Question 9

The nurse is preparing medications for a client with a history of hypertension that is post-op day 3 following hip replacement.

Meds: Atenolol 25 mg PO, Captopril 10 mg PO, Glipizide 5 mg PO, Atorvastatin 20 mg PO, and Enoxaparin 40 mg SQ.

Vital signs: blood pressure 138/90, heart rate 82, respiratory rate 18, temperature 99.7, O2 saturation 96% on room air.

Today's labs: sodium- 143 meq/L, potassium 6.2 mmol/L, hemoglobin 11.1 gm/dL, platelets 104,000, white blood count 10.8, blood glucose 130.

Which medication would be a priority for the nurse to hold?

Choice A reason: This statement is false. The nurse would not be alerted to a possible toxic effect of furosemide by this statement, as this statement indicates a local reaction to the IV site, not a systemic effect of the medication. Furosemide is a diuretic that increases the urine output and reduces the fluid volume in the body. It does not cause irritation, redness, or pain at the IV site. However, the nurse should still inspect the IV site and change it if needed.

Choice B reason: This statement is false. The nurse would not be alerted to a possible toxic effect of furosemide by this statement, as this statement indicates an expected effect of the medication, not a toxic effect. Furosemide is a diuretic that increases the urine output and reduces the fluid volume in the body. It is used to treat heart failure, which is a condition where the heart cannot pump enough blood to meet the body's needs. This causes fluid to accumulate in the lungs, the legs, or the abdomen. By increasing the urine output, furosemide helps to remove the excess fluid and relieve the symptoms of heart failure.

Choice C reason: This statement is true. The nurse would be alerted to a possible toxic effect of furosemide by this statement, as this statement indicates a sign of ototoxicity, which is a damage to the inner ear caused by the medication. Furosemide is a diuretic that increases the urine output and reduces the fluid volume in the body. However, it can also affect the electrolyte balance and the blood flow in the inner ear, which can impair the hearing and cause tinnitus, vertigo, or deafness. Ototoxicity is a serious and sometimes irreversible complication of furosemide therapy. The nurse should stop the medication and notify the prescriber immediately.

Choice D reason: This statement is false. The nurse would not be alerted to a possible toxic effect of furosemide by this statement, as this statement indicates a sign of constipation, which is a common and mild side effect of the medication. Furosemide is a diuretic that increases the urine output and reduces the fluid volume in the body. However, it can also cause dehydration and electrolyte imbalance, which can affect the bowel movements and cause constipation. Constipation is not a life-threatening condition, but it can cause discomfort and complications if not treated. The nurse should advise the client to drink plenty of fluids, eat high-fiber foods, and use laxatives or stool softeners as needed.

Choice A reason: This statement is false. Atorvastatin is not a medication that the nurse should hold, as it is used to lower cholesterol and prevent cardiovascular events. It does not have a significant effect on blood pressure, heart rate, or blood glucose.

Choice B reason: This statement is true. Captopril is a medication that the nurse should hold, as it is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure and prevents kidney damage. However, it can also cause hyperkalemia, which is a condition where the potassium level is too high. The client has a high potassium level, which can cause cardiac arrhythmias or muscle weakness. The nurse should hold the captopril and notify the prescriber.

Choice C reason: This statement is false. Atenolol is not a medication that the nurse should hold, as it is a beta-blocker that lowers blood pressure and heart rate. It can also prevent angina and reduce the risk of heart attack. The client has a normal heart rate and a slightly elevated blood pressure, which can be expected after surgery. The nurse should monitor the client's vital signs and administer the atenolol as ordered.

Choice D reason: This statement is false. Glipizide is not a medication that the nurse should hold, as it is an oral antidiabetic drug that lowers blood glucose by stimulating the release of insulin from the pancreas. The client has a normal blood glucose level, which can be maintained by taking the glipizide as ordered. The nurse should also encourage the client to follow a balanced diet and exercise regimen.