A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse?

Take the medication an hour after antacids.

Notify the healthcare provider of lethargy.

Decrease cigarette use to a pack per day.

Monitor for any signs of sexual dysfunction.

None

Answer and Explanation

The Correct Answer is C

Choice A reason: Antacids can interfere with the absorption of cimetidine. It is generally recommended to avoid taking antacids within 1 hour before or after taking cimetidine to ensure optimal absorption. Therefore, taking cimetidine an hour after antacids is appropriate.

Choice B reason: Notifying the healthcare provider of lethargy is a correct statement, as it may indicate a serious side effect of cimetidine. Cimetidine can cause central nervous system effects, such as confusion, drowsiness, headache, and depression. Lethargy may also be a sign of anemia, which is another possible side effect of cimetidine. The nurse should instruct the client to report any unusual symptoms to the healthcare provider and monitor the client's blood count and liver function.

Choice C reason: Smoking has been shown to impair the effectiveness of cimetidine in treating ulcers and can delay healing. The goal should be complete smoking cessation rather than merely reducing cigarette use. Therefore, the statement about decreasing cigarette use to a pack per day indicates a misunderstanding and requires additional instruction by the nurse.

Choice D reason: Monitoring for any signs of sexual dysfunction is a correct statement, as it may indicate another side effect of cimetidine. Cimetidine can cause endocrine effects, such as gynecomastia, impotence, and decreased libido in men, and menstrual irregularities in women. The nurse should instruct the client to inform the healthcare provider if they experience any changes in their sexual function or reproductive health.

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Correct Answer is B

Explanation

The correct answer is b. Liver function laboratory results.

Choice A reason:

Weight change in the last month can be an important factor to consider for a patient's overall health and may be relevant in the context of depression, as significant weight changes can be a symptom of this condition. However, it is not the most critical piece of information before prescribing duloxetine. Duloxetine is not primarily metabolized by the kidneys, and while weight can affect dosing and efficacy, it is not the most crucial factor to consider before starting treatment.

Choice B reason:

Liver function laboratory results are crucial to obtain before prescribing duloxetine because duloxetine is extensively metabolized by the liver. The prescribing information for duloxetine warns of the potential for hepatotoxicity, and hepatic failure has been reported in some cases. Therefore, it is essential to ensure that the patient's liver function is normal before initiating therapy with duloxetine, as impaired liver function could lead to increased levels of the medication in the body and a higher risk of side effects.

Choice C reason:

Recent use of other antidepressants is important to consider avoiding drug interactions, particularly with monoamine oxidase inhibitors (MAOIs), which can lead to serious, life-threatening side effects if taken together with duloxetine. While this information is important, it is not as critical as liver function, because the primary concern with other antidepressants is the timing of medication changes rather than an absolute contraindication.

Choice D reason:

A family history of mental illness can provide valuable information for understanding a patient's background and potential genetic predispositions to certain conditions. However, this information does not directly impact the safety and initial prescribing of duloxetine. It may be more relevant for long-term treatment considerations and prognosis rather than immediate prescription safety.

A. Blood pressure 100/78 mm Hg. B. Double vision. C. Puffy, bleeding gums. D. Chronic insomnia.

Correct Answer is B

Explanation

Choice A reason: This is not an assessment finding that warrants immediate intervention by the nurse. Blood pressure 100/78 mm Hg is within the normal range for an adult, and it does not indicate any adverse effect of phenytoin. The nurse should monitor the blood pressure for any changes, but it is not a priority.

Choice B reason: This is an assessment finding that warrants immediate intervention by the nurse. Double vision, or diplopia, is a sign of phenytoin toxicity, which can occur due to overdose, drug interactions, or impaired metabolism. Double vision can impair the client's vision, balance, and coordination, and increase the risk of falls and injuries. The nurse should stop the phenytoin infusion, if applicable, and notify the healthcare provider. The nurse should also check the serum phenytoin level and other vital signs, and prepare to administer an antidote, such as fosphenytoin, if indicated.

Choice C reason: This is not an assessment finding that warrants immediate intervention by the nurse. Puffy, bleeding gums are a common side effect of phenytoin, which can cause gingival hyperplasia, or overgrowth of the gum tissue. Puffy, bleeding gums are not life-threatening, but they can affect the client's oral hygiene and appearance. The nurse should instruct the client to brush and floss the teeth regularly, and to visit a dentist for dental care.

Choice D reason: This is not an assessment finding that warrants immediate intervention by the nurse. Chronic insomnia is not a common or serious side effect of phenytoin, which is an anticonvulsant that can have sedative effects. Chronic insomnia may be caused by other factors, such as stress, pain, or caffeine intake. The nurse should assess the client's sleep pattern and quality, and provide education and counseling on sleep hygiene and relaxation techniques.

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A client with peptic ulcer disease receives a new prescription for cimetidine. Which statement provided by the client requires additional instruction by the nurse?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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