A nurse is caring for a client who refused a prescribed dose of valproic acid 250 mg PO. The client states, "I don't want to take that pill because it makes me feel nauseated." Which of the following actions should the nurse take? (Select all that apply.)
Educate the client about the possible consequences of not taking the medication.
Suggest the client take food with the medication to minimize GI effects.
Document the client's refusal in the medication administration record.
Offer to administer the medication IM.
Recommend the client ask the provider to prescribe an enteric-coated medication.
Correct Answer : A,B,C,E
Rationale:
A. Educating the client about the consequences of not taking valproic acid is essential to ensure they understand the importance of adherence to the medication regimen.
B. Suggesting that the client take the medication with food can help minimize gastrointestinal side effects such as nausea.
C. Documenting the client's refusal in the medication administration record is a critical step to maintain accurate medical records and to inform other healthcare providers.
D. Offering to administer the medication IM is not appropriate, as valproic acid is typically given orally and not via intramuscular injection.
E. Recommending the client ask the provider about an enteric-coated formulation may provide a more tolerable option to reduce gastrointestinal side effects.
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Correct Answer is C
Explanation
Rationale:
A. Delaying the incident report until the end of the current shift can compromise the timely documentation of the error and any necessary interventions that may arise.
B. While it's important to notify risk management, the priority should be to document the incident immediately after assessing the client to ensure a complete record of the error.
C. Completing the incident report as soon as the assessment is complete is the most appropriate action, allowing for prompt documentation of the error and any potential effects on patient care.
D. Informing the previous nurse is necessary for communication, but it should not delay the completion of the incident report, which is crucial for tracking errors and improving safety protocols.
Correct Answer is D
Explanation
Rationale:
A. A respiratory rate of 24/min is elevated and may suggest respiratory distress, but it is not a specific adverse effect of propranolol.
B. An oral temperature of 38.9° C (102° F) indicates fever, which is not a typical adverse effect of propranolol.
C. A blood pressure of 118/78 mm Hg is within normal limits and does not indicate an adverse effect of propranolol, which is often used to manage hypertension.
D. An apical pulse of 50/min indicates bradycardia, a known adverse effect of propranolol, which can occur due to its action on the heart rate.