The physician has ordered Amoxil (Amoxicillin) 500 mg capsules for a client with oesophageal varices. The nurse can best care for the client's need by?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The primary nursing responsibility for a client with oesophageal varices is to prevent hemorrhage.
Oesophageal varices are dilated, fragile veins in the wall of the lower oesophagus that are at high risk for rupture.
Swallowing a solid object like a large capsule can cause mechanical trauma or abrasion to these varices, potentially leading to life-threatening bleeding.
Requesting a liquid formulation of the medication is the safest way to administer the antibiotic without causing physical harm.
This action demonstrates critical thinking, patient advocacy, and prioritization of safety.

Option A: Giving the medication as ordered ignores the significant risk of mechanical trauma and hemorrhage associated with the patient's specific condition (oesophageal varices). It is the nurse's responsibility to question an order that could cause harm.
Option B: While extra water may facilitate swallowing, it does not change the solid nature of the capsule or eliminate the risk of it scraping against and rupturing the fragile varices.
Option C: Antacids are used to neutralize stomach acid and would have no effect on the mechanical risk posed by the capsule. This option is irrelevant to the primary safety concern of preventing variceal rupture.

Clinical Relevance

Nursing practice connection: Use the key finding related to Safe Medication Administration in Patients with Oesophageal Varices to guide bedside assessment, documentation, and the next nursing action.
This scenario highlights the nurse's crucial role as a patient advocate and the final safety check in the medication administration process.
Nurses must use clinical judgment to assess if the form of a prescribed medication is safe for a patient's specific condition, and collaborate with the prescriber to make necessary changes.
Failure to identify this risk could lead to a preventable, life-threatening iatrogenic complication (a complication caused by medical treatment).

How to Approach the Question

First, identify the key clinical information in the stem: the patient has 'oesophageal varices' and is prescribed 'capsules'.
Recall the pathophysiology of oesophageal varices: they are fragile, swollen veins prone to bleeding.
Analyze the potential interaction between the patient's condition and the prescribed intervention. Ask yourself: 'What is the risk of giving a hard capsule to someone with fragile veins in their oesophagus?'
Evaluate each option based on its ability to mitigate this risk.
Option A (give as ordered) ignores the risk. Option B (extra water) and C (antacid) do not eliminate the mechanical risk.
Conclude that only Option D (requesting an alternate form) directly addresses and resolves the safety hazard.

Concept Tested & Keywords

Concept Tested: Safe Medication Administration in Patients with Oesophageal Varices
Stem keywords: oesophageal varices, Amoxil, Amoxicillin, capsules
Lead-in keywords: best care
Clinical cues: The diagnosis of oesophageal varices is the critical piece of information that dictates the correct nursing action, as it introduces a high risk of hemorrhage.

Q90vPNxOX5wsduZReoradd

E6 Nursing Fundamentals Potter Perry 12e Part 3 pp. 141-143, 143-145

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.