A client is receiving diazepam IV, a benzodiazepine anticonvulsant, for status epilepticus. Which intervention is most important for the practical nurse (PN) to implement?

Record hourly blood pressures for the next 4 hours

Measure hourly urinary output for the next 8 hours

Monitor the client’s respiratory rate and effort

Observe the client’s eyes for deviation to the side

Answer and Explanation

The Correct Answer is C

Choice A reason: Recording blood pressures is relevant, as diazepam may cause hypotension, but it is less critical than respiratory monitoring. Status epilepticus requires rapid seizure control, and diazepam’s respiratory depression risk is more immediate, as it can lead to life-threatening hypoxia if not addressed promptly.

Choice B reason: Measuring urinary output monitors renal function but is not urgent in status epilepticus. Diazepam’s primary risk is respiratory depression, not renal effects. Ensuring airway and breathing stability is more critical, as seizures and the drug both threaten respiratory function, making this choice secondary.

Choice C reason: Monitoring respiratory rate and effort is critical, as diazepam, a CNS depressant, can cause respiratory depression, especially in status epilepticus, where seizures already compromise breathing. Hypoventilation risks hypoxia, potentially leading to brain damage or death, making this the most urgent intervention to ensure airway safety.

Choice D reason: Observing eye deviation may indicate ongoing seizures but is less urgent than respiratory monitoring. Diazepam controls seizures, but its side effect of respiratory depression poses an immediate threat. Ensuring adequate ventilation is the priority to prevent hypoxia during acute seizure management.

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Correct Answer is C

Explanation

Choice A reason: Appetite changes may occur with levothyroxine due to metabolic effects, but they are not the most critical side effect. Excessive thyroid hormone can overstimulate metabolism, but cardiovascular effects, like tachycardia, are more immediate and dangerous, making appetite monitoring less urgent.

Choice B reason: Sleep disturbances may result from levothyroxine’s stimulatory effects, but they are less severe than cardiovascular risks. Overdose can cause insomnia by increasing metabolism, but heart rate is a more direct indicator of hyperthyroidism, which poses greater health risks, making this choice secondary.

Choice C reason: Heart rate is critical to monitor, as levothyroxine increases metabolism, potentially causing tachycardia or arrhythmias if overdosed. Excess thyroid hormone mimics hyperthyroidism, stressing the cardiovascular system, which can lead to palpitations or heart failure, making this the most important parameter for side effect detection.

Choice D reason: Daily weights track fluid or metabolic changes but are less specific for levothyroxine side effects. Weight loss may occur with excess dosing, but cardiovascular effects, like increased heart rate, are more immediate and life-threatening, requiring closer monitoring than weight fluctuations.

A. Serum levels reflect client compliance and support behavior changes B. Sodium influences a narrow margin between therapeutic and toxic levels C. Myelosuppression and agranulocytosis are common side effects D. Foods containing tyramine influence the drug’s metabolism

Correct Answer is B

Explanation

Choice A reason: Serum lithium levels indicate compliance but do not directly explain the need for frequent monitoring. Lithium’s therapeutic effect stabilizes mood, but monitoring is primarily due to its narrow therapeutic index, where small changes in blood levels can cause toxicity, not just behavioral changes or compliance.

Choice B reason: Sodium levels affect lithium excretion, as both compete for renal reabsorption. Low sodium increases lithium retention, risking toxicity, while high sodium increases excretion, reducing efficacy. Lithium’s narrow therapeutic range (0.6–1.2 mEq/L) necessitates frequent monitoring to prevent toxic levels, which can cause neurological or cardiac issues.

Choice C reason: Myelosuppression and agranulocytosis are not common lithium side effects. Lithium may cause mild leukocytosis, not suppression. Toxicity risks, like neurological or renal effects, drive monitoring needs, not hematologic issues. This choice is incorrect, as it misrepresents lithium’s side effect profile.

Choice D reason: Tyramine, relevant to monoamine oxidase inhibitors, does not influence lithium metabolism. Lithium’s pharmacokinetics are affected by sodium and renal function, not dietary tyramine. This choice is incorrect, as it falsely links a dietary factor to lithium’s monitoring requirements.

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A client is receiving diazepam IV, a benzodiazepine anticonvulsant, for status epilepticus. Which intervention is most important for the practical nurse (PN) to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The practical nurse (PN) is providing discharge instructions to a client who had a partial thyroidectomy. When explaining the actions of the prescribed thyroid supplement levothyroxine sodium, which parameter should the PN tell the client is most important to monitor for potential side effects?

Correct Answer is C

Explanation

A client is admitted with bipolar disorder and lithium carbonate is prescribed. Before administering the daily dose, the practical nurse (PN) plans to monitor the client’s serum lithium levels. Which physiologic action necessitates frequent monitoring of serum lithium levels?

Correct Answer is B

Explanation

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