to most medications. Drinking fluids can help to prevent dehydration, flush out toxins, and maintain kidney function. However, drinking fluids is not specific to zolpidem and does not affect its absorption or metabolism.

Choice C reason: Advising the client to take the medication with the noon meal is not an action that the nurse should take in this situation, but rather a harmful suggestion that can reduce the effectiveness of zolpidem and increase its side effects. Taking zolpidem with food can delay its onset of action and make it less potent. Taking zolpidem at noon can also interfere with the client's circadian rhythm, or natural sleep-wake cycle, and cause daytime sleepiness and nighttime insomnia.

Choice D reason: Explaining that the client needs to allow for sleep time of at least two hours is not an action that the nurse should take in this situation, but rather an inaccurate and insufficient information that can mislead the client and endanger their safety. Zolpidem has a half-life of about two hours, which means that half of its dose is eliminated from the body in two hours. However, this does not mean that its effects wear off in two hours. Zolpidem can still cause residual sedation and impairment for several hours after taking it. The client needs to allow for sleep time of at least seven to eight hours when taking zolpidem, not just two hours.

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Correct Answer is C

Explanation

Choice B reason: Naloxone may be necessary, but first, the source of overdose (patches) must be removed to prevent further opioid absorption. After removal, the nurse should assess the severity and then administer naloxone if needed.

Choice A reason: Applying oxygen face mask is not the first action that the nurse should take in this situation, but rather a supportive measure that can be done after administering naloxone. Oxygen can help to improve the client's oxygenation and prevent hypoxia, but it will not reverse the opioid overdose.

Choice C reason: The client is exhibiting signs of opioid overdose, including respiratory depression (shortness of breath) and decreased level of consciousness (difficult to arouse). The first priority is to remove the excess morphine patches to stop further opioid absorption and prevent worsening of the overdose.

Choice D reason: Monitoring blood pressure is not the first action that the nurse should take in this situation, but rather an ongoing assessment that can be done after administering naloxone. Monitoring blood pressure can help to detect any changes in the client's hemodynamic status and guide further interventions, but it will not reverse the opioid overdose.

A. Crush and mix the tablets with pudding if you have trouble swallowing the tablets. B. Report any tendon pain or swelling to the healthcare provider immediately. C. Increase fluid intake while taking the medication. D. Use nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild joint aches and pains caused by the medication. E. Limit exposure to sunlight and avoid tanning beds.

Correct Answer is ["B","C","E"]

Explanation

Choice B reason: Ciprofloxacin is a fluoroquinolone antibiotic that can treat anthrax, a serious bacterial infection that can affect the skin, lungs, or digestive system. Ciprofloxacin can cause tendonitis or tendon rupture, especially in older adults or those who take corticosteroids. Tendonitis is the inflammation of a tendon, which is a tissue that connects muscle to bone. Tendon rupture is the tearing or breaking of a tendon. These conditions can cause severe pain, swelling, bruising, or difficulty moving the affected area. Therefore, the nurse should instruct the client to report any tendon pain or swelling to the healthcare provider immediately and stop taking ciprofloxacin until further evaluation.

Choice C reason: Increasing fluid intake while taking the medication is an instruction that should be included in the teaching plan, because ciprofloxacin can cause crystalluria, or the formation of crystals in the urine. Crystalluria can lead to kidney stones, kidney damage, or urinary tract obstruction. Therefore, the nurse should advise the client to drink at least 2 liters of water per day while taking ciprofloxacin to prevent crystalluria and maintain kidney function.

Choice E reason: Limiting exposure to sunlight and avoiding tanning beds is an instruction that should be included in the teaching plan, because ciprofloxacin can cause photosensitivity, or increased sensitivity to sunlight or artificial ultraviolet light. Photosensitivity can result in sunburn, rash, blisters, or skin discoloration. Therefore, the nurse should recommend the client to limit exposure to sunlight and avoid tanning beds while taking ciprofloxacin and for several days after finishing the course. The nurse should also suggest the client to wear protective clothing, sunglasses, and sunscreen when outdoors.

Choice A reason: Crushing and mixing the tablets with pudding if you have trouble swallowing the tablets is not an instruction that should be included in the teaching plan, but rather a contraindicated practice that can reduce the effectiveness of ciprofloxacin and increase its side effects. Ciprofloxacin tablets have a special coating that protects them from stomach acid and allows them to dissolve slowly in the intestine. Crushing them will destroy their coating and make them dissolve faster in the stomach. This can cause stomach irritation, nausea, vomiting, diarrhea, or reduced absorption of ciprofloxacin into the bloodstream. Therefore, the nurse should instruct the client to swallow the tablets whole and not chew or crush them.

Choice D reason: Using NSAIDs to relieve mild joint aches and pains caused by the medication is not an instruction that should be included in the teaching plan, but rather a risky behavior that can increase the risk of adverse effects from ciprofloxacin. NSAIDs are anti-inflammatory drugs that can reduce pain, fever, and inflammation. However, NSAIDs can also interact with ciprofloxacin and increase its concentration in the blood. This can lead to toxicity and serious side effects such as seizures, hallucinations, confusion, or liver damage. Therefore, the nurse should caution the client to avoid using NSAIDs while taking ciprofloxacin and consult with their healthcare provider before taking any other medications.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride tablets, which were prescribed because of a suspected anthrax exposure. Which instruction(s) should be included in the teaching plan? (Select all that apply.)

Correct Answer is ["B","C","E"]

Explanation

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