A nurse is reviewing data for a client who receives clonidine daily.
Which of the following findings indicates the nurse should withhold the next dose?
Urine output 600 mL in 8 hr.
Blood pressure 88/50 mm Hg.
Heart rate 110/min.
Blood glucose 70 mg/dL.
The Correct Answer is B
Choice A rationale:
A urine output of 600 mL in 8 hours is within the normal range. The average urine output for adults is about 1 to 2 liters per day.
Choice B rationale:
Clonidine is an antihypertensive medication. If the client’s blood pressure is already low (88/50 mm Hg), administering clonidine could further lower the blood pressure and cause hypotension.
Choice C rationale:
A heart rate of 110/min is slightly high, but it’s not a direct indication to withhold clonidine. Clonidine can actually help lower an elevated heart rate by reducing the levels of certain chemicals in your blood.
Choice D rationale:
A blood glucose level of 70 mg/dL is at the lower end of the normal range (70-100 mg/dL) However, clonidine does not directly affect blood glucose levels, so this would not be a reason to withhold the medication.
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Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is A
Explanation
Choice A rationale:
A respiratory rate of 10/min is lower than the normal range (12-20 breaths per minute for adults), indicating respiratory depression, which is a serious side effect of morphine and should be reported immediately.
Choice B rationale:
Facial flushing is a common side effect of morphine due to histamine release but it’s not life-threatening.
Choice C rationale:
Constipation is a common side effect of morphine and can be managed with laxatives and diet.
Choice D rationale:
Blood pressure 88/56 mm Hg is lower than the normal range (90/60mmHg to 120/80mmHg), indicating hypotension, which can be a side effect of morphine but it’s not as immediately life-threatening as respiratory depression.
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