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

Observe bowel movement pattern and take a stool softener.

Do not drink grapefruit juice after taking morphine.

Watch for signs of agitation and record any insomnia.

Take the benzodiazepine at the same time of taking the morphine.

Answer and Explanation

The Correct Answer is A

A. Observe bowel movement pattern and take a stool softener: Morphine commonly causes constipation due to reduced gastrointestinal motility. Recognizing this and taking preventive measures like a stool softener indicates a good understanding of how to manage one of the most frequent and bothersome side effects of opioid therapy.

B. Do not drink grapefruit juice after taking morphine: Grapefruit juice significantly interacts with certain medications, particularly those metabolized by CYP3A4 enzymes, but it has minimal clinical effect on morphine metabolism. This instruction is not relevant for morphine use.

C. Watch for signs of agitation and record any insomnia: While these symptoms can occasionally occur, they are not typical or expected side effects of morphine. More common effects include sedation, respiratory depression, and constipation.

D. Take the benzodiazepine at the same time of taking the morphine: Combining morphine with benzodiazepines increases the risk of severe sedation, respiratory depression, and overdose. Co-administration should be carefully managed and typically avoided unless specifically directed by the healthcare provider.

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Correct Answer is A

Explanation

A. Hemoglobin level increased to 12 g/dL (7.45 mmol/L): Epoetin alfa stimulates red blood cell production, and an increase in hemoglobin is the primary indicator of the drug’s effectiveness. A hemoglobin of 12 g/dL reflects a significant therapeutic improvement in anemia management for a client with CKD.

B. Reports of increased energy levels and decreased fatigue: Although feeling more energetic is a positive clinical sign, it is subjective and does not provide objective evidence of improved red blood cell production. Lab values are preferred for evaluating medication effectiveness.

C. Food diary shows increased consumption of iron-rich foods: Dietary improvements support erythropoiesis but are not the direct measure of epoetin alfa’s effect. The medication’s success is best gauged by the actual rise in hemoglobin, not dietary habits alone.

D. Takes concurrent iron therapy without adverse effects: Iron supplementation is often needed to maximize epoetin alfa’s effect, but merely tolerating iron therapy does not confirm that epoetin alfa is working to correct the anemia. The focus remains on hemoglobin response.

A. Assess the client's vital signs. B. Review the client's culture and sensitivity reports. C. Implement neutropenic precautions. D. Inform the client that the medication has been effective.

Correct Answer is D

Explanation

A. Assess the client's vital signs: While it is always important to monitor vital signs, the increase in white blood cell (WBC) count indicates a positive response to filgrastim, and there is no immediate concern requiring urgent vital sign assessment based on the WBC count alone.

B. Review the client's culture and sensitivity reports: Reviewing culture reports is necessary when managing an active infection, but the question does not indicate the client currently has an infection. The focus here is evaluating the medication's effectiveness.

C. Implement neutropenic precautions: Neutropenic precautions are necessary when the WBC count is critically low. Since the client's WBC has improved into the low-normal range, these precautions are no longer necessary.

D. Inform the client that the medication has been effective: Filgrastim is used to stimulate WBC production. The client's WBC count has increased to the normal range after five doses, demonstrating that the medication is working effectively as intended.

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

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Naxlex Comprehensive Predictor Exams

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?Reference Range:Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)]

Correct Answer is A

Explanation

After receiving five doses of filgrastim, the nurse notes that the client's white blood cell count has increased from 2,500/mm3 (2.5 x 10 /L) to 5,000/mm3 (5 x 105/L). Which action should the nurse implement?Reference Range:White Blood Cell (WBC) [5,000 to 10,000/mm3 (5 to 10 x 109/L)]

Correct Answer is D

Explanation

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