A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?
Laboratory testing of serum potassium upon admission
Bumetanide 1 mg IV bolus every 12 hr
0.9% normal saline IV at 50 mL/hr continuous
Morphine sulfate 2 mg IV bolus every 2 hr PRN pain
The Correct Answer is C
Choice A Reason: This choice is incorrect because laboratory testing of serum potassium upon admission is an appropriate prescription for a client who has acute heart failure following MI. Serum potassium is an electrolyte that affects the cardiac function and rhythm. A normal serum potassium range is 3.5 to 5 mEq/L, and an abnormal level can indicate hypokalemia or hyperkalemia, which can cause arrhythmias, muscle weakness, or paralysis. Therefore, monitoring serum potassium is important to detect and correct any electrolyte imbalance and prevent complications.
Choice B Reason: This choice is incorrect because bumetanide 1 mg IV bolus every 12 hr is an appropriate prescription for a client who has acute heart failure following MI. Bumetanide is a loop diuretic that helps to reduce fluid retention and edema by increasing the urine output and sodium excretion. It may be used for clients who have heart failure, hypertension, or renal impairment, but it can cause hypokalemia, hypotension, or dehydration.
Therefore, administering bumetanide as prescribed can help to improve the cardiac output and reduce the preload and afterload.
Choice C Reason: This choice is correct because 0.9% normal saline IV at 50 mL/hr continuous is an inappropriate prescription for a client who has acute heart failure following MI. 0.9% normal saline is an isotonic solution that contains the same concentration of solutes as blood plasma. It may be used for clients who have fluid loss, dehydration, or shock, but it can worsen fluid overload and pulmonary edema in clients who have acute heart failure. Therefore, clarifying this prescription with the provider is necessary to prevent further deterioration of the client's condition.
Choice D Reason: This choice is incorrect because morphine sulfate 2 mg IV bolus every 2 hr PRN pain is an appropriate prescription for a client who has acute heart failure following MI. Morphine sulfate is an opioid analgesic that helps to relieve pain and anxiety by binding to the opioid receptors in the brain and spinal cord. It may be used for clients who have moderate to severe pain, dyspnea, or chest discomfort, but it can cause respiratory depression, hypotension, or nausea. Therefore, administering morphine sulfate as prescribed can help to reduce the oxygen demand and improve the cardiac function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason: According to the rule of nines, each arm accounts for 9 percent of the TBSA, and each leg accounts for 18 percent of the TBSA. Therefore, if the client has burns on both sides of both arms and legs, the total percentage would be (9 + 9 + 18 + 18) = 54 percent. However, this choice is incorrect because it does not account for the fact that the rule of nines applies only to adults, not children. For children, the percentages are different because their body proportions are different from adults.
Choice B Reason: This choice is correct because it uses the modified rule of nines for children. According to this rule, each arm accounts for 9 percent of the TBSA, and each leg accounts for 13.5 percent of the TBSA. Therefore, if the client has burns on both sides of both arms and legs, the total percentage would be (9 + 9 + 13.5 + 13.5) = 45 percent. However, this is not the final answer because it does not account for the fact that the rule of nines applies only to partial-thickness burns, not full-thickness burns. For full-thickness burns, the percentages are halved because they do not contribute to fluid loss as much as partial-thickness burns. Therefore, if the client has full-thickness burns on both sides of both arms and legs, the final percentage would be (4.5 + 4.5 + 6.75 + 6.75) = 22.5 percent. However, this is still not the final answer because it does not account for the fact that the rule of nines applies only to first- and second-degree burns, not third-degree burns. For third-degree burns, the percentages are doubled because they require more intensive care and treatment than first- and second-degree burns. Therefore, if the client has third- degree burns on both sides of both arms and legs, the final percentage would be (9 + 9 + 13.5 + 13.5) = 45 percent.
Choice C Reason: This choice is incorrect because it uses the original rule of nines for adults, not children. It also does not account for the depth and degree of the burns.
Choice D Reason: This choice is incorrect because it uses a random percentage that does not correspond to any rule or calculation.
Correct Answer is A
Explanation
Choice A Reason: This is correct because an osmotic diuretic, such as mannitol, works by creating an osmotic gradient that draws fluid from the brain tissue into the blood vessels, thereby reducing cerebral edema and intracranial pressure.
Choice B Reason: This is incorrect because an osmotic diuretic would decrease, not increase, the cell size in the brain by removing fluid from the intracellular space.
Choice C Reason: This is incorrect because an osmotic diuretic would decrease, not expand, the extracellular fluid volume by increasing the urine output and excreting excess fluid from the body.
Choice D Reason: This is incorrect because an osmotic diuretic would not provide fluid hydration, but rather cause fluid loss and dehydration.
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