A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)

Duloxetine

Furosemide

Telmisartan

Atorvastatin

Clopidogrel

Answer and Explanation

Correct Answer : A,B,C

A) Duloxetine: Duloxetine, an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor), is commonly used for depression and chronic pain. It can cause orthostatic hypotension, especially in older adults, due to its effects on norepinephrine, which can lead to blood pressure fluctuations upon standing.

B) Furosemide: Furosemide is a loop diuretic that increases urine output, leading to a decrease in blood volume. This reduction in blood volume can result in orthostatic hypotension, particularly when the client changes positions quickly, such as moving from lying down to standing.

C) Telmisartan: Telisartan is an angiotensin II receptor blocker (ARB) used to treat hypertension. It can cause vasodilation and a reduction in blood pressure, which may lead to orthostatic hypotension, especially in older adults who are more sensitive to blood pressure changes.

D) Atorvastatin: Atorvastatin, a statin used to lower cholesterol, does not typically cause orthostatic hypotension. Its primary action is on lipid levels rather than blood pressure, making it less likely to contribute to this condition.

E) Clopidogrel: Clopidogrel is an antiplatelet medication that reduces the risk of blood clots. It does not generally affect blood pressure or cause orthostatic hypotension, as its mechanism of action is related to inhibiting platelet aggregation rather than influencing vascular tone or fluid balance.

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Correct Answer is C

Explanation

A) "Crushing the medication is a good idea, and I can mix it in some ice cream for you."
Crushing enteric-coated medications is not advisable as it can disrupt the medication’s intended release mechanism. Enteric coatings are designed to protect the stomach lining and ensure that the medication is released in the intestines. Crushing the medication would bypass these protective mechanisms.

B) "Crushing the medication might cause you to have a stomachache or indigestion."
While this statement is somewhat true, it does not fully address the primary concern. Enteric-coated medications are designed to protect the stomach lining and to ensure proper absorption. Crushing them could lead to other issues beyond just stomachache or indigestion.

C) "Crushing the medication would release all the medication at once, rather than over time."
This is the most accurate response. Enteric-coated aspirin is designed to dissolve in the intestines rather than the stomach, and crushing it would lead to the medication being released all at once, which could potentially cause irritation or harm to the stomach and reduce the medication's effectiveness.

D) "Crushing is unsafe, as it destroys the ingredients in the medication."
While crushing enteric-coated medications can be unsafe, the primary issue is not the destruction of the ingredients but the loss of the medication’s intended release mechanism. This can result in adverse effects or reduced efficacy.

A. A nurse injected Demerol IM into the vastus lateralis site of adult. B. A client received gentamicin intermittent IV bolus over 1 hr. C. A client received a crushed bupropion XL tablet mixed with applesauce. D. A nurse used a 25-gauge 3/8 inch needle to administer a heparin injection.

Correct Answer is C

Explanation

C) A client received a crushed bupropion XL tablet mixed with applesauce:
Extended-release (XL) medications like bupropion XL are designed to release their active ingredients gradually over time. Crushing these tablets can alter their release mechanism, potentially leading to an overdose or reduced efficacy. This is a significant error that should be reported through an incident report to ensure patient safety and evaluate the potential impact of the mistake.

A) A nurse injected Demerol IM into the vastus lateralis site of adult:
Injecting Demerol (meperidine) intramuscularly into the vastus lateralis site is not an error. This site is commonly used for intramuscular injections in adults, though other sites like the deltoid or gluteus maximus are also appropriate depending on the situation.

B) A client received gentamicin intermittent IV bolus over 1 hr:
Gentamicin is often administered as an intermittent IV bolus over a period of time, and administering it over 1 hour is a common practice. This does not indicate an error that would require an incident report.

D) A nurse used a 25-gauge 3/8 inch needle to administer a heparin injection:
Heparin injections are typically administered with a smaller gauge needle, but a 25-gauge needle is acceptable for subcutaneous injections. The needle size might be less than ideal but does not necessarily warrant an incident report unless it directly impacts the effectiveness of the medication or causes an issue.

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A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?

Correct Answer is C

Explanation

A nurse is reviewing the medication administration records from the previous shift. Which of the following findings should indicate to the nurse a need for an incident report?

Correct Answer is C

Explanation

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