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 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.
Correct Answer is B
Explanation
Choice A rationale
Insulin lispro is a rapid-acting insulin used to manage hyperglycemia in clients with diabetes mellitus. Its primary mechanism involves facilitating glucose uptake into cells and inhibiting hepatic glucose production. It does not directly mitigate the adverse effects, such as myelosuppression and gastrointestinal issues, associated with topotecan, a topoisomerase I inhibitor used in chemotherapy.
Choice B rationale
Granisetron is a serotonin 5-HT3 receptor antagonist, primarily used to prevent nausea and vomiting induced by chemotherapy. It works by blocking serotonin's action on vagal nerve terminals and in the chemoreceptor trigger zone in the brainstem. This action effectively controls a common and distressing adverse effect of topotecan, thereby improving client comfort and compliance.
Choice C rationale
Magnesium sulfate is an electrolyte replacement and smooth muscle relaxant. It is used in conditions like pre-eclampsia, eclampsia, and hypomagnesemia. Its physiological effects involve stabilizing neuronal excitability and reducing uterine contractions. It is not indicated for the management of topotecan's adverse effects, which predominantly involve myelosuppression and gastrointestinal toxicity.
Choice D rationale
Prednisone is a corticosteroid with potent anti-inflammatory and immunosuppressive properties. It is used to treat various conditions, including autoimmune disorders, allergic reactions, and some cancers. While it can reduce inflammation, it does not specifically target the common adverse effects of topotecan, such as myelosuppression and gastrointestinal disturbances.
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