A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan?

Eliminate spinach and other green vegetables in the diet.

Continue obtaining scheduled laboratory bleeding tests.

Keep an antidote available in the event of hemorrhage.

Avoid use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Answer and Explanation

The Correct Answer is D

Choice A reason: Spinach and other green vegetables are rich in vitamin K, which is essential for blood clotting. However, dabigatran is not affected by vitamin K intake, unlike warfarin, another anticoagulant drug. Therefore, there is no need to eliminate these foods from the diet.

Choice B reason: Dabigatran does not require routine laboratory monitoring of bleeding parameters, such as prothrombin time (PT) or international normalized ratio (INR), unlike warfarin. Therefore, the client does not need to continue obtaining scheduled laboratory bleeding tests.

Choice C reason: Dabigatran is a direct thrombin inhibitor that prevents the formation of fibrin, the main component of blood clots. In case of a major bleeding event, the antidote for dabigatran is idarucizumab, a monoclonal antibody that binds to dabigatran and reverses its effect. However, this antidote is not readily available in most settings and should only be administered by a health care provider. Therefore, the client should not keep an antidote available at home.

Choice D reason: NSAIDs, such as ibuprofen or naproxen, can increase the risk of bleeding by inhibiting platelet aggregation and damaging the gastric mucosa. Therefore, the client should avoid using these drugs while taking dabigatran. The client should consult with the prescriber before taking any other medications, including over-the-counter or herbal products.

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Correct Answer is C

Explanation

Choice A reason: Diarrhea is not a contraindication for phenylephrine, which is a decongestant that reduces swelling and mucus in the nasal passages. However, the nurse should monitor the client's fluid and electrolyte balance and provide adequate hydration.

Choice B reason: Bronchitis is not a contraindication for phenylephrine, which may help relieve some of the symptoms of bronchitis, such as nasal congestion and cough. However, the nurse should also encourage the client to use other measures, such as steam inhalation, expectorants, and rest.

Choice C reason: Hypertension is a contraindication for phenylephrine, which can increase blood pressure and heart rate by constricting blood vessels. The nurse should report this condition to the healthcare provider and withhold the medication until further orders.

Choice D reason: Edema is not a contraindication for phenylephrine, which does not affect fluid retention or distribution. However, the nurse should assess the cause of edema and monitor the client's weight and urine output.

A. Take the medication an hour after antacids. B. Notify the healthcare provider of lethargy. C. Decrease cigarette use to a pack per day. D. Monitor for any signs of sexual dysfunction. E. None F. None

Correct Answer is C

Explanation

Choice A reason: Antacids can interfere with the absorption of cimetidine. It is generally recommended to avoid taking antacids within 1 hour before or after taking cimetidine to ensure optimal absorption. Therefore, taking cimetidine an hour after antacids is appropriate.

Choice B reason: Notifying the healthcare provider of lethargy is a correct statement, as it may indicate a serious side effect of cimetidine. Cimetidine can cause central nervous system effects, such as confusion, drowsiness, headache, and depression. Lethargy may also be a sign of anemia, which is another possible side effect of cimetidine. The nurse should instruct the client to report any unusual symptoms to the healthcare provider and monitor the client's blood count and liver function.

Choice C reason:Smoking has been shown to impair the effectiveness of cimetidine in treating ulcers and can delay healing. The goal should be complete smoking cessation rather than merely reducing cigarette use. Therefore, the statement about decreasing cigarette use to a pack per day indicates a misunderstanding and requires additional instruction by the nurse.

Choice D reason: Monitoring for any signs of sexual dysfunction is a correct statement, as it may indicate another side effect of cimetidine. Cimetidine can cause endocrine effects, such as gynecomastia, impotence, and decreased libido in men, and menstrual irregularities in women. The nurse should instruct the client to inform the healthcare provider if they experience any changes in their sexual function or reproductive health.

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A client with atrial fibrillation receives a new prescription for dabigatran. Which instruction should the nurse include in this client's teaching plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with nasal congestion receives a prescription for phenylephrine 10 mg by mouth every 4 hours. Which client condition should the nurse report to the healthcare provider before administering the medication?

Correct Answer is C

Explanation

A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse?

Correct Answer is C

Explanation

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