A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the client’s history requires follow up by the nurse?

CT scan that was performed six months earlier.

Takes metformin hydrochloride for type 2 diabetes mellitus.

Report of client’s sobriety for the last five years.

Metal hip prosthesis was placed twenty years ago.

Answer and Explanation

The Correct Answer is B

A) CT scan that was performed six months earlier: A previous CT scan performed six months earlier does not necessarily require follow-up by the nurse. However, it would be important to review the results of the previous CT scan to compare findings and assess for any changes over time.

B) Takes metformin hydrochloride for type 2 diabetes mellitus: This is the correct answer. Metformin is excreted by the kidneys, and contrast media used in CT scans can potentially cause kidney damage, particularly in clients with pre-existing renal impairment. Therefore, clients taking metformin may be at increased risk of developing lactic acidosis if renal function is compromised. It is essential for the nurse to follow up on this information and coordinate with the healthcare provider to determine whether metformin should be temporarily discontinued before the CT scan and when it can be safely resumed.

C) Report of client’s sobriety for the last five years: The client’s sobriety status for the last five years is not directly relevant to the CT scan with contrast for evaluating pulmonary embolism. While substance use history is important for overall health assessment, it does not specifically require follow-up related to the CT scan.

D) Metal hip prosthesis was placed twenty years ago: The presence of a metal hip prosthesis placed twenty years ago may be relevant for certain imaging studies, such as magnetic resonance imaging (MRI) or metal artifact reduction sequence (MARS) MRI, but it is not directly related to the CT scan with contrast for pulmonary embolism evaluation. Therefore, it does not require immediate follow-up by the nurse in this context.

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Correct Answer is D

Explanation

A) Take the benzodiazepine at the same time of taking the morphine: This statement is incorrect. Benzodiazepines and morphine are both central nervous system depressants and can potentiate each other’s effects, leading to increased sedation and respiratory depression. Taking them together without proper supervision or dosage adjustment can be dangerous. Therefore, this statement indicates a misunderstanding of the medication regimen.

B) Do not drink grapefruit juice after taking morphine: While grapefruit juice can interact with certain medications by affecting their metabolism, there is no specific interaction between grapefruit juice and morphine that requires avoidance. Therefore, this statement is not directly related to the use of morphine for bone pain.

C) Watch for signs of agitation and record any insomnia: While it is important to monitor for side effects of morphine, such as agitation and insomnia, this statement does not directly relate to the management of constipation, which is a common side effect of opioid analgesics like morphine.

D) Observe bowel movement pattern and take a stool softener: This is the correct answer. Morphine is known to cause constipation as a side effect due to its action on opioid receptors in the gastrointestinal tract. Therefore, monitoring bowel movements and taking a stool softener can help prevent or alleviate constipation associated with morphine use. This statement indicates an understanding of the potential side effects of the medication and the importance of managing them appropriately.

A. Increased frequency of lacrimation. B. Decreased night vision. C. Increased sensitivity to light. D. Diminished color perception.

Correct Answer is B

Explanation

A) Increased frequency of lacrimation is not typically associated with miotic therapy. Miotics work by constricting the pupil and increasing outflow of aqueous humor to reduce intraocular pressure, but they do not directly affect lacrimation (tear production). Therefore, this option is not the etiology for the “Risk for injury” nursing problem.

B) Decreased night vision is a common side effect of miotic therapy. Miotics constrict the pupil, which can reduce the amount of light entering the eye, leading to impaired night vision or difficulty seeing in low-light conditions. This impaired vision increases the risk of injury, particularly in situations with reduced lighting.

C) Increased sensitivity to light (photophobia) is not typically associated with miotic therapy. Miotics constrict the pupil, which may actually reduce sensitivity to light by decreasing the amount of light entering the eye. Therefore, increased sensitivity to light is not the etiology for the “Risk for injury” nursing problem in this case.

D) Diminished color perception is not a common side effect of miotic therapy. Miotics primarily affect pupil constriction and intraocular pressure but do not typically alter color perception. Therefore, diminished color perception is not the etiology for the “Risk for injury” nursing problem.

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A client is scheduled for a spiral computed tomography (CT) scan with contrast to evaluate for pulmonary embolism. Which information in the client’s history requires follow up by the nurse?

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