A nurse is teaching a client who has pernicious anemia to self-administer nasal cyanocobalamin. Which of the following information should the nurse include in the teaching?

Safe medication administration relies on the elimination of transcription errorsand adherence to established safety guidelines, such as avoiding trailing zeros. The Joint Commission mandates specific labeling standards to prevent dosing inaccuracies that could lead to toxicity or subtherapeutic treatment. Clarifying ambiguous or non-standard prescriptions is a fundamental responsibility of the nurse in maintaining patient safetyand preventing adverse events.

Rationale:

A.The prescription for Clozapine 12.50 mg must be clarified because it contains a trailing zero, which is a prohibited notation according to safety standards. A trailing zero can be misread as 125 mg if the decimal point is missed, leading to a ten-fold dosing error and potential toxicity. Standard practice requires writing the dose as 12.5 mg to ensure clear communication.

B.Lamotrigine 200 mg PO daily is a standard maintenance dose for the treatment of epilepsy or bipolar disorder and does not require clarification. This dosage falls within the typical therapeutic range and the notation is clear and free of dangerous abbreviations or zeros. The nurse should simply continue to monitor the patient for adverse effects like Stevens-Johnson syndrome.

C.Donepezil 23 mg PO daily is an approved dosage for the treatment of moderate-to-severe Alzheimer's disease and is not inherently incorrect. While higher than the starting dose, this specific strength was developed to provide additional cognitive benefits for patients with advanced disease. The notation is clear and follows standard pharmaceutical guidelines, so no clarification is needed based on the dosage.

D.Fluoxetine oral solution 20 mg/5 mL administered via a gastrostomy tube is an appropriate route and dose for a patient who cannot swallow. Liquid formulations are the preferred method for tube administration to prevent clogging and ensure the full dose of the selective serotonin reuptake inhibitor is delivered. This prescription follows clear clinical logic and standard safety practices for enteral medication.

Desmopressin is a synthetic analogue of antidiuretic hormone(ADH) that increases water reabsorption in the collecting ductsof the kidney. It is the primary treatment for central diabetes insipidus, effectively concentrating urine and reducing excessive thirst and polyuria. Monitoring for water intoxication is the priority nursing intervention.

Rationale:

A.Bradycardia is not a direct adverse effect associated with desmopressin administration. While significant fluid overload could theoretically stress the cardiovascular system, a slow heart rate is not the specific parameter used to monitor for desmopressin toxicity. The nurse should focus instead on signs of volume expansion and electrolyte shifts, particularly those affecting the neurological system and sodium balance.

B.Fluid retention is a primary adverse effect of desmopressin because the drug effectively stops the kidneys from excreting water. If the client continues to drink large amounts of fluid while taking the drug, they are at risk for water intoxication and dilutional hyponatremia. The nurse must monitor for headache, confusion, and edema, which indicate that the body is retaining too much free water.

C.Blurred vision is not a common or direct side effect of desmopressin therapy. Visual changes are more often linked to medications that affect the autonomic nervous system or those with anticholinergic properties. However, if blurred vision occurs in the context of a severe headache while on desmopressin, it could be a sign of increased intracranial pressure from severe water intoxication.

D.Hypernatremia is the condition desmopressin is meant to treat in a patient with diabetes insipidus, not an adverse effect of the drug. Desmopressin causes water retention, which dilutes the blood and lowers the sodium concentration. Therefore, the nurse should monitor for the opposite effect, hyponatremia, which occurs if the medication works too effectively or if fluid intake is excessive.