A client with pneumonia who has an emergent episode of respiratory distress is intubated and transferred to the intensive care unit. The client's chest x-ray shows consolidation in the left lobe, and physical assessment reveals diminished lung sounds. The nurse administers acetylcysteine as prescribed per nebulization via endotracheal tube. Which therapeutic response of this medication should the nurse expect?

Bronchodilation and wheezing.

Unpleasant smell when using the medication.

Increased sputum, requiring suctioning.

Hypotension.

Answer and Explanation

The Correct Answer is C

Choice C reason: Acetylcysteine is a mucolytic agent that breaks down mucus and makes it easier to cough up or suction out. This helps to clear the airways and improve oxygenation. The nurse should expect to see increased sputum production after administering acetylcysteine and provide frequent suctioning as needed.

Choice A reason: Bronchodilation and wheezing are not therapeutic responses of acetylcysteine, but rather possible adverse effects. Acetylcysteine can cause bronchospasm or bronchoconstriction in some clients, especially those with asthma or chronic obstructive pulmonary disease (COPD). The nurse should monitor the client's breath sounds and oxygen saturation and report any signs of respiratory distress.

Choice B reason: Unpleasant smell when using the medication is not a therapeutic response of acetylcysteine, but rather a common side effect. Acetylcysteine has a rotten egg odor that can be unpleasant for both the client and the nurse. The nurse can minimize this by using a mouthwash or a flavored lozenge before and after administering acetylcysteine.

Choice D reason: Hypotension is not a therapeutic response of acetylcysteine, but rather a rare but serious adverse effect. Acetylcysteine can cause vasodilation or hypovolemia in some clients, leading to low blood pressure and shock. The nurse should monitor the client's vital signs and report any signs of hypotension.

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Correct Answer is C

Explanation

Choice A reason: Holding the calcitriol but administering the calcium carbonate as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.

Choice B reason: Holding the calcium carbonate, but administering the calcitriol as scheduled is not appropriate, as calcitriol alone can also raise the serum calcium level and cause hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization.

Choice C reason: Holding both medications until contacting the healthcare provider is the appropriate action to take, as the client's total calcium level is above the normal range of 9 to 10.5 mg/dL or 2.25 to 2.62 mmol/L and indicates hypercalcemia. Hypercalcemia can cause symptoms such as nausea, vomiting, constipation, confusion, lethargy, muscle weakness, cardiac arrhythmias, and kidney stones. The healthcare provider can adjust the dose or frequency of the medications or prescribe other treatments to lower the serum calcium level.

Choice D reason: Administering both prescribed medications as scheduled is not appropriate, as both drugs can increase the serum calcium level and worsen the condition of hypercalcemia. Calcitriol is a synthetic form of vitamin D that enhances the absorption of calcium from the GI tract and promotes bone mineralization. Calcium carbonate is a supplement that provides additional calcium to the body.

A. Administer levothyroxine at bedtime. B. Consume foods that are high in iodine. C. Avoid the use of iron supplements. D. Take medication on an empty stomach.

Correct Answer is D

Explanation

Choice A reason: Administering levothyroxine at bedtime is not a correct statement, as it may interfere with sleep quality and hormone absorption. Levothyroxine is a synthetic thyroid hormone that replaces or supplements low levels of natural thyroid hormone in hypothyroidism. Levothyroxine should be taken in the morning, at least 30 minutes before breakfast, to avoid insomnia and ensure optimal absorption.

Choice B reason: Consuming foods that are high in iodine is not a correct statement, as it may affect thyroid function and hormone levels. Iodine is an essential element that is needed for thyroid hormone synthesis. However, too much or too little iodine can cause thyroid disorders, such as goiter or hyperthyroidism. Levothyroxine does not require additional iodine intake, and clients should follow a balanced diet.

Choice C reason: Avoiding the use of iron supplements is a correct statement, but it is not specific to levothyroxine. Iron supplements can interfere with many medications, including levothyroxine, by reducing their absorption and efficacy. Iron supplements should be taken at least 4 hours before or after levothyroxine or other medications.

Choice D reason: Taking medication on an empty stomach is a correct statement that indicates effective education. Levothyroxine should be taken on an empty stomach, preferably in the morning, to avoid food-drug interactions and enhance absorption. Food, especially those high in fiber or calcium, can decrease levothyroxine absorption and effectiveness.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Prior to administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement?

Correct Answer is C

Explanation

A client receives a new prescription for levothyroxine. Which statement made by client indicates to the nurse that education was effective?

Correct Answer is D

Explanation

On admission, the healthcare provider prescribes a broad spectrum antibiotic for a client with a gram-negative infection. Before administering the first dose, it is most important for the nurse to implement which prescription?

A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction?

The nurse receives a prescription for ciprofloxacin 400 mg intravenously (IV) every 12 hours to be infused over an hour. The IV bag contains ciprofloxacin 400 mg in dextrose 5% in water (D5W) 200 mL. The nurse should program the infusion pump to deliver how many mL/hr? (Enter numerical value only.)

The nurse initiates an infusion of piperacillin-tazobactam for a client with a urinary tract infection. Five minutes into the infusion, the client reports not feeling well. Which client manifestation should the nurse identify as a reason to stop the infusion?

A client taking atorvastatin develops an increased serum creatine phosphokinase (CK) level. The nurse should assess the client for the onset of which problem?

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?