The nurse is reviewing the laboratory results of a client who reports taking five times the recommended daily allowance of vitamins and minerals in a multivitamin form. Which finding indicates a possible vitamin D overdose?

Reference Range:

Bilirubin [0.3 to 1 mg/dL (5.1 to 17 μmol/L)]

Calcium 19 to 10.5 mg/dL (2.3 to 2.6 mmol/L)]

Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]

Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

Sodium level 140 mEq/L (140 mmol/L).

Total calcium level 12 mEq/L (3 mmol/L).

Total bilirubin 4 mg/dL (68.4 μmol/L).

Serum glucose 170 mg/dL (9.4 mmol/L).

Answer and Explanation

The Correct Answer is B

A) Sodium level 140 mEq/L (140 mmol/L):
The sodium level within the reference range does not indicate a vitamin D overdose. Sodium levels are typically not affected by vitamin D overdose.

B) Total calcium level 12 mg/dL (3 mmol/L):
This finding suggests a possible vitamin D overdose. Vitamin D plays a crucial role in calcium absorption from the intestines. Excessive vitamin D intake can lead to increased calcium absorption, resulting in hypercalcemia. Elevated calcium levels can lead to various symptoms such as nausea, vomiting, weakness, and confusion. Monitoring calcium levels is essential in individuals with suspected vitamin D overdose.

C) Total bilirubin 4 mg/dL (68.4 μmol/L):
Elevated bilirubin levels typically indicate liver dysfunction or hemolysis. It is not directly related to vitamin D overdose.

D) Serum glucose 170 mg/dL (9.4 mmol/L):
Elevated glucose levels suggest hyperglycemia, which can occur due to various factors such as diabetes mellitus or stress response. It is not directly related to vitamin D overdose.

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Correct Answer is B

Explanation

A) Diminished renal output:
Diminished renal output could be a potential concern with cefoxitin administration, as it is primarily excreted by the kidneys. However, it is not specifically related to the client’s allergy to penicillin. While it warrants monitoring, it is not the most critical finding to report in this context.

B) Pruritis and macular rash:
The development of pruritis (itchiness) and a macular rash (flat, discolored skin lesions) following the administration of cefoxitin in a client with a documented allergy to penicillin is a significant finding. It suggests a possible allergic reaction to cefoxitin, which belongs to the cephalosporin class of antibiotics. Cross-reactivity between penicillin and cephalosporins is well-documented, with some cephalosporins having a higher risk of allergic reactions in individuals with penicillin allergy. Therefore, pruritis and rash in this context may indicate an allergic response, and it is crucial to report this finding promptly to the healthcare provider for further evaluation and management.

C) Vomiting and diarrhea:
While gastrointestinal symptoms such as vomiting and diarrhea can occur as adverse effects of cefoxitin, they are not specific to an allergic reaction and may occur with various medications. While it is essential to monitor for these symptoms, they are not the most important findings to report in the context of a known penicillin allergy.

D) Vaginal discharge:
Vaginal discharge is not typically associated with an allergic reaction to cefoxitin. While changes in vaginal discharge may be clinically relevant in certain contexts, such as indicating a possible yeast infection or bacterial vaginosis, it is not directly related to the client’s allergy to penicillin or the administration of cefoxitin.

A. Serum ammonia level of 30 pg/dl (17.62 μmol /dL). B. Serum glucose level of 120 mg/dL (6.7 mmol/L). C. Serum potassium level of 3.8 mEq/L (3.8 mmol/L). D. Hemoglobin level of 13.5 g/dL (135 g/L).

Correct Answer is C

Explanation

A) Serum ammonia level of 30 pg/dl (17.62 μmol /dL): Serum ammonia level is not directly affected by sodium polystyrene sulfonate administration. Ammonia levels are typically related to liver function and are not relevant in assessing the effectiveness of this medication for hyperkalemia.
B) Serum glucose level of 120 mg/dL (6.7 mmol/L): Serum glucose level is unrelated to the action of sodium polystyrene sulfonate. While hyperkalemia can sometimes lead to glucose metabolism abnormalities, the glucose level alone does not provide information about the medication's effectiveness.
C) Serum potassium level of 3.8 mEq/L (3.8 mmol/L): Sodium polystyrene sulfonate, also known as Kayexalate, is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, leading to potassium excretion through feces. A decrease in serum potassium level within the normal range indicates that the medication has been effective in lowering potassium levels, which is the intended therapeutic outcome in the context of treating hyperkalemia associated with acute kidney injury (AKI).
D) Hemoglobin level of 13.5 g/dL (135 g/L): Hemoglobin level is unrelated to the action of sodium polystyrene sulfonate. It reflects the oxygen-carrying capacity of red blood cells and is not directly influenced by potassium-lowering medications.

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Naxlex Comprehensive Predictor Exams

The nurse administers the initial dose of cefoxitin to a client whose medical record indicates an allergy to penicillin. Which finding is most important for the nurse to report to the healthcare provider?

Correct Answer is B

Explanation

Correct Answer is C

Explanation

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