Perfusion

Metoprolol is added to the pharmacologic therapy of a woman with diabetes diagnosed with stage 2 hypertension and initially treated with furosemide and ramipril. An expected therapeutic effect is: a) Decrease in heart rate. b) Improvement in blood sugar levels. c) Increase in urine output. d) Lessening of fatigue

Decrease in heart rate. Correct Explanation: The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output. (less)

A nurse is assessing a client with a urinary tract infection who takes an antihypertensive drug. The nurse reviews the client's urinalysis results (see chart). The nurse should: a) Withhold the next dose of antihypertensive medication. b) Encourage the client to increase fluid intake. c) Restrict the client's sodium intake. d) Encourage the client to eat at least half of a banana per day.

Encourage the client to increase fluid intake. Correct Explanation: The client's urine specific gravity is elevated. Specific gravity is a reflection of the concentrating ability of the kidneys. This level indicates that the urine is concentrated. By increasing fluid intake, the urine will become more dilute. Antihypertensives do not make urine more concentrated unless there is a diuretic component within them. The nurse should not hold a dose of antihypertensive medication. Sodium tends to pull water with it; by restricting sodium, less water, not more, will be present. Bananas do not aid in the dilution of urine. (less)

A nurse is caring for a client with frequent episodes of ventricular tachycardia. The lab calls with a critically high magnesium level of 11 mg/dL on this client. What is the nurse's priority action? a) Obtain an order for calcium gluconate 2 g IV push over 2-5 minutes. b) Increase the rate of the client's IV fluid to 150 ml/hour. c) Arrange for an emergency hemodialysis session. d) Obtain an order for furosemide (Lasix) 80 mg IV push.

Obtain an order for calcium gluconate 2 g IV push over 2-5 minutes. Correct Explanation: All the actions listed will reduce the serum magnesium concentration. The calcium gluconate will react the quickest to reduce the critical level. (less)

A client has a tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes previously. Which of the following should be the nurse's next assessment? a) Presence of a distal pulse. b) Vital sign changes. c) Pain with a pain rating scale. d) Potential for drug tolerance.

Presence of a distal pulse. Correct Explanation: The nurse should assess the client's ability to move her toes and for the presence of distal pulses, including a neurovascular assessment of the area below the cast. Increasing pain unrelieved by usual analgesics and occurring 4 to 12 hours after the onset of casting or trauma may be the first sign of compartment syndrome, which can lead to permanent damage to nerves and muscles. Although the nurse can use a pain rating scale or assess for changes in vital signs to objectively assess the client's pain, the client's concerns suggest early and important signs of compartment syndrome requiring immediate intervention. The nurse should not confuse these signs with the potential for drug tolerance. This assessment might be appropriate once the suspicion of compartment syndrome has been ruled out. (less)

An elderly male client has been taking doxazosin (Cardura) 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first: a) Test his urine for ketones. b) Report the symptoms to the physician. c) Review his other medications. d) Take his blood pressure lying, standing, and sitting.

Take his blood pressure lying, standing, and sitting. Correct Explanation: Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension. Testing the urine for ketones would be appropriate if the client had diabetes mellitus. Because an adverse effect of doxazosin is orthostatic hypotension, the nurse should first take the client's blood pressure; later, she can review other mediations. The client's report of symptoms should be reported to the physician with the blood pressure readings. (less)