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A nurse is assessing a client after administering phenytoin IV bolus for a seizure. Which of the following findings should the nurse identify as an adverse effect of this medication?

Red man syndrome

Hypotension

Hypoglycemia

Bradycardia

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Red man syndrome is associated with vancomycin, not phenytoin.

Choice B rationale:

Hypotension, or low blood pressure, can be an adverse effect of phenytoin.

Choice C rationale:

Hypoglycemia is not a typical adverse effect of phenytoin.

Choice D rationale:

Bradycardia is not a common adverse effect of phenytoin.

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Correct Answer is A

Explanation

- A) Alcohol use disorder is a contraindication for acetaminophen due to the increased risk of liver damage, especially in the case of chronic alcoholism or liver diseases.
- B) Chronic kidney disease is not an absolute contraindication but requires caution. Dosing intervals may need to be adjusted due to altered excretion.
- C) Receiving a Hepatitis B vaccine within the last week is not a contraindication for acetaminophen.
- D) Diabetes mellitus is not a contraindication for acetaminophen. Patients with diabetes should be aware of sugar content in liquid formulations, but it does not preclude the use of the medication.

A. The nurse flushed the client's IV line with dextrose 5% in water before and after the medication was administered. B. The client's absolute neutrophil count was 2.500/mm3 before the medication was administered. C. The client had chemotherapy 12 hr before the medication was administered. D. The medication vial sat at room temperature for 2 hr before it was administered.

Correct Answer is D

Explanation

A: Flushing an IV line with dextrose 5% in water before and after medication administration is a common practice to ensure that the medication is delivered properly and to prevent interactions in the IV line. This would not typically require an incident report.
B: An absolute neutrophil count of 2.500/mm3 is within the normal range for patients undergoing chemotherapy and would not typically necessitate an incident report.
C: Having chemotherapy 12 hours before the administration of filgrastim does not contraindicate its use and is within the appropriate time frame as filgrastim is often given after chemotherapy to help recover white blood cell counts.
D: According to the guidelines, filgrastim should be stored in the refrigerator and allowing it to sit at room temperature for 2 hours could compromise its effectiveness. This is a deviation from the medication's storage requirements and could potentially harm the patient, thus an incident report should be filed.

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A nurse is assessing a client after administering phenytoin IV bolus for a seizure. Which of the following findings should the nurse identify as an adverse effect of this medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of an adult client who has a fever and a prescription for acetaminophen. Which of the following findings should the nurse identify as a contraindication for receiving this medication?

Correct Answer is A

Explanation

A nurse recently administered filgrastim intravenously to a client who has ccer and is receiving cytotoxic chemotherapy. For which of the following data, discovered after the medication was administered, should the nurse file an incident report?

Correct Answer is D

Explanation

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