The practical nurse (PN) is caring for a client with costochondritis who is now experiencing increased discomfort in breathing. The client receives a prescription for meloxicam. Which intervention should the PN include in the client’s POC?
Ensure peak and trough serum levels are collected with the third medication dose
Reassess the client’s pain 30 minutes after medication administration
Observe the client daily for involuntary movements of the lips and tongue
Initiate strict intake and output measurements and record every shift
The Correct Answer is B
Choice A reason: Peak and trough levels are relevant for drugs like vancomycin, not meloxicam, an NSAID. Meloxicam’s efficacy is assessed clinically via pain reduction, not blood levels, as it inhibits inflammation-causing prostaglandins, making this choice irrelevant for costochondritis management.
Choice B reason: Reassessing pain 30 minutes after meloxicam administration evaluates its effectiveness, as this NSAID reduces cyclooxygenase activity, decreasing prostaglandin-mediated pain and inflammation in costochondritis. Timely reassessment ensures adequate relief, guiding further interventions for breathing discomfort, making this the appropriate intervention.
Choice C reason: Involuntary lip and tongue movements are linked to antipsychotics causing tardive dyskinesia, not meloxicam. This NSAID does not affect neurological pathways causing movement disorders. Monitoring for this is irrelevant, as meloxicam’s primary risks are gastrointestinal, not neurological.
Choice D reason: Strict intake and output monitoring is unnecessary for meloxicam, which targets inflammation, not fluid balance. While long-term use may affect renal function, pain reassessment is more immediate for costochondritis, making this choice less relevant than evaluating therapeutic pain relief.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Stopping disulfiram for nausea or vomiting is incorrect, as these are expected in alcohol reactions, not side effects warranting discontinuation. Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde buildup if alcohol is consumed, leading to these symptoms, which reinforce alcohol avoidance.
Choice B reason: Avoiding all alcohol, including in cough syrups, is critical, as disulfiram causes severe reactions (flushing, nausea) by blocking acetaldehyde metabolism. Even small amounts trigger symptoms, reinforcing abstinence in alcohol dependence treatment, making this the most important instruction for safety and efficacy.
Choice C reason: Taking disulfiram at the same time daily promotes adherence but is less critical than avoiding alcohol, which directly prevents severe reactions. Consistency aids therapeutic levels, but alcohol exposure poses immediate health risks, making this instruction secondary.
Choice D reason: Weekly blood tests are not standard for disulfiram, as therapeutic levels are not routinely monitored, and sodium is unaffected. Liver function may be checked periodically, but alcohol avoidance is the priority to prevent acute reactions, making this choice incorrect.
Correct Answer is D
Explanation
Choice A reason: Ankle circumference monitors edema, which mannitol reduces by drawing fluid from tissues. However, this is secondary to urinary output, as mannitol’s primary action is diuresis, increasing urine production to reduce intracranial or intraocular pressure, making edema measurement less critical.
Choice B reason: Heart rate is relevant for overall monitoring but not the primary outcome for mannitol, which acts as an osmotic diuretic. Cardiovascular effects are secondary, and mannitol’s efficacy is better assessed by urine output, which directly reflects its diuretic mechanism.
Choice C reason: Dietary intake is unrelated to mannitol’s therapeutic effect. Mannitol pulls fluid into the bloodstream, increasing urine output, not influenced by diet. Monitoring intake may be relevant for other conditions, but it is not critical for assessing mannitol’s diuretic action.
Choice D reason: Urinary output is the most important outcome, as mannitol, an osmotic diuretic, increases urine production by drawing fluid into the renal tubules, reducing intracranial or intraocular pressure. Adequate output (e.g., >30 mL/hour) confirms efficacy, preventing fluid overload or renal complications.
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