The nurse is caring for a client who experienced a severe headache. When the prescribed dose of analgesics did not cause relief, the client took double the dosage 1 hour later. The nurse should assess the client for what adverse effect?
An allergic reaction
Anaphylactic reaction
Poisoning
Sedative effects
The Correct Answer is C
A. An allergic reaction is a possible response to medication, but it is not directly related to doubling the dosage.
B. Anaphylactic reaction is a severe and rapid allergic response; while possible, it is not the most likely consequence of an overdose in this context.
C. Poisoning is a likely concern when a client takes double the prescribed dosage of analgesics, especially if the medication has a narrow therapeutic index or is known to cause toxicity at high doses.
D. Sedative effects could occur depending on the analgesic used, but poisoning is a more pressing concern following an overdose.
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Correct Answer is A
Explanation
A. Hypocalcemia is correct because esomeprazole, a proton pump inhibitor, can lead to decreased calcium absorption, resulting in low calcium levels, which can cause muscle cramps.
B. Hyperkalemia is incorrect; while potassium levels can be affected by various medications, muscle cramps are not typically associated with high potassium levels.
C. Hypercalcemia is incorrect as it refers to elevated calcium levels, which would not cause muscle cramps and could actually lead to muscle weakness rather than cramping.
D. Hyponatremia is incorrect; low sodium levels may cause other symptoms but are not specifically linked to muscle cramps in the same way as low calcium levels are.
Correct Answer is B
Explanation
A. While dietary intake is important, especially regarding sodium and fluid balance, it is not the highest priority compared to monitoring blood pressure.
B. Monitoring the client's blood pressure is essential to evaluate the effectiveness of the prescribed antihypertensive medications and to ensure the client is within the target range for managing her hypertension.
C. Weighing the client is important for monitoring fluid retention, especially with hydrochlorothiazide, but it is secondary to direct blood pressure monitoring.
D. Monitoring the respiratory rate is generally less critical in this scenario unless there are specific concerns related to medication side effects or respiratory conditions.