When administering an intravenous infusion of monoclonal antibodies, it is most important for the nurse to implement which of the following interventions?
Restrict the client’s intake of fluids.
Premedicate the client with morphine.
Stay with the client during the first 15 minutes of the infusion.
Assess the client for the development of ototoxicity.
The Correct Answer is C
A. Restrict the client’s intake of fluids.
Fluid restriction is not a standard intervention during the administration of monoclonal antibodies.
B. Premedicate the client with morphine.
Morphine is not a standard premedication for monoclonal antibody infusions. Premedication may be used in some cases, but the specific medications used depend on the patient's individual needs and the nature of the monoclonal antibody being administered.
C. Stay with the client during the first 15 minutes of the infusion.
The rationale for staying with the client during the initial part of the infusion is to monitor for any immediate hypersensitivity reactions or infusion-related adverse events, which can sometimes occur early in the infusion process. This allows the nurse to respond promptly if the client experiences any adverse reactions.
D. Assess the client for the development of ototoxicity.
Ototoxicity (hearing loss) is not a common concern with monoclonal antibody infusions. The focus of assessment during the infusion is primarily on immediate hypersensitivity reactions and other infusion-related adverse events.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Explanation:
A. Administer phenergan (Promethazine) 12.5 mg IVP at the first complaint of nausea.
This option suggests waiting until the patient complains of nausea before administering the antiemetic. It is not a proactive approach and may not effectively prevent nausea associated with chemotherapy.
B. Administer ondansetron (Zofran) 4mg IV Push after Ms. Samuels complains of nausea.
Similar to option A, this choice involves waiting for the patient to experience nausea before administering the medication. Again, it is not a proactive strategy for preventing chemotherapy-induced nausea and vomiting.
C. Administer ondansetron (Zofran) 4mg IV push sometime between 1300-1330.
This option is the most appropriate among the given choices. It suggests administering the antiemetic (ondansetron) before the scheduled chemotherapy session. Ondansetron is commonly used as a prophylactic measure to prevent nausea and vomiting associated with chemotherapy.
D. Administer phenergan (Promethazine) 25 mg PO at 1345.
This choice involves administering the antiemetic (phenergan) orally just 15 minutes before the scheduled chemotherapy session. While it is better than waiting for symptoms to appear, oral medications may take some time to be absorbed, and it might not provide as rapid relief as an intravenous (IV) medication.
Correct Answer is C
Explanation
A. "O2 @ 2L NC and titrate to keep SPO2 approximately 88-92%"
While oxygen therapy is essential in COPD exacerbation, the specific target range may vary based on the patient's condition and arterial blood gas values. The nurse may need to assess the patient's response and adjust oxygen accordingly.
B. "Prednisone 20 mg PO daily for one year"
Prescribing prednisone at a dose of 20 mg PO daily for one year seems unusual for the treatment of a COPD exacerbation. Steroid therapy is commonly used in exacerbations, but the duration and dose may vary. This prescription may need clarification.
C. "Albuterol nebulizer treatment q 1 hour prn respiratory distress"
This prescription is consistent with the management of an exacerbation of COPD. Albuterol is a short-acting beta-agonist bronchodilator that is commonly used in the treatment of acute respiratory distress in patients with COPD. The "q 1 hour prn respiratory distress" indicates that the medication can be administered every 1 hour as needed for relief of respiratory distress during the exacerbation.
D. "Cromolyn 20 mg inhaled via nebulization QID"
Cromolyn is a mast cell stabilizer and is not typically a first-line medication for the treatment of COPD exacerbation. This prescription may warrant clarification, especially in the context of an acute exacerbation.
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