When preparing to administer an intravenous medication through a client's triple lumen central venous catheter, the nurse observes that there are no continuous intravenous fluids infusing. Which action should the nurse take?

Position the client's head facing away from the site.

Aspirate for the presence of a blood return.

Prepare a saline flush in a three mL syringe.

Initiate an infusion of 0.9% normal saline solution.

Answer and Explanation

The Correct Answer is B

A. Position the client's head facing away from the site: While positioning can help reduce the risk of infection or discomfort, it does not ensure that the catheter is patent or safe for medication administration.

B. Aspirate for the presence of a blood return: Confirming blood return verifies that the central venous catheter is patent and correctly positioned in the bloodstream. This is a critical safety step before administering intravenous medications to prevent extravasation or ineffective delivery.

C. Prepare a saline flush in a three mL syringe: While flushing the catheter is important for maintaining patency, the nurse must first confirm the catheter is patent by aspirating for blood return before flushing or administering medication.

D. Initiate an infusion of 0.9% normal saline solution: Starting a continuous infusion is not necessary solely for medication administration. The priority is confirming patency and safe access, after which flushing and medication administration can proceed.

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Correct Answer is D

Explanation

A. Drinking grapefruit juice will reduce the effects of the medication: Grapefruit juice can interact with itraconazole, but it typically increases rather than reduces drug levels. The client’s awareness of potential interactions is important, though clarification may be needed.

B. If I experience any difficulty with breathing I will report it: Respiratory symptoms could indicate an allergic reaction or adverse effect; reporting these promptly is appropriate and demonstrates understanding.

C. Monitoring for changes in stool color is important: Itraconazole can affect liver function, and changes in stool or urine may signal hepatotoxicity. Monitoring these changes is appropriate teaching.

D. I should take the medication with antacids: Antacids reduce gastric acidity, which decreases itraconazole absorption and effectiveness. The client should be instructed to avoid antacids around the time of medication administration.

A. Remind the client to keep his appointments to have his cholesterol level checked. B. Assess the elasticity of the client's skin at the next scheduled clinic appointment. C. Teach the client to weigh himself weekly and keep a log of the measurements. D. Encourage the client to keep a diary of his food intake until his next visit to the clinic.

Correct Answer is A

Explanation

A. Remind the client to keep his appointments to have his cholesterol level checked: Ezetimibe works by reducing absorption of cholesterol in the intestines, which lowers serum lipid levels. The most direct way to evaluate effectiveness is through laboratory testing of cholesterol levels at scheduled follow-up appointments.

B. Assess the elasticity of the client's skin at the next scheduled clinic appointment: Skin elasticity is not affected by cholesterol-lowering therapy and does not provide meaningful information about the effectiveness of ezetimibe.

C. Teach the client to weigh himself weekly and keep a log of the measurements: Weight monitoring is more relevant for managing conditions like heart failure or obesity. Ezetimibe’s primary effect is on lipid levels, not weight change.

D. Encourage the client to keep a diary of his food intake until his next visit to the clinic: While dietary tracking supports lifestyle management, it does not directly measure the pharmacologic effectiveness of ezetimibe. Laboratory results remain the standard for evaluation.

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When preparing to administer an intravenous medication through a client's triple lumen central venous catheter, the nurse observes that there are no continuous intravenous fluids infusing. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receives a prescription for itraconazole. Which statement made by the client requires additional instruction by the nurse?

Correct Answer is D

Explanation

To evaluate the effectiveness of a male client's new prescription for ezetimibe, which action should the clinic nurse implement?

Correct Answer is A

Explanation

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