Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Ceftriaxone, with a white blood cell count of 16,000 u/L.

Zafirlukast, with an AST of 30 units/L and ALT of 20 units/L.

Theophylline, with a theophylline level of 21 mg/dL.

Prednisone, with a glucose level of 110 mg/dL.

Answer and Explanation

The Correct Answer is C

Choice A Reason
Ceftriaxone is an antibiotic that may be prescribed during COPD exacerbations to treat or prevent infection. A white blood cell count of 16,000 u/L indicates an elevated level, which could be a response to infection. Therefore, ceftriaxone would be appropriate, and there is no need to question this medication based on the white blood cell count.

Choice B Reason
Zafirlukast is a leukotriene receptor antagonist used for the prophylactic treatment of asthma, and it may be used off-label for COPD. AST and ALT levels are liver enzymes, and the values provided (AST of 30 units/L and ALT of 20 units/L) are within normal ranges. Thus, there is no immediate concern regarding liver function that would prompt the nurse to question the use of zafirlukast.

Choice C Reason
Theophylline is a bronchodilator used in the treatment of COPD. However, a theophylline level of 21 mg/dL is above the therapeutic range, which is generally considered to be 5-15 mg/dL. Levels above 20 mg/dL are associated with toxicity and can lead to serious side effects such as seizures or arrhythmias. Therefore, the nurse should question this medication due to the high theophylline level.

Choice D Reason
Prednisone is a corticosteroid that may be used to reduce inflammation during COPD exacerbations. A glucose level of 110 mg/dL is slightly elevated but may be expected as corticosteroids can increase blood sugar levels. This would not typically be a reason to question the use of prednisone unless the patient has poorly controlled diabetes or other specific contraindications.

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Correct Answer is A

Explanation

Choice A Reason:
Sodium levels in the blood should normally be between 135 and 145 mEq/L. A level of 152 mEq/L is considered high and can be indicative of hypernatremia, which requires prompt medical attention to address potential dehydration, kidney issues, or other underlying conditions.

Choice B Reason:
Potassium levels should be within the range of 3.5 to 5.2 mEq/L for adults. A result of 3.8 mEq/L falls within the normal range, indicating no immediate concern regarding potassium levels.

Choice C Reason:
Calcium levels in the blood are typically between 8.6 and 10.2 mg/dL for adults. Therefore, a calcium level of 10.0 mg/dL is within the normal range and does not require urgent reporting to a physician.

Choice D Reason:
Creatinine levels in the blood should be between 0.6 to 1.3 mg/dL in adults, depending on factors such as age, gender, and muscle mass. A level of 1.2 mg/dL is at the higher end of the normal range but is not typically considered critical unless there are other signs of kidney dysfunction.

A. The approval process for bariatric surgery. B. The effectiveness of behavioral therapy for clients seeking to lose weight. C. The increased risk of morbidity and mortality associated with obesity. D. The importance of diet and exercise in a successful weight loss program. E. The safety and effectiveness of weight loss drugs.

Correct Answer is ["B","C","D"]

Explanation

Choice A Reason:
The process of being approved for bariatric surgery is not relatively simple. It involves a comprehensive evaluation that includes medical tests, psychological assessment, and dietary counseling. The process can take several months to ensure that the patient is a suitable candidate for surgery.

Choice B Reason:
Behavioral therapy has been shown to be effective for clients seeking to lose weight. It involves strategies such as self-monitoring, developing problem-solving skills, and establishing a support network, which can lead to significant and sustainable weight loss.

Choice C Reason:
Obesity is known to increase the risk of morbidity and mortality. Excess body weight is associated with a higher risk of developing chronic diseases such as type 2 diabetes, cardiovascular diseases, and certain cancers.

Choice D Reason:
Diet and exercise are indeed critical components of a successful weight loss program. A combination of a calorie-restricted diet and regular physical activity is the most effective way to achieve and maintain weight loss.

Choice E Reason:
While weight loss drugs can be an adjunct to diet and exercise for weight loss, they are not universally safe and effective. They can have side effects and are not suitable for everyone. Their use should be evaluated on a case-by-case basis, and they are typically prescribed when lifestyle modifications have not been sufficient.

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Which medication should the nurse question for a client admitted with an exacerbation of chronic obstructive pulmonary disease (COPD)?

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