Based on the patient’s status at 1600, what should the Practical Nurse (PN) prepare to do immediately? Select all that apply.
Attach the patient to a continuous cardiac monitor.
Place an indwelling urinary catheter.
Administer a fluid bolus.
Draw a basic metabolic panel (BMP).
Take the patient’s temperature.
Prepare for cardioversion.
Administer an extra dose of furosemide.
Correct Answer : A,C,E,G
Attaching the patient to a continuous cardiac monitor is crucial in this situation. It allows for real-time monitoring of the patient’s heart rate and rhythm, providing valuable information about the patient’s cardiovascular status.
Choice C rationale
Administering a fluid bolus can be beneficial in certain situations. It can help increase the patient’s blood volume, which can improve blood pressure and organ perfusion. This is particularly important if the patient is showing signs of hypovolemia or shock.
Choice F rationale
Preparing for cardioversion is another important step. Cardioversion is a medical procedure that restores a normal heart rhythm in people with certain types of abnormal heartbeats (arrhythmias). It’s usually done by sending electric shocks to your heart through electrodes placed on your chest.
Choice G rationale
Administering an extra dose of furosemide can be helpful. Furosemide is a type of medicine called a diuretic. It’s used to treat high blood pressure, heart failure and oedema (a build up of fluid in the body). It’s also sometimes used to help you pee when your kidneys aren’t working properly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Pyridoxine with a B complex multivitamin is not typically associated with ototoxicity (ringing
in the ears)7.
Choice B rationale
Rifampin is an antitubercular medication, but it is not commonly associated with ototoxicity.
Choice C rationale
Gentamicin is an antibiotic that is known to potentially cause ototoxicity, including ringing in
the ears. Therefore, if a patient who has been receiving gentamicin reports ringing in the ears,
this should be reported to the healthcare provider.
Choice D rationale
Isoniazid is an antitubercular medication, but it is not commonly associated with ototoxicity.
Correct Answer is C
Explanation
Choice A rationale
Heart rate is an important vital sign to monitor in patients, but it is not the primary outcome
data to prioritize when administering a 20% mannitol intravenous (IV) solution. Mannitol is a diuretic that works by increasing the amount of urine produced. Therefore, while heart rate can be affected by fluid balance changes, it is not the most directly relevant outcome to monitor in this context.
Choice B rationale
Ankle circumference could be an indicator of peripheral edema, which might suggest fluid
overload or poor kidney function. However, in the context of mannitol administration, which is a diuretic and would be expected to decrease fluid overload, ankle circumference is not the primary outcome to monitor.
Choice C rationale
Urinary output is the correct answer. Mannitol is an osmotic diuretic that increases urine
production. It is used to reduce intracranial and intraocular pressure by drawing water out of tissues and into the bloodstream, from where it can be excreted by the kidneys. Therefore, urinary output is the most direct measure of its effectiveness and is the key outcome that should be monitored.
Choice D rationale
Dietary intake is always important to monitor in patients, especially those receiving IV
therapy, as it can impact electrolyte balance and overall health status. However, it is not the primary outcome to monitor when administering mannitol.
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