The nurse plans to administer the adult client’s prescriptions which are metoprolol, hydrochlorothiazide, enoxaparin and atorvastatin.

The current laboratory values are; Serum potassium 5.2 mmol/L, Platelet Count 98,000/mm, Serum cholesterol 250 mg/dL and Serum Creatinine 1.2 mg/dL.
Which medication should the nurse hold and notify the prescriber?

Metoprolol.

Hydrochlorothiazide.

Enoxaparin.

Atorvastatin.

Answer and Explanation

The Correct Answer is B

The nurse should hold and notify the prescriber because hydrochlorothiazide is a diuretic that can lower the serum potassium level. The client already has a high serum potassium level of 5.2 mmol/L, which is above the normal range of 3.5 to 5.0 mmol/L.

Giving hydrochlorothiazide could worsen the client’s condition and cause hypokalemia.

Choice A is wrong because metoprolol is a beta-blocker that can lower the blood pressure and heart rate.

The client’s blood pressure and heart rate are not given, so there is no reason to hold metoprolol based on the information provided.

Choice C is wrong because enoxaparin is an anticoagulant that can prevent blood clots. The client has a low platelet count of 98,000/mm, which is below the normal range of 150,000 to 450,000/mm.

However, this does not contraindicate the use of enoxaparin, unless the client has signs of bleeding or bruising.

Choice D is wrong because atorvastatin is a statin that can lower the serum cholesterol

level. The client has a high serum cholesterol level of 250 mg/dL, which is above the desirable level of less than 200 mg/dL.

Giving atorvastatin could help reduce the client’s risk of cardiovascular complications.

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Free Nursing Study Resources

Correct Answer is B

Explanation

This is because the nurse’s reply does not address the client’s fear of radiation therapy, but rather provides factual information that may not be relevant or helpful to the client.

The nurse is not using a therapeutic communication technique, such as reflecting, exploring, or validating the client’s feelings.

Instead, the nurse is shutting down the communication and missing an opportunity to learn more about the client’s concerns and needs.

Choice A is wrong because the nurse is not confronting a painful subject, but rather avoiding it.

The nurse is not acknowledging the client’s fear or inviting the client to talk more about it.

Choice C is wrong because the nurse is not recognizing that the client needs information, but rather assuming that the client does.

The nurse is not asking the client what he or she wants to know about radiation therapy, but rather telling the client what he or she should know.

Choice D is wrong because the nurse is not perceiving that the client is ready to hear more about the treatment, but rather imposing information on the client.

The nurse is not assessing the client’s readiness to learn, but rather giving unsolicited advice.

A. Call the rapid response team. B. Move the client to the bed. C. Call the primary care provider. D. Assess client for unresponsiveness.

Correct Answer is D

Explanation

This is because the nurse should always follow the ABC (airway, breathing, circulation) priority when dealing with a client who suddenly slumps over. The nurse should check if the client is conscious and breathing before calling for help or moving the client.

Choice A is wrong because calling the rapid response team should not be done before assessing the client’s condition and ensuring a patent airway.

Choice B is wrong because moving the client to the bed may cause further harm or aspiration if the client has food in the mouth or airway.

Choice C is wrong because calling the primary care provider is not a priority action in this situation. The nurse should first assess and stabilize the client before notifying the provider.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client says to a nurse, “I’m afraid of radiation therapy.” The nurse replies, “Radiation kills the cancer cells.” Which statement best describes the nurse?

Correct Answer is B

Explanation

A client with dysphagia is eating breakfast and suddenly slumps over. What should the nurse do first?

Correct Answer is D

Explanation

Which action is appropriate for a nurse to remove a soiled wound dressing?

A client has been newly diagnosed with hypothyroidism. What symptoms or signs would be expected with this diagnosis? Select all that apply.

Which statement provides the best documentation of the amount of wound drainage?

Which older adult on bed rest is most at risk to develop skin breakdown? A client who:.

Which assessment finding is suggestive of an adaptive coping strategy in an individual?

A client has lorazepam prescribed before surgery and refuses the injection. If the nurse administers the scheduled injection despite the client’s lack of consent, which term best describes the nurse’s action?

What does the nurse know to be the goals of client teaching? (Select all that apply).

A nurse receives report that a client has been pacing the hallway continuously for almost twenty-four hours and talking excessively. Which action is the priority?