A nurse is reinforcing teaching with a client who has osteoporosis and is prescribed (Fosamax) alendronate 70 mg PO weekly. Which of the following statements by the client indicates a need for further instruction?

"I take my other pills at least 30 minutes after my alendronate."

"I take my alendronate on the same day every week with an 8-ounce glass of milk."

"I sit up and read the morning paper after taking my alendronate."

"I will need to have a bone density test occasionally while taking this medication."

Answer and Explanation

The Correct Answer is B

Choice A reason: This statement does not indicate a need for further instruction. It is recommended to wait at least 30 minutes after taking alendronate before taking other medications to ensure proper absorption of the drug.

Choice B reason: This statement indicates a need for further instruction. Alendronate should be taken with plain water, not milk. Milk and other dairy products can interfere with the absorption of alendronate due to their calcium content.

Choice C reason: This statement does not indicate a need for further instruction. Patients are advised to remain upright for at least 30 minutes after taking alendronate to prevent esophageal irritation or ulceration.

Choice D reason: This statement does not indicate a need for further instruction. Periodic bone density tests are a standard part of monitoring the effectiveness of osteoporosis treatment.

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Correct Answer is A

Explanation

Choice A reason: Administering prednisone before the test may be part of a premedication protocol for clients with a history of allergic reactions to contrast media. However, this is typically done for iodinated contrast used in CT scans, not for gadolinium-based contrast agents used in MRA.

Choice B reason: Consulting with the provider to change to a CT scan would not be appropriate if the client is allergic to iodinated contrast dye, as CT scans commonly use iodinated contrast. MRA typically uses gadolinium-based contrast agents, which may be safer for clients with iodine allergies.

Choice C reason: Assessing the alkaline phosphatase level is not directly related to preparing a client with a contrast dye allergy for an MRA. Alkaline phosphatase is an enzyme measured in blood tests and is not specific to contrast media allergies.

Choice D reason: Obtaining the client's allergy history to seafood is not necessary for MRA preparation. While there is a common misconception that seafood allergies are related to iodinated contrast allergies, the evidence does not support this association.

A. Tap the client's facial nerve and note any facial twitching. B. Strike the client's patellar tendon with a percussion hammer and note any increase in response. C. Gently elevate the client's head and note any nuchal rigidity. D. Run a tongue blade on the outside of the client's sole and note any flaring of the toes.

Correct Answer is C

Explanation

Choice A reason: Tapping the client's facial nerve and noting any facial twitching is not a specific assessment for bacterial meningitis. This action is more related to evaluating facial nerve function and is not typically used to diagnose meningitis.

Choice B reason: Striking the client's patellar tendon with a percussion hammer and noting any increase in response is a test for reflexes, which may or may not be altered in bacterial meningitis. An increased response can be seen in various neurological conditions and is not specific to meningitis.

Choice C reason: Gently elevating the client's head and noting any nuchal rigidity is a key part of the focused assessment for bacterial meningitis. Nuchal rigidity, or stiffness of the neck, is a classic sign of meningitis and is assessed by gently lifting the head and attempting to move the chin toward the chest. If the client resists due to pain or stiffness, this could indicate nuchal rigidity associated with meningitis.

Choice D reason: Running a tongue blade on the outside of the client's sole and noting any flaring of the toes, known as the Babinski sign, is used to assess for central nervous system lesions and is not specific to meningitis. While it can be part of a neurological assessment, it does not specifically indicate bacterial meningitis.

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A nurse is reinforcing teaching with a client who has osteoporosis and is prescribed (Fosamax) alendronate 70 mg PO weekly. Which of the following statements by the client indicates a need for further instruction?

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