The nurse is admitting a new client from the emergency department who suffered a hemorrhagic stroke three days ago. Which of the following prescriptions and orders should the nurse question?Cassidy RhodyID: 112703Question 23Select all that apply:Insert an indwelling catheter due to impaired eliminationLabetalol 10 mg IV PRNIntake of 2000 mL of fluids per dayEnoxaparin 1 mg/kg SC q12hrsActive range-of-motion (ROM) exercises every 4 hours
Question
The nurse is admitting a new client from the emergency department who suffered a hemorrhagic stroke three days ago. Which of the following prescriptions and orders should the nurse question?Cassidy RhodyID: 112703Question 23Select all that apply:Insert an indwelling catheter due to impaired eliminationLabetalol 10 mg IV PRNIntake of 2000 mL of fluids per dayEnoxaparin 1 mg/kg SC q12hrsActive range-of-motion (ROM) exercises every 4 hours
Solution
The nurse should question the following prescriptions and orders:
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"Labetalol 10 mg IV PRN": Labetalol is a beta-blocker used to treat high blood pressure. However, in the case of a hemorrhagic stroke, it could potentially lower blood pressure too much and reduce blood flow to the brain, worsening the patient's condition.
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"Enoxaparin 1 mg/kg SC q12hrs": Enoxaparin is an anticoagulant, or blood thinner, which is usually used to prevent blood clots. In the case of a hemorrhagic stroke, where there is bleeding in the brain, the use of blood thinners could potentially increase the risk of further bleeding.
The other orders seem appropriate. An indwelling catheter may be necessary due to impaired elimination. The intake of 2000 mL of fluids per day can help to prevent dehydration. Active range-of-motion (ROM) exercises every 4 hours can help to prevent muscle stiffness and joint contractures.
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