A patient telephones a nurse and reports that since beginning ...

[cdr_15]

A patient telephones a nurse and reports that since beginning ribavirin (Rebetol) therapy 6 months ago, the patient has had increasing fatigue. Over the past week, shortness of breath also has developed.
 
  Which instruction should the nurse provide?
  a. Come to the office for a complete blood count immediately.
  b. This is a normal response to this medication. It should resolve spontaneously in a few days.
  c. Fatigue and shortness of breath may indicate an allergic reaction to the drug. Take an antihistamine.
  d. Break the pills in half to reduce possible side effects.

Question 2

A patient taking valganciclovir (Valcyte) for cytomegalovirus (CMV) retinitis reports, I'm having difficulty taking the tablets. Can I cut them in half?
 
  The nurse should inform the patient that the medication may not be cut in half because
  a. the potential exists for mutagenesis and carcinogenesis.
  b. the effectiveness of the pill could be lost.
  c. when the coating is destroyed, a bolus of medication is released.
  d. the first-pass effect in the liver is increased.

[Jsherida]

Answer to Question 1

ANS: A
The principal concerns with ribavirin are hemolytic anemia and birth defects. The nurse should instruct the patient to come in for a CBC, because the signs and symptoms are consistent with hemolytic anemia.
The patient's symptoms are not a normal response to the medication.
Fatigue and shortness of breath will not be fixed by administration of an antihistamine.
The medication dosage may be reduced, but the priority is to have the patient come in immediately for a blood test.

Answer to Question 2

ANS: A
The tablets should be ingested intact, without crushing or chewing, because they have the potential for mutagenesis and carcinogenesis and should be handled carefully.
The pills effectiveness would not be lost by this action.
A bolus would not be delivered, and the first-pass effect would not be affected by this action.

[cdr_15]

Excellent

[lcapri7]

Thanks for the timely response, appreciate it