Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a client who is taking lithium and reports starting a new exercise program.
The nurse should assess the client for which of the following electrolyte imbalances?
A. Hypomagnesemia.
Choice A is wrong because hypomagnesemia is not a common side effect of lithium or exercise.
B. Hypocalcemia.
Choice B is wrong because hypocalcemia is not a common side effect of lithium or exercise.
C. Hyponatremia.
Lithium can cause hyponatremia by increasing the secretion of antidiuretic hormone and reducing the renal clearance of sodium.
D. Hypokalemia.
Choice D is wrong because hypokalemia is not a common side effect of lithium or exercise. However, lithium can interact with some diuretics that can cause hypokalemia, so the client should avoid taking these drugs without consulting their doctor. Normal ranges for electrolytes are: Sodium: 135-145 mmol/L Magnesium: 0.7-1.1 mmol/L Calcium: 2.1-2.6 mmol/L Potassium: 3.5-5.0 mmol/L
This question is an excerpt from Nurse Dive's nursing test bank - ATI RN Pharmacology 2019 Proctored Exam. Take the full exam now
Full Explanation
Lithium can cause hyponatremia by increasing the secretion of antidiuretic hormone and reducing the renal clearance of sodium.
Strenuous exercise can also cause hyponatremia by increasing sweat loss and fluid intake. Therefore, a client who is taking lithium and starting a new exercise program is at risk of developing hyponatremia.
Choice A is wrong because hypomagnesemia is not a common side effect of lithium or exercise.
Choice B is wrong because hypocalcemia is not a common side effect of lithium or exercise.
Choice D is wrong because hypokalemia is not a common side effect of lithium or exercise.
However, lithium can interact with some diuretics that can cause hypokalemia, so the client should avoid taking these drugs without consulting their doctor. Normal ranges for electrolytes are:
Sodium: 135-145 mmol/L
Magnesium: 0.7-1.1 mmol/L
Calcium: 2.1-2.6 mmol/L
Potassium: 3.5-5.0 mmol/L
Similar Questions
A nurse is administering naloxone to a client who has developed an adverse reaction to morphine.
The nurse should identify which of the following findings is a therapeutic effect of naloxone?
A. Decreased blood pressure.
Choice A is wrong because decreased blood pressure is not a therapeutic effect of naloxone. In fact, naloxone can cause hypertension (high blood pressure) as a side effect due to opioid withdrawal.
B. Decreased nausea.
Choice B is wrong because decreased nausea is not a therapeutic effect of naloxone. Nausea is a common side effect of morphine, but naloxone does not affect it directly. Naloxone can actually cause nausea and vomiting as a side effect due to opioid withdrawal.
C. Increased respiratory rate.
A therapeutic effect of naloxone is the reversal of opioid-induced respiratory depression, which is one of the most dangerous complications of opioid overdose. Naloxone works by binding to opioid receptors, displacing opioids, and restoring normal respiratory drive. An increase in respiratory rate after administration indicates that naloxone is effective.
D. Increased pain relief.
Choice D is wrong because increased pain relief is not a therapeutic effect of naloxone. Pain relief is a desired effect of morphine, but naloxone antagonizes it by blocking the opioid receptors. Naloxone can cause pain and discomfort as a side effect due to opioid withdrawal.
Full Explanation
A therapeutic effect of naloxone is the reversal of opioid-induced respiratory depression, which is one of the most dangerous complications of opioid overdose. Naloxone works by binding to opioid receptors, displacing opioids, and restoring normal respiratory drive. An increase in respiratory rate after administration indicates that naloxone is effective.
Choice A is wrong because decreased blood pressure is not a therapeutic effect of naloxone.
In fact, naloxone can cause hypertension (high blood pressure) as a side effect due to opioid withdrawal.
Choice B is wrong because decreased nausea is not a therapeutic effect of naloxone. Nausea is a common side effect of morphine, but naloxone does not affect it directly.
Naloxone can actually cause nausea and vomiting as a side effect due to opioid withdrawal.
Choice D is wrong because increased pain relief is not a therapeutic effect of naloxone.
Pain relief is a desired effect of morphine, but naloxone antagonizes it by blocking the opioid receptors.
Naloxone can cause pain and discomfort as a side effect due to opioid withdrawal.
A nurse is reviewing the laboratory results of a client who is taking amitriptyline. Which of the following laboratory values should the nurse report to the provider?
A. WBC count 5,000/mm.
While a normal WBC count typically falls between 4,500 and 11,000/mm³, 5,000/mm³ is not necessarily concerning in a client taking amitriptyline. Amitriptyline is not known to have a significant impact on WBC count as a side effect. Therefore, a WBC count of 5,000/mm³ in this context does not warrant immediate reporting to the provider.
B. Total bilirubin 1.5 mg/dL.
A normal total bilirubin level typically ranges between 0.3 and 1.2 mg/dL. While an elevated bilirubin level can indicate liver dysfunction, a mildly elevated level of 1.5 mg/dL might not be clinically significant, especially without other concerning symptoms or liver function test abnormalities. Amitriptyline can cause mild elevations in liver enzymes in some individuals, but this doesn't always translate to clinically relevant bilirubin changes. Therefore, a total bilirubin of 1.5 mg/dL in this context does not necessarily require immediate reporting to the provider, especially if the client is asymptomatic and has no history of liver problems.
C. Hct 44%.
A normal hematocrit (Hct) level for women is generally between 38% and 48%, and for men, it's between 42% and 52%. An Hct of 44% falls within the normal range for both genders. Amitriptyline is not known to have a significant impact on Hct as a side effect. Therefore, an Hct of 44% in this context does not require reporting to the provider.
D. Potassium 5.2 mEq/L.
A normal potassium level typically ranges between 3.5 and 5.0 mEq/L. A potassium level of 5.2 mEq/L is slightly above the normal range and could indicate hyperkalemia. Amitriptyline is known to cause potential hyperkalemia as a side effect, particularly in older adults or individuals with underlying kidney or heart conditions. Hyperkalemia, even if mild, can lead to serious complications like cardiac arrhythmias. Therefore, a potassium level of 5.2 mEq/L in a client taking amitriptyline warrants prompt reporting to the provider for further evaluation and potential intervention. In conclusion, while all laboratory values should be monitored in a client taking any medication, the potassium level of 5.2 mEq/L in this scenario stands out as the most concerning finding due to the potential risk of hyperkalemia associated with amitriptyline use. The provider should be informed to assess the client's overall health, kidney function, and potential need for medication adjustments or electrolyte monitoring.
Full Explanation
A WBC count of 5,000/mm3 is low and could indicate leukopenia, a possible side effect of amitriptyline. Leukopenia increases the risk of infection and should be reported to the provider.
Choice B is wrong because a total bilirubin of 1.5 mg/dL is within the normal range of 0.3 to 1.9 mg/dL.
Choice C is wrong because a Hct of 44% is within the normal range of 37% to 48% for women and 45% to 52% for men.
Choice D is wrong because a potassium level of 4.2 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.
A nurse is monitoring for an infusion reaction for a client who is receiving a dose of IV amphotericin B. Which of the following findings should indicate to the nurse that the client is experiencing an acute infusion reaction?
A. Pedal edema.
Choice A. Pedal edema is wrong because it is not a typical sign of an acute infusion reaction. Pedal edema may indicate fluid overload, heart failure, or renal impairment, which are not directly related to amphotericin B infusion.
B. Fever.
This is because fever is a common sign of an acute infusion reaction that can occur when receiving IV amphotericin B. An acute infusion reaction is caused by the release of pro-inflammatory cytokines from the fungal cell wall disruption by amphotericin B. It usually occurs within the first hour of infusion and can be prevented by administering pre-medications such as antipyretics, antihistamines, or corticosteroids.
C. Dry cough.
Dry cough may indicate an allergic reaction, pulmonary infection, or interstitial lung disease, which are not directly related to amphotericin B infusion.
D. Hyperglycemia.
Choice D. Hyperglycemia is wrong because it is not a typical sign of an acute infusion reaction. Hyperglycemia may indicate diabetes mellitus, steroid use, or stress response, which are not directly related to amphotericin B infusion.
Full Explanation
This is because fever is a common sign of an acute infusion reaction that can occur when receiving IV amphotericin B. An acute infusion reaction is caused by the release of pro-inflammatory cytokines from the fungal cell wall disruption by amphotericin B. It usually occurs within the first hour of infusion and can be prevented by administering pre-medications such as antipyretics, antihistamines, or corticosteroids.
Choice A. Pedal edema is wrong because it is not a typical sign of an acute infusion reaction.
Pedal edema may indicate fluid overload, heart failure, or renal impairment, which are not directly related to amphotericin B infusion.
Choice C. Dry cough is wrong because it is not a typical sign of an acute infusion reaction.
Dry cough may indicate an allergic reaction, pulmonary infection, or interstitial lung disease, which are not directly related to amphotericin B infusion. Choice D. Hyperglycemia is wrong because it is not a typical sign of an acute infusion reaction.
Hyperglycemia may indicate diabetes mellitus, steroid use, or stress response, which are not directly related to amphotericin B infusion.