A nurse is planning to administer the first dose of iron dextran intermittent IV bolus for a client who has iron-deficiency anemia. Which of the following interventions should the nurse plan to take?
Give a 25-mg test dose of the medication.
Flush the IV site with 3 mL of heparin following infusion.
Instruct the client to remain supine for 10 min after administration.
Dilute the medication in sterile water for injection.
The Correct Answer is D
A) Drowsiness: While drowsiness can be a sign of elevated magnesium levels, it is less critical compared to more immediate symptoms like bradycardia. Monitoring and managing drowsiness is important, but bradycardia poses a more immediate risk of severe cardiovascular issues.
B) Diminished patellar reflexes: Diminished reflexes can indicate elevated magnesium levels, but this finding is less urgent compared to symptoms directly affecting heart function. It still needs to be reported but is not the highest priority.
C) Generalized muscle weakness: Muscle weakness is another common sign of high magnesium levels, reflecting the effect of magnesium on neuromuscular function. However, it is less critical compared to bradycardia, which can be life-threatening.
D) Bradycardia: Elevated magnesium levels can significantly impact cardiac function, leading to bradycardia. Bradycardia can be life-threatening, as it may result in decreased cardiac output and potential for severe complications. Therefore, this finding requires immediate attention and should be reported to the provider first.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Stroke:
Hyperlipidemia and type 2 diabetes mellitus both contribute significantly to the development of atherosclerosis, which can lead to stroke. High levels of lipids in the blood can cause plaque buildup in the arteries, and diabetes can damage blood vessels and increase the likelihood of clots forming.
B) Benign prostatic hyperplasia:
While benign prostatic hyperplasia is a common condition in older men, it is not directly related to hyperlipidemia or diabetes. It is more related to age and hormonal changes rather than metabolic or vascular conditions.
C) Meniere’s disease:
Meniere's disease is a disorder of the inner ear that leads to vertigo, tinnitus, and hearing loss. It is not associated with hyperlipidemia or diabetes. The primary risk factors are genetic predisposition and abnormalities in the ear's fluid dynamics.
D) Hemophilia:
Hemophilia is a genetic disorder that affects the blood's ability to clot. It is inherited and not influenced by lifestyle-related conditions such as hyperlipidemia or diabetes. The risk factors for hemophilia are primarily genetic, with no direct link to metabolic conditions.
Correct Answer is A
Explanation
A) Muscle twitching:
Muscle twitching, also known as tetany, is a common manifestation of hypocalcemia. Low calcium levels increase neuromuscular excitability, leading to symptoms such as muscle cramps, spasms, and twitching. This is a key clinical sign that helps in diagnosing hypocalcemia.
B) Bounding pulse:
A bounding pulse is not typically associated with hypocalcemia. Instead, it is more often seen in conditions such as fluid overload or hyperdynamic circulatory states, where there is increased cardiac output or vascular volume.
C) Hypertension:
Hypertension is not a common manifestation of hypocalcemia. Hypocalcemia is more likely to cause hypotension due to its effect on cardiac contractility and vascular tone, rather than causing high blood pressure.
D) Decreased bowel sounds:
Decreased bowel sounds are not commonly associated with hypocalcemia. Hypocalcemia affects neuromuscular function, but it typically causes increased gastrointestinal motility rather than decreased motility, which would lead to hyperactive bowel sounds rather than decreased ones.
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