For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

Choice A rationale:

Uncontrolled diabetes mellitus: Corticosteroids can have a hyperglycemic effect, meaning they can raise blood sugar levels. This makes them generally unsuitable for use in patients with uncontrolled diabetes mellitus. In fact, corticosteroids might even worsen glycemic control in these patients. While corticosteroids might be used in some cases of diabetes mellitus, such as to treat diabetic retinopathy or nephropathy, they would be used cautiously and with close monitoring of blood sugar levels.

Choice B rationale:

A recent diagnosis of lung cancer: Corticosteroids are not a primary treatment for lung cancer. They might be used in some cases to help manage symptoms or side effects of other treatments, such as chemotherapy or radiation therapy. However, they would not typically be used as a first-line treatment for lung cancer itself.

Choice C rationale:

Acute exacerbation of COPD: Corticosteroids are a mainstay of treatment for acute exacerbations of COPD. They work by reducing inflammation in the airways, which helps to improve airflow and relieve symptoms such as wheezing, shortness of breath, and chest tightness. Corticosteroids can be given orally, intravenously, or by inhalation. The dose and duration of treatment will depend on the severity of the exacerbation.

Choice D rationale:

Chronic asthma: Corticosteroids are often used as a long-term control medication for chronic asthma. However, they are typically used at lower doses than those used for acute exacerbations of COPD. Inhaled corticosteroids are the preferred form of treatment for chronic asthma, as they deliver the medication directly to the airways and have fewer systemic side effects.

Choice A rationale:

Adenosine is a medication used to treat supraventricular tachycardia (SVT), a type of rapid heart rhythm that originates in the upper chambers of the heart. It works by slowing the conduction of electrical impulses through the heart's AV node.

In this patient, the heart rate is already slow (42 beats per minute), so adenosine would not be appropriate. It could further slow the heart rate and potentially cause a dangerous drop in blood pressure.

Choice B rationale:

Amiodarone is a medication used to treat a variety of heart rhythm problems, including ventricular tachycardia (VT) and ventricular fibrillation (VF). It works by slowing the conduction of electrical impulses through the heart muscle.

Amiodarone is not typically used as a first-line treatment for bradycardia (slow heart rate). It is usually reserved for more serious or life-threatening arrhythmias.

Choice C rationale:

Magnesium sulfate is a medication used to treat a variety of conditions, including preeclampsia, eclampsia, and torsades de pointes. It can also be used to treat certain types of arrhythmias.

Magnesium sulfate is not typically used as a first-line treatment for bradycardia. It may be used in some cases of bradycardia caused by electrolyte imbalances or certain medications.

Choice D rationale:

Atropine sulfate is a medication that blocks the action of acetylcholine, a neurotransmitter that slows the heart rate. It is the first-line treatment for symptomatic bradycardia.

Atropine works by increasing the heart rate and improving conduction through the AV node. It is a rapid-acting medication that can be given intravenously, intramuscularly, or subcutaneously.

In this patient, atropine sulfate would be the most appropriate medication to increase the heart rate and improve blood pressure.