The nurse is caring for a client who is taking diclofenac, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client's serum laboratory values is most important for the nurse to review?

Glucose.

Total protein.

Sodium.

Hemoglobin.

Answer and Explanation

The Correct Answer is D

Choice A reason: This is not the most important laboratory value for the nurse to review. Glucose is a measure of blood sugar levels, and it may be affected by various factors, such as diet, medication, stress, or infection. However, glucose is not directly related to the use of diclofenac or the symptoms of the client. The nurse should monitor the glucose levels for any changes, but it is not the priority.

Choice B reason: This is not the most important laboratory value for the nurse to review. Total protein is a measure of the amount of protein in the blood, and it may reflect the nutritional status, liver function, or kidney function of the client. However, total protein is not directly related to the use of diclofenac or the symptoms of the client. The nurse should monitor the total protein levels for any changes, but it is not the priority.

Choice C reason: This is not the most important laboratory value for the nurse to review. Sodium is a measure of the electrolyte balance in the blood, and it may be affected by fluid intake, fluid loss, or hormonal regulation. However, sodium is not directly related to the use of diclofenac or the symptoms of the client. The nurse should monitor the sodium levels for any changes, but it is not the priority.

Choice D reason: This is the most important laboratory value for the nurse to review. Hemoglobin is a measure of the oxygen-carrying capacity of the blood, and it may indicate the presence of anemia, which is a common adverse effect of diclofenac. Diclofenac can cause gastrointestinal bleeding, which can lead to a decrease in hemoglobin and hematocrit levels. The client's appearance and fatigue may be signs of anemia, which can impair the tissue oxygenation and worsen the client's condition. The nurse should review the hemoglobin levels and report any abnormal findings to the healthcare provider. The nurse should also assess the client for other signs of bleeding, such as melena, hematemesis, or hematuria.

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Correct Answer is D

Explanation

Choice A reason: This is not the first action for the nurse to implement. Determining when the last dose was administered is important to prevent overdose and adverse effects of pain medication, but it is not the most immediate intervention. The nurse should first assess the client's pain level and intensity using a pain scale, such as a numeric or a visual analog scale, to determine the appropriate dose and frequency of pain medication.

Choice B reason: This is not the first action for the nurse to implement. Encouraging the client to use diversional thoughts to manage pain is a nonpharmacological strategy that may help reduce the perception of pain and enhance coping, but it is not the most effective intervention. The nurse should first assess the client's pain level and intensity using a pain scale, and then provide pharmacological and nonpharmacological interventions as needed.

Choice C reason: This is not the first action for the nurse to implement. Reviewing the history for a past use of recreational drugs is relevant to identify the risk of addiction, tolerance, or withdrawal from pain medication, but it is not the most urgent intervention. The nurse should first assess the client's pain level and intensity using a pain scale, and then consider the client's history and preferences when selecting the type and dose of pain medication.

Choice D reason: This is the first action for the nurse to implement. Asking the client to rate the current level of pain using a pain scale is the most appropriate and accurate way to assess the client's pain and its impact on the client's recovery and quality of life. The nurse should use a pain scale that is suitable for the client's age, cognitive ability, and language, and ask the client to rate the pain at rest and with movement. The nurse should also ask the client about the location, quality, duration, and aggravating or relieving factors of the pain. The nurse should use the pain assessment as the basis for planning and implementing pharmacological and nonpharmacological interventions for pain management.

A. Weight change in the last month. B. Liver function laboratory results. C. Recent use of other antidepressants. D. Family history of mental illness.

Correct Answer is B

Explanation

The correct answer is b. Liver function laboratory results.

Choice A reason:

Weight change in the last month can be an important factor to consider for a patient's overall health and may be relevant in the context of depression, as significant weight changes can be a symptom of this condition. However, it is not the most critical piece of information before prescribing duloxetine. Duloxetine is not primarily metabolized by the kidneys, and while weight can affect dosing and efficacy, it is not the most crucial factor to consider before starting treatment.

Choice B reason:

Liver function laboratory results are crucial to obtain before prescribing duloxetine because duloxetine is extensively metabolized by the liver. The prescribing information for duloxetine warns of the potential for hepatotoxicity, and hepatic failure has been reported in some cases. Therefore, it is essential to ensure that the patient's liver function is normal before initiating therapy with duloxetine, as impaired liver function could lead to increased levels of the medication in the body and a higher risk of side effects.

Choice C reason:

Recent use of other antidepressants is important to consider avoiding drug interactions, particularly with monoamine oxidase inhibitors (MAOIs), which can lead to serious, life-threatening side effects if taken together with duloxetine. While this information is important, it is not as critical as liver function, because the primary concern with other antidepressants is the timing of medication changes rather than an absolute contraindication.

Choice D reason:

A family history of mental illness can provide valuable information for understanding a patient's background and potential genetic predispositions to certain conditions. However, this information does not directly impact the safety and initial prescribing of duloxetine. It may be more relevant for long-term treatment considerations and prognosis rather than immediate prescription safety.

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The nurse is caring for a client who is taking diclofenac, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client's serum laboratory values is most important for the nurse to review?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client in the surgical recovery area asks the nurse to bring the largest possible dose of pain medication available. Which action should the nurse implement first?

Correct Answer is D

Explanation

The nurse is planning care for a client with major depression who is receiving a new prescription for duloxetine. Which information is most important for the nurse to obtain?

Correct Answer is B

Explanation

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