The nurse is caring for a client who receives a prescription for valproic acid in which the maximum safe dosage is 60 mg/kg/day.

How many mg/day is the maximum safe dosage for a client who weighs 176 pounds? (Enter numerical value only.).

Choice A rationale:

The client will have no signs of infection in the wound by day 7. Rationale: This outcome is appropriate because it sets a specific timeframe (day 7) for assessing the absence of infection in the wound. It provides a clear and measurable criterion for evaluating the effectiveness of the wound care plan.

Choice B rationale:

The client will report a pain level of 4/10 or less during dressing changes. Rationale: Pain management is an essential aspect of wound care. Setting a target pain level (4/10 or less) during dressing changes allows for monitoring and adjustment of pain management strategies, making it an appropriate outcome.

Choice C rationale:

The client will consume at least 75% of meals and snacks daily. Rationale: While nutrition is important for wound healing, this outcome is less directly related to the wound itself. Monitoring meal consumption is a valuable goal for overall health but may not be as closely tied to wound improvement as infection control, pain management, or wound care technique.

Choice D rationale:

The client will reposition self in bed every 2 hours with assistance. Rationale: Repositioning every 2 hours is an important preventive measure for pressure ulcer development. However, this choice may not be appropriate for this particular client if they are unable to reposition themselves, even with assistance. This outcome may not be achievable for all clients, and a more individualized goal may be necessary.

Choice E rationale:

The client will demonstrate proper wound care technique before discharge. Rationale: Ensuring that the client can perform proper wound care techniques independently or with minimal assistance is a crucial outcome. This ensures that the client can maintain wound hygiene and prevent complications after discharge.

Choice A rationale:

The nurse should monitor the client for tachycardia as an adverse effect of beta blockers like metoprolol. Beta blockers work by reducing heart rate and blood pressure, so the presence of tachycardia would be unexpected and could indicate a potential adverse reaction to the medication.

Choice B rationale:

Hyperglycemia is not a common adverse effect of beta blockers like metoprolol. In fact, these medications can sometimes mask the symptoms of hypoglycemia, making it important for diabetic patients to closely monitor their blood glucose levels. However, hyperglycemia is not a typical side effect.

Choice C rationale:

Bronchospasm is not a common adverse effect of metoprolol. Beta blockers like metoprolol can cause bronchoconstriction in some individuals, but this effect is generally more prominent with non-selective beta blockers like propranolol. It is not a common adverse effect of metoprolol and would not be the primary concern when monitoring a patient on this medication.

Choice D rationale:

The nurse should monitor the client for hyperkalemia as an adverse effect of metoprolol. Beta blockers can inhibit the release of insulin from the pancreas, which can lead to elevated blood potassium levels (hyperkalemia). This is particularly important in patients with renal impairment, as they may have difficulty clearing excess potassium from the body.