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 []

Explanation

Cardiopulmonary arrest is not the immediate concern because the client remains hemodynamically stable with a spontaneous pulse and respiration, despite experiencing ventricular tachycardia. Arrest would be indicated by pulselessness, which has not yet occurred.

Hypovolemic shock could be a differential due to vomiting and diarrhea; however, the hallmark features of severe tachycardia, headache, and ventricular arrhythmias are more consistent with systemic drug toxicity, especially in a client on theophylline.
Allergic reaction is unlikely as there is no report of skin manifestations, airway inflammation, or anaphylaxis. The client’s symptoms of dizziness, gastrointestinal distress, and arrhythmias suggest a pharmacologic toxicity rather than hypersensitivity.
Drug toxicity is the most probable diagnosis, given the client’s history of theophylline use, concurrent recent antibiotic therapy that may have impaired theophylline metabolism, and now presenting with ventricular tachycardia, headache, and severe gastrointestinal symptoms.
Assess allergies would be a general precaution in medication reviews but is not a priority intervention in the acute management of suspected theophylline toxicity causing arrhythmias and systemic instability.
Administer albuterol would worsen the clinical situation because it is a beta-agonist that increases heart rate and can precipitate more severe arrhythmias in a client already showing ventricular tachycardia.
Hold theophylline is critical because continuing administration would exacerbate toxicity. Theophylline has a narrow therapeutic index, and symptoms indicate that blood levels are already dangerously elevated.
Assess medication interactions is necessary because many antibiotics, particularly macrolides and quinolones, inhibit cytochrome P450 enzymes and can significantly increase theophylline levels, leading to toxicity.
Give a bolus of IV fluids might address potential dehydration from vomiting and diarrhea; however, it would not directly correct the toxic arrhythmogenic effects currently threatening the client’s stability.
Oxygen saturation should be maintained but is not the primary marker for guiding treatment of theophylline toxicity, which primarily manifests with cardiovascular and neurologic symptoms.
Serum electrolyte levels are useful to assess contributing factors to arrhythmias, but in this situation, the priority is managing the toxic level of theophylline causing direct cardiac irritability.
Respiratory rate should be monitored due to underlying asthma and potential respiratory distress, but changes in respiratory rate alone will not adequately reflect progression or improvement of systemic toxicity.
Cardiac rhythm monitoring is essential because ventricular arrhythmias are life-threatening and are a major clinical feature of theophylline toxicity; immediate identification and management are critical.
Theophylline blood levels must be urgently checked to confirm suspected toxicity, guide the need for interventions such as activated charcoal, and determine the severity of systemic drug accumulation.

A. Notify the healthcare provider if anorexia occurs. B. Consume additional sources of potassium. C. Watch for signs of jitteriness or diaphoresis. D. Administer subcutaneously after meals.

Correct Answer is C

Explanation

A. Notify the healthcare provider if anorexia occurs: Anorexia can be a side effect of exenatide, but it is generally mild and often transient. While persistent or severe anorexia should be reported, it is not the most immediate or dangerous concern compared to the risk of hypoglycemia when combining exenatide with a sulfonylurea like glimepiride.

B. Consume additional sources of potassium: Exenatide is not known to cause significant potassium depletion. Hypokalemia is not a common complication with either exenatide or glimepiride therapy, so there is no specific need to focus on increasing potassium intake.

C. Watch for signs of jitteriness or diaphoresis: Combining exenatide with glimepiride significantly increases the risk of hypoglycemia. Symptoms like jitteriness, diaphoresis, shakiness, and confusion are hallmark signs of low blood sugar, making it crucial to educate the client to recognize and manage hypoglycemia promptly.

D. Administer subcutaneously after meals: Exenatide should be administered subcutaneously, but it must be given before meals, typically within 60 minutes prior to eating. Administering it after meals would decrease its effectiveness in controlling postprandial blood glucose spikes.

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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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Correct Answer is []

Explanation

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Correct Answer is C

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