A nurse is reconciling the medications for a client who was newly admitted for management of mania. Which of the following prescriptions should the nurse clarify with the provider?
Risperidone 3.0 mg PO daily
Clonazepam 0.5 mg PO three times daily
Lithium 300 mg PO three times daily
Divalproex sodium 0.5 g PO daily
The Correct Answer is A
The pharmacological management of acute mania involves mood stabilizers and antipsychotics to achieve rapid symptomatic control. Safety standards prohibit the use of trailing zeros in medication orders to prevent ten-fold dosing errors. A decimal point followed by a zero can be easily misread in a clinical environment, leading to iatrogenic harm and severe medication toxicity.
Rationale:
A. Risperidone 3.0 mg contains a trailing zero, which is a dangerous notation that must be clarified and corrected to 3 mg. If the decimal point is not clearly visible, a clinician might mistakenly administer 30 mg, which could lead to severe extrapyramidal symptoms or neuroleptic malignant syndrome. Following the "Do Not Use" list from The Joint Commission is essential for patient safety.
B. Clonazepam 0.5 mg is a correctly formatted prescription for a benzodiazepine often used as an adjunct in mania to promote sedation and reduce agitation. The leading zero before the decimal point is required to prevent the dose from being read as 5 mg. Since this order follows safe labeling practices and falls within therapeutic ranges, it does not require clarification.
C. Lithium 300 mg is a standard starting dose for a primary mood stabilizer used in the treatment of bipolar disorder. The order is written clearly without dangerous abbreviations or incorrect decimal placements. Because the dose is typical for achieving a therapeutic serum concentration between 0.8 and 1.2 mEq/L, the nurse can proceed with administration and monitoring.
D. Divalproex sodium 0.5 g is an anticonvulsant mood stabilizer written using a leading zero, which is the correct safety format for decimal values. While often prescribed in milligrams (500 mg), the use of grams is clear and follows standard metric notation. There is no ambiguity in this order that would increase the risk of a significant medication error for the patient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Metoprolol is a selective beta-1 adrenergic blockerthat primarily targets receptors in the myocardium. It decreases the cardiac workloadby reducing the heart rate, myocardial contractility, and systemic blood pressure. It is indicated for hypertension, angina pectoris, and the management of heart failure.
Rationale:
A.Heart rate is the most critical vital sign to assess before administering metoprolol because the drug's primary action is to slow the heart rate. If the heart rate is less than 60 beats per minute, the medication should generally be withheld to prevent severe bradycardia. The nurse must ensure the client has sufficient hemodynamic reserve before further suppressing the cardiac rate.
B.Temperature is not influenced by beta-blocker therapy and does not provide information regarding the safety or efficacy of metoprolol. While a fever might increase the baseline heart rate, the drug itself does not possess antipyretic properties. Monitoring the temperature is part of standard care but is not a prerequisite for the safe administration of this cardiovascular agent.
C.Oxygen saturation is generally not affected by selective beta-1 blockers like metoprolol, which have minimal impact on the beta-2 receptors in the lungs. While non-selective beta-blockers could cause bronchoconstriction in asthma patients, metoprolol is cardio-selective. Unless the patient has acute heart failure with pulmonary edema, oxygen saturation is not the priority parameter for this drug.
D.Respiratory rate is not directly impacted by metoprolol, as the drug does not cross the blood-brain barrier in large amounts to affect the respiratory center. Unlike opioids or sedatives, metoprolol does not cause respiratory depression. While assessing the lungs is important for heart failure patients, the heart rate remains the definitive parameter for determining whether to dose the medication.
Correct Answer is ["A","C","D"]
Explanation
An ST-elevation myocardial infarction(STEMI) occurs when a coronary artery is completely occluded, leading to transmural myocardial ischemiaand necrosis. This medical emergency is identified by specific ECG changes and elevated cardiac biomarkerslike Troponin I (> 0.03 ng/mL). Immediate pharmacologic intervention focuses on reperfusion, preventing further thrombus propagation, and reducing myocardial oxygen demand to preserve functional cardiac tissue.
Rationale:
A. Heparin is an anticoagulant indicated in the acute phase of a STEMI to prevent the formation and extension of fibrin clots. By accelerating the action of antithrombin 3, it neutralizes thrombin and factor Xa. This prevents further occlusion of the coronary artery while the patient awaits definitive reperfusion therapy like percutaneous coronary intervention.
B. Digoxin is a positive inotrope and negative chronotrope primarily used for chronic heart failure or atrial fibrillation with rapid ventricular response. In the setting of an acute STEMI, it is generally avoided because it increases myocardial oxygen consumptionby increasing contractility. Excessive oxygen demand during an active infarction can exacerbate myocardial injury and extend the area of necrosis.
C. Aspirin is a cornerstone of acute coronary syndrome management due to its immediate antiplatelet effects. It irreversibly inhibits cyclooxygenase-1, preventing the synthesis of thromboxane A2, which is a potent stimulator of platelet aggregation. Administering aspirin early significantly reduces mortality by limiting the size of the developing thrombus within the obstructed coronary vessel.
D. Morphine is the preferred analgesic for managing the crushing chest pain associated with myocardial infarction when nitrates are insufficient. Beyond pain relief, it provides beneficial hemodynamic effectsby reducing preload through venous dilation and decreasing systemic vascular resistance. These actions lower the myocardial workload and oxygen demand, while also alleviating the patient's anxiety and sympathetic surge.
E. Dopamine is a sympathomimetic amine used for hemodynamic support in cases of cardiogenic shock or clinically significant hypotension. The client's blood pressure is currently stable at 126/80 mm Hg, making a vasopressor or potent inotrope unnecessary and potentially harmful. Administering dopamine in a stable STEMI patient would unnecessarily increase heart rate and myocardial metabolic demand, worsening the ischemia.
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