The nurse is monitoring a client taking a potassium sparing diuretic. Which of the following findings would prompt the nurse to notify the health care provider?
Serum sodium level of 140 mEq/L
Blood pressure of 130/80 mmHg
Serum potassium level of 5.5 mEq/L
Serum potassium level of 3.5 mEq/L
The Correct Answer is C
Choice A reason: Serum sodium level of 140 mEq/L is within the normal range of 135145 mEq/L. It does not indicate any adverse effect of the potassium sparing diuretic, which does not affect sodium excretion significantly. The nurse does not need to notify the health care provider about this finding.
Choice B reason: Blood pressure of 130/80 mmHg is slightly above the normal range of 120/80 mmHg, but it is not a cause for concern. The potassium sparing diuretic can lower the blood pressure by reducing the fluid volume and preventing sodium retention. The nurse should monitor the blood pressure regularly but does not need to notify the health care provider about this finding.
Choice C reason: Serum potassium level of 5.5 mEq/L is above the normal range of 3.55.0 mEq/L. It indicates hyperkalemia, which is a serious and potentially life-threatening complication of the potassium sparing diuretic. The potassium sparing diuretic can increase the potassium level by inhibiting its secretion in the distal tubule of the kidney. The nurse should notify the health care provider immediately and prepare to administer interventions such as calcium gluconate, insulin, or sodium bicarbonate to lower the potassium level and prevent cardiac arrhythmias.
Choice D reason: Serum potassium level of 3.5 mEq/L is at the lower end of the normal range of 3.55.0 mEq/L. It does not indicate any adverse effect of the potassium sparing diuretic, which does not cause potassium loss. The nurse does not need to notify the health care provider about this finding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is incorrect. Miosis is the constriction of the pupils, which can also be caused by morphine, but it is not a life-threatening side effect. Miosis occurs because morphine stimulates the parasympathetic nervous system, which controls the muscles that constrict the pupils¹.
Choice B reason: This is incorrect. Sedation is the state of being calm, relaxed, and sleepy, which can also be caused by morphine, but it is not a life-threatening side effect. Sedation occurs because morphine depresses the central nervous system, which reduces the activity of the brain and the body.
Choice C reason: This is correct. Respiratory depression is the slowing down of breathing, which can be a life-threatening side effect of morphine. Respiratory depression occurs because morphine depresses the respiratory center in the brainstem, which regulates the rate and depth of breathing. If the breathing becomes too slow or shallow, the patient may not get enough oxygen and may lose consciousness or die.
Choice D reason: This is incorrect. Euphoria is the feeling of intense happiness, pleasure, or wellbeing, which can also be caused by morphine, but it is not a life-threatening side effect. Euphoria occurs because morphine stimulates the reward system in the brain, which releases dopamine, a neurotransmitter that causes positive emotions.
Correct Answer is C
Explanation
Choice A reason: “This medication should be taken after eating to reduce nausea.” is not a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron can be taken with or without food, and it does not affect the digestion or absorption of food. Ondansetron is usually taken before the start of chemotherapy, radiation, or surgery, which are the common causes of nausea and vomiting.
Choice B reason: “This medication should not be taken with starfruit.” is not a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron does not interact with starfruit, which is a tropical fruit that contains substances that can inhibit the enzyme CYP3A4, which is involved in the metabolism of many drugs. Ondansetron is mainly metabolized by another enzyme, CYP1A2, and it has a low potential for drug interactions¹.
Choice C reason: “This medication may make me tired and confused.” is a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron can also cross the blood brain barrier and affect other serotonin receptors in the brain, which are involved in regulating mood, cognition, and sleep. Ondansetron can cause side effects such as fatigue, drowsiness, headache, and confusion, which can impair the mental alertness and performance of the client. The client should be advised to avoid driving, operating machinery, or doing other tasks that require attention after taking ondansetron.
Choice D reason: “This medication may cause rebound nausea.” is not a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron does not cause rebound nausea, which is a condition of nausea that occurs after the discontinuation of a medication that suppresses nausea. Ondansetron is not a medication that suppresses nausea, but rather prevents it by blocking the stimulation of the vomiting center. Ondansetron does not cause dependence or withdrawal symptoms, and it can be stopped without causing rebound nausea.
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