A patient was prescribed chlorpropamide (Diabinese) for treatment ...

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A patient was prescribed chlorpropamide (Diabinese) for treatment of type 2 diabetes mellitus. One week after therapy was initiated, the patient comes to the clinic with report of nausea, flushing, and palpitations. The nurse prioritizes which assessment question?
 
  1. Have you taken your medication as directed?
  2. Did you eat or drink anything new this week?
  3. Have you increased the amount of fiber in your diet?
  4. Did you drink any alcoholic beverages this week?

Question 2

The nurse has been doing medication education for the client receiving lithium (Eskalith). Which statement by the client indicates that teaching has been effective?
 
  1. I need to call my physician if I excessively sweat during exercise.
  2. I need to restrict my intake of salt while I am taking lithium.
  3. I don't need to have my blood checked anymore after I leave the hospital.
  4. I can stop taking my lithium when my moods are stable.

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Answer to Question 1

4
Rationale 1: Assessing medication regimen compliance is important but is not the priority.
Rationale 2: Assessing dietary changes is important but is not the priority.
Rationale 3: Assessing dietary changes is important but is not the priority.
Rationale 4: When alcohol is taken with sulfonylureas, some patients experience a disulfiram-like reaction that includes flushing, palpitations, and nausea.

Global Rationale: When alcohol is taken with sulfonylureas, some patients experience a disulfiram-like reaction that includes flushing, palpitations, and nausea. Assessing medication regimen compliance is important but is not the priority. Assessing dietary changes is important but is not the priority.

Answer to Question 2

1

Rationale 1:Excessive sweating can have a dehydrating effect on the body, leading to lithium toxicity.
Rationale 2:I need to restrict my intake of salt while I am taking lithium is incorrect because if a client does not have a regular intake of salt, the kidneys will stop excreting lithium, and lithium toxicity will result.
Rationale 3:I don't need to have my blood checked anymore after I leave the hospital is incorrect because routine serum lithium levels are required every 23 months that a client is receiving this drug.
Rationale 4:I can stop taking my lithium when my moods are stable is incorrect because bipolar disorder is a chronic illness; treatment with a mood stabilizer like lithium is necessary throughout a client's life.

Global Rationale: Lithium, a mood stabilizer, must remain constant in the blood to be in the effective range of 0.61.5mEq/L. Lithium is taken as a salt, so it mixes in the bloodstream like sodium chloride. Conditions in which sodium is lost, like excessive sweating or urination, can cause the kidneys to reabsorb the lithium salts back into the blood, producing elevated serum levels of lithium known as lithium toxicity.

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Gracias!

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TYSM