A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?

Request an order for renal function tests.

Notify the provider to request more frequent dosing.

Count the pills in the prescription bottle.

Ask the patient if she has difficulty swallowing pills

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is B

Explanation

A. Increase fluids: Encouraging oral fluids can promote urination, but this intervention is not the priority until the nurse determines whether the bladder is actually retaining urine or the client is simply producing little urine.

B. Perform a bladder scan: The priority action is to assess the bladder for urinary retention using a noninvasive bladder scan. This determines if the bladder is full and guides the next appropriate intervention.

C. Insert a straight catheter: Catheterization is invasive and carries a risk of infection. It should only be performed after confirming urinary retention through assessment such as a bladder scan.

D. Provide assistance to bathroom: Helping the client to the bathroom may be appropriate, but without first assessing for retention, the nurse may overlook urinary obstruction or an overdistended bladder.

A. Washes their hands for 10 seconds B. Holds their hands below the elbows while rinsing off soap C. Turns off the faucet with their hands D. Uses hot water to wash their hands

Correct Answer is B

Explanation

A. Washes their hands for 10 seconds: Hand hygiene requires scrubbing for at least 15 to 20 seconds to effectively remove microbes and debris. Ten seconds is insufficient to ensure proper cleansing and can increase the risk of pathogen transmission.

B. Holds their hands below the elbows while rinsing off soap: Holding the hands below the elbows allows water and soap to flow downward, preventing contaminated water from running back onto clean areas of the arms and hands.

C. Turns off the faucet with their hands: Turning off the faucet with bare hands can reintroduce microbes that were just washed off. The faucet should be turned off with a clean paper towel or elbow to maintain proper aseptic technique and prevent cross-contamination.

D. Uses hot water to wash their hands: Hot water can irritate or damage the skin, leading to dryness and cracks, which increase infection risk. Warm water is recommended because it is effective for lathering soap while protecting the integrity of the skin barrier.

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A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What will the nurse do next?

Nursing Test Bank

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