A nurse is reviewing the laboratory values for a client who has heart failure and is taking bumetanide. For which of the following results should the nurse notify the provider?
Calcium 10 mg/dL
Sodium 136 mEq/L
Potassium 2.3 mEq/L
Magnesium 1.4 mEq/L
The Correct Answer is C
A. Calcium 10 mg/dL: This calcium level is within the normal range (8.6-10.2 mg/dL) and does not require intervention.
B. Sodium 136 mEq/L: This sodium level is within the normal range (135-145 mEq/L).
C. Potassium 2.3 mEq/L: This potassium level is critically low; bumetanide is a loop diuretic that can cause hypokalemia, which can lead to dangerous cardiac dysrhythmias.
D. Magnesium 1.4 mEq/L: While slightly low, this magnesium level is only mildly decreased and not as immediately concerning as the potassium level.
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Correct Answer is D
Explanation
A. Depression: While propranolol can sometimes worsen symptoms of depression, this is not as critical as the impact on conditions like heart failure.
B. Glaucoma: Propranolol does not typically affect glaucoma; however, some beta-blockers are used to treat glaucoma.
C. Migraine: Propranolol is sometimes used to prevent migraines, so a history of migraines would not require discontinuation.
D. Heart failure: Propranolol can exacerbate heart failure by reducing myocardial contractility. Clients with heart failure require careful monitoring or an alternative medication.
Correct Answer is D
Explanation
A. Barrel chest. A barrel chest is commonly seen in chronic obstructive pulmonary disease (COPD) rather than mitral valve stenosis.
B. Bradycardia. Bradycardia is not typically associated with mitral valve stenosis, as symptoms often include rapid or irregular heartbeat.
C. Clubbing of the fingers. Clubbing is associated with chronic hypoxia, often due to pulmonary conditions, not specifically with mitral valve stenosis.
D. Heart murmur. Mitral valve stenosis causes turbulent blood flow through the narrowed valve, resulting in a characteristic murmur.