The nurse is caring for four clients: Client A, who has emphysema and whose oxygen saturation is 94%; Client B, with a postoperative hemoglobin of 8.2 mg/dL (82 g/L); Client C, newly admitted with a potassium level of 3.8 mEq/L (3.8 mmol/L); and Client D, scheduled for an appendectomy who has a white blood cell (WBC) count of 14,000 mm (14 x 10^9/L). Which intervention should the nurse implement? Reference Range:. Hemoglobin [14 to 18 g/dL (140 to 180 g/L)]. Potassium [3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]. White Blood Cell [5000 to 10,000/mm² (5 to 10 x 10^9/L)].

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.

When the practical nurse (PN) notices that one of the unlicensed assistive personnel (UAP) consistently records subnormal temperatures when using the thermometer, the first action the PN should take is to observe how the UAP obtains temperatures. This allows the PN to directly assess the UAP's technique and determine if any errors or inaccuracies are occurring during temperature measurement. By observing the process, the PN can identify any potential issues, such as incorrect placement of the thermometer or improper technique, and provide appropriate guidance and education.
Let's evaluate the other options:

a) Show the UAP how to chart temperatures.
While accurate charting of temperatures is important, it is not the primary concern in this situation. The PN should first focus on assessing the UAP's temperature measurement technique before addressing charting skills.

b) Return the thermometer for recalibration.
Returning the thermometer for recalibration may be necessary if there is evidence or suspicion of a malfunctioning thermometer. However, before assuming that the thermometer is the issue, it is important to first observe how the UAP obtains temperatures to rule out any human error in the measurement process.

d) Demonstrate how to use the equipment.
Demonstrating how to use the equipment may be beneficial, but it should not be the first action taken in this scenario. The PN should first observe the UAP's technique to identify any potential errors or issues in temperature measurement. Based on the observation, the PN can provide specific guidance and demonstrate the correct technique if necessary.

In summary, when a practical nurse (PN) notices that a UAP consistently records subnormal temperatures when using the thermometer, the first action the PN should take is to observe how the UAP obtains temperatures. This allows for direct assessment of the UAP's technique and identification of any potential errors or issues. Based on the observation, the PN can provide appropriate guidance, education, and intervention as needed to ensure accurate temperature measurement.