A nurse in an acute care facility is reviewing medication administration protocol with another nurse. Which of the following information should the nurse include in the review?

Use one client identifier before administering medication

Read medication labels twice before administration.

Document the administration of medications after all assigned clients have been medicated.

Check the clients' allergy bands with each medication administration.

Answer and Explanation

The Correct Answer is D

The correct answer is D. Checking the clients' allergy bands with each medication administration is a safety measure to prevent adverse drug reactions. According to the Healthline website, "Always ask patient about allergies, types of reactions, and severity of reactions" before giving any medication.

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Correct Answer is A

Explanation

Dark red urine following a transurethral resection of the prostate (TURP) can indicate active bleeding or hematoma formation. It is important to notify the provider because further assessment and intervention may be necessary to address the source of the bleeding and prevent complications.

Frequent urge to urinate is expected after a TURP procedure as the bladder recovers and adapts to the changes. This is not a concerning finding and does not require immediate reporting to the provider.

Urine output of 300 mL over 8 hours can be considered adequate, especially in the early postoperative period. The nurse should continue to monitor the client's urinary output, but this finding does not require immediate reporting.

Occasional small clots in the urine can be expected after a TURP procedure due to the healing process and sloughing of tissue. However, if the clots become large or obstructive, or if there is a sudden increase in the frequency of clots, it should be reported to the provider.

A. Tinnitus with ear pain B. Hyperreflexia C. Skin rash with fever D. Diplopia

Correct Answer is C

Explanation

Explanation

C. Skin rash with fever

Stevens-Johnson syndrome (SJS) is a severe and potentially life-threatening hypersensitivity reaction that can occur as a rare side effect of certain medications, including allopurinol.

Monitoring and early recognition of SJS symptoms are crucial for prompt medical.

Skin rash with fever is a hallmark manifestation of Stevens-Johnson syndrome. It often starts with flu-like symptoms such as fever and malaise, followed by the appearance of a widespread, painful, and rapidly progressing rash. The rash typically involves the mucous membranes, including the mouth, nose, and eyes, and can be accompanied by blisters or sores. Prompt reporting of these symptoms is critical for early diagnosis and intervention.

Tinnitus with ear pain in (option A) is incorrect because it is not typically associated with Stevens- Johnson syndrome. It may indicate another condition or side effect unrelated to SJS.

Hyperreflexia, which refers to abnormally increased reflexes, in (option B) is incorrect because it is not a characteristic manifestation of Stevens-Johnson syndrome. It may indicate a neurological condition or reaction to another medication, but it is not specific to SJS.

Diplopia, or double vision, in option (D) is incorrect because it is not commonly associated with Stevens- Johnson syndrome. It may be caused by other ocular or neurological conditions.

In summary, the nurse should instruct the client taking allopurinol to monitor and report the manifestation of a skin rash with fever. This is important because it may indicate the development of Stevens-Johnson syndrome, a severe and potentially life-threatening reaction to the medication. Early recognition and medical intervention are crucial to minimize complications and ensure appropriate treatment.

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A nurse in an acute care facility is reviewing medication administration protocol with another nurse. Which of the following information should the nurse include in the review?

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Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who is 1 day postoperative following a transurethral resection of the prostate. Which of the following findings should the nurse report to the provider?

Correct Answer is A

Explanation

A nurse is reinforcing teaching with a client who is taking allopurinol about the risk for developing Stevens-Johnson syndrome. For which of the following manifestations should the nurse instruct the client to monitor and report?

Correct Answer is C

Explanation

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