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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Correct Answer is B

Explanation

A. Accommodation: Mydriatic eye drops cause dilation of the pupils, but they do not directly affect the eye's ability to accommodate or focus on near objects. Therefore, accommodation may still be functional, though it can be affected indirectly due to the dilated pupils.
B. Pupillary constriction: Mydriatic eye drops are designed to dilate the pupils, so they inhibit or prevent pupillary constriction. This is the primary purpose of these drops, so pupillary constriction will not occur during their therapeutic effect.
C. Refraction: Refraction refers to the bending of light as it passes through the eye to focus on the retina. This function is generally maintained even when mydriatic drops are used, though changes in pupil size can affect the amount of light entering the eye.
D. Eye convergence: Convergence involves the inward movement of both eyes toward each other to maintain single binocular vision when focusing on a close object. While mydriatic drops primarily affect pupil dilation, convergence can still occur, though it may be affected by the degree of dilation.

A. Obtain a platelet count weekly. B. Take the medication during pregnancy. C. Use folic acid to protect the liver. D. Store the medication at room temperature.

Correct Answer is B

Explanation

A. Obtain a platelet count weekly: Regular monitoring of platelet counts is important for clients on methotrexate due to the risk of bone marrow suppression and potential thrombocytopenia. This instruction is appropriate and necessary.
B. Take the medication during pregnancy: Methotrexate is contraindicated during pregnancy due to its teratogenic effects and potential to cause fetal harm. It is crucial for clients to avoid using methotrexate while pregnant or planning to become pregnant.
C. Use folic acid to protect the liver: While folic acid is often used to help reduce the side effects of methotrexate, particularly its gastrointestinal effects and potential for liver toxicity, it is not used to "protect the liver" per se. The correct approach is to use folic acid as directed by a healthcare provider, often to mitigate some of the side effects of methotrexate.
D. Store the medication at room temperature: Methotrexate should be stored according to the manufacturer's instructions, which usually involve keeping it at room temperature. This information is correct and does not require additional instruction.

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Naxlex Comprehensive Predictor Exams

The nurse is assessing the eyes of a client who just received mydriatic eye drops. Which physiological function of the eye will not respond during the therapuetic period after administration of the eye drops?

Correct Answer is B

Explanation

A client receives a prescription for methotrexate. Which information provided by the client requires additional instruction by the nurse?

Correct Answer is B

Explanation

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