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Have the client swish with commercial mouthwash before therapy:Some commercial mouthwashes contain alcohol, which can be irritating to the mucous membranes, especially in clients undergoing chemotherapy. Chemotherapy can cause mucositis or stomatitis, making the oral cavity more sensitive, so alcohol-based mouthwashes should be avoided

Place fresh flowers in the client's room:Fresh flowers are not recommended in the rooms of clients undergoing chemotherapy because they can introduce bacteria into the environment, which is particularly concerning for clients with weakened immune systems due to chemotherapy. Chemotherapy suppresses the immune system, increasing the risk of infection.

Tell the client to expect dark stools following chemotherapy:
Chemotherapy can cause a variety of gastrointestinal side effects, but dark stools are not a typical or expected side effect. Dark stools may indicate gastrointestinal bleeding, which requires immediate attention.

Assess the patient's knowledge of the treatment plan and her willingness to participate:While it is important to assess the patient's understanding of the treatment plan and her willingness to participate, this is not the immediate priority in this situation. The nurse’s first priority is to address the potential risk of radiation exposure due to the dislodgement of the implant.

Assess the UAP's knowledge and explain the rationale for strict bed rest:
Although it is important for the nurse to ensure that all team members, including UAPs, understand the rationale for strict bed rest during brachytherapy, this action is not the most immediate priority in this scenario. The potential dislodgement of the radiation implant requires urgent assessment and intervention.

Notify the physician about the potential dislodgment of the radiation implant:Notifying the physician about the dislodgement is an important step, but it is not the first action the nurse should take. The immediate priority is to assess and secure the radiation implant using appropriate protocols. Once the dislodged pellets have been safely contained in the lead container, the nurse should then notify the physician for further guidance on the next steps in treatment or care.

Infuse lipoproteins to restore the myelin sheath:Multiple sclerosis (MS) is an autoimmune disease where the immune system attacks the myelin sheath around nerve fibers. Plasmapheresis does not work by infusing lipoproteins to restore the myelin sheath. The treatment's primary goal is to remove harmful substances from the blood that may be contributing to the autoimmune attack, particularly antibodies that target the nervous system, not by restoring the myelin itself.

Remove excess fluid from the bloodstream:Plasmapheresis is a process used to remove certain substances from the plasma, including antibodies and immune complexes that might be exacerbating an autoimmune condition like MS. If the goal were to remove excess fluid, the treatment would be more akin to dialysis or a fluid management procedure, but this is not the case with plasmapheresis.

Restore protein levels in the blood:
While plasmapheresis can sometimes lead to a temporary decrease in protein levels due to the removal of plasma, this is not its primary purpose. The primary goal of plasmapheresis in the context of multiple sclerosis is to remove circulating antibodies and other immune-related substances.

Obtain blood specimen for a BMP test:Although obtaining laboratory tests like a BMP (Basic Metabolic Panel) can be important in evaluating the client’s electrolyte balance and kidney function, it is not the priority intervention in this acute situation. The client is exhibiting a potentially dangerous rhythm and the immediate intervention to stabilize the rhythm is necessary before ordering lab tests.

Start CPR:
While starting CPR is critical for a patient who is unresponsive and in a pulseless rhythm (such as ventricular fibrillation or asystole), this client is still responsive with a pulse of 130 bpm. Although the client is in a high-risk rhythm with signs of hemodynamic instability, CPR is not indicated at this moment because the client is not in cardiac arrest.

Prepare for defibrillation:Defibrillation is indicated for life-threatening arrhythmias such as ventricular fibrillation or pulseless ventricular tachycardia. In this case, the client has a pulse, indicating that defibrillation is not appropriate.

Jaundice:Carbidopa-levodopa works by increasing dopamine levels in the brain to help alleviate symptoms of Parkinson's disease, but it is not typically associated with liver dysfunction that would lead to jaundice. If jaundice were to occur, it could indicate liver problems, which would need to be evaluated further, but this is not a typical side effect of Sinemet.

Hyperglycemia:Sinemet primarily affects dopamine levels in the brain and does not have a direct impact on blood sugar regulation. However, long-term use of certain medications, especially corticosteroids or other specific treatments, can affect glucose levels, but carbidopa-levodopa is not typically linked to hyperglycemia.

Hypertension:
Carbidopa-levodopa may lead to fluctuations in blood pressure, including lowering blood pressure, especially when the patient is changing positions. However, hypertension is not a typical response to this medication. Instead, patients may experience orthostatic hypotension, which is more common with carbidopa-levodopa.

Begin initial discharge teaching on home care activities:While discharge teaching is a vital part of the care process, it is typically an activity assigned to a registered nurse (RN) because it involves comprehensive patient education on topics such as medication management, follow-up care, and recognizing signs of complications. Guillain-Barré syndrome (GBS) often requires intensive care in the acute phase, and the RN is responsible for evaluating the client’s readiness for discharge and ensuring they fully understand the care required at home

Begin administration of red blood cells:Administering blood products, such as red blood cells, requires close monitoring for potential reactions, and it is typically the responsibility of the RN. The RN must assess the client’s baseline status, monitor for transfusion reactions, and adjust care accordingly during the procedure. This task requires a higher level of clinical judgment and nursing knowledge than an LPN.

Reassess the client's mobility in the upper extremity:
Reassessing a client’s mobility, especially in a neurological condition like Guillain-Barré syndrome, requires detailed and ongoing assessment to determine changes in the patient’s strength, motor function, and overall neurological status. This activity is a more complex task that requires a registered nurse's clinical expertise.

Teaching a client with a new order for a renal angiogram:Teaching a client about a new diagnostic procedure, such as a renal angiogram, requires advanced knowledge and clinical judgment to explain the procedure, its risks, and the necessary pre- and post-procedure care. This task is best performed by a registered nurse (RN) because it involves providing detailed patient education and addressing the patient’s concerns.

Evaluate the outflow of peritoneal dialysate:
Evaluating the outflow of peritoneal dialysate is a more complex task that involves assessing the effectiveness of the dialysis process and identifying any potential complications (e.g., infection, leakage). This task requires clinical expertise in dialysis and the ability to interpret changes in the output. Although LPNs may assist in monitoring the process, it is ultimately the RN’s responsibility to evaluate the outcome, interpret any changes, and intervene if necessary.

Assess a client with flank pain due to glomerulonephritis:Assessment of a client with flank pain related to glomerulonephritis requires a thorough evaluation of the client's condition, including understanding the potential causes of pain and monitoring for complications such as renal failure or infection. This type of assessment requires critical thinking and clinical judgment, making it the responsibility of the RN.

Go to the emergency department:An immediate trip to the emergency department is generally not required for a peak expiratory flow rate (PEFR) of 82%. The PEFR of 82% indicates that the client’s airflow is reduced, but it is not necessarily an emergency. PEFR readings are typically classified into zones: green (80-100% of personal best), yellow (50-79% of personal best), and red (below 50% of personal best). A reading of 82% is in the yellow zone, which suggests that the client is experiencing some degree of airway obstruction or worsening asthma symptoms

Continue to use salmeterol and fluticasone as prescribed:While salmeterol (a long-acting beta agonist) and fluticasone (a corticosteroid) are important for long-term asthma control, continuing their use without additional intervention is not the most appropriate action when the PEFR is 82%. A PEFR of 82% indicates that the client’s asthma is not well controlled at the moment, and the nurse should recommend additional short-acting relief to help open the airways (e.g., a rescue inhaler like albuterol.

Call the physician:While it may be necessary to call the physician if the client’s asthma symptoms do not improve after using a rescue inhaler or if there is a significant decline in symptoms, the first immediate action should be to use a rescue medication like albuterol. Calling the physician may be appropriate after assessing the response to the rescue medication, but it is not the first step in managing a PEFR of 82%.

Inverted P waves:Inverted P waves typically suggest issues such as atrial ischemia or ectopic atrial rhythms but are not a hallmark sign of hyperkalemia. They may also appear with other conditions, like atrial fibrillation or atrial flutter. However, inverted P waves are not typically linked to elevated potassium levels.

Widened QRS:
A widened QRS complex can occur in several conditions, including hyperkalemia, but it is generally seen in more severe cases. As potassium levels rise further, the QRS complex may widen due to delayed conduction through the ventricles. Although a widened QRS can indicate hyperkalemia, it is a later sign, and it typically occurs after more specific changes like peaked T waves.

Prominent U wave:Prominent U waves are more often associated with hypokalemia (low potassium levels) rather than hyperkalemia. U waves are typically seen after the T wave on the EKG and can be more prominent in conditions of low potassium.