At the start of the shift, the practical nurse (PN) reviews a client’s medication administration record and notes that a client has a new prescription for a diuretic to be administered at bedtime. Which action should the PN take?
Explain the purpose of the medication to the client just prior to giving the medication as scheduled
Review the prescription with the charge nurse to determine if a change in time of administration is needed
Withhold the medication until the next day for clarification when the healthcare provider (HCP) makes rounds
Administer the medication early in the day to reduce risk of disturbing the client’s nighttime sleep schedule
The Correct Answer is B
Choice A reason: Explaining the medication’s purpose is important but does not address the inappropriate bedtime dosing. Diuretics increase urination, causing nocturia and sleep disruption. Administering as scheduled without review risks client discomfort, making this choice less appropriate than verifying timing.
Choice B reason: Reviewing the prescription with the charge nurse is critical, as bedtime diuretic administration causes nocturia, disrupting sleep. Diuretics, like hydrochlorothiazide, increase urine production, and morning dosing aligns with daily activity, minimizing nighttime disturbance, ensuring safe and effective administration timing.
Choice C reason: Withholding the medication until the next day delays treatment, risking conditions like edema or hypertension. Consulting the charge nurse allows timely clarification of dosing time, ensuring therapeutic benefits without sleep disruption, making this choice overly cautious and unnecessary.
Choice D reason: Administering the diuretic early without confirmation violates protocol, as the prescription specifies bedtime. Unilateral changes risk errors, and morning dosing requires provider approval. Reviewing with the charge nurse is safer, ensuring alignment with clinical intent while addressing sleep concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Taking medications with food may reduce gastric irritation but does not prevent anaphylactic reactions to penicillin, which are immune-mediated. This advice is irrelevant for avoiding future allergic responses, as it does not address the systemic hypersensitivity triggered by penicillin exposure.
Choice B reason: A medic alert bracelet is critical for a client with a penicillin anaphylaxis history, as it alerts healthcare providers to avoid penicillin, preventing potentially fatal allergic reactions. Anaphylaxis involves IgE-mediated histamine release, and re-exposure risks rapid, life-threatening symptoms, making this the most important instruction.
Choice C reason: Keeping epinephrine is useful for managing anaphylaxis but is secondary to prevention. A medic alert bracelet proactively avoids penicillin exposure, reducing the need for emergency intervention. Epinephrine treats symptoms but does not address the root cause of re-exposure risk.
Choice D reason: Taking all prescribed ampicillin is dangerous, as the client had an anaphylactic reaction, indicating a severe allergy. Continuing the drug risks recurrent, potentially fatal reactions. This choice is incorrect, as it contradicts the need to avoid the allergen entirely.
Correct Answer is D
Explanation
Choice A reason: Ankle circumference monitors edema, which mannitol reduces by drawing fluid from tissues. However, this is secondary to urinary output, as mannitol’s primary action is diuresis, increasing urine production to reduce intracranial or intraocular pressure, making edema measurement less critical.
Choice B reason: Heart rate is relevant for overall monitoring but not the primary outcome for mannitol, which acts as an osmotic diuretic. Cardiovascular effects are secondary, and mannitol’s efficacy is better assessed by urine output, which directly reflects its diuretic mechanism.
Choice C reason: Dietary intake is unrelated to mannitol’s therapeutic effect. Mannitol pulls fluid into the bloodstream, increasing urine output, not influenced by diet. Monitoring intake may be relevant for other conditions, but it is not critical for assessing mannitol’s diuretic action.
Choice D reason: Urinary output is the most important outcome, as mannitol, an osmotic diuretic, increases urine production by drawing fluid into the renal tubules, reducing intracranial or intraocular pressure. Adequate output (e.g., >30 mL/hour) confirms efficacy, preventing fluid overload or renal complications.
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