The nurse is caring for a client who is prescribed sulfasalazine. Which question would the nurse ask the client before starting this drug?
"Do you have insurance to cover this drug?"
"Do you have any allergy to sulfa drugs?"
"Are you taking Vitamin C or B?"
"Can you swallow pills pretty easily?"
The Correct Answer is B
Choice A reason: Determining insurance coverage is a logistical concern related to medication adherence and healthcare access. While important for ensuring the client can obtain the treatment, it is not a clinical priority or a safety screening question required before the administration of a potentially high-risk pharmacological agent.
Choice B reason: Sulfasalazine is a compound of 5-aminosalicylic acid and sulfapyridine. It is contraindicated in patients with known hypersensitivity to sulfonamides or salicylates. Asking about allergies is the highest priority to prevent life-threatening Type 1 hypersensitivity reactions, such as anaphylaxis, or severe cutaneous adverse reactions like Stevens-Johnson syndrome.
Choice C reason: Inquiring about vitamins is relevant because sulfasalazine can interfere with the absorption of folic acid (Vitamin B9), often requiring supplementation. However, this is a secondary management concern. The immediate safety priority is screening for allergies that could cause an acute, severe systemic reaction upon the first dose.
Choice D reason: Assessing the ability to swallow pills is a practical consideration for oral medication administration. If a patient has dysphagia, the nurse might need an alternative formulation. However, this does not carry the same clinical weight as screening for a drug allergy that could lead to significant medical morbidity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Hypoactive bowel sounds are typically associated with a paralytic ileus or the later stages of a bowel obstruction. In the acute inflammatory phase of Crohn's disease, the intestinal tract is hyperactive as it attempts to move contents past inflamed or narrowed segments, making dull or absent sounds an atypical initial finding.
Choice B reason: Crohn's disease most commonly affects the terminal ileum, located in the right lower quadrant. During an exacerbation, inflammation and partial obstruction of the intestinal lumen lead to borborygmi, which are high-pitched, rushing, or tinkling bowel sounds as the intestine forcefully contracts to push fluid and gas through the narrowed areas.
Choice C reason: A positive Murphy sign is a specific clinical indicator of acute cholecystitis, elicited by pain during inspiration while the gallbladder is palpated. Rebound tenderness is more indicative of peritonitis or appendicitis. While Crohn's can cause abdominal tenderness, these specific signs point toward different hepatobiliary or surgical emergencies.
Choice D reason: Abdominal pain and cramping in Crohn's disease are typically associated with eating (postprandial) rather than being specifically worse at night. Food intake triggers the gastrocolic reflex and peristalsis, which increases pressure against the inflamed intestinal walls, leading to the characteristic colicky pain experienced by these patients.
Correct Answer is B
Explanation
Choice A reason: Immobilization of the arm for 4 to 6 days is contraindicated following the creation of an arteriovenous (AV) fistula. While the incision site must be protected, gentle exercise of the arm, such as squeezing a rubber ball, is actually encouraged to increase blood flow and promote the "maturation" or thickening of the vessel walls.
Choice B reason: An AV fistula is created by a surgical anastomosis between an artery (typically the radial or brachial artery) and a vein (typically the cephalic vein). This allows high-pressure arterial blood to flow directly into the vein, causing the vein to dilate and become tough enough to withstand repeated large-bore needle cannulations.
Choice C reason: Hemodialysis requires two needles to be inserted into the fistula for each treatment, not one. One needle (the arterial needle) withdraws blood from the body to be sent to the dialyzer for cleaning, while the second needle (the venous needle) returns the filtered blood back to the patient's circulation.
Choice D reason: An AV fistula cannot be used 5 to 7 days after surgery. It requires a significant "maturation" period, usually lasting 2 to 4 months, before it is ready for use. Using it too early can cause the vessel to collapse or infiltrate. If urgent dialysis is needed, a temporary central venous catheter is used in the interim.
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