A nurse in a provider's office is caring for a client.
What actions should the nurse take?
Select all that apply.
Advise the client to take the medication before bedtime.
Advise the client to restrict potassium intake.
Advise the client to change positions slowly.
Monitor the client for dysrhythmias.
Check the client for orthostatic hypotension.
Correct Answer : C,D,E
C. Thiazide diuretics like hydrochlorothiazide can cause orthostatic hypotension, which may contribute to the client's symptoms of dizziness and light-headedness upon standing. Advising the client to change positions slowly can help mitigate these symptoms by allowing the body time to adjust to changes in posture and blood pressure.
D. Thiazide diuretics can alter electrolyte levels, including potassium, which is critical for normal cardiac function. Although the client's potassium level (3.4 mEq/L) is within the normal range, ongoing
monitoring for potential dysrhythmias is prudent due to the electrolyte-altering effects of hydrochlorothiazide.
E. Given the client's report of dizziness and light-headedness upon standing, checking for orthostatic hypotension is important. Thiazide diuretics can cause volume depletion and subsequent orthostatic hypotension, especially in older adults. Assessing blood pressure and symptoms in supine and standing positions will help evaluate for orthostatic changes.
A. This is not typically recommended for hydrochlorothiazide. It is usually advised to take this medication in the morning to avoid nighttime diuresis and nocturia. Therefore, this action is not appropriate.
B. Hydrochlorothiazide is a thiazide diuretic that can cause potassium loss through increased urine output. Restricting potassium intake is not typically necessary unless potassium levels drop significantly below the normal range. Given that the client's potassium level is within the normal range (3.4 mEq/L), advising strict potassium restriction is not indicated at this time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Nicotine gum should be chewed slowly until a peppery taste is experienced, then "parked" between the gum and cheek until the taste fades, and then chewed again. Chewing the gum slowly over 30 minutes allows nicotine to be absorbed through the buccal mucosa, providing controlled nicotine delivery to help manage cravings. This method ensures optimal effectiveness and minimizes potential side effects from rapid absorption.
B. Chewing more than 40 pieces of nicotine gum per day can lead to excessive nicotine intake, potentially resulting in nicotine toxicity. Therefore, it's important for the client to adhere to the recommended dosage to maintain safety and effectiveness of the treatment.
C. Nicotine gum is typically used as a short-term aid to help manage withdrawal symptoms during the initial stages of smoking cessation. While nicotine gum can help manage cravings and withdrawal symptoms, it is not meant to be used for 9 months continuously. It is usually recommended for up to 12 weeks initially, with gradual reduction in use over time to eventually stop using it.
D. Drinking water before using nicotine gum helps moisten the mouth and enhances the absorption of nicotine through the buccal mucosa. This instruction helps optimize the delivery of nicotine from the gum and improves the client's experience with using nicotine gum as a smoking cessation aid.
Correct Answer is D
Explanation
A. Warming the PN formula to room temperature is a routine practice to make it more comfortable for administration but does not directly address hyperkalemia.
B. Lactose-free formulas may be requested for clients who have lactose intolerance or other specific dietary needs but are not directly related to hyperkalemia.
C. IV dextrose (usually in the form of dextrose 5% in water, D5W) can be used to temporarily shift potassium from the extracellular space into the cells, thereby lowering serum potassium levels. Dextrose helps in stimulating insulin release, which facilitates potassium uptake into cells, effectively lowering serum potassium levels. However, it is not the immediate action.
D. Hyperkalemia can lead to serious cardiac arrhythmias due to its effects on myocardial cell membrane potentials. Therefore, close cardiac monitoring is essential to detect any signs of cardiac instability.
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