Which patient’s condition would raise concerns regarding the administration of labetalol (Normodyne)?
A patient diagnosed with COPD.
A patient suffering from narrow-angle glaucoma.
A patient with hypertension.
A patient exhibiting tachycardia.
The Correct Answer is B
Choice A rationale:
COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung disease that causes airflow obstruction. While labetalol can cause some bronchoconstriction, it is generally considered safe for use in patients with COPD. However, it's essential to monitor respiratory status closely, especially in those with severe COPD.
Choice B rationale:
Narrow-angle glaucoma is an eye condition characterized by increased intraocular pressure (IOP) due to impaired drainage of aqueous humor. Labetalol can exacerbate this condition by further increasing IOP through its beta-blocking effects. This can lead to acute angle-closure glaucoma, a medical emergency that can result in permanent vision loss.
Specific mechanisms by which labetalol can increase IOP:
Reduced aqueous humor production: Beta-blockers like labetalol can decrease the production of aqueous humor, the fluid that maintains eye pressure. While this might seem beneficial, a significant reduction can lead to anterior chamber shallowing, which can mechanically block the drainage angle and trigger angle closure.
Impaired uveoscleral outflow: Beta-blockers can also impair the uveoscleral outflow pathway, an alternative route for aqueous humor drainage that becomes more important in glaucoma patients. This can further contribute to IOP elevation.
Vasoconstriction of ciliary blood vessels: Labetalol's alpha-blocking effects can cause vasoconstriction of the ciliary blood vessels, which supply blood to the ciliary body responsible for aqueous humor production. This can reduce blood flow and indirectly hinder aqueous humor drainage.
Pupillary dilation: Beta-blockers can cause pupillary dilation, which can mechanically narrow the anterior chamber angle and obstruct aqueous humor outflow.
Therefore, labetalol is generally contraindicated in patients with known narrow-angle glaucoma.
Choice C rationale:
Hypertension (high blood pressure) is one of the primary indications for labetalol. It is an effective antihypertensive medication that works by blocking beta receptors, leading to decreased heart rate, contractility, and blood pressure.
Choice D rationale:
Tachycardia (fast heart rate) can also be treated with labetalol due to its beta-blocking effects. It helps to slow down the heart rate and restore a normal rhythm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
Choice A rationale:
Insulin glargine (Lantus) is a long-acting insulin analog that is designed to provide a steady, basal level of insulin throughout the day.
It has a duration of action of approximately 24 hours, so it is typically administered once daily at bedtime.
This helps to control blood glucose levels overnight and during the early morning hours, when the risk of hypoglycemia is highest.
Key characteristics of Insulin Glargine (Lantus):
Onset: 1-2 hours
Peak: No pronounced peak Duration: Approximately 24 hours
Administration: Once daily at bedtime
Choice B rationale:
Lispro (Humalog) is a rapid-acting insulin analog that is designed to be taken with meals to help control blood glucose spikes after eating.
It has a onset of action of approximately 15 minutes and a duration of action of 2-4 hours.
Because of its rapid onset and short duration of action, lispro is not typically used as a basal insulin. Key characteristics of Lispro (Humalog):
Onset: 15 minutes
Peak: 30-90 minutes
Duration: 2-4 hours
Administration: With meals
Choice C rationale:
Insulin detemir (Levemir) is another long-acting insulin analog that is similar to insulin glargine in terms of its duration of action.
It is typically administered once daily at bedtime to provide basal insulin coverage. Key characteristics of Insulin Detemir (Levemir):
Onset: 1-2 hours
Peak: No pronounced peak
Duration: Approximately 18-24 hours Administration: Once daily at bedtime Question 23.
The nurse receives an order for insulin: NPH (Humulin NPH) 10 units to be administered intravenously daily at 7:00am.
What action should the nurse take?
A. Administer the dose but ensure that if mixed with another Humulin-R insulin, to draw the regular insulin up first.
B. Give the drug subcutaneously rather than IV
C. Review the insulin order with the prescriber and pharmacy.
D. Administer the insulin ordered mixed in 50 ML of 0.9%NS IV Piggyback (not to infuse faster than 1/2 hour or 30 minutes).
The correct answer is C. Review the insulin order with the prescriber and pharmacy.
Rationale for Choice A:
Intravenous administration of NPH insulin is not recommended. It is an intermediate-acting insulin that is designed to be absorbed slowly from the subcutaneous tissue. IV administration can lead to rapid and unpredictable changes in blood glucose levels, which can be dangerous.
Mixing NPH insulin with regular insulin does not change the route of administration. Both insulins should still be given subcutaneously.
Rationale for Choice B:
Subcutaneous administration of NPH insulin is the correct route. This allows for slow and steady absorption of the insulin, which helps to prevent blood glucose fluctuations.
However, the nurse should still clarify the order with the prescriber and pharmacy. This is because IV insulin orders are unusual and may be a mistake.
Rationale for Choice D:
Adding NPH insulin to a 50 mL IV piggyback is not a safe practice. This would dilute the insulin and make it even more difficult to control the rate of infusion.
IV insulin infusions are typically administered using a dedicated insulin pump. This allows for precise control of the infusion rate and helps to prevent hypoglycemia.
Rationale for Choice C:
Reviewing the insulin order with the prescriber and pharmacy is the safest course of action. This will help to ensure that the order is correct and that the insulin is administered safely.
The prescriber may have meant to order regular insulin instead of NPH insulin. Regular insulin can be given intravenously, but it requires careful monitoring of blood glucose levels.
The pharmacy can also double-check the order and ensure that the correct insulin is dispensed.
Correct Answer is D
Explanation
Choice A rationale:
Adenosine is a medication used to treat supraventricular tachycardia (SVT), a type of rapid heart rhythm that originates in the upper chambers of the heart. It works by slowing the conduction of electrical impulses through the heart's AV node.
In this patient, the heart rate is already slow (42 beats per minute), so adenosine would not be appropriate. It could further slow the heart rate and potentially cause a dangerous drop in blood pressure.
Choice B rationale:
Amiodarone is a medication used to treat a variety of heart rhythm problems, including ventricular tachycardia (VT) and ventricular fibrillation (VF). It works by slowing the conduction of electrical impulses through the heart muscle.
Amiodarone is not typically used as a first-line treatment for bradycardia (slow heart rate). It is usually reserved for more serious or life-threatening arrhythmias.
Choice C rationale:
Magnesium sulfate is a medication used to treat a variety of conditions, including preeclampsia, eclampsia, and torsades de pointes. It can also be used to treat certain types of arrhythmias.
Magnesium sulfate is not typically used as a first-line treatment for bradycardia. It may be used in some cases of bradycardia caused by electrolyte imbalances or certain medications.
Choice D rationale:
Atropine sulfate is a medication that blocks the action of acetylcholine, a neurotransmitter that slows the heart rate. It is the first-line treatment for symptomatic bradycardia.
Atropine works by increasing the heart rate and improving conduction through the AV node. It is a rapid-acting medication that can be given intravenously, intramuscularly, or subcutaneously.
In this patient, atropine sulfate would be the most appropriate medication to increase the heart rate and improve blood pressure.
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