When caring for a client receiving a 20% mannitol IV solution at the rate of 100 grams/24 hours (or 70 mg/min), which outcome data is most important for the practical nurse (PN) to collect?
Ankle circumference
Heart rate
Dietary intake
Urinary output
The Correct Answer is D
Choice A reason: Ankle circumference monitors edema, which mannitol reduces by drawing fluid from tissues. However, this is secondary to urinary output, as mannitol’s primary action is diuresis, increasing urine production to reduce intracranial or intraocular pressure, making edema measurement less critical.
Choice B reason: Heart rate is relevant for overall monitoring but not the primary outcome for mannitol, which acts as an osmotic diuretic. Cardiovascular effects are secondary, and mannitol’s efficacy is better assessed by urine output, which directly reflects its diuretic mechanism.
Choice C reason: Dietary intake is unrelated to mannitol’s therapeutic effect. Mannitol pulls fluid into the bloodstream, increasing urine output, not influenced by diet. Monitoring intake may be relevant for other conditions, but it is not critical for assessing mannitol’s diuretic action.
Choice D reason: Urinary output is the most important outcome, as mannitol, an osmotic diuretic, increases urine production by drawing fluid into the renal tubules, reducing intracranial or intraocular pressure. Adequate output (e.g., >30 mL/hour) confirms efficacy, preventing fluid overload or renal complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Taking a benzodiazepine with morphine is incorrect, as it increases sedation and respiratory depression risk, a dangerous opioid side effect. This indicates misunderstanding, as morphine’s primary management focuses on pain and side effects like constipation, not concurrent sedative use.
Choice B reason: Observing bowel movements and using a stool softener shows understanding, as morphine causes constipation by slowing gastrointestinal motility via opioid receptors. Proactive management with stool softeners prevents complications like impaction, aligning with safe opioid use in cancer pain management.
Choice C reason: Grapefruit juice avoidance is irrelevant to morphine, as it affects drugs metabolized by CYP3A4, not opioids. Morphine is metabolized via glucuronidation, unaffected by grapefruit. This indicates misunderstanding, as it does not address morphine’s key side effects or management.
Choice D reason: Watching for agitation or insomnia is not a primary concern with morphine, which causes sedation. These symptoms may relate to other conditions, but they do not reflect understanding of morphine’s effects, like constipation, making this choice incorrect.
Correct Answer is A
Explanation
Choice A reason: Increasing pain before the next opioid dose suggests inadequate analgesia, possibly due to tolerance or disease progression. Consulting the charge nurse facilitates dosage adjustment or schedule changes, ensuring effective pain control in terminal cancer, where maintaining comfort is critical for quality of life.
Choice B reason: Notifying the provider that the dosage has been increased is incorrect, as the PN cannot unilaterally adjust controlled substances. Pain management requires collaboration, and premature notification without consultation risks legal and clinical errors, making this choice inappropriate.
Choice C reason: Withholding opioid doses risks uncontrolled pain, which is unethical in terminal cancer care. The client’s increasing pain indicates a need for dosage review, not cessation, as opioids are essential for palliation, making this choice harmful and contrary to care goals.
Choice D reason: Administering opioids only when pain exceeds 5 is arbitrary and delays relief. Breakthrough pain before scheduled doses requires proactive dosage or interval adjustments, not reactive thresholds, to maintain consistent analgesia, making this choice inadequate for managing terminal cancer pain.
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