Nokea
The nurse is reviewing prescriptions for assigned clients. Which prescriptions require follow-up with the primary healthcare provider? A client with
- A. congestive heart failure prescribed diltiazem.
- B. hypertension prescribed clonidine.
- C. diabetes insipidus prescribed hydrocortisone.
- D. pulmonary emboli prescribed clopidogrel.
- E. atrial fibrillation prescribed amiodarone.
- F. bacterial cystitis prescribed valacyclovir.
Correct Answer: C,F
Rationale: Hydrocortisone is not used for diabetes insipidus (desmopressin is typical), and valacyclovir (an antiviral) is incorrect for bacterial cystitis (requires antibiotics). Diltiazem, clonidine, clopidogrel, and amiodarone are appropriate for their respective conditions.
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This nurse is caring for a client who is receiving prescribed hydralazine. Which of the following findings would indicate a therapeutic response?
- A. Blood pressure 120/70 mm Hg
- B. Pulse (P) 67/minute
- C. Total cholesterol 185 mg/dL [200 mg/dL]
- D. aPTT 45 seconds [30-40 seconds]
Correct Answer: A
Rationale: Hydralazine, a vasodilator, lowers blood pressure, so 120/70 mm Hg indicates a therapeutic response. Pulse, cholesterol, and aPTT are not directly affected.
A nurse is caring for a client receiving nitroglycerin. It is essential to monitor the client's
- A. heart tones.
- B. respirations.
- C. urinary output.
- D. blood pressure.
Correct Answer: D
Rationale: Nitroglycerin, a vasodilator, can cause hypotension, so monitoring blood pressure is essential. Heart tones, respirations, and urinary output are less critical.
The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a client with septic shock
Item 1 of 1
Nurses' Notes
1400: Follow-up assessment after the infusion of 30 mL/kg of 0.9% saline bolus (1850 mL total) was infused. Vital signs: T 103.4° F (39.7° C), P 104, RR 22, BP 90/61, pulse oximetry reading 95% on room air.
1410: The physician was notified of the vital signs, and a verbal order for a dopamine drip was received for 5 mcg/kg/minute to titrate to a MAP of 65 mm Hg. The order was read back and verified.
1415: Dopamine infusion started in the client's right antecubital peripheral vascular access device.
1445: The client reports 'stinging' pain at the vascular access site. The site had erythema, swelling, and tenderness when touched. The infusion was stopped.
The nurse reviewed all nursing note entries and notified the physician of the vascular access device assessment findings. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress
- A. Obtain a prescription for phentolamine, Flush the vascular access device, Aspirate any residual medication, Restart the infusion at a lower rate.
- B. Extravasation, Hematoma, Infiltration, Phlebitis.
- C. Urinary output, Neurovascular status of affected extremity, Drainage at vascular access site, Pain level.
Correct Answer: B, A, C
Rationale: The client is experiencing extravasation (B) due to dopamine causing stinging, erythema, and swelling. Actions include obtaining phentolamine (A, an antidote for vasopressor extravasation) and aspirating residual medication (A). Monitor neurovascular status (C) and pain level (C) to assess progress.
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.
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.