A nurse is caring for a female client in an outpatient clinic.
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Nurses' Notes
Day 1:
Client is seen by provider for routine follow-up after being started on axcarbazepine 150mg PO twice a day, last week. Client reports no nausea, headache, dizziness, or ataxia. Provider increased oxcarbazepine to 300 mg PO twice a day. Client is to return for a follow-up in 2 weeks.
Day 14:
Client returns for follow-up after increasing oxcarbazepine dosage. Client reports starting to have mild headaches earlier this week. Also states, "Yesterday I was very nauseated and threw up before breakfast." When talking to client they have difficulty remembering the times they are taking their axcarbazepine. Client reports using oral contraceptives as the only means of birth control.
Laboratory Results
Day 14
Hct 40% (37% to 47%)
Hgb 13g/dL (12 to 16g/dL)
Sodium 124 mEq/L (136 to 145 mEq/L)
Vitals Signs
Day 14:
- Temperature 36.3°C (97.4° F)
- Heart rate 86/min
mild headaches
Yesterday I was very nauseated and threw up before breakfast
difficulty remembering the times they are taking their axcarbazepine
Sodium 124 mEq/L (136 to 145 mEq/L)
Hct 40% (37% to 47%)
The Correct Answer is ["A","B","C","D"]
Nurses' Notes Day 1:
Client is seen by provider for routine follow-up after being started on axcarbazepine 150mg PO twice a day, last week. Client reports no nausea, headache, dizziness, or ataxia. Provider increased oxcarbazepine to 300 mg PO twice a day. Client is to return for a follow-up in 2 weeks.
Day 14:
Client returns for follow-up after increasing oxcarbazepine dosage. Client reports starting to have mild headaches earlier this week. Also states, "Yesterday I was very nauseated and threw up before breakfast." When talking to client they have difficulty remembering the times they are taking their axcarbazepine. Client reports using oral contraceptives as the only means of birth control.
Laboratory Results Day 14
Hct 40% (37% to 47%)
Hgb 13g/dL (12 to 16g/dL)
Sodium 124 mEq/L (136 to 145 mEq/L) Vitals Signs
Day 14:
Temperature 36.3°C (97.4° F)
Heart rate 86/min
Rationale:
The patient's follow-up findings on Day 14, particularly the reported symptoms and laboratory results, suggest potential side effects from the increased dosage of oxcarbazepine. Common side effects of oxcarbazepine include dizziness, nausea, and vomiting. The patient's symptoms of mild headaches and nausea, along with difficulty remembering medication times, could be indicative of these side effects. Additionally, the sodium level of 124 mEq/L is below the normal range (136 to 145 mEq/L), indicating hyponatremia, which is a known side effect of oxcarbazepine and can be serious.
Hyponatremia can cause symptoms such as nausea, vomiting, exhaustion, and dizziness, aligning with the patient's reported condition. These findings warrant immediate medical attention to assess the need for adjusting the medication dosage or considering alternative treatments.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This response respects the client's autonomy and fear while offering to discuss alternative treatments, which may increase the client's willingness to receive care.
B. This statement is authoritative and does not respect the client's concerns or autonomy.
C. While it may be true, it does not address the client's fear effectively or offer alternatives.
D. This statement is coercive and does not provide the client with supportive information or options.
Correct Answer is ["C","D","E"]
Explanation
A. A firm-bristle toothbrush can cause further irritation and trauma to the already sensitive and lesioned oral mucosa. A soft-bristle toothbrush is recommended instead. This statement indicates a misunderstanding of proper oral care in the context of stomatitis.
B. Methotrexate can cause folic acid deficiency, and taking folic acid supplements is often recommended to mitigate some side effects of methotrexate, including oral mucositis. Avoiding folic acid supplements is not correct in this context and indicates a misunderstanding of the appropriate use of supplements.
C. Saline rinses help to keep the mouth clean and can soothe mucosal irritation and lesions associated with stomatitis. This indicates effective teaching as it is a recommended intervention for managing stomatitis.
D. Alcohol can irritate the oral mucosa and exacerbate stomatitis. Avoiding alcohol helps prevent further irritation and promotes healing, indicating the client understood the teaching.
E. Consuming soft or semisolid foods can reduce irritation and trauma to the oral mucosa, which is important for clients with stomatitis. This shows that the client has understood and can implement dietary modifications to manage their condition.
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