Nokea
The nurse would need to monitor the serum glucose levels of a client receiving which of the following medications, owing to its effects on glycogenolysis and insulin release?
- A. Norepinephrine (Levophed)
- B. Dobutamine (Dobutrex)
- C. Propranolol (Inderal)
- D. Epinephrine (Adrenalin)
Correct Answer: D
Rationale: Norepinephrine's side effects are primarily related to safe, effective care environment and include decreased peripheral perfusion and bradycardia. Dobutamine's side effects include increased heart rate and blood pressure, ventricular ectopy, nausea, and headache. Propranolol's side effects include elevated blood urea nitrogen, serum transaminase, alkaline phosphatase, and lactic dehydrogenase. Epinephrine increases serum glucose levels by increasing glycogenolysis and inhibiting insulin release. Prolonged use can elevate serum lactate levels, leading to metabolic acidosis, increased urinary catecholamines, false elevation of blood urea nitrogen, and decreased coagulation time.
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A client with COPD is in respiratory failure. Which of the following results would be the most sensitive indicator that the client requires a mechanical ventilator?
- A. PCO2 58
- B. SaO2 90
- C. PH 7.23
- D. HCO3 30
Correct Answer: C
Rationale: A pH of 7.23 indicates severe respiratory acidosis, suggesting inadequate ventilation and the need for mechanical ventilation. PCO2 58 (A) and HCO3 30 (D) are elevated but less critical, and SaO2 90 (B) is low but not definitive.
The nurse is caring for a client with a history of myasthenia gravis. The nurse should assess the client for:
- A. Muscle weakness
- B. Joint stiffness
- C. Skin lesions
- D. Chest pain
Correct Answer: A
Rationale: Myasthenia gravis causes autoimmune destruction of acetylcholine receptors, leading to muscle weakness, especially in the eyes, face, and limbs, a key assessment finding.
MgSO4 is ordered IV following the established protocol for a client with severe PIH. The anticipated effects of this therapy are anticonvulsant and:
- A. Vasoconstrictive
- B. Vasodilative
- C. Hypertensive
- D. Antiemetic
Correct Answer: B
Rationale: An anticonvulsant effect is the goal of drug therapy for PIH. However, we would not want to increase the vasoconstriction that is already present. This would make the symptoms more severe. An anticonvulsant effect and vasodilation are the desired outcomes when administering this drug. An anticonvulsant effect is the goal of drug therapy for PIH; however, hypertensive drugs would increase the blood pressure even more. An anticonvulsant effect is the goal of drug therapy for PIH. MgSO4 is not classified as an antiemetic. Antiemetics are not indicated for PIH treatment.
During morning assessments, the nurse finds that a client's nephrostomy tube has been clamped. The nurse's first action should be to:
- A. Assess the drainage bag.
- B. Check for bladder distention.
- C. Unclamp the tubing.
- D. Irrigate the tubing.
Correct Answer: C
Rationale: Unclamping the nephrostomy tube is the priority to restore urine flow and prevent complications like hydronephrosis or infection.
The physician has ordered DDAVP (desmopressin acetate) for a client with diabetes insipidus. Which finding indicates that the medication is having its intended effect?
- A. The client's appetite has improved.
- B. The client's morning blood sugar was 120 mg/dL.
- C. The client's urinary output has decreased.
- D. The client's activity level has increased.
Correct Answer: C
Rationale: DDAVP reduces excessive urination in diabetes insipidus by mimicking antidiuretic hormone, decreasing urinary output. Appetite, blood sugar, and activity are not directly affected.