A client receives a prescription for methotrexate. Which information provided by the client requires additional instruction by the nurse?

Obtain a platelet count weekly.

Take the medication during pregnancy.

Use folic acid to protect the liver.

Store the medication at room temperature.

Answer and Explanation

The Correct Answer is B

A. Obtain a platelet count weekly: Regular monitoring of platelet counts is important for clients on methotrexate due to the risk of bone marrow suppression and potential thrombocytopenia. This instruction is appropriate and necessary.
B. Take the medication during pregnancy: Methotrexate is contraindicated during pregnancy due to its teratogenic effects and potential to cause fetal harm. It is crucial for clients to avoid using methotrexate while pregnant or planning to become pregnant.
C. Use folic acid to protect the liver: While folic acid is often used to help reduce the side effects of methotrexate, particularly its gastrointestinal effects and potential for liver toxicity, it is not used to "protect the liver" per se. The correct approach is to use folic acid as directed by a healthcare provider, often to mitigate some of the side effects of methotrexate.
D. Store the medication at room temperature: Methotrexate should be stored according to the manufacturer's instructions, which usually involve keeping it at room temperature. This information is correct and does not require additional instruction.

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Correct Answer is B

Explanation

A) Changes in weight: While changes in weight can be important in assessing overall health, they are not specifically linked to the use of goldenseal. This information may be relevant for general health assessment but does not directly relate to potential effects of the herbal supplement.
B) Recent symptoms of infection: Goldenseal is often used for its antimicrobial properties, and its use might affect the body's response to infection. Gathering information about recent symptoms of infection helps in assessing if there might be an interaction between the herbal supplement and the client’s current health status, especially since goldenseal can impact immune response and may interfere with other medications used for infections.
C) Sleep disturbances: While sleep disturbances can be a concern in older adults, they are not directly related to the use of goldenseal. This information may be useful for general health assessments but does not specifically address potential interactions or side effects of goldenseal.
D) Forgetfulness: Forgetfulness, although important, is not directly related to the use of goldenseal. This symptom might warrant further evaluation but is not the primary concern regarding the use of this herbal supplement.

A. Administer an oral analgesic and evaluate its effectiveness before applying the new patch. B. Apply the new patch in a different location after removing the original patch. C. Remove the patch and consult with the healthcare provider about the client's pain resolution. D. Place the patch on the client's shoulder and leave both patches in place for 12 hours.

Correct Answer is B

Explanation

A) Administer an oral analgesic and evaluate its effectiveness before applying the new patch: This action is unnecessary because the client reports no pain. Administering an oral analgesic would not be appropriate when the client denies pain and the previous fentanyl patch is intact.
B) Apply the new patch in a different location after removing the original patch: This is the correct action. Fentanyl patches should be replaced with new ones in a different location to prevent overdosing and ensure proper absorption. The old patch should be removed to avoid accumulation of excess medication.
C) Remove the patch and consult with the healthcare provider about the client's pain resolution: There is no need to consult the healthcare provider or remove the patch if the client denies pain and the patch is intact. The issue is with replacing the patch rather than evaluating pain.
D) Place the patch on the client's shoulder and leave both patches in place for 12 hours: This is unsafe. Applying a new patch without removing the old one can lead to overdose due to excessive fentanyl. The old patch must be removed before placing a new one.

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A client receives a prescription for methotrexate. Which information provided by the client requires additional instruction by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During an annual physical exam, an older adult tells the nurse of using goldenseal as an herbal supplement. Which additional history should the nurse gather from the client?

Correct Answer is B

Explanation

When preparing to apply a scheduled fentanyl transdermal patch, the nurse notes that the previously applied patch is intact on the client's upper back and the client denies pain. Which action should the nurse take?

Correct Answer is B

Explanation

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