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

Take the medication an hour after antacids.

Notify the healthcare provider (HCP) of lethargy.

Monitor for any signs of sexual dysfunction.

Decrease cigarette use to a pack per day.

Answer and Explanation

The Correct Answer is D

A. Take the medication an hour after antacids: Antacids can interfere with the absorption of cimetidine, so spacing them apart is a correct approach. This statement indicates appropriate understanding of medication timing and does not require further instruction.

B. Notify the healthcare provider (HCP) of lethargy: Cimetidine can cause central nervous system effects like confusion or lethargy, particularly in older adults or those with renal impairment. Reporting such symptoms is appropriate and reflects safe medication awareness.

C. Monitor for any signs of sexual dysfunction: Cimetidine has been associated with gynecomastia, decreased libido, and impotence in some cases. The client should be aware of and monitor for these potential effects.

D. Decrease cigarette use to a pack per day: Smoking impairs ulcer healing and increases gastric acid secretion, which can counteract the effects of cimetidine. Reducing to a pack per day is still harmful; the client should be encouraged to stop smoking entirely, not just cut back.

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Correct Answer is ["A","B","D"]

Explanation

A. Review most recent coagulation laboratory values: Checking coagulation studies like INR, PT, or aPTT is essential to assess the client's bleeding risk and determine if the anticoagulant effect is too strong, helping guide further medical management.

B. Report findings to healthcare provider (HCP): Bleeding gums and easy bruising are signs of excessive anticoagulation, which could become life-threatening. Promptly notifying the HCP allows for immediate evaluation and possible adjustment of the medication.

C. Complete a medication variance report: A medication variance report is appropriate when there is an error in prescribing, dispensing, or administering. Since this appears to be a medication side effect rather than an error, a variance report is not needed at this stage.

D. Obtain a soft bristle toothbrush for client: Using a soft toothbrush minimizes trauma to the gums, helping to reduce the risk of further bleeding while still maintaining oral hygiene, an important supportive intervention for clients on anticoagulants.

E. Provide a PRN nonsteroidal antiinflammatory drug (NSAID) for gum discomfort: NSAIDs increase the risk of bleeding and should be avoided in clients taking anticoagulants. Treating discomfort with NSAIDs could worsen bleeding complications rather than relieve them safely.

A. Hemoglobin level increased to 12 g/dL (7.45 mmol/L). B. Reports of increased energy levels and decreased fatigue. C. Food diary shows increased consumption of iron-rich foods. D. Takes concurrent iron therapy without adverse effects.

Correct Answer is A

Explanation

A. Hemoglobin level increased to 12 g/dL (7.45 mmol/L): Epoetin alfa stimulates red blood cell production, and an increase in hemoglobin is the primary indicator of the drug’s effectiveness. A hemoglobin of 12 g/dL reflects a significant therapeutic improvement in anemia management for a client with CKD.

B. Reports of increased energy levels and decreased fatigue: Although feeling more energetic is a positive clinical sign, it is subjective and does not provide objective evidence of improved red blood cell production. Lab values are preferred for evaluating medication effectiveness.

C. Food diary shows increased consumption of iron-rich foods: Dietary improvements support erythropoiesis but are not the direct measure of epoetin alfa’s effect. The medication’s success is best gauged by the actual rise in hemoglobin, not dietary habits alone.

D. Takes concurrent iron therapy without adverse effects: Iron supplementation is often needed to maximize epoetin alfa’s effect, but merely tolerating iron therapy does not confirm that epoetin alfa is working to correct the anemia. The focus remains on hemoglobin response.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After receiving the third dose of a new oral anticoagulant prescription, an older adult client develops bleeding and tender gums and has many new bruises. Which action(s) should the nurse implement? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?Reference Range:Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)]

Correct Answer is A

Explanation

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