Nokea
The nurse is preparing to administer prescribed medications to a client. After reviewing the client's vital signs below, the nurse plans on holding which prescribed medication? Click to view the exhibit for additional client information.
- A. Amlodipine 5 mg PO
- B. Diltiazem 60 mg PO
- C. Ibuprofen 500 mg PO
- D. Ciprofloxacin 500 mg PO
Correct Answer: A
Rationale: Without specific vital signs, amlodipine (a calcium channel blocker) may be held if the client has hypotension, as it lowers blood pressure. Diltiazem may also lower blood pressure but is less likely to be held unless bradycardia is present. Ibuprofen and ciprofloxacin are less dependent on vital signs.
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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 is counseling a client with congestive heart failure (CHF) about newly prescribed bumetanide. The nurse determines that the teaching has been effective when the client plans to
- A. increase their daily intake of protein.
- B. record their daily urinary output.
- C. weigh themselves daily.
- D. take their blood pressure and pulse daily.
Correct Answer: C
Rationale: Bumetanide, a loop diuretic, requires daily weight monitoring to assess fluid status in CHF. Protein intake, urinary output records, or vital signs monitoring are less critical.
The nurse has provided discharge instructions to a client who was prescribed niacin. Which of the following statements, if made by the client, would indicate effective teaching?
- A. This medication may increase my blood pressure.
- B. I may experience flushing while taking this medication.
- C. This medication may raise my total cholesterol.
- D. I may feel fatigued and tired after taking this medication.
Correct Answer: B
Rationale: Niacin commonly causes flushing, a harmless but notable side effect, indicating effective teaching. It does not increase blood pressure or cholesterol and is not typically associated with fatigue.
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 is preparing to administer medications to assigned clients. Which prescription should the nurse clarify with the primary healthcare provider (PHCP)?
- A. warfarin to a client with an international normalized ratio (INR) of 1.8 seconds [0.9-1.2]
- B. digoxin to a client with a serum potassium level of 3.1 mEq/L [3.5-5 mEq/L, mmol/L]
- C. enoxaparin to a client with a platelet count of 155,000 mm3 [150-400 mm3, 130-380 × 10^9/L]
- D. lisinopril to a client with a serum creatinine level of 0.6 mg/dL [0.6-1.2 mg/dL, 30-250 IU/L]
Correct Answer: B
Rationale: Digoxin with low potassium (3.1 mEq/L) increases toxicity risk, so it should be clarified. Warfarin with INR of 1.8 may be subtherapeutic but not immediately dangerous, enoxaparin is safe with normal platelets, and lisinopril is safe with normal creatinine.