The nurse is administering sevelamer during lunch to a client with chronic kidney disease (CKD). The client asks the nurse to bring the medication later. The nurse should describe which action of sevelamer as an explanation for taking it with meals?

Promotes stomach emptying and prevents gastric reflux.

Buffers hydrochloric acid and prevents gastric erosion.

Prevents indigestion associated with ingestion of spicy foods.

Binds with phosphorus in foods and prevents absorption.

Answer and Explanation

The Correct Answer is D

Choice A reason: Promoting stomach emptying and preventing gastric reflux is not a relevant action of sevelamer, which is a phosphate binder that lowers serum phosphate levels in patients with CKD. Gastric reflux may be caused by other factors, such as hiatal hernia, obesity, or spicy foods.

Choice B reason: Buffering hydrochloric acid and preventing gastric erosion is not a pertinent action of sevelamer, which does not affect gastric acidity or mucosal integrity. Gastric erosion may be caused by other factors, such as NSAIDs, alcohol, or Helicobacter pylori infection.

Choice C reason: Preventing indigestion associated with ingestion of spicy foods is not a significant action of sevelamer, which does not affect digestion or food tolerance. Indigestion may be caused by other factors, such as overeating, stress, or gallstones.

Choice D reason: Binding with phosphorus in foods and preventing absorption is the correct action of sevelamer, which should be taken with meals to reduce the amount of phosphorus that enters the bloodstream from the diet. High serum phosphate levels can cause bone loss, calcification of soft tissues, and secondary hyperparathyroidism in patients with CKD.

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Correct Answer is D

Explanation

Choice A reason: Taking a multi-vitamin supplement daily is not a necessary instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. However, some vitamins, such as vitamin K, vitamin E, and vitamin C, can interact with warfarin and affect its effectiveness. Patients should consult their health care provider before taking any supplements or herbal products.

Choice B reason: Using an astringent for superficial bleeding is not a sufficient instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Warfarin can increase the risk of bleeding, both internally and externally. Patients should report any signs of bleeding, such as bruising, nosebleeds, gum bleeding, blood in urine or stool, or prolonged bleeding from cuts or wounds, to their health care provider. They should also avoid activities or products that can increase the risk of bleeding, such as shaving with a razor, using dental floss, or taking aspirin or NSAIDs.

Choice C reason: Adding large amounts of spinach to the diet is an incorrect instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Spinach is a leafy green vegetable that is high in vitamin K, which can counteract the effect of warfarin and increase the risk of clotting. Patients should maintain a consistent intake of vitamin K-rich foods and avoid sudden changes in their diet.

Choice D reason: Avoiding going barefoot, especially outside, is a correct instruction for a client taking warfarin, which is an anticoagulant that inhibits the synthesis of vitamin K-dependent clotting factors and prevents blood clots. Warfarin can increase the risk of bleeding, both internally and externally. Patients should protect their feet from injury or infection by wearing shoes or slippers at all times.

Correct Answer is []

Explanation

Potential Condition:Methemoglobinemia

Methemoglobinemia is a condition in which the hemoglobin in the blood is unable to bind oxygen effectively, resulting in tissue hypoxia. It can be caused by exposure to certain drugs or chemicals, such as nitrates, benzocaine, or dapsone. Some symptoms of methemoglobinemia include cyanosis, headache, fatigue, dyspnea, and tachycardia. In severe cases, it can lead to seizures, coma, and death.

Actions to Take:

Draw blood for a complete blood count
administer methylene blue

A complete blood count (CBC) can help diagnose methemoglobinemia by measuring the level of methemoglobin in the blood. A normal level is less than 1%, while a level above 15% can cause symptoms. A level above 30% can be life-threatening. Methylene blue is a medication that can reduce methemoglobin back to normal hemoglobin and restore oxygen delivery to the tissues. It is given intravenously at a dose of 1-2 mg/kg over 5 minutes.

Parameters to Monitor:

Methemoglobin level
heart rate and rhythm

The methemoglobin level is the most important parameter to monitor in methemoglobinemia, as it indicates the severity of the condition and the response to treatment. The goal is to lower the level below 10% or until symptoms resolve. The heart rate and rhythm are also important to monitor, as methemoglobinemia can cause tachycardia and dysrhythmias due to hypoxia and acidosis. The goal is to maintain a normal sinus rhythm and a heart rate within the normal range for the client’s age and condition.

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The nurse is administering sevelamer during lunch to a client with chronic kidney disease (CKD). The client asks the nurse to bring the medication later. The nurse should describe which action of sevelamer as an explanation for taking it with meals?

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Naxlex Comprehensive Predictor Exams

A client is discharged with a prescription for warfarin. Which discharge instruction should the nurse emphasize to the client?

Correct Answer is D

Explanation

Patient Data Exhibits Review H and P, and nurse’s note. Identify from the choices below which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.

Correct Answer is []

Explanation

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