NUR113 PrepU Assignment

A nurse is caring for a client. After review of the laboratory assessment, the nurse identifies that the potassium level is 6.2 mEq/l (6.2 mmol/l). Select the mechanism of action from each of the following medications. 1. calcium gluconate 2. sodium bicarbonate 3. IV regular insulin and hypertonic dextrose 4. renal replacement therapy

1. calcium antagonizes the potassium in the heart 2. alkalizes the plasma 3. shifts potassium into the cells 4. removal of potassium out out of the body Calcium gluconate antagonizes the potassium in the heart. Calcium chloride and calcium gluconate can be used but caution with both. Sodium bicarbonate alkalizes the plasma. Intravenous regular insulin and hypertonic dextrose shifts potassium back into the cells. Actual removal of potassium from the body can be completed by use of peritoneal dialysis, hemodialysis, or other forms of renal replacement therapy.

A client's intake and output is being measured and recorded each shift. The client has had the following intake: 3 oz apple juice 4 oz tea 5 oz pureed chicken 2 oz mashed potatoes 4 oz orange gelatin 2 oz vanilla ice cream Calculate the amount, in milliliters, the nurse documents as fluid on the intake sheet. Record your answer using a whole number.

390 Intake measurements include all oral and parenteral fluids. Oral fluids include any liquids ingested or any foods that become liquid at room temperature. Gelatin and ice cream are examples of solid foods to include. Pureed foods is not considered fluid intake nor is mashed potatoes. Based on the measurements, the client consumed 13 oz of fluid. One ounce is equal to 30 ml, so 13 oz of fluid is equal to 390 mL.

The nurse is caring for a client diagnosed with an acute myocardial infarction requiring strict monitoring of intake and output. Calculate the intake for the shift. Record your answer using a whole number rounded to the nearest 10 mL. 550 mL of urine ¼ cup of grapes 200 mL of liquid stool 4 oz of Jell-O 250 mL of IV normal saline 1 cup of apple juice

610 The nurse would include all items that are liquid or turn to liquid at room temperature in the calculation. Jello, IV normal saline, and apple juice are calculated as intake. Urine and stool are calculated as output. Grapes will not be included as intake. Convert all units to mL, rounded to the nearest 10 mL: 4 oz of Jello = 120 mL 1 cup of apple juice = 240 mL 120 mL + 250 mL IV fluid +240 mL = 610 mL

A client is to be started on a daily furosemide dosage. Which instructions would be included in the teaching plan? Select all that apply.

Advise the client to reduce dietary sodium intake Advise the client to alert the healthcare provider if any visible edema occurs Instruct the client to take the medication on a regular schedule each day Furosemide is a loop diuretic. Client teaching focuses on actions related to the fluid gradient and electrolyte balance. Reducing dietary sodium intake will help increase the effectiveness of diuretic medication and may allow smaller doses to be ordered. Diuretics are commonly prescribed to control fluid accumulation in the body; therefore, the presence of edema may indicate the need for the health care provider to adjust the therapy. Compliance is very important with diuretics. In order to effectively monitor therapy, the nurse would encourage the client to take the medication exactly as prescribed and on a regular routine. Salt substitutes are not recommended because they contain potassium instead of sodium and may cause serious cardiovascular effects. Diuretics cause an increased urine output, which may interfere with the client's sleep if taken in the evening. It is most commonly suggested to take a daily dosage in the morning.

Assessment of a client reveals the following findings: elevated body temperature, dry skin, low urinary output, and increased pulse rate. Which action should the nurse take?

Encourage the intake of salty liquids like broth and tomato juice. Treatment for extracellular fluid volume deficit includes either oral or IV replacement of sodium, chloride, and water in the same concentrations found in body fluid. The nurse can use oral rehydration fluids and salty liquids such as broth and tomato juice and/or IV normal saline (0.9% sodium chloride). Drinking additional water or foods that contain a high amount of fluid will not provide the sodium required for recovery.

A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be ingested in moderation because of the possible interference with the effect of the therapy. Which foods must be taken in limited quantity?

Foods rich in vitamin K The nurse should inform the client to limit the intake of foods rich in vitamin K as they interfere with warfarin therapy. Foods rich in vitamin A, C, or D need not be limited, as they do not affect the treatment.

The nurse is admitting a client from the healthcare provider's office. The orders read: Bedrest with bathroom privileges, IV 0.9% NSS run at 125mL/hr, MSO4 IV 5mg every 1 hour prn pain. What are the nurse's best action(s)? Select all that apply.

Hold pain medication. Call the healthcare provider and clarify order. MSO4 can mean morphine sulfate or magnesium sulfate, or confused for one another; the medication names should be spelled out, not abbreviated. The nurse should hold the pain medication and then clarify the order with the healthcare provider. Only the healthcare provider should clarify the medication.

An adult client has the following results of morning blood work: Potassium: 2.5 mEq/L (2.5 mmol/L) Sodium: 136 mEq/L (136 mmol/L) Calcium: 9.2 mg/dL (2.3 mmol/L) Magnesium: 2.02 mEq/L (1.01 mmol/L) How should the nurse best respond to these values?

Inform the health care provider and monitor the client's cardiac status. The client has hypokalemia; all of the other values are within reference ranges. Because of the cardiac effects of hypokalemia, close monitoring is essential until the problem is corrected. There is no obvious need to monitor the client's chloride level. The client's calcium levels do not require correction.

The nurse knows that which medication prescription as written has the potential to cause a medication error? (Select all that apply.)

MS 10 mg IM every 4-6 hours for pain Ensure 240 cc every 5 hours per feeding tube Hydromorphone 2 mg IV @ 3 PM MS should not be used as a drug name because its meaning is unclear. It could be morphine sulfate or magnesium sulfate. The abbreviation "cc" should not be used because it may be mistaken for u (units) if poorly written. The symbol @ should not be used because it may be mistaken for the number 2.

A client with renal impairment is in need of a diuretic. Because of the renal problem, potassium-sparing diuretics are contraindicated but may be used if there is no other option. If they are used at all, what nursing intervention would be most important for this client?

Monitoring of serum electrolytes, creatinine, and BUN Potassium-sparing diuretics are contraindicated in clients with renal impairment because of the high risk of hyperkalemia. If they are used at all, frequent monitoring of serum electrolytes, creatinine, and BUN is needed.

Following a heel stick on an infant, the laboratory technician calls the nurse to report a critical potassium level of 7.0 mEq/L (7.0 mmol/L) on the hemolyzed specimen. What action should the nurse take based on these results?

Redraw the sample. Hemolysis of a blood sample can cause falsely elevated bilirubin and potassium levels. This sample was reported as hemolyzed and therefore should be redrawn. Placing the infant on a monitor, obtaining an ECG, and administering IV calcium gluconate may be required if the potassium is really elevated.

A nurse in a health care facility is caring for a patient who is administered milk of magnesia to control constipation. Which nursing diagnosis should the care plan for this patient include?

Risk for imbalanced fluid volume The patient care plan should include risk for imbalanced fluid volume for the patient administered acid neutralizers. The nursing diagnoses checklist should include disturbed sensory perception for a patient receiving anticonvulsants. The nursing diagnoses checklist should include impaired physical mobility for a patient receiving antiparkinsonism drugs. The nursing diagnoses checklist should include ineffective tissue perfusion for a patient receiving cholinergic-blocking drugs.

A client is receiving intravenous fluids and upon assessment presents with increased pulse, increased respirations, and jugular vein distension. What is the priority action by the nurse?

Slow the intravenous rate and notify the physician. The increased volume from too-rapid fluid infusion will result in increased heart rate. There can be pulmonary edema with resultant increase in the respiratory rate to compensate. Jugular vein distension also indicates fluid overload. The rate of the intravenous fluids would need to be slowed, and the physician notified for new orders. Repeating the vital signs in 1 hour is incorrect because the client is already in distress. Lowering the head of the bed will increase the symptoms. Although oxygen may help, the priority is to decrease fluid volume.

A nurse is teaching a client about the newly prescribed furosemide and how it affects fluid and electrolyte balance. In addition to water, the nurse would explain that the drug also affects which electrolyte(s)? Select all that apply.

Sodium Chloride Potassium Magnesium Diuretics are prescribed to increase the excretion of sodium, chloride, and water in clients with high blood pressure or with chronic heart, renal, or liver problems. At times, the medications may remove too much ECF from the body, resulting in a deficit. Diuretics, except for the potassium-sparing diuretics, also promote the excretion of potassium and magnesium from the body, increasing the risk of electrolyte deficits as well. Imbalances of calcium and phosphate are usually not associated with diuretic therapy.

A client with ulcerative colitis is scheduled for a bowel resection. The client is receiving parenteral nutrition prior to surgery. Which is the best explanation for the nurse to give the client about the need for parenteral nutrition?

The client has lost 15% of body weight and has prolonged diarrhea. Clients with ulcerative colitis are often in a poor physical state because of loss of weight, improper absorption, and loss of fluids and electrolytes. Diarrhea and weight loss signify nutrient losses and deficiencies. The client needs to have a good nutritional status prior to surgery to promote recovery and wound healing. The other answers are incorrect because the client's desire to have surgery as soon as possible is not as important as being in a positive nitrogen balance and good nutritional state. Nutrients are not absorbed through the colon, but through the small intestine. Fluids, electrolytes, and acid-base balance do not need to be corrected by parenteral nutrition.

Which medication(s) may be prescribed for clients with peptic ulcers to neutralize gastric acid? Select all that apply.

calcium carbonate aluminum hydroxide magnesium hydroxide There are two pharmacologic methods for reducing gastric acid content: neutralization of gastric acid through the use of antacids and a decrease in gastric acid production through the use of histamine-2 (H2)-receptor antagonists or proton pump inhibitors. Essentially, three types of antacids are used to relieve gastric acidity: calcium carbonate, aluminum hydroxide, and magnesium hydroxide. Calcium gluconate is administered to treat hypocalcemia and is not an antacid. Potassium hydroxide is a chemical that should not be ingested because it causes burns, but it may be used in small concentrations as part of topical treatment in some skin conditions.

A nurse is caring for a client receiving I.V. magnesium sulfate. Which drug is the antidote for magnesium toxicity?

calcium gluconate The nurse should anticipate administering 10 ml of 10% calcium gluconate by I.V. push over 3 to 5 minutes as a calcium gluconate antidote for magnesium toxicity. Hydralazine/hydralazine is given for sustained elevated blood pressures in clients with preeclampsia. Naloxone is used to correct opioid toxicity. Rohm(D) immune globulin is given to clients with Rh-negative blood to prevent antibody formation from Rh-positive fetuses.

A client with gestational hypertension receives magnesium sulfate 50% 4 g in 250 mL D5W over 20 minutes. What priority assessment should the nurse perform when administering this drug?

deep tendon reflexes Magnesium sulfate is given to prevent and control seizures in clients with gestational hypertension. It is administered by IV; 4 g of a 50% solution in 250 mL D5W can be given as a bolus before the dose is titrated for continuous infusion. Magnesium sulfate is a general inhibitor of neurotransmission. As such, the two largest complications are the loss of deep tendon reflexes and the suppression of breathing. These are the priority assessments. If deep tendon reflexes decrease or the respiratory rate is 12 breaths/min or less, the medication should be discontinued and calcium gluconate administered. Magnesium sulfate is excreted entirely through the kidneys so intake and output should be evaluated hourly. The mother becomes very hot and flushed. This is a normal response. The fetal heart rate should not decrease from the drug.

The nurse monitors a client for side effects associated with furosemide, which is newly prescribed for the treatment of heart failure. Complete the following sentence by choosing from the lists of options. Due to the client's high risk for developing __________ as a result of the prescribed medication, the nurse focuses on monitoring the client for ____________.

hypokalemia ventricular arrhythmia Furosemide, a loop diurectic, is often prescribed for clients who experience fluid volume overload due to a diagnosis of heart failure (HF). The client who is newly prescribed furosemide for the treatment of hypervolemia due to HF is at a high risk for developing fluid and electrolyte abnormalites, with a high risk for hypokalemia. Hypokalemia is a potentially life-threatening complication of loop diuretic therapy due to the risk for cardiac arrhythmias. When assessing a client for hypokalemia, the nurse monitors the client for ventricular arrhythmias. This is a priority in the provision of care for a client who is prescribed furosemide for the treatment of heart failure. Although hyponatremia and hyperuricemia are both potential side effects associated with diuretic therapy, they are not high risks for the client who is prescribed furosemide. Although a symptom of hyponatremia is nausea and joint pain is a symptom of hyperuremia, these are not findings that are expected for a client who experiences hypokalemia due to furosemide therapy.

The client is in preterm labor and is ordered magnesium sulfate to help stop labor. The nurse asks the student, "What adverse effects should we be watching for?" What is the most appropriate response made by the student nurse? Select all that apply.

respiratory depression loss of deep tendon reflexes (DTR) slurred speech. Signs of magnesium sulfate toxicity include deep tendon reflexes, paralysis, respiratory depression, drowsiness, lethargy, blurred vision, slurred speech, and confusion. Headache is a side effect of calcium channel blockers, which are sometimes used to stop preterm labor. Palpitations are a side effect of terbutaline, which is sometimes used to stop preterm labor.