A nurse is collecting data from a client who is receiving vancomycin for a Clostridium difficile infection.
Which of the following findings is the priority for the nurse to report to the provider?
Two loose stools in the past 24 hr.
WBC 11,000/mm³.
Heart rate 104/min.
Creatinine 3.1 mg/dL.
The Correct Answer is D
Choice A rationale:
Two loose stools in the past 24 hours could be a symptom of Clostridioides difficile infection, but it’s not necessarily a priority finding. The infection can cause diarrhea, but it’s not life-threatening.
Choice B rationale:
A WBC count of 11,000/mm³ is slightly elevated, indicating a possible infection. However, it’s not necessarily a priority finding as it’s not significantly high.
Choice C rationale:
A heart rate of 104/min is slightly elevated, indicating possible stress or anxiety. However, it’s not necessarily a priority finding as it’s not significantly high.
Choice D rationale:
Creatinine level of 3.1 mg/dL is significantly high, indicating possible kidney damage, which can be a side effect of vancomycin treatment. This should be reported to the provider immediately.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Hypernatremia (high sodium levels) is not a common side effect of spironolactone. Spironolactone is a potassium-sparing diuretic and does not typically affect sodium levels.
Choice B rationale:
Hyperkalemia (high potassium levels) is a potential adverse effect of spironolactone. As a potassium-sparing diuretic, spironolactone can cause an increase in serum potassium levels.
Choice C rationale:
Hypophosphatemia (low phosphate levels) is not typically associated with spironolactone use.
Choice D rationale:
Hypocalcemia (low calcium levels) is also not a common side effect of spironolactone.
Correct Answer is B
Explanation
Choice A rationale:
Donepezil is a medication used to treat symptoms of Alzheimer’s disease and does not typically cause urinary retention.
Choice B rationale:
Scopolamine, an anticholinergic drug, can cause urinary retention. Anticholinergic drugs block the action of acetylcholine, a neurotransmitter that helps to contract the bladder muscles and relax the urinary sphincters to allow urination.
Choice C rationale:
Metoprolol is a beta-blocker used to treat high blood pressure and heart problems. It does not typically cause urinary retention.
Choice D rationale:
Acetaminophen is a common over-the-counter pain reliever and does not typically cause urinary retention.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
