A nurse is preparing to administer a client's antihypertensive medication. When using clinical judgment, which of the following findings indicates the nurse should collect further data from the client before administering medication?
The client reports having trouble sleeping the previous night.
The client reports dizziness when ambulating to the bathroom.
The client has a urine output of 400 mL for the past 8 hr
The client ate 60% of their breakfast.
The Correct Answer is B
A. Trouble sleeping the previous night may not be directly related to the decision to withhold antihypertensive medication.
B. Dizziness when ambulating could indicate hypotension, which can be exacerbated by antihypertensive medication. The nurse should collect further data to ensure the patient's blood pressure is safe for medication administration.
C. Urine output is important to monitor but does not directly indicate a need to withhold antihypertensive medication unless associated with other symptoms.
D. Eating 60% of breakfast does not indicate a need to collect further data before administering antihypertensive medication.
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Related Questions
Correct Answer is D
Explanation
A. "DNR" stands for "Do Not Resuscitate" and is unrelated to medication timing.
B. "Tx" stands for "treatment" and does not indicate medication timing.
C. "NG" stands for "nasogastric" and is related to the route of administration.
D. "Ac" stands for "ante cibum," which means before meals, and is used to indicate medication timing relative to meals.
Correct Answer is B
Explanation
A. The therapeutic effect of Benadryl is to relieve allergy symptoms, not cause drowsiness.
B. Drowsiness is a common side effect of Benadryl, as it is an antihistamine that can cause sedation.
C. Toxic effects refer to harmful effects due to excessive dosing, not typical side effects at therapeutic doses.
D. An allergic reaction would involve symptoms such as rash, itching, or swelling, not drowsiness.
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