A nurse is teaching a client who has pernicious anemia to self-administer nasal cyanocobalamin. Which of the following information should the nurse include in the teaching?
"Use a nasal decongestant 15 minutes before the medication if you have a stuffy nose."
"Administer the medication into one nostril once per week."
"Lie down for 1 hour after administering the medication."
"Plan to self-administer this medication for the next 6 months."
The Correct Answer is B
Pernicious anemia is a condition caused by a deficiency of intrinsic factor, preventing the absorption of dietary Vitamin B12 (cyanocobalamin). Because the oral route is ineffective in these clients, B12 must be administered via parenteral or nasal routes to bypass the gastrointestinal tract. This therapy is essential for erythropoiesis and preventing irreversible neurological damage.
Rationale:
A. Using a nasal decongestant shortly before administering nasal cyanocobalamin is not recommended because it can alter the absorption of the vitamin by constricting the nasal vasculature. The client should be taught to avoid hot foods or liquids immediately before or after administration as well. If the client has a significant upper respiratory infection, they may need to switch to an intramuscular injection temporarily.
B. Nasal cyanocobalamin is typically administered once per week in a single nostril for maintenance therapy in clients with pernicious anemia. This schedule ensures a consistent supply of Vitamin B12 to maintain adequate red blood cell production and nerve health. The nurse must emphasize the weekly schedule to ensure the client remains compliant and avoids a return of hematologic symptoms.
C. There is no clinical requirement for a client to lie down for 1 hour after using nasal cyanocobalamin. The medication is absorbed through the nasal mucosa quite efficiently while the client is in a normal upright position. Instructing the client to lie down for such an extended period is unnecessary and would place an undue burden on their daily routine without improving drug efficacy.
D. Pernicious anemia is a chronic, lifelong condition because the lack of intrinsic factor cannot be cured. Therefore, Vitamin B12 replacement therapy must be continued for the duration of the client's life, not just for 6 months. Stopping the medication will eventually lead to a recurrence of megaloblastic anemia and potentially permanent damage to the spinal cord and peripheral ne
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Phenytoin is a primary anticonvulsantutilized for the management of generalized tonic-clonic seizures and complex partial seizures. It works by blocking voltage-gated sodium channels, thereby preventing the repetitive firing of neuronal action potentials that characterize seizure activity. Its role in neurological stabilizationis well-established, though it requires diligent monitoring of serum drug levels to ensure therapeutic efficacy.
Rationale:
A.Status asthmaticus is an acute, severe asthma exacerbation that does not respond to standard bronchodilator therapy and requires corticosteroids or oxygen. Phenytoin has no pharmacological role in the respiratory system or the treatment of bronchospasm. This condition is a medical emergency focused on ventilation and airway management rather than the control of neuronal electrical activity.
B.Status epilepticus is a life-threatening state of persistent seizure activity where phenytoin is frequently used as a secondary agent for long-term seizure control. Following the initial administration of benzodiazepines to stop the acute seizure, phenytoin provides the sustained neuronal stabilization needed to prevent recurrence. It is a cornerstone of emergency neurological protocols designed to protect the brain from metabolic exhaustion.
C.A kidney transplant requires the lifelong administration of immunosuppressant medications, such as cyclosporine or tacrolimus, to prevent organ rejection. Phenytoin is not an immunosuppressant and actually has significant drug interactions that could lower the levels of transplant medications. Using phenytoin in this context would be inappropriate and potentially detrimental to the survival of the transplanted organ.
D.Endocarditis is a microbial infection of the heart valves or endocardium that necessitates prolonged courses of high-dose intravenous antibiotics. Phenytoin does not possess antimicrobial properties and cannot treat the underlying infection in endocarditis. While a patient with endocarditis might have a seizure due to an embolic stroke, the indication for phenytoin remains seizure management, not the heart condition.
Correct Answer is ["0.75"]
Explanation
Step 1 is to identify the ordered dose and the available dosage strength
Ordered Dose: 60 mg
Available Strength: 80 mg / 1 mL
Step 2 is to calculate the number of milliliters to administer
Volume to administer = (Ordered Dose ÷ Available Dose) × Available Volume
Volume to administer = (60 ÷ 80) × 1
60 ÷ 80 = 0.75
0.75 × 1 = 0.75
Volume to administer = 0.75 mL
Step 3 is to round to the nearest hundredth
0.75 = 0.75
Answer: 0.75 mL
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