Nokea
The nurse is teaching a client who has hypertension about the newly prescribed medication, furosemide. Which of the following should the nurse include in the teaching?
- A. Limit intake of bananas, cantaloupe, and potatoes.
- B. Avoid taking the medication with grapefruit juice.
- C. Take this medication in the early part of the day.
- D. A nagging cough can occur as a side effect of the medication.
Correct Answer: A,C
Rationale: Furosemide, a loop diuretic, can cause hypokalemia, so limiting potassium-rich foods (bananas, cantaloupe, potatoes) is advised, and taking it early prevents nocturia. Grapefruit juice and cough are not concerns.
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The nurse is preparing an educational in-service about valsartan. Which of the following information should the nurse include?
- A. Valsartan blocks the conversion of angiotensin I to angiotensin II.
- B. Valsartan antagonizes angiotensin II receptors.
- C. Valsartan stimulates alpha-2 adrenoceptors in the brainstem.
- D. Valsartan blocks response to beta1- and beta2-adrenergic stimulation.
Correct Answer: B
Rationale: Valsartan, an ARB, antagonizes angiotensin II receptors, reducing blood pressure. It does not block angiotensin conversion, stimulate alpha-2 receptors, or block beta-adrenergic responses.
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 caring for a client experiencing polyarthritis associated with rheumatic fever. The nurse anticipates a prescription for which medication?
- A. Prazosin
- B. Naproxen
- C. Verapamil
- D. Furosemide
Correct Answer: B
Rationale: Naproxen, an NSAID, is used to reduce inflammation and pain in polyarthritis associated with rheumatic fever. Prazosin, verapamil, and furosemide are not indicated for this condition.
The nurse is caring for a client receiving a continuous infusion of heparin and warfarin. Based on the client's laboratory data, the nurse should take which action? See the image below.
- A. Document the findings
- B. Stop the heparin infusion
- C. Hold future doses of the warfarin
- D. Obtain a prescription of Vitamin K
Correct Answer: B
Rationale: Without specific lab data, stopping heparin is likely if INR is therapeutic (e.g., 2-3 for warfarin), as concurrent heparin and warfarin are typically transitioned. Documenting, holding warfarin, or giving Vitamin K depend on specific INR values.
The nurse is teaching a continuing education course regarding cardiovascular medications. It would be appropriate for the nurse to reinforce which condition is a contraindication to administering calcium channel blockers?
- A. Atrial fibrillation
- B. Hypertension
- C. Peripheral vascular disease
- D. Systolic heart failure
Correct Answer: D
Rationale: Calcium channel blockers, especially non-dihydropyridines, are contraindicated in systolic heart failure due to their negative inotropic effects. They may be used in atrial fibrillation, hypertension, or peripheral vascular disease.