Medication Safety & Consequences
A patient with dehydration is prescribed this IV fluid to restore intravascular volume.
What is an isotonic fluid (e.g., Lactated Ringer’s or 0.9% NS)?
Which finding most strongly suggests impaired kidney function rather than a temporary fluid shift?
A. Sodium 130 mEq/L
B. BUN 36 mg/dL
C. Creatinine 2.3 mg/dL
D. Potassium 4.9 mEq/L
What is creatinine 2.3 mg/dL?
A patient with a history of heart failure reports intermittent dizziness and lower-extremity edema. Which patient statement requires immediate clarification?
A. “I will weigh myself daily and report sudden weight gain.”
B. “I will limit my sodium intake.”
C. “If I feel dizzy, I will drink large amounts of water.”
D. “I will notify my provider if my swelling worsens.”
What is “If I feel dizzy, I will drink large amounts of water”?
A patient is anxious, tachycardic, and pale. Blood pressure is normal.
What problem should the nurse focus on?
What is compensated hypoperfusion?
Which patient is most unstable?
A. Crackles at lung bases, SpO₂ 94%, RR 22
B. Weight gain of 3 lb in 24 hours with ankle edema
C. Dyspnea at rest with pink frothy sputum, RR 30
D. Orthopnea relieved by two pillows
Who is the patient with dyspnea at rest and pink frothy sputum?
A patient with potassium 6.1 mEq/L is receiving a new medication. Which type of medication would be most dangerous?
What is a potassium-sparing diuretic?
A patient’s data include:
Sodium 126 mEq/L
Potassium 5.4 mEq/L
Creatinine 1.9 mg/dL
Reports mild headache
Which finding should the nurse prioritize first?
What is potassium 5.4 mEq/L?
A patient with coronary artery disease says,
“As long as my blood pressure is normal, my heart is getting enough blood.”
Which response by the nurse is most important?
What is “Blood pressure alone does not reflect how well your heart muscle is being perfused”?
Vital signs are within normal limits, but the patient is increasingly confused.
What is the most likely underlying issue?
What is early impaired perfusion?
Which patient is the highest priority?
A. Dry mucous membranes and thirst
B. HR 104 with BP 118/72
C. HR 120 with dizziness on standing
D. Decreased skin turgor
Who is the patient with HR 120 and dizziness on standing?
A patient with head trauma and hyponatremia becomes increasingly confused. Which IV fluid would worsen cerebral edema?
What is D5W?
A patient’s ABG shows:
pH 7.30
PaCO₂ 50 mm Hg
HCO₃⁻ 24 mEq/L
Which assessment finding would be most concerning if present?
A. Shallow respirations
B. Diarrhea
C. Muscle twitching
D. Vomiting
What is shallow respirations?
A patient with heart failure receives discharge teaching. Which patient statement indicates correct understanding of when to notify the provider?
What is “I will call my provider if I gain more than 2–3 pounds in one day or 5 pounds in a week”?
A patient has sodium 127 mEq/L and potassium 5.7 mEq/L.
The patient reports palpitations.
What is the real problem?
What is risk for cardiac dysrhythmias?
Which patient requires immediate intervention?
A. Chronic kidney disease with creatinine 2.4 mg/dL, stable
B. Creatinine increased from 1.0 to 2.3 mg/dL in 24 hours
C. BUN 36 mg/dL with nausea
D. Sodium 130 mEq/L with headache
Who is the patient with a rapid rise in creatinine from 1.0 to 2.3 mg/dL?
A patient receiving IV fluids develops crackles and dyspnea. Which medication-related action would be unsafe without further assessment?
What is increasing the IV fluid rate?
A nurse reviews the following:
Creatinine 2.6 mg/dL
Potassium 5.8 mEq/L
Patient reports palpitations
Which conclusion should change the plan of care immediately?
What is increased risk for cardiac dysrhythmias due to impaired potassium clearance?
A patient with chronic kidney disease is reviewing dietary changes. Which food choice requires further teaching?
A. Fresh apples
B. White rice
C. Baked potato
D. Green beans
What is a baked potato?
A patient is admitted for “dehydration.” Assessment shows tachycardia and altered mental status.
What problem should guide nursing care?
What is reduced circulating volume affecting perfusion?
Which patient should the nurse see first?
A. pH 7.48, PaCO₂ 30, RR 28 (anxious, hyperventilating)
B. pH 7.31, PaCO₂ 52, shallow respirations
C. pH 7.36, HCO₃⁻ 18, stable vitals
D. pH 7.44, PaCO₂ 35, SpO₂ 96%
Who is the patient with pH 7.31 and PaCO₂ 52 with shallow respirations?
A patient has the following assessment findings:
Urine output: 18 mL/hr
Creatinine: 2.7 mg/dL
BUN: 44 mg/dL
Blood pressure stable
The provider orders vancomycin IV. What is the most appropriate nursing response?
What is to question the order due to risk of nephrotoxicity and impaired renal clearance?
A patient’s data include:
Sodium 128 mEq/L
Potassium 5.9 mEq/L
Creatinine 2.4 mg/dL
pH 7.31
PaCO₂ 48 mm Hg
BP stable
What is the most important clinical implication of this data?
What is high risk for sudden deterioration despite stable vital signs?
A patient with newly diagnosed hypertension asks what changes will most reduce future cardiovascular risk. Which teaching point is most important?
What is smoking cessation?
A patient’s arterial blood gas results are:
pH 7.30
PaCO₂ 52 mm Hg
HCO₃⁻ 25 mEq/L
The patient is receiving opioid pain medication and has shallow respirations.
What is the real problem the nurse must address?
Impaired ventilation leading to respiratory acidosis and decreased oxygen delivery
Which patient is the highest priority?
A. Acute decompensated HF, crackles halfway up lungs, SpO₂ 92%, BP 146/84
B. AKI with creatinine 2.6 mg/dL, potassium 5.7 mEq/L, asymptomatic
C. pH 7.29, PaCO₂ 50, RR 10 after opioid administration
D. Fluid volume deficit with HR 112, BP 104/68, dry mucous membranes
Who is the patient with pH 7.29, PaCO₂ 50, RR 10 after opioid administration?