An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

Instruct the client that since the hematocrit remains low, the daily injections are still necessary.

Notify the healthcare provider of the patient's hematocrit level so the frequency of injections can be reduced.

Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.

Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.

Answer and Explanation

The Correct Answer is D

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. Withhold the medication until the client’s breakfast tray is available on the unit: Withholding the medication until food is available is not necessary, as risedronate should be taken on an empty stomach to ensure proper absorption. Food can interfere with the medication's effectiveness.
B. Consult with a pharmacist about scheduling the dose one hour after the client eats: This option is not suitable as risedronate should be taken on an empty stomach, and delaying the dose until after eating would compromise the medication's effectiveness.
C. Instruct the client that it is necessary to take nothing but water with the medication: Risedronate must be taken on an empty stomach with a full glass of water and the client should remain upright for at least 30 minutes afterward. Milk or other beverages can interfere with the absorption of risedronate.
D. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low-fat milk: This is not appropriate, as risedronate should be taken with water only to ensure proper absorption. Milk can reduce the effectiveness of the medication.

A. Restlessness. B. Decreased appetite. C. Intolerance to cold. D. Constipation.

Correct Answer is A

Explanation

A. Restlessness: Restlessness is a sign of excessive levothyroxine sodium, which can lead to symptoms of hyperthyroidism. Other signs include palpitations, nervousness, and insomnia. Overmedication can accelerate metabolism and cause these symptoms.
B. Decreased appetite: Decreased appetite is not typically associated with overmedication of levothyroxine. Instead, a decreased appetite might be related to other conditions or medications but is not a primary indicator of excessive thyroid hormone.
C. Intolerance to cold: Intolerance to cold is more indicative of hypothyroidism or insufficient dosing of levothyroxine rather than overmedication. Excessive levothyroxine usually causes symptoms of hyperthyroidism, such as heat intolerance.
D. Constipation: Constipation is more commonly associated with hypothyroidism or insufficient levothyroxine dosing. Overmedication generally leads to symptoms like diarrhea rather than constipation.

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Naxlex Comprehensive Predictor Exams

The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

Correct Answer is C

Explanation

Levothyroxine sodium is prescribed for a client with hypothyroidism. The nurse should instruct the client to report which symptom because it indicates that the client is taking too much levothyroxine sodium.

Correct Answer is A

Explanation

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