The nurse is preparing to administer spironolactone (Aldactone) and furosemide (Lasix) at 0900 to a client diagnosed with ascites. Review of 0600 laboratory results shows serum sodium 130 mEq/L (136-145 mEq/L) and potassium 3.1 mEq/L (3.5-5.0 mEq/L). Which action should the nurse take first?
Request a dietary consult
Order a 2 gram sodium restriction diet
Initiate a fluid restriction
Hold the spironolactone and furosemide
The Correct Answer is D
A) Requesting a dietary consult is useful but not the most immediate action needed.
B) Ordering a 2 gram sodium restriction diet is important but not addressing the immediate issue of electrolyte imbalance.
C) Fluid restriction may be considered but not before addressing the electrolyte issues.
D) Holding the spironolactone and furosemide is the correct action, as administering these could exacerbate the existing hypokalemia and hyponatremia, increasing the risk of adverse effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Chronic and excessive alcohol consumption is a well-established risk factor for the development of chronic pancreatitis.
B) While contributing to other health issues, it is not directly linked to chronic pancreatitis.
C) Smoking is a risk factor, but alcohol abuse is more significantly associated with chronic pancreatitis.
D) Although it contributes to various health problems, it is not as directly linked to chronic pancreatitis as alcohol abuse.
Correct Answer is C
Explanation
A) These symptoms are more indicative of chronic conditions.
B) These are not specific to acute pancreatitis.
C) Elevated lipase and Turner's sign (bruising around the flanks) strongly suggest acute pancreatitis.
D) Amylase within normal limits and steatorrhea do not support acute pancreatitis.
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