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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Rotavirus: The rotavirus vaccine is given orally to infants, with the series completed by 8 months of age. A 12-year-old would be well beyond the recommended age window for this immunization.
B. Herpes zoster: The herpes zoster (shingles) vaccine is recommended for adults, typically beginning at age 50 or older. It is not indicated for a 12-year-old child.
C. Meningococcal conjugate: The meningococcal conjugate vaccine is recommended for adolescents around 11–12 years of age, with a booster at 16 years. This protects against meningococcal disease, making it the appropriate immunization for this client.
D. Pneumococcal polysaccharide: The pneumococcal polysaccharide vaccine is generally given to adults over 65 or individuals with certain high-risk conditions. It is not routinely administered to healthy 12-year-olds.
Correct Answer is C
Explanation
A. Administer at mealtimes: Giving iron with meals decreases gastrointestinal irritation but also reduces absorption significantly. Optimal administration is on an empty stomach or with vitamin C–rich fluids to enhance absorption.
B. Administer at bedtime: Timing at bedtime does not enhance iron absorption or reduce adverse effects. Bedtime administration may even worsen gastrointestinal discomfort while the child is lying down.
C. Give with orange juice: Vitamin C in orange juice enhances the absorption of iron in the gastrointestinal tract. This improves the effectiveness of ferrous sulfate therapy in treating iron deficiency anemia.
D. Give with a 240 mL (8 oz) glass of milk: Milk contains calcium, which interferes with iron absorption. Administering ferrous sulfate with milk would reduce its therapeutic benefit and should be avoided.
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