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
Alendronate is a bisphosphonate medication used to treat osteoporosis. It is known to be highly irritating to the esophageal mucosa, and if it lodges in the esophagus, it can cause severe esophagitis, ulceration, or erosion. Assessing the client's ability to swallow ensures safe passage of the medication and minimizes the risk of esophageal injury, highlighting a critical safety measure.
Choice B rationale
Alendronate should not be administered before bed. For optimal absorption and to minimize the risk of esophageal irritation, alendronate must be taken in the morning upon waking, at least 30 minutes before the first food, beverage, or medication. Taking it before bed increases the likelihood of the pill lingering in the esophagus, leading to irritation and potential injury.
Choice C rationale
Alendronate should not be administered with orange juice. The absorption of alendronate is significantly impaired by food, beverages other than plain water, and certain minerals like calcium. Orange juice contains calcium and can decrease the bioavailability of the medication, thereby reducing its therapeutic effectiveness. It must be taken with plain water only.
Choice D rationale
Informing the client to remain supine after taking the medication is incorrect. To facilitate rapid transit to the stomach and minimize esophageal contact, clients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate, and until after their first food of the day. Lying down increases the risk of esophageal reflux and irritation.
Correct Answer is ["B","E"]
Explanation
Choice A rationale
Blood glucose levels are not directly impacted by epoetin alfa. Epoetin alfa stimulates erythropoiesis, the production of red blood cells, and its effectiveness is assessed by parameters related to red blood cell mass and oxygen-carrying capacity, not glucose metabolism.
Choice B rationale
Iron levels are crucial to monitor when a client is receiving epoetin alfa. Epoetin alfa stimulates red blood cell production, which requires adequate iron stores for hemoglobin synthesis. Insufficient iron can limit the therapeutic response to epoetin alfa.
Choice C rationale
Alanine aminotransferase (ALT) levels are indicators of liver function. Epoetin alfa does not have a direct hepatotoxic effect, and therefore, monitoring ALT is not a primary method to assess its effectiveness. Liver enzyme levels are not directly related to erythropoiesis.
Choice D rationale
Thyroid-stimulating hormone (TSH) levels are indicators of thyroid function. Epoetin alfa does not directly influence thyroid hormone production or regulation, and monitoring TSH would not provide information about the medication's effectiveness in stimulating red blood cell production.
Choice E rationale
Hemoglobin levels are the primary laboratory test to monitor the effectiveness of epoetin alfa. The medication's purpose is to stimulate erythropoiesis, leading to an increase in red blood cell mass and subsequently, a rise in hemoglobin concentration (normal range for adult males: 13.5–17.5 grams/dL; for adult females: 12.0–15.5 grams/dL).
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