Patient Data.

Exhibits

Review H and P, nurses notes, laboratory results, flow sheet, and orders.

Click to mark whether the assessment finding represents a therapeutic result of the sodium bicarbonate administered, a non-therapeutic side-effect, or an unrelated finding. Each row must have one option selected.

Capillary refill 2 seconds

Blood pressure 113/72 mm Hg

Bicarbonate 22 mEq/L (22 mmol/L)

Sodium 152 mEq/L (152 mmol/L)

400 mL urine output

Heart rate 77 beats/minute

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"C"},"F":{"answers":"A"}}

Choice A: Capillary refill 2 seconds

Reason: Capillary refill time is a quick test to assess peripheral perfusion and hydration status. A normal capillary refill time is less than 2 seconds. Initially, the patient had a capillary refill time of 5 seconds, indicating poor perfusion, likely due to dehydration from vomiting and diarrhea. After the administration of IV fluids and sodium bicarbonate, the capillary refill time improved to 2 seconds, which is within the normal range. This improvement indicates that the treatment was effective in restoring adequate perfusion and hydration, making it a therapeutic result.

Choice B: Blood pressure 113/72 mm Hg

Reason: Normal blood pressure for adults is typically around 120/80 mm Hg. The patient’s initial blood pressure was 100/77 mm Hg, which is on the lower side, likely due to dehydration. After receiving IV fluids and sodium bicarbonate, the blood pressure improved to 113/72 mm Hg, which is closer to the normal range. This indicates that the treatment helped to stabilize the patient’s blood pressure, making it a therapeutic result.

Choice C: Bicarbonate 22 mEq/L (22 mmol/L)

Reason: The normal range for bicarbonate (HCO3) is 21 to 28 mEq/L. The patient’s initial bicarbonate level was 15 mEq/L, indicating metabolic acidosis, likely due to severe vomiting and diarrhea. After the administration of sodium bicarbonate, the bicarbonate level increased to 22 mEq/L, which is within the normal range. This indicates that the sodium bicarbonate effectively corrected the metabolic acidosis, making it a therapeutic result.

Choice D: Sodium 152 mEq/L (152 mmol/L)

Reason: The normal range for sodium is 135 to 145 mEq/L. The patient’s sodium level of 152 mEq/L is above the normal range, indicating hypernatremia. This could be a non-therapeutic side effect of the sodium bicarbonate administration, as sodium bicarbonate can increase sodium levels in the blood. Hypernatremia can lead to symptoms such as confusion, muscle twitching, and seizures, and requires careful monitoring and management.

Choice E: 400 mL urine output

Reason: The patient’s urine output of 400 mL is not directly related to the administration of sodium bicarbonate. Urine output is influenced by various factors, including fluid intake, kidney function, and overall hydration status. In this case, the urine output is more likely related to the patient’s overall fluid balance and hydration status rather than a direct effect of the sodium bicarbonate. Therefore, it is considered an unrelated finding.

Choice F: Heart rate 77 beats/minute

Reason: A normal resting heart rate for adults ranges from 60 to 100 beats per minute. The patient’s initial heart rate was 102 beats per minute, which is elevated, likely due to dehydration and metabolic acidosis. After receiving IV fluids and sodium bicarbonate, the heart rate decreased to 77 beats per minute, which is within the normal range. This indicates that the treatment helped to stabilize the patient’s heart rate, making it a therapeutic result.

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Correct Answer is C

Explanation

Choice A Reason:

Reports of increased energy levels and decreased fatigue are subjective indicators of improvement in anemia symptoms. While these reports are important and suggest that the client is feeling better, they do not provide objective evidence of the effectiveness of epoetin alfa. Hemoglobin levels are a more precise measure of the medication’s impact on anemia.

Choice B Reason:

A food diary showing increased consumption of iron-rich foods indicates that the client is making dietary changes to support their anemia treatment. However, this does not directly measure the effectiveness of epoetin alfa. The medication’s primary goal is to stimulate red blood cell production, which is best assessed through hemoglobin levels.

Choice C Reason:

An increase in hemoglobin level to 12 g/dL (7.45 mmol/L) is an objective indicator that epoetin alfa is effective. Hemoglobin levels are a direct measure of the red blood cell count and oxygen-carrying capacity of the blood. An increase in hemoglobin levels indicates that the medication is successfully treating the anemia associated with CKD.

Choice D Reason:

Taking concurrent iron therapy without adverse effects is important for overall treatment adherence and minimizing side effects. However, it does not directly indicate the effectiveness of epoetin alfa. The primary measure of effectiveness is the improvement in hemoglobin levels.

A. Lisinopril B. Quinapril C. Ramipril D. Captopril E. Trandolapril

Correct Answer is ["A","B","C","E"]

Explanation

Choice A reason:

Lisinopril is an ACE inhibitor that is commonly prescribed for once-daily dosing. It is effective in managing hypertension and heart failure with a single daily dose, making it convenient for patients who may have difficulty remembering multiple doses12.

Choice B reason:

Quinapril can also be administered once daily. It is used to treat hypertension and heart failure, and its long half-life allows for effective blood pressure control with a single daily dose

Choice C reason:

Ramipril is another ACE inhibitor that can be given once daily. It is used for hypertension, heart failure, and to reduce the risk of cardiovascular events. Its pharmacokinetics support once-daily dosing, which helps improve patient adherence.

Choice D reason:

Captopril is typically not given once daily due to its shorter half-life. It usually requires multiple doses throughout the day to maintain effective blood pressure control.

Choice E reason:

Trandolapril is an ACE inhibitor that can be administered once daily. It is used for hypertension and heart failure, and its long duration of action supports once-daily dosing.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with anemia secondary to chronic kidney disease (CKD) started a prescription for epoetin alfa two months ago. Which client finding best indicates that the medication is effective?Reference Range:• Hemoglobin (Hgb): 14 to 18 g/dL (8.7 to 11.2 mmol/L)

Correct Answer is C

Explanation

The nurse notifies the healthcare provider (HCP) that the client is having trouble remembering to take his second dose of captopril. What angiotensin-converting enzyme (ACE) inhibitors can be given only once per day? Select all that apply.

Correct Answer is ["A","B","C","E"]

Explanation

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