Question

​A nurse is caring for a client taking vancomycin. The provider has ordered a trough level to be drawn. When should the nurse obtain the blood specimen?

​​A nurse is taking care of a client postangiography. What position should the client be placed in immediately after this procedure?

​A nurse is completing an assessment on a client receiving IV fluids. List three (3) assessment findings that indicate fluid volume overload.

A nurse is providing instructions to a client preparing for an IV urography. In addition, the nurse has informed the client that her metformin will be held. What is the rationale for holding the client's metformin for their procedure?

​A nurse is caring for a client who has dysphagia following an ischemic stroke. The nurse understands that the client must be kept NPO until being evaluated by what member of the health care team?

Answer 1

1.Vancomycin trough level is drawn immediately prior to the next dose of the drug( before the fourth dose) is administered .T[It is checked to optimize the therapy and to measure the efectiveness of the drug.

2.The cline should keep the affected extremity straight to reduce bleeding and a sandbag is palced over it to prevent bleeding after angiography.

3.Fluid overload assessment findings:

Cardiovascular:

• Bounding increased pulse rate
• Increased blood pressure
• Distended neck and hand veins
• Dysarrhythmias
• Elevated CVP

Respiratory:

• Dyspnea
• Tachypnea and shallow respirations
• Moist crackles on auscultation

Neuromuscular:

• Altered level of consciousness
• Headache,visual disturbances
• Skeletal muscle weakness,paresthesias

Gastrointestinal:

• diarrhoea
• Increased weight
• Ascitis
• increased motility
• liver enlargement

Integumentary:

• Pale,cool skin
• Pitting edema

Renal:

• Increased or decreased urine output depending on the kidney function

Laboratory findings:

• Decreased serum sodium,serum osmolality,BUN and urine specific gravity

4.Metformin is withheld before urography because in this procedure iodinated contrast medium is used .This may cause acute renal failure.Metformin is excreted through kidneys and this will accumulate in kidneys if renal failure develops and this would lead to life threatening lactic acidosis.Therefore metformin is withheld 24 hours prior to the procedure and 48 hours after that.

5.The client should should be kept NPO until being evaluated by a Speech and Language therapist as they would help the client to manage the dysphasia after the ischemic stroke.