A nurse is caring for a 62-year-old female client on a medical-surgical unit.
Complete the following sentence by using the lists of options.
The client is at risk for
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}
The client is at risk for hypotension due to hydrochlorothiazide.
Rationale for correct answers: Hydrochlorothiazide is a thiazide diuretic that reduces blood volume by promoting renal excretion of sodium and water, which lowers blood pressure. This mechanism can lead to hypotension, especially in postoperative patients with fluid shifts or concurrent antihypertensive therapy. Normal blood pressure is approximately 120/80 mm Hg, and this client’s current blood pressure of 92/75 mm Hg indicates mild hypotension, likely related to the diuretic effect of hydrochlorothiazide.
Rationale for incorrect Response 1 options:
Hypoglycemia is a low blood glucose state (below 70 mg/dL) often caused by excess insulin or insufficient food intake, but hydrochlorothiazide typically does not cause hypoglycemia. Instead, it can sometimes increase glucose levels due to altered insulin sensitivity. Hyperkalemia (elevated potassium >5.0 mEq/L) is unlikely because thiazides promote potassium excretion, tending toward hypokalemia rather than hyperkalemia. Infection risk is unrelated to hydrochlorothiazide use and would be influenced more by surgery or immune status.
Rationale for incorrect Response 2 options:
Insulin glargine is a long-acting insulin primarily influencing blood glucose, not blood pressure. Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that can cause renal impairment and fluid retention but does not directly cause hypotension. Glucose level is a lab value, not a medication or intervention that causes hypotension.
Take home points:
- Hydrochlorothiazide can cause hypotension through volume depletion and natriuresis.
- Blood pressure monitoring is essential in postoperative patients on diuretics.
- Differentiate drug-induced hypotension from other causes such as bleeding or sepsis.
- Understand that thiazides can increase blood glucose and decrease potassium levels, influencing diabetic management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Allopurinol is a xanthine oxidase inhibitor. This enzyme is crucial in the purine catabolism pathway, converting xanthine and hypoxanthine into uric acid. By inhibiting xanthine oxidase, allopurinol effectively decreases the de novo synthesis of uric acid, thereby lowering serum uric acid levels. This reduction prevents the formation of uric acid crystals in joints and tissues, which are responsible for the painful manifestations of gout.
Choice B rationale
Tophus formation is a direct consequence of chronic hyperuricemia, where uric acid crystals accumulate in soft tissues, leading to palpable nodules. Allopurinol's primary mechanism of action is to reduce uric acid levels. By achieving this, it prevents further crystal deposition and can even lead to the regression of existing tophi over time. Therefore, it does not increase tophus formation.
Choice C rationale
Allopurinol's mechanism of action is specifically related to uric acid metabolism. It does not directly influence calcium homeostasis in the body. Calcium levels are primarily regulated by parathyroid hormone, calcitonin, and vitamin D, which are distinct physiological pathways unrelated to xanthine oxidase inhibition. Therefore, it does not lower calcium levels.
Choice D rationale
While allopurinol ultimately helps relieve joint inflammation in gout, it does so indirectly. Its primary action is to reduce uric acid production, which then prevents the formation of inflammatory uric acid crystals. The direct reduction of inflammation is typically achieved by anti-inflammatory drugs like NSAIDs or colchicine, which act on inflammatory mediators or pathways, not directly by allopurinol.
Correct Answer is B
Explanation
Choice A rationale
Nystagmus, an involuntary rhythmic eye movement, is not a recognized or common adverse effect of oral albuterol. Albuterol is a beta-2 adrenergic agonist primarily acting on bronchial smooth muscle to cause bronchodilation. Its side effects are typically related to sympathetic nervous system stimulation, not oculomotor dysfunction.
Choice B rationale
Tachycardia is a common adverse effect of oral albuterol due to its systemic absorption and stimulation of beta-1 adrenergic receptors in the heart, in addition to its primary beta-2 effects on the lungs. This leads to an increased heart rate (normal range 60-100 bpm) and can cause palpitations, especially in sensitive individuals or with higher doses.
Choice C rationale
Drowsiness is not a typical adverse effect of oral albuterol. In fact, due to its stimulant properties, albuterol is more likely to cause central nervous system excitation, leading to insomnia, nervousness, or tremors rather than sedation. Its action is to activate adrenergic pathways, which generally promote alertness.
Choice D rationale
Oral fungal infections, such as oral candidiasis (thrush), are commonly associated with inhaled corticosteroids, not oral albuterol. Inhaled corticosteroids suppress the local immune response in the oral cavity, allowing opportunistic fungal growth. Oral albuterol does not have immunosuppressive effects on the oral mucosa.
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