The client is a 75-year-old female admitted to the preoperative area to prepare for pacemaker insertion. Client reports she is having this done because her heart rate has been staying very low, she is always tired, and she has passed out once from low heart rate. Client has history of worsening symptomatic bradycardia. History of atrial fibrillation controlled. The nurse is preparing the client's plan of care. Select 4 findings that would indicate to the nurse that the administration of the vancomycin antibiotic would be safe to administer.

No known allergies

Peripheral IV in large vein

Potassium 4.4 mEq/L (4.4 mmol/L)

Used for prophylaxis

Blood urea nitrogen 17 mg/dL (6.07 mmol/L)

Dosage in safe range

Answer and Explanation

Correct Answer : A,B,D,F

A. No known allergies:
Having no known allergies is a significant factor in determining the safety of administering vancomycin, as it reduces the risk of an allergic reaction. Vancomycin can cause allergic reactions or hypersensitivity, so it’s important to ensure the client is not allergic to this medication.

B. Peripheral IV in large vein:
Vancomycin should be administered through a large vein because it can be irritating to smaller veins and potentially cause thrombophlebitis or vein damage. Using a large vein helps to minimize these risks and ensure safe administration.

C. Potassium 4.4 mEq/L (4.4 mmol/L):
While potassium levels are important to monitor, they are not directly related to the safety of administering vancomycin. Vancomycin does not have a direct impact on potassium levels, so this finding does not specifically indicate the safety of vancomycin administration.

D. Used for prophylaxis:
Vancomycin is often used as prophylaxis in certain surgical procedures to prevent infection, especially in cases where there is a high risk of methicillin-resistant Staphylococcus aureus (MRSA) infection. The use of vancomycin for prophylaxis is a common practice and indicates it is being administered for an appropriate reason.

E. Blood urea nitrogen 17 mg/dL (6.07 mmol/L):
A blood urea nitrogen (BUN) level of 17 mg/dL is slightly elevated but not necessarily a contraindication for vancomycin administration. However, vancomycin can impact kidney function, so it is important to monitor renal function but not the sole factor in determining safety.

F. Dosage in safe range:
Ensuring the dosage of vancomycin is within the safe range is crucial for preventing toxicity and achieving therapeutic efficacy. This is an essential consideration when administering the medication to avoid adverse effects and ensure effective treatment.

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Correct Answer is C

Explanation

A. Do not take the medication more than once every 8 hours:
Diphenhydramine is typically dosed every 4 to 6 hours, not just once every 8 hours. However, this instruction is less critical compared to addressing the safety concerns related to drowsiness.

B. Take the medication with food to prevent gastric upset:
Diphenhydramine is generally not known to cause significant gastric upset, so this instruction is less critical. The primary concern with diphenhydramine is its sedative effects rather than gastrointestinal issues.

C. Avoid driving, since this medication causes drowsiness:
Diphenhydramine is known to cause significant drowsiness and sedation. Advising the client to avoid driving is crucial to prevent accidents and ensure their safety, making this the most important instruction.

D. Use sugarless candy or gum to help prevent a dry mouth:
While diphenhydramine can cause dry mouth, using sugarless candy or gum is a helpful but secondary instruction. The primary concern with diphenhydramine is its sedative effect, which affects the client's ability to drive safely.

A. Clients using the discus may experience decreased blood pressure. B. Explain that the client should not use the discus more than twice daily. C. When using the discus, have the client breathe out rapidly into the mouthpiece. D. Offer the discus to the client for use during an acute asthma attack.

Correct Answer is B

Explanation

A. Clients using the discus may experience decreased blood pressure:
Fluticasone propionate and salmeterol are a combination of a corticosteroid and a long-acting beta-agonist. While they help control asthma, they are not typically associated with decreased blood pressure. Instead, potential side effects might include increased heart rate or hypertension.

B. Explain that the client should not use the discus more than twice daily:
Fluticasone propionate and salmeterol combination inhalers are usually prescribed for twice-daily use to maintain control of asthma symptoms. Using the inhaler more frequently than prescribed could lead to increased side effects or diminished effectiveness.

C. When using the discus, have the client breathe out rapidly into the mouthpiece:
The correct technique for using a dry powder inhaler involves inhaling deeply and forcefully to ensure the medication reaches the lungs. Breathing out rapidly into the mouthpiece is incorrect and will not deliver the medication effectively.

D. Offer the discus to the client for use during an acute asthma attack:
The discus is used for long-term control and prevention of asthma symptoms, not for immediate relief during an acute asthma attack. A rescue inhaler, typically containing a short-acting beta-agonist like albuterol, is used for acute symptoms.

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Naxlex Comprehensive Predictor Exams

A client with allergic rhinitis is taking the over-the-counter antihistamine diphenhydramine HCL. Which instruction is most important for the nurse to provide this client?

Correct Answer is C

Explanation

To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

Correct Answer is B

Explanation

A client who is taking dextroamphetamine-amphetamine extended-release tablets for attention deficit hyperactivity disorder (ADHD), reports about having difficulty sleeping at night. Which assessment is most important for the nurse to obtain?

A client with generalized anxiety disorder (GAD) receives a new prescription for lorazepam. Which statement provided by the client requires additional instruction by the nurse?

Which action should the nurse implement to assess the effectiveness of amlodipine?

A client with benign prostatic hyperplasia receives a new prescription of tamsulosin. Which intervention should the nurse perform to monitor for an adverse reaction?

The nurse is teaching a client who has been diagnosed with human immunodeficiency virus (HIV) about the antiretroviral medication regimen. Which statement provided by the client requires additional instruction by the nurse?

A client who is taking an oral contraceptive receives a new prescription for erythromycin. Which instruction should the nurse provide to the client?

Which nursing intervention has priority when initiating a continuous epidural infusion with an opioid analgesic?