Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reviewing the laboratory data of a client who is receiving filgrastim. Which of the following laboratory values should the nurse monitor to evaluate the effectiveness of the treatment?
A. INR
INR (International Normalized Ratio) is incorrect. INR is a measurement used to monitor the effects of anticoagulants like warfarin. It assesses the blood's ability to clot. Filgrastim does not directly affect INR levels, so monitoring INR would not provide information about the effectiveness of filgrastim in stimulating white blood cell production.
B. BUN
BUN (Blood Urea Nitrogen) is incorrect. BUN levels primarily indicate kidney function and hydration status. They are not directly influenced by filgrastim treatment. Monitoring BUN is essential for assessing kidney function but does not reflect the effectiveness of filgrastim therapy in increasing white blood cell counts.
C. WBC count
WBC count is correct. Filgrastim is a medication that stimulates the production of white blood cells (WBCs), particularly neutrophils. Therefore, the key laboratory value to monitor for assessing the effectiveness of filgrastim therapy is the WBC count. An increase in the WBC count, particularly in the neutrophil count, signifies the intended therapeutic effect of filgrastim in boosting the immune system's response by increasing the production of these infection-fighting cells.
D. Potassium level
Potassium level is incorrect. Potassium levels are crucial for heart and muscle function. While certain medications might affect potassium levels, filgrastim's primary action is on stimulating white blood cell production and does not directly impact potassium levels. Monitoring potassium levels is essential for overall health but does not specifically indicate the effectiveness of filgrastim treatment.
This question is an excerpt from Nurse Dive's nursing test bank - RN Pharmacology 2019 Proctored Exam 5. Take the full exam now
Full Explanation
Choice A Reason:
INR (International Normalized Ratio) is incorrect. INR is a measurement used to monitor the effects of anticoagulants like warfarin. It assesses the blood's ability to clot. Filgrastim does not directly affect INR levels, so monitoring INR would not provide information about the effectiveness of filgrastim in stimulating white blood cell production.
Choice B Reason:
BUN (Blood Urea Nitrogen) is incorrect. BUN levels primarily indicate kidney function and hydration status. They are not directly influenced by filgrastim treatment. Monitoring BUN is essential for assessing kidney function but does not reflect the effectiveness of filgrastim therapy in increasing white blood cell counts.
Choice C Reason:
WBC count is correct. Filgrastim is a medication that stimulates the production of white blood cells (WBCs), particularly neutrophils. Therefore, the key laboratory value to monitor for assessing the effectiveness of filgrastim therapy is the WBC count. An increase in the WBC count, particularly in the neutrophil count, signifies the intended therapeutic effect of filgrastim in boosting the immune system's response by increasing the production of these infection-fighting cells.
Choice D Reason:
Potassium level is incorrect. Potassium levels are crucial for heart and muscle function. While certain medications might affect potassium levels, filgrastim's primary action is on stimulating white blood cell production and does not directly impact potassium levels. Monitoring potassium levels is essential for overall health but does not specifically indicate the effectiveness of filgrastim treatment.
Similar Questions
A nurse is assessing a client who is receiving heparin via continuous IV. The client has an aPTT of 90 seconds. The nurse should monitor the client for which of the following changes in their vital signs?
A. Decreased respiratory rate
Decreased respiratory rate is incorrect. Heparin administration and an elevated aPTT typically do not directly cause a decrease in respiratory rate. Respiratory rate changes might occur due to other factors such as respiratory conditions, pain, or medications affecting the respiratory center, but they are not commonly linked to heparin therapy.
B. Increased blood pressure
Increased blood pressure is incorrect. Heparin therapy and an elevated aPTT do not typically result in increased blood pressure. Heparin's primary effect is on preventing blood clotting, and while it can indirectly affect blood pressure by preventing clot formation, it doesn't typically cause a significant increase in blood pressure.
C. Decreased temperature
Decreased temperature is incorrect. Heparin therapy and an elevated aPTT do not generally cause a decrease in body temperature. Changes in body temperature might occur due to various reasons such as infection, environmental factors, or certain medications, but they are not directly linked to heparin administration.
D. Increased pulse rate
Increased pulse rate is correct. An increased pulse rate can be an early indicator of bleeding or a potential side effect of heparin administration. Heparin's anticoagulant effect might predispose individuals to bleeding, so an increased pulse rate could indicate a response to potential bleeding complications rather than a direct effect of heparin itself.
Full Explanation
Choice A Reason:
Decreased respiratory rate is incorrect. Heparin administration and an elevated aPTT typically do not directly cause a decrease in respiratory rate. Respiratory rate changes might occur due to other factors such as respiratory conditions, pain, or medications affecting the respiratory center, but they are not commonly linked to heparin therapy.
Choice B Reason:
Increased blood pressure is incorrect. Heparin therapy and an elevated aPTT do not typically result in increased blood pressure. Heparin's primary effect is on preventing blood clotting, and while it can indirectly affect blood pressure by preventing clot formation, it doesn't typically cause a significant increase in blood pressure.
Choice C Reason:
Decreased temperature is incorrect. Heparin therapy and an elevated aPTT do not generally cause a decrease in body temperature. Changes in body temperature might occur due to various reasons such as infection, environmental factors, or certain medications, but they are not directly linked to heparin administration.
Choice D Reason:
Increased pulse rate is correct. An increased pulse rate can be an early indicator of bleeding or a potential side effect of heparin administration. Heparin's anticoagulant effect might predispose individuals to bleeding, so an increased pulse rate could indicate a response to potential bleeding complications rather than a direct effect of heparin itself.
A nurse is preparing to administer clindamycin to a client who states she forgot to report to the provider that she is allergic to penicillin. Which of the following actions should the nurse take?
A. Give the client the prescribed dose of the clindamycin.
Giving the prescribed dose of clindamycin is not appropriate due to the reported penicillin allergy, which increases the risk of an allergic reaction.
B. Obtain a prescription for an alternative antibiotic.
Obtain a prescription for an alternative antibiotic is correct. Given the client's reported allergy to penicillin, which is in the same antibiotic class as clindamycin (both are antibiotics that belong to the beta-lactam group), there is a higher risk of cross-reactivity and potential allergic reaction. Therefore, it's important to avoid administering clindamycin in such cases and seek an alternative antibiotic that does not have a similar chemical structure to penicillin to prevent an allergic reaction.
C. Premeditate the client with epinephrine before administering the antibiotic.
Premeditating the client with epinephrine before administering the antibiotic is not a standard practice in this context. Epinephrine is used to treat severe allergic reactions but is not used as a preventive measure before administering antibiotics.
D. Administer the clindamycin using a desensitization schedule.
Administering the clindamycin using a desensitization schedule might be an option in certain situations under the guidance of an allergist or immunologist, but it's not typically performed by nurses and requires a specific protocol and expertise in managing drug allergies. Obtaining an alternative antibiotic is a more appropriate and immediate action to avoid the risk of an allergic reaction in this scenario.
Full Explanation
Choice A Reason:
Giving the prescribed dose of clindamycin is not appropriate due to the reported penicillin allergy, which increases the risk of an allergic reaction.
Choice B Reason:
Obtain a prescription for an alternative antibiotic is correct. Given the client's reported allergy to penicillin, which is in the same antibiotic class as clindamycin (both are antibiotics that belong to the beta-lactam group), there is a higher risk of cross-reactivity and potential allergic reaction. Therefore, it's important to avoid administering clindamycin in such cases and seek an alternative antibiotic that does not have a similar chemical structure to penicillin to prevent an allergic reaction.
Choice C Reason:
Premeditating the client with epinephrine before administering the antibiotic is not a standard practice in this context. Epinephrine is used to treat severe allergic reactions but is not used as a preventive measure before administering antibiotics.
Choice D Reason:
Administering the clindamycin using a desensitization schedule might be an option in certain situations under the guidance of an allergist or immunologist, but it's not typically performed by nurses and requires a specific protocol and expertise in managing drug allergies. Obtaining an alternative antibiotic is a more appropriate and immediate action to avoid the risk of an allergic reaction in this scenario.
A nurse is teaching a client who has a prescription for ferrous gluconate. Which of the following statements by the client indicates an understanding of the teaching?
A. "I should notify my provider if my stools turn black."
"I should notify my provider if my stools turn black." This is the appropriate statement. Ferrous gluconate is an iron supplement commonly prescribed to treat or prevent iron deficiency anemia. When taking iron supplements, it's common for stools to become darker or even black in color. This change in stool color is due to the iron and is generally harmless. However, it's essential to inform the healthcare provider about this change because it can also indicate bleeding in the gastrointestinal tract, which requires evaluation.
B. 1 should take an antacid with this medication to prevent stomach upset."
Taking an antacid with iron supplements can interfere with iron absorption. Antacids may decrease the absorption of iron in the stomach, so it's not recommended to take them together.
C. should stay upright for at least 15 minutes after taking this medication."
While staying upright after taking certain medications can help prevent esophageal irritation or reflux, it's not specifically required with ferrous gluconate.
D. should take this medication with 8 ounces of milk."
Taking iron supplements with milk is also not recommended as milk and calcium-containing products can inhibit the absorption of iron. It's generally best to take iron supplements on an empty stomach or with vitamin C to enhance absorption, unless otherwise instructed by the healthcare provider.
Full Explanation
Choice A Reason:
"I should notify my provider if my stools turn black." This is the appropriate statement. Ferrous gluconate is an iron supplement commonly prescribed to treat or prevent iron deficiency anemia. When taking iron supplements, it's common for stools to become darker or even black in color. This change in stool color is due to the iron and is generally harmless. However, it's essential to inform the healthcare provider about this change because it can also indicate bleeding in the gastrointestinal tract, which requires evaluation.
Choice B Reason:
Taking an antacid with iron supplements can interfere with iron absorption. Antacids may decrease the absorption of iron in the stomach, so it's not recommended to take them together.
Choice C Reason:
While staying upright after taking certain medications can help prevent esophageal irritation or reflux, it's not specifically required with ferrous gluconate.
Choice D Reason:
Taking iron supplements with milk is also not recommended as milk and calcium-containing products can inhibit the absorption of iron. It's generally best to take iron supplements on an empty stomach or with vitamin C to enhance absorption, unless otherwise instructed by the healthcare provider.