The nurse is preparing to give a second dose of trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patient's extremities. The nurse will perform which action?
Request an order for a blood glucose level.
Hold the dose and notify the provider.
Request an order for a BUN and creatinine level.
Request an order for diphenhydramine (Renadryl)
The Correct Answer is B
A. Request an order for a blood glucose level: TMP-SMX does not typically cause acute changes in blood glucose, so testing glucose would not clarify the cause of petechiae. Petechial rashes suggest a possible blood dyscrasia such as thrombocytopenia rather than a metabolic disturbance.
B. Hold the dose and notify the provider.: A petechial rash can signal a serious hypersensitivity reaction or drug-induced thrombocytopenia. Giving another dose could worsen the reaction and increase the risk of bleeding or systemic complications. Holding the medication and seeking immediate evaluation is the safest intervention.
C. Request an order for a BUN and creatinine level.: Although TMP-SMX can affect renal function, petechiae primarily indicate a hematologic problem rather than isolated kidney dysfunction. Checking kidney values does not address the risk for severe allergic or platelet-related complications.
D. Request an order for diphenhydramine (Benadryl): Antihistamines can help mild allergic reactions but may mask symptoms of a more serious underlying condition such as thrombocytopenia. Giving it without stopping the medication could delay correct diagnosis and treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. History of angioedema related to ACE inhibitors: Lisinopril can trigger life-threatening angioedema in patients with a prior history of ACE inhibitor–induced angioedema. Re-exposure significantly increases the risk of airway obstruction and anaphylaxis, making it an absolute contraindication.
B. Asthma: Lisinopril does not directly worsen asthma, although it can cause a dry cough in some patients. Asthma alone is not a contraindication, but respiratory symptoms should be monitored if they develop.
C. Chronic sinusitis: Chronic sinusitis is not affected by ACE inhibitors, and there is no increased risk of complications from taking lisinopril. It does not pose a contraindication to therapy.
D. Diabetes mellitus: Lisinopril is often used in diabetes to protect kidney function and manage hypertension. Diabetes is not a contraindication; in fact, it can be a therapeutic benefit in preventing diabetic nephropathy.
Correct Answer is ["2300"]
Explanation
Calculation of Total Intake (mL)
- Continuous IV Infusion (Lactated Ringer's)
Rate: 125 mL/hr
Time: 9 hr
Volume = 125 mL/hr x 9 hr}
=1,125 mL
- Intermittent IV Medications
Cefazolin infusion volume: 100 mL
Ranitidine infusion volume: 50 mL
- Blood Products (Packed RBCs)
Unit 1 volume: 275 mL
Unit 2 volume: 250 mL
- IV Fluid Boluses
Bolus 1 volume: 250 mL
Bolus 2 volume: 250 mL
- Calculate Total Intake
Total Intake = 1,125 mL + 100 mL + 50 mL + 275 mL + 250 mL + 250 mL + 250 mL
Total Intake = 2,300 mL
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