A client is admitted for observation with reports of progressively increasing fatigue over the past month and a brief episode of dizziness that occurred today. The client has a history of heartburn and indigestion that is self-treated with ibuprofen and antacids. Which assessment finding should the nurse report immediately to the healthcare provider?

Reference Range:

Guaiac stool [negative]

Hemoglobin (14 to 18 g/dl. (140 to 180 g/L)]

Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]

Gastric Acid pH (1.5 to 3.5)

Positive guaiac of stool.

Hematocrit 42% (0.42 volume fraction).

Gastric pH 2.0.

Hemoglobin 13 g/dL (130 g/L).

Answer and Explanation

The Correct Answer is A

A) Positive guaiac of stool:
A positive guaiac test indicates the presence of occult (hidden) blood in the stool, which may suggest gastrointestinal bleeding. Given the client’s history of heartburn, indigestion, and self-treatment with ibuprofen and antacids, gastrointestinal irritation or ulceration may be occurring, leading to bleeding. Gastrointestinal bleeding can cause fatigue, dizziness, and other symptoms. Therefore, it is essential to report this finding immediately to the healthcare provider for further evaluation and management.

B) Hematocrit 42% (0.42 volume fraction):
A hematocrit level within the reference range (42% to 52%) is considered normal. While a slight decrease in hematocrit may indicate anemia, it is not an urgent finding that requires immediate reporting. The client’s hematocrit level of 42% is within the normal range, so it does not warrant immediate concern.

C) Gastric pH 2.0:
A gastric pH of 2.0 falls within the normal range (1.5 to 3.5) for gastric acid pH. This finding indicates normal gastric acidity and does not suggest an acute problem that requires immediate reporting to the healthcare provider.

D) Hemoglobin 13 g/dL (130 g/L):
A hemoglobin level of 13 g/dL is slightly below the lower end of the reference range (14 to 18 g/dL) but does not indicate a critical condition requiring immediate intervention. While it may suggest mild anemia, it is not an urgent finding that necessitates immediate reporting to the healthcare provider.

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Correct Answer is B

Explanation

A) Avoid taking the medication on an empty stomach:
While it’s generally recommended to take lithium carbonate with food or milk to minimize gastrointestinal side effects, taking it on an empty stomach does not pose a significant risk. Therefore, it is not the most crucial instruction to emphasize to the client.

B) Maintain a fluid intake of 1,500 to 3,000 mL per day:
This instruction is crucial because lithium can cause dehydration, especially if the client becomes dehydrated due to increased sweating or decreased fluid intake. Adequate fluid intake helps maintain stable lithium levels in the blood and reduces the risk of toxicity. Emphasizing the importance of maintaining hydration is essential for clients taking lithium.

C) Report fluctuations in weight to the healthcare provider:
Weight fluctuations can indicate changes in fluid balance or other metabolic effects of lithium. While it’s important for the client to report changes in weight, this instruction is not as critical as ensuring adequate fluid intake, which directly affects lithium levels and toxicity risk.

D) Keep medication fliers for frequent review and reference:
While it’s helpful for clients to have medication information for reference, this instruction is more about general medication adherence and education rather than a specific requirement related to lithium carbonate.

A. Apply the lotion to plaques on the face. B. Rub the lotion into the area twice daily for 5 weeks. C. Use gloves to rub the lotion into the area. D. Massage the lotion into the psoriasis plaques.

Correct Answer is D

Explanation

A) Apply the lotion to plaques on the face: Betamethasone valerate lotion is a potent corticosteroid that is generally not recommended for use on the face due to the risk of adverse effects, such as skin thinning and irritation. Therefore, applying the lotion to plaques on the face is not advisable.
B) Rub the lotion into the area twice daily for 5 weeks: While it is essential to follow the prescribed frequency and duration of medication use, specific instructions for betamethasone valerate lotion may vary depending on the severity of the condition and the healthcare provider's recommendations. This instruction lacks specificity and may not be accurate for all clients.
C) Use gloves to rub the lotion into the area: While wearing gloves may be necessary when applying certain topical medications to prevent contact dermatitis or to protect the hands, it is not typically required when using betamethasone valerate lotion. This instruction may be unnecessary and could lead to unnecessary waste of gloves.
D) Massage the lotion into the psoriasis plaques: This instruction is appropriate because it ensures proper absorption of the medication into the affected skin. Massaging the lotion gently into the psoriasis plaques helps enhance its penetration and effectiveness in treating the condition.

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Naxlex Comprehensive Predictor Exams

The nurse is providing medication teaching to a client with bipolar disorder who receives a prescription for lithium carbonate. Which instruction should the nurse emphasize with the client?

Correct Answer is B

Explanation

A client with plaque psoriasis receives a new prescription for betamethasone valerate lotion. Which instruction should the nurse include in client teaching?

Correct Answer is D

Explanation

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