The nurse is caring for a client with uterine cancer who is being treated with brachytherapy. The UAP reports that the client ambulated to the restroom and is now reporting, "something feels like it’s coming out." What is the nurse's priority action?

Assess for dislodgement and use forceps to retrieve the dislodged pellets and place in the lead container.

Assess the patient's knowledge of the treatment plan and her willingness to participate.

Assess the UP's knowledge and explain the rationale for strict bed rest.

Notify the physician about the potential dislodgment of the radiation implant.

Answer and Explanation

The Correct Answer is A

A) Assess for dislodgement and use forceps to retrieve the dislodged pellets and place in the lead container:
The priority action when a patient is receiving brachytherapy for uterine cancer is to assess for potential dislodgement of the radioactive implant. If the radiation source has been displaced, it must be handled carefully to prevent radiation exposure to the nurse, other patients, and staff. The nurse should use forceps to carefully retrieve the dislodged pellets and place them in a lead container to prevent contamination.

B) Assess the patient's knowledge of the treatment plan and her willingness to participate:
While it is important to assess the patient's understanding of the treatment plan and her willingness to participate, this is not the immediate priority in this situation. The nurse’s first priority is to address the potential risk of radiation exposure due to the dislodgement of the implant.

C) Assess the UAP's knowledge and explain the rationale for strict bed rest:
Although it is important for the nurse to ensure that all team members, including UAPs, understand the rationale for strict bed rest during brachytherapy, this action is not the most immediate priority in this scenario. The potential dislodgement of the radiation implant requires urgent assessment and intervention.

D) Notify the physician about the potential dislodgment of the radiation implant:
Notifying the physician about the dislodgement is an important step, but it is not the first action the nurse should take. The immediate priority is to assess and secure the radiation implant using appropriate protocols. Once the dislodged pellets have been safely contained in the lead container, the nurse should then notify the physician for further guidance on the next steps in treatment or care.

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Correct Answer is D

Explanation

A) Jaundice:
Carbidopa-levodopa works by increasing dopamine levels in the brain to help alleviate symptoms of Parkinson's disease, but it is not typically associated with liver dysfunction that would lead to jaundice. If jaundice were to occur, it could indicate liver problems, which would need to be evaluated further, but this is not a typical side effect of Sinemet.

B) Hyperglycemia:
Sinemet primarily affects dopamine levels in the brain and does not have a direct impact on blood sugar regulation. However, long-term use of certain medications, especially corticosteroids or other specific treatments, can affect glucose levels, but carbidopa-levodopa is not typically linked to hyperglycemia.

C) Hypertension:

Carbidopa-levodopa may lead to fluctuations in blood pressure, including lowering blood pressure, especially when the patient is changing positions. However, hypertension is not a typical response to this medication. Instead, patients may experience orthostatic hypotension, which is more common with carbidopa-levodopa.

D) Orthostatic hypotension:
Orthostatic hypotension is a well-recognized and common side effect of carbidopa-levodopa. This occurs because Sinemet affects the autonomic nervous system, which can cause a decrease in blood pressure when moving from a sitting or lying position to standing. Patients on carbidopa-levodopa should be advised to rise slowly to minimize the risk of dizziness or fainting due to orthostatic hypotension.

A. Hydration with IV fluids B. Nothing as the digoxin level is within normal ranges C. Hold the Digoxin D. Digibind E. Narcan

Correct Answer is ["A"]

Explanation

A) Hydration with IV fluids:
IV hydration may be ordered to improve kidney function and help facilitate the excretion of excess digoxin from the body. Digoxin toxicity is often related to impaired renal clearance, so improving hydration can promote renal perfusion and enhance the elimination of the drug. This is a common supportive measure to help in managing digoxin toxicity.

B) Nothing as the digoxin level is within normal ranges:
This is incorrect because the patient's digoxin level is 4 ng/ml, which is significantly above the normal therapeutic range of 0.8–2.0 ng/ml. A level of 4 ng/ml is toxic, and immediate action is required. Symptoms like severe bradycardia, nausea, and vomiting are indicative of digoxin toxicity, and they necessitate prompt intervention.

C) Hold the Digoxin:
In the case of digoxin toxicity, it is crucial to hold the digoxin. Digoxin should be discontinued immediately if toxicity is suspected, as continuing the medication could worsen symptoms like bradycardia and increase the risk of potentially life-threatening arrhythmias. This step is essential to prevent further complications.

D) Digibind:
Digibind (Digoxin immune fab) is a digoxin-specific antibody used in cases of severe digoxin toxicity or overdose. It binds to the digoxin molecules and helps to neutralize its effects. Given the elevated level of digoxin (4 ng/ml) and the presence of symptoms like severe bradycardia, nausea, and vomiting, Digibind is likely to be ordered to reverse the effects of the toxicity.

E) Narcan:
Narcan (naloxone) is used to reverse opioid overdoses, not digoxin toxicity. There is no indication for the use of Narcan in this scenario, as digoxin toxicity does not involve opioid overdose. This intervention would be inappropriate and irrelevant to the management of digoxin toxicity.

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The nurse is caring for a client with uterine cancer who is being treated with brachytherapy. The UAP reports that the client ambulated to the restroom and is now reporting, "something feels like it’s coming out." What is the nurse's priority action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with Parkinson's disease is prescribed carbidopa-levadopa [Sinemet]. Which of the following side effects does the nurse recognize can occur with this medication?

Correct Answer is D

Explanation

A patient taking Digoxin is experiencing severe bradycardia, nausea and vomiting. A lab draw shows that their Digoxin level is 4 ng/mi (0.8-2.0 ng/ml). What management does the nurse anticipate the physician to order? Select all that apply.

Correct Answer is ["A"]

Explanation

A nurse is monitoring a client with COPD that suddenly becomes restless and anxious. Which of the following steps should the nurse take next?

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The nurse is caring for a client who was recently diagnosed with ALS (Amyotrophic lateral sclerosis). Which of the following signs and symptoms is MOST important for the nurse to assess for?

The nurse supervises the care of a patient with a temporary radioactive cervical implant. Which action by unlicensed assistive personnel (UAP), if observed by the nurse, would require immediate intervention?