The practical nurse (PN) is helping with the care plan for a client who is taking the nonsteroidal anti-inflammatory drug ketorolac for painful back muscle spasms.
What intervention should the PN include in the client’s care plan?
Observe the client for development of involuntary movements of the lips and tongue.
Administer the medication at least 30 minutes before the client’s meals.
Assess the skin daily for areas of ecchymosis or other signs of bleeding.
Ensure peak and trough serum levels are collected with the third dose of medication.
The Correct Answer is C
Choice A rationale
Involuntary movements of the lips and tongue are typically associated with antipsychotic medications, not nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac15. Therefore, observing the client for these symptoms would not be a relevant intervention for a client taking ketorolac15.
Choice B rationale
Administering the medication at least 30 minutes before meals is not a specific requirement for ketorolac15. Therefore, this would not be a necessary intervention for a client taking this medication15.
Choice C rationale
Ketorolac, like other NSAIDs, can increase the risk of bleeding15. This can manifest as areas of ecchymosis (bruising) or other signs of bleeding on the skin15. Therefore, assessing the skin daily for these signs would be an important intervention for a client taking ketorolac15.
Choice D rationale
Peak and trough serum levels are typically monitored for medications with a narrow therapeutic index, such as certain antibiotics15. Ketorolac does not typically require
monitoring of serum levels15. Therefore, ensuring peak and trough serum levels are collected would not be a necessary intervention for a client taking this medication15.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Pyridoxine with a B complex multivitamin is not typically associated with ototoxicity (ringing
in the ears)7.
Choice B rationale
Rifampin is an antitubercular medication, but it is not commonly associated with ototoxicity.
Choice C rationale
Gentamicin is an antibiotic that is known to potentially cause ototoxicity, including ringing in
the ears. Therefore, if a patient who has been receiving gentamicin reports ringing in the ears,
this should be reported to the healthcare provider.
Choice D rationale
Isoniazid is an antitubercular medication, but it is not commonly associated with ototoxicity.
Correct Answer is ["F"]
Explanation
Choice A rationale
A pain rating of 2/10 is not directly related to the therapeutic effect of Bisacodyl. Bisacodyl is a stimulant laxative used to treat constipation, and its effectiveness would not typically be measured by pain ratings20.
Choice B rationale
A non-blanchable red area could be a sign of a pressure ulcer or other skin condition. It is not a therapeutic result of Bisacodyl administration20.
Choice C rationale
Blood pressure of 135/81 mmHg is a normal reading and is not directly related to the therapeutic effect of Bisacodyl20.
Choice D rationale
Sinus tachycardia, or a faster-than-normal heart rate, is not a therapeutic result of Bisacodyl administration. If a patient experiences sinus tachycardia while taking Bisacodyl, they should seek medical attention20.
Choice E rationale
Itching in legs is not a therapeutic result of Bisacodyl administration. It could be a sign of an allergic reaction or other medical condition20.
Choice F rationale
Semifluid stool is the correct answer. Bisacodyl is a stimulant laxative that works by increasing activity in the intestines to cause a bowel movement. Therefore, the production of semifluid stool can be considered a therapeutic result of Bisacodyl administration20.
Choice G rationale
A burning sensation is not a therapeutic result of Bisacodyl administration. If a patient experiences a burning sensation while taking Bisacodyl, they should seek medical attention20.
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