Nokea
The nurse has administered bumetanide to a client with pulmonary edema. Which of the following findings would indicate an adverse response to bumetanide?
- A. distended neck veins
- B. adventitious lung sounds
- C. leg cramps
- D. increase in urine output
Correct Answer: C
Rationale: Bumetanide, a loop diuretic, can cause hypokalemia, leading to leg cramps as an adverse response. Distended neck veins (A) and adventitious lung sounds (B) are signs of pulmonary edema, not adverse effects. Increased urine output (D) is an expected effect.
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The following scenario applies to the next 6 items.
The nurse in the emergency department (ED) is caring for a 57-year-old male client.
Item 1 of 6
History and Physical
A 57-year-old male client with stage three small cell lung cancer. The client had suddenly become disoriented and did not recognize his family members and relatives. He reports severe lower extremity weakness and has had three episodes of diarrhea in the past four hours. The client is undergoing 6 cycles of chemotherapy with cisplatin and etoposide. He is currently taking a 14-day course of 15 mg of prednisone. He is on his third day of steroid treatment. He has a medical history of dyslipidemia and advanced chronic obstructive pulmonary disease.
Nurses' Notes
0759: Client is completely disoriented and required maximum assistance to the stretcher because of unsteady gait. Lung sounds clear bilaterally. Alopecia noted. Skin is warm and dry and normal for ethnicity. Peripheral pulses 2+. No skin tenting. Hyperactive bowel sounds in all quadrants. 20-gauge peripheral vascular access device placed in the left antecubital space. T 97.8° F (36.6° C) P 88 RR 21 BP 123/68 Pulse oximetry reading 91% on room air.
Laboratory Results
• Hemoglobin 14 g/dL [14-18 g/dL (140–180 g/L)]
• Hematocrit 42% (0.42) [42-52% (0.42-0.52)]
• White Blood Cell 11,000 mm3 [5-10 mm3]
• Platelet Count 140,000 mm3 [150-400 mm3 (150–400 × 109/L)]
• Glucose 139 mg/dL (7.72 mmol/L) [70–110 mg/dL (4-6 mmol/L)]
• Sodium 116 mEq/L [136–145 mEq/L (mmol/L)]
• Potassium 3.3 mEq/L [3.5–5.0 mEq/L (mmol/L)]
• Creatinine 0.7 mg/dL (61.88 mmol/L) [0.6–1.2 mg/dL (53–106 mmol/L)]
• Blood Urea Nitrogen 8 mg/dL (2.86 mmol/L) [10–20 mg/dL (3.6–7.1 mmol/L)]
• Serum Osmolality 277 mOsm/kg [285-295 mOsm/kg (285–295 mmol/kg)]
Which of the following assessment findings require immediate follow-up? Select all that apply.
- A. mental status
- B. reports of diarrhea
- C. serum sodium
- D. serum potassium
- E. white blood cell count
- F. serum glucose
- G. alopecia
Correct Answer: A,C,D,F
Rationale: Mental status changes, severe hyponatremia (116 mEq/L), hypokalemia (3.3 mEq/L), and elevated glucose (139 mg/dL) require immediate attention due to potential neurological and cardiac risks.
Intravenous therapies often consist of electrolyte replacement therapies. Select the electrolyte that is accurately paired with one of its functions.
- A. Sodium: The control and management of circulating blood volume.
- B. Bicarbonate: The regulation of extracellular fluid.
- C. Chloride: The regulation of plasma protein.
- D. Calcium: The metabolism of fats, carbohydrates, and proteins.
Correct Answer: A
Rationale: Sodium regulates circulating blood volume by maintaining osmotic balance.
When assessing for dehydration, the nurse should observe for which of the following?
- A. Headache and increased urinary output
- B. Weight gain and edema
- C. Hypertension and decreased urinary output
- D. Hypotension, headache, and dry mucous membranes
Correct Answer: D
Rationale: Dehydration causes hypotension, headache, and dry mucous membranes due to fluid loss.
The nurse cares for a client with a potassium of 3.2 mEq/L (mmol/L) [3.5-5 mEq/L, mmol/L]. Which of the following medications may cause this abnormality?
- A. spironolactone
- B. triamterene
- C. prednisone
- D. lisinopril
Correct Answer: B
Rationale: Triamterene is a potassium-sparing diuretic that can cause hypokalemia by reducing potassium excretion. Spironolactone (A) also spares potassium but is less likely to cause hypokalemia. Prednisone (C) primarily affects glucose and sodium, not potassium. Lisinopril (D) may cause hyperkalemia, not hypokalemia.
The nurse performs a physical assessment on a client and observes the client demonstrate palmar flexion while obtaining the blood pressure. The nurse should take which action?
- A. Obtain the blood pressure on the client's calf
- B. Request an order for a magnesium level
- C. Assess the client's orthostatic blood pressure
- D. Obtain capillary blood glucose (CBG)
Correct Answer: B
Rationale: Palmar flexion (Trousseau's sign) suggests hypocalcemia or hypomagnesemia, warranting a magnesium level check.