The nurse administers ophthalmic timolol to a client with glaucoma. The client routinely takes carvedilol, spironolactone, and ibuprofen daily. Which medication(s) should the nurse withhold? Select all that apply.

Any antianxiety medications.

Over-the-counter oral antipyretics.

Nonsteroidal antiinflammatory drugs.

Other beta-adrenergic blocker agents.

Oral and subcutaneous anticoagulants.

Answer and Explanation

Correct Answer : C,D

Rationale:
A. Any antianxiety medications: Antianxiety medications are not contraindicated with ophthalmic timolol. Unless they directly impact heart rate or blood pressure significantly, they are generally safe to continue in clients with glaucoma using topical beta blockers.

B. Over-the-counter oral antipyretics: Oral antipyretics like acetaminophen are not known to interact adversely with timolol. These medications can be used safely unless otherwise contraindicated for specific patient conditions like liver disease.

C. Nonsteroidal antiinflammatory drugs: NSAIDs such as ibuprofen, when used long-term with beta blockers like timolol or carvedilol, may blunt the antihypertensive effect and increase renal risk, especially in clients on diuretics like spironolactone. This triple combination increases the chance of nephrotoxicity.

D. Other beta-adrenergic blocker agents: Using timolol with systemic beta blockers like carvedilol increases the risk of bradycardia, hypotension, and heart block. Though timolol is topical, systemic absorption can still occur, requiring caution when combining with other beta-blockers.

E. Oral and subcutaneous anticoagulants: There is no direct contraindication between timolol and anticoagulants. Unless the client has bleeding risks associated with other therapies or conditions, concurrent use is generally acceptable.

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Correct Answer is B

Explanation

Rationale:
A. Meningitis B: This vaccine is not routinely indicated during or after pregnancy unless there is a specific risk factor or outbreak. It is not a standard postpartum immunization.

B. Measles, mumps, rubella: The MMR vaccine is live and contraindicated during pregnancy due to potential fetal harm. It should be given postpartum if the client is non-immune to prevent future infection.

C. Diphtheria, pertussis, tetanus: The Tdap vaccine is safe and recommended during each pregnancy, ideally between 27 and 36 weeks gestation, to provide passive immunity to the newborn.

D. Influenza vaccine: Inactivated influenza vaccine is recommended during pregnancy to protect both mother and baby. It should not be delayed until after pregnancy.

A. Monitoring effects of oxytocin administration to help achieve cervical dilation. B. Assessing the fetal heart rate and pattern for signs of fetal distress. C. Providing pain medication to increase the client's tolerance of labor pains. D. Assisting the client to push effectively so that expulsion of the fetus can be achieved.

Correct Answer is D

Explanation

Rationale:

A. Monitoring effects of oxytocin administration to help achieve cervical dilation: This is appropriate during the first stage of labor. The second stage begins after full dilation, so oxytocin’s role in cervical change is no longer relevant at this point.

B. Assessing the fetal heart rate and pattern for signs of fetal distress: FHR monitoring is important throughout labor, including the second stage, but it is not unique to this phase. It supports safe delivery but does not directly facilitate the main goal of this stage—fetal expulsion.

C. Providing pain medication to increase the client's tolerance of labor pains: Pain management is crucial, but narcotics are typically avoided in the second stage due to potential neonatal respiratory depression. Also, this does not address the primary task of this stage.

D. Assisting the client to push effectively so that expulsion of the fetus can be achieved:
This is the hallmark intervention of the second stage of labor, where full dilation has occurred and the goal is delivery of the baby. Supporting effective pushing directly aids in achieving this outcome.

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The nurse administers ophthalmic timolol to a client with glaucoma. The client routinely takes carvedilol, spironolactone, and ibuprofen daily. Which medication(s) should the nurse withhold? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is reviewing a pregnant client's prenatal immunization history. Which immunization should the nurse instruct the client to receive after pregnancy?

Correct Answer is B

Explanation

Which nursing intervention is indicated for the second stage of labor?

Correct Answer is D

Explanation

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