Question

The nurse is preparing to administer the prescribed betaxolol to a client with open-angle glaucoma. What finding should cause the nurse to hold the medication and contact the healthcare provider?

Answer 1

Correct Answers:

Heart rate 52 beats/minute

Rationale :

💎 Betaxolol is a beta-adrenergic blocker used to reduce intraocular pressure in open-angle glaucoma by decreasing aqueous humor production.

💎 A serious systemic effect of ophthalmic beta-blockers is bradycardia and heart block, since the drug can be absorbed systemically through the conjunctival vessels.

💎 A heart rate of 52 beats/minute is below 60 bpm, indicating clinically significant bradycardia, which is a contraindication for administering beta-blockers.

💎 The nurse should withhold the medication and immediately notify the healthcare provider to prevent worsening bradycardia or potential heart block.

💎 Conditions such as diabetes and an intraocular pressure of 22 mmHg are not absolute contraindications, and a BP of 148/84 is not a reason to hold the drug, but bradycardia requires immediate intervention.

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Answer 2

Correct Answers:

Muscle wasting

Rationale :

✨ Cushing syndrome results from chronic exposure to excess glucocorticoids, often due to long-term corticosteroid use or hypersecretion of cortisol.

✨ One of the hallmark signs is muscle wasting caused by protein catabolism. Cortisol breaks down muscle tissue, leading to weakness, thin extremities, and proximal muscle wasting.

✨ Other features include truncal obesity, moon face, buffalo hump, purple striae, thin skin, poor wound healing, osteoporosis, and hyperglycemia, not weight loss or hypoglycemia.

✨ Skin changes in Cushing’s include thin, fragile skin with easy bruising, not thickened skin.

✨ Identifying muscle wasting helps distinguish the catabolic effects of cortisol and guides monitoring and treatment.

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Answer 3

Correct Answers

Blank 1 Correct Option: Acute kidney injury
Blank 2 Correct Option: Initiate oxygen therapy and Obtain a 12-lead electrocardiogram (ECG)
Blank 3 Correct Option: Oxygen saturation and Renal function labs

Rationale :

Potential Condition: Acute Kidney Injury (AKI) ✅

🔷 Rationale:

💥The client was admitted with a myocardial infarction and stent placement but is now showing evidence of renal impairment.

💥The urine output dropped to 100 mL overnight, which is oliguria (less than 0.5 mL/kg/hr).

💥Elevated BUN (26 mg/dL), creatinine (1.9 mg/dL), and reduced GFR (48 mL/min) confirm declining kidney function.

💥Contributing factors include reduced cardiac output (crackles, edema, irregular pulse, tachycardia) leading to poor renal perfusion and acute kidney injury.

💥The metabolic acidosis (pH 7.31, HCO₃ 20) and hyperkalemia (K+ 5.6 mEq/L) further support AKI as the most likely condition.

Priority Nursing Actions:

🔷 Initiate oxygen therapy

💥AKI often occurs secondary to poor perfusion and hypoxemia due to decreased cardiac output.

💥Supplemental oxygen supports tissue oxygenation and helps relieve cardiac workload.

💥Adequate oxygenation also helps maintain kidney perfusion, slowing further damage.

🔷 Obtain a 12-lead electrocardiogram (ECG)

💥The client has potassium of 5.6 mEq/L, which places them at risk for life-threatening dysrhythmias.

💥Irregular peripheral and apical pulses indicate possible arrhythmias already occurring.

💥A 12-lead ECG provides immediate information about potassium-induced changes (peaked T waves, widened QRS) and rhythm disturbances, guiding urgent treatment decisions.

Priority Parameters to Monitor:

🔷 Oxygen saturation

💥Monitoring oxygen saturation ensures the effectiveness of oxygen therapy and helps assess whether hypoxemia is contributing to poor tissue perfusion.

💥Low O₂ saturation would indicate worsening pulmonary congestion and impaired gas exchange from heart failure, requiring rapid escalation of interventions.

🔷 Renal function labs (BUN, creatinine, GFR, electrolytes)

💥Serial monitoring of kidney function is critical to evaluate progression or improvement of AKI.

💥Rising creatinine and BUN indicate worsening renal impairment, while stabilizing or improving levels show recovery.

💥Electrolytes, especially potassium, must be closely followed to anticipate and prevent life-threatening complications.

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Answer 4

Correct Answers:

75

Rationale :

Total volume: 150 mL

Total time: 2 hours

👉 Formula:

mL/hr = Total volume (mL) ÷ Total time (hr)

👉 Substitution:

mL/hr = 150 ÷ 2 = 75 mL/hr

✅ Final Answer: 75 mL/hr

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Answer 5

Correct Answers:

Fluconazole

Rationale :

🦠Fluconazole is an antifungal medication, not an antibiotic, and is indicated for fungal infections such as candidiasis, not bacterial urinary tract infections (UTIs).

🦠For a bacterial UTI, appropriate choices include ciprofloxacin (fluoroquinolone) or ceftriaxone (third-generation cephalosporin) because they directly target bacterial pathogens.

🦠Phenazopyridine is not an antibiotic but may be prescribed as an adjunct to relieve urinary tract discomfort and burning.

🦠Since the client’s condition is specifically a bacterial UTI, fluconazole would be the inappropriate order and should be questioned.

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Answer 6

Correct Answers:

Check the labels and expiration dates of the insulin vials.

Rationale :

⭐ The first action in medication administration is always to ensure safety—this includes verifying the right medication, concentration, and expiration date before preparing or mixing.

⭐ After confirming the correct vials, the nurse would then gently roll the NPH vial to resuspend the insulin (since it is cloudy).

⭐ Next, the nurse inserts air into the NPH vial first (without withdrawing insulin yet), then air into the regular insulin vial, followed by withdrawing regular (clear) insulin before NPH (cloudy).

⭐ This prevents contaminating the regular insulin with the longer-acting suspension and ensures accurate dosing.

⭐ Checking labels and expiration dates first protects the client from medication errors and is consistent with the five rights of medication administration.

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Answer 7

Correct Answers:

Serum sodium 155 mEq/L

Rationale :

💎 In diabetes insipidus (DI), the body loses large amounts of dilute urine because of insufficient antidiuretic hormone (ADH) or renal resistance to ADH.

💎 This water loss leads to hypernatremia (serum sodium above 145 mEq/L), which is a key laboratory finding in DI.

💎 Clients also present with elevated serum osmolality and low urine specific gravity (<1.005), showing that the urine is very dilute.

💎 Hematocrit is typically increased due to hemoconcentration from fluid loss, not decreased.

💎 Therefore, the expected lab result in DI is high sodium levels, such as 155 mEq/L.

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Answer 8

Correct Answers:

Muscle weakness

Rationale :

⭐ Addison’s disease is adrenal insufficiency, leading to low cortisol and often low aldosterone. This causes hyponatremia, hyperkalemia, and hypoglycemia, all of which contribute to muscle weakness and fatigue.

⭐ Muscle weakness is the priority because it reflects underlying electrolyte disturbances (especially hyperkalemia) that can progress to life-threatening dysrhythmias if not addressed quickly.

⭐ Abdominal pain, decreased appetite, and palpitations may occur, but they are not as immediately critical as muscle weakness indicating severe electrolyte imbalance.

⭐ Prompt recognition of muscle weakness allows the nurse to anticipate and intervene against Addisonian crisis, which can lead to shock if untreated.

⭐ Nursing care includes monitoring potassium, sodium, glucose levels, and providing hormone replacement therapy as prescribed.

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Answer 9

Correct Answers:

"Are you consistently exposed to loud noises?"
"Do you have a history of chronic otitis media?"
"Do you smoke or are you exposed to smoke?"

Rationale :

🟦 Consistent exposure to loud noises

📌Prolonged or repeated exposure to loud occupational or recreational noise (factories, construction, concerts, headphones at high volume) is a major risk factor for sensorineural hearing loss.

📌Noise damages the hair cells in the cochlea, which do not regenerate, leading to permanent impairment.

📌Asking this question helps identify clients who may benefit from preventive strategies such as ear protection and noise reduction.

🟦 History of chronic otitis media

📌Chronic or recurrent middle ear infections can damage the tympanic membrane, ossicles, or cause scarring, resulting in conductive hearing loss.

📌This is especially relevant in childhood infections, which can carry over into adulthood if untreated.

📌Identifying a history of otitis media helps the nurse determine whether the hearing loss may be related to chronic structural or infectious changes.

🟦 Smoking or exposure to smoke

📌Smoking and secondhand smoke are linked to vasoconstriction and impaired oxygenation of the inner ear, contributing to hearing decline.

📌Smoke exposure also increases the risk of ear infections, further worsening hearing ability.

📌Assessing this risk helps guide education on smoking cessation and avoidance of secondhand smoke to preserve hearing function.

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Answer 10

Correct Answers:

Serum creatinine 2.3 mg/dL

Rationale :

💠 Serum creatinine is the most reliable indicator of renal function because it reflects the kidney’s ability to filter waste products through the glomeruli. Creatinine is produced at a relatively constant rate from muscle metabolism and is excreted almost entirely by the kidneys.

💠 A value of 2.3 mg/dL is elevated (normal is ~0.6–1.2 mg/dL), suggesting impaired kidney filtration as seen in acute kidney injury (AKI).

💠 BUN (40 mg/dL) can also be elevated with kidney dysfunction, but it is less specific because it can rise due to dehydration, GI bleeding, or high protein intake.

💠 Hemoglobin (9.5 g/dL) indicates anemia, which may be associated with chronic kidney disease but is not the best direct indicator of acute renal function.

💠 Potassium (5.1 mEq/L) is mildly elevated and important for monitoring complications of AKI (like arrhythmias), but it does not directly measure kidney function.

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QLexNursing

1 :
The nurse is preparing to administer the prescribed betaxolol to a client with open-angle glaucoma. What finding should cause the nurse to hold the medication and contact the healthcare provider?

2 :
What finding should the nurse identify as consistent with Cushing syndrome?

3 :
A nurse was assessing a patient .

Correct Answers

4 :
A nurse is preparing to administer fluconazole 400 mg via intravenous (IV) infusion over 2 hours. Available is fluconazole 400 mg in 150 ml. 0.9% sodium chloride (NaCl). At what rate will the nurse set the infusion?1 mL/hr (if needed, round the answer to the nearest whole number.)

5 :
The nurse caring for a client admitted with a bacterial urinary tract infection receives orders from the healthcare provider. The nurse should question the healthcare provider's order for which medication?

6 :
A nurse is preparing to mix Neutral Protamine Hagedorn (NPH) insulin and regular insulin in the same syringe for administration to a client with type 1 diabetes. Which action should the nurse take first?

7 :
What laboratory finding should the nurse expect when caring for a client with diabetes insipidus?

8 :
The nurse is caring for a client newly diagnosed with Addison's disease. Which finding should the nurse prioritize?

9 :
The clinic nurse is interviewing a client to determine their risk factors for hearing loss. What question(s) should the nurse ask the client? Select all that apply.

10 :
A nurse caring for a client with acute kidney injury is evaluating the client's laboratory values. Which laboratory result is the best indicator of renal function?

QLexNursing

1 : The nurse is preparing to administer the prescribed betaxolol to a client with open-angle glaucoma. What finding should cause the nurse to hold the medication and contact the healthcare provider?

2 : What finding should the nurse identify as consistent with Cushing syndrome?

3 : A nurse was assessing a patient .

Correct Answers

4 : A nurse is preparing to administer fluconazole 400 mg via intravenous (IV) infusion over 2 hours. Available is fluconazole 400 mg in 150 ml. 0.9% sodium chloride (NaCl). At what rate will the nurse set the infusion?1 mL/hr (if needed, round the answer to the nearest whole number.)

5 : The nurse caring for a client admitted with a bacterial urinary tract infection receives orders from the healthcare provider. The nurse should question the healthcare provider's order for which medication?

6 : A nurse is preparing to mix Neutral Protamine Hagedorn (NPH) insulin and regular insulin in the same syringe for administration to a client with type 1 diabetes. Which action should the nurse take first?

7 : What laboratory finding should the nurse expect when caring for a client with diabetes insipidus?

8 : The nurse is caring for a client newly diagnosed with Addison's disease. Which finding should the nurse prioritize?

9 : The clinic nurse is interviewing a client to determine their risk factors for hearing loss. What question(s) should the nurse ask the client? Select all that apply.

10 : A nurse caring for a client with acute kidney injury is evaluating the client's laboratory values. Which laboratory result is the best indicator of renal function?

1 :
The nurse is preparing to administer the prescribed betaxolol to a client with open-angle glaucoma. What finding should cause the nurse to hold the medication and contact the healthcare provider?

2 :
What finding should the nurse identify as consistent with Cushing syndrome?

3 :
A nurse was assessing a patient .

4 :
A nurse is preparing to administer fluconazole 400 mg via intravenous (IV) infusion over 2 hours. Available is fluconazole 400 mg in 150 ml. 0.9% sodium chloride (NaCl). At what rate will the nurse set the infusion?1 mL/hr (if needed, round the answer to the nearest whole number.)

5 :
The nurse caring for a client admitted with a bacterial urinary tract infection receives orders from the healthcare provider. The nurse should question the healthcare provider's order for which medication?

6 :
A nurse is preparing to mix Neutral Protamine Hagedorn (NPH) insulin and regular insulin in the same syringe for administration to a client with type 1 diabetes. Which action should the nurse take first?

7 :
What laboratory finding should the nurse expect when caring for a client with diabetes insipidus?

8 :
The nurse is caring for a client newly diagnosed with Addison's disease. Which finding should the nurse prioritize?

9 :
The clinic nurse is interviewing a client to determine their risk factors for hearing loss. What question(s) should the nurse ask the client? Select all that apply.

10 :
A nurse caring for a client with acute kidney injury is evaluating the client's laboratory values. Which laboratory result is the best indicator of renal function?