Nokea
A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effect?
- A. pH.
- B. Phosphate.
- C. Potassium.
- D. Calcium.
Correct Answer: B
Rationale: Calcium acetate lowers phosphate levels in CKD by binding dietary phosphate. A decreased phosphate level indicates effectiveness. pH, potassium, and calcium are not primary targets.
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The nurse is planning discharge teaching for a client with type 2 diabetes mellitus who has a new prescription for insulin glargine. Which action should the nurse plan to include in the discharge teaching?
- A. Demonstrate how to select dose based on before meal blood sugar readings.
- B. Provide information on increasing medication dosage if ketoacidosis occurs.
- C. Teach the client self-injection skills for daily subcutaneous administration.
- D. Explain to the family how to inject this medication for severe hypoglycemia.
Correct Answer: C
Rationale: Insulin glargine requires daily subcutaneous administration, so teaching self-injection skills is essential. It’s not dosed based on meal readings, adjusted for ketoacidosis, or used for hypoglycemia.
History and physical
The client is a 75-year-old female who was admitted to the preop area to prepare for pacemaker insertion. She states that she needs this procedure because her heart rate has been very low, she feels tired all the time, and she has fainted once due to low heart rate. She has a history of worsening symptomatic bradycardia and atrial fibrillation controlled by medication. She has been off anticoagulants for four days to prepare for the procedure.
Nurses notes
0700
Laboratory specimens have been drawn and completed during a preadmission visit. After changing clothes and settling into bed, client was placed on continuous monitoring. Admission process completed.
0800
Peripheral IV (PIV) started in right antecubital with 20 gauge catheter. IV fluids of 0.9% sodium chloride started at 50 mL/hr. Cardiac surgeon in to see client and answers questions about the procedure.
0830
Client reports no known allergies. Vancomycin 1 gram in 250 ml 0.9% sodium chloride started at 125 mL/hr as endocarditis prophylaxis.
0840
Awaiting transfer to operating room (OR).
Vancomycin infusing at 125 mL/hr.
0845: The client says, "I don't feel well." Assessment reveals dizziness, headache, burning sensation on extremities, and red color on face and extremities. Blood pressure is 108/46 mmHg. Vancomycin infusion was stopped. The surgeon was notified.
0850: The client has flushing and redness over her entire body with hives developing. She complains of feeling hot and nauseous. Cool cloths were applied to her face and extremities. She is restless in bed. IVF of NS is running.
0900
Heart rate 90 beats/minute, blood pressure 110/60 mm Hg. Surgeon remains at bedside.
0915
Heart rate 60 beats/minute, blood pressure 120/70 mm Hg. Appears more relaxed - not thrashing about bed. Skin color remains red: reports itching
resulting in symptoms of skin color0945
Heart rate 52 beats/minute, blood pressure 128/72 mm Hg. To OR for pacemaker placement.
1100
Returned from OR. Heart rate 64 beats/minute, blood pressure 118/68 mm Hg, temperature 97.4° F(36.3° C) orally. Verbalizes not being able to stop shaking and pounding chest pain. Short of breath. Skin color is dark pink. Headache increasing and has nausea. Surgeon at bedside. Chest x-ray done. Echocardiogram performed..
Orders
0800
Start peripheral IV
Vancomycin 1 gram in 250 mL 0.9% sodium chloride
Flowsheet
0700
Vital Sign
• Temperature 97.6° F (36.4° C) orally
• Heart rate 44 beats/minute
• Respiratory rate 18 breaths/minute
• Blood pressure 136/50 mm Hg
The nurse is preparing the client's plan of care. Select 4 findings that would indicate to the nurse that the administration of the vancomycin antibiotic would be safe to administer.
- A. Dosage in safe range
- B. Peripheral IV in large vein
- C. No known allergies
- D. Used for prophylaxis
- E. Blood urea nitrogen 17 mg/dL (6.07 mmol/L)
- F. Potassium 4.4 mEq/L (4.4 mmol/L)
Correct Answer: A,B,C,E
Rationale: A: Safe dosage prevents toxicity. B: Large vein reduces phlebitis risk. C: No allergies avoids reactions. E: Normal BUN indicates renal function for vancomycin excretion. D and F are less directly related to safety.
The nurse is administering SUBQ enoxaparin to a client following knee replacement surgery to prevent a deep vein thrombosis. Which laboratory result requires immediate action by the nurse?
- A. Platelet count of 100,000/mm3 (100 x 10^9/L).
- B. Serum creatinine 1.0 mg/dL (88.4 μmol/L).
- C. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L).
- D. Hematocrit 45% (0.45 volume fraction).
Correct Answer: A
Rationale: A platelet count of 100,000/mm3 indicates thrombocytopenia, increasing bleeding risk with enoxaparin, requiring immediate action. Creatinine, BUN, and hematocrit are within normal ranges.
A client with a history of smoking cigarettes for many years arrives at the clinic and expresses a desire to stop smoking. The client receives a prescription for bupropion to reduce nicotine cravings. Which information should the nurse include in the discharge teaching?
- A. Administer each dose with at least 8 ounces of water.
- B. Consume tyramine-free foods while taking the medicine.
- C. Be aware that difficulty sleeping and weight loss may occur.
- D. Notify the healthcare provider if experiencing changes in taste.
Correct Answer: C
Rationale: Bupropion may cause insomnia and weight loss, which are important side effects for the client to understand. Water intake, tyramine-free diets, and taste changes are not primary concerns with bupropion.
A client with narcolepsy receives a new prescription for methylphenidate. Prior to administration of the medication, the nurse should review the medical record for which condition?
- A. Hypercholesterolemia.
- B. Bronchitis.
- C. Diabetes mellitus.
- D. Hypertension.
Correct Answer: D
Rationale: Methylphenidate, a stimulant, can exacerbate hypertension, requiring careful review of blood pressure history. Hypercholesterolemia, bronchitis, and diabetes are less critical concerns.