Nokea
The nurse is administering prescribed furosemide to a client. Which of the following clinical manifestations would be consistent with the client developing fluid volume deficit? Select all that apply.
- A. tachycardia
- B. bradypnea
- C. weight gain
- D. decreased urine output
- E. tenting of the skin
Correct Answer: A,D,E
Rationale: Furosemide, a loop diuretic, can cause fluid volume deficit, leading to tachycardia (increased heart rate to compensate for reduced volume), decreased urine output (due to dehydration), and tenting of the skin (a sign of dehydration). Bradypnea and weight gain are not typical signs of fluid volume deficit.
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The clinic nurse is caring for a 38-year-old male
Item 4 of 6
Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]
Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.
Physician Progress Notes
1355 - One-week follow-up appointment with a 38-year-old male. Labs show serious metabolic derangements, including high fasting blood glucose and hyperlipidemia. VS shows essential hypertension. Diagnosis - 1. essential hypertension 2. metabolic syndrome. Will perform additional diagnostics and follow up with the client in six weeks.
The nurse reviews the physician's progress notes and formulates a care plan. For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
- A. glycated hemoglobin (a1c) test
- B. antihypertensive medication
- C. consultation with occupational therapy
- D. consultation with dietician/nutritionist
- E. daily weights
- F. 12-lead electrocardiogram (ECG)
- G. serum cardiac enzymes
Correct Answer: A,B,D,F
Rationale: A1C test (to confirm diabetes risk given high glucose), antihypertensive medication (for hypertension), dietician consultation (for dietary changes), and ECG (to assess cardiac status) are indicated. Occupational therapy, daily weights, and cardiac enzymes are not necessary without specific indications.
The nurse in the emergency department (ED) is caring for a client with a myocardial infarction. The nurse anticipates a prescription for which medications? Select all that apply.
- A. labetalol
- B. morphine sulfate
- C. nitroglycerin
- D. enalapril
- E. isosorbide
- F. diltiazem
Correct Answer: B,C,E
Rationale: Morphine sulfate (for pain), nitroglycerin (for vasodilation), and isosorbide (for preload reduction) are used in myocardial infarction. Labetalol, enalapril, and diltiazem are not first-line treatments.
The nurse is preparing to administer prescribed bumetanide to a client. Which clinical finding would indicate a therapeutic outcome?
- A. Increase in central venous pressure (CVP)
- B. Reduced cardiac preload and wall tension
- C. Decreased glomerular filtration rate (GFR)
- D. Increase in systemic vascular resistance (SVR)
Correct Answer: B
Rationale: Bumetanide, a loop diuretic, reduces fluid volume, leading to decreased cardiac preload and wall tension, indicating a therapeutic outcome in conditions like heart failure. Increased CVP, decreased GFR, or increased SVR are not desired effects.
The nurse is caring for a client with the following clinical data. Which medication would the nurse clarify with the primary healthcare provider (PHCP) before administration based on the vital signs?
- A. Atenolol 50 mg PO Daily
- B. Simvastatin 40 mg PO Daily
- C. Albuterol 2.5 mg via nebulizer Daily
- D. Spironolactone 25 mg PO Daily
Correct Answer: A
Rationale: Atenolol, a beta-blocker, may need clarification if the client has bradycardia or hypotension, as it can exacerbate these conditions. Simvastatin, albuterol, and spironolactone are less affected by vital signs.
The nurse is teaching a client who has hypertension about the newly prescribed medication, diltiazem. Which of the following should the nurse include in the teaching?
- A. A nagging cough can occur as a side effect of the medication.
- B. This medication may cause you to go to the bathroom more often.
- C. Avoid taking the medication with grapefruit juice.
- D. You will need to increase your dietary intake of potassium-rich foods.
Correct Answer: C
Rationale: Diltiazem, a calcium channel blocker, interacts with grapefruit juice, which can increase drug levels. Cough, increased urination, and potassium intake are not associated with diltiazem.