The nurse is reviewing the laboratory results of a client who reports taking five times the recommended daily allowance of vitamins and minerals in a multivitamin form. Which finding indicates a possible vitamin D overdose?

Reference Range:

Bilirubin [0.3 to 1 mg/dL (5.1 to 17 μmol/L)]

Calcium 19 to 10.5 mg/dL (2.3 to 2.6 mmol/L)]

Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]

Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

Sodium level 140 mEq/L (140 mmol/L).

Total calcium level 12 mEq/L (3 mmol/L).

Total bilirubin 4 mg/dL (68.4 μmol/L).

Serum glucose 170 mg/dL (9.4 mmol/L).

Answer and Explanation

The Correct Answer is B

A) Sodium level 140 mEq/L (140 mmol/L):
The sodium level within the reference range does not indicate a vitamin D overdose. Sodium levels are typically not affected by vitamin D overdose.

B) Total calcium level 12 mg/dL (3 mmol/L):
This finding suggests a possible vitamin D overdose. Vitamin D plays a crucial role in calcium absorption from the intestines. Excessive vitamin D intake can lead to increased calcium absorption, resulting in hypercalcemia. Elevated calcium levels can lead to various symptoms such as nausea, vomiting, weakness, and confusion. Monitoring calcium levels is essential in individuals with suspected vitamin D overdose.

C) Total bilirubin 4 mg/dL (68.4 μmol/L):
Elevated bilirubin levels typically indicate liver dysfunction or hemolysis. It is not directly related to vitamin D overdose.

D) Serum glucose 170 mg/dL (9.4 mmol/L):
Elevated glucose levels suggest hyperglycemia, which can occur due to various factors such as diabetes mellitus or stress response. It is not directly related to vitamin D overdose.

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Correct Answer is A

Explanation

A) Determine what time the dose is taken: The timing of medication administration, especially for stimulant medications like dextroamphetamine-amphetamine, can significantly impact sleep quality. If the client is taking the medication too late in the day, its stimulant effects may interfere with their ability to fall asleep at night. Therefore, assessing the timing of medication administration is crucial to determine if it correlates with the reported difficulty sleeping.
B) Ask about the client's bedtime routine: While bedtime routine can influence sleep quality, it may not directly address the issue of difficulty sleeping related to medication use. However, understanding the client's overall sleep habits and bedtime routine can provide valuable information for developing sleep hygiene recommendations.
C) Inquire about perceived anxiety: Anxiety can contribute to sleep disturbances, but in this context, the primary concern is the potential impact of dextroamphetamine-amphetamine on sleep. While anxiety assessment is important in comprehensive care, it may not directly address the client's reported difficulty sleeping specifically related to medication use.
D) Determine daily caffeine intake: Caffeine intake can affect sleep quality, but it may not be as directly relevant to the reported difficulty sleeping in the context of medication use. However, it's still valuable information to assess as part of the overall evaluation of sleep habits and factors contributing to sleep disturbances.

A. Expresses that they cannot get enough air to breathe. B. Respiratory rate of 7 breaths/minute. C. Bilateral wheezing on auscultation. D. Pulse oximeter reading of 89% on room air.

Correct Answer is B

Explanation

A) Expresses that they cannot get enough air to breathe: While this statement suggests respiratory distress, it is not as objective an assessment finding as a respiratory rate of 7 breaths/minute. Objective measurements are typically more reliable indicators for initiating interventions.
B) Respiratory rate of 7 breaths/minute: A respiratory rate of 7 breaths/minute is indicative of respiratory depression, which is a potential side effect of opioid analgesics like morphine sulfate. Naloxone is an opioid antagonist used to reverse opioid-induced respiratory depression. Administering a prescribed PRN dose of naloxone is appropriate to counteract the respiratory depression and prevent further complications.
C) Bilateral wheezing on auscultation: Wheezing is more commonly associated with bronchoconstriction or airway obstruction rather than opioid-induced respiratory depression. Naloxone is not indicated for wheezing unless there is concurrent opioid-induced respiratory depression.
D) Pulse oximeter reading of 89% on room air: While a pulse oximeter reading of 89% indicates hypoxemia, it may not be solely due to opioid-induced respiratory depression. Other factors, such as hypoventilation, ventilation-perfusion (V/Q) mismatch, or lung disease, could contribute to decreased oxygen saturation. Administering naloxone solely based on pulse oximetry readings may not address the underlying cause adequately. It is essential to assess the client comprehensively, considering clinical signs and symptoms along with objective data.

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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

A client is receiving morphine sulfate via a patient controlled analgesic (PCA) pump postoperatively. Which assessment finding should prompt the nurse to administer a prescribed PRN dose of naloxone?

Correct Answer is B

Explanation

A client receives a prescription for penicillin G 1,000,000 units intramuscular (IM) daily. The medication is available in 1,200,000 units/2 mL syringe. How many mL should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth.)

The nurse is providing medication teaching to a client with bipolar disorder who receives a prescription for lithium carbonate. Which instruction should the nurse emphasize with the client?

The home health nurse observes a client self-administering an epinephrine injection using an auto-injector pen. Which client action requires intervention by the nurse?

On admission, the healthcare provider prescribes a broad spectrum antibiotic for a client with a gram-negative infection. Before administering the first dose, it is most important for the nurse to implement which prescription?

After receiving the third dose of a new oral anticoagulant prescription, an older client develops bleeding and tender gums and has many new bruises. Which action(s) should the nurse implement? Select all that apply.

When caring for a client with diabetes insipidus who is receiving an antidiuretic hormone intranasally, who serum laboratory test is most important for the nurse to monitor',