A client has a new prescription for zolpidem, a hypnotic. The client tells the home health nurse that he plans to take a dose of the medication during the day because he is exhausted and needs to take a short afternoon nap prior to an evening activity in his home. Which action should the nurse take?

Encourage the client to wait until bedtime to take the medication.

Remind the client to drink plenty of fluids when taking the medication.

Advise the client to take the medication with the noon meal.

Explain that the client needs to allow for sleep time of at least two hours.

Answer and Explanation

The Correct Answer is A

Choice A reason: Zolpidem is a hypnotic drug that induces sleep by enhancing the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. Zolpidem is used to treat insomnia, or difficulty falling asleep or staying asleep. Zolpidem should be taken only at bedtime, when the client is ready to go to sleep and can devote at least seven to eight hours for uninterrupted sleep. Taking zolpidem during the day can cause excessive sedation, drowsiness, confusion, memory loss, and impaired coordination. Therefore, the nurse should encourage the client to wait until bedtime to take the medication and avoid daytime naps.

Choice B reason: Reminding the client to drink plenty of fluids when taking the medication is not an action that the nurse should take in this situation, but rather a general recommendation that applies to most medications. Drinking fluids can help to prevent dehydration, flush out toxins, and maintain kidney function. However, drinking fluids is not specific to zolpidem and does not affect its absorption or metabolism.

Choice C reason: Advising the client to take the medication with the noon meal is not an action that the nurse should take in this situation, but rather a harmful suggestion that can reduce the effectiveness of zolpidem and increase its side effects. Taking zolpidem with food can delay its onset of action and make it less potent. Taking zolpidem at noon can also interfere with the client's circadian rhythm, or natural sleep-wake cycle, and cause daytime sleepiness and nighttime insomnia.

Choice D reason: Explaining that the client needs to allow for sleep time of at least two hours is not an action that the nurse should take in this situation, but rather an inaccurate and insufficient information that can mislead the client and endanger their safety. Zolpidem has a half-life of about two hours, which means that half of its dose is eliminated from the body in two hours. However, this does not mean that its effects wear off in two hours. Zolpidem can still cause residual sedation and impairment for several hours after taking it. The client needs to allow for sleep time of at least seven to eight hours when taking zolpidem, not just two hours.

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Correct Answer is C

Explanation

Choice B reason: Epoetin alfa is a synthetic form of erythropoietin, a hormone that stimulates the production of red blood cells (RBCs) in the bone marrow. Epoetin alfa is used to treat anemia, or low RBC count, which can be caused by CKD, chemotherapy, HIV infection, or other conditions. Anemia can cause symptoms such as weakness, fatigue, shortness of breath, pale skin, and chest pain. Hemoglobin is the protein in RBCs that carries oxygen throughout the body. The normal range of hemoglobin for males is 14 to 18 g/dL (8.7 to 11.2 mmol/L). Therefore, an increase in hemoglobin from below normal to within normal indicates that epoetin alfa has been effective in increasing RBC production and improving oxygen delivery. The nurse should monitor the client's hemoglobin level regularly and adjust the dose of epoetin alfa as needed.

Choice A reason:While iron therapy supports the effectiveness of epoetin alfa by providing the necessary substrate for erythropoiesis, tolerating iron therapy is not an indicator of epoetin alfa's efficacy.

Choice C reason: Epoetin alfa is used to treat anemia associated with chronic kidney disease (CKD) by stimulating erythropoiesis (red blood cell production). The primary measure of its effectiveness is an increase in hemoglobin (Hgb) levels toward the target range. The hemoglobin level increasing to 12 g/dL (7.45 mmol/L) reflects a significant improvement from an anemic state and is within the target range for patients receiving epoetin alfa therapy (generally 10–12 g/dL). This is the most objective and definitive indicator of the medication's effectiveness.

Choice D reason: Taking concurrent iron therapy without adverse effects is not a finding that best indicates that the medication is effective, but rather a preventive measure that can reduce the risk of iron deficiency and improve the efficacy of epoetin alfa. Iron therapy refers to taking oral or intravenous iron supplements to increase iron levels in the blood. Iron therapy can cause side effects such as nausea, vomiting, constipation, diarrhea, dark stools, metallic taste, or allergic reactions. The nurse should instruct the client on how to take iron therapy safely and monitor for any adverse effects.

A. Instruct the client that it is necessary to take nothing but water with the medication. B. Assign an unlicensed assistive personnel (UAP) to bring the client a glass of low fat milk. C. Withhold the medication until the client's breakfast tray is available on the unit. D. Consult with a pharmacist about scheduling the dose one hour after the client eats.

Correct Answer is A

Explanation

Choice A reason: Risedronate is a bisphosphonate that is used to treat osteoporosis by inhibiting bone resorption. It should be taken on an empty stomach with a full glass of water at least 30 minutes before any other food, beverage, or medication. This is because food, milk, and antacids can interfere with the absorption of risedronate and reduce its effectiveness.

Choice B reason: Milk contains calcium, which can bind to risedronate and prevent its absorption. Therefore, the client should not drink milk with or within 2 hours of taking risedronate.

Choice C reason: Withholding the medication until the client's breakfast tray is available is not appropriate, as it would delay the administration of risedronate and disrupt the dosing schedule. The client should take risedronate as soon as possible after waking up and before eating anything.

Choice D reason: Consulting with a pharmacist about scheduling the dose one hour after the client eats is not necessary, as risedronate should be taken at least 30 minutes before any food or beverage. Taking risedronate one hour after eating may not ensure adequate absorption of the drug.

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Naxlex Comprehensive Predictor Exams

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective? Hemoglobin (Hgb) [Reference Range: Male: 14 to 18 g/dL (8.7 to 11.2 mmol/L)]

Correct Answer is C

Explanation

The nurse administers risedronate to a client with osteoporosis at 0700. The client asks for a glass of milk to drink with the medication. Which action should the nurse take?

Correct Answer is A

Explanation

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