Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A patient with cancer-related bone pain is receiving etidronate as an adjuvant analgesic. The nurse should monitor the patient for which of the following laboratory values?
A. Serum calcium
Etidronate is a bisphosphonate that inhibits bone resorption and reduces the risk of skeletal complications in patients with cancer-related bone pain.However, it can also cause hypocalcemia (low serum calcium levels) as a side effect, which can lead to muscle spasms, numbness, tingling, seizures, and cardiac arrhythmias. Therefore, the nurse should monitor the patient’s serum calcium levels regularly and supplement with calcium and vitamin D if needed.
B. Serum potassium
This is wrong because etidronate does not affect potassium levels.Potassium is mainly regulated by the kidneys and can be altered by renal impairment, dehydration, acid-base imbalance, or medications such as diuretics or potassium-sparing agents.
C. Serum creatinine
This is wrong because etidronate does not affect creatinine levels. Creatinine is a waste product of muscle metabolism that is excreted by the kidneys.It reflects the glomerular filtration rate (GFR) and can be elevated in renal dysfunction or dehydration.
D. Serum albumin
This is wrong because etidronate does not affect albumin levels. Albumin is a protein that is synthesized by the liver and helps maintain fluid balance and transport substances in the blood.It can be decreased in liver disease, malnutrition, inflammation, or protein-losing conditions.
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Full Explanation
The correct answer is choice A. Serum calcium. Etidronate is a bisphosphonate that inhibits bone resorption and reduces the risk of skeletal complications in patients with cancer-related bone pain. However, it can also cause hypocalcemia (low serum calcium levels) as a side effect, which can lead to muscle spasms, numbness, tingling, seizures, and cardiac arrhythmias.
Therefore, the nurse should monitor the patient’s serum calcium levels regularly and supplement with calcium and vitamin D if needed.
Choice B. Serum potassium is wrong because etidronate does not affect potassium levels. Potassium is mainly regulated by the kidneys and can be altered by renal impairment, dehydration, acid-base imbalance, or medications such as diuretics or potassium-sparing agents.
Choice C. Serum creatinine is wrong because etidronate does not affect creatinine levels.
Creatinine is a waste product of muscle metabolism that is excreted by the kidneys. It reflects the glomerular filtration rate (GFR) and can be elevated in renal dysfunction or dehydration.
Choice D. Serum albumin is wrong because etidronate does not affect albumin levels.
Albumin is a protein that is synthesized by the liver and helps maintain fluid balance and transport substances in the blood. It can be decreased in liver disease, malnutrition, inflammation, or protein-losing conditions.
Similar Questions
(Select all that apply) A patient with postoperative pain is prescribed hydroxyzine as an adjuvant analgesic. The nurse should teach the patient about which of the following benefits of this medication.
A. It can decrease anxiety related to pain.
Hydroxyzine is an antihistamine that hasantiemeticandsedativeeffects that are thought to be mediated by its actions in the brain.It can alsodecrease anxietyrelated to pain by inhibiting the hypothalamic H-1 histamine receptors.Hydroxyzine may also have apotentiatingeffect on other analgesics, although the evidence for this is not conclusive.
B. It can prevent nausea and vomiting related to pain.
Hydroxyzine is an antihistamine that hasantiemeticandsedativeeffects that are thought to be mediated by its actions in the brain.It can alsodecrease anxietyrelated to pain by inhibiting the hypothalamic H-1 histamine receptors.Hydroxyzine may also have apotentiatingeffect on other analgesics, although the evidence for this is not conclusive.
C. It can reduce inflammation and swelling related to pain.
This is wrong because hydroxyzine does not have any anti-inflammatory properties.It is a competitive antagonist of histamine H1-receptors, not a cyclooxygenase inhibitor.
D. It can promote sleep and rest related to pain.
Hydroxyzine is an antihistamine that hasantiemeticandsedativeeffects that are thought to be mediated by its actions in the brain.It can alsodecrease anxietyrelated to pain by inhibiting the hypothalamic H-1 histamine receptors.Hydroxyzine may also have apotentiatingeffect on other analgesics, although the evidence for this is not conclusive.
E. It can enhance the effect of other analgesics related to pain.
Hydroxyzine is an antihistamine that hasantiemeticandsedativeeffects that are thought to be mediated by its actions in the brain.It can alsodecrease anxietyrelated to pain by inhibiting the hypothalamic H-1 histamine receptors.Hydroxyzine may also have apotentiatingeffect on other analgesics, although the evidence for this is not conclusive.
Full Explanation
The correct answer is choice A, B, D, and E. Hydroxyzine is an antihistamine that has antiemetic and sedative effects that are thought to be mediated by its actions in the brain. It can also decrease anxiety related to pain by inhibiting the hypothalamic H-1 histamine receptors. Hydroxyzine may also have a potentiating effect on other analgesics, although the evidence for this is not conclusive.
Choice C is wrong because hydroxyzine does not have any anti-inflammatory properties. It is a competitive antagonist of histamine H1-receptors, not a cyclooxygenase inhibitor.
The nurse is preparing to administer morphine sulfate, an opioid analgesic, to a client who reports pain at level 8 on a scale of 0 to 10. Which action should the nurse take first?
A. Assess the client’s respiratory rate.
This is wrong because assessing the client’s respiratory rate is not the first action the nurse should take. Although morphine sulfate can cause respiratory depression, which is a serious side effect that needs to be monitored, the nurse should first ensure that the client is not allergic to the medication.
B. Check the client’s allergy history.
This is because morphine sulfate is a medication that can cause severe allergic reactions in some people, such as anaphylaxis, which can be life-threatening. Therefore, the nurse should always check the client’s allergy history before administering any medication, especially opioids.
C. Review the client’s medication record.
This is wrong because reviewing the client’s medication record is not the first action the nurse should take. Although morphine sulfate can interact with other medications, such as sedatives, antidepressants, or alcohol, which can increase the risk of respiratory depression or overdose, the nurse should first ensure that the client is not allergic to the medication.
D. Verify the dosage with another nurse.
This is wrong because verifying the dosage with another nurse is not the first action the nurse should take. Although morphine sulfate is a high-alert medication that requires double-checking to prevent medication errors, the nurse should first ensure that the client is not allergic to the medication.
Full Explanation
The correct answer is choice B. Check the client’s allergy history.
This is because morphine sulfate is a medication that can cause severe allergic reactions in some people, such as anaphylaxis, which can be life-threatening.
Therefore, the nurse should always check the client’s allergy history before administering any medication, especially opioids.
Choice A is wrong because assessing the client’s respiratory rate is not the first action the nurse should take.
Although morphine sulfate can cause respiratory depression, which is a serious side effect that needs to be monitored, the nurse should first ensure that the client is not allergic to the medication.
Choice C is wrong because reviewing the client’s medication record is not the first action the nurse should take.
Although morphine sulfate can interact with other medications, such as sedatives, antidepressants, or alcohol, which can increase the risk of respiratory depression or overdose, the nurse should first ensure that the client is not allergic to the medication.
Choice D is wrong because verifying the dosage with another nurse is not the first action the nurse should take.
Although morphine sulfate is a high-alert medication that requires double-checking to prevent medication errors, the nurse should first ensure that the client is not allergic to the medication.
The nurse is caring for a client who has been prescribed acetaminophen, a non-opioid analgesic, for mild pain. Which laboratory test result should the nurse monitor closely in this client?
A. Serum creatinine
This is wrong because serum creatinine is a marker of kidney function and damage.Acetaminophen has limited nephrotoxicity compared to NSAIDs.
B. Serum potassium
This is wrong because serum potassium is not directly affected by acetaminophen. Serum potassium is an electrolyte that reflects fluid and acid-base balance in the body.
C. Serum albumin
This is wrong because serum albumin is a protein that is synthesized by the liver. Although serum albumin may be low in chronic liver disease, it is not a sensitive indicator of acute liver injury caused by acetaminophen overdose. Normal ranges for serum bilirubin are 0.3 to 1.2 mg/dL for adults and 1 to 12 mg/dL for newborns. Normal ranges for serum creatinine are 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women. Normal ranges for serum potassium are 3.5 to 5 mEq/L for adults and children. Normal ranges for serum albumin are 3.4 to 5.4 g/dL for adults and children.
D. Serum bilirubin.
The nurse should monitor the client’s serum bilirubin level closely because acetaminophen, a non-opioid analgesic, can cause hepatotoxicity and acute liver failure in cases of overdose. Serum bilirubin is a marker of liver function and damage. A high level of serum bilirubin indicates jaundice, a sign of liver injury.
Full Explanation
The correct answer is choice D. Serum bilirubin. The nurse should monitor the client’s serum bilirubin level closely because acetaminophen, a non-opioid analgesic, can cause hepatotoxicity and acute liver failure in cases of overdose.
Serum bilirubin is a marker of liver function and damage.
A high level of serum bilirubin indicates jaundice, a sign of liver injury.
Choice A is wrong because serum creatinine is a marker of kidney function and damage. Acetaminophen has limited nephrotoxicity compared to NSAIDs.
Choice B is wrong because serum potassium is not directly affected by acetaminophen.
Serum potassium is an electrolyte that reflects fluid and acid-base balance in the body.
Choice C is wrong because serum albumin is a protein that is synthesized by the liver.
Although serum albumin may be low in chronic liver disease, it is not a sensitive indicator of acute liver injury caused by acetaminophen overdose.
Normal ranges for serum bilirubin are 0.3 to 1.2 mg/dL for adults and 1 to 12 mg/dL for newborns.
Normal ranges for serum creatinine are 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women.
Normal ranges for serum potassium are 3.5 to 5 mEq/L for adults and children.
Normal ranges for serum albumin are 3.4 to 5.4 g/dL for adults and children.