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 D
Explanation
Choice A rationale:
Amiodarone is an antiarrhythmic medication that is often used to treat ventricular tachycardia and ventricular fibrillation. However, it is not the first-line drug for Torsades de Pointes. In fact, amiodarone can actually worsen QT prolongation and increase the risk of Torsades de Pointes.
It's important to note that amiodarone has a long half-life and can accumulate in the body over time, further increasing the risk of QT prolongation.
Additionally, amiodarone can have several serious side effects, including pulmonary toxicity, thyroid dysfunction, and liver damage.
Choice B rationale:
Lidocaine is another antiarrhythmic medication that is sometimes used to treat ventricular arrhythmias. However, it is also not the first-line drug for Torsades de Pointes.
Lidocaine is less likely to worsen QT prolongation than amiodarone, but it can still have this effect in some patients.
Additionally, lidocaine has a short half-life and must be given as a continuous infusion, which can be challenging in a critical care setting.
Choice C rationale:
Atropine is a medication that is used to increase heart rate. It is not effective in treating Torsades de Pointes and is not indicated in this situation.
Atropine works by blocking the vagus nerve, which slows heart rate. In Torsades de Pointes, the heart rate is already very fast, so atropine would not be helpful.
Additionally, atropine can have several side effects, including dry mouth, blurred vision, and urinary retention.
Choice D rationale:
Magnesium sulfate is the first-line drug for treating Torsades de Pointes. It works by stabilizing the electrical activity of the heart and preventing further episodes of arrhythmia.
Magnesium sulfate is a relatively safe medication with few side effects. It can be given as an intravenous infusion or as an intramuscular injection.
Studies have shown that magnesium sulfate is effective in terminating Torsades de Pointes and preventing recurrences.
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