When administering medications to a group of clients, which client should the nurse closely monitor for development of acute kidney injury (AKI)?
Sucralfate.
Vancomycin.
Lorazepam.
Digoxin.
The Correct Answer is B
Choice B reason: Vancomycin is an antibiotic that can treat serious bacterial infections that are resistant to other antibiotics. However, vancomycin can also cause nephrotoxicity, or damage to the kidneys, especially when given in high doses or for prolonged periods. Nephrotoxicity can lead to AKI, which is a sudden and severe decrease in kidney function that can cause fluid and electrolyte imbalances, acid-base disorders, uremia, and death. Therefore, the nurse should closely monitor the client who is receiving vancomycin for development of AKI by checking their serum creatinine and blood urea nitrogen (BUN) levels, urine output and specific gravity, and signs and symptoms of fluid overload or dehydration.
Choice A reason: Sucralfate is an anti-ulcer drug that forms a protective coating over the stomach lining and prevents further damage from acid or pepsin. Sucralfate does not cause nephrotoxicity or AKI and has minimal systemic absorption or side effects. Therefore, the nurse does not need to closely monitor the client who is taking sucralfate for development of AKI.
Choice C reason: Lorazepam is a benzodiazepine that can treat anxiety, insomnia, seizures, or alcohol withdrawal. Lorazepam does not cause nephrotoxicity or AKI and has low renal clearance or elimination. Therefore, the nurse does not need to closely monitor the client who is taking lorazepam for development of AKI.
Choice D reason: Digoxin is a cardiac glycoside that can treat heart failure or atrial fibrillation by increasing the force and efficiency of heart contractions and slowing down the heart rate. Digoxin does not cause nephrotoxicity
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Correct Answer is D
Explanation
Choice A reason: Telling the client to notify the nurse if the pain is not relieved is an important nursing action, but it is not the highest priority. The nurse should assess the client's pain level before and after administering the medication, and evaluate its effectiveness. If the pain is not relieved, the nurse should report it to the prescriber and consider other interventions.
Choice B reason: Advising the client that the medication should start to work in about 30 minutes is an informative nursing action, but it is not the highest priority. The nurse should educate the client about the expected onset, peak, and duration of action of the medication, and how to take it safely and effectively. However, this does not address any immediate risks or needs of the client.
Choice C reason: Administering a stool softener/laxative at the same time as the analgesic is a preventive nursing action, but it is not the highest priority. The nurse should anticipate and prevent potential side effects of the medication, such as constipation, which can be caused by codeine. However, this does not address any urgent or emergent issues of the client.
Choice D reason: Instructing the client to request assistance when ambulating to the bathroom is the highest priority nursing action, as it addresses a serious safety concern of the client. The nurse should protect the client from falls and injuries, which can be caused by codeine's sedative and drowsy effects. The nurse should also monitor the client's respiratory rate and level of consciousness, as codeine can cause respiratory depression and altered mental status.
Correct Answer is A
Explanation
Choice A reason: Filgrastim is a colony-stimulating factor that stimulates the bone marrow to produce more neutrophils, which are a type of white blood cell that fight infection. Filgrastim is used to treat neutropenia (low neutrophil count), which can be caused by chemotherapy, bone marrow transplant, or other conditions. The normal range of WBC is 5000 to 10,000/mm3 (5 to 10 x 109/L), and the normal range of neutrophils is 2500 to 8000/mm3 (2.5 to 8 x 109/L). Therefore, an increase in WBC from 2500/mm3 to 5000/mm3 indicates that filgrastim has been effective in increasing neutrophil production and improving the client's immune system. The nurse should inform the client that the medication has been effective and encourage them to continue taking it as prescribed.
Choice B reason: Reviewing the client's culture and sensitivity reports is not an action that the nurse should implement in this situation, but rather a routine assessment that the nurse should perform for any client with an infection. Culture and sensitivity reports identify the type and source of infection and the most effective antibiotic therapy. The nurse should review these reports to monitor the client's response to treatment and adjust the antibiotic regimen as needed.
Choice C reason: Assessing the client's vital signs is not an action that the nurse should implement in this situation, but rather a standard practice that the nurse should perform for any client. Vital signs include temperature, pulse, respiration, blood pressure, and oxygen saturation. The nurse should assess these parameters to detect any signs of infection, inflammation, or sepsis, such as fever, tachycardia, tachypnea, hypotension, or hypoxia.
Choice D reason: Implementing neutropenic precautions is not an action that the nurse should implement in this situation, but rather a preventive measure that the nurse should take for clients with severe neutropenia. Neutropenic precautions are a set of infection control practices that aim to protect clients with low neutrophil counts from exposure to pathogens. These include wearing gloves, masks, and gowns; washing hands frequently; avoiding contact with sick people or animals; and avoiding raw or undercooked foods. However, these precautions are not necessary for clients with normal or near-normal neutrophil counts, such as 5000/mm3.
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