Nokea
Which of the following are evaluations the nurse should make when caring for a client receiving naloxone?
- A. Pain relief is resumed.
- B. Adverse reactions are identified and managed.
- C. Therapeutic response is achieved.
- D. Client demonstrates an understanding of the drug regimen.
- E. Client's respiratory rate is normal.
Correct Answer: A,B,C,D,E
Rationale: Pain relief is resumed, adverse reactions are identified and managed, therapeutic response is achieved, client demonstrates an understanding of the drug regimen, and client's respiratory rate is normal are evaluations of successful therapy with an opioid antagonist.
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A nurse determines that an opioid antagonist would most likely be needed in which situation?
- A. Postoperative acute respiratory depression
- B. Reversal of phenytoin toxicity
- C. Reversal of opioid-induced hypotension
- D. Suspected acute benzodiazepine overdosage
- E. Suspected acute opioid overdosage
Correct Answer: A,C,E
Rationale: Opioid antagonists are used for the treatment of the following: postoperative acute respiratory depression, reversal of opioid adverse effects (hypotension, bradycardia, etc.), and suspected acute opioid overdosage.
A nurse would expect to administer naloxone cautiously to which client?
- A. A client who is pregnant
- B. A client with cardiovascular disease
- C. A client with an alcohol dependency
- D. A client with an opioid dependency
- E. A client with chronic obstructive pulmonary disease
Correct Answer: A,B,D
Rationale: Opioid antagonists like naloxone (Narcan) should be used cautiously in those who are pregnant or lactating, in infants of opioid-dependent mothers, and in clients with an opioid dependency or cardiovascular disease.
If time allows, the nurse should review which of the following with the client prior to administering an opioid antagonist?
- A. Initial health history
- B. Allergy history
- C. Bowel history
- D. Family medical history
- E. Current treatment modalities
Correct Answer: A,B,E
Rationale: If time allows, the nurse should review the client's initial health history, allergy history, and current treatment modalities prior to administering an opioid antagonist.
A client with chronic back pain is admitted to a local health care facility for respiratory depression secondary to an inadvertent overdose of his opioid analgesic. The client is to receive naloxone. Which of the following would the nurse include before administering naloxone?
- A. Monitor the client's blood pressure every 5 minutes.
- B. Review the client's allergy history and treatment modalities.
- C. Monitor vital signs every 5 to 15 minutes if the client is responsive.
- D. Monitor respiratory rate and rhythm of the client.
Correct Answer: B
Rationale: Before administering the antagonist, the nurse should review the client's initial health history, allergy history, and treatment modalities. The nurse should also obtain the client's blood pressure, pulse, and respiratory rate and review the record for the drug suspected of causing the symptoms of respiratory depression. All these interventions are part of the preadministration assessment.
A primary health care provider orders opioid antagonist treatment for a client with respiratory depression. The nurse should be aware of which of the following conditions that can occur during an abrupt reversal of opioid respiratory treatment?
- A. Dizziness
- B. Headache
- C. Vomiting
- D. Lightheadedness
Correct Answer: C
Rationale: The nurse should know that an abrupt reversal of opioid respiratory depression with an opioid antagonist results in vomiting. The nurse must maintain a patent airway and should turn and suction the client as needed in such cases. Headache, dizziness, and lightheadedness are not known to occur during an abrupt reversal of opioid respiratory treatment.