The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be

Correct Answer: A

Rationale: In this scenario, the priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be option A) Ineffective tissue perfusion (cerebral and cardiovascular) related to effects of medication. This is the correct answer because metoprolol is a beta-blocker medication that works by slowing the heart rate and reducing the workload on the heart. As a result, it can potentially cause a decrease in blood pressure and cardiac output, leading to inadequate tissue perfusion, especially in vital organs like the brain and heart. Option B) Disturbed sensory perception related to adverse central nervous system effects of the drug is not the priority nursing diagnosis for a patient taking metoprolol. While beta-blockers can have central nervous system side effects like dizziness or fatigue, the risk of inadequate tissue perfusion is a more immediate concern that takes precedence in this case. Option C) Deficient knowledge related to therapeutic regimen and option D) Risk for injury related to possible side effects of the adrenergic blockers are also not the priority nursing diagnoses in this situation. While patient education and monitoring for side effects are important aspects of care, ensuring adequate tissue perfusion is crucial for the patient's immediate well-being. Educationally, understanding the rationale behind selecting the priority nursing diagnosis helps students grasp the importance of critical thinking in nursing practice. By prioritizing the most urgent needs of the patient, nurses can provide timely and effective care to ensure optimal outcomes. This case highlights the significance of assessing and addressing potential complications of specific medications to promote patient safety and well-being.

Correct Answer: B

Rationale: In this scenario, option B, "the residue of the inhaler propellant is coating the inside of the mouth," is the correct answer. When individuals use inhalers for asthma therapy, the propellant in the inhaler can leave a residue that coats the inside of the mouth and throat. This residue can cause irritation and inflammation, leading to a sore throat and the appearance of white patches in the throat. Option A, bacterial infection from the inhaler, is incorrect because the presence of white patches in the throat is not typically associated with a bacterial infection caused directly by the inhaler. Option C, allergic reaction to the medication, is also incorrect as allergic reactions usually manifest differently, such as with swelling or itching, rather than white patches. Option D, viral infection from improper hygiene, is incorrect because the presence of white patches is not typically indicative of a viral infection related to hygiene practices. From an educational perspective, understanding the potential side effects of asthma therapy and the importance of proper inhaler technique is crucial for healthcare providers and patients. Educating patients on how to properly use their inhalers, including rinsing the mouth after each use to minimize residue buildup, can help prevent side effects like sore throat and white patches, improving overall treatment outcomes and patient comfort.

Correct Answer: A

Rationale: In this scenario, the correct intervention is option A: Make no change in Glucophage dose. The rationale behind this choice is based on the patient's HgbA1C level of 6.7%, which indicates fairly good blood sugar control. The advanced practice nurse would want to maintain the current treatment plan as it appears to be effective in managing the patient's diabetes. Option B, adding a sulfonylurea drug like Diabenese, would be an aggressive approach and may increase the risk of hypoglycemia in the patient, especially considering the current HgbA1C level. Option C, decreasing Glucophage to 500mg BID, would likely result in poorer blood sugar control as the current dose seems to be effective based on the lab results. Option D, adding NPH insulin BID, would be an unnecessary escalation of treatment at this point, given the patient's relatively good glycemic control with the current regimen. From an educational standpoint, it is crucial for healthcare providers to interpret lab results in the context of the individual patient and their current treatment plan. Understanding how to adjust medications based on lab values is a critical skill in pharmacology across the lifespan, especially when managing chronic conditions like diabetes in older adults. It is important to prioritize patient safety and effective management of the disease while minimizing adverse effects.

Correct Answer: C

Rationale: In this scenario, the correct answer is to increase the evening dose of NPH insulin that works from bedtime to morning (Option C). This recommendation is based on understanding the pharmacokinetics and pharmacodynamics of NPH insulin. NPH insulin is an intermediate-acting insulin that peaks about 4-12 hours after injection, making it suitable for overnight coverage. Increasing the NPH insulin dose will help address the elevated morning blood glucose levels, ensuring better glycemic control during the early morning hours when the child's glucose levels are high. This adjustment aligns with the child's current insulin regimen and the observed pattern of elevated glucose levels in the morning. The other options are incorrect because decreasing the evening dose of NPH insulin (Option A) could worsen the morning hyperglycemia, and increasing the evening dose of regular insulin (Option B) or decreasing the evening dose of regular insulin (Option D) would not directly address the issue of elevated morning glucose levels caused by the NPH insulin deficiency during that time period. From an educational perspective, this question highlights the importance of understanding the onset, peak, and duration of different types of insulin in managing diabetes effectively across the lifespan. It emphasizes the need for healthcare providers to tailor insulin regimens to individual patients based on their unique needs and response to treatment.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Dysrhythmias and seizures. When a patient is prescribed oral theophylline for COPD, it is crucial for the nurse to monitor the patient for potential complications such as dysrhythmias and seizures. Theophylline is a bronchodilator that works by relaxing the muscles in the airways, but it can also have side effects on the cardiovascular system, leading to dysrhythmias, which can be life-threatening, and seizures due to its narrow therapeutic index. Option B) Thirst and polydipsia is incorrect because theophylline does not typically cause these symptoms. Option C) Hematuria and hypotension are also incorrect as they are not common side effects associated with theophylline use. Option D) Anaphylactoid reactions are not a common concern with theophylline administration. From an educational perspective, understanding the potential side effects and complications of medications used in COPD treatment is vital for nurses to provide safe and effective care to their patients. Monitoring for specific adverse effects of theophylline, such as dysrhythmias and seizures, allows nurses to intervene promptly and prevent serious consequences. This knowledge enhances the nurse's ability to assess, plan, and implement appropriate care for patients with COPD receiving theophylline therapy.