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The client taking glyburide 5 mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client's fingerstick blood sugar result is 56 mg/dL. Which question is most important for the nurse to ask the client?
- A. How many grams of protein do you normally eat?
- B. What time did you eat your dinner last night?
- C. How often do you check your blood sugar level?
- D. What was your alcohol intake like this past week?
Correct Answer: D
Rationale: A: Carbohydrate intake, not protein, is more important to consider in diabetic clients in relation to blood sugar levels. B: Glyburide once daily dose is taken with breakfast, so asking the client about dinner is not consistent with drug administration. C: Asking the client frequency of checking blood sugar levels will not help determine the possible causes of the client's symptoms. D: Alcohol use while taking sulfonylureas such as glyburide (DiaBeta, Micronase) can cause a disulfiram-like reaction, manifested by abdominal cramps, nausea, headache, flushing, and hypoglycemia.
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The client is taking metolazone and diltiazem for treatment of hypertension. Which statement made by the client to the nurse indicates further teaching is needed?
- A. I eat foods high in potassium to prevent the development of hypokalemia.
- B. Metolazone makes me urinate more, so I take my last dose at suppertime.
- C. I took my medication at breakfast with eggs, toast, grapefruit juice, and milk.
- D. Ibuprofen affects my urine output, so I prefer to take acetaminophen for pain.
Correct Answer: C
Rationale: A: Consuming foods daily that are high in potassium is recommended. Thiazide diuretics such as metolazone (Zaroxolyn) can result in hypokalemia. B: The diuretic metolazone (Zaroxolyn) should not be taken at bedtime to avoid nocturia and the subsequent loss of sleep. C: The client should not consume grapefruit juice because it inhibits the metabolism of diltiazem (Cardizem) and can cause toxicity. This client statement indicates the need for further teaching. D: NSAIDs such as ibuprofen (Advil, Motrin) can decrease the diuretic and antihypertensive effects of thiazide diuretics.
The nurse is administering Phenobarbital 300 mg IV to the child weighing 18 kg who is in status epilepticus. Which actions should the nurse take to safely administer the medication? Select all that apply.
- A. Administer the phenobarbital over 20 minutes.
- B. Monitor the IV site for signs of extravasation.
- C. Dilute the phenobarbital dose in 10 mL D5W.
- D. Administer the phenobarbital via IV piggyback.
- E. Identify incompatible medications or solutions being infused.
- F. Inject the phenobarbital over 10 minutes in the port closest to the child.
Correct Answer: B,E,F
Rationale: A: This dose of phenobarbital should be administered as an IV-push medication over 10 minutes; administering it over 20 minutes will delay the medication's effects to treat status epilepticus. B: Whenever IV medications are being administered by any route, the site should be evaluated for irritation and extravasation. An extravasation of phenobarbital (Luminal) may cause necrotic tissue changes that necessitate skin grafting. C: Phenobarbital, if diluted, should be mixed with sterile water for injection and not D5W. D: Phenobarbital should be prepared for direct IV administration and not as an IV piggyback because this would delay the child's receiving the medication to terminate the seizure. E: When administering IV medications, identification of medications or solutions that would be incompatible with that medication must occur so that the tubing can be flushed to ensure that crystallization does not occur in the IV tubing. F: Phenobarbital should be administered no faster than 1 mg/kg/min, with a maximum of 30 mg over 1 minute in infants and children.
A client with stress incontinence should be advised:
- A. to purchase absorbent undergarments.
- B. that Kegel exercises might help.
- C. that effective surgical treatments are nonexistent.
- D. that behavioral therapy is ineffective.
Correct Answer: B
Rationale: Kegel exercises, tightening and releasing the pelvic floor muscles, might improve stress incontinence. Choice A is not an appropriate treatment for stress incontinence. Several effective surgical treatments exist. Lifestyle and dietary modifications can also be helpful.
The 3-year-old with LTB is receiving aerosolized racemic epinephrine. Which assessment finding should the nurse recognize as indicating that the treatment is having an adverse effect?
- A. Heart rate of 180 beats/min
- B. Blood pressure of 60/40 mm Hg
- C. Respiratory rate of 25 breaths/min
- D. Pulse oximetry of 90% on room air
Correct Answer: A
Rationale: A: Tachycardia is an adverse effect of racemic epinephrine (AsthmaNefrin). B: Hypertension, not hypotension, is an adverse effect of racemic epinephrine; a BP of 60/40 mm Hg in a 3-year-old indicates hypotension. C: A respiratory rate of 25 breaths/min is normal for a 3-year-old. D: A pulse oximetry reading of 90% is concerning and may indicate the need for supplemental oxygen, but it is not an adverse effect from the medication.
The client has been successful at controlling gastroesophageal reflux symptoms without prescription medications. Which OTC medication should the nurse explore whether the client is taking for symptom control?
- A. Aspirin once a day
- B. Famotidine
- C. Ibuprofen
- D. Desloratadine
Correct Answer: B
Rationale: A: Aspirin increases gastric acid secretion and may worsen symptoms. B: The nurse should explore whether the client is taking famotidine (Pepcid) for symptom control. Famotidine blocks histamine-2 receptors on parietal cells, thus decreasing gastric acid production. C: NSAIDs, such as ibuprofen (Motrin), do not reduce gastric acid. D: Desloratadine (Clarinex) blocks only histamine-1 receptors and is not effective against histamine-2 receptors.