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. Applying a warming blanket is not appropriate and may worsen the client’s reaction to the infusion. It does not help prevent infusion-related reactions.
B. Infusing amphotericin B deoxycholate over 1 hour is too fast; the medication should be infused over 2-6 hours to reduce the risk of adverse effects.
C. Administering diphenhydramine prior to administration is recommended to help prevent infusion-related reactions, such as fever and chills, which the client experienced during previous infusions.
D. Monitoring vital signs once per hour is inadequate; vital signs should be monitored more frequently during and immediately after the infusion to promptly identify and manage any adverse reactions.
Correct Answer is C
Explanation
Rationale:
A. Magnesium 2.5 mEq/L: A magnesium level slightly above the normal range does not indicate an immediate need to discontinue clozapine, as this level is not related to the adverse effects of the drug.
B. Potassium 5.4 mEq/L: While elevated potassium levels can pose a health risk, this is not a direct indicator to discontinue clozapine. Potassium levels can be managed with other interventions.
C. WBC 2,500/mm³: Clozapine carries a risk of agranulocytosis, a condition where the white blood cell (WBC) count becomes dangerously low, leading to severe infection risk. A WBC count of 2,500/mm³ is below the normal range and indicates the need to discontinue clozapine immediately.
D. Sodium 134 mEq/L: A slightly low sodium level is not typically related to clozapine use and does not warrant discontinuation of the medication.