A 94-year-old patient is receiving gentamicin sulfate (Garamycin) in a continuous intravenous (IV) infusion. The nurse adds to the nursing care plan the diagnosis "Risk for injury." What nursing action should be implemented?
a. Pull side rails in place.
b. Assist with ambulation.
c. Measure intake and output.
d. Provide for a possible seizure.
C
Reduced urine output would cause the drug to stay in the system rather than being excreted, which could result in a drug saturation. Gentamicin is ototoxic and can cause hearing impairment.
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An 80-year old-woman who lives alone has begun calling friends and complaining in an exaggerated
fashion about minor aches and pains. Her physician found no significant medical problems. Over the course of a month, she obtained a number of prescriptions for pain medication, none of which seemed to be effective. Friends counseled her that aches are a normal part of life for the elderly and tried unsuccessfully to involve her in activities. She often suggested that she would be better off dead, to which one friend responded "Well, perhaps. It would get you out of your misery.". As she became increasingly "needy" and demanding of attention, friends agreed that her behavior made them uncomfortable and began to call and visit less. The woman took four pain pills and called a neighbor, saying she had overdosed. After medical clearance, the client will be monitored at the mental health clinic. Principles of paramount importance to care planning in this instance include (more than one answer may be correct): A. Parasuicide with lethal intent requires emergency hospitalization. B. The client should be treated for underlying psychiatric disorder if one exists. C. Client perception of isolation is a significant cause for hopelessness. D. A nonlethal suicide attempt must be viewed as communication of the client's desperate state of mind.
A patient is seen resting quietly; however, when the nurse enters the room, the patient begins to grimace and asks for more pain medication. Which of the following should the nurse do?
1. Assess the level of pain and provide the requested pain medication. 2. Confront the patient and ask about the sudden demonstration of pain. 3. Tell the patient that medication cannot be provided at this time and leave the room. 4. Refuse the medication and document that the patient appears to be faking the need for pain medication.
When the effect of two medications combined is greater than the effects of the medications when given separately, the two medications are said to have a(n):
a. synergistic effect. b. anaphylactic reaction. c. medication interaction. d. idiosyncratic reaction.
A patient nervously explains that she has just become sexually active and has a rash. She quickly states that it can't be a sexually transmitted disease (STD) because "he used a condom
" The nurse examines the patient and finds her vagina to be erythematous and edematous. The most likely cause is: A) HPV. B) Gonorrhea. C) Bacterial infection. D) Latex allergy.