An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

Instruct the client that since the hematocrit remains low, the daily injections are still necessary.

Notify the healthcare provider of the patient's hematocrit level so the frequency of injections can be reduced.

Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.

Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.

Answer and Explanation

The Correct Answer is D

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A) Teach the client self-injection skills for daily subcutaneous administration: Insulin glargine is a long-acting insulin that is typically administered once daily via subcutaneous injection. Teaching the client how to properly administer insulin injections is crucial for managing type 2 diabetes effectively. Proper technique and routine are essential for ensuring correct dosing and preventing complications.

B) Demonstrate how to select dose based on before-meal blood sugar readings: Insulin glargine is not used for adjusting doses based on pre-meal blood sugar readings; it provides a steady baseline of insulin coverage throughout the day. Dose adjustments for type 2 diabetes are generally not based on meal-time glucose readings with long-acting insulin.
C) Explain to the family how to inject this medication for severe hypoglycemia: Insulin glargine is used to maintain long-term glucose control and is not typically used in emergency situations like severe hypoglycemia. Emergency treatment for severe hypoglycemia generally involves glucose administration rather than insulin injections.
D) Provide information on increasing medication dosage if ketoacidosis occurs: Insulin glargine is not adjusted based on acute conditions such as ketoacidosis. Management of diabetic ketoacidosis involves more immediate insulin and fluid management strategies, and dosage adjustments should be guided by a healthcare provider, not based on routine discharge instructions.

A. Low-density lipoprotein (LDL) B. Prothrombin time (PT). C. Creatine phosphokinase (CK) D. High-density lipoprotein (HDL).

Correct Answer is D

Explanation

A. Low-density lipoprotein (LDL): Atorvastatin's primary effect is to decrease LDL cholesterol levels. A decrease in LDL levels would indicate the medication is working as intended, not an increase.
B. Prothrombin time (PT): PT is a measure of blood clotting, which is not directly affected by atorvastatin. This value is more relevant for monitoring anticoagulant therapy.

C. Creatine phosphokinase (CK): CK levels can be used to monitor for muscle damage or side effects related to statin use. An increase in CK levels would suggest muscle damage, not the effectiveness of the statin.
D. High-density lipoprotein (HDL): Atorvastatin is a statin medication used to lower cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, which is a key target in reducing the risk of coronary artery disease (CAD). While the primary goal of atorvastatin is to lower LDL cholesterol, an increase in HDL cholesterol (often termed "good" cholesterol) is also desirable as it can help reduce the risk of CAD. Therefore, an increase in HDL is a positive indicator that the medication is having a beneficial effect.

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Naxlex Comprehensive Predictor Exams

The nurse is planning discharge teaching for a client with type 2 diabetes mellitus who has a new prescription for insulin glargine. Which action should the nurse plan to include in the discharge teaching?

Correct Answer is A

Explanation

An increase in which serum lab value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

Correct Answer is D

Explanation

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