The home health nurse observes that a female client is using a topical preparation that contains echinacea to treat a canker sore. Her husband expresses concern regarding the effectiveness and safety of using herbs. How should the nurse respond?
Echinacea seems to be useful in the treatment of some infections such as canker sores
When preparing to administer the next scheduled dose of fentanyl (Sublimaze) Transdermal patch to a client with metastatic cancer and renal insufficiency, the nurse notes the client has shallow respirations at 8 breaths/min. What action should the nurse t
Notify the health care provider
A client diagnosed with myasthenia gravis recieves a prescription for the anticholinesterease medication, pyridostigmine (Mestinon). Which intervention should the nurse implement when preparing to administer the medication?
Administer the medication thirty minutes prior to meals
A nurse administered a second dose of an opiod containing codeine and acetaminophen to a client fifteen minutes after a first dose was administered by another nurse, because the first dose was not documented in the medication record. Which intervention is
Evaluate the client's vital signs
The nurse retrieves hydromorphone (diluadid) 4 mg/mL from the Pyxis MedStation, an automated dispensing system for a client who is recieving Dilaudid 3 mg IM q6 hours prn severe pain. How many mL should the nurse administer to the client? (Enter numeric v
0.8
A client with emphysema is complaining of difficulty breathing and is exhibiting audible wheezing. The nurse administers albuterol(Proventil) as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate interventi
Irregular rapid heart beat
A client is recieving tamsulosin (Flomax), an alpha adrenergic blocking agent, for the management of urinary retention due to beningn prostatic hyperplasia (BPH). Which instruction is most important for the nurse to provide?
Stand and sit up slowly
After taking lactulose (Cholac) for several days, which thereptic response should the nurse expect for a client with hepatic encephalopathy?
Improved mental status
Which action should the nurse take prior to administering digoxin (Lanoxin) PO?
Listen to the heart rate at the left 5th intercostal space
The nurse is instructing a client with allergic rhinitis about the correct technique for using an intranasal inhaler. What instruction is most important for the nurse to provide to the client?
Hold one nostril closed while spraying the other nostril
A client with multiple sclerosis starts a new prescription, baclofen, to control muscle spasticity. Three days later, the client calls the clinic nurse and reports feeling fatigued and dizzy. What instruction should the nurse provide?
Avoid hazardous activities until symptoms subside
The nurse notes that a client has a new prescription for 20 mEq of potassium chloride (Kcl) to be administered IV push Stat. The client's IV site is slightly inflamed but not tender and has blood flashback. What action should the nurse take?
Contact the healthcare provider to clarify the prescription
A client with a respiratory infection has been receiving an antibiotic and an antipyretic for five days. What current datum is the best indication that the antibiotic is effective?
The sputum specimen culture report shows no growth
A client recieving albuterol (Proventil) tablets complains of nausea every evening with her 2100 dose. What action can the nurse take to alleviate this side effect?
Administer the dose with a snack
Twenty minutes after the nurse starts a secondary IV infusion of cefepime (Maxipime) 2 grams using an infusion pump to deliver the dose in one hour, the client reports feeling nauseated. What action should the nurse implement?
Continue the infusion and administer a PRN antiemetic prescription
Fifteen minutes after receiving sulfamethoxazole (Gantanol), a male client reports a burning sensation over his abdomen, chest, and groin. Which intervention is most important for the nurse to implement?
Auscultate lung sounds for wheezing