The nurse is working on a neurosurgery unit. The patient calls the desk to complain that his arm is really burning and feels hot. The patient is receiving IV phenytoin for his grand mal seizures. What is the nurse's best action?
Call the health carer provider immediately to change the medication to oral.
Continue the infusion and reassure the patient.
Flush the line with 10 mL of normal saline and continue the infusion.
Discontinue the IV and restart the IV infusion in a different site
The Correct Answer is D
A. Call the health care provider immediately to change the medication to oral.
Changing the medication to oral may not address the immediate issue of the burning sensation and feeling of heat at the IV site. This option focuses on changing the route of administration rather than addressing the current discomfort.
B. Continue the infusion and reassure the patient.
Continuing the infusion without addressing the patient's discomfort could lead to potential complications, and it is important to prioritize patient comfort and safety. Reassurance alone may not be sufficient if there is an issue with the IV site.
C. Flush the line with 10 mL of normal saline and continue the infusion.
While flushing the line with normal saline is a good practice to ensure patency, it may not resolve the issue if there is ongoing irritation or infiltration at the site. Continuing the infusion without addressing the patient's complaint might lead to further discomfort.
D. Discontinue the IV and restart the IV infusion in a different site.
This is the best action. Discontinuing the IV allows the nurse to assess the current site for signs of infiltration or irritation. Restarting the IV in a different site addresses the immediate issue, ensuring that the medication is delivered safely and effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Increase the amount of dopamine and reduce the amount of acetylcholine:
This is the correct answer. Parkinson's disease is characterized by a deficiency of dopamine, so medications aim to increase dopamine levels. Additionally, reducing the activity of acetylcholine helps to restore the balance between these neurotransmitters.
B. Increase the amount of dopamine and acetylcholine:
This is not accurate. Increasing both dopamine and acetylcholine would not address the underlying imbalance seen in Parkinson's disease.
C. Reduce the amount of dopamine and increase the amount of acetylcholine:
This is incorrect. Parkinson's disease involves a reduction in dopamine levels, so reducing dopamine further would worsen the symptoms. Additionally, increasing acetylcholine is not the therapeutic goal in Parkinson's disease.
D. Reduce the amount of dopamine and acetylcholine:
This is not the correct approach. Decreasing both dopamine and acetylcholine would exacerbate the symptoms of Parkinson's disease, as the primary issue is the deficiency of dopamine.
Correct Answer is D
Explanation
A. "I may experience urinary retention, dry mouth, and constipation."
This statement is accurate. Urinary retention, dry mouth, and constipation are common side effects of carbidopa-levodopa. The patient should be aware of these potential side effects and report them to the healthcare provider if they become problematic.
B. "I may feel dizzy at first, but this side effect will go away with time."
This statement is accurate. Dizziness is a common initial side effect of carbidopa-levodopa, and it often improves with continued use. The patient should be encouraged to report persistent dizziness to the healthcare provider.
C. "I should report nightmares and mental disturbances to my provider."
This statement is accurate. Nightmares and mental disturbances can be side effects of carbidopa-levodopa. The patient should report these symptoms to the healthcare provider for further evaluation and potential adjustments to the medication.
D. "I should take the drug with food to increase absorption."
This statement indicates a need for further teaching. Carbidopa-levodopa is best absorbed when taken on an empty stomach. Taking it with food, especially high-protein meals, can reduce its absorption. The patient should be instructed to take the medication at least 30 minutes before meals or one to two hours after meals for optimal effectiveness.
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