Nokea
A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect?
- A. Drowsiness
- B. Nystagmus
- C. Dry mouth
- D. Convulsions
Correct Answer: D
Rationale: Lidocaine is a local anesthetic that can have systemic effects if levels become toxic. Continuous infusion of lidocaine can lead to lidocaine toxicity, which can manifest as adverse effects including convulsions, altered mental status, confusion, seizures, and cardiac arrhythmias. Monitoring for signs of lidocaine toxicity, such as convulsions, is crucial when a patient is receiving continuous lidocaine infusion. It is important for the nurse to closely monitor the patient's neurological status and vital signs to promptly recognize and manage any adverse effects.
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Which of the following diuretics inhibits sodium reabsorption in the kidneys while saving K+ and Hydrogen ions?
- A. Spironolactone
- B. Furosemide
- C. Hydrochlorothiazide
- D. Bumetanide
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic, which means it inhibits sodium reabsorption in the kidneys, while saving potassium and hydrogen ions. It accomplishes this by acting as an aldosterone antagonist, blocking the action of aldosterone. Aldosterone is a hormone that normally promotes sodium reabsorption in the kidneys and leads to potassium and hydrogen ion excretion. By inhibiting aldosterone, spironolactone promotes sodium excretion while conserving potassium and hydrogen ions.
Barbiturates are contraindicated in a dental patient with: II. emphysema III. Undiagnosed severe pain III. hypertension IV. Acute intermittent porphyria
- A. I, III & IV
- B. I & IV only
- C. II & III only
- D. II only
Correct Answer: A
Rationale: Barbiturates are central nervous system depressants that can exacerbate conditions such as emphysema, hypertension, and acute intermittent porphyria.
What should you monitor when given a patient Clopidogrel?
- A. Signs of thrombotic thrombolytic purpura
- B. Bleeding during therapy
- C. CBC with differential and platelet count
- D. All the above
Correct Answer: D
Rationale: When monitoring a patient on Clopidogrel therapy, it is important to monitor for signs of thrombotic thrombolytic purpura (TTP), bleeding during therapy, and changes in blood counts. Clopidogrel is an antiplatelet medication that works by preventing platelets from sticking together and forming clots. Monitoring for signs of TTP is necessary as clopidogrel has been associated with an increased risk of TTP in some patients. Additionally, monitoring for bleeding is crucial as clopidogrel, like other antiplatelet medications, can increase the risk of bleeding complications. Monitoring a complete blood count (CBC) with differential and platelet count allows healthcare providers to assess the patient's blood cell levels and ensure that the medication is not causing any adverse effects on blood counts. Therefore, monitoring all of the above parameters is essential to ensure the safety and efficacy of clopidogrel therapy.
The nurse is caring for a young patient with a closed head injury who has an intracranial pressure of 35 (normal <20) and serum osmolality of 330 mOsm/kg. The nurse would anticipate which action?
- A. Administration of mannitol
- B. Withholding mannitol at this time, but taking other measures to reduce intracranial pressure
- C. Administration of sodium nitroprusside
- D. Taking no action at this time because the patient has a serum osmolality of 330, which will offset the effects of the elevated intracranial pressure
Correct Answer: B
Rationale: Mannitol is an osmotic diuretic used to reduce intracranial pressure (ICP) by drawing fluid out of the brain tissue. However, it should be used cautiously in patients with elevated serum osmolality, as it can exacerbate hyperosmolality and lead to renal failure or other complications. In this case, the patient's serum osmolality is already high (330 mOsm/kg), so mannitol should be withheld, and other measures to reduce ICP, such as elevating the head of the bed, maintaining proper oxygenation, and avoiding hypercapnia, should be prioritized. Sodium nitroprusside (C) is used for hypertension, not ICP, and taking no action (D) is inappropriate given the elevated ICP.
A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:
- A. Parasite infection.
- B. Viral infection.
- C. Bacterial infection.
- D. Spirochete infection.
Correct Answer: B
Rationale: Topical corticosteroids can exacerbate viral infections, such as herpes simplex, by suppressing the immune response. They are contraindicated in the presence of viral infections to prevent worsening of the condition. Bacterial, parasitic, and spirochete infections are not absolute contraindications, although caution is advised.