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The following scenario applies to the next 1 items.
The medical-surgical nurse is performing an admission assessment
Item 1 of 1
Current Medications
losartan 25 mg by mouth daily
spironolactone 25 mg by mouth daily
multivitamin 1 tablet by mouth daily
acetaminophen 500 mg by mouth daily, as needed for pain
pantoprazole 40 mg by mouth daily
warfarin 2 mg by mouth daily
aspirin 81 mg by mouth daily
The nurse performs medication reconciliation for this client. Which four (4) medications does the nurse recognize as a potential drug interaction?
- A. losartan
- B. spironolactone
- C. multivitamin
- D. acetaminophen
- E. pantoprazole
- F. warfarin
- G. aspirin
Correct Answer: A,B,F,G
Rationale: Losartan and spironolactone can increase hyperkalemia risk when combined. Warfarin and aspirin together increase bleeding risk due to their anticoagulant and antiplatelet effects, respectively. Multivitamin, acetaminophen, and pantoprazole are less likely to cause significant interactions in this context.
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The clinic nurse is caring for a 38-year-old male
Item 3 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.
The nurse completes and reviews the follow-up nurses' notes and the laboratory results.Complete the following sentence below from the list of options. Based on the clinical data, this client is at the highest risk of developing.............
- A. hypothyroidism
- B. metabolic syndrome
- C. renal insufficiency
- D. secondary hypertension
Correct Answer: B
Rationale: The client has elevated blood pressure (143/91 mm Hg), high fasting glucose (126 mg/dL), hyperlipidemia (high cholesterol, LDL, triglycerides, low HDL), and obesity (BMI 29, waist 41 inches), which are diagnostic criteria for metabolic syndrome.
The emergency department nurse is caring for a client with an abdominal aortic aneurysm at risk of rupturing. The nurse will anticipate the primary healthcare provider (PHCP) to prescribe
- A. esmolol
- B. dexamethasone
- C. heparin
- D. pantoprazole
Correct Answer: A
Rationale: Esmolol, a short-acting beta-blocker, is used to control blood pressure and reduce aortic wall stress in an abdominal aortic aneurysm. Dexamethasone, heparin, and pantoprazole are not indicated.
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 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 teaching a continuing education course regarding cardiovascular medications. It would be appropriate for the nurse to reinforce which condition is a contraindication to administering beta-blockers?
- A. Atrial fibrillation
- B. Myocardial infarction
- C. Congestive heart failure (CHF)
- D. Cardiogenic shock
Correct Answer: D
Rationale: Cardiogenic shock is a contraindication for beta-blockers due to their negative inotropic effects, which can worsen cardiac output. Beta-blockers may be used cautiously in atrial fibrillation, myocardial infarction, or CHF.