Question

The nurse is administering sucralfate to a client with stomatitis secondary to chemotherapy. The client wants to take the medication after breakfast. How should the nurse respond?

Answer 1

Correct Answers:

Explain the need to take the medication at least 1 hour before meals.

Rationale :

💜 Sucralfate is a gastrointestinal mucosal-protective medication that forms a protective barrier over irritated or ulcerated tissue.

💜 Sucralfate works most effectively when administered on an empty stomach, allowing the medication to contact and adhere to the affected mucosal surface.

💜 The medication is generally administered 1 hour before meals and at bedtime, according to the prescribed regimen.

💜 Taking sucralfate before eating allows the medication to establish its protective coating before food enters the gastrointestinal tract.

💜 For this client, sucralfate can provide a protective coating over irritated mucosal tissue associated with chemotherapy-induced stomatitis.

💜 Food can interfere with the medication's ability to adequately bind to and coat the affected mucosa, reducing its therapeutic effectiveness.

💜 The nurse should also consider medication interactions because sucralfate can decrease the absorption of other oral medications, requiring appropriate separation of administration times.

💜 Teaching the client to take sucralfate at least 1 hour before meals promotes maximum mucosal protection and therapeutic benefit.

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Answer 2

Correct Answers:

Explain that the client should not use the discus more than twice daily.

Rationale :

🧿 The fluticasone/salmeterol discus combines an inhaled corticosteroid with a long-acting beta₂-agonist (LABA) for maintenance treatment of asthma.

🧿 Fluticasone decreases chronic airway inflammation, while salmeterol provides prolonged bronchodilation to help prevent asthma symptoms.

🧿 This medication is intended for scheduled maintenance therapy, not for frequent use whenever symptoms occur.

🧿 The discus is commonly prescribed as one inhalation twice daily, usually about 12 hours apart.

🧿 Using additional doses can increase the risk of excessive salmeterol exposure, which may cause tachycardia, tremor, palpitations, and other adverse effects.

🧿 The client should use a separate short-acting rescue inhaler, such as albuterol, for sudden bronchospasm unless another rescue plan is prescribed.

🧿 After using the fluticasone-containing discus, the client should rinse the mouth with water and spit it out to reduce the risk of oral candidiasis.

🧿 Caregivers should therefore reinforce the prescribed twice-daily schedule and recognize that needing more frequent medication may indicate poor asthma control requiring clinical evaluation.

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Answer 3

Correct Answers:

0.64

Rationale :

Dose ordered ÷ Dose available × Volume available

💉 Dose ordered = 40 mg

💉 Dose available = 125 mg

💉 Volume available = 2 mL

💉 40 mg ÷ 125 mg × 2 mL

💉 0.32 × 2 mL

💉 = 0.64 mL

✅ Final Answer: 0.64 mL

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Answer 4

Correct Answers:

Vomiting. dizziness. restlessness, and palpitations.

Rationale :

♦️ Theophylline is a methylxanthine bronchodilator that relaxes bronchial smooth muscle and can improve airflow in clients with chronic obstructive pulmonary disease.

♦️ Theophylline has a narrow therapeutic index, meaning relatively small increases in serum concentration can produce significant toxicity.

♦️ Early gastrointestinal manifestations of toxicity commonly include nausea, vomiting, and abdominal discomfort.

♦️ Central nervous system stimulation can cause restlessness, nervousness, insomnia, headache, dizziness, and tremors.

♦️ Cardiovascular stimulation can produce tachycardia and palpitations, which may progress to serious cardiac dysrhythmias as toxicity becomes more severe.

♦️ Severe theophylline toxicity can cause seizures and life-threatening ventricular dysrhythmias, making early recognition particularly important.

♦️ The nurse should monitor serum theophylline concentrations and recognize that factors such as medication interactions, illness, and impaired clearance can increase toxicity risk.

♦️ Vomiting combined with restlessness and palpitations is therefore highly characteristic of theophylline toxicity and warrants prompt evaluation.

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Answer 5

Correct Answers:

High-density lipoprotein (HDL).

Rationale :

🫀 Atorvastatin is an HMG-CoA reductase inhibitor used to improve lipid levels and reduce the risk of atherosclerotic cardiovascular disease.

🫀 The primary therapeutic effect of atorvastatin is a significant decrease in LDL cholesterol, while it can also produce a modest increase in HDL cholesterol.

🫀 HDL is commonly called the “good cholesterol” because higher levels are generally associated with reduced cardiovascular risk.

🫀 HDL participates in reverse cholesterol transport, carrying cholesterol away from peripheral tissues toward the liver for processing and elimination.

🫀 Therefore, an increase in HDL represents a desirable change in the client's lipid profile.

🫀 Atorvastatin also commonly decreases total cholesterol and triglyceride levels, further reducing atherosclerotic risk.

🫀 Lipid panels are monitored during therapy to determine whether the client is achieving the desired lipid-lowering response.

🫀 Among the laboratory values listed, increased HDL is the only increase that represents a desired therapeutic effect of atorvastatin.

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Answer 6

Correct Answers:

Take the first dose at bedtime.
Get up slowly from a sitting position.
Contact the clinic if palpitations occur.

Rationale :

🌸 Take the first dose at bedtime — CORRECT

🌸 Terazosin is an alpha₁-adrenergic blocker that relaxes smooth muscle in the prostate and bladder neck, improving urinary flow in clients with BPH.

🌸 Alpha₁ blockade also causes peripheral vasodilation, which can lower blood pressure.

🌸 The medication can produce a pronounced first-dose effect, especially when therapy is initiated.

🌸 This first-dose effect may cause orthostatic hypotension, dizziness, weakness, or syncope.

🌸 Taking the first dose at bedtime decreases the risk of injury if dizziness or fainting occurs.

🌸 The client should avoid driving or performing hazardous activities until the response to the medication is known.

🌸 Blood pressure should be monitored during initiation and dose adjustments because hypotension may occur.

🌸 Bedtime administration is therefore an important safety strategy when beginning terazosin therapy.

🌸 Get up slowly from a sitting position — CORRECT

🌸 Terazosin can cause orthostatic hypotension when the client changes position quickly.

🌸 Rising slowly gives the cardiovascular system time to adjust to changes in blood pressure.

🌸 The client should first sit at the edge of the bed before standing, especially after lying down for a prolonged period.

🌸 Sudden standing can cause dizziness, lightheadedness, or syncope.

🌸 Older adults may be particularly vulnerable to falls associated with alpha-blocker therapy.

🌸 The client should use support when standing if dizziness occurs.

🌸 Adequate fall-prevention teaching is especially important during the first several days of therapy.

🌸 Slow position changes help reduce the risk of injury from hypotension-related falls.

🌸 Contact the clinic if palpitations occur — CORRECT

🌸 Terazosin can cause reflex tachycardia or palpitations as a response to peripheral vasodilation.

🌸 Palpitations may indicate an exaggerated cardiovascular response to the medication.

🌸 The client should report persistent or significant palpitations to the healthcare provider.

🌸 The nurse should also teach the client to report fainting, severe dizziness, or chest discomfort.

🌸 Cardiovascular symptoms warrant evaluation because dose adjustment may be needed.

🌸 Monitoring is particularly important in clients who also take other antihypertensive medications.

🌸 The nurse should reinforce that new cardiac symptoms should not simply be ignored as expected effects.

🌸 Reporting palpitations allows early assessment for tachycardia or hemodynamic instability.

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Answer 7

Correct Answers:

Report the symptom to the healthcare provider (HCP).

Rationale :

❣️ Ketorolac is a potent nonsteroidal anti-inflammatory drug (NSAID) used for short-term management of moderate to severe acute pain.

❣️ NSAIDs inhibit cyclooxygenase (COX) enzymes, decreasing prostaglandin production that normally helps protect the gastric mucosa.

❣️ Reduced protective prostaglandins can lead to gastric irritation, gastritis, peptic ulceration, and gastrointestinal bleeding.

❣️ New stomach or epigastric pain after ketorolac administration can therefore indicate significant gastrointestinal irritation and should not be dismissed as an expected harmless effect.

❣️ Ketorolac carries a particularly important risk for serious GI ulceration, bleeding, and perforation, which can occur during treatment.

❣️ The nurse should assess for additional warning signs such as hematemesis, coffee-ground emesis, melena, abdominal tenderness, dizziness, or hypotension.

❣️ The nurse should report the client's new stomach pain to the HCP so the medication regimen can be evaluated and further doses withheld or changed if clinically indicated.

❣️ Prompt recognition is important because gastrointestinal complications associated with NSAIDs can progress to hemorrhage or perforation if exposure continues.

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Answer 8

Correct Answers:

Spironolactone

Rationale :

💙 A 15-lb (6.8-kg) weight gain in 24 hours represents severe acute fluid retention and is concerning for worsening heart failure and volume overload.

💙 The client's potassium level is 2.9 mEq/L, which represents significant hypokalemia and must strongly influence the choice of diuretic.

💙 Spironolactone is a potassium-sparing diuretic and aldosterone antagonist that promotes sodium and water excretion while conserving potassium.

💙 Aldosterone blockade can help reduce fluid retention and preload, which is beneficial in selected clients with heart failure.

💙 Unlike loop and thiazide diuretics, spironolactone does not typically worsen potassium depletion and can help raise a low potassium level.

💙 Spironolactone is also an important component of guideline-directed therapy for appropriate clients with heart failure with reduced ejection fraction, where it can improve clinical outcomes.

💙 The nurse should closely monitor potassium and renal function because spironolactone can eventually produce hyperkalemia, particularly when kidney function is impaired or other potassium-raising medications are used.

💙 Given the combination of substantial fluid overload and a potassium of 2.9 mEq/L, spironolactone is the best choice among the medications provided because it promotes diuresis without further potassium loss.

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Answer 9

Correct Answers:

Lansoprazole

Rationale :

💊 Lansoprazole is a proton pump inhibitor (PPI) commonly prescribed to treat gastroesophageal reflux disease and reflux esophagitis.

💊 It works by irreversibly inhibiting the H⁺/K⁺ ATPase proton pump in gastric parietal cells, markedly reducing gastric acid secretion.

💊 Reduced gastric acidity decreases the amount of acid irritating the esophageal mucosa during episodes of reflux.

💊 This reduction helps relieve typical symptoms such as heartburn, acid regurgitation, and epigastric discomfort.

💊 Suppressing acid also allows damaged or inflamed esophageal tissue to heal, making PPIs particularly effective for erosive reflux esophagitis.

💊 Lansoprazole is generally most effective when taken before a meal, commonly before breakfast, because proton pumps become activated with food intake.

💊 Continued therapy can reduce recurrent reflux symptoms and complications associated with prolonged acid exposure, including esophageal ulceration and stricture.

💊 Relief of this client's reflux symptoms is therefore most directly attributable to the acid-suppressing action of lansoprazole.

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Answer 10

Correct Answers:

2.5

Rationale :

💉 Formula:

Dose ordered ÷ Dose available per mL = mL to administer

💉 Dose ordered = 1 mg

💉 Dose available = 0.4 mg/mL

💉 1 mg ÷ 0.4 mg/mL

💉 = 2.5 mL

💉 No additional multiplication is required because the concentration is already expressed per 1 mL.

💉 The answer is already expressed to the nearest tenth.

💉 Therefore, the nurse should administer 2.5 mL.

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QLexNursing

1 :
The nurse is administering sucralfate to a client with stomatitis secondary to chemotherapy. The client wants to take the medication after breakfast. How should the nurse respond?

2 :
To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

3 :
The nurse is preparing to administer methylprednisolone 40 mg IV. The medication vial is labeled "125 mg per 2 mL." How many mL of medication should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest hundredth.)

5 :
An increase in which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

6 :
A client with benign prostatic hypertrophy (BPH) receives a new prescription for terazosin 1 mg PO daily. Which information should the nurse include in the teaching plan? Select all that apply.

🌸 Take the first dose at bedtime — CORRECT

🌸 Get up slowly from a sitting position — CORRECT

🌸 Contact the clinic if palpitations occur — CORRECT

7 :
A client reports "stomach" pain an hour after receiving an oral dose of ketorolac. Which action should the nurse implement?

9 :
A client with reflux esophagitis reports relief of symptoms. The nurse instructs the client that symptom relief is most likely the result of which of the client's prescriptions?

10 :
The nurse plans to administer naloxone 1 mg. The label of the 10 mL vial indicates that the drug concentration is "Naloxone 0.4 mg/mL." How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.) With calculation

QLexNursing

1 : The nurse is administering sucralfate to a client with stomatitis secondary to chemotherapy. The client wants to take the medication after breakfast. How should the nurse respond?

2 : To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

3 : The nurse is preparing to administer methylprednisolone 40 mg IV. The medication vial is labeled "125 mg per 2 mL." How many mL of medication should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest hundredth.)

5 : An increase in which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

6 : A client with benign prostatic hypertrophy (BPH) receives a new prescription for terazosin 1 mg PO daily. Which information should the nurse include in the teaching plan? Select all that apply.

🌸 Take the first dose at bedtime — CORRECT

🌸 Get up slowly from a sitting position — CORRECT

🌸 Contact the clinic if palpitations occur — CORRECT

7 : A client reports "stomach" pain an hour after receiving an oral dose of ketorolac. Which action should the nurse implement?

9 : A client with reflux esophagitis reports relief of symptoms. The nurse instructs the client that symptom relief is most likely the result of which of the client's prescriptions?

10 : The nurse plans to administer naloxone 1 mg. The label of the 10 mL vial indicates that the drug concentration is "Naloxone 0.4 mg/mL." How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.) With calculation

1 :
The nurse is administering sucralfate to a client with stomatitis secondary to chemotherapy. The client wants to take the medication after breakfast. How should the nurse respond?

2 :
To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

3 :
The nurse is preparing to administer methylprednisolone 40 mg IV. The medication vial is labeled "125 mg per 2 mL." How many mL of medication should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest hundredth.)

5 :
An increase in which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

6 :
A client with benign prostatic hypertrophy (BPH) receives a new prescription for terazosin 1 mg PO daily. Which information should the nurse include in the teaching plan? Select all that apply.

7 :
A client reports "stomach" pain an hour after receiving an oral dose of ketorolac. Which action should the nurse implement?

9 :
A client with reflux esophagitis reports relief of symptoms. The nurse instructs the client that symptom relief is most likely the result of which of the client's prescriptions?

10 :
The nurse plans to administer naloxone 1 mg. The label of the 10 mL vial indicates that the drug concentration is "Naloxone 0.4 mg/mL." How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.) With calculation