A client with a history of schizophrenia, and drug and alcohol abuse is admitted to the hospital for hepatitis. The nurse should contact the healthcare provider before implementing which prescription?

Acetaminophen 650 mg PO PRN.

Olanzapine 30 mg PO at bedtime.

Thiamine, USP 100 mg PO daily.

Ondansetron 8 mg IV PRN.

Answer and Explanation

The Correct Answer is A

Choice A reason: Acetaminophen is hepatotoxic, metabolized by the liver via cytochrome P450 to NAPQI, which depletes glutathione, causing necrosis in hepatitis. A compromised liver from alcohol or viral hepatitis increases toxicity risk, even at standard doses. Contacting the provider ensures safer analgesics, preventing further liver damage in this high-risk client.

Choice B reason: Olanzapine, an antipsychotic, manages schizophrenia by blocking dopamine D2 receptors. It is metabolized by the liver but has low hepatotoxicity risk compared to acetaminophen in hepatitis. No immediate contraindication exists, as it controls psychosis without significantly worsening liver function, making it safe to administer without delay.

Choice C reason: Thiamine (vitamin B1) is essential in hepatitis, particularly with alcohol abuse, preventing Wernicke’s encephalopathy from deficient glucose metabolism. It is liver-safe and beneficial, supporting neurological function without toxicity. Administering thiamine is appropriate, making it unnecessary to contact the provider before implementation.

Choice D reason: Ondansetron, an antiemetic, controls nausea in hepatitis via serotonin 5-HT3 receptor blockade. It is metabolized by the liver but has minimal hepatotoxicity, safe in liver disease. No contraindication exists, as it alleviates symptoms without worsening hepatitis, unlike acetaminophen, which poses significant liver risk.

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Correct Answer is B

Explanation

Choice A reason: Positioning the sterile field at hip level maintains sterility but is not specific to uncircumcised clients. Cleaning the meatus before retracting the foreskin prevents infection by removing bacteria first. This is secondary, per infection control and catheterization procedure standards in nursing practice.

Choice B reason: Cleaning the meatus before retracting the foreskin removes bacteria, reducing infection risk in uncircumcised clients. This sequence ensures sterility before exposing sensitive areas, critical for preventing urinary tract infections, per evidence-based catheterization and infection control protocols in urological nursing care.

Choice C reason: Wiping the meatus in backward strokes is incorrect, as circular strokes from meatus outward are standard to avoid contamination. Cleaning before retracting the foreskin is critical for infection prevention. This violates sterile technique, per catheterization and infection control standards in nursing.

Choice D reason: Advancing the catheter before inflating the balloon is standard but not specific to uncircumcised clients. Cleaning the meatus first addresses foreskin-related infection risks. Balloon inflation timing is universal, per indwelling catheter insertion and urological care protocols in nursing practice.

A. Facilitate a family meeting with the palliative care team. B. Alert the nursing staff of the client’s do not resuscitate wishes. C. Place a certified copy of the living will in the client’s electronic health record (EHR). D. Notify the healthcare provider of the client’s wishes.

Correct Answer is D

Explanation

Choice A reason: Facilitating a family meeting with palliative care discusses end-of-life goals in COPD, where airway obstruction causes respiratory failure. However, notifying the provider of the living will ensures immediate alignment with the client’s wishes, especially on ventilation, addressing the urgent need to respect legal directives in a critical scenario.

Choice B reason: Alerting staff about do-not-resuscitate (DNR) wishes assumes the living will specifies DNR, which requires confirmation. The provider must review the document first, as end-stage COPD necessitates clarity on ventilation preferences to guide urgent care, making notification the priority over premature staff alerts.

Choice C reason: Placing the living will in the EHR ensures documentation but does not immediately affect care. In end-stage COPD with respiratory distress, notifying the provider ensures the client’s wishes, like avoiding intubation, are followed promptly, preventing unwanted interventions, making this more urgent than administrative tasks.

Choice D reason: Notifying the provider of the living will is critical, as it legally specifies the client’s preferences, potentially refusing ventilation in end-stage COPD, where dyspnea results from irreversible obstruction. This ensures treatment respects autonomy, guiding immediate care to align with palliative goals, preventing inappropriate interventions during a crisis.

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A client with a history of schizophrenia, and drug and alcohol abuse is admitted to the hospital for hepatitis. The nurse should contact the healthcare provider before implementing which prescription?

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Naxlex Comprehensive Predictor Exams

Which action should the nurse implement when inserting an indwelling catheter for an uncircumcised male client?

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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