To prevent deep vein thromboses following knee replacement surgery, an adult male client is receiving daily subcutaneous enoxaparin. Which laboratory result requires immediate action by the nurse?

Reference Range:
Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]
Platelets [150,000 to 400,000/mm² (150 to 400 × 10^9/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 μmol/L)]
Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]

Platelet count of 100,000/mm³ (100 x 10^9/L).

Hematocrit 45% (0.45 volume fraction).

Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L).

Serum creatinine 1.0 mg/dL (88.4 μmol/L).

Answer and Explanation

The Correct Answer is A

Choice A reason: Platelet count of 100,000/mm³ (100 x 10^9/L) is below the normal range and indicates thrombocytopenia, which is a decrease in the number of platelets in the blood. Thrombocytopenia can increase the risk of bleeding and bruising, and can be a serious adverse effect of enoxaparin. This laboratory result requires immediate action by the nurse, such as notifying the prescriber, monitoring for signs of bleeding, and withholding the next dose of enoxaparin.

Choice B reason: Hematocrit 45% (0.45 volume fraction) is within the normal range and does not indicate any problem with the client's red blood cells or oxygen-carrying capacity.

Choice C reason: Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) is within the normal range and does not indicate any problem with the client's kidney function or hydration status.

Choice D reason: Serum creatinine 1.0 mg/dL (88.4 μmol/L) is within the normal range and does not indicate any problem with the client's kidney function or muscle metabolism.

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Correct Answer is []

Explanation

Potential Condition:Methemoglobinemia

Methemoglobinemia is a condition in which the hemoglobin in the blood is unable to bind oxygen effectively, resulting in tissue hypoxia. It can be caused by exposure to certain drugs or chemicals, such as nitrates, benzocaine, or dapsone. Some symptoms of methemoglobinemia include cyanosis, headache, fatigue, dyspnea, and tachycardia. In severe cases, it can lead to seizures, coma, and death.

Actions to Take:

Draw blood for a complete blood count
administer methylene blue

A complete blood count (CBC) can help diagnose methemoglobinemia by measuring the level of methemoglobin in the blood. A normal level is less than 1%, while a level above 15% can cause symptoms. A level above 30% can be life-threatening. Methylene blue is a medication that can reduce methemoglobin back to normal hemoglobin and restore oxygen delivery to the tissues. It is given intravenously at a dose of 1-2 mg/kg over 5 minutes.

Parameters to Monitor:

Methemoglobin level
heart rate and rhythm

The methemoglobin level is the most important parameter to monitor in methemoglobinemia, as it indicates the severity of the condition and the response to treatment. The goal is to lower the level below 10% or until symptoms resolve. The heart rate and rhythm are also important to monitor, as methemoglobinemia can cause tachycardia and dysrhythmias due to hypoxia and acidosis. The goal is to maintain a normal sinus rhythm and a heart rate within the normal range for the client’s age and condition.

A. Sleeps soundly through the night. B. Decreased episodes of incontinence. C. Improved ability to concentrate. D. Exhibits fewer emotional outbursts.

Correct Answer is A

Explanation

Choice A reason: Sleeping soundly through the night is the desired outcome of administering zolpidem, which is a sedative-hypnotic that induces sleep by enhancing the activity of GABA, an inhibitory neurotransmitter. Zolpidem is used to treat insomnia, especially difficulty falling asleep.

Choice B reason: Decreasing episodes of incontinence is not a relevant outcome of administering zolpidem, which does not affect urinary function or bladder control. Incontinence may be caused by other factors, such as aging, prostate problems, or urinary tract infections.

Choice C reason: Improving ability to concentrate is not a pertinent outcome of administering zolpidem, which does not affect cognitive function or attention span. Zolpidem may actually impair memory and cause daytime drowsiness or confusion in some patients.

Choice D reason: Exhibiting fewer emotional outbursts is not a significant outcome of administering zolpidem, which does not affect mood or behavior. Zolpidem may actually cause paradoxical reactions, such as agitation, aggression, or hallucinations in some patients.

: [Zolpidem (Oral Route)]

: [Insomnia]

: [Urinary Incontinence]

: [Concentration Problems]

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Naxlex Comprehensive Predictor Exams

Patient Data Exhibits Review H and P, and nurse’s note. Identify from the choices below which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.

Correct Answer is []

Explanation

When administering zolpidem to an older client, which computer documentation indicates that the desired outcome has been achieved?

Correct Answer is A

Explanation

A client who experiences migraine headaches reports having fewer headaches since using the herbal remedy feverfew. Which information is most important for the nurse to include in a teaching plan for this client?

A client with bipolar disorder admitted with severe depression and suicidal ideation receives a prescription for lithium carbonate. Which instruction should the nurse provide to the client?

A client receives a new prescription for somatropin. Which information provided by the client indicates a need for further education by the nurse?

A client with open-angle glaucoma is using pilocarpine ophthalmic solution, a miotic agent. Which action should the nurse at the eye clinic include in evaluating the effectiveness of the medication?

The nurse is administering sevelamer during lunch to a client with chronic kidney disease (CKD). The client asks the nurse to bring the medication later. The nurse should describe which action of sevelamer as an explanation for taking it with meals?

The nurse is administering sevelamer during lunch to a client with chronic kidney disease (CKD). The client asks the nurse to bring the medication later. The nurse should describe which action of sevelamer as an explanation for taking it with meals?

A client who is taking an oral dose of a tetracycline reports gastrointestinal (GI) upset. Which snack should the nurse instruct the client to take with the tetracycline?