Nokea
The client is receiving fludrocortisone for treatment of adrenocortical insufficiency. The nurse is evaluating the client's serum laboratory values for adverse effects of the medication. Place an X in the column indicated for the laboratory values that the nurse should specifically review to evaluate the adverse effects of fludrocortisone. Select all that apply.
- A. Glucose
- B. TSH
- C. Potassium
- D. Platelets
- E. FreeT4
- F. Calcium
Correct Answer: A,C,D,F
Rationale: Adverse effects of fludrocortisone (Florinef) include hyperglycemia, hypokalemia, hypocalcemia, and thrombocytopenia. The nurse should review serum glucose, potassium, calcium, and platelet counts. Thyroid hormones of TSH and free T4, although abnormal, are unaffected by fludrocortisone administration.
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The nurse completes teaching with the client who will be taking daily doses of disulfiram following treatment for alcoholism. Which client statement indicates correct understanding of the safe use of disulfiram?
- A. If I take disulfiram and then drink alcohol, I will become intoxicated much more quickly.
- B. I should take disulfiram in the morning so that I will be more alert throughout the day.
- C. If I do drink any alcohol, I should skip the daily dose of disulfiram to avoid becoming ill.
- D. I should avoid extracts and cough preparations containing alcohol while taking disulfiram.
Correct Answer: D
Rationale: The client should avoid alcohol-containing substances (e.g., cough preparations, extracts) to prevent severe adverse reactions with disulfiram (Antabuse).
Jane Love, a 35-year old gravida III para II at 23 weeks gestation, is seen in the Emergency Department with painless, bright red vaginal bleeding. Jane reports that she has been feeling tired and has noticed ankle swelling in the evening. Laboratory tests reveal a hemoglobin level of 11.5 g/dL. After evaluating the situation, the nurse determines that Jane is at risk for placenta previa, based on which of the following data?
- A. anemia
- B. edema
- C. painless vaginal bleeding
- D. fatigue
Correct Answer: C
Rationale: Painless, bright red vaginal bleeding in the second or third trimester is a hallmark of placenta previa, where the placenta covers the cervical os, causing bleeding as the uterus grows.
The nurse is observing a client self-administer two medications that are in a crushable pill form through their G tube. Which of the following would indicate a need for further instruction?
- A. The client flushes the G-tube before administering the medications, in between the two medications, and after the medications.
- B. The client states they will remain in the Semi-Fowler's position for 30 minutes following administration of the medications.
- C. The client mixes their medications with their tube-feeding formula.
- D. The client mixes each medication separately in warm water.
Correct Answer: C
Rationale: Medication should not be mixed with tube-feeding formula or other medications. The G-tube should be flushed before, between, and after the medications, and the client should remain in the Semi-Fowler's position for at least 30 minutes after medications are administered.
High uric acid levels can develop in clients who are receiving chemotherapy. This can be caused by:
- A. the inability of the kidneys to excrete the drug metabolites
- B. rapid cell catabolism
- C. toxic effects of the prophylactic antibiotics that are given concurrently
- D. the altered blood pH from the acid medium of the drugs
Correct Answer: B
Rationale: Chemotherapy causes rapid cell destruction, releasing uric acid as a metabolite, which can elevate levels and risk conditions like gout or kidney stones.
The nurse is reviewing the chart illustrated of the client diagnosed with stage III HF. Which conclusion should the nurse make?
- A. The medications should be administered as prescribed.
- B. The client may be experiencing toxicity from digoxin.
- C. Hyperkalemia likely caused the client's cardiac dysrhythmias.
- D. Seeing halos can result from the atrial fibrillation or anticoagulants.
Correct Answer: B
Rationale: A: The digoxin should be withheld and not given until a serum digoxin level is determined. B: Signs of digoxin (Lanoxin) toxicity include seeing yellow halos around objects and dysrhythmias. The furosemide (Lasix) diuretic increases urinary excretion of potassium and can cause hypokalemia. Hypokalemia can contribute to both cardiac dysrhythmias and digoxin toxicity. C: A serum potassium level of 2.9 mEq/L indicates hypokalemia, not hyperkalemia. D: The yellow vision is a characteristic sign of digoxin toxicity and is not a sign of cerebral damage from an infarct due to atrial fibrillation or bleeding from the anticoagulants.