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The nurse is caring for a client who is receiving a thiazide diuretic for hypertension. Which food selection by the client indicates to the nurse that dietary teaching about thiazide diuretics is successful? Apples Broccoli Cherries Cauliflower
Broccoli Thiazide diuretics are potassium-depleting agents; broccoli is high in potassium. Apples, cherries, and cauliflower are low sources of potassium.
A pregnant client with a history of hypertension is treated with an angiotensin-converting enzyme inhibitor. Which teratogenic effect of angiotensin-converting enzyme (ACE) inhibitors is the neonate at risk for? 1-Growth delay 2-Skull hypoplasia 3-Neural tube defects 4-Skeletal and central nervous system defects
Skull hypoplasia The use of angiotensin-converting enzyme (ACE) inhibitors in the second and third trimesters of pregnancy may cause skull hypoplasia in the newborn. Antiseizure drugs may cause neural tube defects and growth delays in the newborn. Warfarin may cause skeletal and central nervous system defects in the newborn.
client with a family history of diabetes is concerned about the effects of psychiatric medication on the endocrine system. Which psychotropic medication is most likely to cause metabolic syndrome? 1-Lithium 2-Diazepam 3-Alprazolam 4-Risperidone
Risperidone Atypical antipsychotics such as risperidone can cause metabolic syndrome, in which the client experiences weight gain and increases in cholesterol and triglyceride levels. Diabetes mellitus and diabetic ketoacidosis may occur between 5 weeks and 17 months after initiation of therapy. Although lithium, diazepam, and alprazolam may cause weight gain, none causes metabolic syndrome.
What potentially dangerous adverse effect of an intravenous titrated drip of lidocaine should the nurse immediately report to the healthcare provider? 1-Tremors 2-Anorexia 3-Tachycardia 4-Hypertension
1-Tremors Tremors are a precursor to the major adverse effect of seizures. Although anorexia may occur, it is not a dangerous side effect. Bradycardia, which may lead to heart block, may occur, not tachycardia. Hypotension, not hypertension, may occur.
Carbidopa-levodopa is prescribed for a client with Parkinson disease. The nurse assesses for which adverse responses that are associated with this medication? Select all that apply. 1-Nausea 2-Lethargy 3-Bradycardia 4-Polycythemia 5-Emotional changes
1-Nausea, 5-Emotional changes Nausea and vomiting may occur; this reflects a central emetic reaction to levodopa. Changes in affect, mood, and behavior are related to toxic effects of carbidopa-levodopa. Insomnia, tremors, and agitation are side effects that may occur, not lethargy. Tachycardia and palpitations, not bradycardia, occur. Anemia and leukopenia, not polycythemia, are adverse reactions.
A postoperative client returned from the postanesthesia care unit (PACU) this morning with a patient care analgesia (PCA) pump running with a basal rate of hydromorphone. The nurse assesses the client's vital signs as blood pressure 90/60 mm Hg, heart rate 96 beats per min, and respiratory rate of 10 breaths per min. Which action should the nurse take next? 1-Give naloxone intravenous push med (IVP) per protocol. 2-Assess the client's pain level on a 10-point scale. 3-Document the findings and reassess in 2 hours. 4-Call the rapid response team.
1-Give naloxone intravenous push med (IVP) per protocol. A respiratory rate of 10 breaths/min is abnormal and needs to be treated immediately. Naloxone is an opioid antagonist and antidote and is used in PCA protocols for postoperative opioid-induced respiratory depression. Pain level also is a part of the PCA documentation protocol. According to protocol, PCA status needs to be documented every 2 hours for the first day and then every 4 hours. The rapid response team might still need to be called, but naloxone must be given first.
A nurse is teaching a client about the use of a metered-dose inhaler with a spacer. Which statement made by the client indicates the need for further teaching? 1-"I will wait for at least 1 minute between puffs." 2-"I will shake the whole unit vigorously one or two times." 3-"I will hold my breath for at least 10 seconds after removing the mouthpiece." 4-"I will insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer."
2-"I will shake the whole unit vigorously one or two times." The metered-dose inhaler should be shaken vigorously for a minimum of three or four times for proper mixing of the content inside the inhaler. A minimum of a 1-minute gap should be given in between the puffs to ensure proper movement of the medications into the lungs. After removing the mouthpiece, the client should hold his/her breath for at least 10 seconds so that the drug does not escape with exhalation. Inserting the mouthpiece of the inhaler into the nonmouthpiece end of the spacer is the correct way of closing the inhaler.
A client on antipsychotic drug therapy develops parkinsonism. Which drugs would be beneficial for the client? Select all that apply. 1-Levodopa 2-Benztropine 3-Amantadine 4-Bromocriptine 5-Diphenhydramine
2-Benztropine, 3-Amantadine, 5-Diphenhydramine Benztropine is a centrally-acting anticholinergic drug that can be used to treat symptoms of parkinsonism associated with antipsychotic drugs. Amantadine is also used to treat antipsychotic-induced parkinsonism. Diphenhydramine is another centrally-acting anticholinergic drug that can be used to treat symptoms of antipsychotic-induced parkinsonism. Levodopa and direct dopamine agonists such as bromocriptine should be avoided in antipsychotic-induced Parkinsonism because these drugs activate dopamine receptors, which might counteract the beneficial effects of antipsychotic treatment.
A registered nurse is evaluating the statements of a client after teaching the client measures to decrease the risk for antibiotic-resistant infections. Which statements made by the client indicate a need for more education? Select all that apply. 1-"I should wash my hands frequently." 2-"I should skip doses when I am completely well." 3-"I should avoid taking antibiotics to treat the common cold." 4-"I should save unfinished antibiotics for later emergency use." 5-"I should avoid taking antibiotics without asking the physician."
2-"I should skip doses when I am completely well." 4-"I should save unfinished antibiotics for later emergency use." Antibiotics should not be stopped even if the client is feeling better. Skipping doses may allow antibiotic-resistant bacteria to develop. Antibiotics should not be saved for later emergency use because old antibiotics can lose their effectiveness and in some cases can even be fatal if taken. Hand washing is necessary to prevent infections. Antibiotics are effective against bacterial infections but not viruses, which cause the common cold. Antibiotics should be taken only after asking the physician.
What is an important nursing assessment for a school-aged child who is undergoing long-term steroid therapy? 1-Monitoring the pulse for irregularities 2-Frequent testing of stools for occult blood 3-Repeated inspections of urine for mucous threads 4-Persistent checking of oral mucous membranes for ulcers
2Frequent testing of stools for occult blood Because steroids decrease production of prostaglandins that have a role in protecting the stomach, gastrointestinal bleeding may occur; stools should be checked for frank and occult blood. Steroids do not cause pulse irregularities, mucus in the urine, or ulceration of mucous membranes.
What are the desired outcomes that the nurse expects when administering a nonsteroidal antiinflammatory drug (NSAID)? Select all that apply. 1-Diuresis 2-Pain relief 3-Antipyresis 4-Bronchodilation 5-Anticoagulation 6-Reduced inflammation
2-Pain relief, 6-Reduced inflammation, 3-Antipyresis Prostaglandins accumulate at the site of an injury, causing pain; NSAIDs inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing antipyresis. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.
A client with type 2 diabetes develops gout, and allopurinol is prescribed. The client is also taking metformin and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? 1-Decrease the daily dose of NSAIDs. 2-Limit fluid intake to one quart a day. 3-Take the medication on an empty stomach. 4-Monitor blood glucose levels more frequently.
4-Monitor blood glucose levels more frequently. Allopurinol can potentiate the effect of oral hypoglycemics, causing hypoglycemia; the blood glucose level should be monitored more frequently. NSAIDs can be taken concurrently with allopurinol. A daily fluid intake of 2500 to 3000 mL will limit the risk of developing renal calculi. Allopurinol should be taken with milk or food to decrease gastrointestinal irritation
Sublingual nitroglycerin tablets are prescribed to control periodic episodes of chest pain in the patient with stable angina. Which instruction should the nurse include when teaching the client about sublingual nitroglycerin? 1-Once the tablet is dissolved, spit out the saliva. 2-Take tablets 3 minutes apart up to a maximum of five tablets. 3-Common side effects include headache and low blood pressure. 4-Once opened, the tablets should be refrigerated to prevent deterioration.
3-Common side effects include headache and low blood pressure. The primary side effects of nitroglycerin are headache and hypotension. It is not necessary to spit out saliva into which nitroglycerin has dissolved. For pain that is not relieved, additional tablets may be taken every 5 minutes up to a total of three tablets. It should be stored at room temperature.
A client is prescribed albuterol to relieve severe asthma. What adverse effect will the nurse instruct the client to anticipate? Select all that apply. 1-Tremors 2-Lethargy 3-Palpitations 4-Visual disturbances 5-Decreased pulse rate
3-Palpitations, 1-Tremors Albuterol's sympathomimetic effect causes central nervous stimulation, precipitating tremors, restlessness, and anxiety. Albuterol's sympathomimetic effect causes cardiac stimulation that may result in tachycardia and palpitations. Albuterol may cause restlessness, irritability, and tremors, not lethargy. Albuterol may cause dizziness, not visual disturbances. Albuterol will cause tachycardia, not bradycardia.
A client reports severe itching with redness and wheals on the uncovered parts of the legs after sleeping in an old bed. The primary healthcare provider prescribes antihistamines and topical corticosteroids. Which assessment finding made by the nurse supports the intervention? 1-Spreading, ring-like rash with erythema border after 3 to 4 weeks 2-Presence of burrows with erythematous papules with possible vesiculation 3-Utricaria grouped in threes surrounded by vivid flare, transforming into persistent lesion 4-Progression of minute red points to papular wheal-like lesions with secondary excoriation
3-Utricaria grouped in threes surrounded by vivid flare, transforming into persistent lesion Bedbugs reside in furniture, bedding, and walls and usually feed during night time. Bedbug bites manifest as urticaria grouped in threes surrounded by vivid flare, transforming into persistent lesion. Severe itching due to bedbug bites is treated with antihistamines or topical corticosteroids. Tick bites manifest as spreading, ring-like rash with erythema border after 3 to 4 weeks and are treated with oral and intravenous antibiotics. Scabies manifest with the presence of burrows with erythematous papules with possible vesiculation and interdigital web crusting. It is treated with 5% permethrin topical lotion. Head lice bites manifest as minute, red, noninflammatory points flush with the skin that progress to papular wheal-like lesions with secondary excoriation in intrascapular region. These bites are treated with γ-benzene hexachloride or pyrethrins.
A client is started on tetracycline antibiotic therapy. What should the nurse do when administering this drug? 1-Administer the medication with meals or a snack. 2-Provide orange or other citrus fruit juice with the medication. 3-Give the medication an hour before milk products are ingested. 4-Offer antacids 30 minutes after administration if gastrointestinal side effects occur.
4-Give the medication an hour before milk products are ingested. Any product containing aluminum, magnesium, or calcium ions should not be taken in the hour before or after an oral dose of tetracyclines (with the exception of doxycycline) because it decreases absorption by as much as 25% to 50%. Food interferes with absorption; it should be given one hour before or two hours after meals. Citrus juice has no influence on this drug. Antacids will interfere with absorption.
A client with type 1 diabetes receives regular insulin every morning at 8:00 AM. During what period of time does the nurse recognize the risk of hypoglycemia is greatest? 1-8:30 to 9:30 AM 2-8:00 PM to midnight 3-1:00 PM to 8:00 PM 4-10:00 AM to 1:00 PM
10:00 AM to 1:00 PM Regular insulin peaks in 2 to 5 hours; therefore the greatest risk is between 10:00 AM and 1:00 PM. Although the onset of action occurs earlier, during the period from 8:30 to 9:30 AM, the level is not yet at its highest, so the risk of hypoglycemia is not at its greatest. NPH insulin's peak action is 4 to 12 hours; if hypoglycemia occurs, it will happen most likely between midnight and 8 PM.
A peripherally inserted central venous catheter has just been inserted into the arm of a 7-year-old child. A peripheral intravenous (IV) line is still in place, and an antibiotic is to be administered immediately. What is the nurse's first action? 1-Administering the antibiotic through the central venous catheter 2-Connecting the IV antibiotic to the peripheral line 3-Ordering an x-ray confirmation report on central line placement 4-Documenting a verbal order on the chart stating the central line can be used
2-Connecting the IV antibiotic to the peripheral line The peripheral line must be used until the placement of the central venous line is confirmed with radiography or fluoroscopy; this prevents the instillation of fluid into the lung or interstitial space if the catheter is misplaced. The central line should not be used until placement is confirmed. A verbal order is not the best choice as the nurse is required to confirm placement, which is done via radiography in this situation.
What assessment findings indicate that a client is experiencing an allergic reaction to antibiotic therapy? Select all that apply. 1-Pruritus 2-Confusion 3-Wheezing 4-Muscle aches 5-Bronchospasm
3-Wheezing, 5-Bronchospasm, 1-Pruritus Manifestations of an allergic reaction to antibiotic therapy include pruritus, wheezing, and bronchospasm. Confusion and muscle aches are not specifically identified as being manifestations of an allergic reaction to antibiotic therapy.
A client being treated for hypertension reports having a persistent hacking cough. What class of antihypertensive should the nurse identify as a possible cause of this response when reviewing a list of this client's medications? 1-Thiazide diuretics 2-Calcium channel blockers 3-Angiotensin receptor blockers 4-Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting enzyme (ACE) inhibitors ACE increases the sensitivity of the cough reflex, leading to the common adverse effect sometimes referred to as an ACE cough. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or angiotensin receptor blockers.
A client undergoing tuberculosis therapy reports eye pain that worsens when moving the eyes with decreased color vision. Which medication most likely is responsible for the client's condition? 1-Rifampin 2-Isoniazid 3-Ethambutol 4-Pyrazinamide
Ethambutol Eye pain that is worsened when the eyes are moved with decreased color vision may be indicative of optic neuritis. Ethambutol, especially at high dosages, can cause optic neuritis, a condition that can result in blindness. Rifampin reduces the effectiveness of oral contraceptives, increasing the risk of an unplanned pregnancy, and can change bodily fluid orange. Isoniazid can deplete the body of the B-complex vitamins. Pyrazinamide increases uric acid formation and worsens gout.
A client with heart failure is receiving digoxin and hydrochlorothiazide. The nurse will assess for which signs and symptoms that indicate digoxin toxicity? Select all that apply . 1-Nausea 2-Yellow vision 3-Irregular pulse 4-Increased urine output 5-Heart rate of 64 beats per minute
Nausea, Yellow vision, Irregular pulse Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision). In addition, ECG findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias, all causing an irregular pulse. Increased urine output is an expected effect of the diuretic furosemide; a pulse rate of 64 beats per minute is an acceptable rate when a client is receiving digoxin.
A client is treated with methyldopa for hypertension. For which side effect should the nurse monitor the client? 1-Xerostomia 2-Hemolytic anemia 3-Thrombocytopenia 4-Lupus-like syndrome
Xerostomia Methyldopa is used in the treatment of hypertension. It can be a precipitating factor in an autoimmune disease such as hemolytic anemia. Scopolamine transdermal, an anticholinergic, may cause dry mouth or xerostomia. Chemotherapy drugs, such as mycophenolate mofetil and azathiprine, can cause thrombocytopenia. Procainamide is an anti-arrhythmic agent that can induce the formation of antinuclear antibodies and cause a lupus-like syndrome.
A client with hypertension is to take an angiotensin II receptor blocker (ARB). What should the nurse teach about this medication? Select all that apply. 1-Monitor the blood pressure daily. 2-Stop treatment if a cough develops. 3-Stop the medication if swelling of the mouth, lips, or face develops. 4-Have blood drawn for potassium levels 2 weeks after starting the medication. 5-Do not take nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with this medication.
-Stop the medication if swelling of the mouth, lips, or face develops. -Have blood drawn for potassium levels 2 weeks after starting the medication. The medication should be stopped if angioedema occurs, and the healthcare provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. Daily monitoring is not indicated. The blood pressure should be monitored at routine office visits. There is no need to avoid the use of NSAIDs while taking an ARB. A dry cough may occur during treatment with ARBs; however, it is not necessary to discontinue the medication because the cough usually resolves.
Which nursing interventions may promote safe drug administration in a child diagnosed with heart failure who is receiving digoxin? Select all that apply. 1-Checking for compliance with the client's drug regimen 2-Monitoring the client's serum potassium and magnesium levels regularly 3-Administering digoxin only through the intramuscular route 4-Calculating the correct dosage form, prescribed amounts, and the prescriber's order 5-Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly
1-Checking for compliance with the client's drug regimen 2-Monitoring the client's serum potassium and magnesium levels regularly 4-Calculating the correct dosage form, prescribed amounts, and the prescriber's order 5-Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly Digoxin may alter the serum potassium and serum magnesium levels, which affects heart function. Calculating the correct dose according to the healthcare provider's orders helps to prevent drug toxicity. Checking for compliance with the client's drug regimen is important so that the child does not have drug to drug interactions. Monitoring and recording drug intake and output, heart rate, blood pressure, daily weight, and respiration rate is a part of general nursing care. Administering digoxin through the intramuscular route is not advised because this method is very painful.
A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. 1-Urinary output 2-Deep tendon reflexes 3-Last bowel movement 4-Arterial blood gas results 5-Last serum potassium level 6-Patency of the intravenous access
1-Urinary output, 5-Last serum potassium level, 6-Patency of the intravenous access Before administering IV potassium, the urinary output must be normal. If the urine output is low, a potassium infusion may damage renal cells. The last serum potassium level should also be checked to ensure potassium replacement is appropriate. A patent IV access is essential because potassium is very irritating and painful to subcutaneous tissue. The infusion of KCL 40 mEq in 100 mL of 5% dextrose and water has no direct effect on deep tendon reflexes, bowel movement patterns, or arterial blood gases. Therefore these items are not required to be assessed before administration of this medication.
Temp 105, pulse 128, RR 26, BP unstable Assessment- diaphoresis, severe muscle rigidity, < LOC Labs- metabolic acidosis, ^creatine phosphokinase (CPK) A client with the diagnosis of schizophrenia and type 1 diabetes has recently been receiving haloperidol as part of the treatment plan. When the client has a sudden change in health status, the nurse reviews the client's medical record and performs a physical assessment. What medical emergency does the nurse conclude that the client is experiencing? 1-Oculogyric crisis 2-Serotonin syndrome 3-Diabetic ketoacidosis 4-Neuroleptic malignant syndrome
Neuroleptic malignant syndrome The data presented are indicative of neuroleptic malignant syndrome, a rare and life-threatening complication of antipsychotic medications such as haloperidol. The medication should be discontinued and supportive care provided. An oculogyric crisis is an extrapyramidal side effect of neuroleptic (not antipsychotic) medications in which there is uncontrolled rolling back of the eyes. This should be treated quickly with an antiparkisonian agent. Although many of the adaptations presented are associated with serotonin syndrome, the client is not taking a selective serotonin reuptake inhibitor antidepressant or other drugs that increase the serotonin level. Although diabetic ketoacidosis is a form of metabolic acidosis that can cause increased respiratory and heart rates, it causes dry skin, not diaphoresis. With this condition, the client's creatine phosphokinase will not be increased and muscle rigidity will not be present.
A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action should the nurse take next? 1-Hold the client's morning diuretic dose 2-Notify the healthcare provider that the potassium level is above normal 3-Notify the healthcare provider that the potassium level is below normal 4-No action is required because the potassium level is within normal limits
Notify the healthcare provider that the potassium level is below normal The healthcare provider should be notified immediately because the client's potassium is below normal. The normal potassium levelrange is 3.5 mEq/L to 5.0 mEq/L (3.5 mmol/L to 5.0 mmol/L). Clients on diuretic therapy require close monitoring of their electrolytes because supplemental potassium may be needed.
A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? 1-Stimulates the pancreas to produce insulin 2-Accelerates the liver's release of stored glycogen 3-Increases glucose transport across the cell membrane 4-Lowers blood glucose in the absence of pancreatic function
Stimulates the pancreas to produce insulin Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.
A beta-blocker, atenolol, is prescribed for a client with moderate hypertension. What information should the nurse include when teaching the client about this medication? Select all that apply. 1-Change to standing positions slowly. 2-Take the medication before going to bed. 3- Count the pulse before taking the medication. 4-Mild weakness and fatigue are common side effects. 5-It is safe to take concurrent over-the-counter (OTC) medications.
-Change to standing positions slowly, -Count the pulse before taking the medication. -Mild weakness and fatigue are common side effects. A side effect of this medication is orthostatic hypotension. The client should be advised to move to a standing position slowly to allow the vasomotor response of the body to adjust to the new position. The rate of the pulse should be taken before administering the medication; ventricular dysrhythmias and heart block may occur. Mild weakness and fatigue, as well as dizziness and depression, are side effects of this medication. The blood pressure decreases when the client is sleeping; the medication usually is prescribed to be administered earlier in the day. The medication should be taken with food. No OTC medication should be taken without consulting the prescribing healthcare provider; decreased or increased effects can occur when there is an interaction with another medication.
Which monoamine oxidase inhibitor is used to treat Parkinson disease? 1-Selegiline 2-Phenelzine 3-Isocarboxazid 4-Tranylcypromine
1-Selegiline Selegiline is a monoamine oxidase-B inhibitor used to treat Parkinson disease. Phenelzine, isocarboxazid, and tranylcypromine are nonselective inhibitors of both type A and B used in the treatment of depression.
A 9-year-old child is returned to the postanesthesia care unit after surgery to correct a compound fracture of the humerus. An intravenous (IV) infusion pump is in place, delivering D5% 0.45% NS at a rate of 70 mL/hr. What action will the postanesthesia care nurse implement? 1-Question the prescription 2-Continue the current solution and flow rate 3-Change the IV bag to one containing D5% 0.9% NS 4-Offer oral fluid when the child awakens and slow down the IV rate
2-Continue the current solution and flow rate Because it is the correct solution (isotonic) and flow rate for a healthy 9-year-old child, the infusion should be continued. There is no reason to question the prescription. Changing the IV bag cannot be done without a prescription; also, there is no indication that the child needs a hypertonic solution (D5% 0.9% NS). Offering fluids and slowing the IV rate are not necessary. The client's gag reflex and the presence of bowel sounds must first be assessed before the administration of oral fluids.
A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1-"I will take the drug with food." 2-"I must swallow my medication whole and not crush or chew it." 3-"I will notify my doctor if I develop muscular or abdominal discomfort." 4-"I will stop taking metformin for 24 hours before and after having a test involving dye."
4-"I will stop taking metformin for 24 hours before and after having a test involving dye." Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider
At 10 AM the nurse hangs a 1000-mL bag of D 5W with 20 mEq of potassium chloride to be administered at 80 mL/hr. At noon the healthcare provider prescribes a stat infusion of an intravenous (IV) antibiotic of 100 mL to be administered via piggyback over 1 hour. How much longer than expected will it take the primary bag to empty if the nurse interrupts the primary infusion to use the circulatory access for the secondary infusion of the antibiotic? 1-Quarter hour 2-Half hour 3-Three quarters of an hour 4-1 hour
4-1 hour An infusion of 1000 mL at 80 mL should take 12.5 hours. Because the primary infusion is interrupted for an hour while the antibiotic is infused, the primary bag will run an hour longer than if it were running uninterrupted. One quarter, half, and three quarters of an hour are incorrect calculations.
A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? 1-Perform daily weights 2-Auscultate breath sounds 3-Monitor intake and output 4-Assess for dependent edema
Auscultate breath sounds Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kilogram) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is most important.
A healthcare provider prescribes a diuretic for a client with hypertension. What should the nurse include in the teaching when explaining how diuretics reduce blood pressure? 1-Facilitates vasodilation 2-Promotes smooth muscle relaxation 3-Reduces the circulating blood volume 4-Blocks the sympathetic nervous system
Reduces the circulating blood volume Diuretics block sodium reabsorption and promote fluid loss, decreasing blood volume and reducing arterial pressure. Direct relaxation of arteriolar smooth muscle is accomplished by vasodilators, not diuretics. Vasodilators, not diuretics, act on vascular smooth muscle. Drugs that act on the nervous system, not diuretics, inhibit sympathetic vasoconstriction.
