A nurse is monitoring a client who has a head injury and is receiving mannitol 25% via IV infusion. The nurse should identify which of the following as an adverse effect of the medication and report to the provider?

Glasgow coma scale rating of 15

Crackles on auscultation

Increase in urinary output

Intracranial pressure reading of 12mm

Answer and Explanation

The Correct Answer is B

A. Glasgow Coma Scale rating of 15: A Glasgow Coma Scale (GCS) rating of 15 is a positive sign indicating that the client is fully conscious and oriented. It is not an adverse effect of mannitol.
B. Crackles on auscultation: Crackles, also known as rales, can indicate fluid overload or pulmonary edema, which can be an adverse effect of mannitol. Mannitol can cause shifts of fluid, including into the lungs, leading to pulmonary edema.
C. Increase in urinary output: Mannitol is an osmotic diuretic, and an increase in urinary output is an expected and therapeutic effect of the medication. It is not considered an adverse effect.
D. Intracranial pressure reading of 12 mmHg: A decrease in intracranial pressure is a therapeutic effect of mannitol, and a reading of 12 mmHg is generally within a normal range. It is not considered an adverse effect.

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Correct Answer is D

Explanation

A. Urine specific gravity 1.020: While this value indicates concentrated urine and can be useful in assessing dehydration, it doesn’t specifically confirm effective treatment. High urine specific gravity suggests dehydration because the kidneys are conserving water, but it doesn’t directly confirm the effectiveness of treatment.
B. BUN 28 mg/dl (Blood Urea Nitrogen): Elevated BUN levels can be seen in dehydration, but it's not a direct marker of effective treatment. It indicates dehydration due to increased urea concentration in the blood but doesn’t confirm if the treatment has been effective or not.
C. Serum hematocrit 55%: In dehydration, the blood becomes more concentrated due to water loss, causing an increase in hematocrit levels. However, while this value might indicate dehydration initially, it may not specifically confirm the effectiveness of treatment once initiated.
D. Serum osmolarity 310 mOsm: Serum osmolarity measures the concentration of particles in the blood. In dehydration, the blood becomes more concentrated, leading to increased serum osmolarity. When treatment is effective, rehydration occurs, diluting the blood and bringing serum osmolarity back toward normal levels. Therefore, a decrease in serum osmolarity towards the normal range (280-300 mOsm) would indicate effective treatment of dehydration

A. INR B. Potassium level C. WBC count D. BUN

Correct Answer is C

Explanation

A. INR (International Normalized Ratio): INR is a measure of blood clotting and is not directly affected by filgrastim, which stimulates the production of white blood cells. Monitoring INR is more relevant when assessing anticoagulant therapy.
B. Potassium level: Filgrastim does not directly influence potassium levels. Monitoring potassium is important for certain medications and conditions, but it is not the primary parameter to evaluate the effectiveness of filgrastim.
C. WBC count: Filgrastim (granulocyte colony-stimulating factor) is used to stimulate the production of white blood cells, specifically neutrophils. Monitoring the white blood cell count is crucial in evaluating the effectiveness of filgrastim treatment. An increase in the WBC count, particularly the neutrophil count, indicates a positive response to the medication.
D. BUN (Blood Urea Nitrogen): BUN is a measure of kidney function and is not directly influenced by filgrastim. While monitoring kidney function is important in general patient care, it is not the primary parameter to assess the effectiveness of filgrastim.

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A nurse is monitoring a client who has a head injury and is receiving mannitol 25% via IV infusion. The nurse should identify which of the following as an adverse effect of the medication and report to the provider?

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Correct Answer is D

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