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 A
Explanation
Choice A reason: Giving the medication in the morning daily is a correct instruction, as it helps to prevent asthma attacks throughout the day and night. Montelukast is a leukotriene receptor antagonist that blocks the inflammatory response and bronchoconstriction caused by leukotrienes. Montelukast has a long duration of action and can be given once a day, preferably in the evening or at bedtime. However, for children who have exercise-induced asthma, the medication can be given in the morning to prevent exercise-induced bronchospasm.
Choice B reason: Administering the granules mixed with 20 oz of water is not a correct instruction, as it may reduce the absorption and effectiveness of the medication. Montelukast granules should be administered within 15 minutes of opening the packet and can be mixed with a small amount of soft food, such as applesauce, mashed carrots, or ice cream. The granules should not be mixed with liquids, such as water, juice, or milk, as they may dissolve and lose their potency.
Choice C reason: Giving the medication at the onset of wheezing is not a correct instruction, as it may not provide immediate relief of the symptoms and may delay the use of a rescue inhaler. Montelukast is not a bronchodilator and does not work quickly to open the airways. Montelukast is a preventive medication that should be taken regularly to reduce the frequency and severity of asthma attacks. The child should use a short-acting beta-agonist, such as albuterol, for the quick relief of wheezing.
Choice D reason: Administering the medication 2 hr before exercise is not a correct instruction, as it may not prevent exercise-induced bronchospasm and may interfere with the daily dosing schedule. Montelukast should be taken once a day, preferably in the evening or at bedtime, to provide consistent protection against asthma triggers. However, for children who have exercise-induced asthma, the medication can be given in the morning to prevent exercise-induced bronchospasm. The child should also use a short-acting beta-agonist before exercise, as needed.
Correct Answer is B
Explanation
Choice A reason: This is incorrect because dextrose 5% in 0.45% sodium chloride is a hypotonic solution that can cause hemolysis of the RBCs. It can also cause fluid shifts from the intravascular to the intracellular space, leading to edema and hypotension.
Choice B reason: This is correct because 0.9% sodium chloride is a isotonic solution that is compatible with blood products. It does not cause hemolysis or fluid shifts and maintains the osmotic pressure of the blood.
Choice C reason: This is incorrect because lactated Ringer's solution is a isotonic solution that contains electrolytes, such as potassium, calcium, and lactate, that can interfere with the blood products. It can also cause metabolic alkalosis due to the conversion of lactate to bicarbonate.
Choice D reason: This is incorrect because dextrose 5% in water is a hypotonic solution that can cause hemolysis of the RBCs. It can also cause fluid shifts from the intravascular to the intracellular space, leading to edema and hypotension.
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