Which patient would be a concern for the nurse when administering mannitol (Osmitrol)?
A patient who is extremely hypertensive.
A patient who has increased intracranial pressure.
A patient who is in congestive heart failure (CHF).
A patient who has fluid volume overload.
The Correct Answer is C
Choice A rationale:
Hypertension is not a primary contraindication for mannitol use. While it's important to monitor blood pressure during mannitol administration, it's not the most concerning factor in this scenario.
Mannitol can even be used cautiously in hypertensive patients with conditions like intracranial hypertension or acute renal failure, where its benefits may outweigh the potential risks of exacerbating hypertension.
Choice B rationale:
Mannitol is actually indicated for the treatment of increased intracranial pressure (ICP). It works by drawing fluid from the brain tissues into the bloodstream, thereby reducing pressure within the skull.
Therefore, a patient with ICP would not be a concern for mannitol administration; rather, they would be a potential candidate for its use.
Choice D rationale:
While fluid volume overload can be a concern with mannitol use, it's typically managed with careful monitoring and fluid restriction.
The more significant concern in this scenario is congestive heart failure (CHF).
Choice C rationale:
Mannitol is contraindicated in patients with congestive heart failure (CHF). Here's why:
Increased Circulating Volume: Mannitol is an osmotic diuretic, meaning it draws fluid from the tissues into the bloodstream, increasing circulating blood volume. This can overload the already compromised heart in CHF patients, leading to worsening heart failure and pulmonary edema.
Elevated Blood Pressure: Mannitol can also cause a transient increase in blood pressure due to its osmotic effects. This can further strain the heart and worsen CHF symptoms.
Renal Impairment: CHF patients often have impaired renal function, which can reduce their ability to excrete mannitol effectively. This can lead to fluid retention and electrolyte imbalances, further complicating CHF management.
In summary, administering mannitol to a patient with CHF could potentially lead to:
Exacerbation of heart failure symptoms Pulmonary edema
Worsening renal function Electrolyte imbalances Increased risk of mortality
Therefore, it's crucial to avoid mannitol use in patients with CHF and to closely monitor fluid status and electrolytes in those who must receive it for other indications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Stevens-Johnson syndrome (SJS) is a rare, serious skin condition that is typically caused by an allergic reaction to medication. While amiodarone has been associated with a few cases of SJS, it is not considered a common long-term side effect.
Choice B rationale:
Ventricular tachycardia (VT) is a type of fast heart rhythm that originates in the ventricles of the heart. Amiodarone is actually used to treat VT, so it would be counterintuitive to list it as a long-term side effect.
Choice C rationale:
Pulmonary fibrosis is a condition characterized by scarring of the lung tissue. While amiodarone can cause pulmonary toxicity, which includes pulmonary fibrosis, this is a relatively rare side effect. Moreover, it's usually associated with high doses or
long-term use of the medication.
Choice D rationale:
QT prolongation is a condition in which the heart's electrical activity takes longer than normal to recharge between beats. This can lead to a potentially fatal arrhythmia called torsades de pointes. Amiodarone is known to prolong the QT interval, and this is considered one of its most significant long-term side effects. It's important to monitor patients on amiodarone for QT prolongation and to adjust the dose or discontinue the medication if necessary.
Correct Answer is C
Explanation
Rationale for Choice A:
Decreasing the morning insulin dose by half without consulting the provider could lead to hyperglycemia, which can be dangerous for patients with diabetes, especially those undergoing surgery.
It is important to individualize insulin doses based on the patient's blood glucose levels, insulin sensitivity, and other factors. The provider may need to assess the patient's blood glucose levels and adjust the insulin dose accordingly.
Rationale for Choice B:
It is not safe to assume that the provider would want the client to receive the usual insulin dose prior to surgery without confirming this with the provider.
Patients with diabetes who are NPO (nothing by mouth) are at risk for hypoglycemia, as they are not receiving their usual intake of carbohydrates.
It is important to adjust insulin doses to prevent hypoglycemia in these patients.
Rationale for Choice D:
Holding the morning dose of insulin until after a fasting glucose is done could lead to hyperglycemia, as the patient would not be receiving any insulin to cover their blood glucose levels.
It is important to administer insulin to patients with diabetes, even if they are NPO, to prevent hyperglycemia.
Rationale for Choice C:
This is the best action for the nurse to take because it ensures that the provider is aware of the situation and can provide appropriate orders for the patient's insulin management.
The provider may need to adjust the insulin dose, order a fasting glucose level, or provide other instructions for the patient's care.
It is important to communicate with the provider to ensure that the patient receives safe and appropriate care.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today