Answer and explanation

The question is about calculating the volume of methylnaltrexone to administer to a client. The client needs a dose of 12 mg, and the available methylnaltrexone is 8 mg/0.4 mL.

Let’s calculate the volume step by step:

Step 1: Identify the given values:

• Desired dose (D) = 12 mg
• Available dose (A) = 8 mg
• Volume for available dose (V) = 0.4 mL

Step 2: Use the given values in the formula for calculating the volume to administer:

Volume to administer=Available doseDesired dose×Volume for available dose Step 3: Substitute the given values into the formula:

Volume to administer=(12*0.4)/8

Step 4: Perform the multiplication and division:

Volume to administer=4.8mL/8

Step 5: Simplify the division to find the volume to administer:

Volume to administer=0.6mL

So, the nurse should administer 0.6 mL of methylnaltrexone to the client.

Choice A rationale:

Fluconazole Fluconazole is an antifungal medication used to treat and prevent fungal infections. It works by stopping the growth of certain types of fungus. However, it is not effective against bacterial infections such as anthrax.

Choice B rationale:

Tobramycin Tobramycin is an aminoglycoside antibiotic used to treat various types of bacterial infections, particularly Gramnegative infections. It works by stopping the growth of bacteria. However, it is not typically used to treat anthrax.

Choice C rationale:

Ciprofloxacin Ciprofloxacin is a fluoroquinolone antibiotic used for the treatment of a number of bacterial infections. This includes bone and joint infections, intra-abdominal infections, certain type of infectious diarrhea, respiratory tract infections, skin infections, typhoid fever, and urinary tract infections, among others. For the treatment of anthrax, ciprofloxacin is one of the antibiotics that could be used. It works by killing the anthrax or by stopping the anthrax from growing. When the anthrax can’t grow anymore, it dies.

Choice D rationale:

Vancomycin Vancomycin is an antibiotic used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. However, it is not typically used to treat anthrax.

Choice A rationale:

Sodium levels in the blood are typically between 135 and 145 milliequivalents per liter (mEq/L). A sodium level of 140 mEq/L falls within this range, indicating normal sodium levels. Sodium plays a key role in your body. It helps maintain normal blood pressure, supports the work of your nerves and muscles, and regulates your body’s fluid balance. A normal sodium level is therefore crucial for the body’s overall function.

Choice B rationale:

A glucose level of 120 mg/dL is considered normal for a fasting blood sugar test. Glucose is your body’s main source of energy. It comes from the food you eat and is carried through your bloodstream to the cells of your body. If the glucose level in the blood is too high or too low, it can indicate a medical condition such as diabetes.

Choice C rationale:

Potassium levels in the blood are typically between 3.6 and 5.2 millimoles per liter (mmol/L). A potassium level of 4.5 mEq/L falls within this range, indicating normal potassium levels. Potassium is a type of electrolyte that is vital to the function of nerve and muscle cells, including those in your heart. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L). Having a blood potassium level higher than 6.0 mmol/L can be dangerous and usually requires immediate treatment.

Choice D rationale:

The Blood Urea Nitrogen (BUN) test is a routine test used to assess kidney function. Urea nitrogen is a waste product that’s created in your liver when the body breaks down proteins. Healthy kidneys filter urea nitrogen from your blood, but when your kidneys aren’t working well, the BUN level rises. The normal range for BUN is typically around 7-20 mg/dL2. A BUN level of 55 mg/dL is significantly higher than the normal range, indicating that the kidneys may not be functioning properly. This is a critical finding that should be reported to the provider before initiating the medication amphotericin B. Amphotericin B is an antifungal medication used to treat serious, life-threatening fungal infections. However, it is known for its severe and potentially lethal side effects, including kidney damage. Therefore, a high BUN level should be reported to the provider before initiating this medication.

Choice A rationale:

This choice suggests that the nurse is advising the patient to take the medication first and then check with the doctor. This is not a safe practice. The nurse should always verify any doubts or concerns before administering the medication. Administering an unfamiliar medication can lead to adverse effects if it turns out to be incorrect.

Choice B rationale:

This choice implies that if a medication is listed on the medication administration record (MAR), it must be correct. However, errors can occur when transcribing medication orders onto the MAR. Therefore, it’s crucial for the nurse to verify any concerns or doubts before administering the medication.

Choice C rationale:

This is the correct choice. If a patient expresses concern about a medication, the nurse should always check the order before administering it. This is a fundamental aspect of patient safety and medication administration. It ensures that the right patient receives the right medication at the right dose via the right route at the right time.

Choice D rationale:

This choice suggests that because the medication is listed on the medication sheet, the patient should take it. However, this does not address the patient’s concern about the unfamiliar medication. It’s important for the nurse to validate the patient’s concern and verify the medication order before administration.

Choice A rationale:

Phenytoin is an anticonvulsant drug used in the prophylaxis and control of various types of seizures. It has a narrow therapeutic index, which means that the safe and toxic plasma levels of the drug are very close to each other. This characteristic makes the dosing of phenytoin challenging, as even small deviations from the recommended therapeutic range can lead to suboptimal treatment or adverse effects. Therapeutic effect without clinical signs of toxicity occurs more often with serum total concentrations between 10 and 20 mcg/mL34. Therefore, clinicians are advised to initiate therapeutic drug monitoring in patients who require phenytoin.

Choice B rationale:

The statement that phenytoin has a low chance of being effective is incorrect. Phenytoin is a widely used and effective anticonvulsant. It works by slowing down impulses in the brain that cause seizures. It is used to control seizures but does not treat all types of seizures. The effectiveness of phenytoin is not determined by its narrow therapeutic index but by its pharmacological action in the brain.

Choice C rationale:

The assertion that there is no difference between safe and toxic plasma levels of phenytoin is incorrect. There is indeed a difference between the safe (therapeutic) and toxic levels of phenytoin. The therapeutic range for phenytoin is typically between 10 and 20 mcg/mL34. Levels above this range can lead to toxicity, while levels below this range may not provide the desired therapeutic effect.

Choice D rationale:

The statement that a very small dosage of phenytoin can result in the desired therapeutic effect is not entirely accurate. While it’s true that phenytoin is effective in controlling seizures, the dosage required to achieve this effect is not necessarily “very small”. The usual adult dose for seizures is 100 mg orally 3 times a day. The dosage may need to be adjusted based on individual patient factors and response to therapy. Therefore, it’s not accurate to generalize that a “very small” dosage will result in the desired therapeutic effect for all patients.

Choice A rationale:

Shortness of breath is a common symptom of a hypersensitivity reaction. This occurs because the body’s immune system responds to a foreign substance, known as an antigen, by producing specific antibodies. This immune response can cause inflammation and swelling in various parts of the body, including the airways, leading to shortness of breath.

Choice B rationale:

A black hairy tongue is not typically associated with a hypersensitivity reaction. It is a condition that causes the tongue to appear black and hairy, and it’s usually caused by an overgrowth of bacteria or yeast on the tongue. It’s not related to allergies or hypersensitivity reactions.

Choice C rationale:

Itching is another common symptom of a hypersensitivity reaction. When the body encounters an antigen, it triggers an immune response that releases chemicals like histamine. Histamine can cause itching, among other symptoms.

Choice D rationale:

Swelling of the tongue can be a symptom of a severe hypersensitivity reaction known as anaphylaxis. This is a medical emergency that requires immediate attention. The swelling is caused by inflammation in response to an antigen.

Choice E rationale:

Wheezing is a symptom of a hypersensitivity reaction, specifically type I hypersensitivity. This type of reaction includes allergic disorders, which affect the lungs among other parts of the body. The immune response to an antigen can cause the airways to narrow and produce a wheezing sound.

Choice A rationale:

Macrolides Macrolides, such as erythromycin and azithromycin, are a class of antibiotics that are typically used to treat infections caused by gram-positive bacteria and some respiratory tract infections. They are not the first line of treatment for urinary tract infections.

Choice B rationale:

Sulfonamides Sulfonamides, such as sulfamethoxazole, are often used to treat urinary tract infections. They work by stopping the growth of bacteria. Sulfonamides are often combined with other antibiotics like trimethoprim to increase their effectiveness. This combination is commonly known as co-trimoxazole.

Choice C rationale:

Carbapenems Carbapenems are a class of antibiotics that are usually reserved for serious infections caused by gram-negative bacteria. While they can be used to treat a variety of infections, they are not typically the first choice for urinary tract infections.

Choice D rationale:

Tetracyclines Tetracyclines are a group of broad-spectrum antibiotics that are effective against a wide range of bacteria. However, they are not typically used for urinary tract infections. They are more commonly used for infections such as acne, chlamydia, and Lyme disease.

Please consult with a healthcare professional for accurate information.

Choice A rationale:

Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin. Insulin is a hormone that helps the body to use glucose for energy. Glucose is a sugar that comes, in large part, from foods we eat. Insulin allows glucose to enter cells in the body. Therefore, if a client with type 1 diabetes refuses breakfast and requests to sleep, it could lead to hypoglycemia, a condition characterized by abnormally low blood glucose levels. Hypoglycemia can cause symptoms such as weakness, sweating, confusion, and in severe cases, unconsciousness or seizures. It is a medical emergency and should be reported immediately.

Choice B rationale:

Trimming a toenail may seem like a simple task, but for a person with diabetes, it can lead to serious complications. Diabetes can cause nerve damage that leads to numbness in the feet, making it difficult for a person to feel a cut, blister, or sore. These injuries can become infected and lead to serious complications, such as the need for amputation. However, this situation is not as immediately life-threatening as hypoglycemia and does not need to be reported immediately.

Choice C rationale:

Dark yellow urine can be a sign of dehydration, which can be a concern for individuals with diabetes. However, it can also be a result of less serious causes such as certain medications, foods, or simply not drinking enough fluids. While it’s important for the AP to encourage the client to drink more fluids, this situation is not as immediately life-threatening as hypoglycemia.

Choice D rationale:

Dizziness when standing, also known as orthostatic hypotension, can be a side effect of some medications used to treat diabetes. It can also be a symptom of dehydration or other conditions. While it’s important for the AP to monitor the client’s symptoms and report any changes, this situation is not as immediately life-threatening as hypoglycemia

Choice A rationale:

Bounding peripheral pulses are not typically associated with diabetes insipidus. Diabetes insipidus is a condition characterized by excessive thirst and excretion of large amounts of severely dilute urine.

Choice B rationale:

Moist mucous membranes are not a common finding in diabetes insipidus. In fact, due to excessive urination, patients may experience dehydration which can lead to dry mucous membranes.

Choice C rationale:

Bradycardia, or a slower than normal heart rate, is not a typical symptom of diabetes insipidus. The condition does not directly affect the heart rate.

Choice D rationale:

Decreased urine specific gravity is a key finding in diabetes insipidus. The condition causes an imbalance of water in the body, leading to the production of large amounts of dilute (or low specific gravity) urine.

Please note that these rationales are based on general knowledge about diabetes insipidus and the specific symptoms mentioned in the choices. For a more detailed understanding, it’s recommended to refer to medical textbooks or consult with healthcare professionals.

Choice A rationale:

Waiting to see if the fever gets worse is not the best course of action. Fever is a symptom that the body is fighting off an infection, and it can cause discomfort in children. However, the main concern with chickenpox and fever is not the fever itself, but the risk of complications from the chickenpox. Therefore, it’s important to manage the fever for the child’s comfort but also monitor for any signs of complications.

Choice B rationale:

Aspirin should not be given to children or teenagers who have chickenpox or flu symptoms before a doctor is consulted about Reye’s Syndrome, a rare but serious illness. Reye’s syndrome is a potentially life-threatening condition that has been associated with aspirin use in children and adolescents with viral illnesses, especially chickenpox or influenza.

Choice C rationale:

Acetaminophen (Tylenol) should be used to reduce his fever, not aspirin. This is because of the risk of Reye’s syndrome associated with aspirin use in children and adolescents who have viral illnesses. Acetaminophen is a safe and effective choice for fever reduction in children.

Choice D rationale:

While it’s important to always follow the instructions on the bottle when giving medication, aspirin should not be used in children or teenagers with chickenpox due to the risk of Reye’s syndrome. Therefore, this advice could potentially lead to a dangerous situation.

The question is about calculating the volume of phenytoin oral solution that the nurse should administer per dose. The client is prescribed 250 mg of phenytoin and the available solution has a concentration of 25 mg/5 mL.

Let’s calculate the volume step by step:

Step 1: Identify the prescribed dose and the concentration of the available medication. The prescribed dose is 250 mg and the concentration of the available medication is 25 mg/5 mL.

Step 2: Set up the calculation. We want to find out how many mL correspond to the prescribed dose. We can set up the calculation as follows: (Prescribed dose ÷ Concentration) × Volume.

Step 3: Substitute the known values into the calculation. This gives us: (250 mg ÷ 25 mg/5 mL).

Step 4: Perform the division operation first due to the order of operations (BIDMAS/BODMAS). This gives us: (250 mg ÷ 5 mg/mL).

Step 5: Perform the final calculation. This gives us: 50 mL.

So, the nurse should administer 50 mL of the phenytoin oral solution per dose.

Please note that this calculation assumes that the prescribed dose (250 mg) is to be administered in one go. If the dose is to be split over the day, the volume to be administered would change accordingly.

Choice A rationale:

The client stating, “I haven’t had anything to eat or drink since last night” is not a cause for concern. This is because patients are often advised to fast before undergoing certain medical procedures or tests, including an intravenous pyelogram (IVP).

Fasting helps to ensure that the test results are accurate and not influenced by recent food or drink consumption.

Choice B rationale:

The client expressing that “The last time I voided it was painful” could be related to their recurrent kidney stones. Kidney stones can cause discomfort or pain during urination. However, this statement does not necessarily require additional data collection in the context of an IVP. The pain could be a symptom of the kidney stones rather than a contraindication for the IVP1.

Choice C rationale:

The statement “I took my metformin before breakfast” is of concern. Metformin is a medication used to treat type 2 diabetes. It is important for the nurse to collect additional data about this statement because metformin can potentially interact with the iodine-based contrast dye used in an IVP. This interaction can increase the risk of lactic acidosis, a serious and potentially lifethreatening condition. Therefore, patients are often advised to stop taking metformin before and for a couple of days after having an IVP12. Choice D rationale:

The client mentioning, “I took a laxative yesterday” is not necessarily alarming. Laxatives are often used before an IVP to clear the bowels, which helps to ensure clear images during the procedure. Therefore, this statement does not require additional data collection in the context of an IVP1.

Choice A rationale:

Polyuria, which is frequent or excessive urination, is not typically a symptom of hypoglycemia. It is more commonly associated with hyperglycemia, or high blood sugar levels.

Choice B rationale:

Sweating is indeed a common symptom of hypoglycemia. When blood sugar levels fall too low, the body may respond by sweating as it releases adrenaline in response to the hypoglycemic state.

Choice C rationale:

Tachycardia, or a fast heartbeat, is another common symptom of hypoglycemia. This is part of the body’s response to low blood sugar levels, as it releases adrenaline to try to raise these levels.

Choice D rationale:

Blurry vision can be a symptom of hypoglycemia. When blood sugar levels fall, it can affect the ability of the eyes to focus, leading to blurry vision.

Choice E rationale:

Polydipsia, or excessive thirst, is not typically a symptom of hypoglycemia. Like polyuria, it is more commonly associated with hyperglycemia.

Choice A rationale:

Holding the drug and administering it 4 hours later is not the appropriate action. The trough vancomycin level of 24 mcg/mL is higher than the recommended range of 10-20 mcg/mL, indicating potential risk for toxicity. Administering the drug later does not address the immediate concern of a high trough level.

Choice B rationale:

Administering the vancomycin as ordered is not the correct action in this case. The trough level is above the recommended range, which could lead to vancomycin toxicity. The nurse should not administer the medication without addressing the high trough level. Choice C rationale:

This is the correct action. The nurse should hold the drug and notify the prescriber because the trough vancomycin level is higher than the recommended range. The prescriber can then make a decision based on this information, which may include adjusting the dose, extending the dosing interval, or ordering additional tests.

Choice D rationale:

While repeating the test to verify results might be done eventually, it should not be the immediate next step. The nurse has a responsibility to ensure patient safety, and with a trough level above the recommended range, the priority is to prevent potential toxicity. Therefore, the nurse should hold the drug and notify the prescriber.

The correct answer is Choice D.

Let’s go through the calculations step by step:

Step 1: Convert all the quantities to milliliters (mL), as the nurse needs to record the intake in mL. We know that 1 oz is approximately 29.5735 mL.

4 oz of juice = 4 × 29.5735 mL = 118.294 mL

6 oz of tea = 6 × 29.5735 mL = 177.861 mL 8 oz of broth = 8 × 29.5735 mL = 236.628 mL Step 2: Add all the quantities together:

118.294 mL (juice) + 177.861 mL (tea) + 100 mL (soda) + 150 mL (IV bolus) + 236.628 mL (broth) = 783.783 mL Step 3: Round off the total intake to the nearest whole number as required, which gives us 784 mL.

Therefore, the nurse should record 784 mL on the patient’s chart. However, this option is not available in the choices given. The closest option to this calculated value is 800 mL (Choice D).

Now, let’s discuss the rationales for each choice:

Choice A rationale:

500 mL would be an underestimate of the patient’s fluid intake. It does not account for all the fluids the patient consumed.

Choice B rationale:

600 mL, similar to Choice A, is an underestimate. It does not accurately represent the total volume of fluids the patient consumed. Choice C rationale:

700 mL is closer to the calculated intake but is still an underestimate. It does not fully account for all the fluids the patient consumed.

Choice D rationale:

800 mL is the closest option to the calculated intake of 784 mL. Although it’s slightly over the actual intake, it’s the best choice among the given options.

Choice A rationale:

Amphotericin B is a potent antifungal medication used to treat severe fungal infections. However, it is typically reserved for life-threatening systemic fungal infections due to its potential for serious side effects, including kidney damage and infusion reactions. It is not commonly used as a first-line treatment for vaginal yeast infections.

Choice B rationale:

While antifungal creams can be effective for treating vaginal yeast infections, they typically require a treatment course of several days. This option may not be the best choice for a patient seeking a quicker, one-time treatment.

Choice C rationale:

A single dose of a fluconazole oral tablet is often an effective treatment for vaginal yeast infections. Fluconazole works by inhibiting the growth of the yeast causing the infection. It is convenient for patients because it only requires one dose, unlike creams or suppositories that need to be applied for several days.

Choice D rationale:

There are indeed alternatives to antifungal suppositories for treating vaginal yeast infections. As mentioned above, a single dose of fluconazole is one such alternative. Therefore, stating that there is no better alternative to the suppositories is not accurate.

Choice A rationale:

Aspirin is known as a salicylate and a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking a certain natural substance in your body to reduce pain and swelling. However, one of the key reasons aspirin is administered to a patient with a history of myocardial infarction (MI) is due to its antiplatelet aggregate properties. This effect reduces the risk of stroke and heart attack. If a patient has recently had surgery on clogged arteries (such as bypass surgery, carotid endarterectomy, coronary stent), doctors may direct them to use aspirin in low doses as a “blood thinner” to prevent blood clots.

Choice B rationale:

While aspirin does have analgesic properties, meaning it can relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches, this is not the primary reason it would be administered to a patient with a history of MI. The main goal in this context is to prevent further cardiac events, which is achieved through aspirin’s antiplatelet effects.

Choice C rationale:

Aspirin does have anti-inflammatory properties and it may be used to reduce pain and swelling in conditions such as arthritis. However, in the context of a patient with a history of MI, the anti-inflammatory property is not the primary reason for administering aspirin. The key purpose is to leverage its antiplatelet effects to prevent further cardiac events.

Choice D rationale:

Aspirin can be used to reduce fever, which is what the term ‘antipyretic’ refers to. However, similar to the analgesic and antiinflammatory properties, the antipyretic property is not the primary reason for administering aspirin to a patient with a history of MI. The main goal is to prevent further cardiac events through its antiplatelet effects.

Choice A rationale:

Administering the medications using a 3-mL medication syringe is not the best practice. While it is possible to use a 3-mL syringe for medication administration, it is not the most efficient or safest method. A larger syringe allows for easier administration and reduces the risk of creating too much pressure which could potentially damage the PEG tube.

Choice B rationale:

Applying firm pressure on the syringe’s piston to infuse the medication is not recommended. This can create too much pressure in the PEG tube and could potentially cause damage. It is generally advised to allow the medication to flow into the tube via gravity. Choice C rationale:

Flushing the tubing with 30 mL of saline after the medication has been given is the correct technique. This helps to ensure that all of the medication has been administered and also helps to keep the tube clear of any potential blockages.

Choice D rationale:

Using the barrel of the syringe, allowing the medication to flow via gravity into the tube is a common practice. However, it is not the only step in the process. It is also important to flush the tube before and after medication administration to ensure all medication is delivered and to maintain the patency of the tube.

Choice A rationale:

Reporting a near-miss using the facility’s recommended protocol and correcting the error on the MAR is the appropriate action. A “near-miss” in healthcare is a situation where an error could have happened, but didn’t, either by chance or timely intervention. It’s crucial to report these incidents as they provide valuable information for risk management and quality improvement. By analyzing near-misses, healthcare facilities can identify potential hazards and take preventive measures to ensure patient safety. Correcting the error on the MAR is also important to prevent the same mistake from happening in the future.

Choice B rationale:

Reporting the near-miss to the next shift before the next dose is due is not the best course of action. While it’s important to communicate any potential issues to the next shift, it’s more crucial to report the incident immediately using the facility’s recommended protocol. This allows for a timely investigation and corrective action. Waiting until the next shift could delay these processes and potentially put patient safety at risk.

Choice C rationale:

Correcting the MAR error but saying nothing because nothing happened is not an appropriate response. Even though the error did not result in any harm, it’s still important to report it. Near-misses are often indicators of underlying system issues that need to be addressed. By not reporting the incident, the opportunity to improve patient safety and prevent future errors is lost.

Choice D rationale:

Notifying the pharmacy about the error they almost caused is not the most appropriate action. While it’s important to communicate with the pharmacy if they were involved in the error, the first step should always be to report the near-miss using the facility’s recommended protocol. This ensures that the incident is properly documented and investigated, and that appropriate corrective actions are taken.

Choice A rationale:

Polyuria, which is frequent or excessive urination, is not typically a symptom of hypoglycemia. It is more commonly associated with hyperglycemia, or high blood sugar levels.

Choice B rationale:

Sweating is indeed a common symptom of hypoglycemia. When blood sugar levels fall too low, the body may respond by sweating as it releases adrenaline in response to the hypoglycemic state.

Choice C rationale:

Tachycardia, or a fast heartbeat, is another common symptom of hypoglycemia. This is part of the body’s response to low blood sugar levels, as it releases adrenaline to try to raise these levels.

Choice D rationale:

Blurry vision can be a symptom of hypoglycemia. When blood sugar levels fall, it can affect the ability of the eyes to focus, leading to blurry vision.

Choice E rationale:

Polydipsia, or excessive thirst, is not typically a symptom of hypoglycemia. Like polyuria, it is more commonly associated with hyperglycemia.

Choice A rationale:

A WBC count of 16,000/mm is higher than the normal range of 5,000 to 10,000 cells/mm. This indicates that the body is fighting an infection, which is a common reason for prescribing Vancomycin. Therefore, a high WBC count could indicate a therapeutic response to the medication as it suggests that the body’s immune system is actively fighting the infection.

Choice B rationale:

A BUN level of 42 mg/dl is higher than the normal range of 7 to 20 mg/dL3456. Elevated BUN levels can indicate kidney damage or disease, which is not a desired therapeutic response to Vancomycin. Vancomycin can be nephrotoxic, and its use requires careful monitoring of kidney function. Therefore, a high BUN level does not indicate a therapeutic response to the medication. Choice C rationale:

A blood pressure reading of 95/64 is considered normal. Maintaining normal blood pressure is important for overall health and can indicate that the patient’s body is responding well to the medication. Therefore, a blood pressure reading within the normal range could indicate a therapeutic response to Vancomycin.

Choice D rationale:

A body temperature of 101.8F is considered a fever14. Fever is a common response to infection and can indicate that the body is fighting off an infection, which is a common reason for prescribing Vancomycin. Therefore, a high body temperature could indicate a therapeutic response to the medication as it suggests that the body’s immune system is actively fighting the infection.

Choice A rationale:

Instructing the client to soak his feet daily is not recommended for individuals with diabetes. Soaking the feet can increase the risk of foot problems, particularly if the person has nerve damage or poor blood flow. It can lead to dry and cracked skin, which can increase the risk of infection. Therefore, this intervention should not be included in the care plan.

Choice B rationale:

Assisting the client in developing an individualized meal plan is a crucial intervention for managing type 2 diabetes. Meal planning is the first step in healthy eating and is especially important for people with diabetes because food directly impacts blood glucose levels. An individualized meal plan considers the person’s goals, tastes, lifestyle, and any medicines they’re taking. Therefore, this intervention should be included in the care plan.

Choice C rationale:

Checking the client’s blood glucose level before meals and at bedtime is an essential part of managing diabetes. Regular monitoring of blood glucose levels can help track the effect of diabetes medicines, understand how diet and exercise affect blood glucose levels, and detect if blood glucose levels are high or low. Therefore, this intervention should be included in the care plan.

Choice D rationale:

Administering an extra dose of insulin if the client’s blood glucose level drops to 50 mg/dl is not recommended. If a person’s blood glucose level is already low, administering additional insulin can lead to an insulin overdose, which can be lifethreatening. Therefore, this intervention should not be included in the care plan.

Choice A rationale:

Erythromycin Erythromycin is a macrolide antibiotic that is often used as an alternative to penicillin. It is generally safe for use in patients with a penicillin allergy. It works by inhibiting bacterial protein synthesis and is effective against a wide range of bacteria.

Choice B rationale:

Amphotericin B Amphotericin B is an antifungal medication, not an antibiotic. It is used to treat serious, systemic fungal infections. It has no cross-reactivity with penicillin, so it would not be a concern for a patient with a penicillin allergy.

Choice C rationale:

Amoxicillin-clavulanate Amoxicillin-clavulanate is a type of penicillin antibiotic. Patients with a known penicillin allergy should avoid this medication, as they may have a cross-reactivity to it. This is why the nurse should verify this prescription with the provider.

Choice D rationale:

Gentamicin Gentamicin is an aminoglycoside antibiotic used to treat serious bacterial infections caused by gram-negative bacteria. It is not related to penicillin and would be safe for a patient with a penicillin allergy.

Choice A rationale:

Rifampin is an antibiotic used to treat or prevent tuberculosis (TB). However, the treatment with this medication typically lasts longer than one month. In fact, TB treatment usually involves taking several drugs for a long time.

Choice B rationale:

While it’s important to take some medications with meals to increase absorption or decrease stomach upset, rifampin should be taken at least 1 hour before or 2 hours after a meal. This helps to ensure optimal absorption of the medication.

Choice C rationale:

Insomnia is not typically listed as a common side effect of rifampin. The medication can cause a number of side effects, but these more commonly include things like upset stomach, loss of appetite, nausea, vomiting, diarrhea, and changes in behavior.

Choice D rationale:

One of the known side effects of rifampin is that it can cause a red-orange discoloration of body fluids, including urine, sweat, saliva, and tears. This can be alarming to patients if they are not forewarned, so it’s important for the nurse to provide this information during discharge instructions.

Choice A rationale:

The statement “The intravenous medication will have delayed absorption into the body’s tissues” is incorrect. Intravenous (IV) therapy is administering fluids directly into a vein. It benefits treatment by enabling water, medication, blood, or nutrients to access the body faster through the circulatory system. This bypasses the gastric system so the body can take on more fluids quickly. Therefore, the absorption of intravenous medication into the body’s tissues is not delayed but rather immediate.

Choice B rationale:

The statement “The action of the medication will begin sooner when given intravenously” is correct. Administering a medication intravenously eliminates the process of drug absorption and breakdown by directly depositing it into the blood. This results in the immediate elevation of serum levels and high concentration in vital organs, such as the heart, brain, and kidneys. Therefore, the action of the medication begins sooner when given intravenously.

Choice C rationale:

The statement “The medication will cause fewer adverse effects when given intravenously” is not necessarily true. While some medications might cause fewer adverse effects when given intravenously, this is not a general rule for all medications. The adverse effects of a medication depend on various factors including the type of medication, the dose, the patient’s health condition, and more.

Choice D rationale:

The statement “There is a lower chance of allergic reactions when drugs are given intravenously” is not necessarily true. The chance of allergic reactions depends on various factors including the type of drug, the patient’s immune response, previous exposure to the drug, and more. It’s not related to the route of administration.