A patient complains of vomiting, diarrhea, and insomnia. During ...

[LCritchfi]

A patient complains of vomiting, diarrhea, and insomnia. During the assessment, the patient begins having seizures. The nurse suspects theophylline toxicity. Which of the following actions would be the nurse's priority intervention?
 
  a. Obtain a stat theophylline level.
  b. Call the prescriber.
  c. Administer charcoal.
  d. Protect the patient from injury and monitor the airway.

Question 2

A patient in heart failure shows a decrease in the glomerular filtration rate. The patient has been taking digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL).
 
  Considering the change in the patient's status, what change in the medication regimen would the nurse anticipate? a. A change from hydrochlorothiazide (HydroDIURIL) to furosemide (Lasix)
  b. A change from hydrochlorothiazide (HydroDIURIL) to spironolactone (Aldac-tone)
  c. A change from hydrochlorothiazide (HydroDIURIL) to mannitol (Osmitrol)
  d. A change from digoxin (Lanoxin) to verapamil (Calan)

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Answer to Question 1

D
When a patient is having a seizure, regardless of the potential cause, the priority of care is patient safety, along with airway, breathing, and circulation (ABCs).
Although blood should be drawn for measurement of a stat theophylline level. it should not be done until the patient's condition has stabilized.
Although the prescriber should be called, that activity can be delegated to someone else while the nurse takes care of the emergency needs of the patient.
Although the symptoms of theophylline toxicity are present (nausea, vomiting, diarrhea, sei-zures), the diagnosis of theophylline toxicity has not been confirmed by serum values, therefore administering activated charcoal at this time would be premature.

Answer to Question 2

A
The decrease in the GFR indicates the need for a stronger diuretic to help pull volume off the patient. Furosemide is the drug of choice for diuresis. Loop diuretics are preferred to thiazides when cardiac output is greatly reduced and renal insufficiency is a factor.
Spironolactone is not as strong a diuretic as furosemide and would not facilitate the GFR as well.
Mannitol is indicated for brain injury and hydrocephalus.
Nothing indicates that digoxin should be changed to verapamil; the issue in this scenario is the low GFR and the fact that thiazide diuretics are not effective in patients with renal dysfunction.

[LCritchfi]

TYSM

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