Order: 200 mL normal saline bolus IV over 15 minutes

On hand: 500 mL normal saline bags

What rate will the nurse set the pump to deliver the fluid?

Choice A reason: This choice is incorrect because sulfa allergy is not a priority assessment for the nurse to make prior to giving nifedipine. Sulfa allergy is a hypersensitivity reaction to drugs that contain sulfonamide, such as antibiotics, diuretics, or antidiabetic agents. Sulfa allergy can cause symptoms such as rash, itching, fever, or anaphylaxis. Nifedipine does not contain sulfonamide and does not cross-react with sulfa drugs. The nurse should ask the client about any drug allergies and document them, but sulfa allergy is not relevant to nifedipine.

Choice B reason: This choice is incorrect because aPTT is not a priority assessment for the nurse to make prior to giving nifedipine. aPTT stands for activated partial thromboplastin time, which is a measure of how long it takes the blood to clot. It is used to monitor the effect of anticoagulant drugs, such as heparin, that prevent blood clots. Nifedipine does not affect the blood clotting time and does not interact with anticoagulant drugs. The nurse should check the aPTT only if the client is taking anticoagulant drugs and has signs of bleeding or clotting.

Choice C reason: This choice is incorrect because hemoglobin is not a priority assessment for the nurse to make prior to giving nifedipine. Hemoglobin is a protein in the red blood cells that carries oxygen to the tissues and organs of the body. Hemoglobin levels can be affected by conditions such as anemia, dehydration, or blood loss. Nifedipine does not affect the hemoglobin levels or the oxygen delivery. The nurse should monitor the hemoglobin levels and the signs of anemia, such as fatigue, pallor, or shortness of breath, but they are not related to nifedipine.

Choice D reason: This choice is correct because blood pressure is the priority assessment for the nurse to make prior to giving nifedipine. Nifedipine is a calcium channel blocker that lowers blood pressure and relaxes the blood vessels. It is used to treat conditions such as hypertension, angina, and Raynaud's phenomenon. However, nifedipine can cause side effects such as hypotension (low blood pressure), dizziness, headache, flushing, and edema (swelling). The nurse should check the client's blood pressure before giving nifedipine and withhold the dose if the blood pressure is too low. The nurse should also monitor the client's blood pressure and the signs of hypotension, such as fainting, weakness, or chest pain.

Choice A reason: Elimination is the process of removing a drug from the body, usually through the kidneys or the liver. Acute renal failure is a condition where the kidneys suddenly lose their ability to filter waste products and excess fluid from the blood. This can impair the elimination of drugs that are mainly excreted by the kidneys, leading to increased drug levels and potential toxicity. The nurse should monitor the patient's renal function and adjust the dose of drugs that are renally eliminated.

Choice B reason: Metabolism is the process of transforming a drug into one or more metabolites, usually by enzymes in the liver. Acute renal failure does not directly affect the metabolism of drugs, unless it causes liver damage or alters the blood flow to the liver. The nurse should monitor the patient's liver function and the levels of drugs that are metabolized by the liver.

Choice C reason: Distribution is the process of transferring a drug from the blood to the tissues and organs of the body. Acute renal failure can affect the distribution of drugs that are bound to plasma proteins, such as albumin. When the kidneys are damaged, they may leak protein into the urine, causing hypoalbuminemia (low levels of albumin in the blood). This can increase the amount of free or unbound drug in the blood, which may enhance the drug's effect or cause adverse reactions. The nurse should monitor the patient's serum albumin level and the effects of drugs that are highly protein bound.

Choice D reason: Absorption is the process of moving a drug from the site of administration to the bloodstream. Acute renal failure does not directly affect the absorption of drugs, unless it causes changes in the gastrointestinal tract, such as edema, bleeding, or motility disorders. The nurse should monitor the patient's gastrointestinal function and the bioavailability of drugs that are administered orally.