A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client?

Check the client's belongings for additional drugs.

Pad the side rails of the bed because seizures are likely.

Prepare a dose of ipecac, an emetic.

Monitor respiratory function.

Answer and Explanation

The Correct Answer is D

D. Barbiturates can cause respiratory depression, hypoventilation, and potentially respiratory arrest, which can lead to hypoxia and cardiac arrest if not promptly recognized and managed.

A. While it's important to assess for any additional drugs or substances that the client may have ingested, this action is not the priority when managing a client with a barbiturate overdose.

B. Seizures can occur as a result of barbiturate overdose, but respiratory depression is the more immediate and life-threatening concern.

C. Ipecac is no longer recommended for the induction of vomiting in cases of drug overdose due to the risk of complications such as aspiration pneumonia and delayed treatment.

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Correct Answer is D

Explanation

D. Remaining with the client provides support and reassurance during a period of agitation and restlessness. The presence of the nurse can help the client feel safe and supported, and it allows the nurse to assess the client's condition closely and intervene as needed.

A. While administering a PRN (as needed) sleeping medication may be considered in some situations, it is not the first-line intervention when a client is experiencing agitation and restlessness.

B. Encouraging the client to return to bed may be appropriate if they are willing and able to do so. However, if the client is agitated and pacing the floor, they may not feel comfortable or able to go back to bed.

C. Exploring alternatives to pacing the floor involves assessing the client's needs and preferences and identifying activities or strategies that may help alleviate agitation and promote relaxation. However, proper observation of the client behavior should be prioritized.

A. The client cannot claim abuse if there is no evidence of physical harm. B. Laws do not provide protection against abuse when the suspect(s) is/are family members. C. The client has no financial resources to hire legal representation against the client's children. D. The client is emotionally close to the children and does not want to bring them harm.

Correct Answer is D

Explanation

D. Victims of abuse, especially perpetrated by family members, may feel conflicted about reporting the abuse due to feelings of guilt, shame, or fear of repercussions.

A. This implies that the client may believe they cannot report the abuse because they perceive abuse as only valid if there is physical evidence of harm. However, it's important to recognize that abuse can take various forms, including emotional, psychological, financial, and neglectful abuse, which may not always leave physical evidence.

B. While it's true that cases of abuse perpetrated by family members can be complex and challenging to address legally, there are laws and resources available to protect victims of family abuse. Many jurisdictions have laws specifically addressing domestic violence and elder abuse.

C. Reporting abuse to appropriate authorities, such as adult protective services or law enforcement, does not necessarily require hiring legal representation.

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A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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