A client with amyotrophic lateral sclerosis (ALS) has been taking riluzole for two weeks. The nurse notes that the client remains weak with observable muscle atrophy. Which action should the nurse take?

Document the assessment findings in the electronic health record.

Explain that the medication takes several weeks to reverse symptoms.

Advise the client to schedule an appointment for liver function tests.

Withhold the medication until the healthcare provider is notified.

Answer and Explanation

The Correct Answer is A

A. Document the assessment findings in the electronic health record: Riluzole is not curative for ALS; it only modestly slows disease progression. Continuing muscle weakness and atrophy are expected findings in ALS, even after starting treatment. Accurate documentation is appropriate because no immediate change in therapy is indicated based solely on these observations.

B. Explain that the medication takes several weeks to reverse symptoms: Riluzole does not reverse ALS symptoms. It may slightly prolong survival by slowing the progression of muscle weakness, but it does not regenerate lost function or reverse disease-related damage.

C. Advise the client to schedule an appointment for liver function tests: Riluzole can affect liver function and periodic monitoring is important, but muscle weakness alone does not directly signal liver problems. Unless there are signs of hepatotoxicity, there is no immediate need for unscheduled testing.

D. Withhold the medication until the healthcare provider is notified: There is no indication to withhold riluzole based on ongoing muscle weakness, as this is consistent with the natural course of ALS. Interrupting therapy without a clear medical reason could harm the client.

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Correct Answer is A

Explanation

A. Hold the dose and notify the healthcare provider (HCP) of the changes in the laboratory studies: Fluconazole is hepatotoxic and can cause elevations in liver enzymes, including AST. A rising trend in liver enzymes suggests possible liver injury, and administering another dose without medical clearance could worsen hepatic damage. Immediate communication with the HCP is the safest and most appropriate action.

B. Hold the dose and notify the pharmacy to stop dispersing the next premixed doses: Although stopping further dispensing may eventually be needed if the drug is discontinued, the pharmacy cannot make this clinical decision. Notifying the HCP for evaluation and new orders must take priority.

C. Begin the infusion and submit a drug reaction report to the nursing supervisor: Initiating the infusion despite abnormal liver function tests can endanger the client. Reporting an adverse reaction to the supervisor is important after ensuring the client’s safety, but the infusion should be held first pending provider instructions.

D. Begin the infusion and monitor the client's blood urea nitrogen (BUN), serum creatinine, and liver function tests: While monitoring labs is critical during fluconazole therapy, starting the infusion in the presence of worsening liver enzyme trends without provider approval can increase the risk of serious hepatic complications.

A. Sodium. B. Glucose. C. Total protein D. Hemoglobin.

Correct Answer is D

Explanation

A. Sodium: Monitoring sodium is important in many conditions, but diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), is more commonly associated with gastrointestinal bleeding rather than causing significant electrolyte imbalances like hyponatremia. Sodium levels are not the primary concern in this scenario.

B. Glucose: Blood glucose monitoring is critical for clients with diabetes or corticosteroid use, but diclofenac is not known to directly impact glucose metabolism. Reviewing glucose levels would not immediately address the symptoms of pallor and fatigue.

C. Total protein: Total protein levels reflect nutritional and liver status but are not the best marker for acute blood loss or anemia. Changes in total protein would not directly explain symptoms like pallor and fatigue related to NSAID complications.

D. Hemoglobin: Diclofenac can cause gastrointestinal irritation and occult bleeding, leading to anemia. Pallor and fatigue are classic symptoms of low hemoglobin levels, making it the most important laboratory value to review to evaluate for possible GI bleeding and anemia.

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A client with amyotrophic lateral sclerosis (ALS) has been taking riluzole for two weeks. The nurse notes that the client remains weak with observable muscle atrophy. Which action should the nurse take?

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Naxlex Comprehensive Predictor Exams

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Explanation

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