A nurse is assessing a client who has a transdermal fentanyl patch in place. Which of the following findings should the nurse document as an adverse effect of this medication?
Hypotension
Tachycardia
Diarrhea
Insomnia
The Correct Answer is A
A. Hypotension: Hypotension can occur as an adverse effect of fentanyl, particularly if the client experiences excessive sedation or respiratory depression. Fentanyl is a potent opioid analgesic
that can cause vasodilation and a decrease in blood pressure, especially when used in high doses or in susceptible individuals.
B. Tachycardia: Tachycardia is not a typical adverse effect of fentanyl. Opioids like fentanyl typically cause bradycardia or have minimal effects on heart rate.
C. Diarrhea: Diarrhea is not a common adverse effect of fentanyl. Opioids more commonly cause constipation due to their effects on gastrointestinal motility.
D. Insomnia: Insomnia is not a typical adverse effect of fentanyl. Opioids typically cause sedation and can lead to drowsiness or somnolence, especially during initial use or when administered in high doses.
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Related Questions
Correct Answer is D
Explanation
A. The client has a history of anaphylaxis following a bee sting: This finding is not directly related to the safety of taking alendronate for osteoporosis.
B. The client has a first-degree relative who has Paget's disease: While family history is
important in assessing the risk of osteoporosis, it is not a direct safety risk for taking alendronate.
C. The client is postmenopausal: Postmenopausal status is a common indication for the use of alendronate to prevent or treat osteoporosis. It is not a safety risk.
D. The client has immobility that restricts her to a supine position: Immobility, especially in a supine position, can increase the risk of esophageal irritation and reflux when taking alendronate. Therefore, this finding poses a safety risk for the client when taking this medication.
Correct Answer is ["A","B"]
Explanation
A. Advise the client to change positions slowly: The client's symptoms of dizziness and light- headedness upon standing suggest orthostatic hypotension, which can be managed by advising the client to change positions slowly to minimize blood pressure drops upon standing.
B. Check the client for orthostatic hypotension. Monitor the client for dysrhythmias: The client's symptoms, along with the report of waking up at night to void, are suggestive of orthostatic hypotension, a drop in blood pressure upon standing. Checking for orthostatic hypotension and monitoring for dysrhythmias are appropriate nursing actions to assess and manage this condition.
C. Advise the client to restrict potassium intake: Restricting potassium intake is not indicated based on the client's symptoms of dizziness and light-headedness. This action is not relevant to the situation described.
D. Advise the client to take the medication before bedtime: There is no indication in the scenario provided that medication timing is related to the client's symptoms. This action is not relevant to addressing the client's reported symptoms.
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