A nurse is caring for a 45-year-old male client in an acute care unit.
For each provider prescription, click to specify if the intervention is anticipated or contraindicated for this client.
Metformin 500 mg PO twice daily
Bumetanide 0.5 mg/hr IV infusion
Labetalol 10 mg IV bolus x 1 dose
Oxygen at 2 L/min via simple face mask
Midodrine 10 mg PO every 8 hrs
Calcium gluconate 1 gram IV bolus x 1 dose
Potassium 20 mEq intermittent IV bolus x 1 dose
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"B"},"G":{"answers":"A"}}
- conditions. The client has dyspnea, tachycardia, and low oxygen saturation, suggesting acute illness or cardiovascular instability.
- Bumetanide, a loop diuretic, is contraindicated here as it may worsen hypovolemia and electrolyte imbalance. The client’s blood pressure is high but he is already showing signs of dehydration and electrolyte abnormalities (hypokalemia). Diuretics may exacerbate hypokalemia and hypotension later.
- Labetalol is anticipated for managing the acute hypertension (BP 160/98 mm Hg), especially with the client’s tachycardia and hypertensive urgency signs. It acts by blocking alpha and beta receptors to lower blood pressure safely.
- Oxygen is anticipated because the client’s oxygen saturation is 92% on room air with dyspnea and tachypnea; supplemental oxygen will improve tissue oxygenation and reduce hypoxia.
- Midodrine is contraindicated because it raises blood pressure via alpha-1 agonism; given the client’s elevated BP, it would worsen hypertension and increase cardiovascular risk.
- Calcium gluconate is contraindicated because the client’s calcium is within normal limits (10.3 mg/dL) and giving calcium unnecessarily can cause hypercalcemia or arrhythmias.
- Potassium supplementation is anticipated as the client has hypokalemia (2.8 mEq/L) on Day 2, which can cause arrhythmias and muscle weakness, requiring prompt correction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
An INR (International Normalized Ratio) of 4.0 indicates that the client's blood is much thinner than the therapeutic range for most conditions (usually 2.0-3.0 for warfarin). This significantly increases the risk of bleeding. Vitamin K is the antidote for warfarin because it is essential for the synthesis of clotting factors (II, VII, IX, X) in the liver. Administering vitamin K reverses the anticoagulant effect of warfarin, reducing the risk of hemorrhage by promoting the production of functional clotting proteins.
Choice B rationale
Protamine sulfate is the antidote for heparin. It works by forming a stable ion pair with heparin, neutralizing its anticoagulant effects. It has no effect on the anticoagulant properties of warfarin, which acts by inhibiting vitamin K epoxide reductase, an enzyme crucial for the regeneration of active vitamin K necessary for clotting factor synthesis. Therefore, protamine is not indicated for warfarin overdose.
Choice C rationale
Calcium gluconate is used to treat hypocalcemia and magnesium toxicity. Calcium plays a vital role in numerous physiological processes, including bone health and muscle function, and is essential for blood coagulation. However, it does not directly counteract the effects of warfarin, which targets vitamin K-dependent clotting factors, and is not the appropriate antidote for an elevated INR.
Choice D rationale
Epinephrine is a potent vasoconstrictor and bronchodilator used in anaphylaxis, cardiac arrest, and severe asthma. It acts on alpha and beta-adrenergic receptors, leading to increased heart rate, blood pressure, and bronchodilation. It has no role in reversing the anticoagulant effects of warfarin and is not indicated for managing an elevated INR.
Correct Answer is B
Explanation
Choice A rationale
Gingival hyperplasia is an overgrowth of gum tissue, often associated with certain medications like phenytoin or cyclosporine. It is caused by an increase in the number of fibroblasts and collagen deposition in the gingiva. Haloperidol, an antipsychotic, primarily affects dopamine receptors in the brain and does not cause gingival hyperplasia.
Choice B rationale
Haloperidol is a first-generation antipsychotic that blocks D2 dopamine receptors in the brain. This blockade, particularly in the nigrostriatal pathway, can lead to extrapyramidal symptoms (EPS) such as acute dystonia, parkinsonism (including muscle rigidity, bradykinesia, and tremor), and akathisia. Muscle rigidity is a common manifestation of drug-induced parkinsonism.
Choice C rationale
Polyuria is the excessive production of urine, often a symptom of diabetes mellitus or insipidus. It results from impaired water reabsorption in the kidneys. While some medications can affect fluid balance, haloperidol's primary pharmacological action on dopamine receptors does not directly induce polyuria as a typical adverse effect.
Choice D rationale
Bruising, or ecchymosis, results from bleeding under the skin, often due to trauma or coagulation disorders. It is caused by extravasation of blood from capillaries into surrounding tissues. Haloperidol does not affect coagulation factors or platelet function and is not associated with increased bruising as a direct adverse effect.
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