25. Which order by a physician should a nurse question?
. A client with COPD who is prescribed metoprolol (Lopressor).
. A client with chronic renal failure receiving an aluminum hydroxide gel (Amphogel).
. A client with an abdominal aortic aneurysm (AAA) taking diltiazem (Cardizem).
. A client on long-term hemodialysis receiving epoetin alfa (Epogen).
Test-Taking Tip
Three of the answers produce the desired effect for the condition; one does not. Think about the drug action and the potential for an adverse effect as the result of the drug's normal action.
Content Area: Adult Health, Respiratory; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Adverse Effects/Contraindications/Interactions
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Answer 1 is correct because beta blockers (metoprolol) cause bronchoconstriction. Note that the client already has a respiratory problem. Answer 2 is incorrect because an aluminum hydroxide gel is used to reduce the elevated phosphate level, which results in renal failure. Answer 3 is incorrect because calcium channel blockers (diltiazem) are used to control blood pressure in the client with an AAA. Answer 4 is incorrect because clients on hemodialysis are often anemic. Epoetin stimulates RBC production.