Before administering a laxative to a bedfast client, it is most important for the nurse to perform which assessment?

Evaluate the client's ability to recognize the urge to defecate.

Determine the frequency and consistency of bowel movements.

Observe the skin integrity of the client's rectal and sacral areas.

Assess the client's strength in moving and turning in the bed.

Answer and Explanation

The Correct Answer is B

A) Evaluate the client's ability to recognize the urge to defecate: Assessing the client's ability to recognize the urge to defecate is important for promoting independence in toileting. However, this assessment may not directly indicate the need for administering a laxative. It is more relevant for clients who are able to ambulate or have control over their bowel movements.

B) Determine the frequency and consistency of bowel movements: Assessing the frequency and consistency of bowel movements provides valuable information about the client's bowel function and helps determine the need for a laxative. It allows the nurse to establish a baseline and evaluate the effectiveness of interventions. Understanding the client's typical bowel pattern is crucial before administering a laxative to avoid overmedication or potential complications such as diarrhea or fecal impaction.

C) Observe the skin integrity of the client's rectal and sacral areas: Assessing skin integrity in the rectal and sacral areas is crucial for preventing pressure ulcers, especially in bedfast clients. However, it is not directly related to the need for administering a laxative.

D) Assess the client's strength in moving and turning in the bed: While assessing the client's strength and mobility is important for overall care and prevention of complications related to immobility, it may not be directly related to the need for administering a laxative. This assessment is more relevant for preventing complications such as pressure ulcers and maintaining musculoskeletal function.

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Correct Answer is ["A","B","D"]

Explanation

A) Tendon pain or swelling can be a sign of tendinitis or tendon rupture, which can be serious side effects of ciprofloxacin. Therefore, it is crucial for the client to report any tendon pain or swelling to the healthcare provider immediately.

B) Ciprofloxacin can increase sensitivity to sunlight, leading to an increased risk of sunburn. Therefore, clients should be advised to limit exposure to sunlight and avoid tanning beds while taking this medication.

C) Crushing or mixing ciprofloxacin tablets with pudding is not recommended, as it may alter the absorption and effectiveness of the medication. Clients should swallow the tablets whole with a full glass of water.

D) Increasing fluid intake while taking ciprofloxacin is generally recommended to prevent dehydration and help flush the medication through the kidneys. Adequate hydration can also help reduce the risk of crystalluria, a potential adverse effect of ciprofloxacin.

E) Using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve joint aches and pains caused by ciprofloxacin is not recommended, as NSAIDs can increase the risk of tendon problems when used with ciprofloxacin. It is important for the client to report any joint aches or pains to the healthcare provider for proper evaluation and management.

A. Take the medication one hour after meals and other medications. B. Remain upright for thirty minutes following drug administration. C. Follow medication administration with an additional glass of water. D. Avoid the intake of dairy products while using the medication.

Correct Answer is C

Explanation

A) Taking the medication one hour after meals and other medications may help prevent interference with the absorption of nutrients or other medications. However, it is not a specific instruction related to the administration of bulk-forming laxatives.

B) Remaining upright for thirty minutes following drug administration is a common instruction for medications that may cause esophageal irritation or reflux. However, it is not typically necessary for bulk-forming laxatives, which work primarily in the colon rather than the esophagus or stomach.

C) Following medication administration with an additional glass of water is the correct instruction for self-administration of bulk-forming laxatives. These laxatives absorb water in the intestines, which helps to soften the stool and promote bowel movements. Adequate hydration is essential to prevent the bulk-forming laxative from causing intestinal obstruction.

D) Avoiding the intake of dairy products while using the medication is not a specific instruction related to the administration of bulk-forming laxatives. Bulk-forming laxatives are generally well-tolerated and do not interact with dairy products. However, increasing fluid intake, particularly water, is essential to prevent constipation and ensure the effectiveness of the medication.

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Before administering a laxative to a bedfast client, it is most important for the nurse to perform which assessment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing a discharge teaching plan for a client who is taking ciprofloxacin hydrochloride tablets, which wore prescribed because of a suspected anthrax exposure. What instruction(s) should be included in the teaching plan? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

Which instruction should the nurse include when teaching a client about self-administration of a bulk-forming laxative?

Correct Answer is C

Explanation

The nurse is providing discharge instructions for a client with metastatic cancer who is proscribed morphine for bone pain. Which information from the client indicates to the nurse an understanding of the medication?

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