A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following severe reactions to this medication?
Ototoxicity
Hypokalemia
Tachycardia
Postural hypotension
The Correct Answer is D
Choice A reason: Ototoxicity is not a severe reaction to propranolol, but it may occur with some other medications, such as aminoglycosides, loop diuretics, or salicylates. Ototoxicity may damage the inner ear or the auditory nerve and cause hearing loss, tinnitus, or vertigo. The nurse should assess the client's medication history and monitor the client's hearing function.
Choice B reason: Hypokalemia is not a severe reaction to propranolol, but it may occur with some other medications, such as thiazide diuretics, corticosteroids, or insulin. Hypokalemia may cause muscle weakness, cramps, arrhythmias, or cardiac arrest. The nurse should advise the client to eat foods rich in potassium, such as bananas, oranges, or potatoes, and to have regular blood tests to check the electrolyte levels.
Choice C reason: Tachycardia is not a severe reaction to propranolol, but it may be a sign of overdose, withdrawal, or rebound effect. Propranolol is a beta-blocker that lowers the heart rate and blood pressure by blocking the effects of epinephrine and norepinephrine. Propranolol may cause bradycardia, not tachycardia, as a side effect. The nurse should monitor the client's vital signs and advise the client to take the medication as prescribed and not to stop it abruptly.
Choice D reason: Postural hypotension is a severe reaction to propranolol, as it may cause dizziness, fainting, or falls. Postural hypotension occurs when the blood pressure drops significantly when the client changes position, such as from lying to sitting or standing. Propranolol may cause postural hypotension by reducing the vascular tone and the cardiac output. The nurse should instruct the client to change position slowly and to report any symptoms of postural hypotension to the provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: The nurse collects a urine specimen is an appropriate action, as it can help detect the presence of hemoglobinuria, which is a sign of hemolysis. Hemoglobinuria is the excretion of hemoglobin in the urine, which can cause the urine to appear red or brown.
Choice B reason: The nurse sends a blood specimen to the laboratory is an appropriate action, as it can help confirm the diagnosis of a hemolytic reaction and identify the cause. The laboratory can perform tests such as blood typing, cross-matching, direct antiglobulin test (DAT), and serum bilirubin.
Choice C reason: The nurse initiates an infusion of 0.9% sodium chloride is an appropriate action, as it can help maintain the client's fluid and electrolyte balance and prevent hypovolemic shock. 0.9% sodium chloride is the preferred solution for blood transfusion reactions, as it is isotonic and compatible with blood products.
Choice D reason: The nurse starts the transfusion of another unit of blood product is an inappropriate action, as it can worsen the client's condition and increase the risk of complications. The nurse should not resume the transfusion until the cause of the reaction is determined and the provider orders a new unit of blood product. The nurse should also return the unused blood product and tubing to the blood bank for analysis.
Correct Answer is A
Explanation
The Correct answer is A.
Choice A reason: Evaluating the client for nausea, vomiting, and anorexia is important because these are common signs of digoxin toxicity. Digoxin is a cardiac glycoside used to treat heart failure and certain arrhythmias, but it has a narrow therapeutic window. Toxicity can occur due to various factors, including renal insufficiency or drug interactions. Monitoring gastrointestinal symptoms like nausea, vomiting, and loss of appetite can help detect toxicity early.
Choice B reason: Withholding digoxin if the heart rate is above 100/min is not typically recommended. Digoxin has a negative chronotropic effect, meaning it can decrease heart rate. However, the decision to withhold medication usually depends on a heart rate that is too low (bradycardia), not high. The normal range for resting heart rate in adults is 60-100 beats per minute. Therefore, withholding digoxin for a heart rate above 100/min without other clinical justifications would not be appropriate.
Choice C reason: Measuring the apical pulse rate for 30 seconds before administration is not the standard practice. The apical pulse should be measured for a full minute to ensure accuracy, especially in clients with heart failure who are receiving digoxin. This is because digoxin can cause arrhythmias, and a shorter measurement period may not provide a true representation of the heart's rhythm.
Choice D reason: Instructing the client to eat foods that are low in potassium is incorrect. Clients taking digoxin should maintain a normal potassium level, as hypokalemia can increase the risk of digoxin toxicity. The normal serum potassium level is 3.5-5.0 mEq/L. Foods high in potassium can help maintain this balance and should not be avoided unless there is a specific clinical indication, such as hyperkalemia.
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