A nurse is caring for a client who has recurrent kidney stones and a history of diabetes mellitus.
The client is scheduled for an intravenous Pyelogram (IVP). The nurse should collect additional data about which of the following statements made by the client?

“I haven’t had anything to eat or drink since last night.”

“The last time I voided it was painful.”

“I took my metformin before breakfast.”

“I took a laxative yesterday.”

Answer and Explanation

The Correct Answer is C

Choice A rationale:

The client stating, “I haven’t had anything to eat or drink since last night” is not a cause for concern. This is because patients are often advised to fast before undergoing certain medical procedures or tests, including an intravenous pyelogram (IVP).

Fasting helps to ensure that the test results are accurate and not influenced by recent food or drink consumption.

Choice B rationale:

The client expressing that “The last time I voided it was painful” could be related to their recurrent kidney stones. Kidney stones can cause discomfort or pain during urination. However, this statement does not necessarily require additional data collection in the context of an IVP. The pain could be a symptom of the kidney stones rather than a contraindication for the IVP1.

Choice C rationale:

The statement “I took my metformin before breakfast” is of concern. Metformin is a medication used to treat type 2 diabetes. It is important for the nurse to collect additional data about this statement because metformin can potentially interact with the iodine-based contrast dye used in an IVP. This interaction can increase the risk of lactic acidosis, a serious and potentially lifethreatening condition. Therefore, patients are often advised to stop taking metformin before and for a couple of days after having an IVP12. Choice D rationale:

The client mentioning, “I took a laxative yesterday” is not necessarily alarming. Laxatives are often used before an IVP to clear the bowels, which helps to ensure clear images during the procedure. Therefore, this statement does not require additional data collection in the context of an IVP1.

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Correct Answer is D

Explanation

Choice A rationale:

Aspirin is known as a salicylate and a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking a certain natural substance in your body to reduce pain and swelling. However, one of the key reasons aspirin is administered to a patient with a history of myocardial infarction (MI) is due to its antiplatelet aggregate properties. This effect reduces the risk of stroke and heart attack. If a patient has recently had surgery on clogged arteries (such as bypass surgery, carotid endarterectomy, coronary stent), doctors may direct them to use aspirin in low doses as a “blood thinner” to prevent blood clots.

Choice B rationale:

While aspirin does have analgesic properties, meaning it can relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches, this is not the primary reason it would be administered to a patient with a history of MI. The main goal in this context is to prevent further cardiac events, which is achieved through aspirin’s antiplatelet effects.

Choice C rationale:

Aspirin does have anti-inflammatory properties and it may be used to reduce pain and swelling in conditions such as arthritis. However, in the context of a patient with a history of MI, the anti-inflammatory property is not the primary reason for administering aspirin. The key purpose is to leverage its antiplatelet effects to prevent further cardiac events.

Choice D rationale:

Aspirin can be used to reduce fever, which is what the term ‘antipyretic’ refers to. However, similar to the analgesic and antiinflammatory properties, the antipyretic property is not the primary reason for administering aspirin to a patient with a history of MI. The main goal is to prevent further cardiac events through its antiplatelet effects.

A. Hold the drug, and administer 4 hours later. B. Administer the vancomycin as ordered. C. Hold the drug, and notify the prescriber. D. Repeat the test to verify results.

Correct Answer is C

Explanation

Choice A rationale:

Holding the drug and administering it 4 hours later is not the appropriate action. The trough vancomycin level of 24 mcg/mL is higher than the recommended range of 10-20 mcg/mL, indicating potential risk for toxicity. Administering the drug later does not address the immediate concern of a high trough level.

Choice B rationale:

Administering the vancomycin as ordered is not the correct action in this case. The trough level is above the recommended range, which could lead to vancomycin toxicity. The nurse should not administer the medication without addressing the high trough level. Choice C rationale:

This is the correct action. The nurse should hold the drug and notify the prescriber because the trough vancomycin level is higher than the recommended range. The prescriber can then make a decision based on this information, which may include adjusting the dose, extending the dosing interval, or ordering additional tests.

Choice D rationale:

While repeating the test to verify results might be done eventually, it should not be the immediate next step. The nurse has a responsibility to ensure patient safety, and with a trough level above the recommended range, the priority is to prevent potential toxicity. Therefore, the nurse should hold the drug and notify the prescriber.

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A nurse is caring for a client who has recurrent kidney stones and a history of diabetes mellitus. The client is scheduled for an intravenous Pyelogram (IVP). The nurse should collect additional data about which of the following statements made by the client?

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Naxlex Comprehensive Predictor Exams

When a patient is undergoing aminoglycoside therapy, which indicators should the nurse monitor for potential toxicity?

Correct Answer is D

Explanation

The nurse checks the patient’s laboratory work prior to administering a dose of vancomycin and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next?

Correct Answer is C

Explanation

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections?

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A nurse is caring for a client who has recurrent kidney stones and a history of diabetes mellitus.
The client is scheduled for an intravenous Pyelogram (IVP). The nurse should collect additional data about which of the following statements made by the client?