Nokea
A client who is newly diagnosed with Parkinson's disease and beginning medication therapy asks the nurse, 'How soon will I see improvement?' The nurse's best response is:
- A. That varies from client to client
- B. You should discuss that with your physician
- C. You should notice a difference in a few days
- D. It might take several weeks before you notice improvement
Correct Answer: D
Rationale: Parkinson's medications often take several weeks to show improvement, as they gradually adjust neurotransmitter levels to manage symptoms.
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The client is prescribed varenicline for smoking cessation. The nurse concludes that varenicline is being prescribed primarily for its antagonistic effect. Which statement describes this effect?
- A. Gets readily absorbed into the bloodstream for rapid effectiveness
- B. Demonstrates a high degree of attractiveness for a specific receptor
- C. Blocks receptors in the brain that produce the pleasurable effects of smoking
- D. Stimulates receptors stimulated by smoking, producing similar pleasurable effects.
Correct Answer: C
Rationale: Varenicline (Chantix) functions as an antagonist, blocking receptors to reduce the pleasurable effects of smoking.
The nurse is caring for a group of clients all in need of pain medication. The nurse has determined the most appropriate pain medication for each client based on the client's level of pain. Prioritize the order that the nurse should plan to administer the pain medications, beginning with the most potent analgesic for the client with the most severe pain.
- A. Ketorolac 10 mg oral
- B. Fentanyl 0.1 mg IV bolus per patient-controlled analgesia (PCA)
- C. Hydromorphone 5 mg oral
- D. Morphine sulfate 4 mg IV
- E. Propoxyphene 65 mg oral
Correct Answer: B,D,C,A,E
Rationale: B: Fentanyl 0.1 mg IV bolus per PCA. Fentanyl (Sublimaze), the most potent of the medications, is an opioid narcotic analgesic that binds to opiate receptors in the CNS, altering the response to and perception of pain. A dose of 0.1 to 0.2 mg is equivalent to 10 mg of morphine sulfate. D: Morphine sulfate 4 mg IV. Morphine sulfate is also an opioid analgesic. This dose is IV and would be fast-acting. C: Hydromorphone 5 mg oral. Hydromorphone (Dilaudid), another opioid analgesic, would be next in priority. The oral dosing of this medication would indicate that the client's pain is less severe than the client receiving fentanyl or morphine sulfate. Hydromorphone 7.5 mg oral is an equianalgesic dose to 30 mg of oral morphine or 10 mg parenteral morphine. A: Ketorolac 10 mg oral. Ketorolac (Toradol) is an NSAID and nonopioid analgesic that inhibits prostaglandin synthesis, producing peripherally mediated analgesia. E: Propoxyphene 65 mg oral. Propoxyphene (Darvon) should be given last. It binds to opiate receptors in the CNS but is used in treating mild to moderate pain. It has analgesic effects similar to acetaminophen's.
The nurse observes a colleague about to administer an IM injection to the 12-month-old. Which intervention requires the nurse to intervene?
- A. Prepares to give no more than 2 mL of fluid
- B. Plans to give the injection using a 1-inch needle
- C. Plans to give the injection in the dorsal gluteal site
- D. Plans to give the injection after applying lidocaine/prilocaine cream
Correct Answer: C
Rationale: A: No more than 2 mL of fluid should be injected into a muscle. B: The appropriate needle length for an IM injection for children ages 2 to 12 months is 1 inch and 1% inch for toddlers. C: Use of the dorsal gluteal site is not recommended due to a high risk of nerve damage. D: Use of lidocaine/prilocaine cream (EMLA) to numb the area is suggested when time allows but is not required.
The initial treatment regimen of isoniazid, rifampin, and ethambutol is prescribed for the adolescent who has a positive tuberculin skin test. The client confides that she thinks she may be pregnant and asks if she should be taking these medications. Which rationale should be the basis for the nurse's response?
- A. These drugs cross the placental barrier, and treatment should be withheld until the postpartum period.
- B. The medications should be taken, but the diagnosis is an indication for termination of the pregnancy.
- C. The medications should be postponed because the risk for hepatitis is greatly increased in the intrapartum period.
- D. The medications should be taken; untreated TB represents a far greater hazard to the pregnant woman and her fetus.
Correct Answer: D
Rationale: A: The medications do not cross the placental barrier, so treatment should not be withheld. B: Administering antituberculosis medications would not be an indication for termination of pregnancy because the medications are safe during pregnancy. C: The risk of hepatitis is slightly increased with the use of antituberculosis medications in pregnant women; however, the benefits of treatment strongly outweigh postponement of treatment. D: Infants born to women with untreated TB may be of lower birth weight, but rarely would the infant acquire congenital TB. Isoniazid (Nydrazid), rifampin (Rifadin), and ethambutol (Myambutol) are all considered safe for use in pregnancy.
The client admitted to the ED has drowsiness, clammy skin, and slow, shallow breathing. A friend states that the client took multiple oxycodone tablets. Which medication should the nurse plan to administer to this client?
- A. Naloxone
- B. Disulfiram
- C. Flumazenil
- D. Acetylcysteine
Correct Answer: A
Rationale: Naloxone (Narcan) reverses CNS and respiratory depression due to opioid overdose.