A nurse is preparing to administer epoetin to a client who has anemia due to chemotherapy. Which of the following actions should the nurse plan to take?
Review the client’s Hgb level prior to administration.
Use the Z-track method when administering the medication.
Shake the vial for 30 seconds prior to withdrawing the medication.
Ensure the client is not taking iron supplements while on this medication.
The Correct Answer is A
Choice A Reason
Review the client’s Hgb level prior to administration. This is the correct action. Monitoring hemoglobin (Hgb) levels is crucial before administering epoetin because it helps determine the appropriate dosage and ensures the treatment is safe and effective. Epoetin is used to stimulate red blood cell production, and administering it without checking Hgb levels can lead to complications such as hypertension or thromboembolic events if the Hgb level is too high.
Choice B Reason
Use the Z-track method when administering the medication. This statement is incorrect. The Z-track method is used for intramuscular injections to prevent medication from leaking into subcutaneous tissues. Epoetin is typically administered subcutaneously or intravenously, not intramuscularly, so the Z-track method is not applicable.
Choice C Reason
Shake the vial for 30 seconds prior to withdrawing the medication. This statement is incorrect. Shaking the vial of epoetin can damage the protein structure of the medication, rendering it ineffective. The vial should be gently swirled if necessary, but not shaken.
Choice D Reason
Ensure the client is not taking iron supplements while on this medication. This statement is incorrect. Iron supplements are often necessary when administering epoetin because iron is required for the production of hemoglobin. Ensuring adequate iron levels helps maximize the effectiveness of epoetin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Notifying the provider if you experience a stinging sensation following administration is not necessary. A mild stinging sensation is a common side effect of timolol eye drops and usually subsides quickly. However, if the stinging persists or is severe, it should be reported.
Choice B Reason:
Watching for a decreased heart rate while using this medication is important. Timolol is a beta-blocker, and one of its systemic side effects can be bradycardia (a slower than normal heart rate). Patients should be aware of this potential side effect and monitor their heart rate regularly.
Choice C Reason:
Developing a harmless darkening of the iris is not associated with timolol. This side effect is more commonly linked to prostaglandin analogs, another class of medications used to treat glaucoma.
Choice D Reason:
Timolol does not cause the lashes of the affected eye to lengthen. This side effect is also associated with prostaglandin analogs, not beta-blockers like timolol.
Correct Answer is B
Explanation
Choice A Reason:
Suctioning secretions from the endotracheal tube is a common intervention for high-pressure alarms, which indicate an obstruction in the airway. However, a low-pressure alarm typically signals a disconnection or leak in the ventilator system, not an obstruction.
Choice B Reason:
Checking the ventilator tubing connections is the appropriate response to a low-pressure alarm. This alarm usually indicates a disconnection or leak in the ventilator circuit, which can compromise the delivery of adequate ventilation to the patient. Ensuring all connections are secure is the first step in troubleshooting this issue.
Choice C Reason:
Administering intravenous sedation and analgesia is not directly related to addressing a low-pressure ventilator alarm. While sedation may be necessary for patient comfort and to prevent agitation, it does not resolve the underlying issue of a disconnection or leak in the ventilator system.
Choice D Reason:
Reassuring the client and instructing them not to bite on the tube is more relevant to high-pressure alarms, where patient actions such as biting the tube can cause increased airway resistance. It does not address the cause of a low-pressure alarm, which is typically due to a disconnection or leak.
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