An elderly client with chronic kidney disease is admitted with urosepsis.
Based on the admitting diagnosis and laboratory results, which
prescriptions would the nurse question? Select all that apply. Click on
the exhibit button for additional information.
- Continue home dose of valsartan
-Chronic kidney disease impairs the excretion of excess potassium
and can potentiate hyperkalemia, which can lead to life-threatening
arrhythmias (eg, ventricular fibrillation). ACE inhibitors (eg,
lisinopril, ramipril) or angiotensin II receptor blockers (eg,
valsartan, losartan, irbesartan) can be used to manage hypertension
secondary to renal disease; however, these drugs can worsen
hyperkalemia - Obtain CT scan of abdomen with contrast
- Clients with chronic kidney disease and elevated creatinine are
unable to excrete the iodinated contrast administered for CT scans.
Toxic effects from the contrast can occur; therefore, this
prescription should be clarified before the scan.
Urosepsis is a type of bloodstream infection that originates from the
urinary tract. The initial treatment of sepsis focuses on the management
or prevention of septic shock, mainly by administering boluses of
isotonic IV fluids (fluid resuscitation) and IV broad-spectrum antibiotics
(Option 1). Blood and urine cultures are obtained, ideally before the first
dose of antibiotics (Option 4). Continuous vital sign and cardiac
telemetry monitoring are initiated as hyperkalemia (high potassium of
6.5) and sepsis cause cardiovascular disturbances (eg, dysrhythmias and
hypotension, respectively)
While the nurse and unlicensed assistive personnel are turning an
intubated and heavily sedated client during a bath, the client coughs and
expels the endotracheal tube. What is the priority nursing action?
- Deliver rescue breathing with a bag-valve-mask attached to 100%
oxygen
If a client is accidentally extubated, the nurse should remain with
the client, protect the airway using the head-tilt chin-lift or the jawthrust maneuver if spinal injury is suspected, and deliver breaths
using a bag-valve-mask with 100% oxygen until reintubation is
achieved (Option 2).
Code blue should only be initiated if cardiac arrest occurs
A client is at 28 weeks gestation with suspected preeclampsia. Which of
the following signs/symptoms indicate that the client has developed this
syndrome? Select all that apply. - Epigastric pain
- Headaches and blurry vision
- Proteinuria
Preeclampsia is a multisystem disorder that can occur during
pregnancy and is defined as new-onset hypertension and proteinuria
or signs of end-organ damage. Cerebral symptoms (eg, headache,
visual changes) from severe hypertension and/or epigastric pain
secondary to decreased liver perfusion and hepatic damage can
occur. Pregnancy causes an intravascular volume expansion larger
than the rise in the number of red blood cells, resulting in
hemodilution.
The nurse is performing a medication reconciliation during a clinic visit
with a client recently prescribed lithium. Which of the client’s home
medications is the priority to clarify with the health care provider? - Hydrochlorothiazide
Lithium is a mood stabilizer most often used to treat bipolar
affective disorders. Lithium has a very narrow therapeutic index
(0.8-1.2 mEq/L [0.8-1.2 mmol/L]) that should be closely monitored;
it also has the potential for many drug interactions. Several
medications can cause increased lithium levels, including thiazide
diuretics (eg, hydrochlorothiazide), nonsteroidal anti-inflammatory
drugs, and antidepressants. Thiazide diuretics have demonstrated
the greatest potential to increase lithium concentrations, with a
possible 25%-40% increase in concentrations (Option 2). The nurse
should assess the client for signs and symptoms of lithium toxicity
and report the findings to the health care provider.
Four pediatric clients are brought to the emergency department at the
same time. Which client should be seen first? - Child with bruising behind the ears after a football injury
Bruising behind the ear (eg, Battle sign) following head trauma may
indicate a basilar skull fracture (Option 3). Because of their close
proximity to the brainstem, basilar skull fractures pose a risk of
serious intracranial injury, which is the most common cause of
traumatic death in children. Other signs include blood behind the
tympanic membrane, periorbital hematomas (ie, raccoon eyes), and
cerebrospinal fluid leakage from the nose or ears. This client
requires cervical spine immobilization, close neurologic monitoring,
and support of airway, breathing, and circulation
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