The nurse is caring for a client who is taking diclofenac, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client's serum laboratory values is most important for the nurse to review?
Glucose.
Total protein.
Sodium.
Hemoglobin.
The Correct Answer is D
Choice A reason: This is not the most important laboratory value for the nurse to review. Glucose is a measure of blood sugar levels, and it may be affected by various factors, such as diet, medication, stress, or infection. However, glucose is not directly related to the use of diclofenac or the symptoms of the client. The nurse should monitor the glucose levels for any changes, but it is not the priority.
Choice B reason: This is not the most important laboratory value for the nurse to review. Total protein is a measure of the amount of protein in the blood, and it may reflect the nutritional status, liver function, or kidney function of the client. However, total protein is not directly related to the use of diclofenac or the symptoms of the client. The nurse should monitor the total protein levels for any changes, but it is not the priority.
Choice C reason: This is not the most important laboratory value for the nurse to review. Sodium is a measure of the electrolyte balance in the blood, and it may be affected by fluid intake, fluid loss, or hormonal regulation. However, sodium is not directly related to the use of diclofenac or the symptoms of the client. The nurse should monitor the sodium levels for any changes, but it is not the priority.
Choice D reason: This is the most important laboratory value for the nurse to review. Hemoglobin is a measure of the oxygen-carrying capacity of the blood, and it may indicate the presence of anemia, which is a common adverse effect of diclofenac. Diclofenac can cause gastrointestinal bleeding, which can lead to a decrease in hemoglobin and hematocrit levels. The client's appearance and fatigue may be signs of anemia, which can impair the tissue oxygenation and worsen the client's condition. The nurse should review the hemoglobin levels and report any abnormal findings to the healthcare provider. The nurse should also assess the client for other signs of bleeding, such as melena, hematemesis, or hematuria.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Measuring the client's urinary output is not the most appropriate action for the nurse to take. Although urinary output is an important indicator of renal function, it is not related to the color change of the urine. The nurse should monitor the client's fluid balance as part of the routine care, but it is not a priority.
Choice B reason: Explaining the color change is normal is the most appropriate action for the nurse to take. Carbidopa/levodopa can cause the urine to become dark brown or black, which is a harmless side effect. The nurse should reassure the client that this is not a sign of a serious problem and does not affect the effectiveness of the medication.
Choice C reason: Obtaining a specimen for a urine culture is not the most appropriate action for the nurse to take. A urine culture is used to diagnose a urinary tract infection (UTI), which is characterized by symptoms such as dysuria, frequency, urgency, and hematuria. The color change of the urine due to carbidopa/levodopa is not indicative of a UTI. The nurse should obtain a urine culture only if the client has signs or symptoms of a UTI.
Choice D reason: Encouraging an increase in oral intake is not the most appropriate action for the nurse to take. Although adequate hydration is important for the client's health, it is not related to the color change of the urine. The nurse should encourage the client to drink enough fluids to prevent dehydration, but it is not a priority.
Correct Answer is D
Explanation
Choice A reason: Spinach and other green vegetables are rich in vitamin K, which is essential for blood clotting. However, dabigatran is not affected by vitamin K intake, unlike warfarin, another anticoagulant drug. Therefore, there is no need to eliminate these foods from the diet.
Choice B reason: Dabigatran does not require routine laboratory monitoring of bleeding parameters, such as prothrombin time (PT) or international normalized ratio (INR), unlike warfarin. Therefore, the client does not need to continue obtaining scheduled laboratory bleeding tests.
Choice C reason: Dabigatran is a direct thrombin inhibitor that prevents the formation of fibrin, the main component of blood clots. In case of a major bleeding event, the antidote for dabigatran is idarucizumab, a monoclonal antibody that binds to dabigatran and reverses its effect. However, this antidote is not readily available in most settings and should only be administered by a health care provider. Therefore, the client should not keep an antidote available at home.
Choice D reason: NSAIDs, such as ibuprofen or naproxen, can increase the risk of bleeding by inhibiting platelet aggregation and damaging the gastric mucosa. Therefore, the client should avoid using these drugs while taking dabigatran. The client should consult with the prescriber before taking any other medications, including over-the-counter or herbal products.
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