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 D

Explanation

A. Administer sucralfate once a day, preferably at bedtime: Sucralfate is typically administered multiple times a day, not just once. It is commonly given in divided doses, often four times a day, to ensure adequate coverage and effectiveness. Administering it at bedtime alone would not provide consistent therapeutic effects.
B. Monitor for electrolyte imbalance: Sucralfate is not known to cause significant electrolyte imbalances. It works locally in the gastrointestinal tract and does not usually affect electrolyte levels, so monitoring for electrolyte imbalances is not a primary concern with this medication.
C. Assess for secondary Candida infection: While sucralfate may affect the gastrointestinal flora, secondary Candida infections are not a common side effect. Sucralfate is not an antibiotic and does not typically lead to fungal infections.
D. Give sucralfate on an empty stomach: Sucralfate should be administered on an empty stomach, ideally 1 hour before meals or 2 hours after meals. This allows the medication to properly adhere to the ulcer site and form a protective barrier, enhancing its effectiveness in treating peptic ulcers.

A. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication. B. One hour after completion of the IV dose and one hour before the next administration of the medication. C. Two hours after completion of the IV dose and two hours before the next administration of the medication. D. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication.

Correct Answer is A

Explanation

A. Immediately after completion of the IV dose and 30 minutes before the next administration of the medication: This timing is correct for monitoring vancomycin levels. The peak level is typically measured immediately after the completion of the infusion (though peak levels are less commonly required for vancomycin), and the trough level is measured just before the next dose is due, 30 minutes before administration. This approach helps in evaluating the medication's efficacy and safety.
B. One hour after completion of the IV dose and one hour before the next administration of the medication: This timing is not ideal. The peak level for vancomycin is usually measured immediately after the dose rather than one hour later. Trough levels are measured closer to the next dose, typically 30 minutes before the next dose.
C. Two hours after completion of the IV dose and two hours before the next administration of the medication: Measuring levels two hours after the dose completion is too late for a peak level. The trough level should be measured closer to the next dose, generally 30 minutes before the next administration.
D. Thirty minutes into the administration of the IV dose and 30 minutes before the next administration of the medication: Measuring the level 30 minutes into the infusion is not appropriate for peak levels, which are typically measured.

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Naxlex Comprehensive Predictor Exams

The nurse is planning to administer sucralfate to a client with peptic ulcer disease. Which action should the nurse indude in this patient's plan of care?

Correct Answer is D

Explanation

A client is receiving IV vancomycin and the nurse plans to draw blood for a peak and trough to determine the serum level of the medication. Which collection times provide the best determination of these levels?

Correct Answer is A

Explanation

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A daily dose of aspirin 325 mg PO is most beneficial for an adult client with which medical diagnosis?

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