A nurse is caring for a client.

 

Exhibits

A nurse is caring for the client. Which of the following actions should the nurse take? Select all that apply.

A. Request an order for renal function tests: Renal function tests are important when monitoring for drug toxicity or impaired clearance, especially in older adults. However, a subtherapeutic level suggests underdosing or nonadherence rather than impaired elimination.

B. Notify the provider to request more frequent dosing: Changing the dosing regimen without first confirming whether the patient is taking the medication correctly could lead to inappropriate adjustments and potential harm. The nurse must first investigate possible causes of the low drug level.

C. Count the pills in the prescription bottle: Checking the number of pills helps determine whether the patient has been taking the medication as prescribed. Nonadherence is a common cause of subtherapeutic drug levels in older adults and should be assessed before considering other actions.

D. Ask the patient if she has difficulty swallowing pills: Difficulty swallowing could affect adherence, but directly counting the pills provides a more objective measure of whether the medication is being taken consistently.

A. Pyridoxine (vitamin B6): Deficiency in vitamin B6 can cause peripheral neuropathy, irritability, depression, and seizures. While glossitis may occur, the combination of cheilosis and corneal vascularization is not typical of B6 deficiency.

B. Riboflavin (vitamin B2): Riboflavin deficiency is classically associated with cheilosis, glossitis, corneal vascularization, and seborrheic dermatitis affecting areas like the scrotum and vulva. These findings are hallmark signs of ariboflavinosis.

C. Thiamine (vitamin B1): Thiamine deficiency causes beriberi and Wernicke-Korsakoff syndrome, with manifestations including neuropathy, heart failure, and confusion. It is not linked to cheilosis or corneal changes.

D. Niacin (nicotinic acid): Niacin deficiency results in pellagra, characterized by the “three Ds”: dermatitis, diarrhea, and dementia. The dermatitis is photosensitive but does not involve cheilosis or corneal vascularization.