A client is prescribed ondansetron for nausea. When reviewing the client's medical history, which finding would concern the nurse?

Cerebral Vascular Accident

Depression

Glaucoma

Congestive Heart Failure

Answer and Explanation

The Correct Answer is C

A) Cerebral Vascular Accident (CVA): While a history of a CVA (stroke) is important to consider when prescribing medications, ondansetron is not contraindicated for clients with a history of CVA. The nurse would need to assess the client’s overall neurological status and risk factors but this condition is not an immediate concern for ondansetron use.

B) Depression: Ondansetron is not typically contraindicated in patients with depression. However, the nurse should be mindful of the potential for interactions with other medications the client may be taking for depression, but there is no direct contraindication between ondansetron and depression itself.

C) Glaucoma: This is the most concerning finding. Ondansetron can increase the risk of complications in clients with glaucoma, particularly narrow-angle glaucoma. Ondansetron has some serotonin receptor-blocking properties that can cause dilation of the pupil, which could increase intraocular pressure in clients with glaucoma. Therefore, this condition would require careful monitoring, and the nurse would need to consult with the healthcare provider before administering ondansetron to a client with glaucoma.

D) Congestive Heart Failure (CHF): While patients with CHF need to be monitored for fluid balance, ondansetron is not contraindicated in clients with CHF. The primary concern in these patients would be potential fluid retention or electrolyte imbalances, but this is generally not a direct concern for the administration of ondansetron itself.

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Correct Answer is D

Explanation

A) "I will wash the inhaler once a week with running warm water.": This statement is accurate. It is important to wash the inhaler, especially the mouthpiece, at least once a week to prevent the build-up of medication residue and ensure proper function. The recommendation of using warm water is appropriate, and washing weekly is commonly advised by healthcare providers.

B) "I will administer the second puff 1 minute following the first puff.": This is correct. When using a metered-dose inhaler, it is recommended to wait about 1 minute between puffs to allow the medication to be inhaled properly and for the first dose to be fully delivered before administering the second dose. This ensures that each dose is effective.

C) "I will rinse my mouth with water or mouthwash after inhaler use.": This is a correct statement, particularly for inhaled corticosteroids. Rinsing the mouth after using an inhaler helps prevent the development of oral thrush and other side effects such as irritation or infection. It’s also a good habit to remove any leftover medication from the mouth.

D) "I will take slow deep breaths while activating the inhaler.": This statement indicates the need for additional education. The correct technique involves inhaling slowly and deeply after activating the inhaler, not while activating it. If the client exhales forcefully while pressing the inhaler, they may not be able to inhale the medication effectively. It is crucial that the client activates the inhaler and then takes a slow, deep breath to ensure the medication is delivered properly into the lungs.

A. Cut the 50 mcg/hr patch in half to obtain 25 mcg/hr dosing B. Ask pharmacy to send a 25 mcg/hr transdermal patch C. Contact the healthcare provider and request to increase the dose to 50 mcg/hr D. Remove the previous patch and apply the 50 mcg/hr patch in a different location

Correct Answer is B

Explanation

A) Cut the 50 mcg/hr patch in half to obtain 25 mcg/hr dosing: Cutting a fentanyl patch in half is not recommended because it can lead to inconsistent dosing. The patches are designed to release medication at a controlled rate, and cutting them could cause the medication to be released too quickly or unevenly, which could result in overdose or insufficient relief of pain. It’s essential to follow the manufacturer's guidelines and avoid altering the patch.

B) Ask pharmacy to send a 25 mcg/hr transdermal patch: The best course of action is to ask the pharmacy to send the correct 25 mcg/hr transdermal patch. This ensures that the patient receives the prescribed dose in the most accurate and safe manner. The 25 mcg/hr patch is formulated to deliver the correct amount of medication, and it will avoid any risk associated with altering the patch.

C) Contact the healthcare provider and request to increase the dose to 50 mcg/hr: Requesting an increase in the dose is premature without a clear justification from the healthcare provider. The healthcare provider decreased the dose to 25 mcg/hr for a reason, possibly due to side effects, effectiveness, or other clinical factors. Altering the prescribed dose without a proper review would be inappropriate. The nurse should follow the current prescribed dose and resolve the issue by requesting the correct patch from the pharmacy.

D) Remove the previous patch and apply the 50 mcg/hr patch in a different location: Switching to the 50 mcg/hr patch without approval could lead to administering an incorrect dose of fentanyl, which can increase the risk of overdose or severe side effects like respiratory depression. The nurse should adhere to the prescribed 25 mcg/hr dose and request the correct patch from the pharmacy rather than substituting with a higher dose patch.

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Laboratory Test	Result	Normal Range
Sodium	146 mEq/dL	135-145 mEq/L
Calcium	8.2 mg/dL	8.4-10.2 mg/dL
Magnesium	1.2 mg/dL	1.6-2.2 mg/dL
Gastric pH	6	1-4

A client is prescribed ondansetron for nausea. When reviewing the client's medical history, which finding would concern the nurse?

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Naxlex Comprehensive Predictor Exams

You are providing education to newly diagnosed asthma client on metered-dose inhaler use. Which statement by the client would indicate the need for additional education?

Correct Answer is D

Explanation

The healthcare provider decreased the ordered dose of fentanyl to 25 mcg/hr transdermal patch. The pharmacy delivers a 50 mcg/hr patch to the nurse when the next dose is scheduled. What is the best action by the nurse?

Correct Answer is B

Explanation

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