NORCET 1 - 2020
Medical & Surgical Nursing
Medium
A patient is receiving mannitol. What is the role of the nurse for a patient on mannitol?
Appeared in: NORCET 1 - 2020
Explanation
- to monitor urine output.
- Mannitol is a powerful osmotic diuretic that pulls large amounts of fluid into the kidneys to be excreted as urine.
- Monitoring urine output is the most critical safety check to ensure the kidneys are functioning and can eliminate the fluid load.
- Failure to produce urine while on mannitol leads to rapid fluid volume overload, which can cause life-threatening pulmonary edema and heart failure.
- A urine output below 30 mL/hr is a critical sign that the drug should be stopped and the provider notified immediately.
Why Other Options Were Wrong
- Option A: While monitoring the therapeutic value (e.g., decreased intracranial pressure) is important, it is not the most immediate priority. The patient's physiological safety from the drug's side effects comes first.
- Option C: This answer is too general. While all nursing actions are aimed at patient safety, this option does not describe the specific, critical action required for a patient on mannitol.
- Option D: Diet management is not a primary or acute nursing responsibility related to mannitol administration, which is typically a short-term intervention for an acute condition.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Nursing responsibilities for administering osmotic diuretics to guide bedside assessment, documentation, and the next nursing action.
- Monitoring urine output is a fundamental nursing skill that becomes a critical safety intervention when administering potent drugs like mannitol.
- Failure to recognize decreased urine output in a patient receiving mannitol can lead to a rapid and fatal outcome from fluid overload.
- What if? If the patient has a pre-existing history of heart failure or renal insufficiency, the nurse's monitoring must be even more vigilant, as these patients are at an extremely high risk for complications. The threshold to alert the provider for low urine output would be even lower.
How to Approach the Question
- First, identify the drug mentioned in the question: Mannitol.
- Recall the drug class and its primary mechanism of action. Mannitol is an osmotic diuretic.
- Think about the primary effect of a diuretic: it makes you urinate. Now, consider the main risk associated with this powerful action.
- The biggest risk is what happens if the drug is given but the intended effect (urination) doesn't happen. The fluid pulled by the drug gets trapped in the body, causing overload.
- Therefore, the most critical nursing action is to monitor for the intended effect, which also serves as the primary safety check. In this case, that is monitoring urine output.
- Evaluate the options based on this priority. Monitoring urine output directly addresses the most significant and immediate risk of the drug, making it the best answer.
Concept Tested & Keywords
- Concept Tested: Nursing responsibilities for administering osmotic diuretics
- Stem keywords: patient, mannitol, role of the nurse
- Lead-in keywords: What is the role
Question ID
QsVV893l21M9QKKALDcIBA
Reference Book
E6 Pharmacology Nursing Lilley 11e Part 2 pp. 150-152, 170-172
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 81-83
Practise the full NORCET 1 - 2020
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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