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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A rationale:

Erythromycin ointment does not have moisturizing properties. Its primary purpose is to prevent bacterial infection, not to provide moisture to the eyes.

While some ointments may have a slight moisturizing effect, this is not the main reason for using erythromycin ointment in newborns.

If moisture is the primary concern, other products specifically designed to lubricate the eyes would be more appropriate.

Choice B rationale:

Chemical conjunctivitis is typically caused by exposure to irritants such as chlorine in swimming pools or strong chemicals. Erythromycin ointment is not effective in preventing chemical conjunctivitis.

In fact, it could potentially worsen the irritation if used in cases of chemical conjunctivitis.

If chemical conjunctivitis is suspected, flushing the eyes with water or saline solution and seeking medical attention would be the appropriate course of action.

Choice D rationale:

Erythromycin ointment is an antibiotic, but it is not typically used to treat active infections in newborns.

If a newborn has a suspected eye infection, a healthcare provider would likely prescribe a different antibiotic eye drop or ointment that is more effective in treating the specific infection.

However, erythromycin ointment can be used as a prophylactic measure to prevent eye infections, which is why it is commonly administered to newborns shortly after birth.

Choice C rationale:

Erythromycin ointment is primarily used to prevent eye infections in newborns.

It is effective against a variety of bacteria that can cause conjunctivitis, including Neisseria gonorrhoeae (the bacteria that causes gonorrhea) and Chlamydia trachomatis (the bacteria that causes chlamydia).

These bacteria can be passed from the mother to the baby during childbirth, and if left untreated, they can cause serious eye infections that can lead to vision loss.

By applying erythromycin ointment to the newborn's eyes shortly after birth, the risk of these infections can be significantly reduced.

A. Request that if testing is further delayed, the patient will eat lunch first. B. Plan to discontinue the evening dose of insulin. C. Save the lunch tray for the patient’s later return. D. Send a glass of orange juice to the patient in the diagnostic testing area.

Correct Answer is A

Explanation

Choice A rationale:

Requesting that the patient eat lunch first if testing is further delayed is the most appropriate action to prevent hypoglycemia for the following reasons:

1. Timing of NPH Insulin Peak:

NPH insulin is an intermediate-acting insulin with a peak action time of 4-12 hours after administration.

In this case, the patient received NPH insulin at 7:00 AM, meaning its peak effect is likely to occur between 11:00 AM and 5:00 PM.

Delaying lunch beyond 1:00 PM significantly increases the risk of hypoglycemia as the insulin's action peaks without adequate food intake to balance glucose levels.

2. Ensuring Consistent Mealtimes:

Consistency in meal timing is crucial for managing blood glucose levels in diabetic patients. Delaying meals can disrupt the balance between insulin and glucose, leading to hypoglycemia.

Prioritizing lunch at the usual time, even amidst testing delays, helps maintain a more predictable glucose pattern.

3. Addressing Acute Hypoglycemia Risk:

Hypoglycemia is a serious complication of diabetes that can occur if blood glucose levels fall too low. Symptoms can include shakiness, sweating, dizziness, confusion, and even loss of consciousness.

Promptly addressing potential delays in food intake is essential to prevent hypoglycemia and its associated risks.

Rationales for other choices:

Choice B: Discontinuing the evening dose of insulin does not address the immediate risk of hypoglycemia due to the missed lunch. It could lead to hyperglycemia later in the day or overnight.

Choice C: Saving the lunch tray for later may not be feasible if testing is significantly delayed. It also does not prevent hypoglycemia in the immediate timeframe.

Choice D: While a glass of orange juice can provide a quick source of glucose, it is a short-term solution and does not replace a balanced meal. It could also lead to a rapid rise in blood glucose followed by a subsequent drop.

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Which patient would be a concern for the nurse when administering mannitol (Osmitrol)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is instilling erythromycin ointment to the lower lid of the newborn’s eyes. Why is this medication being given to the newborn?

Correct Answer is C

Explanation

A patient with diabetes has been administered 38 units of NPH insulin at 7:00 AM. By 1:00 PM, the patient has been away from the nursing unit for 2 hours and missed lunch while waiting for a chest X-ray. What is the most appropriate action for the nurse to prevent hypoglycemia?

Correct Answer is A

Explanation

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