A nurse is caring for a client who is receiving intravenous heparin therapy for deep vein thrombosis. The nurse evaluates for side effects of this drug by observing for:

Petechiae

Slowing pulse rate

Confusion

Pruritus

Answer and Explanation

The Correct Answer is A

Rationale:

A. Petechiae are small, pinpoint red or purple spots on the skin that may indicate bleeding or thrombocytopenia, which can be a side effect of heparin therapy.

B. Slowing pulse rate is not typically associated with heparin therapy.

C. Confusion is not typically associated with heparin therapy.

D. Pruritus (itching) is not typically associated with heparin therapy.

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Correct Answer is C

Explanation

Rationale:

A. Salt substitutes often contain potassium and should be avoided in clients with hyperkalemia.

B. Citrus juices and bananas are high in potassium and should be avoided in clients with hyperkalemia.

C. A 12-lead ECG may include changes such as peaked T wave, flattened P wave, prolonged PR interval, ST depression, and prolonged QRS duration.

D. A serum sodium level should be obtained but it is not the priority in this case.

A. Hyperkalemia B. Cardiac dysrhythmias C. Seizures D. Hypoglycemia

Correct Answer is B

Explanation

Rationale:

A. Hyperkalemia is not typically associated with thiazide diuretics.

B. Cardiac dysrhythmias can occur with thiazide diuretics due to electrolyte imbalances.

C. Seizures are not typically associated with thiazide diuretics.

D. Hypoglycemia is not typically associated with thiazide diuretics.

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A nurse is caring for a client who is receiving intravenous heparin therapy for deep vein thrombosis. The nurse evaluates for side effects of this drug by observing for:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is caring for a patient with a history of hypertension. The client reports compliance with the prescribed Thiazide medication but is complaining of generalized weakness and palpitations. The nurse should monitor the client for which potential complications of diuretics.

Correct Answer is B

Explanation

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