Which patient’s condition would raise concerns regarding the administration of labetalol (Normodyne)?

A patient diagnosed with COPD.

A patient suffering from narrow-angle glaucoma.

A patient with hypertension.

A patient exhibiting tachycardia.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

COPD (Chronic Obstructive Pulmonary Disease) is a chronic lung disease that causes airflow obstruction. While labetalol can cause some bronchoconstriction, it is generally considered safe for use in patients with COPD. However, it's essential to monitor respiratory status closely, especially in those with severe COPD.

Choice B rationale:

Narrow-angle glaucoma is an eye condition characterized by increased intraocular pressure (IOP) due to impaired drainage of aqueous humor. Labetalol can exacerbate this condition by further increasing IOP through its beta-blocking effects. This can lead to acute angle-closure glaucoma, a medical emergency that can result in permanent vision loss.

Specific mechanisms by which labetalol can increase IOP:

Reduced aqueous humor production: Beta-blockers like labetalol can decrease the production of aqueous humor, the fluid that maintains eye pressure. While this might seem beneficial, a significant reduction can lead to anterior chamber shallowing, which can mechanically block the drainage angle and trigger angle closure.

Impaired uveoscleral outflow: Beta-blockers can also impair the uveoscleral outflow pathway, an alternative route for aqueous humor drainage that becomes more important in glaucoma patients. This can further contribute to IOP elevation.

Vasoconstriction of ciliary blood vessels: Labetalol's alpha-blocking effects can cause vasoconstriction of the ciliary blood vessels, which supply blood to the ciliary body responsible for aqueous humor production. This can reduce blood flow and indirectly hinder aqueous humor drainage.

Pupillary dilation: Beta-blockers can cause pupillary dilation, which can mechanically narrow the anterior chamber angle and obstruct aqueous humor outflow.

Therefore, labetalol is generally contraindicated in patients with known narrow-angle glaucoma.

Choice C rationale:

Hypertension (high blood pressure) is one of the primary indications for labetalol. It is an effective antihypertensive medication that works by blocking beta receptors, leading to decreased heart rate, contractility, and blood pressure.

Choice D rationale:

Tachycardia (fast heart rate) can also be treated with labetalol due to its beta-blocking effects. It helps to slow down the heart rate and restore a normal rhythm.

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Correct Answer is B

Explanation

Choice A rationale:

Incorrect. Insulin pumps should be removed before bathing or swimming to prevent damage to the device. Water can enter the pump through the infusion set or through the battery compartment, causing it to malfunction. This can lead to inaccurate insulin delivery, which can result in hyperglycemia or hypoglycemia.

Additionally, the adhesive that holds the infusion set in place may not stick well to wet skin, which can increase the risk of the infusion set falling out.

It is important to note that some insulin pumps are now waterproof and can be worn while bathing or swimming. However, it is still important to check the manufacturer's instructions before doing so.

Choice B rationale:

Correct. Even though insulin pumps deliver insulin continuously, people who use them still need to monitor their blood glucose levels regularly. This is because many factors can affect blood glucose levels, such as food intake, exercise, stress, and illness.

Monitoring blood glucose levels allows people to adjust their insulin doses as needed to keep their blood glucose levels within a target range.

Recommended frequency of blood glucose monitoring:

Before meals and snacks Two hours after meals At bedtime

Before and after exercise During times of illness or stress

Whenever they feel symptoms of hypoglycemia or hyperglycemia

Choice C rationale:

Incorrect. People who use insulin pumps still need to count carbohydrates. This is because the amount of insulin that is needed to cover a meal depends on the amount of carbohydrates in the meal.

The insulin pump can be programmed to deliver different amounts of insulin for different meals, snacks, and corrections based on carbohydrate intake. This allows for more precise insulin dosing and better blood glucose control.

Choice D rationale:

Incorrect. Insulin pumps are not designed to help people lose weight. They are designed to help people manage their blood glucose levels.

While some people may lose weight when they start using an insulin pump, this is usually due to improved blood glucose control rather than the pump itself.

A. A patient with a PH of 6.9 per arterial blood gas (ABG) B. A patient who did not respond to calcium carbonate C. A patient with a PH of 7.6 per arterial blood gas (ABG) D. A patient who has extremely low serum sodium (Na) levels

Correct Answer is A

Explanation

Choice A rationale:

Severe acidemia: A pH of 6.9 indicates severe acidemia, a condition where the blood is too acidic. Sodium bicarbonate is an alkalizing agent that can help raise the blood pH back to a normal range.

Rapid correction: Intravenous (IVP) administration of sodium bicarbonate allows for rapid correction of acidemia, which is crucial in severe cases to prevent life-threatening complications.

Buffering action: Sodium bicarbonate acts as a buffer, accepting excess hydrogen ions (H+) in the blood and converting them into water and carbon dioxide (CO2), which can be exhaled.

Specific indications: Sodium bicarbonate is typically used in cases of severe acidemia caused by metabolic acidosis, such as diabetic ketoacidosis or lactic acidosis. It may also be considered in cases of respiratory acidosis, but other interventions like ventilatory support are often prioritized.

Choice B rationale:

Calcium carbonate is not a direct treatment for acidemia: It is primarily used as an antacid to neutralize stomach acid and as a calcium supplement for bone health. While it can have a mild alkalizing effect, it is not as effective as sodium bicarbonate in rapidly correcting severe acidemia.

Choice C rationale:

Alkalemia: A pH of 7.6 indicates alkalemia, a condition where the blood is too alkaline. Administration of sodium bicarbonate in this situation would worsen the alkalemia and potentially lead to serious complications.

Choice D rationale:

Hyponatremia: Low serum sodium levels do not directly require treatment with sodium bicarbonate. Sodium bicarbonate is primarily used to address acid-base imbalances, not electrolyte imbalances.

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Which patient’s condition would raise concerns regarding the administration of labetalol (Normodyne)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which client statement indicates understanding of the use of an external insulin pump?

Correct Answer is B

Explanation

For which of the following patients would the RN anticipate an order for sodium bicarbonate IVP?

Correct Answer is A

Explanation

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