A nurse is reviewing the laboratory findings for a female client who is taking zidovudine to treat HIV. Which of the following should the nurse identify as an adverse finding associated with this medication?
Neutrophil count 650/mm³ (2,500 to 8,000/mm³).
Platelets 450,000/mm³ (150,000 to 400,000/mm³).
Hgb 17 g/dL (12 to 16 g/dL).
Creatinine 1.5 mg/dL (0.5 to 1 mg/dL).
The Correct Answer is A
Choice A rationale
A neutrophil count of 650/mm³ is significantly lower than the normal range (2,500 to 8,000/mm³) and indicates neutropenia, which is a known adverse effect of zidovudine. Neutropenia increases the risk of infections and requires close monitoring and potential dose adjustment or discontinuation of the medication.
Choice B rationale
A platelet count of 450,000/mm³ is slightly above the normal range (150,000 to 400,000/mm³) but is not typically associated with zidovudine toxicity. Zidovudine is more commonly associated with bone marrow suppression leading to anemia and neutropenia rather than thrombocytosis.
Choice C rationale
An Hgb level of 17 g/dL is above the normal range for females (12 to 16 g/dL) but is not a common adverse effect of zidovudine. Zidovudine is more likely to cause anemia, leading to lower hemoglobin levels rather than elevated levels.
Choice D rationale
A creatinine level of 1.5 mg/dL is within the upper limit of the normal range (0.5 to 1 mg/dL) and is not a typical adverse effect of zidovudine. Zidovudine primarily affects the bone marrow and does not have a significant impact on renal function.
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Correct Answer is E
Explanation
Choice A rationale
Hypercalcemia is not typically a risk in the emergency department unless the patient has a specific condition that causes elevated calcium levels.
Choice B rationale
Hypotension can occur in the emergency department, especially in cases of shock or severe dehydration, but it is not the most common risk.
Choice C rationale
Hypokalemia can occur, particularly in patients with certain medical conditions or those taking diuretics, but it is not the most common risk.
Choice D rationale
Hypernatremia can occur, especially in patients with dehydration or certain medical conditions, but it is not the most common risk.
Choice E rationale
Hypoglycemia is a common risk in the emergency department, especially in patients with diabetes or those who have not eaten for an extended period.
Correct Answer is B
Explanation
Choice A rationale
Decreased excretion of urine sodium is not an expected therapeutic effect of bumetanide. Bumetanide is a loop diuretic that works by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle, leading to increased excretion of sodium and water.
Choice B rationale
Increased urinary output is the expected therapeutic effect of bumetanide. As a potent loop diuretic, bumetanide increases the excretion of water and electrolytes, which helps reduce fluid accumulation in conditions like ascites.
Choice C rationale
Decreased serum glucose is not associated with bumetanide. Bumetanide primarily affects fluid and electrolyte balance and does not have a significant impact on blood glucose levels.
Choice D rationale
Increased blood pressure is not an expected effect of bumetanide. On the contrary, bumetanide can help lower blood pressure by reducing fluid volume and decreasing the workload on the heart.