A client with a history of schizophrenia, and drug and alcohol abuse is admitted to the hospital for hepatitis. The nurse should contact the healthcare provider before implementing which prescription?

Acetaminophen 650 mg PO PRN.

Olanzapine 30 mg PO at bedtime.

Thiamine, USP 100 mg PO daily.

Ondansetron 8 mg IV PRN.

Answer and Explanation

The Correct Answer is A

Choice A reason: Acetaminophen is hepatotoxic, metabolized by the liver via cytochrome P450 to NAPQI, which depletes glutathione, causing necrosis in hepatitis. A compromised liver from alcohol or viral hepatitis increases toxicity risk, even at standard doses. Contacting the provider ensures safer analgesics, preventing further liver damage in this high-risk client.

Choice B reason: Olanzapine, an antipsychotic, manages schizophrenia by blocking dopamine D2 receptors. It is metabolized by the liver but has low hepatotoxicity risk compared to acetaminophen in hepatitis. No immediate contraindication exists, as it controls psychosis without significantly worsening liver function, making it safe to administer without delay.

Choice C reason: Thiamine (vitamin B1) is essential in hepatitis, particularly with alcohol abuse, preventing Wernicke’s encephalopathy from deficient glucose metabolism. It is liver-safe and beneficial, supporting neurological function without toxicity. Administering thiamine is appropriate, making it unnecessary to contact the provider before implementation.

Choice D reason: Ondansetron, an antiemetic, controls nausea in hepatitis via serotonin 5-HT3 receptor blockade. It is metabolized by the liver but has minimal hepatotoxicity, safe in liver disease. No contraindication exists, as it alleviates symptoms without worsening hepatitis, unlike acetaminophen, which poses significant liver risk.

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Correct Answer is A

Explanation

Choice A reason: Clear breath sounds indicate effective suctioning, as it removes secretions obstructing the airway, improving ventilation. This aligns with the goal of endotracheal suctioning to maintain airway patency, ensuring adequate oxygenation and reducing infection risk, per critical care and respiratory management protocols in nursing practice.

Choice B reason: Increased respiratory rate suggests respiratory distress, indicating ineffective suctioning. Clear breath sounds confirm secretion removal, ensuring airway patency. A rising rate may reflect persistent obstruction or hypoxia, requiring further intervention, per respiratory assessment and critical care standards for endotracheal tube management in nursing.

Choice C reason: Decreased oxygen saturation indicates ineffective suctioning, as secretions likely remain, impairing oxygenation. Clear breath sounds confirm airway clearance, improving gas exchange. Low saturation requires immediate reassessment, per oxygenation monitoring and critical care protocols for clients with endotracheal tubes in nursing practice.

Choice D reason: Presence of wheezing suggests airway narrowing or persistent secretions, indicating ineffective suctioning. Clear breath sounds demonstrate successful secretion removal, ensuring unobstructed airflow. Wheezing requires further intervention, per respiratory assessment and airway management standards in critical care nursing for intubated clients.

A. Obtain an arterial blood gas (ABG) prior to the procedure. B. Explain that the client may be placed in five positions. C. Perform the drainage immediately after meals. D. Instruct the client to breathe shallow and fast.

Correct Answer is B

Explanation

Choice A reason: Obtaining an ABG assesses oxygenation in COPD but is not needed before postural drainage, which mobilizes secretions. ABGs are invasive, used for exacerbations. Explaining positions prepares the client, enhancing cooperation for effective mucus clearance, addressing airway obstruction without unnecessary invasive testing.

Choice B reason: Postural drainage uses gravity in five positions (e.g., Trendelenburg, lateral) to drain lung segments in COPD, where mucus obstructs airways. Explaining this reduces anxiety, ensuring cooperation, optimizing secretion clearance to improve ventilation and gas exchange, addressing the pathophysiological need for airway clearance.

Choice C reason: Drainage after meals risks aspiration, as a full stomach increases reflux in positions like Trendelenburg. COPD’s mucus retention obstructs airways, and timing drainage appropriately enhances efficacy. Explaining positions ensures effective procedure execution, avoiding complications like aspiration, making this approach unsafe.

Choice D reason: Shallow, fast breathing is contraindicated in COPD, where deep, slow breaths reduce air trapping and improve alveolar ventilation. Postural drainage clears mucus, and proper breathing enhances efficacy. Explaining positions prepares the client, optimizing outcomes, making this instruction incorrect for effective breathing.

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A client with a history of schizophrenia, and drug and alcohol abuse is admitted to the hospital for hepatitis. The nurse should contact the healthcare provider before implementing which prescription?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After suctioning a client who has an endotracheal tube, which assessment finding indicates to the nurse that the intervention was effective?

Correct Answer is A

Explanation

When performing postural drainage on a client with chronic obstructive pulmonary disease (COPD), which approach should the nurse use?

Correct Answer is B

Explanation

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After placing a client who is having a seizure in the side-lying position, which intervention should the nurse implement?

Following a total thyroidectomy, the nurse plans to observe a client for complications. Which finding indicates that the client has developed a complication?

At 0800, the practical nurse (PN) reports to the registered nurse (RN) that a client’s blood pressure is 140/90 mm Hg. When the RN arrives to administer the 0900 antihypertensive medication, the client is oriented but lethargic, pale, and diaphoretic. Which action should the RN implement first?

The nurse measures the client’s blood pressure (BP) and notes that it is significantly higher than the previous reading. Which should the nurse do next? (Select all that apply)