A nurse in a long-term care facility is assisting a client with eating during meal time and recognizes another client indicating he is choking. Which of the following situations requires the nurse to perform the Heimlich maneuver?
The client is coughing only.
The client is not making any sounds.
The client is able to whisper.
The client has a high-pitched inspiratory stridor.
The Correct Answer is B
A. A client who is coughing only is still able to clear the airway by themselves.
B. Inability to make any sounds indicates a complete airway obstruction, requiring the Heimlich maneuver.
C. A client who can whisper has a partial airway obstruction and should be encouraged to continue coughing.
D. A high-pitched inspiratory stridor indicates a partial obstruction, not requiring the Heimlich maneuver but close monitoring.
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Correct Answer is C
Explanation
A. Gentamicin administered over 1 hour is an appropriate method for this medication.
B. Injecting Demerol IM into the vastus lateralis is an acceptable site for adults.
C. Crushing bupropion XL (extended-release) tablets is contraindicated as it alters the drug's release mechanism, which can lead to a risk of overdose or ineffective treatment, requiring an incident report.
D. Using a 25-gauge ⅝ inch needle for heparin injection is an appropriate technique.
Correct Answer is A
Explanation
A. Propranolol is a beta-blocker used to control blood pressure and heart rate. However, the nurse has a hold order for propranolol if the apical pulse (heart rate) is less than 50 beats per minute. The nurse documented a heart rate of 42 bpm at 0815, which falls below the hold parameter for propranolol. Administering propranolol in this case could worsen the client's bradycardia (slow heart rate) and therefore requires an incident report.
B. Pantoprazole is a proton pump inhibitor and doesn't have a direct impact on heart rate within the usual therapeutic range.
C. Lovastatin is a cholesterol medication and wouldn't cause a significant drop in heart rate at this dosage.
D. While morphine can slow the heart rate, it's typically used for pain management and may be necessary for the client's comfort. However, the nurse should monitor the respiratory rate closely due to potential respiratory depression.
E. Cefuroxime is an antibiotic and wouldn't significantly affect heart rate.
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