Patient Data

Exhibits

Click to mark whether the assessment finding represents a therapeutic result of the minoxidil administered, a nontherapeutic side effect, or an unrelated finding. Each row must have one option selected.

Blood glucose 218 mg/dL (12.1 mmol/L)

Dizziness while sitting up

Blood pressure 162/111 mm Hg

Pain rated at 1 on a 0 to 10 scale

Urine output 600 mL

Answer and Explanation

The Correct Answer is {"A":{"answers":"C"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"C"},"E":{"answers":"C"}}

Blood glucose 218 mg/dL (12.1 mmol/L)

Classification: Unrelated Finding
Rationale: Minoxidil does not influence blood glucose levels. This elevated blood glucose is likely related to the patient’s known history of type 2 diabetes mellitus. It's not a side effect or intended therapeutic action of minoxidil.

Dizziness while sitting up

Classification: Nontherapeutic Side Effect
Rationale: Minoxidil is a vasodilator that can cause a rapid drop in blood pressure, particularly when changing positions (orthostatic hypotension). Dizziness is a common side effect due to decreased cerebral perfusion when blood pressure drops too quickly or too much.

Blood pressure 162/111 mm Hg

Classification: Therapeutic Result
Rationale: On admission, the patient’s BP was dangerously high at 203/166 mm Hg. A subsequent reading of 162/111 mm Hg shows a significant drop, indicating that minoxidil is having the desired therapeutic effect of lowering blood pressure, even though it's still above target.

Pain rated at 1 on a 0 to 10 scale

Classification: Unrelated Finding
Rationale: Minoxidil is not a pain medication and does not impact pain perception. A low pain score of 1 is likely due to an unrelated mild discomfort or pre-existing condition and has no connection to minoxidil's effects.

Urine output 600 mL

Classification: Unrelated Finding
Rationale: Minoxidil may cause fluid retention, but 600 mL urine output is within the normal range over a few hours (depending on timing and context). This measurement alone does not indicate a therapeutic or side effect of the drug, and without signs of oliguria or diuresis, it remains unrelated.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Determine what time the dose is taken: Dextroamphetamine-amphetamine is a stimulant that can interfere with sleep if taken too late in the day. The timing of the dose is crucial because early morning dosing minimizes insomnia, making this the most important initial assessment.

B. Ask about the client's bedtime routine: While bedtime routines can influence sleep quality, stimulant medication timing has a much stronger direct effect on insomnia, making this a secondary consideration after reviewing dose timing.

C. Inquire about perceived anxiety: Anxiety can contribute to sleep difficulties, but in clients taking stimulants, medication effects are a more likely cause. Addressing medication-related factors takes priority over psychological causes in this case.

D. Determine daily caffeine intake: Caffeine may worsen insomnia, but stimulant medications are generally a stronger factor in causing sleep disturbances. Assessing caffeine use is important but not the first priority compared to reviewing medication timing.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Explanation

The nurse determines that the client's s experiencing (adverse drug reaction), and the blood pressure changes are the result of(need for IV fluids).

Given the client’s bradycardia and low heart rate, IV fluids may be necessary to support circulation and blood pressure, as they help restore blood volume.

Any observed blood pressure changes may be due to the client’s body's response to medications or preoperative preparations, potentially indicating an adverse drug reaction.

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Patient Data Exhibits Click to mark whether the assessment finding represents a therapeutic result of the minoxidil administered, a nontherapeutic side effect, or an unrelated finding. Each row must have one option selected.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who is taking dextroamphetamine-amphetamine extended-release tablets for attention deficit hyperactivity disorder (ADHD), reports about having difficulty sleeping at night. Which assessment is most important for the nurse to obtain?

Correct Answer is A

Explanation

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Explanation

The nurse is instructing a client with allergic rhinitis about the correct technique for using an intranasal inhaler. Which instruction is most important for the nurse to provide the client?

Patient Data Exhibits The nurse prepares to give 2 units of insulin lispro. Which should the nurse double check with a second nurse? Select all that apply.

A client receives a prescription for ophthalmic ketorolac. Prior to administering the medication, the nurse should review the electronic medical record (EMR) for which condition?

A client with postpartum depression receives a prescription for sertraline. Which information is most important for the nurse to include in client teaching?

A client with type 2 diabetes mellitus who takes glimepiride PO daily calls the nurse to report a recent onset of nausea, vomiting, and diarrhea. Which response should the nurse provide?

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?Reference Range:Hemoglobin (Hgb) [14 to 18 g/dL (8.7 to 11.2 mmol/L)]

The nurse is administering the muscle relaxant baclofen PO to a client diagnosed with multiple sclerosis. Which intervention should the nurse implement?

Patient Data

Exhibits

Click to mark whether the assessment finding represents a therapeutic result of the minoxidil administered, a nontherapeutic side effect, or an unrelated finding. Each row must have one option selected.