A nurse is caring for a client who has a new prescription for alendronate.
Which of the following actions should the nurse take?
Assess the client's ability to swallow.
Administer the medication before bed.
Administer the medication with orange juice.
Inform the client to remain supine after taking the medication.
The Correct Answer is A
Choice A rationale
Alendronate is a bisphosphonate medication used to treat osteoporosis. It is known to be highly irritating to the esophageal mucosa, and if it lodges in the esophagus, it can cause severe esophagitis, ulceration, or erosion. Assessing the client's ability to swallow ensures safe passage of the medication and minimizes the risk of esophageal injury, highlighting a critical safety measure.
Choice B rationale
Alendronate should not be administered before bed. For optimal absorption and to minimize the risk of esophageal irritation, alendronate must be taken in the morning upon waking, at least 30 minutes before the first food, beverage, or medication. Taking it before bed increases the likelihood of the pill lingering in the esophagus, leading to irritation and potential injury.
Choice C rationale
Alendronate should not be administered with orange juice. The absorption of alendronate is significantly impaired by food, beverages other than plain water, and certain minerals like calcium. Orange juice contains calcium and can decrease the bioavailability of the medication, thereby reducing its therapeutic effectiveness. It must be taken with plain water only.
Choice D rationale
Informing the client to remain supine after taking the medication is incorrect. To facilitate rapid transit to the stomach and minimize esophageal contact, clients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate, and until after their first food of the day. Lying down increases the risk of esophageal reflux and irritation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Ocular erythema, or redness of the eye, is not a typical adverse effect associated with spironolactone. Spironolactone is a potassium-sparing diuretic that primarily acts on the renal tubules to inhibit aldosterone, affecting electrolyte balance and fluid excretion, not directly impacting ocular tissues or causing inflammatory responses in the eye.
Choice B rationale
Diarrhea is not a common or expected adverse effect of spironolactone. While gastrointestinal disturbances can occur with many medications, spironolactone is more commonly associated with effects related to its diuretic and anti-androgenic properties, such as electrolyte imbalances (hyperkalemia) or endocrine-related symptoms, rather than increased bowel motility.
Choice C rationale
Muscle weakness can occur as an adverse effect of spironolactone, particularly due to its potential to cause hyperkalemia. Spironolactone's mechanism of action involves conserving potassium, and elevated serum potassium levels (normal range 3.5-5.0 mEq/L) can impair the excitability of muscle cells, leading to symptoms like muscle weakness, fatigue, and in severe cases, cardiac dysrhythmias.
Choice D rationale
Depression is not a recognized or common adverse effect of spironolactone. Spironolactone's primary pharmacological actions are on the kidney and endocrine system, and it is not known to directly affect neurotransmitter systems in the brain in a way that would commonly induce depressive symptoms. Psychotropic effects are not typically associated with this medication.
Correct Answer is B
Explanation
Choice A rationale
Naloxone is an opioid antagonist used to reverse opioid-induced respiratory and central nervous system depression. Midazolam is a benzodiazepine, not an opioid. Therefore, naloxone would not be effective in reversing the adverse effects of midazolam. Its mechanism of action specifically targets opioid receptors.
Choice B rationale
Flumazenil is a benzodiazepine receptor antagonist. It specifically binds to benzodiazepine receptors, competitively inhibiting the effects of benzodiazepines like midazolam. In cases of benzodiazepine overdose or excessive sedation leading to adverse effects such as hypotension, flumazenil can rapidly reverse these central nervous system depressant effects.
Choice C rationale
Moxifloxacin is a fluoroquinolone antibiotic. It is used to treat bacterial infections and has no pharmacological action that would counteract the effects of benzodiazepines or specifically address drug-induced hypotension during a procedure like a colonoscopy. Administering an antibiotic in this scenario would be inappropriate.
Choice D rationale
Fludrocortisone is a mineralocorticoid used primarily for its effects on electrolyte and fluid balance, often in conditions like Addison's disease or orthostatic hypotension. It would not be an appropriate choice for rapidly reversing acute drug-induced hypotension caused by midazolam during a medical procedure. Its action is not immediate.
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