Nokea
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.
You may also like to solve these questions
The following scenario applies to the next 6 items
The clinic nurse is caring for a 38-year-old male
Item 1 of 6
Nurses' Notes
1456 - 38-year-old male reports to the clinic for an annual physical examination and to establish care. The client reports no acute concerns but does admit to gaining a few pounds over the past several months. The client reports having decreased physical activity. He reports his dietary habits have changed because of his job, where he relies on fast food for breakfast and lunch. On assessment, the client is alert and completely oriented to person, place, and situation. The skin is warm and dry—patches of darkening and thickening of the skin around the skin folds. Lung sounds are clear; S1/S2 heart tones are auscultated. Peripheral pulses palpable, 2+. Bowel sounds are active in all quadrants. He denies any dysuria and reports his sex drive has decreased over the past several months. He reports occasional constipation, which causes him to use stool softeners. He reported no medical or surgical history besides an appendectomy four years ago. His parents are living, his mother is being treated for ovarian cancer, and his father has hypothyroidism and had a myocardial infarction two years ago. He recently started taking daily over-the-counter aspirin because of his father's cardiovascular disease. He takes a multivitamin 'when he remembers.' He is separated from his wife and currently going through what he describes as a bitter divorce which has been 'stressing him out.' He has one child. He denies using tobacco products but drinks one to two glasses of wine weekly. Current weight 269 pounds (122.27 kilograms); Body Mass Index 29; 40 inches (102 cm) waist size. Oral temperature 98.6°F (37° C) Pulse 92 Respiratory Rate 17 Blood Pressure 141/92 mm Hg Pulse oximetry 96% on room air
Select the client findings that require follow-up. Select all that apply.
- A. respiratory rate
- B. blood pressure
- C. pulse
- D. waist size
- E. body mass index (BMI)
- F. dietary habits
- G. darkening patches in the skin folds
Correct Answer: B,D,E,F,G
Rationale: Blood pressure (141/92 mm Hg) indicates hypertension, waist size (40 inches) and BMI (29) suggest obesity, dietary habits (fast food reliance) contribute to cardiovascular risk, and darkening skin patches (acanthosis nigricans) may indicate insulin resistance, all requiring follow-up. Respiratory rate (17) and pulse (92) are within normal limits.
While reviewing a client's medication list, the nurse understands which prescribed medication(s) is/are classified as calcium channel blockers. Select all that apply.
- A. Nifedipine
- B. Propranolol
- C. Verapamil
- D. Hydralazine
- E. Digoxin
Correct Answer: A,C
Rationale: Nifedipine and verapamil are calcium channel blockers used to treat hypertension and angina. Propranolol is a beta-blocker, hydralazine is a vasodilator, and digoxin is a cardiac glycoside.
The nurse has taught a client who has been prescribed nitroglycerin transdermal. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. It is okay for me to apply this patch to the area that has been shaven.
- B. This patch should be removed for 4 to 6 hours to avoid me developing a tolerance.
- C. It is okay for me to wear this patch while I shower.
- D. I should apply this patch below my knee to lessen my chance of getting a headache.
Correct Answer: A
Rationale: Applying a nitroglycerin transdermal patch to a shaved area ensures good adhesion and absorption, indicating correct understanding. Nitroglycerin patches are typically removed for 10-12 hours to prevent tolerance, not 4-6 hours. While water-resistant, applying below the knee is not standard and does not reduce headache risk.
The nurse reviews newly prescribed laboratory tests and medications for the following clients. Which of the laboratory tests and prescriptions should the nurse question?
- A. Liver function tests (LFTs) for a client prescribed atorvastatin
- B. International normalized ratio (INR) for a client prescribed rivaroxaban
- C. Serum creatinine level for a client prescribed lisinopril
- D. Glycosylated hemoglobin (HgbA1C) level for a client prescribed olanzapine
Correct Answer: B
Rationale: INR monitoring is not typically required for rivaroxaban, a direct oral anticoagulant, as it does not affect INR. LFTs for atorvastatin, creatinine for lisinopril, and HgbA1C for olanzapine are appropriate monitoring tests.
The nurse is caring for a client who received a prescription for amlodipine for hypertension and was advised to lose weight. Which of the following statements by the client would require follow-up?
- A. I have enrolled myself at a gym and I am receiving dietary counseling from a nutritionist.
- B. I should drink grapefruit juice while taking the amlodipine.
- C. What is the best way for me to follow my treatment regimen with diet and exercise?
- D. Sometimes I feel dizzy after taking the amlodipine pills.
Correct Answer: B,D
Rationale: Grapefruit juice can increase amlodipine levels, leading to toxicity, and dizziness may indicate hypotension, both requiring follow-up. Gym enrollment and questions about regimen compliance are appropriate.