A nurse is preparing to administer verapamil 0.1 mg/kg via intermittent IV bolus over 2 min.

Available is verapamil 2.5 mg/mL. The client weighs 165 Ib. How many mL should the nurse administer?

Choice A rationale

Dry mouth can be an anticholinergic effect of some medications or a symptom of dehydration, but it is not a direct, priority adverse effect associated with ketorolac, which is an NSAID. While uncomfortable, it does not indicate immediate life-threatening organ dysfunction.

Choice B rationale

Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis, which can lead to adverse renal effects. Prostaglandins play a crucial role in maintaining renal blood flow and glomerular filtration rate. Oliguria (urine output < 0.5 mL/kg/hr or < 400 mL/24 hr) indicates potential acute kidney injury, a serious and life-threatening complication that requires immediate reporting to the provider.

Choice C rationale

Nausea is a common gastrointestinal adverse effect of NSAIDs, including ketorolac, due to direct irritation of the gastric mucosa or central effects. While it can cause discomfort and impact client well-being, it is generally not a life-threatening symptom and does not take priority over signs of organ damage.

Choice D rationale

Altered taste, or dysgeusia, can be an idiosyncratic drug reaction but is not a common or priority adverse effect of ketorolac. While it can affect appetite and client satisfaction, it does not signify acute organ damage or a life-threatening condition requiring urgent intervention.

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.