The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Client with diabetes who has a serum creatinine of 0.8 mg/dL (61 mcmol/L).

Client who recently fell and has vertebral compression fractures.

Hypertensive client who takes calcium channel blockers.

Client with a spinal cord injury who cannot tolerate sitting up.

Answer and Explanation

The Correct Answer is D

Choice A reason: Bisphosphonates are generally safe for clients with diabetes and normal renal function (serum creatinine 0.8 mg/dL is within normal range, indicating adequate kidney function). These drugs inhibit osteoclast activity, reducing bone resorption, and are not contraindicated in diabetes unless renal impairment is present, which is not the case here.
Choice B reason: Vertebral compression fractures are a common complication of osteoporosis. Bisphosphonates are often prescribed to strengthen bones and prevent further fractures by inhibiting bone resorption. Recent fractures do not contraindicate their use; in fact, they are indicated to improve bone density and reduce future fracture risk.
Choice C reason: Calcium channel blockers, used for hypertension, do not interact significantly with bisphosphonates. These drugs work on different systems—bisphosphonates on bone metabolism and calcium channel blockers on vascular smooth muscle. There is no evidence suggesting this combination poses a risk, making bisphosphonates appropriate for this client.
Choice D reason: Bisphosphonates, especially oral ones, require patients to sit upright for 30–60 minutes post-dose to prevent esophageal irritation and ensure proper absorption. A client with a spinal cord injury unable to tolerate sitting up cannot comply with this requirement, increasing the risk of esophageal damage, making bisphosphonates a poor choice.

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Correct Answer is D

Explanation

Choice A reason: Drinking 2 liters of water daily supports general health but is not specific to phenytoin therapy. It does not prevent complications like gingival hyperplasia or hepatotoxicity, which are more directly related to phenytoin’s pharmacological effects and monitoring needs.
Choice B reason: Phenytoin does not eliminate seizure auras, which are sensory warnings due to focal cortical activity. It stabilizes neuronal membranes via sodium channel blockade, reducing seizure frequency but not preventing prodromal symptoms like auras.
Choice C reason: Not driving is appropriate, as phenytoin can cause dizziness or ataxia, impairing motor coordination. However, this is a safety precaution, not the most comprehensive indicator of understanding the need for long-term adherence to prevent seizure recurrence.
Choice D reason: Continuing phenytoin even after seizures stop is critical, as abrupt cessation can cause rebound seizures due to unopposed neuronal excitability. This reflects understanding of lifelong therapy needs for status epilepticus to maintain seizure control and prevent recurrence.

A. The seizure lasts more than 5 minutes. B. The child is sleepy and lethargic after the seizure. C. The child fell at the onset of the seizure. D. The child is confused and has slurred speech after the seizure.

Correct Answer is A

Explanation

Choice A reason: A seizure lasting over 5 minutes is considered status epilepticus, a medical emergency requiring immediate intervention to prevent brain hypoxia or injury. Prolonged seizures increase glutamate release, causing excitotoxicity, neuronal damage, and systemic complications like respiratory failure, necessitating urgent 911 response.
Choice B reason: Postictal sleepiness and lethargy are common after generalized seizures due to neuronal exhaustion and temporary metabolic changes in the brain. This is expected and not an emergency unless prolonged or accompanied by other concerning symptoms like respiratory distress.
Choice C reason: Falling at seizure onset is typical in generalized seizures due to loss of muscle control. Unless injury (e.g., head trauma) is suspected, it does not warrant an immediate 911 call, as it is a common seizure manifestation.
Choice D reason: Postictal confusion and slurred speech are normal after a generalized seizure, reflecting temporary cortical dysfunction. These resolve within minutes to hours and do not require emergency services unless persistent or associated with other critical symptoms like unresponsiveness.

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The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin), the nurse assesses the client’s understanding. Which statement by the client indicates a correct understanding of the teaching?

Correct Answer is D

Explanation

An adolescent has just had a generalized seizure and collapsed in the school nurse’s office. When should the nurse call 911?

Correct Answer is A

Explanation

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A nurse is planning postoperative care for a client following a total hip arthroplasty. What nursing interventions would help prevent venous thromboembolism for this client? (Select all that apply)

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A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, “The cast is loose enough to slide off.” How would the nurse respond?

A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching?

What statement by a patient’s mother leads the nurse to determine she understands instructions about administering an oral antibiotic for otitis media?

A nurse is providing education to a community women’s group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply)

What does the nurse explain to parents of a child with febrile seizures?