A female client with mild depression reports to the nurse recently starting St. John's wort. Which information provided by the client requires further instruction?

Choice A reason: Expectorating bronchial secretions is not an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It does not loosen or thin the mucus in the airways, which would facilitate expectoration.

Choice B reason: Reports reduced nasal discharge is not an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It does not affect the production or drainage of nasal secretions, which are caused by inflammation and infection in the upper respiratory tract.

Choice C reason: Able to sleep through the night is not an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It does not have any sedative or hypnotic effects, which would promote sleep. However, by reducing coughing, benzonatate may indirectly improve the quality of sleep for the client.

Choice D reason: Denies having coughing spells is an assessment information that indicates that the antitussive medication benzonatate is effective. Benzonatate is a medication that suppresses the cough reflex by numbing the throat and lungs. It reduces the frequency and intensity of coughing, which can relieve discomfort and irritation for the client.

Choice A reason: This statement indicates understanding of naloxone. Naloxone is an opioid antagonist that can reverse the effects of opioid overdose, such as respiratory depression, sedation, and hypotension. Naloxone can be administered by different routes, depending on the availability and urgency of the situation. Intravenous, intramuscular, and subcutaneous routes are all acceptable ways to give naloxone.

Choice B reason: This statement also indicates understanding of naloxone. Naloxone works best on pure agonist opioids, such as morphine, heroin, and fentanyl. These opioids bind to the same receptors as naloxone, but naloxone has a higher affinity and can displace them. Naloxone is less effective on partial agonist or mixed agonist-antagonist opioids, such as buprenorphine and pentazocine. These opioids have lower intrinsic activity or antagonize some receptors, making them less susceptible to naloxone.

Choice C reason: This statement indicates no understanding of naloxone. Naloxone is not a harmless drug that can be given repeatedly without consequences. Naloxone has a short half-life of about 30 to 90 minutes, which means it can wear off before the opioid does. This can cause the patient to relapse into respiratory depression and require repeated doses of naloxone. However, giving too many doses of naloxone can also cause adverse effects, such as agitation, hypertension, tachycardia, pulmonary edema, and seizures. Therefore, naloxone should be given cautiously and titrated to the minimum effective dose to reverse respiratory depression.

Choice D reason: This statement indicates no understanding of naloxone. Naloxone will affect the client's level of pain by blocking the analgesic effects of opioids. This can cause the patient to experience acute pain and distress, especially if they have a chronic pain condition or a surgical wound. Naloxone should not be used to treat opioid-induced sedation or pruritus without respiratory depression, as this will unnecessarily expose the patient to pain and suffering.

Choice E reason: This statement indicates no understanding of naloxone. When given IV, naloxone starts working immediately, but it does not last several hours. As mentioned earlier, naloxone has a short half-life and can be eliminated from the body quickly. The duration of action of naloxone depends on the dose, route, and frequency of administration, as well as the type, dose, and route of the opioid involved. Generally, naloxone lasts for about 30 to 90 minutes when given IV, which may not be enough to counteract the longer-lasting effects of some opioids. Therefore, continuous monitoring and repeated doses of naloxone may be needed until the opioid is cleared from the system.