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. Alternate the use of each nostril when administering the nasal spray each day: Alternating nostrils can help reduce local irritation and rhinitis associated with the use of nasal spray medications. This practice allows each nostril to recover and reduces the risk of continuous irritation from the spray.
B. Do not lie down within thirty minutes of use of the nasal spray: While this can help ensure the medication is absorbed properly, it is not specifically aimed at reducing rhinitis. It is more important to manage irritation by alternating nostrils.
C. Use a nonsteroidal anti-inflammatory drug (NSAID) PRN to reduce any inflammation that may occur: NSAIDs might not be suitable for everyone, and using them could mask symptoms or lead to additional side effects. They are not a primary strategy for managing rhinitis caused by nasal spray use.
D. Take an over-the-counter antihistamine with each daily dose of nasal spray: Antihistamines are not typically used to manage rhinitis caused by nasal sprays. Additionally, combining medications should be done cautiously and usually under medical advice.

A. Coronary artery disease. B. Seasonal allergic rhinitis. C. Type 2 diabetes mellitus. D. Irritable bowel syndrome.

Correct Answer is A

Explanation

A) Coronary artery disease: It is crucial to assess for a history of coronary artery disease (CAD) before administering sumatriptan, as the medication is a serotonin receptor agonist that can cause vasoconstriction of coronary arteries. This can increase the risk of serious cardiovascular events, such as heart attack or stroke, particularly in clients with preexisting CAD.

B) Seasonal allergic rhinitis: While seasonal allergic rhinitis may be a concern for other medications due to potential allergic reactions or interactions, it is not directly related to the administration of sumatriptan. This condition does not pose a significant risk with the use of sumatriptan.

C) Type 2 diabetes mellitus: Although type 2 diabetes mellitus is an important consideration in the overall health management of a client, it is not the most critical condition to assess before administering sumatriptan. However, if the client has diabetes with associated complications like cardiovascular disease, this would increase concern for using sumatriptan.

D) Irritable bowel syndrome: Irritable bowel syndrome (IBS) is a gastrointestinal disorder that typically does not influence the decision to administer sumatriptan. While IBS may affect a client’s comfort or medication regimen, it does not present the same immediate risks as coronary artery disease when using sumatriptan.

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