A nurse is explaining to a client who is preparing for emergency surgery due to a small bowel obstruction.

The client is anxious and doesn’t understand what the surgeon means by “adhesions” causing the blockage.

Which of the following statements is the best response from the nurse?

Choice A rationale
Alendronate should be taken at least 30 minutes before the first food, beverage, or medication of the day with plain water only. This is because other beverages (including mineral water), food, and some medications are likely to reduce the absorption of alendronate.
Choice B rationale
Alendronate should not be taken with milk. This is because the calcium in the milk can bind to the alendronate, preventing it from being absorbed into the body and therefore making it less effective. This is why the patient’s statement indicates a need for further instruction.
Choice C rationale
After taking alendronate, the patient should not lie down and should remain fully upright (sitting, standing, or walking) for at least 30 minutes. This is to help alendronate reach the stomach more quickly and also to reduce the risk of irritation to the esophagus. Therefore, sitting up and reading the morning paper after taking alendronate is a correct practice.
Choice D rationale
Regular bone density tests are necessary while taking alendronate. This is to monitor the drug’s effectiveness in increasing bone mass and to adjust the treatment plan as necessary. Therefore, the patient’s statement is correct.

Based on the provided exhibits, the client is most likely experiencingBacterial Meningitis. This is indicated by symptoms such as severe headache, fever, sensitivity to light, nuchal rigidity, and the presence of Neisseria meningitidis in the cerebrospinal fluid with elevated white blood cell count and lactic acid levels.

The two actions the nurse should take to address this condition are:

1. Anticipate administering antibiotic therapy- This is crucial as the client’s culture and sensitivity test indicates the presence of Neisseria meningitidis, which requires antibiotic treatment.
2. Place the client on droplet precautions- Since Neisseria meningitidis can be spread through respiratory droplets, it is important to implement droplet precautions to prevent the spread of infection.

The two parameters the nurse should monitor to assess the client’s progress are:

1. Level of consciousness- Monitoring for changes in the client’s level of consciousness can indicate the effectiveness of the treatment and the progression of the disease.
2. Increased intracranial pressure- Signs of increased intracranial pressure can include changes in vital signs, level of consciousness, and the presence of headache or vomiting. Monitoring these signs is important in the management of bacterial meningitis.