A nurse is preparing to administer medications to a client.
The client tells the nurse "I will take the pills but not that liquid medication.”. Which of the following actions should the nurse take?

Document the reason for the missed dose of medication in the nurses notes.

Ask an assistive personnel (AP) to ensure the client drinks the medication after breakfast.

Notify the pharmacist that the client is refusing to take the medication.

Mix the medication in juice on the client's breakfast tray.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Documenting the client's refusal and the stated reason in the nurses' notes is crucial for legal and ethical reasons. It provides a clear record of the event, ensures continuity of care by informing other healthcare providers, and allows for follow-up interventions to address the client's concerns or alternative medication strategies. It upholds the client's right to refuse treatment.

Choice B rationale

Delegating medication administration to an assistive personnel (AP) is inappropriate as medication administration is a complex nursing function requiring assessment, judgment, and patient education, which are outside the scope of practice for an AP. An AP's role is typically limited to basic care activities, and they are not trained or authorized to administer medications.

Choice C rationale

Notifying the pharmacist is not the immediate or primary action when a client refuses medication. While the pharmacist may offer insights into alternative formulations or administration routes, the nurse's initial responsibility is to understand the client's refusal, document it, and then notify the prescribing provider for a revised plan of care.

Choice D rationale

Mixing medication in juice without the client's explicit consent is considered a breach of the client's autonomy and can be construed as coercive or deceptive. It violates the client's right to self-determination and informed consent regarding their treatment. Medications should only be administered with the client's knowledge and cooperation.

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Correct Answer is C

Explanation

Choice A rationale

Metoprolol is a beta-blocker primarily used to treat hypertension, angina, and heart failure. It works by blocking beta-adrenergic receptors, leading to decreased heart rate and blood pressure. It is not indicated for managing tremors or dyskinesias associated with levodopa/carbidopa therapy in Parkinson's disease, as these are typically dopaminergic in origin.

Choice B rationale

Bethanechol is a muscarinic cholinergic agonist that increases bladder tone and stimulates gastrointestinal motility. It is primarily used for urinary retention and gastroesophageal reflux disease. Its mechanism involves directly stimulating muscarinic receptors. It has no role in addressing the motor complications like tremors and twitching seen with levodopa/carbidopa in Parkinson's disease.

Choice C rationale

Amantadine is an antiviral drug also used to treat dyskinesia associated with levodopa therapy in Parkinson's disease. Its precise mechanism of action in Parkinson's is not fully understood, but it is thought to modulate dopaminergic and glutamatergic neurotransmission. It can help reduce tremors, rigidity, and involuntary movements.

Choice D rationale

Gabapentin is an anticonvulsant and neuropathic pain medication. It is structurally related to GABA but does not act directly on GABA receptors. Its mechanism of action involves modulating calcium channels. While it can treat some neurological symptoms, it is not a primary treatment for levodopa-induced tremors and twitching in Parkinson's disease.

A. Administer the medication at bedtime. B. Avoid administering the medication with antacids. C. Administer the medication with food. D. Crush the medication prior to administration.

Correct Answer is C

Explanation

Choice A rationale

Administering diclofenac at bedtime does not specifically mitigate its gastrointestinal side effects. NSAIDs like diclofenac can cause gastric irritation and ulceration by inhibiting cyclooxygenase-1 (COX-1), which produces prostaglandins essential for gastric mucosal protection. Time of administration is less critical than co-administration with food or protective agents.

Choice B rationale

Antacids can interfere with the absorption of some medications, but specifically for diclofenac, avoiding concomitant administration is not a standard recommendation to mitigate adverse effects. In fact, antacids can sometimes be used to alleviate gastric distress associated with NSAIDs, although they do not prevent direct mucosal damage.

Choice C rationale

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the gastric mucosa, potentially causing dyspepsia, nausea, and ulceration. Administering the medication with food or milk helps to buffer the gastric acid and physically protect the stomach lining, thereby reducing the direct irritant effect on the gastrointestinal tract and enhancing tolerability.

Choice D rationale

Diclofenac is typically formulated as an enteric-coated tablet or delayed-release capsule to protect the stomach from irritation and ensure targeted drug release in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach, increasing gastric irritation, and potentially reducing therapeutic efficacy.

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A nurse is preparing to administer medications to a client. The client tells the nurse "I will take the pills but not that liquid medication.”. Which of the following actions should the nurse take?

Nursing Test Bank

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A nurse is preparing to administer medications to a client.
The client tells the nurse "I will take the pills but not that liquid medication.”. Which of the following actions should the nurse take?