During interleukin drug therapy, a client is showing signs of severe fluid retention, with increasing dyspnea and severe peripheral edema. The next dose of the interleukin is due now.
Which action will the nurse take next?
Give the drug, and notify the prescriber.
Hold the drug, and notify the prescriber.
Give the drug along with acetaminophen and diphenhydramine.
Monitor the client for 2 hours, and then give the drug if the client's condition improves.
The Correct Answer is B
B. Interleukin causes capillary leak syndrome which present as fluid retention, dyspnea and edema hence should be held.
A. Giving the drug will worsen the condition
C. Diphenhydramine cannot prevent capillary leak syndrome
D. Delaying the drug is inappropriate as it could worsen the condition of the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A.The charge nurse can provide support, but they are not responsible for confirming or authorizing medical orders. Telephone orders must be verified directly with the prescriber.
B.The pharmacist can review medication safety, but they cannot confirm or validate the prescriber’s order over the phone. The responsibility for clarification remains between nurse and prescriber.
C. It's the correct answer and follows the standard safety protocol for verbal/telephone orders:
- The nurse writes the order exactly as given
- Then reads it back to the prescriber verbatim
- The prescriber confirms accuracy before the call ends
This is known as read-back verification, and it reduces medication errors significantly.
D.While clarification may sometimes be needed, routinely hanging up and calling back is not standard practice and increases communication delays. The correct step is to confirm during the same call.
Correct Answer is D
Explanation
D. smoking increases acid production counteracting the effects of cimetidine
A. Cimetidine should be taken with meals
B. Other medications including antacids can be taken 2hrs after cimetidine
C. Water has no effect on effectiveness of cimetidine
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